Genital Reconstructive Surgery
This surgery is performed to create female genitalia, including a neoclitoris and neovagina (if requested), using the patient’s external genitalia.
Some patients do not wish to have a vaginal cavity created, electing instead to have a vaginal ‘dimple’ created.
If you are thinking of organising an appointment for surgery with Mr Ives, 'Click here' for information that will assist your pre operative journey.
Genital Reconstruction Patient 1
Genital Reconstruction Patient 2
Genital Reconstruction Patient 3
Genital Reconstruction Patient 4
Genital Reconstruction Patient 5
Vaginoplasty
Mr Ives performs the “Inverted Penile skin” technique. Most surgeons performing genital reconstructive surgery use a variation of this technique, and Mr Ives, like them, uses his own variations on the procedure.
The skin of the penis is used to create the lining of some of the perineum, opening to the vaginal cavity and the lining of the vagina as well. Scrotal skin, if required, is used to line the top part of the vaginal cavity (the vaginal vault).
The testicles are removed. The head of the penis (the glans) is used to create the neoclitoris. The urethra is shortened and positioned below the clitoris and above the vaginal opening. A catheter is inserted into the bladder.
The scrotal skin is used to create the labia majora. If the patient is uncircumcised the foreskin is used to create the labia minora. In a circumcised patient some of the penile shaft skin is used to create the labia minora. The operation takes about 3-4 hours to perform, in a single stage.
This procedure is similar to a vaginoplasty, however, a neovagina is not created. Instead, a vaginal dimple is created.
The result looks the same externally as a vaginoplasty result. However, patients do not have to dilate since they have no vaginal cavity.
Frequently Asked Questions
For a primary procedure Mr Ives performs the 'Inverted Penile Skin' technique. He uses the skin of the penis and, if needed scrotal skin to line the vaginal cavity. The PPV technique involves laparoscopic surgery, and Mr Ives is not trained in laparoscopic surgery as it is not part of a Plastic surgeons training. If a patient's preferred surgery primary surgery is a PPV they will need to see another surgeon who performs this technique. Similarly, if a patient does not have enough penile and scrotal tissue for the penile inverted technique, Mr Ives will refer them to a surgeon for consideration of the PPV technique.
For secondary surgery (or lack of scrotal and penile skin) Mr Ives will refer the patient to a surgeon who performs the PPV technique.
Mr Ives does not perform either primary or secondary colovaginoplasties.
During your consultation with Mr Ives, you will be asked about your past medical history and your general health. You will also be asked about your journey to date, including when you started your hormone therapy.
Mr Ives will then examine your abdomen and perineum. Skin quality and tissue volume will be assessed.
Mr Ives will then discuss the operation with you. He will also discuss the postoperative regime and the amount of time you will spend in hospital, as well as the length of time you will need to stay in Melbourne if you are from country Victoria or Interstate.
Afterwards, you will have a consultation with Mr Ives’ Specialist Nurse. She will also discuss with you the pre-operative work up for surgery, as well as the post-operative regime that must be followed after surgery. If you are from interstate, you can also have a tour of the ward as well, to help familiarise yourself with the hospital. If you are local, a tour of the ward is usually undertaken at your pre-operative visit.
Following the Specialist Nurse consultation, you will have a consultation with a member of the Administrative Team. They will discuss with you Private Health Insurance, provide you with a quote containing the relevant item numbers for the procedure, as well as be able to give you an indication of lead in time for your surgery. It is important that you allow plenty of time for these consultations, usually about 60 to 90 minutes.
A second consultation will also be arranged. This will not cost you anything and is usually a telehealth consultation. Of course, you can attend this consultation in person as well if you wish. At the second consultation Mr Ives will rediscuss the operation and the risks of surgery with you. He will also rediscuss the WPATH requirements and the post-operative plan.
You can book surgery for a date that suits you, any time after your initial consultation. However, Mr Ives will not perform the surgery without the WPATH criteria being met and having the relevant reports. See "WPATH criteria".
Labiaplasty - Laser hair removal is not required for Labiaplasty (no vaginal cavity) with Mr Ives.
Vaginoplasty - Laser hair removal or electrolysis is strongly recommended. Hair growing in the vaginal cavity post operatively can cause several problems including discomfort and vaginal infections and discharge. These will be discussed with you during your consultation. Whichever is performed, you will need to complete your treatments at least 3 weeks prior to your genital reconstructive surgery.
An information sheet with the minimum areas that are recommended for treatment will be given to you as part of your information pack following your consultation.
Your general medical health is very important. Make sure you bring your referral letter with you. Also inform Mr Ives of all medical conditions that you have or have suffered from. This includes operations that you may have had as a child.
If you are a diabetic, it’s important to optimize your medical control of this in the lead up to surgery. If you have a medical condition, or are over the age of 55, Mr Ives advises consultation with one of the general medical physicians at Masada hospital, who will help manage this medical condition whilst you are an inpatient at Masada. Mr Ives will discuss this with you at your initial consultation. Mr Ives has an upper age limit of 70 for this operation.
If you have a cardiac condition it may be necessary to perform your surgery at Knox Hospital. Please make certain you have up to date reports and results from your treating cardiologists when you come for your consultation.
You must also consider your weight. Mr Ives WILL NOT operate if your BMI is >30 for labiaplasty or 28 for a vaginoplasty. The anaesthetic complications and postoperative complications increase significantly above these parameters.
Smoking (including vaping and ‘weed’) also increases the risk of complications following surgery. You must stop smoking 8 weeks prior to surgery, and abstain for at least 8 weeks following surgery.
Mr Ives performs most of his gender surgery at Masada Hospital in East St Kilda. He also operates at Knox Hospital in Wantirna, for patients who have complex medical histories.
It is therefore important to inform Mr Ives of all your past medical history so he can determine the safest place to perform your surgery.
Labiaplasty - Patients stay in hospital for at least 4-5 nights.
You will rest in bed after your surgery for 24 hours. On day 2 post op you will be assisted standing with the nurses and your outer dressing will be removed. At this time you will start your daily salt washes. On day 3 or 4 post op you will be discharged from hospital with your catheter still in if everything is progressing as planned. You will be readmitted as a day case a week after your surgery to have the catheter removed. You will have an appointment with Mr Ives and the Specialist Nurse two weeks after your surgery date.
Vaginoplasty - Patients stay in hospital for about 7 nights You will rest in bed for 24 hours. On day 2 post op you will be assisted standing with the nurses On Day 3 post op your outer dressing will be removed and you will commence your twice daily salt baths. On day 5 post op your vaginal pack will be removed and you be taught how to dilate by the nursing staff and Mr Ives' Specialist Nurse. On day 6 post op your catheter will be removed . You will be discharged from hospital on day 7 post op, following a review of your dilating by the Specialist Nurse. You will have a follow up appointment with Mr Ives and the Specialist Nurse one week later (two weeks after your surgery date).
If you are from interstate, then you need to plan to stay in Melbourne for about 14-18 days in total. Of this, the first 3-4 days are as an inpatient at Masada hospital. Obviously, this is only an estimation of the total time that may be required to stay.
Recovery can take up to 10-12 weeks, but most patients are able to resume work after 4-6 weeks or so, depending on their occupation. Strenuous activity, including sex should be avoided for 12 weeks.
Labiaplasty - After your discharge from hospital, you will be readmitted a week after your surgery date as a day case to have your catheter removed. You will be discharged once we know you are passing urine without problems (usually after lunch or later in the day). You will next be seen by Mr Ives and his Specialist Nurse at his rooms approximately one week later.
Vaginoplasty - Following your discharge after a week, a follow up appointment will be made for one week later (two weeks post surgery). This appointment will be with both Mr Ives and the Specialist Nurse. During this consultation they will review your progress.
Our routine follow-up after this is one month later (six weeks post op), and then six weeks after this (three months post op). After this, consultations will be organised as needed.
If you are from interstate, these appointments can be performed by Telehealth. This will be coordinated by the specialist nurse.
If you are in town though, we are happy to see you any time. It's always nice to review results and your progress face to face. The rooms will always try and accommodate a time that is suitable for you.
However, the sooner you can let us know you are in town the easier it is to organise the appointment.
If you are from out of town or interstate, we advise organizing a review with your regular doctor about a month after you return home.
Long term follow up should again be organized with your regular doctor. Some bleeding postoperatively can be due to the presence of granulation tissue. This can be treated with excision, and/or silver nitrate application.
This can again be performed or coordinated with Mr Ives and the Specialist Nurse.
Any operation has risks associated with it. Complications rarely occur. Mr Ives will discuss these with you during the consultations.
Complications from surgery can be divided into 'General Complications' that you can get from this or any other operation, and 'Specific Complications' that are specific to the operation itself.
General complications include:
Infection
Keloids (lumpy scars)
Deep Vein Thrombosis (DVT) - clots in the legs
Haematoma (collection of blood in the wound) and bleeding
Anaesthetic complications
Chronic Pain
Specific complications include:
Perforation of bladder. May have permanent urinary incontinence
Rectal perforation requiring repair
Rectovaginal fistula - may need temporary/permanent colostomy
Disruption of anal sphincter - causing faecal incontinence
Loss of neoclitoris
Urinary incontinence (temporary or permanent)
Urethral stricture
Perineal skin necrosis (Loss)
Loss of vaginal dimple or vaginal cavity
Inability to create a vaginal cavity
Need for secondary surgery
Mr Ives will discuss with you the risks of surgery during your initial consultation.
Prior to surgery your hormone dosage will be reduced, but not stopped completely. This will be discussed and organised with you during your six week preoperative appointment with Mr Ives and the Specialist Nurse. After discharge from hospital (or even before your admission), you will need to organise an appointment with your hormone prescriber for a review and recommencement of your hormones at their recommended dosage.
If you have any other questions about the procedure, please feel free to contact the rooms and we will be happy to get back you.