Hey Everyone
My name's Michelle
I'm 23, been on HRT for 1 year, and finally confirmed my SRS date with Dr. Suporn in Thailand!
I decided on him because I want to go to someone who does the "non-penile" inversion technique and he is the best at that it seems.
I was wondering though, does anyone know the specifics of how Dr. McGinn performs her SRS, because I recently saw a clip from National Geographic (http://video.nationalgeographic.com/video/magazine/170103-ngm-gender-issue-gender-identity-transition)
where she says in the operating room that she uses the scrotal skin for the vaginal canal...
that's what Suporn does!, and is NOT standard penile inversion so if a doctor in the U.S. is doing this technique I would love to know! (and possibly change doctors)
i know this is a super-specific and "medicaly" question but if anyone has any info on this I'd love to know.
thanks!
Moon:
Dr. McGinn uses the tissue that is available, if needed. What that means is, that she will use the inverted scrotal and penile tissue to create the vaginal canal, by sowing the two together. If no penile tissue is usable, then she will use just the scrotal tissue.
Dr. McGinn was my surgeon, and in my case, it was just the opposite, and no scrotal tissue was used and just the penile tissue was used.
I'm not familiar with the non-penile inversion technique that you refer to, unless you are referring to using the sigmoid colon for the vaginal canal. I do not think that Dr. McGinn performs a sigmoid colon vaginoplasty.
-Sandy
Its a variation on the standard Penile Inversion used to get more depth when the penile skin is not sufficient. Its not what Suporn does.
There's a paper describing this, among other things, "Male-to-female vaginoplasty: Preecha's surgical technique."
I can't post a link since it has surgical photos' in it, but its possible to find it with google.
Quote from: AnonyMs on March 09, 2017, 08:55:34 AM
Its a variation on the standard Penile Inversion used to get more depth when the penile skin is not sufficient. Its not what Suporn does.
There's a paper describing this, among other things, "Male-to-female vaginoplasty: Preecha's surgical technique."
I can't post a link since it has surgical photos' in it, but its possible to find it with google.
Okay, I am assuming neither of us are surgeons, but I just read Preecha's paper (J Plast Surg Hand Surg. 2015 Jun;49(3):153-9. doi: 10.3109/2000656X.2014.967253), with particular attention to fashioning of the vaginal cavity:
"Usually, the cavity is variable between 4–6 inches. However, the penile skin is not enough for covering of the entire cavity. Scrotal skin is usually harvested as a full-thickness skin graft. The penile skin is then opened posteriorly with scissors."
How is this different from McGinn using "the inverted scrotal and penile tissue to create the vaginal canal", as Sandy pointed out?
Just wondering,
Terri
Terri's question is highly interesting to me as McGinn is my U.S. choice if I don't go to Thailand. If that isn't what Preecha and Suporn do than what is? My understanding was that healing time was longer with the Thai Dr's as adding the scrotal tissue (which is actually serrated into a mesh like material), requires a much longer healing time.
Quote from: Maybebaby56 on March 09, 2017, 04:42:03 PM
Okay, I am assuming neither of us are surgeons, but I just read Preecha's paper (J Plast Surg Hand Surg. 2015 Jun;49(3):153-9. doi: 10.3109/2000656X.2014.967253), with particular attention to fashioning of the vaginal cavity:
"Usually, the cavity is variable between 4–6 inches. However, the penile skin is not enough for covering of the entire cavity. Scrotal skin is usually harvested as a full-thickness skin graft. The penile skin is then opened posteriorly with scissors."
How is this different from McGinn using "the inverted scrotal and penile tissue to create the vaginal canal", as Sandy pointed out?
Safe to say I not a surgeon either.
Preecha does penile inversion, and its probably much the same as what McGinn does. So both penile inversion. I referenced the paper as it shows penile inversion with the use of scrotal skin in the vagina
Suporn was taught by Preescha and initially did penile inversion like what's described in the Preecha paper, but went on to develop his own technique which is different. Suporn uses scrotal skin to line the vagina, and penile skin for the labia.
There's pictures out there of these SRS results. I'd post a link but its against the terms of service.
Hi AnonyMs,
Okay. I still don't fully understand, but I will have my chance to ask Dr. McGinn herself next month. I've pretty much settled on her as my surgeon, as she has been pre-certified by my insurance carrier (Aetna) as in-network. Plus, she has a good reputation, and she is ex-Navy. Since I am a Navy civilian, she gets extra points for that :).
With kindness,
Terri
Quote from: jentay1367 on March 09, 2017, 05:26:21 PM
My understanding was that healing time was longer with the Thai Dr's as adding the scrotal tissue (which is actually serrated into a mesh like material), requires a much longer healing time.
Hi Jentay,
I have heard that, too, about the serration of the donor skin to achieve greater depth -and longer healing times. Can anyone else comment?
~Terri
Suporn cuts the scrotal skin into a mesh, and I believe its this bit that makes the recovery longer.
It is longer, as stated on his website
In our experience, Dr Suporn's patients require about twice the duration of total recovery period (3 to 4 months) compared with having SRS elsewhere. All SRS patients must stay at least 24 days and preferably 30 days in Thailand to ensure proper recovery under the care of the Clinic staff.
http://www.supornclinic.com/restricted/scheduling/protocol.aspx
I got that from here
http://totalirc.net/hosted/Suporn2015.pdf
Quote from: Maybebaby56 on March 09, 2017, 05:47:15 PM
Okay. I still don't fully understand, but I will have my chance to ask Dr. McGinn herself next month. I've pretty much settled on her as my surgeon, as she has been pre-certified by my insurance carrier (Aetna) as in-network. Plus, she has a good reputation, and she is ex-Navy. Since I am a Navy civilian, she gets extra points for that :).
Maybe you can ask her about Preecha's paper and how she's the same/different? I'm kind of curious.
From all my research, the differences between Suporn and the US surgeons is basically his surgery is much more invasive vs the surgeons in the states. As in he leaves more erectile tissue, creates more depth and always uses a graft where as bowers and Mcginn only do it if necessary. Plus he likes to tweak and do revisions in that month after the initial surgery to make sure the aesthetics are as perfect as possible, which is why I'm guessing he's so well reviewed in that area. He also offers free revisions for life (not sure if thats correct?). And having so much depth also explains why his dilation schedule is much more rigorous than most surgeons.
Bowers (who trained Mcginn) recently improved her surgery, is now creating (from what I've seen on her site) labia minora fully extending to the vaginal entrance rather then stopping right above and a fuller aesthetic overall. Suporn has been doing this for quite some time but in the way of revisions and sometimes in the initial OP but I'm guessing those that had it done the first go around usually had their foreskin intact. With that being said idk if Mcginn is using the same technique Bowers is currently using.
Quote from: AnonyMs on March 09, 2017, 06:16:41 PM
Maybe you can ask her about Preecha's paper and how she's the same/different? I'm kind of curious.
I'm also interested!
The graft that other (non-Suporn) surgeons use is a supplement to the penile skin. Suporn uses uses the penile skin for something else. Its not really a matter of more or less amount of graft, its different.
He does offer free revisions. All medical costs, but you do have to get there yourself.
I'm not 100% sure, but I think the recovery is harder due to the meshing of the scrotal skin. It forms a lot of scar tissue than wants to heal and contract, hence a lot of dilation. Its also why he does dynamic dilation rather than the usual (static) dilation technique other surgeons use, as its more powerful technique.
I think Suporn gets great results, but you pay for it in recovery. Its quite common to hear from Suporn patients having long recovery times.
Quote from: AnonyMs on March 09, 2017, 06:43:29 PM
The graft that other (non-Suporn) surgeons use is a supplement to the penile skin. Suporn uses uses the penile skin for something else. Its not really a matter of more or less amount of graft, its different.
He does offer free revisions. All medical costs, but you do have to get there yourself.
I'm not 100% sure, but I think the recovery is harder due to the meshing of the scrotal skin. It forms a lot of scar tissue than wants to heal and contract, hence a lot of dilation. Its also why he does dynamic dilation rather than the usual (static) dilation technique other surgeons use, as its more powerful technique.
I think Suporn gets great results, but you pay for it in recovery. Its quite common to hear from Suporn patients having long recovery times.
aye gotcha but yeah basically, that recovery seems hellish. I'm constantly going back and forth on who I want to go with since I've had to delay scheduling surgery for quite some time. So who knows in the next 5 years what improvements will be had and the differences in cost by then too.
Quote from: AnonyMs on March 09, 2017, 06:16:41 PM
Maybe you can ask her about Preecha's paper and how she's the same/different? I'm kind of curious.
I will give everyone a full report after my consultation on April 3rd!
~Terri
Quote from: Maybebaby56 on March 09, 2017, 07:37:57 PM
I will give everyone a full report after my consultation on April 3rd!
~Terri
Very very very interested in your report Terri, as she is on my short list.
How does Meltzer compare?
Sent from my iPhone using Tapatalk
Quote from: moon on March 09, 2017, 01:47:34 AM
I'm 23, been on HRT for 1 year, and finally confirmed my SRS date with Dr. Suporn in Thailand!
Congrats! (: I don't have anything to add that hasn't already been said.
I'm booked with Suporn too. I wrote a script to notify me via text message every time there was an update to the scheduling calendar. I know this is a bit off topic, but if you're looking to move your date forward as well. I'm happy to share my grease monkey script. I used it to move my date forward over a year. and I'm now scheduled for mid-June. Just shoot me a PM if you're interested.
Sent from my iPhone using Tapatalk
I had GCS with Dr. McGinn 11/15/2016. I am intersexed and had a very small penis ( 3/4 inch penile skin) and not much scrotal skin. She used the scrotal skin for my vaginal canal. I have just a smidge under 5 inched depth. She used my whole penile gland for my clitoris. Initially I though to was too big but it continues to shrink in size and should be fine. She and her PA-c have provided excellent care.
I had The GCS then 2 procedures in office and several well visits. I have labiaplasty 5/15/2017 in office and I will schedule the BA then.
I did the genital clearings there (6) and other than the very painful numbing injections (5 minutes each) it was a good experience.
I live close to New Hope PA and did not have to stay in a hotel after GCS. I am very glad I went to Dr. McGinn.
My cost for GCS with labiaplasty and BA including Hospital and anesthesia was about $27,500 before insurance and about $5000 after insurance.
Mcginn creates gorgeous porn star pretty NeoVagina's ... I have a friend who went to her ... its perfection
So, today I had my consultation with Dr. McGinn, and I would like to relay some of what we talked about.
Unfortunately, I was not able to take notes as Dr. McGinn went through a torrent of information very quickly, but I can recount a few comments. Any anatomical errors are mine, not hers. I had to do this from memory after a 400-mile road trip.
First of all, let me say I did not find Dr. McGinn brusque or impersonal. If anything, she impressed me with how much she truly cares about her patients and the transgender community. She is direct, yes, and very busy, but she was focused on me and wanted me to be as informed and prepared as possible for what SRS entailed.
I am listing these comments in no particular order:
1. Dr. McGinn made a point that she has very definite surgical objectives for both form and function of the neovagina. It's hard to separate the two, but I will first mention that she spent a significant amount of time explaining that this is not just plastic surgery. You are not done once she has constructed your new vagina. You will be taught not only how to take care of your vagina, but how your vagina should function, and how you can become orgasmic. You should be able to function as a woman, and that includes sexual relations with your partner. The hormone regimen is big part of it. She does believe in prescribing testosterone, and managing your hormone levels.
2. More on form. The Thai technique involves folding in the base of the scrotum inward, like the tongue of a shoe, to form part of the fourchette. She does not like this approach. For one, the fourchette does not come out shaped like a V but more like a U. Secondly, the entrance to the vulva is not as pink as it is in cisgender women when using this technique.
3. She does not find the "meshing" technique some Thai surgeons use to be a good thing. Tougher recovery. Much greater chance for scar tissue to form. Vaginal depth is *not* necessarily related to penis length. It has more to do with available space between the rectum and peritoneum.
4. Every surgical outcome is individual. She really hates that many SRS surgeons only post the best post-surgical results and not the pre-surgical pictures. She says the photos on her site are typical, not necessarily "the best".
5. Labia minora. Labia minora are made from urethral tissue. The amount of urethral tissue does *not* correlate with penis size. She said you can't tell until you dissect the penis. Some have less, and some have more. There are three advantages to using urethral tissue in her opinion. For one, it is pink in color, so closely resembles what cisgender women look like. Secondly, she said the urethral tissue is also erectile in nature, and this is not a bad thing. During arousal, you will feel a kind of tightness, a kind of responsiveness in your vagina when sexually aroused. Thirdly, the urethral tissue is secretory and aids in lubrication during arousal. BTW, she has professional differences of opinions with Dr. Meltzer about this technique. They have had direct conversations and they agree to disagree.
6. Penile inversion technique vs. non-penile inversion. She said this was a misnomer. The penis is not actually "inverted". She discards almost all "penile skin" - not penile tissue, but penile dermis. The corpus cavernosa is not used, but the glans and urethral tissue are used. The only thing from your penis that goes inside the neovagina is the nerve. Again, she pays particular attention to aesthetics. The insides of pussies are pink. Your pussy will be pink inside, not brown.
7. General comments. She doesn't like what she sees as the medical profession exploiting the transgender population. She said there are dozens of new SRS surgeons that have sprung up over the last few years because they see the demand outstripping the supply and the potential for creating a lucrative money stream. She does not say this because they are taking away business. She has more requests for her services than she can handle. She does over 100 SRS procedures a year, and has been doing it for ten years. She will come right out and tell you that the best SRS surgeons in North America are Meltzer, Bowers, Brassard, and herself, with Meltzer having more experience than anybody. She feels the newer surgeons cannot give adequate medical support in the event of complications. When things go right, everything is fine, but they simply don't have the experience to fix things when they go wrong. She runs what she describes as a "boutique" medical practice that specializes in transgender health care, not just plastic surgery, although she is a board-certified plastic surgeon.
8. I went with McGinn. I really liked her. I really trust her. My SRS date is August 8th.
Hope that helps answer some questions. Again, this was from memory, so any errors in details are mine alone.
With kindness,
Terri
EDIT: fixed several errors, with thanks to KayXo
Quote from: Maybebaby56 on April 03, 2017, 09:14:15 PMYou will be taught not only how to take care of your vagina, but how your vagina should function, and how you can become orgasmic. You should be able to function as a woman, and that includes sexual relations with your partner.
I had my surgery with Dr. Brassard. None of that information was provided to me but I figured it out on my own pretty quickly, exploring my vagina, etc. I was orgasmic by week 5 without testosterone, just on estrogen.
QuoteShe does believe in prescribing testosterone, and managing your hormone levels.
I recently started taking a small amount of Androgel. I'm 11 yrs post-op. In terms of libido, I honestly can't say it has made a difference. Progesterone, on the other hand, has, especially in terms of how much I lubricate. Maybe I don't take enough T to see a difference.
QuoteVaginal depth is *not* necessarily related to penis length. It has more to do with available space between the rectum and peritoneum.
I think you mean to say perineum, the space between the scrotum (or vulva in ciswomen) and rectum. Peritoneum, on the other hand, is the membrane that forms the lining of the abdominal cavity.
QuoteLabia minora. Labia minora are made from urethral tissue. The amount of urethral tissue does *not* correlate with penis size. She said you can't tell until you dissect the penis. Some have less, and some have more. There are two advantages to using urethral tissue in her opinion. For one, it is pink in color, so closely resembles what cisgender women look like. Secondly, she said the urethral tissue is also erectile in nature, and this is not a bad thing. During arousal, you will feel a kind of tightness, a kind of responsiveness in your vagina when sexually aroused. Thirdly, the urethral tissue is secretory and aids in lubrication during arousal.
Yes, yes and yes! I can vouch for all of the above. Is the urethra mucosal? Can anyone confirm?
QuoteThe insides of pussies are pink. Your pussy will be pink inside, not brown.
Yup! ;D
QuoteMy SRS date is August 8th.
I feel she is a great choice. Best of luck and congrats!
I agree with your assessment of Dr. McGinn's demeanor. She is serious about her outcomes. Her office is very responsive as well.
Had fun meeting you at dinner Terri.
Moni
Quote from: KayXo on April 03, 2017, 09:41:51 PM
I think you mean to say perineum, the space between the scrotum (or vulva in ciswomen) and rectum. Peritoneum, on the other hand, is the membrane that forms the lining of the abdominal cavity.
Thank you for catching this, Kay. I meant perineum.
Quote from: KayXo on April 03, 2017, 09:41:51 PM
I feel she is a great choice. Best of luck and congrats!
Thanks again, Kay. You are a wonderful resource on this forum.
~Terri
Quote from: HappyMoni on April 03, 2017, 10:09:51 PM
I agree with your assessment of Dr. McGinn's demeanor. She is serious about her outcomes. Her office is very responsive as well.
Had fun meeting you at dinner Terri.
Moni
Thanks, Moni. You are truly a treasure. I am glad we met. I hope we meet again!
With kindness,
Terri
I am going to Dr. McGinn's Friday. I have gone there 8 or so times since my GCS. They have really taken tremendous care of me. I have labiaplasty 5/15 and If I am fully healed from GCS they will give me a BA date.
They prescribed T for me. I took the 1 month supply over 3 months (with 20% remaining in the container) and with my doctor we agreed I should not take it because of how I felt about T. My T was 80 ng/dl when tested. Papillion's objective was 40 ng/dl.
I think you made a good choice with McGinn.
Quote from: Rachel Lynn on April 04, 2017, 06:06:08 PMThey prescribed T for me. I took the 1 month supply over 3 months (with 20% remaining in the container) and with my doctor we agreed I should not take it because of how I felt about T. My T was 80 ng/dl when tested. Papillion's objective was 40 ng/dl.
I personally think the goal shouldn't be a number but rather that the person feels and looks good without compromising health or femininity. Some don't need T despite very low levels. Some may do fine with lower than 40, others may need even more than 40. Also, total testosterone doesn't account for the fact that some of it is bound to SHBG so that if your SHBG is high (like it is with me, over 200 ng/ml), much of it is inactive. It also depends on hormonal environment so that with higher concentrations of estrogen, 40 T may not do enough, etc.
My doctor just prescribed me a very small dose and suggested I go from there, deciding on my own if I need more or less, judging by how I feel and virilization symptoms (oily skin, body hair growth, etc.).
Before starting T, my total testosterone was between 3 and 12 ng/dl, VERY low. My free T was undetectable. I asked for some to help with energy, motivation/drive and general well-being. So far, so good for me. Everyone is different. :)
Quote from: Maybebaby56 on April 03, 2017, 09:14:15 PM
So, today I had my consultation with Dr. McGinn, and I would like to relay some of what we talked about.
Unfortunately, I was not able to take notes as Dr. McGinn went through a torrent of information very quickly, but I can recount a few comments. Any anatomical errors are mine, not hers. I had to do this from memory after a 400-mile road trip.
First of all, let me say I did not find Dr. McGinn brusque or impersonal. If anything, she impressed me with how much she truly cares about her patients and the transgender community. She is direct, yes, and very busy, but she was focused on me and wanted me to be as informed and prepared as possible for what SRS entailed.
I am listing these comments in no particular order:
1. Dr. McGinn made a point that she has very definite surgical objectives for both form and function of the neovagina. It's hard to separate the two, but I will first mention that she spent a significant amount of time explaining that this is not just plastic surgery. You are not done once she has constructed your new vagina. You will be taught not only how to take care of your vagina, but how your vagina should function, and how you can become orgasmic. You should be able to function as a woman, and that includes sexual relations with your partner. The hormone regimen is big part of it. She does believe in prescribing testosterone, and managing your hormone levels.
2. More on form. The Thai technique involves folding in the base of the scrotum inward, like the tongue of a shoe, to form part of the fourchette. She does not like this approach. For one, the fourchette does not come out shaped like a V but more like a U. Secondly, the entrance to the vulva is not as pink as it is in cisgender women when using this technique.
3. She does not find the "meshing" technique some Thai surgeons use to be a good thing. Tougher recovery. Much greater chance for scar tissue to form. Vaginal depth is *not* necessarily related to penis length. It has more to do with available space between the rectum and perineum.
4. Every surgical outcome is individual. She really hates that many SRS surgeons only post the best post-surgical results and not the pre-surgical pictures. She says the photos on her site are typical, not necessarily "the best".
5. Labia minora. Labia minora are made from urethral tissue. The amount of urethral tissue does *not* correlate with penis size. She said you can't tell until you dissect the penis. Some have less, and some have more. There are three advantages to using urethral tissue in her opinion. For one, it is pink in color, so closely resembles what cisgender women look like. Secondly, she said the urethral tissue is also erectile in nature, and this is not a bad thing. During arousal, you will feel a kind of tightness, a kind of responsiveness in your vagina when sexually aroused. Thirdly, the urethral tissue is secretory and aids in lubrication during arousal. BTW, she has professional differences of opinions with Dr. Meltzer about this technique. They have had direct conversations and they agree to disagree.
6. Penile inversion technique vs. non-penile inversion. She said this was a misnomer. The penis is not actually "inverted". She discards almost all "penile skin" - not penile tissue, but penile dermis. The corpus cavernosa is not used, but the glans and urethral tissue are used. The only thing from your penis that goes inside the neovagina is the nerve. Again, she pays particular attention to aesthetics. The insides of pussies are pink. Your pussy will be pink inside, not brown.
7. General comments. She doesn't like what she sees as the medical profession exploiting the transgender population. She said there are dozens of new SRS surgeons that have sprung up over the last few years because they see the demand outstripping the supply and the potential for creating a lucrative money stream. She does not say this because they are taking away business. She has more requests for her services than she can handle. She does over 100 SRS procedures a year, and has been doing it for ten years. She will come right out and tell you that the best SRS surgeons in North America are Meltzer, Bowers, Brassard, and herself, with Meltzer having more experience than anybody. She feels the newer surgeons cannot give adequate medical support in the event of complications. When things go right, everything is fine, but they simply don't have the experience to fix things when they go wrong. She runs what she describes as a "boutique" medical practice that specializes in transgender health care, not just plastic surgery, although she is a board-certified plastic surgeon.
8. I went with McGinn. I really liked her. I really trust her. My SRS date is August 8th.
Hope that helps answer some questions. Again, this was from memory, so any errors in details are mine alone.
With kindness,
Terri
EDIT: fixed several errors, with thanks to KayXo
Hi Terri...Dr. McGinn just sounds like the gold standard to me. I would love to hear what kind of quote you received from her. If you'd feel more comfortable, You can PM the info to me and of course, I would keep it to my self. On a different note, I saw Dr. Z today and I would suggest the military discount he afforded you was real as I was quoted a good bit more than you were for what appears to be roughly the same work. Love to talk more in private if you're interested. 23 hours of electrology faces me tomorrow...ugh!
Anyways, All the best to you always. J
Hi Jentay,
I would be glad to exchange PMs with you. I am running around this morning, but I can shoot you a PM this afternoon/evening.
Blessings to you,
Terri
Not quite sure if this is ok or not, but if you want to see some results for these surgeons search for A collection of links to photos of SRS results. Its not a link, so I guess we'll see,
QuoteVaginal depth is *not* necessarily related to penis length. It has more to do with available space between the rectum and peritoneum.
Quote from: KayXo on April 03, 2017, 09:41:51 PM
I think you mean to say perineum, the space between the scrotum (or vulva in ciswomen) and rectum. Peritoneum, on the other hand, is the membrane that forms the lining of the abdominal cavity.
The peritoneal wall would absolutely define a limit on depth. The perineum is external.
Depth is still related to the skin available from the penile shaft + some of the scrotal skin. If that's not sufficient then it can only be made up from almost grafts taken from elsewhere on the body, usually the thigh.
The advantage of inverting the penile skin seems to me to be that it's innervated, which I don't think a graft can ever be. ** I verified this with Dr Wittenberg **.
Excess urethral mucosa is used by various docs in different ways. Satterwhite and Wittenberg use it to form inner labia, I think that's the most common use in the use. It's not what the surgical team at BMC is doing and so I think also not the method used by the docs they observed at UMich and Baltimore (names escape me). I think Oates at BMC mentioned using it near the neocltoris. There's a surgeon in Germany using it as part of the neovaginal wall.
Quote from: SadieBlake on April 08, 2017, 03:27:38 PM
The peritoneal wall would absolutely define a limit on depth.
I'm not sure that's quite correct, assuming peritoneal wall and peritoneal reflection are the same thing. This is from Suporn's site
Maximum vaginal depth attained with the scrotal skin graft beyond the original position of the peritoneal reflection (Douglas Pouch). A minimum of 6.0" (15.25 cm) vaginal depth is guaranteed immediately after surgery in all cases of SRS. The modal average is 7.0" (17.8 cm) depth.http://www.supornclinic.com/restricted/SRS/srstechnique.aspx
Disclosure: I was a Suporn patient
It isn't just about which skin type is used. Two related questions are:
1. What hair removal is needed? Suporn nurses punch the follicles so no hair removal is needed.
2. Will the graft retain its blood supply? One possible downside of the Suporn technique is that the graft is separated from its original blood supply. Some surgeons see this as a potential risk of graft failure. The advantage is greater flexibility in where the vaginal opening is created so that Suporn can make the most anatomically correct choice.
Quote from: Maybebaby56 on April 03, 2017, 09:14:15 PM
3. She does not find the "meshing" technique some Thai surgeons use to be a good thing. Tougher recovery. Much greater chance for scar tissue to form.
There are advantages and disadvantages to using the meshing technique. Yes, when used, there is potential for scarring that requires using a special dilation technique and recovery is usually longer. Realize though that meshing is only used when the amount of scrotal tissue is insufficient to achieve a sufficiently deep vagina. Girls who transition pre-puberty generally have very little penile and scrotal tissue to work with. By using the meshing technique, Suporn can avoid using skin grafts from elsewhere on the body. I have a friend who had GRS with Suporn and meshing was not done because there was adequate scrotal tissue available.
Quote from: Maybebaby56 on April 03, 2017, 09:14:15 PM
6. Penile inversion technique vs. non-penile inversion. She said this was a misnomer. The penis is not actually "inverted". She discards almost all "penile skin" - not penile tissue, but penile dermis. The corpus cavernosa is not used, but the glans and urethral tissue are used. The only thing from your penis that goes inside the neovagina is the nerve. Again, she pays particular attention to aesthetics. The insides of pussies are pink. Your pussy will be pink inside, not brown.
I'm totally confused by this. Penile skin is certainly used in one way or another. In the penile inversion technique it is used to line at least the first few inches of the vaginal canal. The glans is cut down to form the clitoris in all methods and the penile dorsal nerve HAS to be left in tact for clitoral sensitivity. It makes no sense to use the dorsal nerve to fashion the neo-vagina canal. It cannot be cut or its length shortened. But it has to be placed somewhere. Could McGinn be placing it along the top of the vagina on the way up to the clitoris?
Quote from: Clara Kay on April 08, 2017, 10:14:42 PM
There are advantages and disadvantages to using the meshing technique. Yes, when used, there is potential for scarring that requires using a special dilation technique and recovery is usually longer. Realize though that meshing is only used when the amount of scrotal tissue is insufficient to achieve a sufficiently deep vagina. Girls who transition pre-puberty generally have very little penile and scrotal tissue to work with. By using the meshing technique, Suporn can avoid using skin grafts from elsewhere on the body. I have a friend who had GRS with Suporn and meshing was not done because there was adequate scrotal tissue available.
I did not know that about Suporn. I assumed the meshing was always used so that the increased depth could be achieved. I had assumed that was one of the larger factors in why Suporn is able to get an average of 7" rather than the 5.5" I see in the states more commonly.
The analysis of surgeons techniques is interesting, but personally I'm not really clear on how it relates to results. I'm not confident we even have the correct basic information about what the surgeons actually do and why they do it.
Instead I like to look at photo's of post-op SRS results. You can find a bunch of photo's for these surgeons if you look at my previous post. Its not ideal as there's not a large number, but its better than nothing, and its something you can judge for yourself rather than relying on others opinions.
I think its also fairly well established that for whatever reason Suporn is really good at depth regardless of the starting material, and that his recovery is double that of USA surgeons (he says it himself, so I guess it must be true). You definitely have to travel to Thailand, but you also get a very high level of aftercare. He's known for that and his free revisions.
Suporn doesn't require hair removal (its on his site), but a small percentage of women do have hair post-op. On the plus side due to his technique its in a location that's easily removed (according to one women who had it and wrote about it).
I attended a presentation by Dr. Marci Bowers a couple of years ago. She said that most GRS surgeons are very secretive about their methods. That certainly is the case for Dr. Suporn whose website has not been updated in years. A friend who went to Suporn confirmed this "close to the vest" stance concerning the details of his methods. She asked him straight out how her operation was done, and never got a satisfactory answer. She obtained 7" depth and her recovery has been rapid because the meshing technique was not needed in her case.
In the non-penile inversion method the vaginal tube is formed completely from scrotal skin which has been scraped of all fat and follicles and then meshed if necessary. There is little risk of hair growing deep inside the vagina. The vaginal lining is sutured around a form (e.g., a condom filled with gauze), and inserted into the space created between the rectum and the bladder/prostate as far in as the peritoneal reflection, a point beyond which the vagina cannot extend. A patient's unique anatomy puts a limit the vaginal depth achievable. The neo-vagina/stent is then stitched in place around its opening (introitus) and to a flap of skin (perineum) which has had hair follicles removed by cauterization. It's this area (the bottom entrance of the vagina) where hair sometimes returns, and some girls have this small area treated by electrolysis prior to GRS surgery to ensure that the hair is removed. I, a Chettawut girl, didn't, and a few hairs have grown back. My electrologist has offered to clear these hairs when I'm ready. Frankly, they are of little bother to me.
Quite interesting discussion.
Quote from: Clara Kay on April 09, 2017, 10:07:52 AM
The neo-vagina/stent is then stitched in place around its opening (introitus) and to a flap of skin (peritoneum) which has had hair follicles removed by cauterization.
I assume you mean perineum.
I forgot to mention that Suporn's offer to do free revisions is not unique. Chettawut also does free revisions. It's something to consider, but realize that travel to/from Thailand and lodging expenses for a couple of weeks is on your buck. These expenses are not insignificant if you live in the U.S. A 20+ hour flight in coach is no picnic either, especially with a sore bottom. I chose to have my labia majora revised here in Chicago at my expense despite Chett offering to do it for free. The cost difference was minimal.
From my experience seeing the results of various GRS surgeons, the results are all over the map. To categorically say that you'll have a more realistic looking vulva going to Suporn is simply not true. You might think that a surgeon's method determines the outcome, but that's not the only factor at play. A patient's anatomy is so important. It's too bad there isn't a provision here at Susan's to post photos of results. It would go a long way toward helping girls decide which surgeon is best for them.
Quote from: Lucie on April 09, 2017, 10:23:31 AM
Quite interesting discussion.
I assume you mean perineum.
Yes, thanks. Corrected. <3
Can someone explain to me the mesh technique? I don't quite get it...Thanks. :)
Scrotal tissue, by the way, doesn't contain fat.
If it's the same thing as used in skin grafts, it's cutting a lot of slits into the skin, so that it can be stretched to cover a larger area. It's a technique that's often used with severe burns, to quickly cover a large area.
I'm not trying to argue one surgeons better than another here (though I do have an opinion on that), only on what basis we can can judge such things.
Quote from: Clara Kay on April 09, 2017, 10:25:49 AM
It's too bad there isn't a provision here at Susan's to post photos of results. It would go a long way toward helping girls decide which surgeon is best for them.
Couldn't agree more, but I can't imagine it will ever happen.
Quote from: Clara Kay on April 09, 2017, 10:25:49 AM
I forgot to mention that Suporn's offer to do free revisions is not unique. Chettawut also does free revisions. It's something to consider, but realize that travel to/from Thailand and lodging expenses for a couple of weeks is on your buck. These expenses are not insignificant if you live in the U.S. A 20+ hour flight in coach is no picnic either, especially with a sore bottom. I chose to have my labia majora revised here in Chicago at my expense despite Chett offering to do it for free. The cost difference was minimal.
That's an example of something that's either true or not and presumably easy to check. I could go and have a look at other posts and see if everyone else says the same. Its a useful filter on selecting a surgeon if it matters to you.
Quote from: Clara Kay on April 09, 2017, 10:25:49 AM
From my experience seeing the results of various GRS surgeons, the results are all over the map. To categorically say that you'll have a more realistic looking vulva going to Suporn is simply not true. You might think that a surgeon's method determines the outcome, but that's not the only factor at play. A patient's anatomy is so important.
Not so easy to check. I don't know really how important anatomy is, and if a particular surgeon is better for a certain type of anatomy. To state a particular surgeon is always better is not possible without them both doing the SRS on the same patient, for all patients - apart from that we can only look at a sample and guess. My approach is to look at the samples I have and guess. The sample is really small, so at the end of it I can only hope my guess is correct.
Another factor I forgot to mention is to look at complaints about the surgeons. They all have them, some more than others. Like with the results photo's there's not that many complaints, so its hard to judge. There's one surgeon, not mentioned here, that has a large number of complaints.
Quote from: AnonyMs on April 09, 2017, 11:06:23 AM
I'm not trying to argue one surgeons better than another here (though I do have an opinion on that), only on what basis we can can judge such things.
Couldn't agree more, but I can't imagine it will ever happen.
That's an example of something that's either true or not and presumably easy to check. I could go and have a look at other posts and see if everyone else says the same. Its a useful filter on selecting a surgeon if it matters to you.
Not so easy to check. I don't know really how important anatomy is, and if a particular surgeon is better for a certain type of anatomy. To state a particular surgeon is always better is not possible without them both doing the SRS on the same patient, for all patients - apart from that we can only look at a sample and guess. My approach is to look at the samples I have and guess. The sample is really small, so at the end of it I can only hope my guess is correct.
Another factor I forgot to mention is to look at complaints about the surgeons. They all have them, some more than others. Like with the results photo's there's not that many complaints, so its hard to judge. There's one surgeon, not mentioned here, that has a large number of complaints.
Unfortunately, in the case of GCS, it does look as though size matters. The less material they have to work with and generally speaking, the longer you have spent on HRT, is going to make a difference on aesthetics and function(the latter point meaning more time being detrimental). At least based on everything I've gleaned over the years that appears to be the case. And this all seems to be regardless of Surgeon :'(
Quote from: jentay1367 on April 10, 2017, 08:44:05 AM
Unfortunately, in the case of GCS, it does look as though size matters. The less material they have to work with and generally speaking, the longer you have spent on HRT, is going to make a difference on aesthetics and function(the latter point meaning more time being detrimental). At least based on everything I've gleaned over the years that appears to be the case. And this all seems to be regardless of Surgeon :'(
It seems obvious that anatomy is important, and may be the most important factor in affecting the outcome which is why surgeons who do the penile inversion method like patients who are uncircumcised. I believe that the choice of a surgeon becomes especially important when the amount of genital tissue is lacking. To achieve a good result in girls with under developed genitals is much more challenging. This is, I believe, why Dr. Suporn is considered one of the best, and his meshing technique is one of the ways he deals with such patients. His reputation for using ALL available tissue is another indication for his being an especially good choice for young trans women who avoided male puberty. Suporn's fees are much higher than other Thai surgeons because of this special expertise.
If a patient has ample genital material for the surgeon to work with, the choice of a surgeon is not as important. The choice then comes down to affordability, method, timing, and location. I considered going to Dr. McGinn and Dr. Bowers for my GRS. They are both tops in their field, and I liked the idea of them being trans women themselves. Their fees, however, were quite high and their waiting lists quite long.
When my research uncovered the work of Thai surgeons like Dr. Suporn and Dr. Chettawut, I was intrigued. The non-penile inversion method appeared to be an improvement over the inversion method. I contacted both Suporn and Chettawut with inquiries about fees and timing. I got a recommendation from a friend who went to Dr. Chettawut, so when Ms. Som wrote back that Dr. Chett had an opening in just two months and that the fee was half what Dr. Suporn wanted, my decision was made. Even with the cost of business class travel for two to Thailand and a stay of 30 days, the cost was several thousand dollars less than if I had waited for Drs. McGinn or Bowers.
I was lucky, however, if I had experienced complications after returning home, followup treatment would have been difficult depending on the problem. Fortunately, by the time one is released to go home, the chances of an unforeseen complication are very low.
As much as I would like to use McGinn, my concern too, is for her waiting list with what may not be enough difference to be important to me. Many here seem to recommend PAI for a number of reasons and they seem like my alternate to McGinn. Add to that, I get a trip to Thailand. Get to mark two things off the bucket list ;)
It seems to me that these are very theoretical exercises as to who does what and why, and how it translates into results. Theory is useful only so long as it matches reality, and I'm not sure it does. I've seen a fair number of photographic results now that don't match what I'd expect from reading about surgeons.
Quote from: AnonyMs on April 10, 2017, 12:53:33 PM
It seems to me that these are very theoretical exercises as to who does what and why, and how it translates into results. Theory is useful only so long as it matches reality, and I'm not sure it does. I've seen a fair number of photographic results now that don't match what I'd expect from reading about surgeons.
So what's your suggestion? In the final analysis, you must choose a surgeon and deal with their results. Without a crystal ball, there's really nothing left to be done about it. Like any surgery, it's a calculated risk.
I'd reduce the risk by looking at photo's of their work - they are out there. I'd also (and have) read a massive number of posts about them trying to look information that I can have some confidence in.
Unfortunately, the photos on the surgeons' websites most likely show only the more successful results. It's marketing. Not that these photos aren't of value in making a decision as long as you realize they've been cherry picked. I've exchanged post-op pics with other girls privately and seen the good, bad and the ugly from highly regarded surgeons. It's got to be more than just the choice of a surgeon.
There's plenty of photo's that are not from the surgeons sites. Search for "A collection of links to photos of SRS results", or pm me.
Quote from: AnonyMs on April 10, 2017, 02:05:36 PM
I'd reduce the risk by looking at photo's of their work - they are out there. I'd also (and have) read a massive number of posts about them trying to look information that I can have some confidence in.
I'm going more by accounts of experiences with specific surgeons, their training, experience and reputation and last but ultimately most important, verifying these things and assessing less quantifiables in my interaction with the docs. My filter is a bit different, having worked in the medical industry all my life and interacted with a lot of surgeons.
Some elements of the results are simply going to be luck and biology. I happen to know I heal well and fast and if I didn't I'd probably not be proceeding to GCS at all. On the one hand I discount virtually all opinions about how good or bad any given surgeon is, however I also rejected a couple based on those less tangible interactions; good practitioners, no doubt but one wonderful thing today is that we have a lot of choices.
The Thai surgeons aren't an option as I don't have that much money and am covered by insurance, however their long healing times also make them a no-no for me.
RE: SadieBlake: I happen to know I heal well and fast and if I didn't I'd probably not be proceeding to GCS at all.
Hmmmmmm . . . I'm 65, and while I have always healed well and fast, I'm not as good as I used to be. Been on HRT for over 15 years and under an excellent doctor's care for all of this time. My Labs and heart are outstanding. They say I have the heart of a 16 year old and signed off on GCS for me without hesitation. Still, I do have some concerns since I'm older. . . and your comment makes me think again . . . . any thoughts??
65's not so old for SRS - have a read of this great post by Warlockmaker
My wonderful surgeries SRS, BA and FFS at PAI Bangkok
https://www.susans.org/forums/index.php/topic,204651.0.html
Gail, my body is fundamentally functioning as well as it was when I last had surgery, that was about 6 years ago. I just turned 61 yesterday and feeling good about the procedure, I'll let you know how it goes.
Quote from: SadieBlake on April 11, 2017, 09:19:12 PM
Gail, my body is fundamentally functioning as well as it was when I last had surgery, that was about 6 years ago. I just turned 61 yesterday and feeling good about the procedure, I'll let you know how it goes.
Well, that is a surprise. I had you pegged for someone much younger. :) Yes, please let me know how things progress. I had a Consultation last week for GCS and I'm waiting for a date right now. My usually bullet-proof GP's letter did not have the correct recommendations. They're doing a re-write and when it's finally received my surgeon they will give me a date. I need to get Medicare to pay for this so everything needs to be perfect when it's submitted. My date will likely be next January.
And thanks AnonyMs for the link . . . and your thoughts as well. . . :)
I don't' know how many of us there are here but perhaps an "Over-60 GCS Thread" would be beneficial for some . . . ?
Quote from: Gail20 on April 12, 2017, 01:07:03 PM
I need to get Medicare to pay for this so everything needs to be perfect when it's submitted.
Hi Gail, I too am planning on using Medicare.
Is Dr. Mcginn currently accepting Medicare patients? If you are planning on going elsewhere may I ask where? Also is there any particular contact person I should try and reach?
I could really use the feedback and information. If you'd rather not post it on this thread, I would highly appreciate a PM.
Thanks!
~Brooke~
Has this been superseded with new policy?
https://gendertrender.wordpress.com/2016/08/31/medicare-denies-national-coverage-for-gender-reassignment-surgery-no-evidence-of-therapeutic-outcome/ (https://gendertrender.wordpress.com/2016/08/31/medicare-denies-national-coverage-for-gender-reassignment-surgery-no-evidence-of-therapeutic-outcome/)
update...apparently they do on a case by case basis. My question would be what criteria they're using this week and what kind of percentages are being covered? It would be tragic to count on this and have it dismissed and denied out of hand after having counted on it. Seems like all government programs, it does more harm than good. :(
From Medicare:
"Based on a thorough review of the clinical evidence available at this time, there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria. There were conflicting (inconsistent) study results – of the best designed studies, some reported benefits while others reported harms."
Quote from: jentay1367 on April 12, 2017, 04:03:46 PM
Has this been superseded with new policy?
https://gendertrender.wordpress.com/2016/08/31/medicare-denies-national-coverage-for-gender-reassignment-surgery-no-evidence-of-therapeutic-outcome/ (https://gendertrender.wordpress.com/2016/08/31/medicare-denies-national-coverage-for-gender-reassignment-surgery-no-evidence-of-therapeutic-outcome/)
update...apparently they do on a case by case basis. My question would be what criteria they're using this week and what kind of percentages are being covered? It would be tragic to count on this and have it dismissed and denied out of hand after having counted on it. Seems like all government programs, it does more harm than good. :(
From Medicare:
"Based on a thorough review of the clinical evidence available at this time, there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria. There were conflicting (inconsistent) study results – of the best designed studies, some reported benefits while others reported harms."
Private practice surgeons are VERY UNLIKELY to ever taker Medicare. Medicare pays less and these surgeons are overbooked. They don't want to take Medicare; they'd lose money. Once any Doctor accepts a single Medicare patient for a procedure they MUST take all Medicare patients in the future.
Best to go to the surgeons connected with Gender Programs in Universities and Hospitals. They already take Medicare and know how to work with it. . .
Also, if you're going to try to use Medicare make sure you make it easy for the Practice to work with you. Look organized!! Make it harder to tell you no. Get all your letters done in advance; 1 each from two different Therapists and also a letter from your Doctor who has been prescribing HRT for you, saying he is recommending you for GCS.
Quote from: jentay1367 on April 12, 2017, 04:03:46 PM
Has this been superseded with new policy?
https://gendertrender.wordpress.com/2016/08/31/medicare-denies-national-coverage-for-gender-reassignment-surgery-no-evidence-of-therapeutic-outcome/ (https://gendertrender.wordpress.com/2016/08/31/medicare-denies-national-coverage-for-gender-reassignment-surgery-no-evidence-of-therapeutic-outcome/)
update...apparently they do on a case by case basis. My question would be what criteria they're using this week and what kind of percentages are being covered? It would be tragic to count on this and have it dismissed and denied out of hand after having counted on it. Seems like all government programs, it does more harm than good. :(
From Medicare:
"Based on a thorough review of the clinical evidence available at this time, there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria. There were conflicting (inconsistent) study results – of the best designed studies, some reported benefits while others reported harms."
Medicare uses "Best Evidence-" or should be.
Looks like the right hand is not talking to the left.
The 2014 decision that removed blanket ban won as evidence prior to 1981 that determined srs was experimental was ruled as not relevant and thrown out.
A national coverage decision (ncd) was triggered by this decision.
The decision summery recommendation that is quoted does indeed state that their was not enough evidence for the Medicare population.
But... they never took the 2014 decision into account, and that the "experimental evidence prior to 1981" was dismissed. In their meta(like)-analysis they used all studies that matched their search criteria from pubmed, including all of the evidence that was dismissed in 1981. Their results then of course were determined to be inconclusive.
Because there is no NCD, there is also no set reimbursement amount a surgeon can look up. This is a biggie, and then because of the seeming misinformation with the local MACs coverage is denied.
Currently best evidence is of course wpath. In their revised statements of medical necessity they argue that care (and procedures) must be customized to the patient.
I am working through a Medicare Appeal for hair removal that I imagine is going to end up in front of an Administrative Law Judge. I am also building up a case for the NCD recommendation based on "best evidence, and wpaths SOC/necessity statements".
If we can get a NCD, we then have a far better chance of finding surgeons willing to work with us.
Because Medicare does not have a prior auth system it's currently a huge gamble if it will be covered.
~Brooke~
I hope these people snap out of it and take care of those of us that need this life saving procedure. I'll cross my fingers for some civilized decisions to be made. Thanks for that great info, Brooke!
Quote from: Brooke on April 12, 2017, 07:37:24 PM
I am working through a Medicare Appeal for hair removal that I imagine is going to end up in front of an Administrative Law Judge. I am also building up a case for the NCD recommendation based on "best evidence, and wpaths SOC/necessity statements".
If we can get a NCD, we then have a far better chance of finding surgeons willing to work with us.
Because Medicare does not have a prior auth system it's currently a huge gamble if it will be covered.
~Brooke~
Thank you so much for your summary and activism!!
Quote from: Brooke on April 12, 2017, 03:16:02 PM
Hi Gail, I too am planning on using Medicare.
Is Dr. Mcginn currently accepting Medicare patients? If you are planning on going elsewhere may I ask where? Also is there any particular contact person I should try and reach?
I could really use the feedback and information. If you'd rather not post it on this thread, I would highly appreciate a PM.
Thanks!
~Brooke~
I had surgery with Dr. Mcginn on 4/1/17.
She'll "accept" any patient because Dr. McGinn requires payment up front in the form of a money order/certified check, and then her office will work with your insurance to get approval. Her office was SOO helpful getting approval, but they do make it clear at the end of the day, it is the patient's financial responsibility.
I paid up front for her surgery fee and the anesthesia fee, and then I had to submit a reimbursement form to my insurance company after the procedure was completed. The hospital fee was billed directly to my insurance (Tufts PPO in Massachusetts).
Quote from: Ellemrob on April 13, 2017, 02:43:01 PM
I had surgery with Dr. Mcginn on 4/1/17.
She'll "accept" any patient because Dr. McGinn requires payment up front in the form of a money order/certified check, and then her office will work with your insurance to get approval. Her office was SOO helpful getting approval, but they do make it clear at the end of the day, it is the patient's financial responsibility.
I paid up front for her surgery fee and the anesthesia fee, and then I had to submit a reimbursement form to my insurance company after the procedure was completed. The hospital fee was billed directly to my insurance (Tufts PPO in Massachusetts).
I don't have the money for GRS. If Medicare doesn't pay I'm out of luck so McGinn is not an option for me at all. . . My first choice was Dr Satterwhite. I had all my documentation in with them and made an impassioned plea but they said no to Medicare. That's when I realized the impact of taking just one Medicare patient was to a practice. It just does not make good business sense for them. . . I'm now just looking at University or Hospital based programs. . . .
Quote from: Ellemrob on April 13, 2017, 02:43:01 PM
I had surgery with Dr. Mcginn on 4/1/17.
She'll "accept" any patient because Dr. McGinn requires payment up front in the form of a money order/certified check, and then her office will work with your insurance to get approval. Her office was SOO helpful getting approval, but they do make it clear at the end of the day, it is the patient's financial responsibility.
I paid up front for her surgery fee and the anesthesia fee, and then I had to submit a reimbursement form to my insurance company after the procedure was completed. The hospital fee was billed directly to my insurance (Tufts PPO in Massachusetts).
Good to know. I'm actually a patient at Tuff's already- for corneal issues. In any case I go to Boston once a year for that. A trip is coming up this summer, may just have to book a consult while I'm there.
~Brooke~