Trying to decide on a surgeon ...

[Jamie-o]

I'm mostly just thinking out loud here, and it's undoubtedly going to be a long post, but if anyone has any insights or advice, I'm all ears.

Here's the deal:  I'm trying to decide whether I should take the trip down to Florida to have top surgery with Dr. Garramone, or to stay here in the Twin Cities and see Dr. Tholen.

Advantages to Garramone

• He's less expensive -  but then, by the time I add in travel expenses, the cost will probably be very similar.
• He has more experience - This is really the big factor to push me toward Garramone.  He has done hundreds of these surgeries, and does about 20 a week.  In fact, his practice has become almost exclusively FtM top surgeries, and his results are very consistent.

Disadvantages to Garramone

• I would have to travel almost 1800 miles
• He requires a letter, which seriously pisses me off, for a number of reasons I won't go into.
• I would be doing the hardest recovery in a strange hotel room, without the conveniences of home.
• If I need revisions, the chances are slim to none that I will be able to make it back down to FL to have them done in the next year, while the surgery is still "under warranty," so to speak.

Advantages to Tholen

• I can recover at home - At home I would be more comfortable, both emotionally, and physically, given I have a big, comfy easy chair to sleep in. 
• I don't have to find someone to look after my cats. - The only person I know around here whom I could ask a big favor from is my mom, and she would be coming down to FL with me if I went down there.
• My expenses would be more controllable. - The expenses would, barring an emergency hospital stay, be pretty much agreed upon before hand.  On a long trip to FL, I would have to figure out lodging expenses, eating expenses, car rental and gas expenses, etc.
• Tholen doesn't require a letter - I really appreciate the fact that he treats us like any other rational adult, and doesn't ask us to waste valuable time and money getting some head shrink to certify that we are simultaneously sane enough and insane enough for surgery.   

Disadvantages to Tholen

• He has less experience with this particular procedure.
• The results I have seen have been less consistently good. - In all fairness, some of the results I've seen have been of his earliest attempts.  I attended a lecture he did on Trans surgeries, and he showed some of those less stellar results, and talked about what he had learned, and what he would do differently now.  I have seen some of his recent results, and they were quite good.  But there aren't as many to look at, so it's really hard to judge.  I have put out a request to the local community to get more pix, so we'll see what comes of that.

Other Things to Consider

• Every body is different, therefore the results can be good or bad regardless of the surgeon.  But then, more skill and practice generally leads to a greater likelihood of success.

• Something I still need to discuss with each of them is scar placement.  If I'm really honest with myself, I know that the scars, no matter how well made, will bother me enough that I will likely never be comfortable taking my shirt off in public.  The reality is, even the best DIs aren't really "good enough" to make me really thrilled, and I'm not a candidate for peri.  (I'm talking about my own feelings about my own chest here.  I'm not making a judgment call on other people's chests.)  I have an idea, however, for an alternative, less orthodox placement of the incisions, and if one of them is willing to work with me (or is able to give me a solid reason why my idea wouldn't work) that may sway my decision.  In any case, if I end up with the standard DI scars, i will probably eventually have them tattooed over, so whether one does a better job than the other at scar placement, may be moot.

• Frankly, I'm feeling a little overwhelmed by all the steps I have to go through to get surgery done.  It's like I was saying in another thread:  I need to have a surgery date to get the time off work, but I don't want to schedule surgery until I know if I can get the time off work.  I have a relative who has a time-share about an hour from Dr. Garramone, so it's possible that I can get really cheap accommodations, but I'm on a waiting list.  I can barely afford to do this, so if I make an appointment but can't get those accommodations, I may have to cancel and lose my deposit, but if I wait until I have confirmation of the accommodations, he may not have any openings left for that time frame.  I'm really stressing out about the details, so a major part of me just wants to stay here where there is less to work out.

• Would all the traveling I would have to do shortly after surgery, if I went to FL,  increase the chances of pulling stitches, or of other complications? That's something I need to look into.

Gah!  So, in conclusion, it would appear that Garramone only has one real advantage working in his favor, but it's a major advantage, so I'm still not sure what I want to do.  Any thoughts, anyone?

[xAndrewx]

Does Tholen do revisions free for the first year as well or no? Sounds to me like Tholen has better advantages so if it were me I would go with him. Good luck with everything

[Radar]

For me I chose a reputable doctor with great results closer to me in case there were any complications. I'm so glad I did. We've had to drain two hemotomas (this last one was huge) and have decided to put another drain in. This drain isn't as complex as the original drains since I don't need one as intrusive. All these things have been done in her office so have been free.... well, included in the price. I don't have to pay extra for anything done in the office.

Even though it's a pain it's not disastrous and everything else is healing up good. If I went with a doctor far away- like Garramone- there's no way I could go back to him about the hemotomas. So, I'd either have to go to hospital (which would be disastrous around here ) or go to the doctor I already go to.

So, I made a wise decision for myself, but many guys have no complications after surgery. It's all a gamble I guess. Overall choosing a closer doctor saved me alot of money too but that wasn't the main deciding factor.

[Jamie-o]

Thanks for the input, guys.

Radar - That sucks that you had complications.  If you don't mind me asking, how long after the initial surgery did you experience these complications?  And are you still having to deal with them?

[Sean]

I was recently in the same position of researching and choosing a surgeon.

The only upside to Dr. G that I could see was that his results - on average - have the best scar placement.

That was it. There was nothing else from my perspective, given my situation (the procedure, the distance, my caregiver situation, cost, etc.) that was a plus in the Dr. G column. There were a few minuses, but I'm weird and particular, and I was very concerned about the right 'fit' of the surgeon for me.

If you don't care about the scar placement very much for the reasons you stated, I can't see why you'd want Dr. G.

I didn't consider Dr. Tholen, so I'm unfamiliar with him or his results. If you're not comfortable with his results, you might want to look for another dr. who is closer to you than Dr. G, but not in your hometown, if you feel like there is someone with better results (so you can split the difference on your concerns).

[Radar]

Radar - That sucks that you had complications.  If you don't mind me asking, how long after the initial surgery did you experience these complications?  And are you still having to deal with them?

My mother and I noticed the first hemotoma when we first took off the bandages. The other one showed up around the middle of last week. Both times I had them drained.

It's odd because the draining into the original bulb acted normal and reduced down enough to take the drain out. This last fluid build up just seemed to happen. My doctor said this can be common- including happening on just one side. I still have a smaller drain in to removed the fluid build up. It will stay in until that side stops draining.

I had my surgery on 11 January so I'm still in the early healing stage. I assume most hemotomas develop then. It's not a severe complication- more like an annoyance. I do have to keep everything very clean and sterile and I'm take antibiotics again for safety's sake.

If you don't have hemotomas drained out the body will eventually absorb them but you'll have a longer healing period, worse complications might happen and it might affect the results. So it's best to have them drained.

[sneakersjay]

I know there is a lot to consider and finances are a factor, but back when I was choosing a surgeon I chose one with lots of experience.  I stayed 10 days post-op, which was required, for the follow-up rechecks.  Most major complications like hematomas will show up in that time frame.

I know nothing of Dr. Tholen, so can't speak to him or his results and skill level, but I have read reports of guys who used local surgeons who had results they were not happy with.

While no surgeon can guarantee their work, odds are you will be very happy with what Dr. Garramone does, as you've seen lots of pictures; but Dr. Tholen's results are less sure.  They may be stellar, good, average, but maybe not.

I figured it was a once in a lifetime procedure and I wanted it done right the first time.  I was lucky and had no complications (all top surgeons have patients with complications at times).

Decisions can be hard to make.


Jay

[Ender]

My number one criteria for choosing a surgeon was results: have they performed a significant number of surgeries, were those surgeries performed using the particular technique I wanted (peri vs. DI), and were those surgeries consistently good?

Sure, a local doctor may seem easier in the short run.  Will you be happy with the results?

I had the option of going with a lesser-known surgeon 4 hours away (the closest "local" option) or going with a fairly well-known surgeon 8 hours away.  I chose the latter, because of the number of surgeries he had performed and the consistently good results I had seen.  If you're wondering, I went with Dr. Medalie of Cleveland, Ohio.  That said, he wasn't the most well-known surgeon I could have gone to.  I think Dr. Fischer in Maryland is somewhat better known for the procedure I had done (periareolar).  However, I liked Dr. Medalie's peri results just as much as Dr. Fischer's, but he was closer and a bit cheaper.

Jay is right, this is a once in a lifetime procedure.  If you're leaning towards Dr. Tholen, really, really look into the number of surgeries he has performed (since you mentioned Garramone, I'm guessing you're looking at a DI) and the consistency of his results.  From what you've already posted about his results, I would proceed with caution.  I suppose every surgeon has a period of 'practice,' of honing their skills.  You say some of his more recent works look pretty good, but I would do the same as what you're already doing: look for more photos of recent work, since he didn't show all that many.

If given the choice of going with a local surgeon because of cost restraints and hoping it will be 'good enough' or waiting longer and going with a more established surgeon--I would wait.  For scheduling, it sounds like you need to: 1) be sure that you can get accommodations in the time share, 2) make sure you can get time off of work for that time frame, 3) schedule surgery for that time frame.  It seems like these are all things that are best scheduled months in advance.  Is there any way that you can get a confirmed date for the time share, say, 6-12 months in advance?  It may be further out than you were already planning, but it seems like the accommodations are the linch pin, and cutting things much shorter than 6 months may make it hard to schedule surgery (what's Garramone's waiting list like?).  I don't know what your workplace is like, but I'm hoping that a 6-12 month notice of time off for something as important as a surgery date would be sufficient...

As for traveling after surgery: I did it.  The 8-hour-turned-12-hour car ride (blizzard and black ice) was not pleasant.  I survived and didn't hurt anything in transit (but do watch out for the shoulder strap on seat belts).  However, I don't know what I would have done without my mother's help.  I stayed in the area for 10 days, but when it came time to leave, I couldn't even lift my backpack of clothes + laptop without it hurting.  Me driving wasn't happening; I was OK being a passenger--car or plane, it wouldn't have mattered.  If you're doing this alone, you're going to have to pack very, very light, take a rolling suitcase, and not be shy about asking people to help you lift it up, if necessary.

One final thought: if you were to push the time frame you were planning on for surgery back, would you be able to save up more money so that cost would not be such an issue?  Chiefly, would you be able to save enough so that you could get guaranteed accommodations at an extended stay hotel in Florida?  That may make things simpler, especially if you can find a place very close to the surgeon.  I'm not sure if driving yourself home after surgery is a great idea--you may have to take a taxi if you have no one to drive you.  And for taxis... close is good.