- The team of Noval Clinic performed in the hospital IMED Valencia a full surgery from woman to man in just one surgery. In the same surgical time a phalloplasty was performed, female intern genitals were removed, mastectomy and face masculinisation.
The Hospital IMED Valencia it’s been the first spanish hospital to host a sex reassignment operation from woman to man in just one surgery. This pioneer operation, was performed by Dr. César Noval (Noval Clinic Plastic Surgery institute), and is considered a milestone because it was performed at the same time the phalloplasty, female intern genitals removement, mastectomy and face masculinisation. The intervention last 17 hours and took part of it a team formed by gynaecologists and urologists directed by Dr. Noval as plastic surgeon, with the previous support of endocrinologists and psychologists.
To achieve this objective, the intervention was divided in three phases. The first one consisted in the creation of the penis with skin, arteries, veins and nerves of the patient’s arm. A second one where the uterus and ovaries were removed with suitability of the external genitals, creating the testicle area. And the final phase, in which the neopenis was moved from the arm till the pubic area so later there was the connection of the arteries , veins and nerves of the recipient area of the abdomen through microsurgery. In parallel to the uterus , ovaries and vagina removal there was the face and breast masculinisation.
Likewise, to create the penis was used the double flap technique, like this they created a functional urethra so the patient can urinate standing and an external cover that gave the shape of a penis. Moreover, a thigh skin graft is made to replace the skin used of the arm. To this we associate the face and breast surgery so the adequacy was complete. “The challenge doesn’t consist in creating a penis, but to be functional, sensory, voiding and sexual, and the result has to be anatomical and natural” highlighted the Doctor.
The specialist highlighted that “probably it was the most difficult operation I’ve ever performed”. In this sense, highlighted that “microsurgery is a complex branch of plastic surgery, because when microsurgery use is related with the needs to obtain a functional result, difficulties increase”.
Nowadays, and some weeks after the operation, the patient is really fine, urinates standing normally, there were no relevant complications and he had normal intercourse.
It is a surgery with high rate of complications, around 65%. The majority is in the postoperative and are related with urine fistulas onset in the new created urethra. Likewise, is required microsurgery check-up during the first 24 hours in almost 40% of the cases. In this case, even with the high rate of operation complications, there was no need of surgical reintervention, thus, is considered a success.
So that a patient can have an operation with these features, the patient has to be in good physical and psychological shape, and also have their family support. In this surgery, the Doctor confirmed that the patient’s family gave him “an excellent support”.
Moreover, Dr. Noval want to highlight the important role that the psyichologist has in this kind of surgery, because it is true that “without family and social circle support, we can’t operate”. Likewise, he pointed out that “in these cases what is harder is to say to the patient that you are not going to operate him, because he need it and it is essential for his personal development”.
“This kind of operations create a special link with the patient. It is a moment that stays forever. These patients waited for their surgery for years, with previous hormone treatment. They show an enviable strength, socially and with family they live very difficult situations. They are an example for everybody” finished Dr. Noval.
The hospital IMED Valencia is featured by a flexible management model, that is capable of managing his own team with release of facilities and services for external doctors giving them , if they need it, the hospital services.