Innovation in Vaginoplasty: Integration of a Silicone Tissue Expander Prosthesis Into the McIndoe Technique—A Case Report

Background and Aims Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome is a congenital condition marked by agenesis of the uterus and upper vagina in individuals with a normal female karyotype. Surgical reconstruction is often required to enable satisfactory sexual function. The McIndoe procedure is a widely used technique; however, traditional static molds may lead to graft contraction, stenosis, and prolonged dilation. This report presents a modified McIndoe vaginoplasty incorporating a silicone tissue expander prosthesis to improve graft adherence and maintain neovaginal patency. Methods A 19‐year‐old woman with MRKH syndrome underwent neovaginal creation via dissection of a space between the bladder and rectum. A split‐thickness skin graft harvested from the thigh was wrapped around a silicone tissue expander, which was then inserted into the neovaginal canal and inflated with saline to provide uniform internal support. Postoperative care included multimodal analgesia, prophylactic antibiotics, and later, transition to a conventional dilator. Results At 8 days postoperatively, graft integration was satisfactory, with adequate neovaginal length and diameter confirmed. The patient continued outpatient dilation, transitioned to sexual activity at 3 months, and reported a satisfaction score of 8/10 on a verbal analog scale. No perioperative or postoperative complications, graft failures, infections, or donor site morbidity were observed. Conclusion The use of a silicone tissue expander in a modified McIndoe vaginoplasty is a feasible and innovative alternative for patients with MRKH syndrome. This approach promotes effective graft integration, maintains neovaginal patency, and supports early functional outcomes. Additional studies are needed to compare long‐term results with conventional techniques.