Susan's Place Transgender Resources

Hi everyone,

I'm working my way toward MTF bottom surgery, and right now I'm the most interested in Dr. McGinn. The more I read about GRS, the more it seems like the technique used by surgeons in Thailand is actually better than the one most surgeons in North America use. Is that true? If so, in what ways? If it's a better technique, why is it not practiced here, as well?

there's pro's and con's to all the options and it's subjective. It's kind of like asking is Thai food better than North American food

You could have  look here:
https://www.susans.org/forums/index.php/topic,193067.msg1721458.html#msg1721458
and here:
https://www.susans.org/forums/index.php/topic,193632.msg1726310.html#msg1726310



-there are differences in techniques and in look.
Usually the N.A. surgeons are optimized for circumsized people and as result have a tidy look with small inner and outer labia
The thai surgeons may generate more generous outer labia.
Both can handle circumsized and uncircumsized people, just talk with the surgeon.
If necessary skin grafts are used.
Some surgeons ask for preferences, depth, looks, feelings.


hugs

There's more than one technique used in Thailand. Dr Suporn invented a new one, it looks like Dr Chett has some variant of it, and others do penile inversion. To me the title suggest the question, is Suporn's technique better, followed by what about Chett because its the same only cheaper. Except some people say Chett's aesthetics is better than Suporns. And others that at least some USA surgeons don't do the old style penile inversion anymore.

The difficulty is that there's no consensus on the truth of any of that. There's not enough solid evidence out there that you can check and they all have patients that like them and patients that have had bad problems. Personally I prefer Suporn for all sorts of the most excellent reasons, but whats that worth exactly?

And chances are someone will take issue with me saying Chett has a variant of Suporn's technique.

Personally I confront this problem by doing a lot of research then guessing.

Quote from: Serenation on January 06, 2016, 08:56:11 AM
there's pro's and con's to all the options and it's subjective. It's kind of like asking is Thai food better than North American food

I would not really compare food since food is an acquired taste.

If you don't like it you can try the other.

With GRS if you try one, You are STUCK with that ONE choice. There is no "Acquired" taste to see which is better.

I think the OP is trying to gather information based on those who have experienced either types and locations of procedures with GRS.

Here was a comment on Suporn:
https://www.susans.org/forums/index.php/topic,96561.msg706793.html#msg706793

He is imo the only one who meshes the tissue to gain extra depth.
And some people say with the meshing tissue might turn more easy into a mucosa.

He seems to have experience in reconstructive surgery and integrated this method.
He seems to leave some erectile tissue in place which some say is more like a female arousal where there is also some erectile tissue.
Some well endowed candidates reported problems.


hugs

I forgot to say in my previous post that I'm quite certain one is better than the other, that's the nature of people, but which one?

Hi Shadowcharms,

Irrespective of technique; which after the extensive research I did into it, do I believe any technique practiced in Thailand is better than anywhere else { can be more marketing hype than anything else} I tend to believe it's the follow up and post op support you get from your surgeon. That's where I believe you realise the worth of your investment. Just do your homework, do your research. Ask, ask and keep asking questions until you're satisfied.

Personally myself, I found the language barrier (ESL) in Thailand presented a considerable barrier. Particularly if anything went pear shaped. I also sensed a little too much marketing hype as to their capabilities. Whereas in North America it was more like "Well sweetheart, this is the way it goes."

The surgeons I interviewed in North America, perhaps instilled greater confidence in their overall capacity and experience than elsewhere.

Just remember, at the end of the day, it's your body, your responsibility. You need to be 110% happy with not only your choice, but with the procedure, post op care, and everything else along the way. Ensure you're FULLY informed. No questions unanswered, no doubt whatsoever.

Hope 2016 sees your dreams and series fulfilled.

Speak to you as soon as it stops raining.

Huggs
Catherine

The problem is that what is "better" differs from person to person. For example, I didn't care too much about depth; the Thai surgeons generally guarantee more depth (with a more invasive surgery technique), but that's not better for me. Whereas I also like smaller inner labia and better defined outer labia, which the Thai results generally seem to trend *against*; again, not better for me. So which is better is going to come down to what you want most. :) You may want to figure that out first, then go shopping for the surgeon who  most reliably produces in the area that is your #1 priority.

Everyone has to prioritize depth, sensation, function, and aesthetics (and sometimes specifics of how we want it to look or function). I cared most about sensation and function, and then aesthetics, and then depth. So I picked a surgeon with a solid track record in producing the first three and a known tendency to achieve acceptable depth and call it good, and I was satisfied. (I also cared a lot about getting adequate aftercare - which the Thai surgeons are in fact known for doing excellently as well - because I believed the first couple weeks post-op can influence the final result substantially and also I wanted the peace of mind. And I found a surgeon who did 10 days of aftercare [first 2-3 in a hospital, remainder in a recovery residence with 24/7 resident nurses on duty].)

Quote from: Laura_7 on January 06, 2016, 10:15:01 AM
.........He seems to leave some erectile tissue in place which some say is more like a female arousal where there is also some erectile tissue.
Some well endowed candidates reported problems.

The erectile tissue left refers to a portion of the corpus cavernosum and corpus spongiosum soft blood vessel structure of glan penis which originates and supports erection. Most surgeons leave a portion of these elements in order to cope with the increased blood flow summoned during sexual stimulation. If this procedure is not carried out correctly, excessive and prolonged swelling can occur post sexual stimulation that can be painful and in some cases, quite harmful.

Speak to you as soon as I glue this stamp to my tongue.

Huggs
Catherine

I won't get into which is better but I took into consideration language barriers, and the distance to travel both ways. It can be hell to be sitting on a very sore spot for 12 hours or more. The again, whet if you run into a problem and have to return to the office? It's faster and by far cheaper to be in the US as opposed to flying all the way across the globe! I believe that many surgeons will not repair another's work unless it's life threatening so something to contemplate.

My surgery was done by Dr. McGinn in June and I'm very happy with the results! I'm sure that most of those who have had it done recommend their surgeon and I'm certain most of them are good otherwise they won't last long in business.

Love,
Clare

Quote from: Catherine Sarah on January 06, 2016, 10:40:08 AM...excessive and prolonged swelling can occur post sexual stimulation that can be painful and in some cases, quite harmful.

Call your doctor (seek medical attention) if an erection lasts for more than 4 hours?  Is this a Viagra thing? :P
It's my experience, proper attention to sexual stimulation tends to take care of the...mmm post-op female erection.

If I was younger the Thailand treatment would make sense.  But I'm old and dislike traveling, so 'walk-in SRS' in Los Angeles was my choice.

Thank you,
Anne

You need to choose surgeon who's technique and result will be the best for you. No surgeon is best for everybody, we all have different preferences.

mine are:
- depth. 6 inch at least... If I get more, even better.
- self-lubricating vaginal wall. Suporn's technique gives the best chance for that, apart from old colon technique I don't want
- keeping most erectile tissue. I want full sexual sensation, which includes having erectile tissue, in natural female pattern, not just in clitoral glans
- prominent inner labia. I don't like the innie look with barely any labia minora, which is usually result of penile-inversion variations
- labia majora made from penile skin. I don't like the appearance of labia majora made from scrotal flaps
- frenulum looks amazing!!!
- secondary sensate organ. Whole glans with nerve bundle is preserved. Excess material is carefully separated, and is used as secondary sensate organ (2nd clitoris) placed near vaginal entrance.
- not needing to do any electrolysis

That made pretty easy choice for me...

Quote from: Jessika on January 06, 2016, 10:02:30 AM
I would not really compare food since food is an acquired taste.

If you don't like it you can try the other.

With GRS if you try one, You are STUCK with that ONE choice. There is no "Acquired" taste to see which is better.

I think the OP is trying to gather information based on those who have experienced either types and locations of procedures with GRS.

I know, but I don't see the point in that since no one can have an unbiased valid opinion.

Well I am going to the surgeons session at the Amsterdam WPATH conference in June, so I could stand up and ask them to vote who is the best?

Not sure I'd be popular or get an unbiased opinion ::)

Quote from: Cindy on January 07, 2016, 12:44:41 AM
Well I am going to the surgeons session at the Amsterdam WPATH conference in June, so I could stand up and ask them to vote who is the best?

Not sure I'd be popular or get an unbiased opinion ::)

I'd not trust a word they said. On the other hand an independent academic paper on it would be very interesting.

Quote from: OOAnne on January 06, 2016, 03:55:33 PM
Call your doctor (seek medical attention) if an erection lasts for more than 4 hours?  Is this a Viagra thing? :P

No, it's not a Viagra thing. It was a reference made to some surgeons who are known to create serious problems by not carrying out the appropriate procedures correctly.

Blood summoned by sexual stimulation isn't given the necessary drainage system back to the vascular network, causing extended and prolonged swelling with subsequent pain levels.

Speak to you as soon as I eat my banana (They're in season, so are the cherries)

Huggs
Catherine

I am watching this thread with interest. I want to make a decision too. I may end up being able to pull off a Thailand trip after all, depending.

I am not circumcised however the "donor material" has always been rather small. Like much thinner than average, almost like a child's (I also had lots of trouble conceiving naturally and Low T throughout life). I am hoping I don't have to do sigmoid colon but not being circumcised could work to my advantage.

With that said, Thai or NA? I wish I could get on Schaff's waiting list but 3 years... oh my

What about:
-Brassard
-Suporn
-Chett
-Kamol, Sanguan    ?

If the donor material is small often docs use a skin graft.
And some people ... work ... a few minutes a day  .. a bit on donor material to add a bit of length.


hugs

I know that Chett. recommends "grafts" based upon allot of the posts from his patients that I have encountered.

An earlier comment regarding donor material has me wondering.  Just what is considered adequate donor material?

I have what would be considered a "partial" or "incomplete" circumcision.  I presume that this would be somewhat advantageous in the construction of the "clitoral" hood (although no one has ever confirmed this for me).

And with regard to the "other donor material" As erections are a distant memory -  How does one calculate "adequate"?
Is it number the of inches or centimeters in the flaccid state that is the determinant?

Seems kinda late in the "game" (for me) to be posing these questions, but in fact, it looks like we don't get to find out until we're front & center with our surgeon just days before surgery.     

I can't speak for other surgeons... but I know Brassard had adequate material to get 5.5-6" of depth with every woman except the one who was less than 1" erect (she had to have a small skin graft from her thigh, but she did get her depth as well). I'm not sure how he managed it, either, but I can at least say that in my pre-op exam he judged my likely depth by examining the donor material while flaccid and stretching it out by hand. (That was HORRIBLE. At least it was over quickly.)

Quote from: Joi on January 09, 2016, 08:58:04 PM
I know that Chett. recommends "grafts" based upon allot of the posts from his patients that I have encountered.

An earlier comment regarding donor material has me wondering.  Just what is considered adequate donor material?

I have what would be considered a "partial" or "incomplete" circumcision.  I presume that this would be somewhat advantageous in the construction of the "clitoral" hood (although no one has ever confirmed this for me).

And with regard to the "other donor material" As erections are a distant memory -  How does one calculate "adequate"?
Is it number the of inches or centimeters in the flaccid state that is the determinant?

Seems kinda late in the "game" (for me) to be posing these questions, but in fact, it looks like we don't get to find out until we're front & center with our surgeon just days before surgery.     

Some knead the ... thing ... a bit and stretch it...

there are methods to regrow foreskin on wikipedia...

and some surgeons accept photos of the state now and make comments...

and many say they will use skin grafts if necessary...


hugs

Quote from: Laura_7 on January 09, 2016, 08:31:54 PM
What about:
-Brassard
-Suporn
-Chett
-Kamol, Sanguan    ?

If the donor material is small often docs use a skin graft.
And some people ... work ... a few minutes a day  .. a bit on donor material to add a bit of length.


hugs

I don't know about Brassard because I am diabetic and he seems averse to working on diabetics. I am not seriously diabetic though (A1C of 6 or slightly less) and I manage it well but I don't know. His requirements are rather strict health wise.

Suporn or Chett maybe. The whole chonburi organ thing seems a bit odd to me but I guess he (suporn) knows what he's doing.

Yeah I need to work on the donor material again even if it sickens me to even touch it.

Quote from: iKate on January 10, 2016, 08:43:11 PM

Suporn or Chett maybe. The whole chonburi organ thing seems a bit odd to me but I guess he (suporn) knows what he's doing.

Turns out Chettawut also makes chonburi organ (surely he doesn't call it that..).

 I know that his thread has drifted a bit from it's "original" intent but I guess we're not breaking any rules by expanding on it.

Just looking for feedback.

Would one whose donor material fell into the range of 4 inches. flaccid and 6 inches erect be considered adequate enough donor material to preclude the necessity of a "graft" ?

That's a good question that I would like to see answered. I'm nowhere near ready for this but compiling answers helps. :)

Quote from: Joi on January 10, 2016, 11:16:17 PM
I know that his thread has drifted a bit from it's "original" intent but I guess we're not breaking any rules by expanding on it.

Just looking for feedback.

Would one whose donor material fell into the range of 4 inches. flaccid and 6 inches erect be considered adequate enough donor material to preclude the necessity of a "graft" ?

Sent from my iPhone using Tapatalk

Quote from: Joi on January 10, 2016, 11:16:17 PM
I know that his thread has drifted a bit from it's "original" intent but I guess we're not breaking any rules by expanding on it.

Just looking for feedback.

Would one whose donor material fell into the range of 4 inches. flaccid and 6 inches erect be considered adequate enough donor material to preclude the necessity of a "graft" ?

You are having your surgery with dr. Chettawut. Penis size doesn't matter because depth of neovaginal wall isn't made from penile skin and isn't dependant on penis size. Surface of scrotal skin will determine whether it is enough for neovaginal wall on it's own, or a surgeon will have to use additional skin graft from groin. Only your surgeon will be able to give you that answer after the examination.

Thanks Lagertha!

It's quite likely that a graft will be on the agenda for me.  Long term HRT takes a toll on the "huevos" & that in turn leads to a reduction in the size of the scrotal sack.  Perhaps this would have been better explained if using a US based surgeon and having had an in person visit well before the date of the surgery.  As is my case and that of many others, can't just drop in for an appointment with Dr. Tulayaphanich anytime. 

Hugz!

Depends where you go Joi,  Suporn and Chett will do graft no matter what, because they like to use the penile skin elsewhere.

I don't think a western surgeon would need to graft with the measurements you gave. They will tell you beforehand in a consult anyway. I had a graft it's nothing to worry about it really. Only things I ever noticed were it produced more scar tissue and at a guess made dilation more difficult.

I would say that's why chett and suporn have such different dilation requirements than most western surgeons.

Thanks for your input Serenation!

I think that I "finally" understanding the procedure better.  Good thing because it happens next week. I'll be ready for the graft  ($cha'ching$).  I'm confident that things will be fine.

Hugz!

I've been thinking about what my priorities are in terms of the surgery, and I think they matter to me in this order (most important to least important):

Appearance
Sensation
Lubrication
Depth

I'm not into men, so I don't know how much depth matters for me. Lubrication seems important because I don't want to be uncomfortable all the time. Sensation would be nice because I've never really been able to have a sexual experience that wasn't riddled with dysphoria, and I think that would be really good for me to have one. I'm not much of a sexual person though, so if I didn't have a lot of sensation, I could learn to live with that. Appearance, of course, would be nice so that I can feel a bit more normal.

I assume that appearance isn't a huge concern regardless of who I go with (provided that they are experienced). As far as I can tell, the north american surgeons all seem to do something that's a bit cleaner and more tucked in than how the majority of cis women look, but that is not an unnatural look for a cis woman to have. I'm actually okay with the smaller labia minora look. I'm worried that I will find it too tidy, but maybe it won't matter to me.

I'm currently considering Dr. McGinn as my top choice. Does anyone know how her surgeries tend to measure up against Suporn and Chett and  in terms of sensation and lubrication?

Quote from: Jenna Marie on January 06, 2016, 10:17:39 AM
The problem is that what is "better" differs from person to person. For example, I didn't care too much about depth; the Thai surgeons generally guarantee more depth (with a more invasive surgery technique), but that's not better for me. Whereas I also like smaller inner labia and better defined outer labia, which the Thai results generally seem to trend *against*; again, not better for me. So which is better is going to come down to what you want most. :) You may want to figure that out first, then go shopping for the surgeon who  most reliably produces in the area that is your #1 priority.

Everyone has to prioritize depth, sensation, function, and aesthetics (and sometimes specifics of how we want it to look or function). I cared most about sensation and function, and then aesthetics, and then depth. So I picked a surgeon with a solid track record in producing the first three and a known tendency to achieve acceptable depth and call it good, and I was satisfied. (I also cared a lot about getting adequate aftercare - which the Thai surgeons are in fact known for doing excellently as well - because I believed the first couple weeks post-op can influence the final result substantially and also I wanted the peace of mind. And I found a surgeon who did 10 days of aftercare [first 2-3 in a hospital, remainder in a recovery residence with 24/7 resident nurses on duty].)

Would you be comfortable with telling me who you went with? It sounds like you wanted a lot of the same things I do.

ShadowCharms : I went to Brassard. I was sensate from the moment I woke up and orgasmic in my sleep at 3 weeks post-op, so I exceeded my best hopes in terms of sensation. :) Functionally, I have adequate depth, can accommodate the largest dilator, and do self-lubricate. In terms of aesthetics, I really lucked out - I've had a gynecologist and some ER doctors who thought I was cis. I'm generally very pleased with the results.

He definitely does do the "tidier" look, but it was not too extreme for me; I've seen enough cis vulvas that looked similar to be comfortable with it.  Heck, these days, some cis women with larger inner labia are paying plastic surgeons to *get* that look... (I do like that he used some leftover urethra to give me pink, moist mucosal tissue on the inside of the inner labia and clitoral hood, which looks very natural.)

The other thing is, within the general range of cis norms, once you're done and healed up it's yours, you know? I figure I had a little more input than the average cis woman, but not by much, and just like she has to learn to live with what nature gave her, I see what I ended up with as unique and all mine. I have a couple of quirks I don't like, but so does my wife.

Hi Lagertha;
Based on your criteria who diode you choose?
Judith

Quote from: judithlynn on January 14, 2016, 12:26:59 AM
Hi Lagertha;
Based on your criteria who diode you choose?
Judith

I'm having my surgery with dr. Suporn.

From what I have heard (second hand), the Thai surgeons (namely Suporn) give more depth. That said, comparing the 2 pictures I was able to find of Suporn's work with what I've seen for American (Sinclair) and Canadian (Brassard) surgeons, the North American surgeons seem to produce more aesthetically pleasing results in line with what I would want my vagina to look like. I guess its a tradeoff. Do you want depth (Thailand), cosmetics (USA), or sensation (???)

Quote from: lisarenee on January 15, 2016, 10:57:43 PM
From what I have heard (second hand), the Thai surgeons (namely Suporn) give more depth. That said, comparing the 2 pictures I was able to find of Suporn's work with what I've seen for American (Sinclair) and Canadian (Brassard) surgeons, the North American surgeons seem to produce more aesthetically pleasing results in line with what I would want my vagina to look like. I guess its a tradeoff. Do you want depth (Thailand), cosmetics (USA), or sensation (???)

Its a pity we can't post links here as I've seen a few more than that, and in those Suporn's aesthetics look far better than Brassard's.

Quote from: AnonyMs on January 15, 2016, 11:49:11 PM
Its a pity we can't post links here as I've seen a few more than that, and in those Suporn's aesthetics look far better than Brassard's.

You could have a look here :
https://www.susans.org/forums/index.php/topic,69392.msg929639.html#msg929639

There are pictures of results from Brassard, some years old but according to descriptions he strives for consistency and results might still be the same.

Imo its also a matter of liking : more genereous labia or a more tidy look.

Additionally imo you might ask the surgeon. Its possible they can make some changes in their usual results, like generating more generours labia if desired. They can give no guarantees though.


hugs

Quote from: AnonyMs on January 15, 2016, 11:49:11 PM
Its a pity we can't post links here as I've seen a few more than that, and in those Suporn's aesthetics look far better than Brassard's.

Part of the problem (causing the dearth of good images) seems to be Suporn's focus on depth. I found a lot of images, but in all but 3 of them, the lips are being manually pulled apart or a rod is stuck inside to show "how deep" the vagina is. Of the remaining 3, one was taken from too far away and made too small to see anything to speak of and the other 2 were taken at odd angles.

Quote from: lisarenee on January 22, 2016, 05:43:32 PM
Part of the problem (causing the dearth of good images) seems to be Suporn's focus on depth. I found a lot of images, but in all but 3 of them, the lips are being manually pulled apart or a rod is stuck inside to show "how deep" the vagina is. Of the remaining 3, one was taken from too far away and made too small to see anything to speak of and the other 2 were taken at odd angles.

I guess you're talking about the images on Suporn's site. I'd agree they are not very useful, but there's quite a few others available on Internet. From everything I've heard is does focus a great deal on aesthetics. I'll send you a PM.

Quote from: lisarenee on January 22, 2016, 05:43:32 PM
Part of the problem (causing the dearth of good images) seems to be Suporn's focus on depth. I found a lot of images, but in all but 3 of them, the lips are being manually pulled apart or a rod is stuck inside to show "how deep" the vagina is. Of the remaining 3, one was taken from too far away and made too small to see anything to speak of and the other 2 were taken at odd angles.

You might google Danielle Foxxx . Its not sure if photos were improved with software though.


hugs

Quote from: Laura_7 on January 23, 2016, 04:28:35 AM
You might google Danielle Foxxx . Its not sure if photos were improved with software though.

I'm pretty sure the videos were not.