„I know what war looks like, what it smells like“
Interview with Prof. Gress
(published in STERN, December 2023)
You are considered the “Godfather of intimate surgery”, the “Pope of labia” and “Vagina Picasso”. Do you like such titles?
I never wanted to be called that. But when you, as a patient, have to choose between 20 surgeons and one of them says he is the pope of his field, it arouses curiosity.
You treat women who want a perfect body. And you operate on seriously injured soldiers in Ukraine. Two worlds could hardly be more different, could they?
Only at first glance, in reality they go together: Both are a craft and a medical art. We plastic surgeons don’t just correct breasts or noses, we also sew on limbs, operate on burns and deformities and perform sex changes. The only difference is the reaction: those who operate on wounded soldiers get a pat on the back. Intimate surgery often triggers the question: Does it have to be?
That’s exactly what we wanted to ask you.
I have operated on more than 7000 women, so I know how it works. Correcting labia (labia reduction) is a delicate work of art: 150 stitches alone! For soldiers, it’s about being able to walk or reach again, to recognize themselves in the mirror with a somewhat human face. Everyone says: great. That’s true! But I think the other thing is great too: I free a woman from the feeling of not being “right”.
Can this suffering be compared to that of a soldier whose arm has been shot off?
Of course not. But even someone who doesn’t have a shredded arm can suffer. And the solution is reached in two hours. She feels liberated and has a good sexual life.
Where did your interest in Ukraine come from?
I’ve always been interested in Russian history. I’ve been to St. Petersburg, Moscow and the Siberian taiga. And then I really wanted to see Kiev. That’s where I met my wife Iryna.
Where were you when the war broke out?
We were celebrating Christmas 2021 in Switzerland. Before Iryna returned to Ukraine, I proposed to her. When the maneuvers on the Ukrainian border began shortly afterwards, I asked her to come to Germany. I bought her a one-way ticket and wanted to build up a bit of pressure. Her son was also in Ukraine at the time. If they had waited a day longer, he wouldn’t have been able to leave the country because of the military obligation.
Iryna: I said to my son: Let’s go, maybe we can come back after a few days. We flew. It was a Sunday. It was the last passenger plane to take off from Ukraine.
What about your family?
Iryna: My brother is in the army. His son started school this summer. They chose the school based on whether it had a bunker. A few weeks ago, there was an attack on the town where my parents live. I called them the next morning. I went through hell in the minutes until they picked up the phone.
Mr. Gress, you are not the only plastic surgeon who does voluntary work abroad. Does this kind of commitment help to raise your profile?
I don’t see myself as a hero. My wife and I asked ourselves how we could help when the war started. We started fundraising in the summer. We raised 85,000 euros. I used it to buy materials for hospitals. Iryna was in contact with a military hospital southwest of Kiev. We took the medicines and materials there. When I saw the wounded there, I decided to come back, operate and bring serious cases to Germany. We have now been there five times.
What injuries did you see?
Torn arms and legs, open stomach, bullet through the head, missing face. There’s an eighteen-year-old in front of you who is missing his left upper arm, his right hand, his left leg and his left eye – he won’t even be able to get around in a wheelchair because he has no hands. Injured people like this happen every day. The number and intensity of the mutilations are staggering. I estimate that 80 percent will need medical care for the rest of their lives.
Under what conditions do the surgeons work?
There are broad specializations. But actually everyone operates on what they can. That is also necessary given the number of injured people. There is a lack of even simple surgical instruments. Almost all patients require complex reconstructions, which cannot be offered or cannot be offered to the necessary extent due to a lack of microsurgical options. The problem with a lacerated arm is not the bones themselves, but the skin to cover soft tissue and thus protect against infection. This requires a larger tissue block with skin and connect it to arteries and veins so that it is supplied with blood. This is the task of microsurgery.
Do you perform such free tissue transplants in Ukraine?
No, you need a team and close follow-up care. If a thrombosis occurs and the tissue flaps are lost, it’s a disaster and I don’t want to put patients in additional difficulties. They have already suffered enough. That’s why I operate on such cases in Munich. For example, a young man with a bullet hole. Half his face was gone, one eye, the bony eye socket, half his nose. We first transported him to Lübeck, where they reconstructed the bottom of his eye, gave him an artificial eye and started to reconstruct his nose. However, it was still a thick lump of flesh. I made a nose out of it again. I also had a patient with an open back…
What does open back mean?
A bullet through the spine. He had paraplegia. I visited him twice in the military hospital. On the third day, the bed was empty. He was dead. If they had brought him to Germany and covered his back with microsurgery, he would still be alive.
We hear that many wounded bleed to death on the battlefield.
I don’t have any statistics, but we hear the patients’ stories. One told me that he suddenly fell to the grass, everything felt warm. When he tried to get up, he couldn’t. He had no legs left.
War-disabled, a word from the last century. What does it mean today to live with a disfigured face or amputated limbs?
Ukraine has 40 million inhabitants. Half of them are men, half of whom are of fighting age. At some point, you will only see cripples on the streets of Ukraine. That’s why it’s so incredibly important that this war stops. I am not a politician. But I know what war looks like and what it smells like.
What does war smell like?
Like old blood. Like blood-soaked clothes, sticky hair. War is a fight for territory. And endless suffering for people. You can’t get rid of that desperate look. And then I read in the media that the Germans are tired of war. That makes me want to puke. We’re sitting here, we’re not on bomb alert. And we are war-weary? If I operated the way some politicians do, I’d be in prison. I want politicians who have balls. I can’t stand the cowardice of our chancellor, who hides under Biden’s apron: We’ll only supply tanks if the Yanks do it too.
What solution are you thinking of?
A lot more material, airplanes, tanks, everything we can provide. Ukraine should have so much military equipment that they can shoot the Russians out of the country.
Many of the soldiers who have been operated on later return to the war. Can you understand that?
Yes.
Do you also have Russian patients in your practice?
I had many. Not any more.
Why is that?
The influx has died down due to the war. However, I would also struggle with Russian patients.
As a doctor, don’t you have to be there for everyone?
You don’t have to.
Don’t you?
No. The patients don’t come to me because they have a serious medical problem that only I can treat. If someone has an acute medical problem, I can help them, they can come from the moon. But the patients who come to me are looking for beautification.
Earlier you spoke about the great suffering of your patients.
It’s not life-threatening.
Would you also operate on Russian soldiers?
Yes, of course. I can understand the suffering of the young men who did not start this war.
Do you learn from the operations in Ukraine?
Always. I had a boy who was shot through the penis. I can tell you that you don’t meet anyone in Munich who has been shot through the penis.
Were you able to help him?
Yes. He later sent me a video – of him peeing standing up. But I want to talk about my concern.
That would be?
The incredibly poor logistics of transporting patients between Ukraine and Germany.
What do you mean by logistics?
That patients are transported to where they are best cared for.
What speaks against this?
The German cloverleaf system, which was originally used to distribute corona patients to hospitals. Today, paramedics, who were responsible for this, decide on the transfer of war casualties. Everyone who was supposed to be treated in Germany ended up somewhere else. We had to collect them ourselves and take them to the hospitals we had won.
Do you have an example?
The soldier Viacilaw had an open thigh. A huge hole. There was no hip bone left. Skin, muscles, everything was missing. He fell over when he was supposed to stand, and he also had an abdominal injury. He needed specialists. A friend of mine is head of plastic surgery at the Ludwig Maximilian University in Munich. He said he would take him, but he needed health insurance and cost approval. I got that. But those whistles from the cloverleaf took him to Ludwigsburg, even though he had a note with him: Munich. He was in Germany, but in the wrong hospital.
Shouldn’t injured people like that be treated quickly?
Immediately. It already takes a long time in Ukraine before they get permission to leave the country. Patients who are still in Ukraine do not have the status of war refugees in Germany. They need an invitation. However, a German hospital can only send them if the costs are covered. I have written to Health Minister Lauterbach: Can’t you give me a power of attorney for this so that the cost issue no longer plays a role? No answer.
Was soldier Viacilaw still being treated?
Yes, but it took a month to get him. After the treatment, he was taken to a hotel in Munich, just like other soldiers. Nobody cares, they don’t get anything to eat, they are bombarded with bureaucracy. They have to register as war refugees and go to the authorities with their documents. Why do war-wounded people have to go to the authorities at all? One soldier had to register, he couldn’t even stand up. We called the social services. After two and a half months, someone from the office came to see him.
What exactly are you calling for?
There should be a contingent to look after these poor young people. In the Netherlands and Scandinavia, injured soldiers are cared for from start to finish.
What else connects you to Ukraine?
My wife has a dacha with chickens, we love being there, digging potatoes and picking raspberries. My parents-in-law live there. Family is very important in Ukraine, very different from here.
Iryna: Have you shown this yet?
This is a medal. I got it from the Ukrainian military. I’m the first German doctor to receive it.
Are you proud of the medal?
Yes, of course. I’ve never received one before.
Iryna: I’m also very proud of it.
My wife deserves the medal more than I do. She organizes people to take care of the injured soldiers in Germany. She never gets tired.
How do you become a cosmetic surgeon?
I am a plastic surgeon. I actually wanted to be an actor. I took the entrance exam at the Otto Falckenberg School, didn’t pass, then at the Max Reinhardt Seminar in Vienna, didn’t pass either. After that, I thought to myself, before I end up at the Mindelheim Volksbühne, I’ll do something else.
What did you do?
In Brazil, I had met the son of a well-known surgeon at a soccer match on the Copacabana. His father was Ivo Pitanguy, an icon there. We went to his clinic. That’s when I realized: this is what I want to do.
Medicine?
No, plastic surgery. I never wanted to study medicine. I’m not interested in other people’s illnesses.
That sounds amazing coming from a doctor.
Here is my only landscape painting. Otherwise I only paint people.
Gress points to a large picture hanging on the side of his office.
Iryna: That’s in the Ukraine, we were there for our honeymoon. Tchaikovsky found his inspiration for “Swan Lake” in this place.
What is “beautiful” in the intimate sphere?
That’s very subjective. What most people find pretty is that the labia minora don’t hang over the labia majora. It should look taut.
Does this also apply to minors? A ban on cosmetic surgery has been discussed for years.
I don’t perform breast surgery on minors, but I do perform genital surgery if there is a diagnosis. My youngest patient was 13 and had labia that were too large. Both parents have to be in agreement. If you can put ears on 13-year-olds, you can also operate on labia. If someone is otherwise unable to develop sexually, I think the operation is justified.
Your field was initially viewed very disparagingly by colleagues. Is that still the case?
No. This type of surgery is internationally associated with my name. I have developed new surgical methods and I wanted to work artistically. And for plastic surgery you need an artistic eye. I developed paintings and published them. Many people envy my success.
Do you know more about female sensations than women themselves?
At least I know them better anatomically. The second most common operation in the genital area following labiaplasty is vaginal tightening. Women who have a wide vagina after giving birth and no longer feel any stimulation. Gynecologists say: You’ve had two births, now you have to deal with it. No! You can do it again so that it fits perfectly and – just a second…
Gress grabs dildos from a tray, one yellow and larger, one red and smaller.
I ask the patients: So, what does your husband’s look like? The women always point to the red model, the men to the yellow one. If it matches the vagina again, it’s successful surgery.
Isn’t it unfair that women should always be perfect, at work, in the family and now also down there?
A feminist said: “Now there’s another thing we women have to do for you men.” I said: “You didn’t understand, women do it for themselves.”
That’s what you have to say
In over 95 percent of cases, surgery is something women want. I agree with you that it’s different with breasts. The men sit next to it, pull out their Playboy and say: I’d like it that way.
During the conversation, Iryna and Stefan Gress move closer and closer together, at some point she puts her arm around him and they lean their cheeks against each other.
When are you going back to Ukraine?
Probably in February.
Are you afraid to be there?
No. Are you, Honey?
Iryna: No. Nobody runs into a bunker when the alarm goes off. You just keep going. That’s their life now. They’ve gotten used to it. If you go into a bunker every time there’s a bomb alert, there’s nothing else you can do.
Mr. and Mrs. Gress, thank you for this interview
Prof. Gress was interviewed by Ingrid Eißele and Jana Luck