Bottom Surgery Debacle?

[SaerJoe]

Thanks for the response, FTMax.  I'm using the Tapatalk app now, so forgive me if this reply shows up in some strange place!

I appreciate the feedback regarding incontinence--that's good news.  Honestly (sorry if it's too personal), I don't have any designs on an uncomfortably large member, as in wearing the T2 prosthetic for 3 years I've battled with how to minimize the size of it in the shorts.  Normal to slightly on the smaller size -- would be just fine with me (us), and if that helps w urethral lengthening, then maybe I'd consider it.  That's good information about going in with the assumption--that you'll have complications or at minimum, some sort of set back.  All the more reasons to get healthy and stay that way--after. 

My quandary, now in my early 50's--is long term.  The whole medicalization reality is something I grapple with.  I generally don't care for surgery and all the issues that anesthetics etc bring as time goes on.  I did see my endo/internist today, and notified her that I am considering the surgery.  Onward with the research.  After reaching out by email yesterday, I've not yet heard back from Dr Miro, nor Mt Sinai as yet.  Dr Raphael has responded.  Do you know if he also does phallo?


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Size, as far as I have ever been told, has no bearing on UL success or complication rate. You would think the complication rate would be greater with phallo because you have that much more lengthened urethra to deal with, but all the surgeons I've spoken with cite almost identical urethral complication rates in their patients who have meta vs. those that have phallo. Size is more of a concern for blood flow and necrosis.

Miro will probably take a few days to respond. If you haven't heard anything back in a week, send another email. He's a busy guy so your message might've gotten buried. I've never talked to anyone at Mt. Sinai so I'm not sure how responsive they are to emails.

Last I checked, Dr. Raphael was only doing meta. If you wanted to stay local to that region, Dr. Crane is operating in Austin now.

I'd read that Dr Crane was now also in Austin.  I understand he has done some training with Dr Miro, so he surely would be next on the list.  Do you have any more feedback on Dr Ting in NYC?  Of the two, if you know, who is more experienced at MLD phallo, and who has done more procedures, Ting or Crane?

I really appreciate your comments here, and will continue the search.


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[FTMax]

Crane has undoubtedly done more than Ting at this point, and would also be (I'd imagine) more experienced with MLD. It's probably the least common donor site that he uses, but I would be willing to bet he is the most experienced surgeon with that particular donor site in the US.

[SaerJoe]

Crane has undoubtedly done more than Ting at this point, and would also be (I'd imagine) more experienced with MLD. It's probably the least common donor site that he uses, but I would be willing to bet he is the most experienced surgeon with that particular donor site in the US.

I understand that the sensation is often better with forearm and thigh donor sites, but that infection are necrosis chances are elevated over MLD.  In my case, forearm is out (too small) and leg--second choice.  Another detail I'd have to work out, whether thigh or MLD.  Sure wish they could put some cells in a dish and 6 months later have tissue they could use ; )


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[FTMax]

Crane has undoubtedly done more than Ting at this point, and would also be (I'd imagine) more experienced with MLD. It's probably the least common donor site that he uses, but I would be willing to bet he is the most experienced surgeon with that particular donor site in the US.

I understand that the sensation is often better with forearm and thigh donor sites, but that infection are necrosis chances are elevated over MLD.  In my case, forearm is out (too small) and leg--second choice.  Another detail I'd have to work out, whether thigh or MLD.  Sure wish they could put some cells in a dish and 6 months later have tissue they could use ; )


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Yeah, it really depends. If I go back for phallo, MLD is the only donor site I would consider personally. I don't want to spend a year doing hair removal, and sensation is not a big deal to me.

[SaerJoe]

I understand that the sensation is often better with forearm and thigh donor sites, but that infection are necrosis chances are elevated over MLD.  In my case, forearm is out (too small) and leg--second choice.  Another detail I'd have to work out, whether thigh or MLD.  Sure wish they could put some cells in a dish and 6 months later have tissue they could use ; )


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Yeah, it really depends. If I go back for phallo, MLD is the only donor site I would consider personally. I don't want to spend a year doing hair removal, and sensation is not a big deal to me.

Exactly--to me the HEALTH of the boy is of the utmost importance.  And sensation?  It has to be better than the silicone stand-in that I live with now.  I'd do my best to get in the best shape ever going in--and give it heck.  You'd think for an "old guy" my age, it wouldn't matter, but....of course it does.  At any age. 

What city are you in?  (Sorry if I'm breaking any rules of protocol here).  Thanks for the conversation.  Very helpful.  With my practitioners (internists) --- they are all very helpful, but I feel more like a study animal than just about anything else.  Truthfully, we'll all get better information from each other on these forums anyway!


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[FTMax]

I understand that the sensation is often better with forearm and thigh donor sites, but that infection are necrosis chances are elevated over MLD.  In my case, forearm is out (too small) and leg--second choice.  Another detail I'd have to work out, whether thigh or MLD.  Sure wish they could put some cells in a dish and 6 months later have tissue they could use ; )


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Yeah, it really depends. If I go back for phallo, MLD is the only donor site I would consider personally. I don't want to spend a year doing hair removal, and sensation is not a big deal to me.

Exactly--to me the HEALTH of the boy is of the utmost importance.  And sensation?  It has to be better than the silicone stand-in that I live with now.  I'd do my best to get in the best shape ever going in--and give it heck.  You'd think for an "old guy" my age, it wouldn't matter, but....of course it does.  At any age. 

What city are you in?  (Sorry if I'm breaking any rules of protocol here).  Thanks for the conversation.  Very helpful.  With my practitioners (internists) --- they are all very helpful, but I feel more like a study animal than just about anything else.  Truthfully, we'll all get better information from each other on these forums anyway!


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I'm in northern Virginia/Washington DC.

[SaerJoe]

Exactly--to me the HEALTH of the boy is of the utmost importance.  And sensation?  It has to be better than the silicone stand-in that I live with now.  I'd do my best to get in the best shape ever going in--and give it heck.  You'd think for an "old guy" my age, it wouldn't matter, but....of course it does.  At any age. 

What city are you in?  (Sorry if I'm breaking any rules of protocol here).  Thanks for the conversation.  Very helpful.  With my practitioners (internists) --- they are all very helpful, but I feel more like a study animal than just about anything else.  Truthfully, we'll all get better information from each other on these forums anyway!


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I'm in northern Virginia/Washington DC.

Awesome.  I'm back up in the Finger Lakes Region of New York State, after 35 years in Dallas-Fort Worth. 


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[SaerJoe]

Exactly--to me the HEALTH of the boy is of the utmost importance.  And sensation?  It has to be better than the silicone stand-in that I live with now.  I'd do my best to get in the best shape ever going in--and give it heck.  You'd think for an "old guy" my age, it wouldn't matter, but....of course it does.  At any age. 

What city are you in?  (Sorry if I'm breaking any rules of protocol here).  Thanks for the conversation.  Very helpful.  With my practitioners (internists) --- they are all very helpful, but I feel more like a study animal than just about anything else.  Truthfully, we'll all get better information from each other on these forums anyway!




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I'm in northern Virginia/Washington DC.

I've another question for you, if you might have info on, FTMax.  This is with regard to meta + phallo; and the ultimate placement of the enlarged neo-penis (meta) after phalloplasty/glansplasty surgery.  I read on one site that the neo-penis (enlarged clitoris) can be left outside (below), or within-- the base of the constructed phallus.  Have you heard of any discussion of this issue?  Alternatively, I'm a bit confused about recalling that in some instances, the clitoris can also be located where the glans of the phallus is located.  Thoughts (clarifications) on this from what your forum indicates?  (sorry I'm paranoid of privacy on FB--and the danger of hitting a wrong button posting information to my family/friends)

[FTMax]

Exactly--to me the HEALTH of the boy is of the utmost importance.  And sensation?  It has to be better than the silicone stand-in that I live with now.  I'd do my best to get in the best shape ever going in--and give it heck.  You'd think for an "old guy" my age, it wouldn't matter, but....of course it does.  At any age. 

What city are you in?  (Sorry if I'm breaking any rules of protocol here).  Thanks for the conversation.  Very helpful.  With my practitioners (internists) --- they are all very helpful, but I feel more like a study animal than just about anything else.  Truthfully, we'll all get better information from each other on these forums anyway!




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I'm in northern Virginia/Washington DC.

I've another question for you, if you might have info on, FTMax.  This is with regard to meta + phallo; and the ultimate placement of the enlarged neo-penis (meta) after phalloplasty/glansplasty surgery.  I read on one site that the neo-penis (enlarged clitoris) can be left outside (below), or within-- the base of the constructed phallus.  Have you heard of any discussion of this issue?  Alternatively, I'm a bit confused about recalling that in some instances, the clitoris can also be located where the glans of the phallus is located.  Thoughts (clarifications) on this from what your forum indicates?  (sorry I'm paranoid of privacy on FB--and the danger of hitting a wrong button posting information to my family/friends)

The clitoris can be placed in the base of the phalloplasty, or it can be left slightly visible underneath the phalloplasty in between the phallo and the scrotum.

I've never heard of it being anywhere near the glans in a phalloplasty.

[Ryuichi13]

I've another question for you, if you might have info on, FTMax.  This is with regard to meta + phallo; and the ultimate placement of the enlarged neo-penis (meta) after phalloplasty/glansplasty surgery.  I read on one site that the neo-penis (enlarged clitoris) can be left outside (below), or within-- the base of the constructed phallus.  Have you heard of any discussion of this issue?  Alternatively, I'm a bit confused about recalling that in some instances, the clitoris can also be located where the glans of the phallus is located.  Thoughts (clarifications) on this from what your forum indicates?  (sorry I'm paranoid of privacy on FB--and the danger of hitting a wrong button posting information to my family/friends)


The clitoris can be placed in the base of the phalloplasty, or it can be left slightly visible underneath the phalloplasty in between the phallo and the scrotum.

I've never heard of it being anywhere near the glans in a phalloplasty.

I'm wondering if there's any way of feeling pleasure if the neo-penis is buried inside of the phallo?  I mean, its the neo-penis that has the most sensitve nerve endings so you can "properly get off" during sex, but if its buried, how can you organsm?

Anyone here have this proceedure done that can answer this?

Ryuichi

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[FTMax]

Microsurgery connects all kinds of nerves down there. I've never met a guy who is post-op who can't get off.

[SaerJoe]

Microsurgery connects all kinds of nerves down there. I've never met a guy who is post-op who can't get off.

That's my impression also--and where I was essentially going in our conversation.  I would think whether buried or not, the motion/sensation would allow for orgasm whether buried--or not.  I will surely ask Dr Miro in our consult.  He did reply yesterday!


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[FTMax]

Microsurgery connects all kinds of nerves down there. I've never met a guy who is post-op who can't get off.

That's my impression also--and where I was essentially going in our conversation.  I would think whether buried or not, the motion/sensation would allow for orgasm whether buried--or not.  I will surely ask Dr Miro in our consult.  He did reply yesterday!


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Tell him I said hi! I need to email and see if I can head back for revisions sometime soon.

[SaerJoe]

I am happy to do so!  Too bad he's not working any 2 for 1 specials right now LOL?!  Seriously--I've yet to get in to it with my insurance company (I'm so very lucky I got out of Texas and am in NY where coverage is good, although not sure about overseas, we'll see.  I'll plead the case through my "navigator").  Thanks for the great insights here.  Randomdude also has some helpful comments.  All I know is that after 3 years, the hardware is talking to me and looking for attention.  In my wildest dreams I wouldn't have thought I'd consider this, but I am heartened by the improvements in technique afforded by science and technology (micro surgery).  Onward.


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[Ryuichi13]

Microsurgery connects all kinds of nerves down there. I've never met a guy who is post-op who can't get off.

That'a great to know.  Its an option, but first, I need my top surgery! [emoji6]

Ryuichi

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[SaerJoe]

That's my impression also--and where I was essentially going in our conversation.  I would think whether buried or not, the motion/sensation would allow for orgasm whether buried--or not.  I will surely ask Dr Miro in our consult.  He did reply yesterday!


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Tell him I said hi! I need to email and see if I can head back for revisions sometime soon.

Hey FTMax-- update on the doc and insurance front.  Right now we're awaiting word back from my team on talking with the insurance company about coverage overseas.  I'm still hopeful that we can get coverage for the surgery over there.

I suppose my backup would be Dr Ting or Crane, although I'd really prefer Doc Miro. 

Your further thoughts on these three physicians?  Any others--by all means, please chime in on physicians, staffs etc. Regarding meta and phallo.  Thanks all-


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[FTMax]

I would personally be very surprised if you can get coverage for an overseas surgery. I would not hold out for that - BUT, I have always been told by everyone I've spoken to about bottom surgery that if it is within your means to pay out of pocket to go to the surgeon of your choice and you are making a very informed choice when it comes to surgeons, that you should go to your first choice. Not sure if that is the situation you are in or not. And I'm sure financially it depends whether you're going for meta or phallo. But that was the advice I received, and I followed it and am happy. So just that little caveat before the rest.

Dr. Crane is the most experienced surgeon in the US currently. I would not hesitate to go to him for a meta if he was in network for me. I would want to have a lengthy, in-person consult with him before I committed to phallo. He currently has 5 open malpractice lawsuits against him, all from phallo patients, one of whom is a friend of mine. I have another friend who consulted with him, asked about those, and was satisfied enough with his answers to schedule surgery. I would personally want to do the same thing. And since I would only be interested in MLD and I would want to drop down to as few stages as possible, we'd need to hammer out the details on that before I would commit. I do think I'd be able to come to a decent level of comfort with the idea of using him as my surgeon. His staff I have heard can be difficult to work with until you are a patient, and then post-op you are well taken care of.

Dr. Ting I was previously more positive about, but I have heard inklings of a lawsuit against Mt. Sinai for misrepresenting their trans surgery program and providing poor or no aftercare. Aftercare is a huge part of managing/reducing/eliminating complications from surgery, and as that is forming the basis of the lawsuit (which multiple patients are a part of), I would rank him last as an option currently until we know more. I know the organization that will be filing it is looking for additional patients who had similar experiences, and it hasn't been filed yet so I haven't been able to read any of it. So, I'd reserve judgment on Ting for now and wait to see how it plays out.

I think regardless of how that goes though, for me, Crane's experience puts him out ahead. He's done 200+ phallos at this point and I would imagine even more metas though I don't have a firm number on that.

[SaerJoe]

Thanks so much, FTMax.  Great information, and generally my impression so far, especially with regard to offices and their operation prior to a person becoming a patient.  That's typical, although difficult to deal with.

Of course I'm full of a thousand questions, but quite honestly--maybe I can work through this here. 

Dr Miro did quote a specific price for meta, hysto, scrotoplasty + testicular implants, and I wonder how it compares to US?  (13K EU = approx 15.4 USD).  I suppose the question is, how comparable is that to the states?  And further--does that include vaginectomy, oophorectomy (is it even recommended?)

Another:  is there a difference, going in to meta, as to whether you will or won't decide to do phallo?  Is the approach from one or the other different?  I wouldn't think so.

Lastly; is Centurion meta easily compatible to further phallo later on?  Any word on complication rate in that process?   If I hadn't had my top surgery done with Dr Raphael and known how amazing his staff is--I wouldn't consider him, but since I did....I have to ask!

I am leaning toward Dr Miro for meta, and like the following year would do phallo, but as you said--there's no harm in not if you should decide that the meta results are an end point in themselves.

Sorry to pepper you with questions. 



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[FTMax]

Miro's price would include everything - so meta, hysto + oophorectomy, vaginectomy, UL, scrotoplasty, and testicular implants. If he didn't list those separately, the implants themselves are 960 Euro.

In the US if you were paying with insurance, the price would be based on whatever your deductible and/or out of pocket maximum is. I was told when I spoke with my insurance that for these surgeries, I would be expected to pay my out of pocket maximum because of how expensive they are. So for me that was $10k but I know my plan is very expensive. So yours may be less.

Paying out of pocket in the US, you are looking at around $20k-30k plus the cost of a hysto. I believe Crane will do the hysto at the same time, but he does testicular implants separately at a second stage.

They don't do anything differently if you know you're coming back for phallo.

Centurion is just a modified meta, so no different than a regular one in terms of going from meta to phallo. The complication rate for that you would need to get from Dr. Raphael, as it's surgeon specific and he's the only one doing these.

If you're planning on phallo, I personally would not have a meta done and would just go straight ahead with phallo. If you're undecided, I would really spend more time thinking about what exactly you want to get out of it. I think it is a waste of resources to have meta knowing you want phallo.

[SaerJoe]

Miro's price would include everything - so meta, hysto + oophorectomy, vaginectomy, UL, scrotoplasty, and testicular implants. If he didn't list those separately, the implants themselves are 960 Euro.

In the US if you were paying with insurance, the price would be based on whatever your deductible and/or out of pocket maximum is. I was told when I spoke with my insurance that for these surgeries, I would be expected to pay my out of pocket maximum because of how expensive they are. So for me that was $10k but I know my plan is very expensive. So yours may be less.

Paying out of pocket in the US, you are looking at around $20k-30k plus the cost of a hysto. I believe Crane will do the hysto at the same time, but he does testicular implants separately at a second stage.

They don't do anything differently if you know you're coming back for phallo.

Centurion is just a modified meta, so no different than a regular one in terms of going from meta to phallo. The complication rate for that you would need to get from Dr. Raphael, as it's surgeon specific and he's the only one doing these.

If you're planning on phallo, I personally would not have a meta done and would just go straight ahead with phallo. If you're undecided, I would really spend more time thinking about what exactly you want to get out of it. I think it is a waste of resources to have meta knowing you want phallo.

Thank for the discussion.  I suppose my understanding is that in essence, the two stage process entailed 1. Meta and 2. Phallo, but you've clarified that here a bit.  Regardless, if you say "phallo" -- it's still a 2 and perhaps 3 stage surgery, correct?

After spending much of the day on transbucket and other sites and getting more information about results and different physicians, I could see where a meta would not work for my end goals, so likely, phallo including glansplasty (I am in disbelief, with all the plastic surgery talent out there--that surgeons cannot make a glans look more realistic). 

It will be a few days before I run this course with my insurance company; they've requested contact (verbal, then written) from my practitioners here domestically requesting this surgeon, so we'll see where that goes.  I will not wait long, however.  I've had 30 years as an employer---dealing with insurance companies, so I am well aware of how they operate and what I'm working with (against).  My top surgery (and masculinization lipo) I paid for out of pocket in 2013, so no illusions here.  I do feel, though, that Dr Miro would be my guy.  It does make us nervous (my wife and I) about the having the doctor in a foreign country should I have trouble here stateside.  Who did you use for follow up here?



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