So, here's a summary rundown of the questions I asked during my consult:
Surgical Experience? GRS Experience?
- Plastic surgeon since 2003, mostly with trans patient experience. She mentioned her most common surgery performed was FTM breast removal.
- 4 MTF GRS surgeries performed with Dr. Marci Bowers, 7 solo (to date).
What technique do you use?
-Penile inversion with scrotal graft for the vaginal canal lining. The tissue used in this process to line the vagina has been known to frequently "turn into" mucosal tissue, turning pink and moist over time.
- Some of the excess urethra is used to line from the urethra to the clitoris for "pinking" and moisture in the area.
- She does not line the vagina with urethral tissue because the results haven't suggested a significant improvement in self-lubrication, healing time is longer due to extra incisions/stitches, and in some cases the graft has even failed to survive.
Likelihood of a revision/repair needed? Cost involved? Warranty?
- To date, no second step or revision surgery has been needed with her patients using this technique.
Scarring?
- Two lines running up the groin/leg crease, then down around and behind the vaginal opening. Like a U or V shape. Fairly common practice is sounds like.
Estimated Depth?
- I believe she said that all of her patients to date have achieved ~7 inches of depth with the largest dilator (I was shocked to hear this).
Recovery Time/Location/Follow-ups/Schedule?
- 2 days in the hospital post-op, then discharged to home if local.
- Follow up at 1 week to remove the packing and catheter.
- 1 week follow-ups after that, spacing out over time as doctor and patient feel comfortable.
Returning to Work/Activity?
- No lifting or strenuous activity for 6-8 weeks to prevent internal stitches from rupturing (all disolvable stitches are used)
- Can work from home after a couple weeks if up to it and able.
- No driving while on heavy pain meds, obviously, but safe after 2-3 weeks probably.
- Returning to a desk job would be patient specific, but as early as 3 weeks is possible. More time away from work equals a better recovery though.
At-home care needed?
- Possible assistance with cleaning the area, keeping it iced, pain management, etc...
- Patient should be up and walking around a bit every couple of hours however, so preparing light meals isn't out of the question for instance.
Dilation Schedule and Aftercare?
- Dilation 3x daily (~45 minutes each session) for up to one year is recommended, but she says many patients find that logistically unfeasible. More frequent dilation however equals better results.
- Compression underwear is needed for the first couple weeks to help with swelling (plus ice!)
- Pads, multiple pads, are encouraged postop to catch discharge and keep pressure on the area to reduce swelling (in conjuction with ice, noticing a theme?).
- After the first week or so, pads are recommended after dilating to catch excess lubricant...
Requirements for consideration/surgery?
- If using insurance, they have their own requirements, but MacPhee generally follows the WPATH standards.
Orchiectomy first?
- She actually recommended this if SRS is a ways out due to Spironolactone being not good for long term use. She expressed no concerns when I asked her about scrotal skin shrinkage as well. "It is very stretchy," she said, lol.
Electrolysis needed?
- Recommended, if not required. She does scrape away follicles, but can't necessarily guarantee that she'll get them all. Less time scraping equals less time under anesthesia as well. I believe that heavy laser treatment may be a suitable alternative if it is effective for your hair and skin color.
Other health concerns?
- Mostly concerned about possible prostate issues that could cause problems not only with depth but healing and time under anesthesia to work around them.
Total cost? Upfront cost? And what does that include? (in US dollars)
- For GRS:
Credit Payment
- Surgeon Fee: 10,500.00
- Anesthesia Fee: 2,494.80
- Facility Fee: 4,240.95
- Devices: 162.75
- 2 night stay: 1,575.00
- Pathology Fee: ~1,000.00
- Total Estimate: ~19,973.50
Cash, Check or Debit Payment
- Surgeon Fee: 10,000.00
- Anesthesia Fee: 2,376.00
- Facility Fee: 4,039.00
- Devices: 155.00
- 2 night stay: 1,500.00
- Pathology Fee: ~1,000.00
- Total Estimate: ~19,070.00
- For Orchiectomy:
Credit Payment
- Surgeon Fee: 2,195.55
- Anesthesia Fee: 1,201.20
- Facility Fee: 1,621.62
- Pathology Fee: ~1,000.00
- Total Estimate: ~6,018.37
Cash, Check or Debit Payment
- Surgeon Fee: 2,091.00
- Anesthesia Fee: 1,144.00
- Facility Fee: 1,544.40
- Pathology Fee: ~1,000.00
- Total Estimate: ~5,779.40
- Surgeon fee is due upfront at least 2 weeks prior to procedure date.
- Other fees are also due, but she can work with insurance to help courtesy file pre-authorizations for the rest, iirc, if they cover it. Otherwise, it is all due (minus the pathology fee) upfront.
- The pathology fee is billed after the procedure and is variable (~900-1200).
- If you have an orchi first, then GRS, you will only be charged the pathology fee once, not twice.
Payment plan/assistance?
- Nothing in-house. External credit is available, but the interest rate is outrageous. Better off taking out a loan against your car or something!
Procedure Scheduling?
- High availability.
What insurance companies have she had success with?
- United Healthcare
- Blue Cross Blue Shield
Insurance Codes?
- GRS Procedure (CPT): 55970 - Intersex surgery; male to female
- Orchi Procedure (CPT): 54520 - Bilateral Orchiectomy
- Diagnosis Code (ICD10): F64.1 - Gender Identity Disorder
