Hymenoplasty (Revirginisation procedure)

Hymenoplasty is the term to refer a vagina plastic surgery that aims to repair broken hymen inside a woman’s vagina. Many patient do this surgery as a form of virginity repair and most of them do it some days before wedding. The point of hymenoplasty is to pierce together the tear of the hymen. But, before hymen reconstruction is performed, surgeons have to approximate if the hymenal remnants inside the vagina are sufficient to be repaired. If not, surgeons may consider using sompe part of vaginal flap. It then creates a vascular band across the introitus. Of course, patient will be put under anesthetic just like normal surgery. It is short because it only takes about one or two hours.

Hymenoplasty is no doubt a virginity repair surgery. Many cultural, religious, or social norms are against this surgery because they believe hymen is not a proof of virginity. Therefore, hymenoplasty is just mere to make the patient looks virginal, not bring back her virginity like in the first place. But, there are also other social or family values that insist of having the bride’s vagina bleeding after the first penetration in the first night after wedding. Whatever reasons of the patient to undergo a hymenoplasty, hymenoplasty is a medically safe surgery as long as each procedures are done carefully.

All women can be patients of hymenoplasty. Whether their hymens were torn due to premarital sexual intercourse or just unintentionally torn because of some accidents, hymenoplasty can be performed. However, there is only one condition that disallow women to do hymenoplasty. That is if she suffered from some venereal disease.

Several reasons of a woman performing hymenoplasty, are:

• As a woman ages, the vagina muscles get loose and elongated. Some women do not want to be in this condition. Therefore, some of them prefer having hymenoplasty to deal with this aging problem.
• Hymen is actually one reason that makes your sexual activity with your partner becomes more satisfying. Maybe you and your partner want to enjoy a coitus just like when you were a virgin? Here, hymenoplasty gives a solution.
• Just like previously said, some women had their hymens torn not because of sexual penetration. Instead, they had it because of sexual abuse, rape, or other accidents. Hymenoplasty can heal the wound of these accidents so that everything would be back as if they weren’t happened.
• Re-marriage is also another cause of hymenoplasty. Some cultures insist a widow to perform hymenoplasty before she remarriages to another man, because they believe that virginity only belongs to the husband.

The advantages of hymenoplasty? Of course, the patient’s hymen will be tighten up just like a virgin. But what is it for? Hymen can give a more pleasure sensation to a woman during sexual intercourse. She will feel fuller inside her vagina and she has a bigger probability to have orgasm. Moreover, hymenoplasty is performed in relatively short time (and the recovery time is also short).

After undergoing this virginity repair surgery, a woman must take care of herself. This includes a slight change in her lifestyle. She has to make sure that no outer accident happened and tore her hymen, except after sexual intercourse. She musts keep her vagina clean. Remember, although the recovery time of hymenoplasty is relatively short, always wait for some reasonable time before doing sexual activity. It is to make sure that the wound after surgery is completely healed. Avoid hardworking or lifting heavy things for about a week after hymenoplasty because hymen is prone to be torn again because of the pressure within the vagina.

Breastfeeding Using Implant Breasts

Breastfeeding Function

Breasts are basically a milk-producing glands which are used to feed babies. There is a nipple in an aerola area (or called nipple areola complex—NAC), with varying colors from pink to dark brown. Within this gland, breast milk is produced by lactiferous ducts and distributed throughout the breast. For every breast, there are four until eighteen lactiferous ducts ending to the nipple. The comparison of glands to fat within the breasts tissue is 2 to 1—in lactating women—or 1 to 1—in non-lactating women. Thre are more than just glands inside a woman’s breasts; there are collagen, elastin, fat, and ligaments. There are also nerve system in breasts, where the anterior and lateral branches of the fourth, fifth, and sixth nerves are located. Thoraric spinal nerve 4 or T4 in breasts also supplies a specific sensation to the nipple area.

The most important concerns about breastfeeding is in the potential of digestive contamination and toxicity. If the filler of breast implant device is leaked to the breast milk, it will endanger the baby. Substances contained in a breast implant filler is chemically and biologically inert, because they were made of environmentally common substances like salt water (for the saline filler)—although silicone in the filler is unable to be digested. Besides, experts have said that whatever the reasons, there shouldnot be any contraindication for breastfeeding by women with implanted breasts. In the beginning of the use of breast implant (at early 1990s), perhaps there are many non-technical complains from patients and doctors about possible complications from the implant device. Yet, there is no disease casuality related to the device.

Augmented Breasts

Meanwhile, women with implanted breasts are still able to feed babies using their breasts. But, this implant devices may give a kind of difficulties. Mammoplasty surgery, which includes a periareolar incisions and subglandular replacement, is the main cause of this difficulties. Moreover, other difficulties are about the potential damage of lactiferous ducts and the nerves around the nipple area.

If the surgeon cut the ducts and any major nerves within the breast tissue or if the glands are damaged somehow, possible difficulties risk arises. The first is common to surgical procedures that involve periareolar incision implantation because it cuts breast tissue close to the nipple. In the other hand, other implantation incisions like inframmamory fold, trans-axillary breast augmentation, or trans-umbilical breast augmentation, avoid this step. However, if the patient is serious about the possibilities of this breastfeeding difficulties, she can ask the doctor to make effective the incision step so that the damage of the milk ducts and nerves can be reduced. Basically, only implants that are placed under the gland (or called subglandular implants) and implants for large-sized breast that mostly affect the milk glands. Implantation for small size breasts and for submuscle gives less risk of breastfeeding function problems.

Vaginoplasty Procedures

Vaginoplasty is a term of plastic and construction surgery which aims to construct, reconstruct, or reshape vagina, both in cis women and trans women. There are many kinds of vaginoplasty procedures that current surgeons use. Some of them including:

Balloon vaginoplasty

Balloon vaginoplasty is a new technique of vaginoplasty. It is simple by technic, physically safe, and a good alternative of vaginoplasty, especially in creating a new vagina, if the common laparoscopic surgery is unsafe. Balloon vaginoplasty is mostly used to treat vaginal aplasia. Balloon vaginoplasty is done by inserting a foley catheter into rectouterine pouch, where gradual traction and distension are placed to create new vagina.

Buccal (oral) mucosa

Still a relatively new technique, buccal or oral mucosa is used in treating vaginal agenesis. Buccal or oral mucosa is used as a tissue for the vagina lining (or 8 cm deep). Its advantages includes the good qualities, biological and from recovery process, of the patient. Meanwhile, the downside of this technique is regarding to the very limited size of vaginal (both in depth and width), and the potent of intraoral damage and complications.

Colovaginoplasty

Also known as colon section surgery, colovaginoplasty uses a part of the sigmoid colon to shape a vaginal lining. Usually, colovaginoplasty is preferred as vaginoplastic in women with some specific conditions, including androgen hormone insensitivity, vaginal and mullerian agenesis, congenital adrenal hyperplasia, and other genital conditions which makes it unable to do vaginal deepening to be an alternative way to inverse penile—both with and without any accompanying graft skin (sometimes from the stomach and upper thigh). Colovaginoplasty is often recommended by most surgeons to trans women patient who wants to undergo a vaginal plastic and reconstruction surgery.

Don Flap (labia minora flap)

Just like penile inversion, the Don Flap or labia minora flap correction in vaginoplasty joins the labia minora altogeher to shape a new vagina. This is an improvement of vaginoplasty surgery which utilizes the hood skin (prepucial skin) of clitoris as a horse-shoe shaped piece flap. Many surgeons find that the Don Flap technique is easier and simpler, but it also comes with a downside, including the necessity to do labiaplasty and cervical dilation restoratively to create a vagina with a good size, both in depth and width.

McIndoe technique

The McIndoe vaginoplasty technique utilizes split-thickness skin grafts that cover a mold, which then is inserted to a surgically created space, between the bladder and the rectum. The principal, technical difference between the McIndoe vaginoplasty and the Vecchietti vaginoplasty, is which tissue to utilize to line the created neovagina. Each surgical procedure has positive and negative factors, especially regarding upon whom such a plastic surgical technique can be applied, because the post-operative outcome varies with the patient’s indications.

Penile inversion

This is actually more common for a sex reassignment surgery, especially in trans women. Penile inversion is a vaginoplasty method that creates a new vagina. It is one of the two most common and important procedure in vaginoplasty. It removes the spongiform erectile tissue of the penis and the skin, together with the nerves and blood system, is utilized to make a vestibule and labia minora area. Some parts of the head of the penis is used to shape the clitoris, while the urethra is cut short to end at the proper place like in normal vagina. Sometimes, to make the clitoris, urethral spongiform tissue is used. Although this is the most common part of a vaginoplasty, some surgeons prefer not to shape a new clitoris in this method but choosing a separate procedure instead.

Vecchietti procedure

Vecchietti method is a method of laparoscopic surgery to treat mullerian agenesis. It results in a new vagina with sizes similar or comparable to normal vagina). “Olive”, a small plastical sphere is used as a thread against vagina. The “olive” is then drawn from the vaginal skin to the abdomen, via the navel. It is then placed on a traction device. Every day, the “olive” is tighten up so that it pulls and strecthes the vagina by about a centimeter in a day. So, in seven days, the thread will shape a 7 x 7 (width and shape) cm of vagina. Depending on the condition of the patient, Vecchietti method could take at least 45 minutes.

Wilson Method

This method is different from any other common penile-inversion method. Wilson method uses a three stages surgery, including two stages of beginning vaginoplasty. This method is started like common penile inversion. Then, after the creation of vaginal-vault step, it is then left as a raw tissue and packed with a sterile stent. In five until seven days, it is lined with a graft skin from bottoms. The penile skin itself is utilized to shape a labia minora, frenulum, and clitoral hooding, while the glans penis is utilized to make a clitoris. The scrotum is also used to make a labia majora.  

Surgical Otoplasty Definition and Indications

Surgical otoplasty is a surgical procedure to reshape damaged ears so that they will appear back as normal, without any evidences or indications that they have been medically changed. After performing a surgical otoplasty, a person’s ear should be normal viewed from front perspective (the helical rim should be clearly visible), rear perspective (the helical rim is straight), and side perspective (the contours of the ear should be soft, not sharp). The perfect timing to undergo a surgical otoplasty depends on how is the ear deformity. For example, kids with pointy ears can perform a surgical otoplasty on age 4 or more. General anaesthesia is required before performing surgical otoplasty.

Ear reconstruction

The general procedure of surgical otoplasty is collecting a costal cartilage graft from the rib cage of the patient and sculpting it into the auricular framework placed under the temporary skin on the head of the patient. The skin envelope will then encompass the cartilage framework, or the ear prosthesis. After that, the surgeon will create an outer ear shape called pinna based on natural proportions and appearance of normal ears. It takes some months to perform a follow-up surgery, in which the surgeon starts to create the earlobe and put the now reconstructed pinna off the side of the head. It then reforms into a small round projection placed next to the external entrance of the ear, called a tragus.

Under certain circumstances which do not allow this general procedure to be performed (like when there is not enough cartilage to be collected), a technique called Antia Buch helical advancement may be applied. First, the surgeon creates a design of an incision inside the helical rim and around the shank of the helix, using ink. The skin and the cartilage are then cut without piercing the rear skin behind the ear. Then, let the helical rim suture and remove the graft of skin from behind the ear.

Indications

There are many indications of ear deformity necessary to be treated with surgical otoplasty. The right method of surgical otoplasty depends on which indications of ear deformity appear:

• Cagot ear: Ear without an earlobe, commonly caused by genetic. Mostly found in northern Spain and western France, among Cagot people.
• Cat’s ear: Outer edges of the ears folded away from the head sides towards the face, just like a cat’s ear.
• Cauliflower ear: Ear deformity caused by repetitive injuries to the tissues, making the blood in the ear to have the tendency to be cartilaginous, making the ear looks like a cauliflower. Mostly happens to boxers and wrestlers.
• Cleft earlobe: An indentation or notch on the fleshy part of the ear lobe.
• Constricted ear: An ear deformity where, in the most damaged case, makes the shank of the helix to go out of the concha. Some other case includes the shank to be advanced into the helical rim.
• Cryptotia: The rim of the helix cartilage in ear buried under the skin of the head, making the ear looks a little bit hidden.
• Darwinian ear: An ear deformity in which the conchal bowl of the ear is flat, not folded inwards. It derives from the name of Britis biologist and evolutionary theoretician, Charles Darwin.
• Lop ear: An ear deformity characterized by a too-small cartilage stiffened rim of the ear and a large depression near the ear opening part. This overall characteristic makes the ears look like a cup.
• Macrotia: Ears whose size proportion is significantly bigger than the person’s head.
• Microtia: The opposite of macrotia; ears whose size proportion is significantly smaller than the person’s head. It is because either a mild underdevelopment or an absence of the outer ear.
• Question Mark Ear: This is a rare ear deformity. It is characterized by an indentation between the earlobe and the outer cartilage rim of the external ear.
• Scroll ear: A congenital ear deformity in which the outer part of the ear curled down, up, and back against the head.
• Skin cancer and malignant melanoma: Melanoma appears on the ear. In this case, the Antia-Buch surgical otoplasty technique may be applied.
• Stahl’s ear deformity: Ear looks pointed rather than rounded, and the skin and the cartilage of the ear folded abnormally, making the ear looks like an elf.
• Wildermuth’s ear: Ear with the curved cartilage border face backwards, deformint he ear by protruding the inner ridge of the ear. This indication found by Hermann A. Wildermuth and thus named after him.

Definiton of Sex Reassignment Surgery

Sex reassignment surgery, or also known as gender reassignment surgery, sex affirmation surgery, sex realignment surgery, genital reconstruction surgery, or sex change operation, is a medical procedures to change the existing sexual characteristics from physical appearance and function of a person into opposite sex. Sex reassignment surgery is sometimes undergone to treat people with gender identity disorder, transsexual or transgender people, and intersex people (mostly in infancy). The people who undergone a sex reassignment surgery are usually addressed as transsexual, meaning literally as “person who change his or her sexual characteristics”. Trans women are former men who perform specific sex reassignment surgery to change male to female sexual characteristics, while trans men are former women who perform specific sex reassignment surgery to change female to male sexual characteristics.

Definition

Although people mostly imagine a sex reassignment surgery as a procedure to reshape the genitals of a person, the World Professional Association for Transgender Health (WPATH) has included larger scope to the procedures defined as sex reassignment surgery. Some of these medical procedures are chest and breast reconstruction or augmentation, genital reconstruction, and certain facial plastic reconstruction. This larger definiton also includes some medically non-surgical procedures like facial electrolysis.

To protect patients with gender identity disorder who needs to perform sex reassignment procedure, the American Medical Association House of Delegates declared that the denial to these patients is a form of discrimination and supported public and private health insurance to cover sex reassignment surgery as a treatment recommended by physician. This statements are also issued by other organizations like American Psychological Association and the National Association of Social Workers.

Male to Female or Female to Male Sex Change Difference

Male to female sex reassignment procedure for trans women is different with female to male for trans men. Sex reassignment procedure for trans women includes medical construction of a vagina, facial feminization surgery, and breast augmentation. For trans men, besides medical construction of a penis, several other procedures like mastectomy (breast removal procedure) and hysterectomy or male chest reconstruction are necessary. But, in both cases, sex surgery also includes several necessary ancilliary procedures like orchiectomy or vaginectomy.

In trans women, medical advancement has made it possible to childbearing, by using a donor uterus from other natural women that is strong enought to carry an infant without having any implication from the anti-rejection drugs. A DNA transfer is also possible by removing DNA from the donated ovum to be replaced by the DNA of the receiver.

Health Considerations

Not all people could undergo a sex reassignment surgery. There are several health considerations to pass before performing the surgery. For example, the patient with HIV or hepatitis C may find it difficult to do a sex reassignment surgery. Many surgeons avoid these kinds of patient due to the safety problem. Although some medical experts agree that avoiding patients with HIV or hepatitis C to undergo a sex reassignment surgery is a form of discrimination, the patients themselves are willing to pay higher fees in order to recruit a surgeon to perform the surgery safely.

Not only HIV and hepatitis C, other health conditions like diabetes, abnormal blood clotting, and obesity must be considered by the patient. Obese patient, for example, is suggested to lose weight before performing surgery. Meanwhile, smoking patient is suggested to quit before and after surgery. This is necessary to avoid any problems after the surgeons.

Standards of Care

While sex reassignment surgery sometimes feels so difficult to be performed due to financial difficulties or minimum experienced surgeons, a document called Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People becomes a guidance or a governance by some individuals who wants to perform the surgeries. With an increasing number of surgeons in this field in many regions, Standard of Care is widely spread and sometimes revised by the World Professional Association for Transgender Health. The Standard of Care is also becomes a guidance by many countries, including the United States, to treat transsexualism. Standard of Care includes a period of full time life as a member of the target sex before performing the sex reassignment surgery.

Beside that, Standards of Care lists several minimum requirements as guidelines for treating transsexualism. Some of these requirements is accessing hormone replacement from the opposite sex and other surgical interventions. Here then comes the controversy. Many countries do not follow the right Standards of Care, some of them insert their local standards of care in it, like Netherlands, Germany, and Italy. Some European Standards of Care are even based on older versions of the standards. That makes some standards are stricted than other standards, mostly the latest revision of Standards of Care. However, in the United States, many professional sex reassignment surgeons apply the Standards of Care in a more flexible term, regarding to how the patient’s condition is, as long as it is consistent to the Standards.

Surgeons require at least one suggestion from an experienced mental health professional who works in diagnosing sex identity disorder for a patient more than a year. This suggestion is compulsory because it becomes a sign that sex reassignment surgery is the one and only treatment to be performed. Moreover, many medical professionals and associations stated that no surgical interventions are required during performing the sex reassignment surgery procedures. But, laws in many countries are still unable to list transsexual and transgender people as the opposite sex in the public records, except if they attach a testimonial letter from a physician or medical experts that said that the sex reassignment surgery has been undergone. Several strict countries do not even allow any kind of sex change, even after sex reassignment surgery has been performed.

Estimating the Salary of A Plastic Surgeon

Plastic surgeon is a person who specializes in reconstructing human body. Human body reconstruction is often performed under patients with disfigurements or displaced body parts or under normal patients who want to improve their appearance. Due to the heavy task, many people said that the salary of a plastic surgeon musts be high. Moreover, applying to be one of professional plastic surgeons is not easy, too. The American College of Surgeons makes a report that a plastic surgeon has to complete a six year training and residency program after eight years of pre-medical and medical school.

National Statistic

Medscape, a health care industry website, reports that the median salary of a plastic surgeon is $270,000 per 2011. It also tells us that about 54 percent of plastic surgeons gain $300,000 annual salary maximum, while 30 percent of them gain about $300,000 to $500,000 annual salary and 16 percent received more than $500,000 per year. Based on this statistic, profession plastic surgeon ranked ninth in the list of biggest salary among other medical and surgical specialties professions.

Regional Data

Meanwhile, regionally, the salary of plastic surgeons also varies. Plastic surgeons in the Great Lake states are the most prosperous, with median annual salaries of $339,500 per 2011. Mid-Atlantics plastic surgeons are the second most prosperous, with annual salaries of $335,000. In North Central states, plastic surgeons are paid $297,500 annually in average, while in South Central, they were paid $290,000 per year. Southeast and Northeast plastic surgeons are paid with similar amount of dollar, $265,000 per year, while in the Northwest and Southwest, plastic surgeons gain about $250,000 per year. This data is gathered by Medscape.

Data by Practice Field

By practice field, Medscape reported a similar variation of salary of plastic surgeons. Plastic surgeons who work for private practices received the lowest annual salary, which is about $250,000, per 2011. Those who work as partners in private practices, in opposite, receive the highest annual salary, which is about $400,000. Similar amount of salary is also gained by plastic surgeons who work as independent contractors. Plastic surgeons who work for academic institutions and hospitas have median income about $270,000 annually, while those who practice in multispecialty field received about $500,000 per year.

Miscellanous Information

With those fantastic salary statistic gained by plastic surgeons, Medscape reported other considerations from this condition. Approximately 38 percent of plastic surgeons who work in private practice are pleased enough with the salary they received. Meanwhile, 82 percent of all plastic surgeons agree that they would choose similar medical specialty. This is twice as higher than the other 41 percent who would cross to other medical specialty.

From all this statistical data, we may have concluded that plastic surgeons is one of the best medical profession not only by salary but also by job satisfaction.