Is there a "Best" surgeons

[Brooke]

Is there a consensus of the best surgeon in the world

Is there a consensus of what the best region is?

For instance is the best surgeon in the states better than the best surgeon in Thailand or vice versa.

For this question I would want to eliminate other variables such as price, location, wait etc.

In making my shortlist I have several surgeons from different regions but finds it difficult to compare those that are in different regions to get to "the best".

Thanks!
Brooke

[TinaVane]

Short answer No.... People who have been to certain docs would tell you their doc is the best basically a bias


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[becky.rw]

Surgical outcomes are dependent on such a wide array of variables beyond the surgeon himself, I'm not sure there's a valid way to arrive at "best".   You can look for "good" and "respected" type attributes...

[Brooke]

Any tips on comparing surgeons from different regions.

Specifically those in the states to those in Thailand. It seems that most people first narrow down by region, then surgeons which makes direct comparisons (in terms of feedback) in different regions very difficult.

We might have the top 3 surgeons in the states and top 3 in Thailand but those six surgeons are never on the same list of comparisons- if that makes sense?


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[Rachel]

For me, BA and GCS is covered by insurance if in the USA. So my choices were limited to the USA.

I had a consult with Dr. McGinn and really like her and felt very comfortable. She referred me to Dr. Spiegel for FFS because of what I need and Dr. Cooley for hair.

She said I needed a two stage GCS and why and a two stage BA and why. She also said I could go to other doctors and some would do each in one step and how that would differ from what she would do. I like her results in GCS and BA, especially due to my physical differances.

I had 6 genital clearings at Papillion and I like the staff.

So Papillion was the choice for me. It was a feeling that lead me to the choice.

I have another consult with Dr. McGinn on 8-29-2016 because she has not seen me for a while and wanted to go over things again. The only bad point is she will reexamine me which is not fun. She was going to do a phone consult but they know I live close to Papillion.  I also have a genital and prostate exam with my PCP on the 9-26 for GCS, as well as a bunch of tests.

[AnonyMs]

I don't think there's enough independent information available about the surgeons to be sure of working it out. There's a lot of stories about how happy people are, and relatively few where they not.

Personally I like to find photo's of post-op results, preferably not from the surgeons websites, and read as many stories I can find, both good and bad. The photo's because my idea of a good result is not necessarily the same as others. Its a lot of time, but I think you can filter out a lot of surgeons quite quickly.

Another way to look for consensus is look at surgeons wait lists and prices. Marci Bowers and Suporn both have relatively long wait lists and its not because they are cheap.

[Carrie Liz]

I'd personally advise Suporn or Chettawut, because their technique, the non-penile-inversion skin-graft-based method, is the newest and most advanced technique. The penile inversion that every other surgeon does, although it's been refined over the years, is a 50-year-old technique. And I'm pretty sure that Suporn and Chett are the only two in the world who do the non-inversion technique. Other surgeons are objectively as good in terms of aesthetics, but in terms of ease of recovery and feeling like everything is objectively in the "right" place compared to a cis woman, you're only going to get that from a surgeon who does non-inversion. (I've heard that Preecha might do it too, but the information is mixed on whether his technique is the same non-inversion or whether it's half-and-half.)

Just my opinion, and why I wasn't really even considering anyone else from the beginning.

In terms of everything looking good and retaining good sensation, though, you're pretty much good going to any of the world's top surgeons. McGinn, Bowers, Meltzer, Brassard, Suporn, Chett, Preecha, Sanguan, they'll all give you a top-notch result there, and I've heard nothing but praise from everyone I know who's been to one of them.

[Brooke]

I'd personally advise Suporn, Chettawut, or Preecha, because their technique, the non-penile-inversion skin-graft-based method, is the newest and most advanced technique. The penile inversion that every other surgeon does, although it's been refined over the years, is a 50-year-old technique. And I'm pretty sure that Suporn, Chett, and Preecha are the only three in the world who do the non-inversion technique, because Preecha pioneered it and Suporn and Chett refined it.

Thanks Carrie. If you don't mind me asking what aspects of the non penile inversion technique draw you in/will not consider surgeons that use the penile inversion technique?

Also thank you for confirming that the non penile inversion technique is not in use beyond those three surgeons.

[Carrie Liz]

Thanks Carrie. If you don't mind me asking what aspects of the non penile inversion technique draw you in/will not consider surgeons that use the penile inversion technique?

Also thank you for confirming that the non penile inversion technique is not in use beyond those three surgeons.

Again, this is just my opinion, and just what I personally care about, so don't take what I'm saying as more than just what one person who was researching surgery techniques cared about. But if you look at a diagram of what the human genitals look like in their fetal stage where they're still identical, and then watch which parts grow into the male parts and female parts, you'll see that the inner labia and clitoris are analagous to the penis, the outer labia is analagous to the scrotum. With an inversion technique, the penis becomes the vagina. With a non-inversion technique, the penis is used to make the bulbs of the clitoris and the lining of the inner labia. This, to me, makes the non-inversion technique more anatomically correct, because the parts that would have been the labia if you'd been a cis woman are used to make the labia, the parts that would have been the clitoris are used to make the clitoris, and the vagina is made with a skin graft rather than with the penis.

So again, penile inversion works just fine, but it's an older technique that results in a few more things being moved around, objectively to positions where they wouldn't have been if your sexual differentiation had been as a cis woman.

Again, just my personal priority. I really wanted everything to be analogous and to feel as much like it would have felt had I been born cis as possible, and I feel like that technique does it better.

[Brooke]

That makes perfect sense Carrie- I can definitely relate to everything you stated. I did not know that was one of big differences, so thank you for the information!


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[AnonyMs]

You might find this pdf on Suporn interesting

https://www.the-ress.net/files/SRS-With-Dr-Suporn-2015.pdf

[Richenda]

Hi Brooke,

We all tend to praise our own surgeon or surgical team for reasons that are understandable. No-one wants to believe they are putting everything in the hands of a charlatan, dud or just someone who isn't quite up to scratch. Discussions on here occasionally get a little heated as a result. Personally though I find the cultic nature of some followings a little questionable.

Carrie's information about penile / non-penile is really rather old hat I'm afraid. I would recommend PAI as well worth consideration. I personally wouldn't go anywhere else in Thailand, having lived there and looked into this deeply, but then safety matters to me for GA work and I wouldn't touch one of the two mentioned by her in the discussion above with a bargepole. That's just my opinion, but a little googling by you including on Facebook will show you what I mean. Also be a little careful on here as there are a few people earning commissions through referrals, which you will not get with PAI. I have no vested interest in recommending them: I just think they're brilliant.

PAI is a superb modern clinic (http://pai.co.th) with a team of surgeons, which I personally think is far preferable. Not only does this reduce the cult following (which is dangerous), it means you can opt for your preferred surgeon, tailor things to your needs (see below re technique) and you are also in a peer-culture so there is both shared technique and constant work to improve things. It's a superb modern clinic in a great area of Bangkok and they use a top hospital: Piyvate.

As for the techniques, well yes if you want to go under the knife for hours and hours with Dr Suporn and have your scrotum put through a skin stretching machine you might get another inch or so of depth. Set against that is the location of the place (I personally wouldn't risk having this major surgery outside Bangkok where, unlike Chonburi, you have the top hospitals) and the hugely increased post-op dilation procedure. All for an extra inch of depth (allegedly): not my priority personally.

PAI don't use a 50-year old technique. That's an erroneous remark that must be corrected. Have a look here at a peer-reviewed academic article, which I think may be the only one on the topic. I cannot put the full link which is available top right from this abstract link because it is very graphic:

http://www.ncbi.nlm.nih.gov/pubmed/25356769

As you will see, PAI have constantly refined their techniques and offer multiple options. In my opinion they are the best in Thailand taking all things into consideration, including care and safety.

Discussions on PAI here:

https://www.susans.org/forums/index.php?topic=212657.new;topicseen#new

https://www.susans.org/forums/index.php?topic=204651.new;topicseen#new

https://www.susans.org/forums/index.php?topic=203552.new;topicseen#new

Note that you can tailor things at PAI: so ask for the emphasis you want and they will accommodate you.

[SadieBlake]

Brooke there are so many variables in play, declaring a 'best' seems off-point.

My choices are likely between Satterwhite and the new team at Boston medical center who are performing their first procedures this month. Little though I want to go to the other coast for my procedure, at first blush the Satterwhite team is presently my first choice and while I might have preferred Dr Bowers for having more years of working experience, her wait times as well as consultation fee are deal breakers for me.

BMC is unknown in that they may have performed only a couple of dozen procedures by the time I'd be seeing them and on the other hand they're performing only one a month to start and not expecting to be up to weekly until mid next year so might actually be later in their queue than the date I have lined up for Satterwhite in SF. I fear being locked in to BMC because I know my insurance co. is contracting with them.

The flip side is that the BMC surgeons are very clearly top guys doing cutting edge work. I do believe that the very best surgeons are going to be good at whatever they take on. Yet another take I have, however is they've observed/trained in research hospital settings (UMich primarily) with surgeons who've also done a relatively small number of these procedures. I don't believe that research hospitals deliver better outcomes, in part because they're so conservative that they can be slow to take on new methods. (e.g. Boston, the largest center of medical education and research in the US was late in applying first balloon dilatation and then stenting for coronary artery disease).

On which procedure, all of the surgeons I'd consider are using a similar inversion including the use of a section of urethra as part of the construction of the neovagina. The section of urethra is said to provide some lubrication. The other way of doing that is to harvest and graft a bowel segment which has the disadvantage of 'lubricating' all the time.

As I understand it, the Thai techniques involve aggressive stretching of the skin including perforations in order to obtain greater depth and that this is what results in the longer healing time. While clearly the girls who've gone this way seem as happy as patients of Bowers etc, I'm also a bit put off on the lack of explicit disclosure of the technique. Still, if I didn't have health insurance and had to do this out of pocket, I'd be weighing Thailand as well as Montreal as options.

Hope that helps, my estimates are my best knowledge, recognising my understanding is limited and I could be misstating some of the details.

[Maria77]

I believe Dr. Sanguan also does a non-inversion surgery.   However his procedure is done in stages and his average  depth may be as great as Chet or   This is all based on memory though.

[CrysC]

Best is subjective as everybody noted.  For me I consider Dr Bowers the best and yea, that's who is doing my surgery so I totally agree that we all generally call out our own doctors.  In this case, I consider her the best due to reputation, the fact that Dr Bowers has herself been through it herself and the fact that she is also a trained gynecologist rather than a plastic surgeon.  Dr Bowers continuously refines her procedure to improve it and teaches others. 
The other very important consideration that I had was that she was in network for my insurance.  She was already my first choice but that was like a sign from above. 

I can't believe it's less than 2 weeks away for me. 

[kelly_aus]

As I understand it, the Thai techniques involve aggressive stretching of the skin including perforations in order to obtain greater depth and that this is what results in the longer healing time. While clearly the girls who've gone this way seem as happy as patients of Bowers etc, I'm also a bit put off on the lack of explicit disclosure of the technique. Still, if I didn't have health insurance and had to do this out of pocket, I'd be weighing Thailand as well as Montreal as options.

Hope that helps, my estimates are my best knowledge, recognising my understanding is limited and I could be misstating some of the details.

The perforation and stretching of the skin grafts is nothing new, it's been done as part of burns treatment for some time, information about the process is readily available.

[Richenda]

Crys - fantastic. Very best with it. How exciting!

Kelly - absolutely right. I've seen the burns units first hand with their skin stretching and meshing techniques in grafting. We're on the verge too of artificial skin which will revolutionise skin grafting.