I'm going to Schaff (summer 2017), Suporn's German counterpart. He developed his own technique in 2003, after having seen many sub-par results with the traditional PI, and superb results from Thai surgeons such as Suporn. Unfortunately, there aren't many non-german girls going there, since he's rather expensive (20k), and most (if not all) documentation is in German. Still, over here, he's considered to be the best, on par with Suporn, Chett, Meltzer and the like. There are ever more surgeons picking up on his success, Marci Bowers has adopted his technique last spring, and Brassard is offering his own take on it. So it's gaining ground.
Dr. Schaff is trained as a plastic surgeon, with most of his career focusing on hand surgery. He has been an accomplished microsurgeon for years, and has lots of experience with very fine, nitty-gritty surgical steps like attaching nerves etc... About 25 years ago, he started doing PI-inversions and FTM metoidioplasty surgery and phalloplasties as well. Unfortunately, German law generally forbids to place photos of genitalia online. Therefore, it is rather hard to find example pictures, but they are out there. From what I've seen myself, the results are spectacular, definitely on par with Suporn and Chettawut. A friend who went to a gynecologist told me, the gyn couldn't tell the difference with a cis-vagina.
His technique for MTFs is called the "combined method", for reasons I'll describe below... I'll offer you a translation of the German info lying around here. It comes down to this:
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Schaff offers his technique in two surgeries. Why two? His technique is very complicated, and due to esthetic concerns over swelling, most of his girls have a revision after 6 months.
First surgery in steps:- First: an orchiectomy
- The dorsal (back) part of the scrotal skin is de-epithelialized, meaning the layer of the skin containing the hair follicles is removed, thus making it hair-free. Suporn does the same. Schaff uses this part of the scrotum for the vagina. The ventral (foremost) part of the scrotum is left intact and is used for the labia majora.
- The upper penile shaft skin is removed, and the foreskin is divided into its inner and outer skin. The glans is then taken aside, and the upper most layer is removed from most of it to make it more sensitive (microsurgery). Furthermore, Schaff removes the innermost part, the uninnervated cavernous body. The rest of the glans is kept completely, and is made into a Chonburi Organ and clitoral glans. The inner layer of the foreskin is used for the preputium clitoridis (clitoral hood) and labia minora. All of the nerves and bloodvessels are kept intact. In doing all of this, he follows Suporn's technique.
- Both of the penile corpora cavernosa are removed until the pubic bone. The parts of the corpora cavernosa that are attached to the pubic bone are left intact, since cis-women also have these same corpora (clitoridis). Suporn does the same.
- Next, he creates space between the urethra/prostate/bladder on the one side and the rectum on the other, for the placement of the vagina.
- The actual clitoris is made out of the parts he has made available (see above). All of the nerves and blood vessels are left intact and are positioned there where they would have been in cis-women. Suporn does the same.
- The entrance of the vaginal opening is created by folding the leftover penile skin (bottom) into the vaginal cavity (it's de-epithelialized first). Suporn uses a meshed scrotal skin for this.
- The penile urethra and the attached urethral cavernous body are removed from the penis. Schaff then places these inside the vagina, covering the front side (where the bladder is etc). The innervation and blood vessels are left intact. The point of doing this, is that the urethra has a mucous membrane, it's not normal surface skin. Furthermore, the penile urethral skin contains
Littre glands. Their normal function is to keep the urethra wet and during sexual arousal, they lubricate the urethra in expectation of the ejaculation. The mucous membrane in the urethra is very similar to the vaginal wall in cis-women. By placing the urethral membrane (which by itself is lubricating) and its glands in the vagina, it adapts to its new environment and thus offers lubrication and self-cleaning properties to the vagina. Furthermore, the urethral mucous membrane later adapts to the estrogen in your blood stream and transforms into a normal vaginal mucous membrane, thus offering the necessary binding factors for the lactic bacilli that regulate the vaginal PH and allowing for a completely normal bio-flora to develop inside. The corpus spongiosum can't be removed because doing so would cause irreparable damage to the urethra itself. The urethra is placed length-wise on the front of the vagina, with the corpus spongiosum being placed in the abdominal cavity. This entire step is unique to Schaff's technique.
- Next, Schaff uses the inner part of the foreskin to form the clitorial hood and the inside of the labia minora. The outside of the labia minora is created by using the outer foreskin. Suporn does the same.
- The labia majora are formed out of the ventral scrotal skin. Usually, Schaff leaves lots of skin in the beginning, so the area can swell if need be. This excess skin is removed in the second operative step, if necessary/wanted.
- The deepest part of the vagina is created out of the bottom of the scrotal skin, again de-epithelialized to make it hair free. By doing so, the vagina consists out of three parts: penile skin (around the opening, except for front), the urethra (front, running all the way inwards) and the deepest part by the non-meshed scrotal skin. Therefore, the tension on the mons-pubis (created by the traditional PI) is avoided, greatly improving blood flow and thus reducing the chance of complications. Because the vagina is constructed out three combined parts of tissue, the method is called 'the combined method'. Figures
- Schaff keeps the Cowper glands and prostate intact, leaving them where they are naturally (secretions exiting in the urethra, thus later lubricating the vulva)
After the first surgery- A placeholder is inserted into the vaginal cavity, same goes for a bladder catheter. This is the same in all methods. After 7-9 days the catheter is removed and the patient can start dilating.
- The patient has to dilate three times a day, 45 min each for the first six months after surgery. This is significantly more than required in the traditional Penile Inversion, but still less than Suporn's technique requires (12 months)
Second surgeryAfter six months of healing, the body has created all of the scar tissue it will, and the vagina itself is healed. The second operation will focus primarily on the vulva. First and foremost: due to the fact that a part of the penile skin is still turned into the vagina, the typical 'donkey ear' skin flaps can be present. These will be taken care of. Second, the excess skin for the labia majora is removed, and any further cosmetic changes to the vulva are made as requested. Even though severe complications rarely happen (fistulas etc), these are also taken care of.
Also, the second surgery can be combined with breast augmentations, FFS, tracheal shaves etc
Advantages of the Combined Method- Except for the testes and the penile corpora cavernosa, all parts of the male reproductive organs are used
- Because Suporn's technique is followed for the creation of the vulva, outer scarring is reduced to a minimum
- Because there is no tension on the mons pubis, there are no problems with the post-operative blood-flow, thus promoting healing. Furthermore, this neglects the need to construct a mon pubis afterwards, it's already there because of the natural (homologous) nature of the vulva
- The clitoris has, same as with Suporn's technique, a sensitive hood.
- The labia minora are quite large, and cover the vulva and vagina completely. Furthermore, the vulva is created out of homologous tissues, thus maintaining the appearance and color of a cis-vagina
- Depth: Schaff has a statistical mean of 13,2 centimeters, varying between 11 and 21 centimeters in total.
- The vagina is self-cleaning, has a natural bio-flora and is self-lubricating. Furthermore, it is hair-free.
Limits and complicationsThese good results can only be guaranteed when you have:
- No circumcision
- No bilateral orchiectomy
- No prolonged use of anti-androgens (due to shrinkage of the penis and scrotum)
- No medical problems (diabetes, previous DVT incident, etc...)
- No scar tissues (piercings)
- No smoking
- Not being overweight
- After-care (proper dilation!)
Homologous resultsThis is the only method in the world that reaches complete homologous results with the natal (cis) vagina:
- Glans: Clitoris
- Clitorial hood and inner side of labia minora: Inner foreskin
- Outer side of labia minora: Outer foreskin
- Entrance of vaginal cavity: Penile shaft skin
- Labia majora: Scrotal skin
One cannot get closer to the natal female vagina and vulva, within the limits of what science currently offers of course
Differences to Suporn's techiqueDr Schaff's technique offers many similarities to Suporn's. There are some differences:
- Schaff does create a Chonburi Organ, but he doesn't divide the penile glans into three parts, as Suporn does. The reason for this is that he's afraid of additional and unnecessary scarring.
- Schaff connects the labia minora to the clitorial hood directly, he doesn't offer a fenulum clitoridis, as he believes the frenulum Suporn builds is only scar tissue.
- Schaff uses the scrotal skin for the labia majora, whereas Suporn uses penile skin. His reasoning for this is that the scrotal skin is homologous to the labia majora. Furthermore, Suporn uses the entire scrotum for the vagina (meshing it for additional size). This also requires the patient to dilate less (6 months vs 12)
- Schaff puts the penile urethra in the vagina, making sure it self-cleans and self-lubricates.
Hope this helps anybody!
