I am a transgender female who is looking for SRS options. I would like to know if there is any method of operation that allows the doctor to perform vaginoplasty with ADM material or other external material (artificial material, animal material, etc.). Are there any precedents? Will the operation be safe and tangible? What are the prognoses?

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Acellular dermal matrix has been used experimentally [1,2] to successfully repair vaginal agenesis in cisgender female patients, so there's some evidence to support that ADM could be used in an SRS vaginoplasty. It's important to note that these authors are from institutions in China, which may mean that their surgical technique is region-specific (and perhaps not allowed by regulatory agencies in the United States). Generally speaking, any type of SRS procedure you might receive from a qualified plastic surgeon will likely produce satisfying and relatively uncomplicated results. [3]

Researchers in South Korea, another hotspot for plastic surgery, have published very favorable data on long-term results (in terms of anatomic and sexual function as well as patient satisfaction) on a minimally-invasive vaginoplasty that takes a laparoscopic rectosigmoid approach. [4] Naturally, this procedure can have complications, as it involves dissection of the rectum, creating potential for gut flora to migrate into the peritoneum and neovagina. However, long-term studies (10 and 25 years) have shown the rectosigmoid approach to be "useful, safe, and well-accepted" without requiring a graft. [5,6] Again, this procedure is largely region-specific.

Finally, you might consider that the "additional use of full-thickness skin graft does not influence neovaginal shrinkage, nor does it affect the patient- and physician-reported aesthetic or functional outcome" [7], so you'll likely be able to avoid having a graft if you explain your wishes to your surgeon. I can find at least one surgeon in the United States from cursory Googling [8] who mentions the optional nature of the graft: "Occasionally, skin grafts are required in order to achieve adequate vaginal depth. Your consultation will determine whether or not a skin graft is necessary."

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