title: Reversal Surgery in Regretful Male-to-Female Transsexuals After Sex Reassignment Surgery.
abstract: Sex reassignment surgery (SRS) has proved an effective intervention for patients with gender identity disorder. However, misdiagnosed patients sometimes regret their decision and request reversal surgery. This review is based on our experience with seven patients who regretted their decision to undergo male-to-female SRS.
  
  
  
  To analyze retrospectively seven patients who underwent reversal surgery after regretting their decision to undergo male-to-female SRS elsewhere.
  
  
  
  From November 2010 through November 2014, seven men 33 to 53 years old with previous male-to-female SRS underwent reversal phalloplasty. Preoperatively, they were examined by three independent psychiatrists. Surgery included three steps: removal of female genitalia with scrotoplasty and urethral lengthening, total phalloplasty with microvascular transfer of a musculocutaneous latissimus dorsi flap, and neophallus urethroplasty with penile prosthesis implantation.
  
  
  
  Self-reported esthetic and psychosexual status after reversion surgery and International Index of Erectile Function scores for sexual health after phalloplasty and penile prosthesis implantation.
  
  
  
  Follow-up was 13 to 61 months (mean = 31 months). Good postoperative results were achieved in all patients. In four patients, all surgical steps were completed; two patients are currently waiting for penile implants; and one patient decided against the penile prosthesis. Complications were related to urethral lengthening: two fistulas and one stricture were observed. All complications were repaired by minor revision. According to patients' self-reports, all patients were pleased with the esthetic appearance of their genitalia and with their significantly improved psychological status.
  
  
  
  Reversal surgery in regretful male-to-female transsexuals after SRS represents a complex, multistage procedure with satisfactory outcomes. Further insight into the characteristics of persons who regret their decision postoperatively would facilitate better future selection of applicants eligible for SRS.
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia. Electronic address: djordjevic@uromiros.com.
authors.forename: Miroslav L
authors.initials: ML
authors.lastname: Djordjevic
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Marta R
authors.initials: MR
authors.lastname: Bizic
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Dragana
authors.initials: D
authors.lastname: Duisin
authors.affiliation: VUMC University, Amsterdam, The Netherlands.
authors.forename: Mark-Bram
authors.initials: MB
authors.lastname: Bouman
authors.affiliation: VUMC University, Amsterdam, The Netherlands.
authors.forename: Marlon
authors.initials: M
authors.lastname: Buncamper
mesh_terms: D000328:Adult; D005260:Female; D000068116:Gender Dysphoria / Q000523:psychology*; D005836:Genitalia, Female / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019935:Penile Implantation; D015917:Penile Prosthesis; D010413:Penis / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D057830:Gender-Affirming Surgery / Q000523:psychology*; D013524:Surgical Flaps; D014189:Transsexualism / Q000523:psychology; D014521:Urethra / Q000601:surgery
keywords: Male-to-Female Transsexuals; Outcomes; Phalloplasty; Regret; Sex Reassignment Surgery