Are transitional surgeries (SRS/top surgery/FFS, etc) reconstructive surgery?
Why or why not?
On the one hand, they're correcting a defect. On the other hand, reconstructive surgery, by definition has to improve function.
And there's the stuff about cutting into perfectly 'normal' healthy parts, etc
What do you think?
I thought about this a bit recently actually.
Is mtf srs really plastic? Nothing is fake, nothing is added, and it is not really a cosmetic surgery. In many ways it really is reconstructive. Same for top surgery for you guys. You guys are having an "abnormal growth" removed you could say.
In some ways though, almost all of it could be seen that way, are we not just correcting a birth defect? The problem is where to draw the line on reconstructive vs. plastic. In terms of breasts, girls get what they get, so is it still reconstructive for us? I would say no. And while testicle implants for you guys are technically cosmetic, like a woman with a mastectomy, you are just fixing what is missing.
Quote from: Nero on February 21, 2009, 12:41:58 PM
Are transitional surgeries (SRS/top surgery/FFS, etc) reconstructive surgery?
Why or why not?
On the one hand, they're correcting a defect. On the other hand, reconstructive surgery, by definition has to improve function.
Yes and they DO improve function.
If the question is are these surgeries reconstructive or are they corrective, then I think the answer is "yes." ;)
They're only 'corrective' or 'reconstructive' if the parts being worked on are somehow dysfunctional. Any form of SRS is cosmetic surgery.
Quote from: Mister on February 21, 2009, 04:41:21 PM
They're only 'corrective' or 'reconstructive' if the parts being worked on are somehow dysfunctional. Any form of SRS is cosmetic surgery.
Being physically repulsed and feeling nauseous by touching a part and hating the sight of it, not to mention emotional distress when it performs its supposed function... I'd say that was pretty dysfunctional, in that it doesn't function properly in the way it's supposed to, in the context of the entire organism. And it's detrimental to the physical and mental well-being of the person concerned, preventing them from living life to the full.
So... reconstructive in that it can reconstruct a person's sense of self, sense of place, sense of well-being, ability to enjoy parts of life which they've previously been denied, ability to function confidently in society... perhaps. :)
What Leiandra said!
tink :icon_chick:
Quote from: Leiandra on February 21, 2009, 04:54:11 PM
Being physically repulsed and feeling nauseous by touching a part and hating the sight of it, not to mention emotional distress when it performs its supposed function... I'd say that was pretty dysfunctional, in that it doesn't function properly in the way it's supposed to, in the context of the entire organism. And it's detrimental to the physical and mental well-being of the person concerned, preventing them from living life to the full.
So... reconstructive in that it can reconstruct a person's sense of self, sense of place, sense of well-being, ability to enjoy parts of life which they've previously been denied, ability to function confidently in society... perhaps. :)
*shrug* sorry, I disagree. hate your penis as much as you'd like, but does it allow you to urinate? ejaculate (hormones aside)?
If it works and you just want rid of it, it's plastic surgery.
If I have a bump on the bridge of my nose that i hate and i want it removed, this is plastic surgery. If a deviated septum made breathing difficult, that is reconstructive.
Quote from: Mister on February 21, 2009, 05:03:30 PM
*shrug* sorry, I disagree. hate your penis as much as you'd like, but does it allow you to urinate? ejaculate (hormones aside)?
If it works and you just want rid of it, it's plastic surgery.
If I have a bump on the bridge of my nose that i hate and i want it removed, this is plastic surgery. If a deviated septum made breathing difficult, that is reconstructive.
That's true... but consider if it didn't allow you to ejaculate simply because you couldn't have sex or masturbate due to the psychological trauma such acts caused. Not didn't want to,
couldn't. Psychosomatic dysfunction is just as potent and detrimental as physical dysfunction.
Quote from: Leiandra on February 21, 2009, 05:12:28 PM
That's true... but consider if it didn't allow you to ejaculate simply because you couldn't have sex or masturbate due to the psychological trauma such acts caused. Not didn't want to, couldn't. Psychosomatic dysfunction is just as potent and detrimental as physical dysfunction.
That's like saying a woman who has trauma around a rape should have a vaginectomy covered by her insurance as 'reconstructive.'
Quote from: Mister on February 21, 2009, 05:17:00 PM
That's like saying a woman who has trauma around a rape should have a vaginectomy covered by her insurance as 'reconstructive.'
If it goes some way to reconstructing her ability to function as a productive, emotionally stable human being... maybe it should.
But that's a flawed analogy. Your example is based on trauma caused by an outside event that happened to someone, and dysfunction through feelings that event caused. With counselling, time, therapy and support, that can be alleviated somewhat.
However, with GID sufferers, the trauma is caused by the anatomical organs themselves and their very existance, free from all external stimuli and influence. And, as I assume you know, the above methods will
not alleviate that dysfunction and mental suffering... and there is often only one option to allow sufferers to function as complete human beings. The reconstruction, or correction, of the individual's physical anatomy to correlate with their internal identity and self-perception. And, for now, that can
only be accomplished through surgery.
So... no, it's not really the same thing.
I get where this whole thread is going- surgeries should be covered by insurance companies, which i also don't agree with. they're not necessary.
That's your opinion and in your case that may or may not be true. But you can't claim to know everyone else, their lives, circumstances, and what they do or do not need in order to be able to function properly.
The question was whether transition related surgeries were reconstructive or not. Insurance and how those surgeries are paid for, in this instance, are irrelevant and not part of the debate.
Quote from: Mister on February 21, 2009, 05:49:27 PM
I get where this whole thread is going- surgeries should be covered by insurance companies, which i also don't agree with. they're not necessary.
that's not the intent behind this thread. i'm just interested in discussion about whether our surgeries seem more reconstructive or cosmetic. not in the legal sense.
...and also let's remember that for some of us, SRS is a matter of life and death; hence, it is extremely necessary (for some of us, of course).
I know, I know..off topic, but it needed to be said.
tink :icon_chick:
The "plastic" in plastic surgery refers to moulding and shaping, and in that sense SRS IS plastic surgery.
Is it reconstructive? No because it is not recreating or repairing something that was there before and was damaged.
Is it necessary? It was for me. I would have been dead 35 years ago if I had not found a surgeon. That is not a supposition but a fact. I was seriously suicidal prior to the availability of SRS and only escaped the last attempt by a miracle.
One can very easily argue that these surgeries are medically warranted.
Look at the suicide numbers for trans people... A 20%+ death rate is not exactly good odds.
Besides even the medical community is now standing behind it, so obiously they feel they are necessary as well.
Quote from: Mister on February 21, 2009, 04:41:21 PM
They're only 'corrective' or 'reconstructive' if the parts being worked on are somehow dysfunctional. Any form of SRS is cosmetic surgery.
1. That's YOUR opinion, which isn't shared by many here.
2. Try being a little respectful and understanding of other people here.
3. If you really believe that BS you're spewing why transition at all?
4. If you really believe that BS you don't belong here, try the "Transgender" section.
Quote from: Mister on February 21, 2009, 05:49:27 PM
I get where this whole thread is going- surgeries should be covered by insurance companies, which i also don't agree with. they're not necessary.
The AMA seems to disagree with you. http://www.gires.org.uk/assets/Medpro-Assets/AMA122.pdf (http://www.gires.org.uk/assets/Medpro-Assets/AMA122.pdf)
Seems like there's a wolf in the henhouse. As a preop transsexual, I find this abusive:
I get where this whole thread is going- surgeries should be covered by insurance companies, which i also don't agree with. they're not necessary.
My belief (100%) is that if you are a classic transsexual, then SRS and FFS are reconstructive. In the case of FFS, I think that if you pass 100% then any FFS would be plastic surgery in my books. By the way, it freaked me out that someone would come here and make blanket statements that are obviously offensive and confidence shaking. I come here looking for knowlege and support. Thanks to those who are helping me with that. To me it's like sharing love which is akin to sacred space.
I cant say I would call SRS reconsturctive surgery but It is corrective. I am female. The penis is not supposed to be there. I actually have taken to calling it GCS (Gender Corrective Surgery) as opposed to SRS. In my opinion its not reassigning my gender but correcting it.
I believe the exclusions related to the care of transsexuals in health insurance coverage is a civil rights issue which organizations such as the ACLU should involve themselves with.
I agree asking for coverage for FFS may be stretching it, but to deny coverage of any treatment as though this is something we are making up is ridiculous. In fact, I find the exception clauses found in most insurance plans offensive to read.
State of Connecticut Teachers' Retirement Board Health and Prescription Drug Benefits PlanQuoteFor all Medical Benefits shown in the Schedule of Benefits, a charge for the following is not covered: ... Care, services or treatment for transsexualism, gender dysphoria or sexual reassignment or change, including medications, implants, hormone therapy, surgery, medical or psychiatric treatment.
Saying that GRS is "not" necessary for someone who's truly transsexual is the same of kind of sick logic you get from fundamentalists, and those peeps that choose to live in between sexes for the rest of their lives. It's disgusting & nothing more than rubbish!
Id say no... its not reconstructive... that suggests a ... in the case of an m2f, a vagina was present, removed, or damaged, and is being repaired.
Its corrective surgery for a defect.... its 'giving the paitent quality of life' which is what so very many seemly 'vital' surgeries do... Hip replacements, pace makers, artificial synovial sacks, and arthritis surgeries are not 'life threatening' in the view of opponents. but they provide identical comfort to the recipiant, and allow them to live a functional life.... I'd love to see them challenge that tbh.... as there would be an uproar if they removed funding for say... Hip replacements and joint repair surgeries for those needing it.... well, they can have a wheelchair cant they? i think not.
Quote from: Starbuck on February 21, 2009, 11:22:19 PM
its 'giving the paitent quality of life' which is what so very many seemly 'vital' surgeries do... Hip replacements, pace makers, artificial synovial sacks, and arthritis surgeries are not 'life threatening' in the view of opponents. but they provide identical comfort to the recipiant, and allow them to live a functional life.... I'd love to see them challenge that tbh.... as there would be an uproar if they removed funding for say... Hip replacements and joint repair surgeries for those needing it.... well, they can have a wheelchair cant they? i think not.
It comes, at least in America, from an early theory put forth by a co-founder of the Gender Identity Clinic at Johns Hopkins, who had "tabula rasa" inclinations. He felt the mind of the infant comes into this world having no inherent personality characteristics.
He advocated treating intersexed babies with "corrective surgeries" converting their genitals so they resembled, well whatever was easier- usually vaginas, then raising the child accordingly. Eventually this became the accepted practice of the time.
This theory also would have suggested transsexualism must be a learned trait, which as such should be possible to unlearn. So surgeries to fix the bodies rather than the brain certainly didn't seem like the only option, and this gave insurance companies the ammunition to make exclusions for the treatment.
Unfortunately, the blank slate theories, especially pertaining to gender identity, have been proven completely wrong by now, as (among other things) this follow-up study on some of those children who were surgically turned into the wrong sex shows: http://ai.eecs.umich.edu/people/conway/TS/HopkinsStudy.html (http://ai.eecs.umich.edu/people/conway/TS/HopkinsStudy.html)
Not surprisingly, the insurance companies haven't taken the initiative to remove the exceptions from their policies in spite of all the new evidence.
it was males where possible.... females where not...
And the man you speak of was the enlightened Doctor Money? i think we need say no more, that man's false theroires landed me in this mess...
Females converted to males were definitely a rarity, for obvious reasons.
http://en.wikipedia.org/wiki/Intersex_surgery (http://en.wikipedia.org/wiki/Intersex_surgery)
And yep, it was Dr. Money. His theories were loosely based on AIS girls pretty much always having a well-adjusted female identity after being raised as girls, in spite of their XY chromosomes. So it makes sense how the mistake was made, at least to me. He just didn't realize their female identities might have been set in the womb by their insensitivity to testosterone.
Quote from: Nero on February 21, 2009, 12:41:58 PM
Are transitional surgeries (SRS/top surgery/FFS, etc) reconstructive surgery?
Why or why not?
On the one hand, they're correcting a defect. On the other hand, reconstructive surgery, by definition has to improve function.
And there's the stuff about cutting into perfectly 'normal' healthy parts, etc
What do you think?
Yes. (at least from my point of view they are. Im sorry "normal"? Whats that?. Improve function, I hope so)
My GRS has been a cure for my birth defect. It's allowed me to be a normal female in every aspect of life.
Was it necessary? for me it was. I'm alive. It saved my life. It made me whole. So for me it wasn't a "cosmetic operation" or "unnecessary". Sometimes a little bit of empathy goes a long way (even if you don't understand what GRS means to some people like myself) rather than giving blanket, ignorant statements about something you have no idea about.
Quote from: Cami on February 21, 2009, 10:43:26 PM
I cant say I would call SRS reconsturctive surgery but It is corrective. I am female. The penis is not supposed to be there. I actually have taken to calling it GCS (Gender Corrective Surgery) as opposed to SRS. In my opinion its not reassigning my gender but correcting it.
I agree with the Standards of Care (v6 2001) in this matter:
QuoteSex Reassignment is Effective and Medically Indicated in Severe GID. In persons diagnosed with transsexualism or profound GID, sex reassignment surgery, along with hormone therapy and real-life experience, is a treatment that has proven to be effective. Such a therapeutic regimen, when prescribed or recommended by qualified practitioners, is medically indicated and medically necessary. Sex reassignment is not "experimental," "investigational," "elective," "cosmetic," or optional in any meaningful sense. It constitutes very effective and appropriate treatment for transsexualism or profound GID.
Sounds pretty clear to me.
I have to comment on Mister declaring that the thread was leading toward insurance paying for the surgery. I have to respond:
For some of us, what the insurance company's do or don't compensate isn't any of our concern. I (like a large portion of Americans) don't have insurance. The surgery (whatever anyone wants to label it -- corrective, reconstructive, cosmetic) is coming out of my own pocket. Then again, I don't really care if nay-sayers consider my surgery "cosmetic", as long as I am externally the man I am in my head when the doctor's finished.
But for the record, I consider it both cosmetic and reconstructive: It would be reconstructive where what should be there is missing, what is there shouldn't be; and cosmetic where there is unwanted excess growth.
"GRS isn't medically necessary, GRS is purely cosmetic"
says who? the "transgender"? the "non-ops by choice"? the "trans men"?, the "religious right"? who? don't get me started please!
Jen: please dont lecture me on how intersex children are treated... especially those caught in Doctor Money's period of medical influence... I was one.
I'm no wolf- this thread was requesting people's opinions and I gave mine.
As for whoever said my opinion was BS, i didn't say that yours was so please give me the same respect that i have given to you.
And a "classic transsexual"? Yep, I am. My surgeries are done.
re reading the title, FFS, ba, top surgery etc are all cosmetic procedurs... GRS, in either direction is not.
Quote from: Jen on February 22, 2009, 12:41:32 AM
Females converted to males were definitely a rarity, for obvious reasons.
http://en.wikipedia.org/wiki/Intersex_surgery (http://en.wikipedia.org/wiki/Intersex_surgery)
And yep, it was Dr. Money. His theories were loosely based on AIS girls pretty much always having a well-adjusted female identity after being raised as girls, in spite of their XY chromosomes. So it makes sense how the mistake was made, at least to me. He just didn't realize their female identities might have been set in the womb by their insensitivity to testosterone.
Dr. Money didn't just not "realize", he blatantly lied to make the results fit his theory. He wanted the fame. The people he was studying/treating rebelled against him, told him repeatedly it was not right, and he put down in the notes that everything was great.
If it were an accident I could handle what he did, but this man did this on purpose. He hurt a lot of people and set us back 50+ years in terms of research.
Quote from: Nero on February 21, 2009, 12:41:58 PM
Are transitional surgeries (SRS/top surgery/FFS, etc) reconstructive surgery?
Why or why not?
On the one hand, they're correcting a defect. On the other hand, reconstructive surgery, by definition has to improve function.
And there's the stuff about cutting into perfectly 'normal' healthy parts, etc
What do you think?
Transitional surgeries that legally change a transperson's gender should be considered the same as surgeries related to health. That should be a no-brainer.
When you get into other surgeries such as FFS then you have to weigh the social implications. A person born with a cleft palate will most likely be discriminated against, not to mention mocked and ridiculed and all the other cruel things people do. If they have corrective surgery that gives them a typically normal appearance. Is that reconstructive or beautification surgery? I'd say the former and feel it should be covered by insurance.
My electrologist (GG) was hirsute. She had substantial facial hair. Her husband's insurance covered the cost of electrolysis because it was considered a medical necessity.
Once a trans person is diagnosed as trans, any medical procedure related to bringing the body to within social norms should be covered by insurance. Unfortunately we are a long way from this happening because the ignorant still make the rules.
Julie
Quote from: Rachael on February 22, 2009, 07:50:48 AM
Jen: please dont lecture me on how intersex children are treated... especially those caught in Doctor Money's period of medical influence... I was one.
Oh, I wasn't meaning to lecture anybody, well at least not you :). I was just trying to show the exceptions for transgender issues in health insurance come from some bad leaps of logic made back in the sixties, not from there being an actual good reason to deny coverage. The whole intersex treatment thing is something I only have vague knowledge of and I think, given some of the responses here (including yours) there is something going on there which I need to read up on a bit more. It sounds like Dr. Money may be a character I could dislike very much, and I'm always looking for something to be furious about :P.
I really should try to understand the intersex condition better. I have a book I have started but haven't finished yet, called "Middlesex" which is a work of fiction but so far seems to be treating the intersexed protagonist's story with compassion. Has anybody read this book? If so, is it worth finishing? I am always leery of books or other media that venture into topics of gender.
Middlesex isnt entirely fiction, and is only one form... CAIS...there are MANY different forms of Intersex conditions present today.
Did you read it, and if you did what did you think? I'm also curious what you mean about it not being fiction?
Yes, i have, it was hard to get into.... but the style opened up as the book got on... you'll forgive me specifics, it was 2 years ago. But it was lovely, and quite close to how I felt at several points.
Its not fiction because its the writer's true story....
Hm, we must be talking about 2 different books then. Oh well.