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Penile Inversion Vaginoplasty with or without Additional Full-Thickness Skin Graft: To Graft or Not to Graft?

Buncamper, Marlon E. M.D., Ph.D.; van der Sluis, Wouter B. M.D., Ph.D.; de Vries, Max B.Sc.; Witte, Birgit I. Ph.D.; Bouman, Mark-Bram M.D., Ph.D.; Mullender, Margriet G. Ph.D.

Plastic and Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 649e–656e
doi: 10.1097/PRS.0000000000003108
Cosmetic: Original Articles

Background: Penile inversion vaginoplasty is considered to be the gold standard for gender reassignment surgery in transgender women. The use of additional full-thickness skin graft as neovaginal lining is controversial. Some believe that having extra penile skin for the vulva gives better aesthetic results. Others believe that it gives inferior functional results because of insensitivity and skin graft contraction.

Methods: Transgender women undergoing penile inversion vaginoplasty were studied prospectively. The option to add full-thickness skin graft is offered in patients where the penile skin length lies between 7 and 12 cm. Neovaginal depth was measured at surgery and during follow-up (3, 13, 26, and 52 weeks postoperatively). Satisfaction with the aesthetic result, neovaginal depth, and dilation regimen during follow-up were recorded. Satisfaction, sexual function, and genital self-image were assessed using questionnaires.

Results: A total of 100 patients were included (32 with and 68 without additional full-thickness skin graft). Patient-reported aesthetic outcome, overall satisfaction with the neovagina, sexual function, and genital self-image were not significantly associated with surgical technique. The mean intraoperative neovaginal depth was 13.8 ± 1.4 cm. After 1 year, this was 11.5 ± 2.5 cm. The largest decline (−15 percent) in depth is observed in the first 3 postoperative weeks (p < 0.01).

Conclusions: The authors can confirm neither of the suggested arguments, for or against full-thickness skin graft use, in penile inversion vaginoplasty. The additional use of full-thickness skin graft does not influence neovaginal shrinkage, nor does it affect the patient- and physician-reported aesthetic or functional outcome.


Amsterdam, The Netherlands

From the Department of Plastic, Reconstructive and Hand Surgery, EMGO+ Institute for Health and Care Research, Center of Expertise on Gender Dysphoria, and the Department of Epidemiology and Biostatistics, VU University Medical Center; and Gender Surgery Amsterdam.

Received for publication February 16, 2016; accepted September 16, 2016.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Marlon E. Buncamper, M.D., Ph.D., Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands,

©2017American Society of Plastic Surgeons