4 Months Post-Op RFF


Last time I updated in reference to seeking a revision for my scrotum and perineum that has a small opening, I mentioned that I had the option of going to Dr Nikolavsky in Syracuse, NY or Crane/Chen in San Francisco, CA. I had been planning on the Dr N option mostly because I live on the east coast and it would have been far cheaper to travel there. As it turns out a close friend of mine was booked for phallo last minute with Chen and I made my way out west to help him while he’s recovering. I figured if I’m going to be out there anyhow, I might as well see if I can have my revision done with Chen. It ended up working out and I’m currently scheduled with Dr Chen for June 20th, 2016.

I do believe that Dr Nikolavsky would have been a great “local-ish” (5+ hour drive from me) option and I was quite pleased with the communication and responsiveness from both Dr N and his office staff – his nurse Janice was especially helpful. All that being said, I’m pretty elated that a revision with Chen ended up being in the cards for me. Dr Nikolavsky is a reconstructive urologist, and while he quoted as regularly doing some form of plastic surgery (about 20% of his work) I feel more confident returning to a surgeon who does plastics a bit more frequently, and specifically has an eye for addressing the issues that I’m looking to have resolved, on a regular basis. Had I gone to Dr Nikolavsky, I would have only had my perineum, and the two small sebaceous pockets on my scrotum addressed. But since I’m going back to SF, I’m considering having a couple other things done as well.

Urethra: I’ve noticed since surgery that even though I’m peeing just fine, it feels like it’s taking me longer to completely empty my bladder. I also notice that peeing in a seated position sometimes is uncomfortable that I feel like I might be slightly compressing the urethra. I discussed this with Dr Crane over a phone consult a couple weeks back and he asked me how long it takes me to completely empty my bladder. I told him that I guessed it probably took less than a minute depending on how full my bladder was, but that I hadn’t ever timed it. He said that at that rate it’s unlikely I have a stricture but that we could do a cystoscopy to look inside the urethra to be sure. He mentioned that it’s fairly easy to diagnose strictures when it’s taking guys 3, 4, even 5 minutes to empty their bladder, but with what I’m reporting it’s hard to know if there truly is an issue, without scoping. If it’s a minor stricture usually they are able to just cut it with the blade that’s on the end of the scope while they are inside. Depending on the findings and severity, a foley catheter is sometimes placed during early healing. I also should mention, that the other reason I am suspecting a small stricture is that I have a very tiny bit of moisture (not enough to drip, more of an ooze) that constantly comes out of the urethra, even hours after peeing. Even when I wake up in the morning and haven’t peed in 8+ hours sometimes. I do also notice an odor with this moisture, and it DOESN’T smell like urine, at all. It actually had a bit of a fishy odor to it. Gross, I know. However, I’ve had two urine cultures done and neither showed any signs of infection or other issues. I noticed a marked decrease in the odor and a moderate decrease in the fluid passing after taking 4 Diflucan pills over the course of 2 weeks, but the issue was not completely resolved. A scope of the UL seemed like the next logical step to me in finding the source of the issue.

Scrotum: Immediately after surgery from stage one (February 4th, 2016), I had pretty dramatic swelling and bruising in my scrotum. As I healed I developed what is called an eschar on my scrotum. This essentially looked like a scab and it formed along the horizontal incision line of my sack. In early healing it looked pretty rough and I was worried what things would look like a couple months down the line.It actaully healed quite beautifully, and the skin is soft and healthy, however the incision line looks a little funky and jaged. I’m seeking to have the scar revised in an effort for it to look more seamless, right now the scar line dips down into an odd groove. I’m not fully certain if over time it would flatten out completely or not – it’s likely that it might, especially with the addition of testicular implants that will further fill out and stretch the tissue. But I feel better just revising the scar while he’s going to be in that area trimming out the little sebaceous pockets anyway.

Perineum: It’s hard to know exactly why it happened and what caused it, but I have a small opening along the perineum that started at around 10-14 days post-op and since then has been exudative – which is just a nicer way of saying that it’s been oozing and secreting fluids.  It also slightly bleeds as there is a teeny tiny opening that is technically a wound. It’s healed up A LOT since February, March, and the beginning of April when it was at it’s worst. Packing it with the Curity iodoform packing strips was tremendously helpful in aiding the healing process. However, there is a spot that continues to reopen and bleed a little. In general, the perineum is under a tremendous about of tension when going about even the most basic of daily movements and positions, especially when sitting. So this area is prime for having troubles with the incision healing. I’m still convinced that the incredible amount of fluid that was draining from my massively swollen scrotum after surgery contributed to this area opening up. Incision lines need to stay fairly dry to heal adequately and the v-nectomy area was more often than not, very wet from all the scrotal draining I had going on. It also endured quite a lot of friction from regular wiping and cleansing of the draining fluids. I really believe that this is what caused or at least contributed to the perineum opening up initially. I mention this because it’s an example of how one issue or complication could potentially cause or instigate issues elsewhere. If I could do this over I would have found some way to cup my balls better in a way that caught any drainage rather than allowing it to drip down along the perineum and then wiping it away. This is easier said than done, because I did try my best to do that at the time… Regardless, Dr Chen looked at the area and feels confident that he should be able to close the area just by using local tissue (cutting out the affected area and bringing the surrounding skin together again). I’ll be relieved when that is fully closed up.

Fat Grafting: Around the end of the 3rd month post-op I noticed that my penis had continued to have less and less of a plump feel. Immediately after surgery you have quite a bit of swelling in the penis, even when it might look like you don’t. By about 1 week post-op I didn’t think I was all that swollen. It just looked full and fabulous, but it wasn’t stiff or puffy by any means. I was pretty happy with my girth and fullness at this point. But as the weeks go by the edema slowly starts to dissipate and it’s typical for the penis to feel more and more malleable and feel like it’s losing density. It’s not exactly shrinking, it’s just that all the swelling is going away. It was at about this time that I started thinking about my options of giving fat grafting a go. I had heard from a couple others that they had great results immediately after fat grafting but that within about a month the fat was completely reabsorbed or died off because the fat cells were unable to connect to the blood supply in their new habitat which they need in order to survive. Nonetheless, I figured I would see if I could get insurance coverage for it and if so, then I didn’t see a reason not to at least give it a shot. The out of pocket cost for this procedure is around I was able to get coverage, it was denied at first and then they did a peer-to-peer review where Dr Chen talked with a doc through my insurance company and explained why the procedure was needed. Once that happened it was approved. This is essentially a fat transfer procedure, also called lipo transfer. They will take fat from my abdominal area and then use a needle to inject it throughout the entire length of the penis to give it a fuller appearance.

WRAPPING UP: I will be following up on these revisions, especially on the fat grafting because I know that is a topic of interest for a lot of thinner guys going for RFF that want to bulk up their dicks to be thicker and more full.

PHOTOS: I know I haven’t done any photo updates in a while. I’ll be adding some in probably with my 8 month update. I’m still working on backdating blogs that I never got a chance to post when I got busy after this June surgery. Thanks for reading, I’m looking forward to getting this up to date and writing about some things that I think could be really helpful for others to hear about.


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