GRS Revision postop care - advice needed

[rejennyrated]

Hi

Could someone who has undergone cosmetic revision surgery give me some advice on what post-op care regimen you followed please?

My surgeon has meticulously done a very thorough rebuild including a small amount of unexpected work inside the vagina itself. I have many stiches. I am told these are all self disolving so will not need removal. But I am anxious not to cause any problems by incorrect aftercare. It would be a shame to spoil what is a real work of art.

My surgery included labiaplasty, clitoroplasty, urethral revision, and work to my intoitus.

The surgeon did advise no sexual activity for several weeks, and I have been showering in preference to bathing for the first few days since returning home to avoid prematurely disolving any sutures.

I believe that in view of the (minor) internal revisions it may now possibly be advisable for me to commence at least some gentle dilation, even though the original vaginaplasty surgery was done a long time ago.

Can anyone who has undergone this sort of revision work please advise on a suitable regimen. I am racking my brains trying to recall how long after the original surgery I commenced dilation, but I don't want to constantly bombard the surgeon with my idiot email questions...

Thanks to anyone who can advise me. 

[spacial]

I don't have any actual experience of this type of surgery, but I do have quite a bit with general surgery.

The principals are, keep clean. Showers are best, but bath is great.

Don't play with dressings. Try not to scratch.

Lots of good food, especially fruit. Lots of water. Exercise, but take it slowly and with each move, see how you feel.

That, incidently, is no excuse for not exercising. Exercise is a must. Climbing stairs is a good start. Take it slowly at first.

Try to get your bowel habit going as soon as you can. Sit there and wait. Clean away from wounds and orifices.

Modern surgical techniques are really quite amazing and well tested.

If you think you have a problem, phone up, but relax.

[Flan]

my advice would be topical antibiotic ointment on the incisions, and break out the doughnut/pillow to not sit on the incisions for 2 weeks.

since intravaginal work was done I would do cleanup after dilation so no infection chance. if you do that, some probiotics would be good to restore vaginal flora.

[rejennyrated]

Thank you both for your advice.

Spacial - Happily I don't seem to have any problems with bowels! I'm regular as usual, and Alison is keeping me very well fed and watered.

I've been getting up and walking around in short spells for exercise, but I tire astonishingly quickly.

I can't believe how much surgery seems to have come on since the early 1980's when the original job was done. Even the anesthetic seemed gentler.

Flan - wish I had remembered your advice about the donut pillow for my train journey home (4 hours) I made the mistake of going it alone and the return journey was agony and jolly nearly killed me!

Sadly one suture did pull open, obviously I did contact the surgeon about that, but when I told him which one had pulled he thought it would be ok to leave it - he thought it would just cause a very tiny scar which won't be noticable where it is... That's why I don't want to bother him again if I can avoid it. He's already been more than patient with me.

Yesterday I also seem to have developed a massive bruise over the pubic bone. I'm watching that, and it seems to be starting to fade now, but for a while it was the colour of raw liver!

Is there any particular antibiotic cream or lotion I should use?

I have in my home pharmacy: Cetramide Cream, Fucidin,  Neomycin cream, Videne (Betadine), Zinc oxide cream, and Brulidene.

I'm guessing the Fucidin or Videne would be the best?

I still can't believe how much work he actually did. The result is completely unrecognisable and looks beautiful already. It also feels totally different from the old model - (when it's not being sore it already feels very nice indeed. VERY conscious of the new clit too! ) Hence my determination not to spoil it all. I was honestly expecting a much less comprehensive job so naturally I'm delighted. Just very anxious not to mess up!

[Flan]

Videne (Betadine)

That is what my surgeon suggests I use, although I'm sticking to this http://www.target.com/Double-Antibiotic-Cream-5-oz/dp/B002OL9AP4 because I can't find Betadine locally.

[spacial]

Jenny

I say this with great respect for Flan, but please don't start using creams on your wounds.

Antibiotic creams are only available on perscription in the UK.

All creams, including antibiotic creams, can harbour a number of germs. When nurses use them in hospital they do so using specific techniques which you need to be shown and are quite complicated.

Let the wounds heal and if you get any discharge, have a shower.

I strongly suggest that, before doing anything of that kind, you phone your surgeon, your GP, a practice nurse or any surgical nurse in the local hospital.

But please, stop worrying. You are going to be fine, provided you don't try to scratch or pick at the dressings and have lots of showers.

Keep up with the exercise. Stop when you're tired. Water, fruit, vegatables.

[rejennyrated]

Ok thanks...

In fact I've now located my original aftercare notes Betadine is/was the recommended treatment for SRS patients because the iodine promotes faster healing, and I already have some as it is still the recommended first response for post-SRS patients if you get a vaginal infection.

These days I don't use it as much because I found probiotics mostly work as well if not better.

Spacial - Regarding prescriptions - don't worry, yes I did know that, although for various reasons which I'm not going to bore you with, I do have a stock of quite properly prescribed antibiotic creams and indeed extensive relevant training in their correct use in that precise area.

(It's a rather long, and possibly strange, story, probably only of interest to me, which actually has some slight bearing on why I had a rework over 26 years after the original...)  You're obviously very well informed about this so thank you for being concerned.

But yes - I'm going to try and worry less. Thanks.

[Janet_Girl]

Jenny, having had some major surgery in the past, I do remember that my surgeon did not wish anything on the site for at least a week.  But it was a different kind of surgery.

And your probiotics will probably help in your healing anyway.

Heal fast, heal well.
Hugs,
Janet

[spacial]

It's your stock that's worrying me. You mentioned it in #3.

I'm trying to make the point that you need to stop worrying and let nature take its course.

Modern surgery is quite amazing. Small infections heal without intervention in healthy people.

If you needed aditional topical treatments, the Dr would have given them to you. But old stock really belongs in the bin, I'm sorry to say.

I'll try and find a reasonably reliable source on the matter. Sadly, most of what I have is is locked nursing sites. I'll get back to you here if I do.

[rejennyrated]

Well I've pretty well decided to go with Spacial's advice and leave it be and trust in nature.

Actually the stock is not old - it's all in date, unused and recent and supplied because prior to this surgery I had a recurrent problem for reasons far too complex and boring to explain.

In point of fact only the Fucidin and the Betadine are really relevant to this. Two of the other creams are just general antiseptics and the neomycin is no good for sites with potential Gram positive bacteria exposure anyway. So obviously I wouldn't use them.

But like I say I'm going with your advice and leaving well alone.

The only thing is dilation. I think I will have to gently flush afterwards. I'm trying to figure whether a saline or dilute betadine/ videne would be best.

Years ago the advice was 100% to use dilute betadine - but these days I think they tend to suggest saline as it is less aggressive.

[spacial]

Jenny.

I'm really pleased you will. And I'm so very sorry to have pushed the point so hard.

I can't advise you on the dilation as I have no experience in this area of medicine at all. Janet is pretty switched on and certainly has first hand experience. Perhaps you could PM her.

[Sandy]

I haven't had any revision surgery down there so I can't say other than re-iterate some of the very good advice that has already been mentioned.

But I will mention that self dissolving sutures are designed to dissolve *inside* the body.  If you have any sutures showing externally they probably look like very fine fishing string.  They will not dissolve or release if they become exposed to air.  That is their point.  When they dissolve internally the external tail will fall out or you may gently tug at them.  Additionally some of those same sutures may make their way to the surface of the skin over the next few weeks to months.  My surgeons colloquially referred to this as "spitting stitches".

Those stitches that make their way out of your body may present as a lump and eventually make a serum pocket around it and eventually burst.  They can be a bit tender during that process.

If that happens, just keep the site clean and apply anti-biotic creme.  They will heal quite quickly once they are expelled.

I've had many of these post FFS/BA and SRS.  I felt like I looked like Frankenstein's monster with those strings sticking out of my face.

Also in addition to your best friend, your donut, remember to lower yourself into a sitting position, do not drop down.

As for dilation, you can probably safely start in the next couple of weeks or so.  As mature a post-op woman you are, you probably are not in any danger of vaginal collapse by delaying.  Though those first couple of attempts my be a bit uncomfortable.  Remember to start with your smallest diameter dilator.  But you probably already know that.  Sorry if I am Ms. Obvious here.

-Sandy

[rejennyrated]

Thanks for such a comprehensive reply Sandy. Today, thankfully things are feeling almost back to normal - I can now sit without wincing and the twinges have calmed down. Being a medical minimalist, once again, I've not swallowed a single pain killer either.

I never did on the first go either... The nurses all thought I was mad, but the way I figured it was that if I could feel what was happening there was less chance I would inadvertantly do something to damage things...

I actually gently tried the dilators last night as I eventually found my 1980's postoperative care notes and realised that 5 days was the recommended wait time. I still have my original 1984 vintage perspex dilators.

I used both the large and small, with no difficulty once I had learned the new shape of my revised introitus. The "internal" surgery has opened up a small gland the previous blockage of which had caused me endless issues and as a result that I am now effectively fully self lube, which is a massive and unusual bonus.

I'm glad I did dilate because as I guessed my vag was already full of goo (not blood - but mucus) which needed clearing. Thankfully I don't seem to have lost any of my 7 inches - or indeed any sensitivity, I can still lose the entire dilator to the hilt I think it will be a few weeks before I let Ali loose on me though...

Now when the blooming bruises go down, my new clit stops twitching randomly, and the weeping blood stops I'll be almost back to normal.

[jade]

Revision post-op care is similar to that of SRS but a lot less hectic and it heals quicker. Relax, just listen to what your surgeon says, and you will be fine. I have had 3 revisions on my puss. It's not that scary anymore. Congratulations on your revision by the way, I wish you lots of healing.

[Jinny]

Hi Jenny
Who did you have your original surgery with - I had mine done in 1988 with James Dalrymple & have recently decided that I would really like to have labioplasty & a small amount of left over erectile tissue removed. I was considering going to Thailand, as I hadn't heard much in the way of positive feedback about UK surgeons with regard to cosmetic results. The old type of penile inversion technique used by Mr Dalrymple didn't make a proper clitoris but one combined with my urethra (sounds similar to what you had. So I wasn't sure of what would be possible. How much did it end up costing in the end I have been quoted about £5000 for the Thailand operation.
Thank you so much in advance
Best wishes
X

[rejennyrated]

Hi Jenny
Who did you have your original surgery with - I had mine done in 1988 with James Dalrymple & have recently decided that I would really like to have labioplasty & a small amount of left over erectile tissue removed. I was considering going to Thailand, as I hadn't heard much in the way of positive feedback about UK surgeons with regard to cosmetic results. The old type of penile inversion technique used by Mr Dalrymple didn't make a proper clitoris but one combined with my urethra (sounds similar to what you had. So I wasn't sure of what would be possible. How much did it end up costing in the end I have been quoted about £5000 for the Thailand operation.
Thank you so much in advance
Best wishes
X

Yep I was one of James Dalrymple's very early patients. I was done during the "handover period" whilst Mr Philip was showing him the techniques.

From the way I am constructed I am guessing that I was actually peno-scrotal and as it turns out I had a slightly non standard starting internal anatomy because of undisclosed partial AIS - but yes the end result was pretty similar.

For my revision I went to see James Bellringer at Charing Cross but you could also go to see Phil Thomas in Brighton. I felt happier going to Charing Cross because in the unlikely even that something did go wrong Charing Cross has far better nursing facilities.

The cosmetic result is pretty good now. He will tell you that he can't make a clitoris out of nothing, but I asked him to try and I ended up with a nice little sensitive button of flesh under the clitoral hood... it is non erectile but it does produce sensations, so job done! 

He will also warn you that you may get some numbness. Again all I can say is that I personally didn't, but when you are cutting around highly nerve filled tissue you can understand why he has to make that warning.

He removed some excess errectile tissue. He relocated the urethra to the correct position just over the vaginal opening. He constructed a clitoral hood, and some small labia minora. In my case he also did some minor repair work inside the vagina where I have a small amount of "anomalous tissue".

If I am honest my only reservation is that the labia minora are rather small - but as he pointed out making something out of nothing isn't easy.

The total cost was under £2500 although that may have risen slightly due to inflation. The end cosmetic result, whilst perhaps not perfect is unquestionably 1000% better than the original and now well within normal female ranges of appearance.

Despite the warnings, that he understandably has to give to cover himself, I am still sensate and fully orgasmic too.

Yes perhaps some of the overseas surgeons can produce marginally better in SOME patients, but remember this isn't rocket science. A photo on the web of someone's result does NOT guarantee that you will get the same because your starting point is different to hers. A close friend went to Toby Meltzer for example, but the costs involved were an order of magnitude higher in the USA and of course you run the risk that when you get there the surgeon may reject you for some reason. I looked at going to Mcginn - but because I am a well developed lady (F cup bust which is all natural and non silicone) I do not meet her BMI requirements so I would have run the risk that she would have refused me.

Even in Thailand, when you add in air-fares and so on the costs were closer to £6000 than £3000.

Overall I think Mr Bellringer did a great job and I would certainly go to him again.

[Padma]

Okay: I'm just in awe of a universe that includes a Mr Bellringer whose job is to build clitorises .

[Jinny]

Hi Jenny
Thank you so much for the prompt & detailed reply - sounds perfect & the price is amazing - obviously it may not be the same for me of course! I have sent you an email.
Have a wonderful day
Best wishes
X
Don't seem to be able to send an email as they keep getting bounced back