Sexual reassignment surgery is often the last and the most considered step in the treatment process for transsexuals with gender dysphoria. In male-to-female SRS, I developed some unique skills such as W-clitoroplasty, tubing of tunica albuginea, fat transposition and V-Y flaps technique for labia minora reconstruction. Those procedures actually improve the cosmetic outcome of external genital area. I used penoscrotal flaps, so called two-flaps, to build up the new vaginal lining. In addition, the modified technique of skin graft affords adequate depth and width of new vagina. Diced urethral mucosa may grow up some mucosal surface in the neovagina. However, the perioperative complications of male-to-female SRS are not uncommon, which include vaginal stenosis, bleeding, partial preputial flap necrosis and other unusual problems.
In the other hand, female-to-male SRS is more challenged and takes time to be completed. The staged surgery is recommended for the circulation of flaps to reconstruct the neophallus. I designed some techniques that the previous articles had not mentioned before, such as, dermofat testicle graft, extending prelaminated urethra, McDonald incision for pubic area and Calla lily preparation for the urethral connection. Complications sometimes are difficult to deal with.
I personally had completed the surgeries on more than two hundred individuals who were diagnosed as transsexuals with gender dysphoria. I would like to share the personal experience about these surgeries.

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