I recently attended Dr Loren Schecter’s presentation in New York that was made possible by the non profit organization: CK Life. Being that I live in MA, this was a bit of a drive for me, but it felt worth it. Dr Loren Schecter’s name has come up more and more over the past few months and he was on my radar as being a surgeon whose waiting list is around 6 weeks. That alone was a huge driving force for needing to at least hear him speak and get a feel for if he would be an option that I was comfortable with. Although his presentation covered the gamut in terms of MTF and FTM procedures, because of the nature of this blog I am only going to be mentioning anything related to phalloplasty.
Dr Schecter was available for free mini-consults prior to his presentation. I actually attended with a buddy of mine and we are planning on scheduling our surgeries a couple days apart so we just did our consult together and that really allowed us to not miss any of the questions that we had. That, as well as making a list of questions (and continuing to add to it) WELL in advance is really key to utilizing your consult time in the most efficient way – I can’t stress this enough.
So let’s get right to it. First I will document the actual consultation and then give a rundown of his “powerpoint” presentation and share my overall impression and experience of meeting him…
Just like my Crane consult, this is not word-for-word what Dr Schecter said and I am in no way quoting him. The following is a recap to the best of my ability to share with you what I remember him saying:
Me: Tell me a bit about your background. Where did you learn to do phallo and how long have you been doing them?
Dr Schecter: I worked with the Serbia and Belgium team, I started doing phalloplasty back in the 90’s.
Me: How many have you done at this point?
Dr Schecter: About 25 or so.
Me: So you’re a plastic surgeon and a micro surgeon, is that correct?
Dr Schecter: Yes
Me: So you bring in a urologist to do the UL (urethral lengthening)?
Dr Schecter: Yes, we have a great urologist that we work with, and also a reconstructive urologist that we can bring in if we need to.
Me: What are your complication rates?
Dr Schecter: They are about 40%
Me: How are those rates effected by one’s choice to either have or not have a vaginectomy? How much higher are complication rates if you don’t do a vaginectomy?
Dr Schecter: You mean with urethral lengthening? Because we only do UL with vaginectomy. If you don’t want a vaginectomy then UL is not an option.
Me: Do you perform a VY scrotoplasty?
Dr Schecter: I don’t perform that exact scrotoplasty technique. What we do is very similar in that it brings the tissue forward and creates a hanging scrotum but we don’t call it VY.
Me: What is the positioning like for the arm flap for RFF? Is the urethra formed from the skin on the underside of the forearm?
Dr Schecter: I don’t have my templates with me right now but essentially the flap is harvested starting on the underside of the forearm along the pinky finger side of the arm (ulnar). That is the tissue used for the urethra, and the flap continues almost all the way around the arm. The skin along the arm where your thumb is (radial) will end up being the “top” of the shaft (ie the skin that would be most visible when looking down at your penis). The skin on the top of the arm would be wrapping around to the underside of the penis.
Me: Have you ever had any total phalloplasty flap failures?
Dr Schecter: No we haven’t. But sooner or later it could happen. I do all sorts of flap surgeries in my work that are not phallo-related and I have seen flap losses happen, but we’ve never had a phallo flap fail.
Me: Where is the incision line on the penis for the RFF phalloplasty placed?
Dr Schecter: It used to be on the top but now we place it on the underside. ALT incisions are on the top and the bottom.
Me: Do you ever do full thickness skin grafts to cover the flap site?
Dr Schecter: We sometimes have, but we’ve seen enough promising results from using a combination of Integra and a split thickness graft that we usually don’t do full thickness grafts. Because it becomes an issue of then where we get that skin from.
Me: I noticed that the hospital stay of 2 weeks post-op is longer than other surgeons are quoting – Can you speak to this?
Dr Schecter: 10-14 days. It varies person to person. We do a scope of the urethra before you leave and we also do the secondary surgery that places the split thickness skin graft on the donor site, because using the Integra requires a separate procedure a week after the phalloplasty.
Me: Do you anchor the penile prosthesis to bone or is it stitched in place?
Dr Schecter: We do a variety of methods. Sometime we anchor it to the bone other times it’s sutured in place.
Me: I’m worried about having a really skinny penis because of how lean I am, have you done phallos on guys my size and if so how were their results in terms of girth?
Dr Schecter: It’s actually beneficial if someone is lean because it makes the surgery much easier. Sometimes with people that are on the heavier side we are looking at needing to add grafts to be able to completely close the phallus. In terms of girth the penis still ends up being a reasonable size.
Me: When you de-glove the clitoris do you leave the erectile tissues?
Dr Schecter: Yes, we are only removing a very thin layer of skin.
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That was pretty much all the questions that I can remember asking in looking back at my notes. I didn’t write down my buddy’s questions but these were the bulk of them. As for the presentation itself, much of the information that was covered was not phallo specific, understandably. He covered most ALL of the procedures that he offers to women and men as well as took time to do some trans 101 and just talk about his practice in general. This makes sense because there was a very wide variety of people attending the presentation including some healthcare professionals. He did show a few pictures of RFF and ALT and I think he might have shown an MLD but I can’t recall. He did have a graph that layed out the pros and cons of each method give them ratings/stars in terms of what donors site offers the best sensation, girth, size, rigidity and so on. This was helpful to see, so if you consult with him you might ask to see this if you are still on the fence about which donor site is right for you. Also it’s worth mentioning, that if you are HIV+ or have an STI he is still able to operate. However, folks have to be on medication or have their conditions under control. If you have any open wounds at the time of your operation this would be a contraindication to surgery.
My overall impression of Schecter is a positive one. I know that public speaking can be awkward and that is not always the realm in which all folks exceed but he seemed well spoken and compassionate.
THE PROS (for me personally): His waiting list is a TINY fraction of what Crane’s is. You’re looking at MAYBE a couple months out from the time of your consult. He also refers people out to a local electrolysis technician that is familiar with his procedure and the phallo “template” that he uses and typically the hair along where the urethra will be can be removed in one session. Just to clarify, the outside of the penis would still grow hair if you currently have hair in that area already. This is strictly a strip of skin used for the urethra where the hair would be removed. Also, another HUGE PLUS is that because he is on staff at a hospital and not in a private practice it makes using insurance with him MUCH easier. Even if you have a state funded low-income type of insurance, as long as you get the go ahead from your insurer, reimbursing the hospital at a much lower rate is not going to be an issue in the same way that it is with someone like Crane who has a personal practice with a lot of overhead. I was told today by Katrina (Dr Crane’s nurse) that Medicare has offered as little as $1,100 for phallo, it’s truly laughable what Medicare and Medicaid are willing to pay out. So if you have this type of insurance and are looking to move forward with surgery sooner rather than later, Dr Schecter might be your guy!!!
The Cons (for me personally): I’m probably 90% positive that I don’t want to have a vaginectomy. It’s a procedure that I don’t feel like I NEED at this point even as someone who practically never engages in anything penetrative. I want the option of changing my mind on this procedure up to the last minute. There is a chance that in the next 10 or 11 months leading up to surgery that I might change my mind and decide: Sure, get it out while you’re down there. But I’m fairly certain that I won’t. This wouldn’t be an option with Schecter. So really for that reason alone, I have to admit, my brain kinda shut down in terms of considering him as an option for myself… The other fairly large factor in my decision process even if not having V-nectomy was an option with him, was that a complication rate of 40% felt a bit high for me… I did however think his work looked solid, however, I would personally want a much more defined glansoplasty. This could totally be a personal choice that the good folks in the photos chose for themselves, so it’s hard to know if that’s just his technique or a personal decision. Also, his cut seems to be one that is a very clean even circle around the tip of the phallus where I would prefer a more comprehensive cut that looks different towards the frenulum than it does on the top side of the head of the penis – rather than being uniform all the way around. Again, these are my desires for glansoplasty and not everyone’s, he very well might offer this if asked. And let’s be honest, although glansoplasty has the potential to add a lot of aesthetic appeal to a phalloplasty, it’s fairly minor in terms of the “whole package” and doesn’t impact functionality at all. So even if you don’t like his glansoplasty technique it would be easy enough to have someone else do it or ask if he would be willing to perform a different technique that suits you better.
Lastly: I won’t put this in the cons list but I will add it as just general “room for growth” after having seen his presentation and spoken with him. It’s very clear to me that Dr Schecter is a compassionate man and is interested in helping folks like us mend these delicate and sensitive parts of our bodies. However, I did notice that some of the language he uses could be off-putting to some. I noticed that he referred to a completed meta and talked about it using the word “clitoris” where I feel like he really should have been saying “penis”, “phallus” or even “glans”! Although I recognize that not all people that have top surgery are male identified, and not everyone that is *trans male is “cock identified”, I’m willing to bet that far more ARE than ARE NOT if they are seeking a reconstructive PENIS surgery… I’m sure that someone mentioning this to him would be all that it would take to help shift the way he approaches speaking about these body parts. I just know that if I was post-op meta and my surgeon was calling my penis a “clitoris” I would be devastated! There were some other things he sited during his presentation like that far more men than women seek these surgeries and although I think I knew what he was trying to say (more transwomen than transmen) I think I might have either said that or: “more people assigned male at birth than females”. Again, these are REALLY subtle nuances to most people, but I think if he sees himself expanding and offering care to more trans folks, he would benefit from a little more understanding with how we speak about our bodies and just the general language that tends to me more respectful and understanding of the ways we relate to our bodies. All that being said, I freely admit to being a virgo and a bit overly critical at times. So take this as you will – He’s a great guy with good intentions.
I think Dr Schecter is certainly a great option for some folks. Choosing a surgeon is a REALLY…PERSONAL…DECISION… and you have to go on your gut instinct for who will be most able to meet those very personal needs. Sometimes this process is like shopping for jeans – they usually look great on the mannequin, but upon further inspection and a more personalized quick trip to to the changing room you immediately feel any areas of discomfort and need for other options. OR you run to the check out line eager to pay and bring home your new favorite jeans. The latter was my experience with Crane. The jeans looked great on the mannequin, the fitting room experience was shockingly wonderful, and now I’m just in that dreaded long line with 50 people ahead of me hoping that my credit card won’t be declined… So, at this point, I’m still moving forward with using Dr Crane as my surgeon. However, if for some reason my plans A, B and C with health insurance don’t allow for me to have him do my phallo, I might give Schecter another look.