Hi wonderful people! I have my first GCS consult this week and I have a question about how the skin grafting works. I understand that skin is taken from a different area of the body. Is there a usual donor site? Does this area then get stitched up or is the donated skin only certain layers of skin? I am not sure I will need this but suspect I might. I would like to see if others have words of wisdom before I have my meeting. Thanks to any who reply.
Moni

As far as I know western surgeons almost exclusively use penile inversion and don't usually use grafts - perhaps for girls who want more depth when starting with less penile skin.

Again as far as I know, including Thai surgeons who exclusively use grafts, common donor sites include the thigh and torso.

Hi HappyMoni 

Most Chett patients get a skin graft including me. When he makes his incisions he takes slightly more skin from one side than the other in my case the top of my left inner thigh. This means when he stitches you up you only have the same scar you would if he didn't use a skin graft. I had to ask Sri where he took it from because I couldn't see any sign he had done it but I paid for it.

Hope that helps you 

Hugs

Sorcha 

Thank you Sadie and Sorcha! I do not plan go over seas for my surgery. Because of my size I didn't know if a graft was something I would be presented with at a consult. The penis  is probably on the smaller side of the bell curve length wise, but not real small. I guess I was picturing a secondary area with a big scar at the donor site. Thanks!
Moni

Depending on the doctor used, some procedures use the scrotum to create the vagina as well as to create the external structures. This wasn't the case when I had surgery so my PI surgery use the scrotum tissue only for the eternal work and some of it was discarded. If the tissue is used internally you may require hair removal before surgery so the hair doesn't end up inside the vagina. This will be dependent on the surgeon as different surgeons have different guidelines on this.

Hi Monica,

I have a micro penis and a small scrotum. Anyhow, she examined me twice. Once recently and once February 2015. While I was laying on the table she said I was lucky. (I once was 327 pounds and now 200.) I have loose skin 4 or so inches above the mons pubis and she said she would take the graph from there.

The labiaplasty is included in with the vagioplasty cost and done in the office at a later date. The scrotum is used for blood supply for the vaginal tube graph at the time of vagioplasty.

The risks she said are loss of graph and infection.

Thanks for responding ladies. Not having had a consult yet, I really don't have a feel for how much if any choice is open to the surgical candidate. I imagine a lot of what happens depends on the actual body one has. Also, I'm sure surgeons have a pattern of techniques that they usually use. I would like to have reasonable depth. Not having a terribly large penis, I wonder if that is possible. I have already begun hair removal in the area and will continue. Guess this will really only be answered by the individual surgeons. I do appreciate the perspective of my friends on this site. Having more than one opinion is very helpful.
Moni

Quote from: SadieBlake on October 16, 2016, 07:54:06 PM
As far as I know western surgeons almost exclusively use penile inversion and don't usually use grafts

Hi, I just wanted to say that's old information.  Bowers and McGinn, maybe others too(?), now use skin grafts and a new hybrid method.  I just had surgery and the surgery report shows a lot of innovation I hadn't expected.

Quote from: Tiamet on October 22, 2016, 01:25:14 PM
Hi, I just wanted to say that's old information.  Bowers and McGinn, maybe others too(?), now use skin grafts and a new hybrid method.  I just had surgery and the surgery report shows a lot of innovation I hadn't expected.

Hi Tiamet,
   Could you be more specific on the hybrid method? Dr. McGinn is a surgeon I am having a consult with. I had another consult with a doctor who uses scrotal skin as a graft for increased depth. Any info would be appreciated.
Monica

Quote from: Tiamet on October 22, 2016, 01:25:14 PM
Hi, I just wanted to say that's old information.  Bowers and McGinn, maybe others too(?), now use skin grafts and a new hybrid method.  I just had surgery and the surgery report shows a lot of innovation I hadn't expected.

What's a surgery report?

Hi, anytime someone has surgery in the U.S. the whole procedure is documented in detail, even what kind of stitches were used.  That's what the report is.

It's a lot of medical jargon, but I'll try to summarize it. The penile tissue is used to form the clitotal hood and inner labia minora.  The outer scrotal skin and perenium skin forms the labia majora, and stitches are placed there.  The rest of scrotal skin is worked on by a dedicated doctor who turns it into a graft of mucosa-like tissue, then this is used for the vagina lumen.  The former urethera mucosa tissue lines the area between the inner labia and produces lubrication.  The clitoris is buried under the clitoral hood exept for a small nub.  All erectile tissue is removed.

It's very cis-like, especially when looking from below, including folds of labia meeting under the vaginal vestibule.

Quote from: AnonyMs on October 22, 2016, 05:08:15 PM
What's a surgery report?

I couldn't figure out if I had a clitoris as it wasn't visible like todays are and I was having difficulty getting my surgical report so I located one from the same doctor that happened two years after mine. I knew by the time my surgery was done, it was pretty routine so a report two years latter should give me an idea what the procedure was. This link will take you to the one I found.

Dena, thank you! I've been looking for something like that for months (should have dug deeper into the Lynn Conway pages). I've long wondered what was used in that time frame for forming a clitoris. I had also understood that the glans was used by Biber to form a cervix back then so it's great to read the details.

My GP requested a surgery report from Brassard - and it came in French. Figures, I guess! Lucky for me, my GP's practice employed translators (on staff, not just for my sake), and he was willing to send me a translated copy. It was fascinating reading.

My results were very similar to Tiamet's, the report said, except that the majority of penile tissue was still used for the vaginal vault in my case. However, it could still be fairly called a "hybrid" method, as a small amount of scrotal skin was used to form the end of the vaginal vault (as a graft to replace what was removed from the tip of the penis to form the clitoris) and a perineal graft (the skin that covered the area where the vagina would be placed) was saved and used for part of the outer labia construction.

In terms of the original question, if Brassard needs to take a skin graft from elsewhere in the body, he uses a "split thickness" graft from the upper thigh, meaning he takes only the top layers of skin from an approximately 1" square of skin there. The result is faster healing and a more discreet scar that looks like a skin discoloration rather than a "stitched" sort of scar.  I didn't need a graft, but I saw some long-time post-op women there and observed those results. If you know what you're looking at, it's still a distinctive scar, but 99.99% of people have no idea what it means, and it could be passed off as a long-healed burn.

I'm surprised I've not heard of these surgery reports before. You'd think people would be comparing them between surgeons and working out what the differences in their techniques were.

Well, I only got my hands on mine because my *doctor* requested it and then passed it along; I don't think it's standard procedure to hand them over. My GP was curious, and he wanted to make sure he knew what he was looking at when I came in for a 3-month follow-up. Of course, by that point, he said he would never have been able to guess what the tissues originally were...

(I believe it is standard procedure for most US and Canadian surgeons - generally, not just GRS - to make one. I have no clue whether Thai surgeons routinely do.)

Dena, that report was fascinating, and an excellent example of what we're talking about! And it looks as though, while a clitoris was formed, the majority of the penile nerve bundle and the glans was used as a "cervix" instead, which is vastly different from most current methods. (No offense meant, but I also think the newer methods are an improvement - personally, I'd much rather have all the sensitive nerves located in my clitoris, as is typical with cis women, and forgo having a pseudo-cervix ["pseudo" because there is no uterus, which the cervix actually is part of in cis women].) I almost wonder if that was an example of men imagining how the female genitals should work. Cis women do not have the majority of their sexual sensation inside the vagina, after all.

From what I have been reading, Biber looked at what John Hopkins was doing and based the surgery off that. He had the view that you should be sexual sensitive at both ends so creating an artificial cervix was his attempt to do so. The names escape me at the moment but one surgeon splits the glans and uses part of it for the clitoris and plants the other end at the base of the vagina. This is a more realistic of a CIS woman as the clitoris of a woman is enormous and wraps around the vagina.

My surgery was very early and about the best available at the time. I couldn't wait 20 to 30 years for the surgery to evolve to the modern state so I had to go with what was available at the time. Appearance wise, it would never pass a close up inspection but I have appeared naked before  women and there haven't been any questions so it's not worth the trouble to me for an upgrade.

Yes I am a bit envious of the surgeries the girls are getting today but I am also happy for them and will do everything I can to make their experience a great one. I watch every surgery thread for the first sign of trouble and if I can help them in any way, I post to the thread. I could have used a guardian angle when I went through this so I am trying to be one for them.

Thanks Dena! I am going into these consults a bit intimidated. I am in my 50's, so I don't expect to be doing much "showing off" of the "goods." My priority is long term lack of pain, sensitivity and functionality and finally appearance last. The surgery itself doesn't scare me. The thought that something might prevent it from happening really scares me. I guess I wanted to express that your work as a guardian angel and the responses from the other ladies here have really helped me and are appreciated. My consult is Monday. Wish me luck!
Moni