Non Penile inversion technique surgeons in USA

[Brooke]

I know the typical penile inversion technique is the norm in the states, however it seems like the non penile inversion technique used by suporn and others in Thailand have the advantage in several ways.

I'm wondering if there are in surgeons in the states who have adopted this technique and if not, why?

I got my surgery recommendation letter yesterday and, because I'm trying to get it covered through insurance- a surgeon in the United States in necessary.


Any input is appreciated.

Thanks!
Brooke

[Maybebaby56]

Hi Brooke,

I don't know if you saw this thread, https://www.susans.org/forums/index.php/topic,220916.0.html, but I tried to recap what Dr. McGinn said about the "non-penile inversion" technique and the approach she uses.  She calls the term "penile inversion" a misnomer, at least the way she approaches it.  The only part of the penis that ends up in the neovagina is the dorsal nerve. The penile skin is largely discarded.

With kindness,

Terri

[Brooke]

I missed that thread, thanks Teri! Very helpful and informative.

You mention in that thread how Dr amcGinn and Meltzer disagree on the urethral useage. Do you per chance know what/why Dr Meltzer view/alternative is?

Meltzer is on my list, in a good part as I live in AZ. But the insurance with him will be tough.

Thanks again!
Brooke

[Maybebaby56]

No, unfortunately I cannot recall the specifics other than my impression that Meltzer does not use urethral tissue for the labia minora.  I am guessing he uses penile skin.  McGinn is very big on aesthetics.  Penile skin is not pink.  Labia minora in ciswomen are pink. But again, if you talk to Dr. Meltzer and he tells you "that's not correct", then the error is mine, not Dr. McGinn's.  I tried my best to remember what Dr. McGinn said from memory, and I hope it was accurate.

Meltzer is supposed to be one of the best. McGinn said as much. That much I do remember. As far as insurance, I have Aetna, and they will pre-certify McGinn as in-network, but I still have to pay first and get reimbursed later.  Insurance companies do whatever they can to avoid paying claims, or at least make it as hard as possible.

With kindness,

Terri

[Brooke]

No, unfortunately I cannot recall the specifics other than my impression that Meltzer does not use urethral tissue for the labia minora.  I am guessing he uses penile skin.  McGinn is very big on aesthetics.  Penile skin is not pink.  Labia minora in ciswomen are pink. But again, if you talk to Dr. Meltzer and he tells you "that's not correct", then the error is mine, not Dr. McGinn's.  I tried my best to remember what Dr. McGinn said from memory, and I hope it was accurate.

Meltzer is supposed to be one of the best. McGinn said as much. That much I do remember. As far as insurance, I have Aetna, and they will pre-certify McGinn as in-network, but I still have to pay first and get reimbursed later.  Insurance companies do whatever they can to avoid paying claims, or at least make it as hard as possible.

With kindness,

Terri

Okay, thanks!
Oh yes, I know all about the insurance game.

The three D's of insurance.

Defer!
Deny!
Delay!

[Rachel]

I went to Dr. McGinn and I really did not have much penile skin for use (0.75 inches). She use my scrotum for a graft. I started with 4.5 inches of depth and yesterday they measured 5.5 inches.

I was pre-approved by Aetna for GCS and a BA. The cost for McGinn, anesthesia and the hospital for the GCS and BA was just under $30,000 and I ended up paying about $4,500. I paid up front. The day of the GCS the hospital decided to go through insurance direct. I received my hospital certified check back from Papillion later. I took it to the bank and had the money deposited into my account.

[Maybebaby56]

I went to Dr. McGinn and I really did not have much penile skin for use (0.75 inches). She use my scrotum for a graft. I started with 4.5 inches of depth and yesterday they measured 5.5 inches.

I was pre-approved by Aetna for GCS and a BA. The cost for McGinn, anesthesia and the hospital for the GCS and BA was just under $30,000 and I ended up paying about $4,500. I paid up front. The day of the GCS the hospital decided to go through insurance direct. I received my hospital certified check back from Papillion later. I took it to the bank and had the money deposited into my account.

Hi Rachel,

How did you get Aetna to pay for the BA?  I thought I remembered you saying that McGinn charged about $22K for the GCS and BA.  Does that mean that the anesthesia and hospital fees were $8000?  Aetna caps hospital charges at $200 a day, or $600 for three nights. Sorry for all the questions.  I'm just trying to get my facts straight, and I'm really amazed Aetna covered the BA.  I declined to have the BA because of the added cost.

With kindness,

Terri   

[Miss Clara]

Wow, I've read so many conflicting accounts of the various GRS providers both here in the states and in Thailand.  I'm not aware of any state-side surgeon who does a Suporn/Chettawut non-penile inversion method.  Most do some version of penile inversion with scrotal skin grafting if penile tissue is insufficient to achieve a reasonable neo-vaginal depth.

My understanding of why you have to go to Thailand for a vagina constructed solely from scrotal skin graft is because the amount of time it takes to accomplish it is much longer.  My GRS with Dr. Chettawut took 6 hours under general anesthesia.  Suporn spent at least that amount of time for a friend of mine.  Chettawut does just one surgery a day three days a week.  McGinn, Meltzer, Brassard, Bowers, etc. do the whole operation in less than half that time, and some US surgeons perform as many as three a day.   With hospital and anesthesiologist rates so high in the US,  the cost of doing a true non-penile inversion technique would be horrendously expensive and uncompetitive.

[Brooke]

Thanks for the input Clara, all of that makes sense for the business/financial side of this.

I wonder how much of it is business and how much of it is a "good enough", or just not wanting to have to learn an entirely new technique.


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[Maybebaby56]

Wow, I've read so many conflicting accounts of the various GRS providers both here in the states and in Thailand.  I'm not aware of any state-side surgeon who does a Suporn/Chettawut non-penile inversion method.  Most do some version of penile inversion with scrotal skin grafting if penile tissue is insufficient to achieve a reasonable neo-vaginal depth.

My understanding of why you have to go to Thailand for a vagina constructed solely from scrotal skin graft is because the amount of time it takes to accomplish it is much longer.  My GRS with Dr. Chettawut took 6 hours under general anesthesia.  Suporn spent at least that amount of time for a friend of mine.  Chettawut does just one surgery a day three days a week.  McGinn, Meltzer, Brassard, Bowers, etc. do the whole operation in less than half that time, and some US surgeons perform as many as three a day.   With hospital and anesthesiologist rates so high in the US,  the cost of doing a true non-penile inversion technique would be horrendously expensive and uncompetitive.

Hi Clara,

A couple of things come to mind that you may want to comment on.  I am under the impression that Thai surgeons do not require pre-surgical genital electrolysis, as they assume responsibility for hair follicle removal by punching out the follicles individually during the surgery.  That has to take time.  McGinn, for one, strongly suggests six full clearings prior to surgery, even though all US surgeons scrape the follicles from the scrotal donor skin prior to grafting.

In my consultation with Dr. McGinn, she explained that she does not do a "penile inversion" technique in the sense that penile dermis tissue is not used in constructing the neovagina; only the dorsal nerve is inverted into the neovagina, while the glans tissue is used for the clitoris, and the urethral tissue is used for the labia minora.  The neovagina is formed entirely from scrotal skin, presuming there is enough.

With kindness,

Terri

[Miss Clara]

In my consultation with Dr. McGinn, she explained that she does not do a "penile inversion" technique in the sense that penile dermis tissue is not used in constructing the neovagina; only the dorsal nerve is inverted into the neovagina, while the glans tissue is used for the clitoris, and the urethral tissue is used for the labia minora.  The neovagina is formed entirely from scrotal skin, presuming there is enough.

Hi Terri,
It's all quite confusing still.  Her website states:  "Dr. McGinn routinely performs the present day standard 'penile inversion' technique with dorsal nerve sparing..."

Unless her website is out of date, that's pretty clear.  The 'dorsal nerve sparing' means that the nerve that extends the length of the penis to the glans is left intact so as to not affect the sensitivity of the clitoris which is fashioned from the glans.  I question whether the dorsal nerve is used in constructing the vaginal lining.  It doesn't make any sense.

On her website Dr. McGinn recommends that electrolysis be performed 4 to 6 times at the base of the penis prior to surgery.  This is only a concern in the penile inversion technique because the skin at the base of the penis is part of the penile skin flap used to create the vaginal lining.  If she is only using scrotal skin for the vaginal lining, electrolysis is not needed at the base of the penis. 

The reason recovery is much faster with the penile inversion method is that the blood vessels which supply blood to the inverted skin flap that serves as part or all of the vaginal lining are not cut, thus speeding the healing process.

Yes, having pre-surgical electrolysis will reduce the length of time to complete penile inversion GRS because cauterizing hair follicles takes time, time that the surgeon could be using to construct the vulva and vagina.  It is not a time saving factor in the Thai non-penile inversion method because removal of hair follicles from excised scrotal skin, and forming the vaginal lining can be done by others while the lead surgeon is constructing the vulva. 

I would seek clarification from Dr. McGinn concerning these details if you are unsure of what she's going to do.

Clara

[Maybebaby56]

Hi Terri,
I question whether the dorsal nerve is used in constructing the vaginal lining.  It doesn't make any sense.

On her website Dr. McGinn recommends that electrolysis be performed 4 to 6 times at the base of the penis prior to surgery.  This is only a concern in the penile inversion technique because the skin at the base of the penis is part of the penile skin flap used to create the vaginal lining.  If she is only using scrotal skin for the vaginal lining, electrolysis is not needed at the base of the penis. 

Hi Clara,

Any errors or confusion are my fault. I tried to remember things the best I could to answer the original thread topic. I'm sorry my recapitulation was not helpful to you.  I think Dr. McGinn probably was describing how the dorsal nerve and the base of the penile skin is used in the construction of the clitoris and vaginal vestibule. I do remember clearly her saying she throws most of the penile skin away.

As for myself, I really don't care exactly how she puts everything together. She promises a sensate clitoris, a mucosal vagina, and excellent aesthetics. She is also very exacting with her pre-op requirements an post-operative care.  She is experienced and compassionate.  And she is a three-hour drive away, which makes follow-up visits easier. I believe she is the right choice for me.

~Terri

[Miss Clara]

Hi Terri,
I hope you don't think I was being critical of your choice of Dr. McGinn for your GRS.  I think she's an excellent surgeon and you'll most probably be very pleased with the results.  I only wanted to understand as best I can how her methods differ from those of other surgeons.
Clara

[Brooke]

I am also quite interested in the differences.

I often feel that it's extremely difficult to get a full version of the techniques, ability, and optimal scenarios in assessing surgeons for GCS.

Find it frustrating as it's hard to make comparisons between them, and understand what surgeon is best for specific needs, goals, and body type/anatomy etc.


~Brooke~

[Miss Clara]

I've posted this image before as an example of what meshed skin looks like when it is sutured around a gauze stent.  Every one of those small slices must heal closed to produce the continuous vaginal lining. That accounts for the longer recovery for Suporn patients.  Scar tissue wants to contract, so it is extremely important to follow the dynamic dilation regimen that Suporn prescribes to maintain depth and width.  Interestingly, the same dilation procedure is prescribed even if he doesn't mesh the scrotal skin.