Virginity Repair Surgery

These day, virginity repair or restoration surgery, or medically termed as hymenoplasty, becomes quite popular among women. There are many websites on the internet, like revirgination.net, that offer many benefits and ease to this vagina plastic surgery. Many of them come with reasons, such as to make their boyfriend or husband happy with the sexual intercourse they have, and so on. Virginity repair surgery or hymenoplasty (or sometimes called as hymenorrhaphy) today is undergone by women from old to young and from many different countries and rages.

BBC interviews a surgeon that is able to perform hymenoplasty. Dr. Abecassis, the surgeon, recalls that in a week, he could perform two or three hymenoplasties. The patients vary from all kind of social backgrounds, but most of them are young women with age about 23-27. Mostly, their reasons are about the need of virginity before getting married with their boyfriends because virginity becomes an important thing based on their traditions or family cultures. Dr. Abecassis admits that he never judges whether certain patient really has to undergo the surgery or not; he just does his task. For the record, Dr. Abecassis is one of very few Arab surgeons who want to talk openly about it.

For Dr. Abecassis, vagina repair surgery is both a mere medical plastic surgery and a taboo reinforcement. But for his patients, hymenoplasty is surely the only option—that makes them happy. Hymenoplasty is proven to be low risk, but still it is quite expensive. The high cost of the surgery sometimes make another non-medical procedure become an interesting alternative. BBC reported that there is a website that markets Chinese-made artificial hymens for only £20 or about 23 euors. It is created with elastic plastic and filled with fake blood, so once it it inserted in the vaginas, after the first penetration the woman can drip blood out of her vagina just to simulate virginity. The problem with this is that many married couple will agree the wrong definition about hymen and virginity—that somehow, torn hymen is not always caused by sexual penetration premarriage.

This is proven in an interview to a young man, who admitted that although the society accepts that virginity is not in tact in making decision before marriage, he refused to marry such a woman with lack of virginity.

A website called NewHymen.dk gives a more arguable explanation about this situation. It suggests that women do not have to feel that hymenoplasty is the only option available to repair their torn hymen. This website was created and run by a woman who admits as “a nurse, a social worker, and a professional educator”. It gives several explanations that are against the old formula and taboo like using chicken livers due to the infection whatsoever. It even suggests the readers to ask for some pill prescription to doctor—or if the readers are currently consuming the pill, it suggests them to plan their period to match the first night after marriage. This is a little bit pragmatic, actually, but it comprehends the gap between the feeling of guilty that women had and the reasonable solution to fight it.

That being said, an alternative—a heart-pleasing alternative—to young women is already available with the presence of these kinds of sites. There is an available solution to deal with their past and heal the wound and fear about family culture or men’s perception. The good thing from these websites is, like in a forum where a member—a young woman—wrote about what she feels about this virginity problem, they provide solution to see that hymenoplasty is not the only choice.

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.

Firming Up Sagging Breasts using Several Natural Techniques

As you are getting older, your breasts appearance is not the same again. Many activities you have since you were young have make your breast sagged. Some of these activities are having kids, diet, breastfeeding, and natural aging. Having perfect breasts just like those of young women is a dream of many women. Here is a good news: you can do it naturally without any surgeries. Well, perhaps you have to keep in mind that whatever procedures you undergo, both surgery and natural technique, you won’t get your breasts as tight as they were when you were teenagers. But, several techniques below could fix up your sagging breasts so that they look nice.

Push Up

You know how to do push up, don’t you? Well, all you need to do is simply flopping down your stomach on the floor and pushing yourself back up with your arms. Some women find that push up is not easy, regarding to their ages, but physically, push up is proven to build muscles around your breasts tissue. A scheduled push up will stretch your breasts muscle and make them look a bit larger.

Weight Winging

Free weight or popularly called dumbbells on each of your hand is a good start to firm up your sagging breasts. Prepare two dumbbells, each weighing around 1-5 pounds. Grip them right on each hand, stand still, hang your hands on every side of your body, and start lifting them up just like flapping your wings. It will increase the strength of muscles on and behind your breasts.

Bench Press

You can do a bench press with light weight you find most comfortale. Bring the weight right down to your chest and lift. Repeat this process several time. Bench pressing can help straightening up your breasts because it targets the effective muscle within your chest. That said, it then pushes your breasts forwards and firms up your sagging breasts.

Arm Resistance

Put your both arms right in front of your body. Make a prayer pose with your arms, bring your hands together, and put your palm right perfectly on the other palm. Press your palms as hard as you can towards each other. Feel the muscles in your breasts: they are triggered. You can also provide yourself an exercise band, an exercise bar weigh with resistance, or with just your bare hands. Press them hard, and release. Repeat this several times until you feel that the muscles in your breasts are stressed. Do some variations like pulling your arms apart with resistance.

Fix Your Posture

Try to stand. Do you stand straight? Check if your belly comes in, then your breasts will be seen a lot more firmer. Poor posture will affect your breasts. Have a good posture whenever you stand or sit. Always sit or stand straight, thrust your chest. It will sometimes become a habit, and it gives you a feel like you are “proud” with your firm breasts.

Firm Breasts Aren't Everything

While these exercises and techniques are able to give strength and enlarge the muscles of your breasts, you need to keep in mind that they do not eventually increase your breast size to the perfect breasts size. These exercises will give a feel that your breasts look nice and less sagging. Some support these techniques by using supportive bra that can make breasts look prominent. Good posture and cloth are also responsible to give the nice look of your breasts. And, again, it takes no surgery just to make the appearance of your breasts better.

Still, whether you choose to do surgery instead, if you do not take care of your breasts by doing exercises, you will just end up spending money and time in vain. Without these exercises, your breasts will start sagging again. Moreover, it is compulsory for every woman to do a so-called breast examination once in every year to make sure that your breasts are not suffering from certain diseases, like cancer. Monthly self examination is recommended too, while most women over 35 years old have to do an annual mammogram.

Breast Implant Surgical Procedures

Breast implantation, or medically termed as mammoplasty, is a procedure to implant a breast implant device within the breast tissue. There are three purposes of this breast surgery: (1) reconstruction, if the breast tissues were damaged by trauma, disease, or other accidents; (2) revision, to fix up the result of other breast surgeries performed previously; (3) cosmetic purposes, to give the breasts an aesthetically better look.

Five Kinds of Incisions

Breast implant emplacement is performed with five (5) types of surgical incisions:

There are five kinds of surgical incisions in this breast surgery:

• Inframammary. This is the incision created around the infra-mammary fold (IMF). This incision will give maximum access to most areas within the breast tissues. Because of that, this incision is usually made if the surgeons want to do an emplacement of the silicone-gel breast implants. However, this incision leaves a thicker, more visible scars onto the breast skin.
• Periareolar. This is the incision created in a border line of the areola. This incision will give a better depth-look into the breast tissue right if inframammary incisions need to be adjusted in certain ways. This incision is also necessary to be created if the surgery includes a breast lift (mastopexy). Unlike the inframammary incision, periareolar incision does not enable surgeons to emplace silicone gel implants due to the small size of the incision. Lucky that this incision is less visible than the inframammary incision because it is located around the areola’s border.
• Transaxillary. This is the incision created in the armpit (axilla). This incision will create a dissection tunnels from where surgeons can emplace the implants. The emplacement can be done both bluntly or with the help of video microcamera, and therefore produces less or even no scars on the breast skin. However, this incision is less acurate in positioning the implant device. That’s why, transaxillary incision in mammoplasty is mostly revised with an inframammary or periareolar incision.
• Transumbilical. This is the incision created at the navel. This incision is actually less common because it creates a dissection tunnels upwards from the bust. It is also so much trickier to position the breast implant device more accurately, although it creates less or even no scars. Transumbilical incision is not suitable to placing silicone gel implants within the breast tissue because of its inaccuracy nature. Moreover, silicone gel implants cannot be inserted through an incision this small because they are more incompressible.
• Transabdominal. This is mostly similar to transumbilical incision. This incision creates tunnels from the abdominal incision to the implant tissue. Mostly, an abdominoplasty is undergone simultaneously with this incision.

Breast Implant Emplacement

By definition, breast implant emplacement is a cross-sectional plan of two different implantantions: subglandular breast prosthesis implantation and submuscular breast prosthesis implantations. There are four different procedures can be apply to perform a breast implant emplacement to the implant pocket within the breast tissue.

• Subglandular. The emplacement is done onto the retromammary area, which is located between the gland and the pectoralis muscle. This emplacement method gives the most good-looking results. However, subglandular position often shows up some ripples and wrinkles, especially in patients with thin pectoral tissue size. This emplacement procedure also gives higher rate of capsular contracture incidence.
• Subfascial. The emplacement is done under the fascia of the pectoralis muscle. Actually, subfascial emplacement is a variation from subglandular position. This emplacement method is still under debate, because some surgeons said that this emplacement method gives a more vast coverage of implantation and better position sustainability, while other surgeons were against this opinion.
• Subpectoral. This emplacement is done under the pectoralis muscle. Because this emplacement can only be done after the surgeon wears off the attachments from the inferior muscle, the upper part of the implant is put under the pectoralis muscle while the lower part is in the subglandular area. Although in some patients the possibility of the implants moving from its initial position is a bit higher, subpectoral emplacement cover the maximum area of the implant and allows the lower part of the implant to be expanded.
• Submuscular. This emplacement is done under the pectoralis muscle, similar to subpectoral emplacement. But, submuscular emplacement does not require the surgeons to wear off the attachments of the inferior muscle. Coverage of this emplacement method can be reached maximally by wearing off the lateral muscle from the chest (the serratus muscle, the pectoralis minor muscle, or the two). In most breast surgery, submuscular emplacement method gives the best result to the breast implants.

Post-surgical recovery

Scars from breast augmentation surgery usually appear 6 weeks after the surgery. It then fades in several months. However, patients can go back to their normal daily life just in a week after surgery as long as they do not do hard physical activities. However, longer recovery time can happen for patients of submuscular placement breast augmentation. These patients can only be back to their daily activities after more than 6 weeks. This is because the incisions of the chest muscles takes longer period to be healed. During this recovery time, it is recommended for the patient to do some light exercises on their arms. These arm exercises are good to let go the pain within the breast tissue. Sometimes, analgesic medication catheters are used to alleviate the pain. Some other advanced techniques of breast implantation enables the patient to recover a lot faster. About 95 percent of women undergoing these techniques can resume their normal lifestyle just in 24 hours with barely any helps of bandages, catheters, and other medical devices.

10 Worst Plastic Surgery Disasters

While plastic surgery is supposed to fix someone’s appearance, these are ten worst plastic surgery ever happened in history.

Hang Mioku

Hang Mioku is an example of plastic surgery gone wrong. She is a 48-year-old woman living in South Korea. She began undergoing her first plastic surgery when she was 28 years old and became so addicted to it eversince. Many plastic surgeries have been done, resulting on her face is no longer recognizable by her surroundings. Her face became larger and deformed, and surgeons did not want to perform any more plastic surgeries on her. Moreover, surgeons said that her addiction to plastic surgery is because of some kind of psychological disorder. Knowing that not any surgeons wanted to re-fix her face, she ended up “performing it by herself” by injecting cooking oil into her face. It didn’t take long for her becoming a nation-wide news-maker as she was featured on television. Fortunately, many people took pity on her and sent in some money and donations for her undergoin some more plastic surgeries to fix her outlook. As surgeons want to handle this job, several sessions of plastic surgery are done, removing 60 grams of unknown substance from her face and 200 grams from her neck. Her face became significantly back to normal size, but scars were still left and hard to be repaired.

Jocelyn Wildenstein

She might have been recorded as a woman who spent the highest amount of money to have cosmetic plastic surgery—and making it a plastic surgery disaster. She spent approximately US$ 4 million over several years. Before making her nickname, “The Bride of Wildenstein”, Jocelyn was actually a pretty woman, a nice-looking mom of two children, and a wife of a rich art dealer. But, things gone wrong after she caught her husband cheated on her by having an affair with a Russian model. Instead of divorcing her husband, she came up with an idea to get her husband back to her by making over her appearance—by doing plastic surgery. However, not only that the plastic surgery gone wrong, she was also left by her husband.

Michael Jackson

I think we all have known what plastic surgery disaster that Michael Jackson had. More than ten times nose surgeries made him so much different, at least compared to how he looked in the 70s. Rumor said that he had also some kind of psychological disorder due to his addiction to celebrity plastic surgery.

Pete Burns

Dead or Alive, the British band that is famous for their song “You Spin Me Round (Like A Record)”, had its frontman enter the world of celebrity plastic surgery. Pete Burns, then a former member of the band, had many polyacrylamide injections to his lips, followed by some other plastic surgery procedures like cheek implant, nose reshaping, and tattoos. He admitted that in just eighteen month of plastic reconstructive surgery (that gone wrong), he wiped out his lifetime savings.

Dennis Avner

Different from others who undergo a plastic surgery to fix their appearance, Dennis Avner has undergone an extensive plastic surgery to make he looks like his animal: a tiger. Transdermal implants (to wear whiskers), tattoos, subdermal impants (to reshape his face), and teeth reshaping made him look so much similar to tiger. There he got his nickname, “The Catman”.

Eric Sprague

This one is also ridiculous. Eric Sprague was known as the Lizardman after he underwent a plastic surgery that splits his tongue just like a reptile. Born in 1972, Eric has made himself beyond everyone’s imagination by impersonating reptile so closely via plastic surgeries. He had done 700 hours of tattooing, 5 Teflon horns implantation under his eyebrows, a teeth reshaping to make his teeth looks like sharp fangs, a split tongue, and a stretch on his earlobes.

Donatella Versace

Dontalla Versace is not only known as the sister of Gianni Versace—the owner of Versace, one of the biggest fashion brands in the world—but also by her significant change after her undergoin a plastic surgery that gone wrong. Nose reshaping, which was supposed to make her nose looks smaller, eventually enlarged her nose after several years. It turned to be wide, flat, and crooked. Besides her nose, her large lips—that was made after a celebrity plastic surgery—showed that she might have been using collagen. She might also have undergone facelift, seen from her firm skin. Perhaps, she might also have had Botox to decrease her wrinkles. Breast implants? Might be; it could be seen from her weight loss.

Jackie Stallone

Jackie Stallone was famous because of several reasons. First, she was the mother of actor Silvester Stallone. Second, she claimed that she can predict the future by having a discussion with dogs and open up a hotline that gave advices for the callers. Third, she had several celebrity plastic surgery on almost every part of her face—face lift, eye brow lift, cheek implant, nose surgery, and lip surgery.

Amanda Lepore

Countless surgeries had not only make Amanda Lepore, once known as Armand Lepore, have different appearance, but also put her on the top list of world’s most famous transexuals. Her first plastic surgery was when she was 15 years old, and in the last year of her high school, she had her sex reassignment surgery to change her from male into female.

Michaela Romanini

She is a famous Italian socialite. Just as many other cases of plastic surgery that gone wrong, she was abused with lip collagen when she was 40 years old before undergoing several more plastic surgeries that end up as just plastic surgery disasters.

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 Procedures of Mastopexy

Mastopexy for Women

Before performing a mastopexy, surgeons will see if the woman who wants to do this breast-lift surgery comprehends the medical benefits and risks of the procedure. She needs to understand that there are certain body images that can be and cannot be achieved from mastopexy. Some of the indications before running a mastopexy are sagging breasts, post-explantation ptosis, congenital ptosis and pseudoptosis, and acquired or relative ptosis,

For the sagging breast

Mastopexy of the sagging breasts are inquired for both full breast- and modified breast-lift. This technique can only be performed to the surgical incisions to the skin envelope of the breast, not the parenchyma (or the inner substance of the breast).

For a full breast lift, the sagging breasts are lifted under circumvertical and horizontal incision from the Anchor mastopexy. This includes three kinds of incisions: (1) the Anchor ring, an circle-shaped incision on the upper part of the nipple-areola complex; (2) the Anchor shank, a vertical incision from the lower part of the nipple area until the inframammary incision; (3) the Anchor stock, a horizontal incision around the inframammary or around the joint between breast and chest.

In cutting the folds of excess skin from the sagging, inelastic skin-envelope of the breast (and occasionally reducing the nipple-areola complex diameter), the three-incision technique of the Anchor mastopexy allows maximal corrections to the breasts, thereby producing an elevated bust with breasts of natural size, look, and feel. Moreover, each of the three scars to the breast hemisphere produced by the Anchor-pattern mastopexy has a characteristic healing pattern:

To cut the excess skin created from this process (which acquires the sagging skin envelope of the breast, sometimes includes the nipple area diameter), these three kinds of incision permit some maximum corrections of the breasts. Then, it produces an elevated breasts with natural size and appearance. And removing the scars on the breasts due to the mastopexy process requires a skin pigment transition from light to dark skin color—light skin for the breast and dark skin for the areola skin. This is performed for scars around the periareolar area. Meanwhile, for scars on the medial vertical around the nipple areola complex to the inframammary fold or horizontal scars around it, there is no concealing needed because the scars are hidden by the shadow of the breast.

Post-surgically, of the three breast-lift surgery scars, the scar to the inframammary fold exhibits the greatest tendency to hypertrophy, to thickness and large size. Although the coloration of mastopexy scars fades with the full maturation of the tissues, they do remain visible.

In mastopexy for modified breast lift, it takes smaller number of cuts and scars. However, it does not allow the surgeon to make more changes to the skin envelope of the breast. In most occurences, modified breast lift is regarded as a sub-ordinate surgery under a mastopexy for breast augmentation surgery. Sometimes it is also included after lifting and enlarging breast surgery. Some variations of incisions in the modified breast lift are:

• periareolar lift, with a crescent shaped incision above and at some part of the nipple area, will cut and remove the crescent flesh so that the transposition of the nipple will be a bit higher compared to the breast;
• circumareolar lift, with a cut on the concentric ring flesh around the nipple area, will prohibit the size of the circle-shaped scar to be maximum;
• circumvertical lift, with a circumareolar incision around the circle of nipple area and a vertical incision starting from the lower part of the nipple until the inframammary fold.

For the augmented breast

Breast augmentation is sometimes followed by a high potential of breast ptosis. Breast ptosis may be created by stresses—both mechanically and physically—from the implanted breast to the tissue and skin envelope. The overstrecthing thins of the skins may result in the stresses. But, however, based on statistic, breast augmentation and mastopexy come with low medical risks, although the risks may increase of the two are performed altogether and as a combination. The risks can increase the potential of infection of the incision, exposure to the implanted breast, breast and nipple nerves damage, and deformity of nipple and breast implant. The reason of this risk is that breast augmentation and mastopexy, when performed as a combination, may increase the surgical complication level—at least compared to if each is performed separately. Technologies still make several advancement to enable the simultaneous procedure of breast augmentation and mastopexy with a lower risk and medical complication. This advancement, named SAM—stands for simultaneous augmentation mastopexy, includes invaginating and tacking the tissue as the first step. It enables surgeon to previsualize the final result of the surgery before creating any kinds of incision to the breast.

Contraindications

Although most mastopexies are safe, there are certain contraindications appear in some surgical process. These contraindications include aspirin, tobacco smoking, diabetes, and obesity. Surgeon evaluates the fit of a woman who wants to undego a breast lift procedure after explantation, especially for woman with encapsulated breast implants. This facilitates assessment of the real level of ptosis exists in the explanted breasts. Moreover, for women with a high risk of breast cancer development (both primary or recurrent), histologic architecture of the breasts may be altered after mastopexy. Changes of tissue may be interfered with detailed MRI detection and treatment of cancer. In this case, the risks and benefits of doing a mastopexy will be discussed by the surgeon specifically.

Introduction to Vaginoplasty

Vaginoplasty is a medical term referring to a plastic and reconstructive surgery to the vagina and its mucous membrane. Vaginoplasty is required on some medical conditions like the absence or deformity of vulvo-vaginal structure because of sexual disease or other genetics problem. Sometimes vaginoplasty is performed for aesthetic purposes. While vaginoplasty scopes only some kinds of cosmetic reconstruction and correction of vagina, neovaginoplasty scopes the procedures of construction or reconstruction of the vulvo-vaginal structure, either partially or entirely. Vaginoplasty is also known as vaginal rejuvenation, cosmetic vaginal surgery, or aesthetic vaginal surgery. The goal of vaginoplasty varies, from increase the function of the vulvo vaginal structure, to reshape the vagina for aesthetic purposes, or to heal diseases or symptoms happened on the vagina due to daily activities, sex, or others. Mostly, the general procedure of a vaginoplasty is lifting the skin of vulva and vagina. It is done by cutting off excess vaginal skin and retightening the soft tissues and muscles around the vagina. Labiaplasty is a plastic reconstruction surgery around the labia to decrease or reshape the small lips (called labia minora) outside the vagina. Sometimes, labiaplasty is combined with vaginoplasty. This surgery is called vaginal rejuvenation. After performing this plastic and reconstructive surgery, a person could still doing sexual activities with opposite sex although sensitivity could be a little bit decreased. Menstruation and fertilization are also possible, as long as the uterus and ovaries function normally. Even vaginal childbirth is also possible.

In case of sex reassignment surgery, vaginoplasty is more to be undergone by transwomen regarding to their physical sex transition. A longer period of recovery (about six weeks) is needed to allow sexual activity after surgery and to have a good sensation in sex. The biggest difference in performing vaginoplasty to transwomen is to dilating the vagina. The vaginal stent is then cut off several days after surgery, and after that, the vaginal dilation is started. It requires a complete set of dilators for every dilation took place, and each of this tool has an increasing size. Smaller dilators are used for the first or the second week (or sometimes the fourth week) for several times. Then the size of dilators used increase once per day, every other day, once in a week, until the largest-sized tool is used. This frequency is sometimes used rarer, especially for trans women who perform vaginoplasty. But, the important thing is the time spared between each dilation (or more specifically, the time after surgery) has too be short enough to decrease any difficulties in re-dilating. Vaginal dilation is important in vaginoplasty, because it allows the patient to do sexual intercourse. Vaginoplasty also requires some reshapement to the dimensions of the vagina, including the depth (Denonvillier’s Fascia), diameter (the Levator ani muscle), and narrowness—especially in transwomen.

To reshape vaginal and vulvo-vaginal areas of the patient, autologous (patient-derived) tissue from the patient is also used. Other tissue that can be used for this surgical procedures are the oral mucosa, the skin flaps, the skin grafts, the vaginal labia, the penile tissue, the penile skin, intestinal mucosa, and scrotal skin. It is also important to clear the follicles from the skin graft (if it grows hairs), usually by electrocauterization, by depilating it intra-operatively, or by manual hands. There are many different procedures of vaginoplasty, but mostly what is discussed here is the general procedure of it. Some advancement of vaginoplasty also exist, regarding to current technologies.

Further Methods of Phalloplasty

As we have known that phalloplasty is a medical surgery to construct, reconstruct, or modify a person’s penis, phalloplasty is mostly performed with skin graft. There are six further methods of phalloplasty, explained below:

Graft from the arm

Graft from arm is actually the easiest method to perform phalloplasty, but it leaves scar on arm—which can not be hidden. Moreover, the function of the arm may be worse if it does not heal properly. A full scale metoidioplasty can be performed several months earlier before phalloplasty. This is to decrease the complications possibilities after the surgery.

Below is the most common steps of this method of phalloplasty. Some variations may apply, but mostly below is the general approaches:

• After the patient is prepared, the surgery starts by marking the forearm with the size of the graft. The graft is then taken. In case the graft is too large, another graft from other parts of the body may be used to reconstruct the arm.
• The graft skin is then separated to see the veins and several antebrachial nerves. This is performed very carefully.
• The urethra and the phallus will be joined at this step, if both requires construction at the same time. If they don’t, the glans is formed.
• To let the joining of the graft and the existing tissues joined easily, a part of vein around the patient’s groin is used.
• The vein is placed to the femoral artery very carefully.
• The flap and the vein to the femoral artery are then joined.
• The ligament and clitoral hood is removed, while the nerve bundle is being untouched for some moments. Some surgeons make an alternative of leaving the clitoral tissue as it is after metoidioplasty.
• Some part of the flap is then placed as the nerve bundles are joined.
• If there is an urethral extension required, the urethra is joined with a catherer. It will be kept in place for two until four weeks recovery. The skin sometimes need to be sealed and the scrotum is also made up.

Moreover, if the urethra extension is required until the top of the glands of the new penis, a mixture of saline and epinephrine is injected to the labia minora. It is then opened up, and the layers are separated. The layers are then closed around a catheter and sewed up.

Sometimes, in an urethral extension, a mucosal flap from inside the vagina may be used. This requires a separate surgery.

Graft from the side of the chest

Graft from chest is actually not an old method. This is one of the biggest advancement in phalloplasty. Some advantages of this methods are good appearance, no prominent scar, lower potential of complications, and no need of hair removal. This method of phalloplasty requires three parts, spanning over six to nine months. The steps are:

• The surgery starts (after the patient is prepped) with the side of the chest marked for graft size.
• After the patient is prepared, the surgery starts by marking the side of the chest with the size of the graft. The graft is then taken.
• The graft skin is then separated to see the veins and several thoracodorsal nerves.
• With the graft still attached to the blood supply from the vein, the graft is rolled to shape a rough penis.
• To let the joining of the graft and the existing tissues joined easily, a part of vein around the patient’s groin is used.
• The vein is placed to the femoral artery very carefully.
• The flap and the vein to the femoral artery are then joined.
• The ligament and clitoral hood is removed, while the nerve bundle is being untouched for some moments.
• Some part of the flap is then placed as the nerve bundles are joined.
• The new penis is protected from any contact to other muscles and skins during the beginning recovery period. This step requires a constructed dressing to keep away any potential complications of blood supply
• Urethral extension is then started after three months pass.
• The new penis is separated and an oral mucosa graft is laid onto the cavity and extended to the urethra. Both are then joined to let urination while standing.
• A catheter is placed for several weeks to allow for proper healing
• For recovery, a catherer is used for some weeks. After three until six months, the erection device can be placed.

Graft from leg

This method is akin to that of forearm graft, except that the scar of the donor will be easily hidden by socks or pants. The remaining steps are similar to as in the forearm graft method, including the removal of permanent hair before the operation. Sometimes, the graft from the leg may be combined with forearm graft to reshape the glans penis.

Pubic area flap

Graft is taken from the skin around the pelvic bone, across the abdomen around the stomach. There will be a big horizontal scar, making it a little bit unaesthetic. Moreover, the grafts are usually seen unnatural and less permanent to keep an erecticle implant for a further term. Hair removal is necessary before proceeding this method.

Gillies technique

This method of phalloplasty is actually the first phalloplasty method ever used. An abdominal skin is rolled, making a form of tube, to simulate a natural penis. Urethral extenion is performed in another part of the skin, creating a tube within a tube. A flexible rod is required to implant erectile. A more improved method of Gillies technique includes an inclusion of a blood supply pedicle to avoid dead tissue before being transplanted to the groin.

Abdominal muscle

This last method of phalloplasty is rarely undergone. There are three minimum steps in this method, including implantating an expansion balloon to help grafting the necessary skin parts. Finally, the grafts will be a little bit unnatural, and less likely to keep the implanted erectile in a further term.

A Brief Information about Phalloplasty

Phalloplasty is a medical term of constructing, reconstructing, or modifying a person’s penis due to medical condition or cosmetic purposes (also known as penis enlargement). A phalloplasty is usually performed to patients with genitalia deformities like micropenis or hypospadias, patients who lost their penis, or female to male transsexual patients. First phalloplasty ever recorded in history was performed with the aim of female to male sex reassignment surgery, undergone by a trans man, Michael Dillon, in 1946. Dr. Harold Gillies, the surgeon, documented the technique in Pagan Kennedy’s book “The First Man-Made Man”.

Basic Methods of Phalloplasty

Surgeons have four different methods in performing phalloplasty. Basically, these methods include a graft of tissue and skin from donor and an extention of the urethra. Phalloplasty can create a penis up to 7 inches long (approximately 14-18 cm) and 5.9 inches (approximately 11-15 cm) in circumference.

Phalloplasty is simpler for real male (or termed as cis men) than for trans men, because there is no significant requirement of urethra extension. In trans men, the urethra finishes close to the vaginal opening and, therefore, needs to be significantly extended. The urethra extension is the most difficult phase of phalloplasty. In trans men, phalloplasty is also followed by scrotoplasty. Scrotoplasty is a construction of scrotum, where testicles are located. Scrotoplasty can be done by using labia majora or vulva. Then prosthetic testicles can be inserted in the scrotum after scrotoplasty is done.

The success of a phalloplasty can not be measured just by whether the penis has been constructed/reconstructed or not, but by whether the penis could perform similar functions like natural penis. For instance, could it achieve an errection and sexual penetration? In this case, an implanted erectile prosthesis is required in every phalloplasty. Some kinds of this implanted erectile prosthesis include malleable rod-like medical devices—that allow the penis to erect or be flaccid. Still, in this case, the success rate of erectile prosthesis implantation in trans men is lower than that in cis men. But, surgeons usually use their experience in sex reassignment surgery to trick the implantation to lower down the potential risk.

Former methods of this implantation require a bone graft as part of the phalloplasty. Studies from Germany and Turkey have given proof that these reconstructions can hold the stiffness without any further complications. However, in this case, the penis will not have the ability to become flaccide without breaking the bone graft apart.

In penis enlargement, phalloplasty is sometimes performed by cutting the suspensory ligament that hold the penis near to the upper skin. It allows the penis to grow toward the outside of the body instead of upward. This is done by doing a horizontal incision around the pubic bone region, where the pubic hair will help covering the incision part. After all, the penis is free from any incisions.

There is still research in progress about synthesizing corpus cavernosa, or the erectile tissue, performed on rabbits in laboratory. This is done to dig more about eventual use in patients who require phalloplasty. The last report of this research tells that the rabbits give response to sexual stimulation, just like to the tissue of male rabbit which is not any parts of the research.

Patient Satisfaction

Approximately 90% of the patients undergoing phalloplasty is satisfied, while only 9% of them complain about the sensitivity of their new penis. Meanwhile, 51% of them are able to do sexual penetration without pains or difficulties. Moreover, 40% of these patients are able to apply for a job they can not apply for when they were still female. There is 27% of them who needs temporary use of anti-depressants, while 93% (or mostly) of them said that they were happy with their new penises.

10 Natural Breast Development for Women

More than just providing nutrition for babies, breast for women has become an important thing to increase her appearance and sexiness. That is why women often want to try some ways to increase their breast size. Some sees a surgeon and perform a breast enlargement surgery, some other consume certain medicines or pills to get the same result. While breast size development is medically possible, only a few of them know that there are many natural breast development technique they can try for increasing their breast size.

Breast Massage

This technique comes from old Taoist massage exercise. Rub your palms together to heat them up and locate them right on each breast. Then, massage them in a circular and downward line. Repeat it for about 15 minutes, twice a day (once in the morning and once in the evening). You can also use massage oil from almond, olive, or geranium to perform this technique. The massage will increases the blood flow in your breasts, allowing more phytoestrogen to come into the blood flow and stimulate the growth receptors to work. Some said that after a month full of performing this technique, there will be a significant change seen.

Palm Pushing

Put your two palms on your breasts and push towards your chest, as if you are praying. Count one to five, then relax. Repeat this technique ten times. This technique looks simple, but beyond, it helps your breast muscles to be strong and firmer. There is no limited schedule to perform this technique; you can do it whenever you want.

Push-Up

While you think that push-ups is an exercise for arm muscles, few knows that it also a good exercise for pectoral muscles, That is the muscle that will give a look to your breasts as if they are firmer and larger. Well, you know how to push-ups, don’t you? But here is how a good push-up is supposed to be. Lie face down on the floor. Put your feet and palms apart flat on the floor, and keep your back straight. Now, push yourself up and down while keeping your body straight.

Chair Grip

This technique needs to be performed using a chair with arm rests. It require you to put your arms on the rest and your bady straight. Grip your arms on the chair and push your body up away the chair. Hold for about five seconds, then relax. One set of this technique requires 10 until 15 times grip, and you require 10 set everyday to increase breast size.

Yoga and Pilates

Yoga and pilates give power to your body from within. Both affect your main muscular areas that connected directly to your breasts. That is why yoga and pilates are good to strengthen your breast tissue and muscles, which finally increase your breasts size.

Meals

Protein in your body will help you increasing muscle mass. Chicken is a good source of protein. It will help your breasts grow not only by increasing muscle mass, but also by nourishing them with estrogen. Another good meal for your breasts is fenugreek sprouts, which also contains estrogen. You can also try flax, pumpkin seed, sunflower seeds, and anise.

Dong Quai Plant

Ever heard of “dong quai” plant? This plant is rare actually, but some said that it is effective to increase breast size naturally. There are still some medical arguments about this plant.

Gaining Weight

Smaller breasts are usually the problem of thin women, not fat women. So, if you are thin, why don’t you consider a new healthy diet to gain more weight? Gaining weight does not always affect your body entirely, but it will give your breasts a better look.

New Bras

Sometimes it is not your breast that does not look good, it is your bra! Are you really sure that you wear the perfect bra size? Try to re-decide your bra size that suits perfectly with your breast size. Measure the increase of your breast size every six months, and if there are any changes, consider buying some new bras.

Bravo for Brava

Food and Drug Administration has approved Bravo for Brava Enhancement System as a natural development to increase breast size. One cup size of Bravo for Brava will support your breasts with two domes and slight tension, which will give a sensation of pull-and-stretch to your breast tissue.

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.