Transsexualism, or gender incongruence, presents a state in which a person's assigned sex at birth conflicts with their psychological gender. It is classified in International Classification of Diseases as F64. Treating these persons require multidisciplinary approach, including psychiatrist, endocrinologist, gynecologist, urologist, plastic and reconstructive surgeon. Genital reconstruction is the final step in transition, and can be performed when all other conditions required by World Professional Association for Transgender Health (WPATH) are accomplished. Female to male sex reassignment surgery Several surgical procedures can be done in female to male transsexuals, including mastectomy, removal of female genitalia, metoidioplasty, scrotoplasty with implantation of testicular implants, as well as total phalloplasty. The current operative technique of metoidioplasty comprise the following steps: vaginal removal, the release of the ventral chordee and clitoral ligaments, straightening and lengthening of the clitoris, urethroplasty by combining buccal mucosa graft and genital flaps and scrotoplasty with insertion of testicle prostheses. The goal is to perform all these procedures in one stage, and that makes our team famous worldwide. Metoidioplasty results in excellent cosmetic outcome with completely preserved sensitivity and sexual arousal, enables voiding while standing, but without ability to penetrate due to small size of the neophallus. Considering these advantages, including low complication rate, patients often choose this option. For those who require bigger phallus which enables implantation of penile prosthesis, several surgical techniques have been reported using either available local vascularized tissue or microvascular tissue transfer. However, none of them satisfy all the goals of modern penile construction, i.e. reproducibility, tactile and erogenous sensation, a competent neourethra with a meatus at the top of the neophallus, large size that enables safe insertion of penile implants, satisfactory cosmetic appearance with hairless and normally colored skin. We developed a new technique using the musculocutaneous latissimus dorsi free transfer flap, which mostly satisfies the requirements noted above. It has many advantages, such as its workable size which enables prosthesis implantation, long neurovascular pedicle and minimal functional loss after removal, as well as small phallic retraction. Total phalloplasty using latissimus dorsi flap, including total removal of female genitalia, reconstruction of the neourethra to reach the top of the glans, glans and scrotal reconstruction, implantation of testicular implants and penile prosthesis, is performed in 2 or 3 stages, presenting very complex and demanding surgical procedure with longer postoperative recovery period. Male to female sex reassignment surgery Several feminizing surgical procedures are performed in male to female transsexuals, including facial, neck, breast and genital surgery. Genital reconstruction comprises vaginoplasty, introitoplasty, clitoroplasty, labioplasty and urethroplasty. There are two substantial tissues for vaginal replacement: skin and bowel. For transgender patients penile inversion vaginoplasty presents the best option. Procedure starts with bilateral orchidectomy. The penis is dissected into its anatomical components and corpora cavernosa are completely removed. Glans with neurovascular bundle is used to create clitoris with preserved sensation, while skin of the penis is inverted, as a pedicled flap preserving blood and nerve supplies to form a fully sensate vagina. Urethra is reconstructed as in a female. Available and hairless flap, elasticity of penile skin, preserved erogenous sensation, good cosmetic and functional outcome, are the main advantages of this technique. After penile inversion skin flap, and in cases of failed surgery, sigmoid colon technique presents the method of choice in male to female reassignment surgery. Beside aesthetic and functional result, psychosocial and psychosexual outcome of these procedures are necessary in achieving a good quality of life for these patients.