"1 Step" vs "2 step" surgery

[SweetShannon]

I am hoping to get my Gender Confirmation Surgery next year.  I am just beginning to gather information on procedures and surgeons that will be appropriate for me.

I am 58, overweight, and diabetic.  I had an bilateral orchiectomy done by a GCS surgeon, Dr. Tuan Nguyen in Portland, OR, a year ago.

My first questions are what are the pros and cons of the "1 Step" surgery? 


My first questions are what are the pros and cons of the "2 Step" surgery? 


Thank you for any information you might give me.

[girl_ashley]

Pretty much all surgeons use a 1 stage technique.  The 1-stage vs 2-stage is an aged debate back when the technique for this kind of genital surgery wasn't as advanced as it is today.  Don't worry about 1-stage vs 2-stage, most are happy with their results after the first initial surgery.  If you feel like you need further definition of your vulva, then you can inquire to your surgeon about going in for a second stage.

[SweetShannon]

As a diabetic, my circulatory system is, by definition, compromised.  As is my ability to heal from wounds.  A friend of mine in Seattle implied that I might want to consider 2-stage to improve because of my circulatory and healing issues. I need to assess what the best process is for me.  I know that there can be complications from the GCS surgery in all cases.  I need to find the process that is less likely to impact my general health and still give me the best results.

[Janet_Girl]

Of the gals that I know who have had the two stage, some times they don't go on to stage two, which is just a cosmetic cleanup.

[Susan Kay]

In researching surgeons, I sent a twenty question survey to ten surgeons that I had found listed or otherwise became aware of. Six of the ten answered; apparently the other four thought I gave out too much homework.

Of the 6 six that answered, five use the one-stage method, and said that was usually all that was needed. The surgeon I selected answered that he uses one-stage, but if not satisfied he would do further surgery at no charge within a year. The one surgeon that does two-stage, three months apart, thus requiring two 3,000 mile round trips plus stays, said the two-stage was needed to "make it look pretty." An admirable enough goal I guess, though I don't know that I've ever seen a "pretty" one. Extremely desirable and envy inspiring yes; pretty not so much. It's all how you look at it I guess (pun intended). 5 out of 6 can't be too far off course.

Susan Kay

[Sandy]

The whole 1 step vs 2 step discussion is quite an active topic.  The thing is that most "Rock Star" SRS surgeons perform 1 step surgeries.  The modern surgical techniques reflect the changes that have gone on in the last 30 years.

But there are some physical constraints that cannot be overcome.  And constructing a labia minora during the initial surgery cannot be done without having the constructed tissue becoming necrotic, I.E. die.  The nature of the construction of the inner labia requires healthy circulatory tissue in order to remain viable.  The body has to heal in order for this to happen.  That is why most surgeons recommend a second cosmetic labiaplasty at least 3-6 months following the initial surgery.  At that time the outer labia has healed sufficiently to allow for the resection / construction of the inner labia.  Also at that time they can construct or trim the clitoral hood and do any other minor cosmetic changes as may be appropriate.

Dr. McGuinn has a section on it on her website:
http://drchristinemcginn.com/monthlytopic/read.php?id=7

Many if not most women opt not to have a follow up.  After six months, the majority of the swelling and healing has occurred and the patient gets a good idea of how they will look from then on.  And in many cases the presentation is sufficiently pleasing that the follow up surgery is not needed.

The thing is each of us is different and we all look different following the surgery.  But so do natal women.  We all look different.  And that is one of the wonderful things about being a woman.

-Sandy

[SweetShannon]

I am, perhaps, overly concerned about my healing.  I know that the circulation to my wounds is a big issue.  My orchiectomy healed ok and the scar from it is not particularly noticeable.  But I have always had scarring issues.  And some wounds do not heal well. I have heard that circulation is critical to the 1-Stage method and I am very concerned about it.  I have not done myself any favors with this diabetes.

Recovery time is also something I am considering.  Dr. Meltzer's site appears to say that the recovery time before going back to work is much shorter than what I have heard about Dr. Bowers' or Dr. Suporn's methods.