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The Maercks approach to FTM surgery

The full spectrum of microsurgical and local phalloplasty options are available at The Maercks Institute in Miami; however, Dr. Maercks’s preference is to use an advanced technique described below that maximizes safety, efficacy, form, and function. This technique is called the MAERCKS (Multifocal Anatomic Emulating Reconstructive Clitoral Kinaesthetic SCIP) Phalloplasty. Each part of the MAERCKS Phalloplasty is described below, with a highlight of advantages and disadvantages is included. Dr. Maercks prefers to avoid conventional techniques because of extensive scar burden, long-term complications, poor sensation, as well as the need for implants, staged procedures, and revisionary procedures.

FTM surgery that reflects you

You are unique. There is only one of you in the entire world. This means that your surgery should be different than anyone else’s surgery. That’s why Dr. Rian Maercks personalizes a treatment plan just for you during your consultation. He will also answer any questions you have, discuss the cost and the risks of FTM surgery, and guide you on the next steps to take.

Requirements for FTM bottom surgery

If you’re considering female to male surgery in the Miami area, you may be an excellent candidate. However, there are some requirements. Before a patient can undergo any type of transgender surgery concerning the genitals, they must have two referral letters from a gender psychiatrist, therapist, psychologist, or primary care physician.

They must also have one from a doctorate-level professional stating that the transgender surgery is the next step during the transition process. Female to male patients who are interested in genital surgery are required to be under hormone therapy for 12 consecutive months. The journey to a new body can be a long one, but we promise to help you every step of the way as you change your body to match your identity. If you have any questions or concerns about these requirements, please don’t hesitate to contact our office. 

Conventional transgender phalloplasty

Conventional flaps

Whereas standard procedures use conventional flaps, Dr. Maercks prefers to avoid them because of unnecessary donor site morbidity and complication profiles. We do offer these techniques to patients that specifically request them, but we recommend the procedures listed under “modern histiocentric phalloplasty” in the section below.

Anterolateral thigh flap (ALT flap phalloplasty)

The anterolateral thigh flap has the advantage of being less conspicuous than a radial forearm flap, and yields much more tissue to work with. It is also harvested with a nerve and has enough tissue to provide a ureter, but can be difficult to sculpt when used this way — and therefore typically looks unnatural. The donor site is large, and like the radial forearm flap, a secondary defect for skin graft harvest is necessary leaving behind a thigh covered in scarring.

Latissimus dorsi, lattisimus perforator, and parascapular flaps

These are great reliable flaps that can be configured to create a wonderful phallus with chimeric opportunities, but they tend to leave behind an extensive donor site and require skin grafts like the two flaps mentioned above. Because of this, Dr. Maercks avoids these techniques unless they are specifically requested by the patient.

Radial forearm flap

This is the most commonly-used phalloplasty technique. The advantages are that it’s a very straightforward and reliable procedure, with enough pliable tissue to create a urethra and penis of sufficient length with a nerve supply. The disadvantages are the resulting large and obvious donor site, as well as scarring both on the wrist and forearm, or the leg or back where a skin graft must be taken to cover the wrist defect. Furthermore, as a significant portion of the blood supply is removed from the hand, patients may experience pain and cold intolerance later in life. The flap is also generally thin, which can often limit girth of the penis. This results in a less-than-ideal length-to-width ratio. The radial forearm flap also requires an expensive secondary procedure of placing an implant or pump in order to be sexually functional. In addition, creating a glans (head of the penis) is yet another procedure, and the results typically look unnatural.

Modern histiocentric phalloplasty

SCIP flap superficial circumflex iliac perforator flap

The SCIP flap has the advantage of leaving only an abdominoplasty scar-like donor site — unlike the extensive morbidity of the flaps listed previously.

It’s a wonderfully reliable flap that, if harvested from both sides, can be used as a double flap that has many advantages (both functionally and aesthetically) over the two former flaps.

This flap, however, has been drastically improved upon through Dr. Maercks’s studies and experience leading to the two flaps listed below.

CIS phalloplasty flap clitorally innervated SCIP flap

The CIS flap is a breakthrough technique developed by Dr. Maercks and brought to reality by his collaboration with international colleagues.  The advantages of the CIS phalloplasty FTM surgery include no need for skin grafting, and only a single closed scar that resembles that of an abdominoplasty. Innervation from the clitoral nerve is concentrated near the head of the phallus, more closely approximating natural anatomy. The base can be innervated by local nerves in the groin. The glans is thicker than the shaft in a single stage, and a secondary urethral design is not necessary. This reduces chances of complications of the two techniques mentioned under the “conventional transgender phalloplasty” section above. 

The MAERCKS Phalloplasty

The MAERCKS Phalloplasty is the result of Dr. Maercks being dissatisfied with the amount of morbidity associated with female to male phalloplasty techniques and the relatively poor function, need for foreign bodies, and the vast complication profile. His goal was to design a transgender phalloplasty FTM surgery that would: 

  • Be aesthetically pleasing with crucial anatomical features
  • Leave behind no stigmata of transgender surgery
  • Provide more analogous innervation to a natural penis with independent clitoral sensation to the glans
  • Obviate the need for secondary procedures or implants/pumps
  • Provide robust independent flap tissue for the urethra to avoid the common problems of urinary fistulas and strictures 
  • Limit recovery time for the patient

Advantages of the MAERCKS Phalloplasty

Dr. Maercks visited multiple international centers and brainstormed with colleagues. He did extensive anatomical research and cadaver study to bring this ultimate phalloplasty to fruition. The first step was to prove that the novel vascularized nerve supply was attainable. The CIS phalloplasty female to male surgery was developed, and successfully demonstrated this concept. By taking a flap in the groin crease of both sides, the patient is left with a straight-line scar that resembles an abdominoplasty scar and does not clearly declare reconstructive efforts. An independent flap is used for the urethra, and the second flap is used for the penile shaft. This methodology allows independent innervation of a true glans that actually appears like a natural glans, without additional stages.

Three modes of innervation with the MAERCKS Phalloplasty

The MAERCKS Phalloplasty is the only transgender phalloplasty technique with three modes of innervation. The glans, the shaft, and the internal base of the flap are fed by three independent nerves, making it the most innervated phalloplasty to date. By virtue of this separated innervation, the perception of kinaesthesia and more natural sexual feedback is possible. By nature of its double flap construction and tissue quality, implants and pumps are not necessary for penetrative intercourse. Size and girth are not restricted, and a truly customized phallus can be designed. Some patients require a condom for penetrative sexual intercourse; however, there is an option to include natural cartilaginous structure again in one stage to avoid the need for a condom.  

Why choose The Maercks Institute for FTM surgery in Miami?

Dr. Rian Maercks’s expertise in plastic surgery is not limited by gender or body part. He has been widely recognized for helping the transgender community with his advanced procedures, which include augmentative techniques for male and female genitalia. This is one of the main services performed at The Maercks Institute, a high-profile, Miami-based surgical center that delivers bespoke results that appear as if they are made by nature. Dr. Maercks is a board-certified cosmetic specialist who has earned international recognition by surgeons and patients alike for his innovative and progressive approaches to aesthetic interventions of the face and body. He views patients in a manner that is anything but cookie-cutter, and utilizes his artistic vision and experienced judgement to achieve optimized results in the safest most effective, and most natural-looking way possible. If you’re ready to schedule your female to male surgery consultation at our Miami office, we welcome you to reach out to us.

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