Pump vs. Rod – How I Decided

To Pump, Or Not To Pump?… THAT, is the question!…

I’ve been getting this question A LOT, so I just decided to type it once here and just link folk to this posting because it’s not necessarily a one sentence answer. There are quite a few factors that went into my decision making process. And understandably so!

I never thought I would get the semi rigid when I first started my personal research into this process in 2005. Yes, 2005. Actually it wasn’t until only about 4 months ago that I experienced 180° turn in terms of my implant desires. Up until then I didn’t really fully relate to or understand how anyone would think it was the ideal choice to go with the rod if they had the option of choosing the pump. Logically I understood the idea of not wanting to have to replace it every so often with future surgery, but the idea of future surgery seemed well worth it to have a “naturally” soft penis when I wasn’t having sex or aroused. However, I’ve always had a really strong desire to have two symmetrical testicles which, with the pump is not an option. I know some people have questioned whether two testicular implants as well as the pump bulb might all fit into the scrotum. It’s worth noting however, that the UK found that one of the leading causes of pump failure was the scrotum being too tight around the pump bulb – and that’s with only one testicular implant! I also was not all that satisfied with the level of fullness that my penis had when in it’s natural flaccid state which the pump would allow it to be in the vast amount of the time when I wasn’t erect. I’m a very lean guy with thin arms which equates to not much fat in my penis. After trying a fat grafting procedure in June 2016, 4 months post stage 1 and the fat being completely absorbed by my body within a month’s time, I felt like the rod was just going to meet more of my needs. I LOVED how fat/full/thick my penis was right after the fat grafting and that experience made me realize that I would be a whole lot happier with my penis if it always had that level of fullness.

The main reason I went with the rod was because I wanted to have a larger appearing package all the time, first and foremost. And not only just in terms of appearance, but what I would touch and interact with when I reached into my pants. I’ve never been a size queen, but always when imagining my body after finishing all stages of phallo, I absolutely did picture myself having at least a mildly visible bulge in my pants, and I really didn’t have that once the initial stage-one post-op swelling went down. Maybe that would have changed a bit with the introduction of testicular implants but I also wanted the shaft to not only be more visible but thicker and dense. I just all around wanted more to hang on to.

Now that I have the semi rigid rod and balls I am wildly happy with the profile of my package. No, it’s not as floppy as a flaccid penis, and that has certainly been an adjustment. But I was willing to give up a flaccid, floppy penis if it meant that I would have a larger feeling, more noticeable package. I also was not a fan of the way my flaccid penis felt when it fell down completely between my thighs and just seemed to get lost. Sometimes even when wearing thin/light shorts with the way it fell it just didn’t look like there was much of anything there, even to me, and that was a really dysphoria inducing experience. I can’t say that I’ll never get the pump or that I’ll have this specific implant forever, because I don’t think that I will. In the future I would like to have some version of the pump or, even better, an altogether better/new model that is designed specifically for the anatomy of a neo phallus. It’s just that none of the erectile options right now feel like they could completely 100% meet my needs, and for the interim I knew I needed something to hold me over till there was a more suitable option available for us – which will be who knows when.

I thought I would list out my personally experienced pros and cons to the semi rigid rod. Please keep in mind that 1.) these are my opinions – and 2.) I am still in early recovery from having this device implanted (less than 3 weeks post-op). So these pros and cons could still very well shift as swelling and pain decreases and mobility and healing progresses.

 

my PROs:

  • Fuller, more girthy penis 100% of the time to interact with
  • Much more pronounced and visible”profile”
  • Less likely to have complications, infections, and mechanical breakdown than any of the inflatable options, giving it a potentially much longer lifespan
  • Allows for two symmetrical testicular implants

my CONs:

  • At least initial (temporary) audible clicking noise and palpable clicking sensation when changing position of penis
  • At least initially not able to sleep on belly while healing
  • Potentially might be unable to comfortably lay face down on hard or firm surfaces
  • Detaching device at pubic bone connection point is a risk (i.e. sports, falling wrong, a kick in the groin etc.)
  • Never being able to experience a flaccid penile state for as long as I have the device
  • Not being able to experience the full range of the erectile process

 

So there’s clearly more cons than pros, however the numbers in one category versus the other wasn’t what allowed me to make my decision. Not to mention that 2 months into healing the scales might tip in the opposite direction with hopefully making the first 3 cons non-issues. In the end it comes down to what your priorities are. What really REALLY matters most to you when it comes to a device, to your everyday state of being, to complication rates, mobility, comfortability, self confidence, etc. When I had this discussion with Dr Chen in August during my phone consult I asked a ton of questions to find out if one device was really better or safer for the penis in the long run. His reply was that wasn’t really a factor in coming to a decision about an erectile device. He said what it’s really more about is which one you feel more excited about. And truly that’s a damn good way of looking at it. This is your dick, and this is your dick with an erection. Which one feels more exciting??? Maybe that’s a really obvious question, but it worked for me. I was more hesitant about the outcome with the inflatable cylinders than I was about a semi rigid rod.

As I said before, this decision is right for me right now, and that could absolutely change down the road. One of the best things that a close friend reminded me of years ago when I was in the midst of making big decisions (that felt permanent at the time but weren’t) was that you just have to make the best decision that feels right for you NOW. And if at some point down the road things don’t feel right, you make another decision. There’s not too much in life (or anywhere for that matter) that’s truly permanent, and thankfully an erectile device isn’t one of them.

I hope this explanation of how I made my decision was helpful to you. If you haven’t read it already and are looking for more more details about what the rod is like, please first take a look at the exhaustively long:

2 Weeks Post-Op Stage 2 (Semi-Rigid Rod & Testicular Implants)

It goes into detail about everything I ever wondered about the semi rigid and testicular implants, and more… And trust me, I wondered a lot… It felt important for me that I make that available to others… So if you have questions, please read that before asking.

Thanks!

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3 Months Post-Op RFF Phallo

Yesterday, Thursday the 5th technically makes 13 weeks since surgery. I had surgery on February 4th, 2016, so I’m going to try my best to keep doing monthly updates around the 4th of the month rather than keeping track of weeks from now on. I can’t say how lengthy I will continue to make these posts, but I’ll do my best to keep them informative and detailed. At some point I’m likely to switch to posting every 3 months and then eventually only when something worth updating about occurs.

In the meantime:

Things are mostly going well. I’ve been back at work for a month and I’ve been managing, again, mostly well. Surprisingly what I thought would be the biggest challenge (my arm) is the least of my worries. My hand strength is getting better all the time and more than enough for all basic daily personal and work tasks. My wrist mobility is nearly 100% what it was prior to surgery – however it does FEEL stiff, but I can still get almost equal flexion compared to my other wrist. Heavy weight-bearing with my palm flat down and my wrist bent is the most uncomfortable position. So while push ups are certainly possible and have been for many weeks, it’s not something that I’m doing regularly. Weight-bearing in that position over flexes the joint and it’s uncomfortable. I’m still continuing to do O.T. on my own at home when I think to do exercises and stretches and I’ve been able to achieve satisfactory results this way.

FOREARM/DONOR SITE: The scar continues to look more and more blended in with the surrounding tissue color. The color actually looks even more blended and natural in person, the photo doesn’t do it justice. The light brown spots corresponds to areas where the graft had some minor slough. The graft just didn’t take quite as well as the pinker areas. I’m sure eventually it’ll all blend in quite evenly.

Forearm 01.JPG

I have noticed some progression in scar edges flattening, although the main ridge that runs radially where the two skin grafts were stitched together continues to remain more pronounced than the other edges. I wish I had pressed on this ridge line earlier to help flatten it but I did have some pieces of the healing graft that looked to be pulling away from where it was suppose to be and so I literally let the ridge dry up because it was mushy and too wet at one point from too frequently changing the xeroform. I figured at the time that if it dried up more that it would stay in place and not pull away from the wound bed. I massage this ridge pretty much daily now to aide in breaking up scar tissue and help with flattening the ridge – the issue though is with the sensitivity that I have radially near the wrist. If I take my index finger and firmly tap on this area, or god forbid accidentally bump it on something like I did the other day, the pain can be mildly uncomfortable to intensely painful depending on how hard it is struck. I honestly don’t even want to THINK about getting tattooed in that area. YIKES! Maybe in time this will calm down in the same way that the hypersensitivity along the back of my hand did. But I was warned by the hand therapist at CPMC, that Dr Safa advises against tattooing in this specific area because you can damage the nerve and cause a lot of issues.

Forearm 03.JPG

HAIR GROWTH: This is specific to the hair growth that I’ve experienced on the healthy non-grafted tissue on my donor arm. If you’ve ever had a cast or worn a compression sleeve on your arm you may be familiar with what can happen to the hairs underneath. I’ve been told that it’s friction that can cause it, but areas that are covered with a tight sleeve or cast for many weeks often sprout new coarse hairs that didn’t exist before. It’s a temporary phenomenon and it’s gone away in my previous experiences with it but I thought I would share a few photos showing the occurrence. The following photo is of course the bridge of my donor arm. The bridge is the area where I’m experiencing the excess hair growth since it’s the only area that’s covered with the sleeve that is still capable of growing hair:

Hair Growth.JPG

And this is my non-donor are in that same exact area. The hair is much finer and more sparse. Also keep in mind that I had almost completely cleared my donor arm in that area where all the hair is growing. This is a perfect example of how the body can trigger inactive or dormant hairs to start growing in certain circumstance. And if friction on the skin can cause this, it would stand to reason that that is the reason why even guys that clear the fine blonde hairs from the inside of their forearms can still have substantial hair growth show up in their urethra post-op.

Non Donor Arm.JPG

Here’s a side by side:

Comparison.JPG

DONOR ARM LEASH SITE: The leash that they harvest from the forearm above the flap site is doing better than ever. The scar is still pink and dark-ish at times, but adhesion was the big issue here initially. I am no longer having any issues relating to adhesion that bother me. Certainly there is still some existent adhesion that I notice when I am moisturizing and massaging the area, but I no longer feel pain or discomfort when extending my arm or reaching for things. It was probably at about the 6+ week mark that that sensation completely went away. It didn’t just happen on it’s own, I really worked at it to relieve the tension with massage, and stretches. Be proactive, push through the discomfort and eventually it will dissipate.

Forearm 04.JPG

SELF-CARE: I’ve been moisturizing my scars with shea butter for about a month and I’ve been happy with the outcome.My forearm graft feels softs and healthy. It does get dry easily and 2x daily moisturizing is most ideal, but it doesn’t always happen. At about the 2 month mark I did become a bit more lazy with upkeep on things such as my daily rituals of moisturizing all my scars, massaging, always wearing my silicone patch and sleeve. I started not being quite as vigilant and obsessive about all of it.

Shea Butter.png

THIGH: My thigh still gets really itchy at times. Interestingly enough weight-bearing activities can increase the itching sensation. It must have something to do with more blood flow happening in the area, but it’s odd none the less. I’m moisturizing that area at least 1-3 times per day. Since I switched to the shea butter it seems to lock in the moisture for longer than the Eucerin did.

Liquidy sperm shaped Eucerin from last month: (photo 04/08/16 – scar is darker)

IMG_2830.JPG

The Eucerin was nice though because it was a quicker and easier application – whereas the shea butter is a very firm/harder substance and it takes a bit longer to warm it up on the skin before it will rub in and absorb.

Shea Solid.JPG

So I tend to probably use it a bit less frequently since it takes longer to apply. Either way, the scar appears to be doing well and continues to fade. I have gotten some ingrown hairs a few times that resulted in a pimple forming. That’s been slightly annoying but seriously a non-event. I just pop it, free the trapped hair and move on.

This is a photo of my leg this evening immediately before the shea butter application:

Pre-lotion.jpg

And this is after 3 minutes of moisturizing and massage – there is quite a noticeable difference in the shade of the scar afterward:

Post Lotion.jpg

Here’s a side-by-side for easier comparison:

Side by side.png

 

HOOK-UP, GLANSPLASTY, SP SCAR: All three of these incisions are still continuing to heal well, with no issues or anything remarkable to report. Since last month I think I’ve noticed more progression in terms of scar fading with the hook-up scar:

Hook up.JPG

more so than the glansplasty scar. These incisions I admit to being WAY lax about tending to and I very rarely apply lotion to them or massage them – maybe just 1-2 times per week.

Glansplasty & SP.JPG

PAIN: I continue to experience mild, to fairly intense building pressure and pain in my groin when I stand for long periods of time. It’s most inconvenient and annoying when I’m at work and sitting and/or lying down wouldn’t be appropriate. This sensation feels like really extreme blue balls – like blood flow is just increasing and increasing and as though I am getting a rock hard erection but one that just throbs and aches. That’s the best way I can describe it. I also often refer to it as my balls having a migraine. It’s not a pleasant sensation. I’ve been experiencing this since the very first time I stood up at the hospital and it has been by far the most painful thing throughout all of this. Initially I couldn’t stand for more than 30 seconds without breaking out in a literal sweat because the pain was so intense. Gradually though, the time frame I could stand without pain increased and I could make it to the bathroom, to the kitchen to grab something then hobble back to the couch. Always once I am in a scooched way back sitting position where I’m able to lean mostly reclined, or fully laying down, then immediately the pressure/pain is relieved. I’m really hoping that in another month or two this experience will be gone. This pain and my v-nectomy site are the main things that feel like they are keeping me from being all that active right now.

PERINEUM: *sigh*… Ok, the hole is honestly doing WAY better than it was when I first got home from California,  and then a couple weeks after being instructed to pack it with gauze it really started doing much much better. It’s so shallow and small now that the gauze falls out immediately. I really wish Crane has instructed me to pack it when I saw him at my last post-op appointment and had him look at the site. As it stands, I didn’t end up making an appointment to have it looked at locally till a month after I got home because I just didn’t know any better. I figured I would have been told to pack it if the wound needed it. I would have really benefitted from packing it starting at just  a couple weeks post-op, it might have not even gotten to the size that it did, even though it was still fairly small and I would have been more comfortable in the meantime… Right now the tissue is 90% healed with light healthy pink tissue, but there is a noticeable divit where the skin dips into a crevice. The crevice has healed tissue on the inside, but to me it looks like a mini shallow vagina, which is just not ok with me. This divit is what I am seeking to revise. I want it closed up and brought back to the midline like a typical male perineum. I am currently trying to book surgery with Dr Nikolavsky in Syracuse, NY. I was going to have the procedure done locally in Boston, by a uro-gyn, but there is a secondary issue that I  am still having with my scrotum that the uro-gyn is not comfortable addressing.

SCROTUM: I continue to have an existing “pocket” of thin sebaceous tissue that previously functioned as the inner tissue of my labia majora. This specific tissue is sebaceous in nature, which means that it secretes oils and fluids. The inside of the labia majora is a thinner/wetter skin. It also can build up the same kind of “cheese” (sorry, I know it’s gross) that is especially produced in the foreskin of uncircumcised natal males. So no matter how much I keep this area clean and dry, it just produces more wetness and creates smegma over the course of the day. The pocket is just large enough to fit the head of a q-tip into and I honestly didn’t even know it existed till I got really up close and personal with my sack at around 4 weeks post-op and was horrified to find a pocket of smegma that had been growing there for weeks. There is another tiny missed piece of sebaceous tissue on the opposite side of my scrotum, however it’s  much smaller, about 5% of the size of the larger pocket… I had a follow-up with the uro-gyn in Boston about surgically closing the v-nectomy opening and also asked if he would be able to fix the pocket in my sack, although I was fairly sure he wouldn’t be able to. He looked at my scrotum and didn’t feel confident in messing with it since it was closer to my UL than he felt comfortable cutting into and he wasn’t sure about what was just under the skin in that area. I completely understand and truly appreciate him being honest about his comfort level. I’d rather know that a surgeon isn’t comfortable with doing a procedure rather than have him try to do something unfamiliar and then the outcome be that I wind up with another complication or an aesthetic result that would leave me disappointed. For those reasons I’m seeking out a revision of both my scrotal and perineal issues with Dr Nikolavsky in NY. I’m hoping for a date later this month or the middle/end of June… I have the option of returning to CA to have either Crane or Chen do the revision but it would cost me a pretty penny to fly out there, deal with local transport to and from the office, hospital, lodging, airport, and other expenses. My other option is that I could just wait until stage 2 to have the revisions done, but I really feel like I need to have it taken care of sooner than later, because I’m pretty uncomfortable.

ELECTROLYSIS: I just resumed electrolysis post-op for the first time on 04/28/16 (one week ago). I didn’t feel any pain associated with the hair removal, so I’ll be grateful for that. I had a 1 hour treatment and 100% of the hair was easily treated within that 1 hour session. The majority of the hair that is growing on my penis is on the UNDERside, on the lower right quadrant if I look down. There are a few stragglers here and there on the top and all over the shaft, but most is on the underside. I did about 11 months of hair removal pre-op (started with laser and then finished up with electrolysis). If I had it to do over I would have ideally had a solid 18 months of hair removal done prior to surgery. It’s not a big deal that I’m finishing up post-op, but it’s not all that ideal either. Also, I do have some hairs that I can see growing out of the tip of the UL. I debated about what to do with these hairs for a while. At first I was just trimming them VERY carefully, with very accurate small medical scissors. I also discussed the potential of using nair (in the UL, and peeing it out) with my electrolysis. I know a handful of guys who have gotten the go-ahead from their surgeon to do this and have tried it. The first time I heard this technique was being used inside the penis I’ll own up to being pretty shocked and horrified. But I guess with all things lower surgery I’ve just gotten used to the things that we sometimes have to deal with. So understandably when I mentioned the hairs sprouting out of the tip of my dick and the possibility of squirting Nair inside my penis, she had a similar reaction that I had when I heard about it initially too. She said that some people report burns just when using it on their legs or other body parts and that ingrown hairs are common too. She suggested that tweezers instead. My main worry is that tweezing might lead to ingrown hairs, which can lead to swelling at the site, which could potentially lead to a urine blockage… Alas, I eventually made the decision to tweeze them out. No issues thus far, although it’s of course early on and it’s only been a few days – but I’m relieved to look down at my dickhead and not seeing hairs sprouting out of my urethra.

SENSATION: I actually just noticed some sensation beginning only a few days ago and it was completely accidental. After my electrolysis appointment I was rubbing zinc ointment onto my shaft as directed to soothe and protect the skin post-treatment.

Zinc Ointment.jpg

I noticed an odd twinge of sensation and assumed I must have tugged at the base and that was what I was feeling. However, after more observation and experimentation I have been able to duplicate the sensation while mobilizing the base and not creating any tugging motion. I can firmly squeeze or pinch the head of my dick and when I do, a zap of sensation shoots down and is felt in my buried dick. I can also kind of roll my shaft in my fingers, pressing firmly into it and this creates a similar sensation, again, felt in the buried anatomy. I wouldn’t say the sensation I’m feeling is necessarily pleasurable. Although it’s certainly psychologically exciting to know that the nerves are steadily working their way through the highway sheathes, growing in, and making connections. Keep on networking, buddies! Keep on networking!!! I’m mostly shocked because I had imagined that the sensation would begin at the base and I would feel it there for a while and as time passed it would slowly make it’s way up the shaft. Currently though, I can trigger this sensation along all points of the length of my penis. It’s certainly not enough that I could orgasm from it, but still it’s a step in the right direction. There are multiple types of sensation (tactile, protective, erotic, hot/cold, wetness) so I still have a long while to wait as the nerves keep on doing their work! But as it stands, every day since discovering this I’m noticing it more and from less and less pressure. Even gently pulling him out to pee I feel it!

ORGASM: Orgasming has still been a fairly regular occurrence and was possible since right before week 5. I’m pretty sure I explained all that in detail in a past post, so I won’t really get into it here. But it’s primarily a tugging or pumping/bumping (into the anatomy at the base) that allows for orgasm to occur, at least for me. Currently the build up to the orgasm is much more psychological than it was pre-op, but the orgasm itself is easily just as strong. I keep telling myself that it only gets better from here on out, so that’s comforting to know. While I’m glad I haven’t lost my orgasmic ability, it’s certainly more work to achieve orgasm and the time during the build up to orgasm can actually be just as great if not equally amazing to climax. So that’s kind of frustrating to not have access to the intensely sensate buildup right now in the way that I could access pre-op. But this is a process, and time really does make a big difference. The odds are in my favor that I will eventually have pretty amazing sensation in my shaft and I believe that that will make all the difference for me once that occurs.

IMPLANTS: I still am on schedule to have implants in October of this year with Chen in San Fran. However, I am concerned about the current options available in the states for an erectile device. If I had access to any implant I really think I would go with the new Zephyr rod. My reasoning being low maintenance, few parts to fail, and I like that it would fill out my penis more 100% of the time rather than a rod that would only fill it out while inflated. I’m a skinny dude and my penis is certainly on the thinner side. I would like an overall thickening to my profile and I don’t think that the current options for rods available in the states would at all meet my needs. If given the choice between rod or pump, I’d choose pump. The overall shape and thickness of regular rods compared to the Zephyr looks wildly different. I like that the Zephyr model has the defined glans stopper at the tip and also that the overall girth of the implant seems to be thicker which I think would add to the density of my penis. I think it’s unlikely that the two Zephyr models will be available within the states anytime soon. So come October I’ll have to decide between getting the inflatable plus one testicle, or holding off on an erectile device for now and just getting my testicular implants. Immediately after surgery and for the first 6 weeks afterward I loved the thickness I had. It didn’t even look all that swollen, it just looked like a reasonably thick cock and I didn’t think I had any swelling there to go away. As the weeks progressed though I did notice that the girth decreased. It’s not a huge deal, but I would feel more confident with a bit more thickness happening all around, and not just during an erection.

PEEING: Urination is still going well. At one point last month I was worried I might have a UTI. I’ve never had one before so I only have a vague idea of what sensations to look out for. I was having a bit of discomfort close to the kidney area during the first pee of the day. This can be a common sensation if you have a UTI. So I made an appointment with my PCP to have a urine culture done. Everything came back with no issues. Then a couple weeks ago I started noticing a strong odor coming from my penis. Smelled like… ugh, ok, it smelled reminiscent of potent vagina that hadn’t been washed in a couple days. I reached out to Crane and asked if I could go on a course of Bactrim and described the odor. He suggested I go get a culture done because Bactrim doesn’t work on everything. I emailed back and said I had just had a culture done recently and it was normal and asked if I could just try the Bactrim anyway… Buuut, I never heard back from him. This was last Friday. In the meantime the odor has mostly dissipated. I haven’t felt the need to contact him or the office about it currently, but I was kind of annoyed and felt ignored that there was no follow-up after that.

PEEING HACKS: Otherwise my stream is strong and straight. If I’m at home or walk into a bathroom that is a single stall or that no one is it, I will tear off a small piece of paper towel and then after peeing use that to dab the tip of my penis and soak up a couple drops that would otherwise end up in my underwear. It’s not a big deal if they up in my underwear, but I feel drier and cleaner blotting the tip. I can’t tell you how often I see bio guys come out of the bathroom and they are leaking through their underwear and pants in a single circle drop at the head of their penis. I’d rather not be that guy if I can avoid it. If you choose to use this method, just be mindful to not drop the piece of tissue or paper towel in the urinal!!! Urinals can’t flush solid material or waste. I know, this might sound like a really obvious and basic concept, but I’ve accidentally done this a couple times because it’s habit for me to flush the single square of toilet paper that I use at home when standing to pee, in the toilet after I’m done. Muscle memory WILL make you drop it in the urinal! So be careful – you don’t want to be that guy either! Clogged or overflowing urinals are a pisser. Just discretely put your penis back in the stable and when you walk to the sinks to wash your hands you can toss it in the trash. No biggie. I’ve discretely observed men in restrooms for over a decade and plenty of guys do this. I tend to notice it more as a practice used by older gentlemen, but it still happens. No one will think or say anything about it.

WEIGHT: I probably lost like 10 lbs immediately following surgery. My appetite was terrible and I was nauseated just thinking about trying to get food down. The food issue alone was one of the BIG reasons I was so grateful that I had someone there to help with caretaking. Many days there was only one or two things I could even fathom being able to stomach and sometimes it was not a food I even had in the house. So having someone to walk down to a local store or make some food that was already in the house was a huge lifesaver. I honestly would have probably eaten 75% (and I was already eating so little) had I not had a caretaker. And adequate calories and protein are really important when you’re trying to heal. Currently I have the opposite problem now that I’ve long gotten my appetite back but still am not at the activity level that I was prior to surgery. I’ve probably put on 8 – 10lbs over my regular pre-surgery weight, which is a lot for me. Weight gain is common after major surgery. I’m trying not to let it get me down, but it does contribute to not really feeling like myself.

PSYCHOLOGICAL CHANGES: I really feeling like in a lot of ways I’ve been reborn. There is both deep joy and also some angst in that experience. I feel really grateful for having had only very minor hiccups along my recovery so far. But I also have worries at times that are not uncommon to most if not all men at some point in their developmental stages and throughout life. Like: is my penis big enough? There are times when I have asked myself if I chose the right donor site… I ask myself a lot of questions in life and so acknowledging that question and curiosity doesn’t mean that I have regret. Rather, I think it is important to bring up because if you were someone that is currently or was previously swaying between donor sites at some point in time, that thought or “what if” curiosity could still linger at times post-op. I’m not going to pretend it’s a thought that doesn’t exist because that only gives it more power. I freely admit that I would have and still do wish I could have known exactly what my penis outcome would have been like (functionally, aesthetically, sensate-wise) using every single donor site possible. Who wouldn’t, right?!?! Donor site is a big decision. I think it’s natural to want your penis to match as closely to the image you have in your mind as possible.

I love my penis, but I do also wish that I ended up with a bit more length and girth. And while I don’t get mad at myself to wondering what outcome I would have had with say, ALT, I try not to linger too long on these questions… In the same way that I feel I am on the more modest side of the scale of penis owners, there was potential for the complete opposite to be true for me and feeling uncomfortable with far too much girth for my preference. My body could have also reacted negatively with the use of a different donor site and I could have had major complications. So there’s really no way of knowing. I say all this because it’s a mental process that does feel in some ways that it’s landed me back in that adolescence phase that starting T does to us. Relearning a new body, feeling a bit awkward at times while we adjust to it, and relearning and experimenting with how to interact around and with others in both platonic and sexual exchanges.

7 Weeks Post-op, & Stage 2 Update

Heys folks. Not really a ton to update about this week, in terms of things looking differently, so no pictures. I do have the last remaining stitches from my glansplasty finally flaking off, which is nice. My arm pretty much looks the same as last week as do the rest of my scars. I’m still having a bit of trouble with the hole along my v-nectomy and decided to have a “local” (90 min away) specialist look at it, just to make sure there is no infection and to have someone actually following me, since I’m really not seeing anyone right now. So this afternoon I’m driving to Boston to meet with a urogynecologist… ugh… It’s for the best though. After the appointment I plan to send an email to Crane and follow up with him as well to cross check any instructions I’m giving to make sure it’s safe and he concurs. The main thing I want to confirm is that there is no infection, which it doesn’t look like there is. Last weekend I was running a fever though and feeling really ill, so, another reason to be checking in with someone about it all. The other thing I’m not sure if I should be doing is packing the hole. I know a lot of guys have been instructed to pack their wounds and Crane never told me to do that when I had my last post-op appointment with him. Since I left CA, the hole did open a bit further into an area just below, where the incision line looked weak, so I was expecting that to happen. It’s still relatively small. I don’t think I could fit the tip of my pinky in their. So hopefully after meeting with him and emailing Crane I’ll have some further direction on how to move forward. I think it’s just going to take time, as my understanding with wounds that are holes is that they need to heal/fill in from the inside.

I’m generally feeling really well! I had initially taken 3 months off work and I’m now considering going back a month early! I feel strong. To be honest I probably could have gone back at 6 weeks, it would have been tough, and I’m glad I’ve had the extra time to take it easy and continue to heal, but I just don’t know that I need an entire extra month. Depending on how today goes, I might contact my employer and let them know. The hole along the v-nectomy is sore and annoying, but it’s really not bad enough to keep me from working. My arm is still stiff and not 100% but I think working will just be further exercise and rehab for it getting back to normal faster.

Lastly, I’ve scheduled my date for stage 2!!! I currently have a date to get the inflatable pump and one testicular implant on October 11th, 2016 with Chen! At some point I’m going to have a phone “consult” with him about some remaining questions that I have surrounding the surgery as well as the best practices they use. So I won’t get into all of that right now, but I will eventually do a detailed posting with the info I find out. I’ll check in again at 8 weeks.

Dr Loren Schecter (New York Presentation & Mini-Consult)

Loren Schecter PhotoI 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.

Phalloplasty Consult w/ Dr Curtis Crane

Dr Curtis CraneAt the beginning of this month (January 2015) I had a surgical consultation with Dr Curtis Crane to discuss my options for and his methods of phalloplasty. I’ve been researching lower surgery options for well over 10 years but I’ve only had one other consultation before now (Dr Toby Meltzer in 2013) and it was actually when I was considering doing meta as a stage one to see if it would be enough for me since it doesn’t “burn any bridges” in terms of moving on to later needing phalloplasty.

Just a heads up, this is going to be a VERY long post that covers EVERYTHING I spoke with Dr Crane about. I had literally pages of questions for him and I am happy to be able to share the information that I was able to ascertain because I know it was really crucial in figuring out which surgeon was the best fit for me and what procedures made the most sense given my desired outcome and personal preferences.

SETTING UP THE CONSULT: Back in late September 2014 I contacted Crane’s office seeking information about phalloplasty, consulting with him, and what his wait times looked like. His office took about 3 business days to get back to me, which felt reasonable for someone just seeking information. I was emailed new patient intake forms and was requested to fill them out and send them back. This same email listed out of pocket costs for phalloplasty ranging from $68,000 – $78,000 depending on the donor site of the flap and whether or not urethral lengthening is required. Also, if one requires a penile implant that would be a separate surgery that would cost $16,000 out of pocket.

I did inquire about both RFF (Radial Forearm Flap) as well ALT (Anterior Lateral Thigh Flap) phalloplasty and was informed that the BMI cutoff for the ALT phalloplasty is 35. If you desire urethral lengthening extended to the tip of the phallus and have a BMI higher than 25, you may require an extra stage of surgery. Hysterectomy must be performed at least 3 months prior to phalloplasty. Consultations with Dr Crane are $200 and can be done over the phone or in-person. You can make this payment by check or via PayPal. A phone or in office consultation is required before scheduling surgery.

I also asked about insurance coverage: “Dr. Crane is currently only contracted with United Healthcare, Anthem Blue Cross, and Kaiser Permanente as in network providers for bottom surgery. Our office is willing to work with other insurance companies, but first we need to verify that your insurance company offers trans benefits and that if a lifetime maximum exists, that surgery will be covered. If Dr. Crane is out of network with your insurance company, you will be required to pay the self pay surgeon’s fee up front prior to surgery and our office will submit for reimbursement with your insurance.”

The Consult: I chose to do an in-person consultation because I felt like I wouldn’t be able to get clear answers on the best graft site by just speaking with him over the phone. I am very lean so I knew I would be a great candidate (with my low BMI) for ALT if I wanted it but I needed to gather that information face-to-face. This just felt like too big of a decision to make over the phone. I needed to look into the eyes of the guy who was going to potentially do this surgery that I’ve been needing since I was 7. So I arranged for a quick trip out to San Francisco (I live on the east coast) with only two nights stay in the area at a Youth Hostel to keep the costs low ($30 per night). I booked my consult in the beginning of October 2014 and my consult was the beginning of January 2015 – It was just a hair over a 3-month wait period.

His office is located across the Golden Gate Bridge so I had to take a bus out of the city and then had under a 20 min walk to his office from the bus stop. His office has a relatively small but comfortable waiting room that had a couple other young transguys in it that were going over paperwork and waiting for appointments. I arrived about 5 minutes early and waited about 20 minutes in the waiting room and then another 40 minutes once I was called back and brought into an exam room. Oddly enough I felt good about waiting a bit longer for my appointment. It made me feel like he was giving his other patients the thorough time that they needed with him and would eventually get to everyone.

I had a very long list of questions for Crane so I’m just going to list the questions and then list what his responses to them. These are not all exact quotes from Dr. Crane, just the closest that I was able to remember in documenting our consult… Ok, let’s get to it…

Me: About how many phalloplasty have you done?

Dr. Crane: More than 100. I think I have most in the country right now, by A LOT.

Me: What are your thoughts on leaving the frontal opening verses closing it with a full vaginectomy and what are the complication risks involved with that and having full urethral lengthening?

Dr Crane: If you leave the vagina it’s fine, I think I’m the only guy in the country that will leave it and still do urethral lengthening. I’ve done it that way a lot. However, you have an increased fistula rate. Fistula is an opening from the inside of the urethra to the outside of the body. It doesn’t make you sick it doesn’t cause an infection, it just means you need another surgery to repair it if it doesn’t heal on it’s own. I’d say the risk of fistula WITH vaginectomy is around 10%, withOUT vaginectomy it’s closer to 25%.

Me: So worst case scenario you need another surgery, but in the end the fistulas are always able to be repaired, right? Have there been any cases where you haven’t been able to repair the fistula?

Dr Crane: No, I haven’t had that yet.

Me: Would keeping the frontal opening affect the positioning of the phallus? For example, would it need to be placed lower on the body if you did not do a vaginectomy?

Dr Crane: No, it wouldn’t affect position.

Me: So the only real visual difference would be in how the scrotalplasty is formed, right? Like it couldn’t be in one sac if there was no vaginectomy?

Dr. Crane: It would look the same. I make it the exact same way with or without vaginectomy. Maybe just a bit smaller so that I could close all the surrounding tissues.

Me: So you’re opening a new practice in Austin, Texas?!

Dr Crane: Yes! The end of this year. I’m bringing in a new guy, Mang Chen, he’s an amazing surgeon who did the exact same fellowship as I did. This year alone we have 150 cases booked already where I am teaching him my technique – where I will be working with him. Once I have him good and trained and believe me I’m not going to leave my baby in the hands of just anyone, he’s going to stay here (San Francisco) and I’m going to move to Austin… My goal in say 40 years when I’m on my deathbed, I want to be able to look back and say: I helped to make it possible for a transgender person to never have to leave their state for healthcare. I think that’s reasonable. The first goal was to have a successful practice. I’ve got that here so then I decided let’s go to the most conservative state and the most liberal place in the state (Austin) and make transgender care mainstream and from there it’s just going to propagate… And it doesn’t have to be all “Brownstein & Crane’s”, I just want this access for the community and this is the only way I see that happening. I could stay here in SF and just hide away in a successful practice and never promote anything. But since opening this practice now every ER doc, and family practitioner, and endocrinologist in the areas knows about what I’m doing. It happened here, it’s gonna happen in Austin. I know some people are worried about the change in the teams but really phalloplasty (and other surgeries especially lower specific) are not just a one man show. I’m the name on it but I’m only 33% of the team – the other 66% of the team I’ve been working with will still be here in SF and I will be training Chen to take over that 33%. So if you need to have me as a surgeon (starting next year) you can come to Austin and you’ll have that same 33% and the other 66% will be all people I’ve trained, or if you want to have surgery in SF, the same micro surgery team will be there and the other 33% will be Chen who is an amazing surgeon. Everyone has to start somewhere – in one year his name will be just as well known and in demand as I am.

Me: So what does your scheduling timeframe look like right now?

Dr Crane: November 2015 here in SF w/ Chen and myself, after that I will be booking the end of December 2015 or absolute latest January 2016 in Austin……. Are you thinking forearm, thigh???

Me: I’m still up in the air about that. As far as priorities go, sensation and urethral lengthening are neck and neck for me. However, I do want an implant. Being able to have penetrative sex is an absolute must for me and so I’m worried that maybe ALT is able to maybe sustain an implant a little better than forearm, would you say that’s true?

Dr Crane: I wouldn’t say that’s true. Well, the ALT is very girthy. If you are someone that wants a 6,  7,  7.5 inch phallus, then definitely ALT.

Me: I want 5 inches MAX!….. I have some burns on my forearm from when I was younger; I know they fall along where the tissue for the urethra would be harvested would that interfere with the integrity of the urethra?

Dr Crane: Those won’t be a problem.

Me: Does the forearm graft have to start right at the wrist or is it possible to go back a bit away from the wrist.

Dr Crane: You would shorten your length, if you wanted 5 inches we could come back a bit.

Me: *Touching my wrist* So this would be the base of the penis or the tip?

Dr Crane: The tip

Me: So, sensation differences between forearm and thigh?

Dr Crane: Forearm is better.

Me: As far as functionality of the donor arm, I’m wondering long-term what the functioning is like. I know initially, it’s going to be rough going but do you think that people tend to get 100% functioning of their arm back?

Dr Crane: Yes! I don’t know of someone who hasn’t. It’s like 4-6 weeks. Because we don’t take any muscle we just take skin and fat.

Me: Do you ever use Integra?

Dr Crane: We don’t because 1.) it really jacks up the price of the surgery 2.) it requires a separate surgery 3.) we take a thick enough split-thickness skin graft that it’s our opinion (mine, the microsurgery team and the Buncke clinic) that it doesn’t actually help at all and just raises costs and requires more surgery.

Me: So it seems like from what I’ve seen that maybe folks with a higher BMI have a bit more noticeable indentation on the donor arm from the graft – Would you say that it’s accurate to assume that since I have very little body fat my indentation might be less noticeable?

Dr Crane: Yes. So everywhere on your body you have skin, fat, muscle. What we take to make the phallus is skin and fat and then we take a split thickness graft (skin, no fat) and place that on the donor site. So it’s like skin right on muscle, then transitions to skin, fat, muscle. So if you have an extra centimeter of fat you’re going to have a centimeter higher divot – you won’t have to worry about that since your so lean.

Me: Ok, so then my worry becomes: Am I going to have a very thin penis?

Dr Crane: You would end up like this ***puts thumb to index finger in a cupped grasp shape with thumb and index finger a bit away from one another*** which seems reasonable for what you expressed in wanting in a 5 inch phallus.

Me: So, pre-lamination of the urethra?

Dr Crane: It’s like, the WORST idea! Monstrey, in Belgium, he’s done 600 phallos – He realized pre-lamination was horrible 10 years ago. I know Salgado is using this as a selling point but he’s a plastic surgeon, he’s never done reconstructive urology. I did 7 years of urology and any urologist will tell you pre-lamination is NOT a good idea. It hurts people and it’s not a standard of care. Unfortunately there is a lot of bad information spread among the community via blogs and there isn’t anything I can do about that.

Me: When you repair a fistula, from where are you taking those grafts?

Dr Crane: I usually do an adjacent tissue transfer of vascularized tissue and cover up the fistula.

Me: Do you ever use vaginal mucosa or buccal mucosa for repair?

Dr Crane: For phallo I don’t really ever use a graft. There’s enough vascularized tissue there that I don’t need to use graft. Vascularized tissue is always better than graft. When you take a graft from somewhere else and sew it in there is always a lot of scar tissue that builds up and really increases the risk of stricture, that’s why doing a pre-laminated graft is worse than using healthy vascularized tissue that’s attached to it’s own blood supply. You know how we take a skin graft from the leg and put it on the donor arm and it heals kind of gnarly? It’s because it’s a graft. Verses when we take all this tissue in a flap that’s attached to it’s own blood supply to make a phallus and it looks like regular skin. People look at the arm and think “burn victim”, but the phallus looks great!!! That’s the difference between a GRAFT healing WITHOUT it’s blood supply and a FLAP healing WITH the blood supply. It’s the same thing with pre-laminating a urethra. Every time you use graft you are just cutting out a piece of skin, slapping it on and crossing your fingers hoping it will reattach to a blood supply. When the blood supply is lacking there is a lot more scar tissue that builds up and it becomes thick like concrete, it’s really hard. So EVERYTIME graft is used it’s going to heal that way. Verses when you bring a blood supply with it like the RADIAL forearm, (it’s named that because of the radial artery) it heals great! So when you have people suggesting that it’s much better to use a graft, a pre-laminated graft… It’s just insane. Why are you going to build the most important functional part of this penis out of something that’s going to heal worse?

Me: Wow! That makes SO…MUCH…SENSE! Even though pre-lamination wasn’t something I was sold on, I was open to it if it truly was the best way to go and would reduce complication rates. I had been under the impression that this was a new technique, not something that had been tried long ago and tossed out because it hadn’t yielded a good outcome. I don’t see how I could pursue having a pre-lamination done after hearing that explanation – that was really informative……. As far as blood loss goes? Do people ever bank their own blood prior to surgery?

Dr Crane: I’ve transfused maybe 3 or 4 people out of 100 and those 3 or 4 were very early on in our first 15-20.

Me: As far as the insurance companies that you are contracted with currently – do you foresee those changing when you move to Austin?

Dr Crane: I’ll only add more. Because they don’t care what location I am in, they just look at the name.

Me: As far as the deepithelization/de-nuding/de-gloving of the clitoris, do people say that they still experience (although no longer a visual change in the tissues since they are inside the base of the phallus) the sensation of becoming erect? That sensation of growing and thickening is something that I would really hate to lose.

Dr Crane: That’s a good question, I haven’t asked. It would stand to reason that they would though because I leave all that erectile tissue. I only remove the thinnest layer of skin so that there is no sebaceous cyst that forms. But I specifically take the thinnest layer of skin, and leave all the erectile tissue and all the nerves just below the skin so that you have a really erogenous spot.

Me: The skene’s glands and bartholins glands, do you leave them intact?

Dr Crane: I leave them. I leave all the glands that I can so that there is some ejaculation.

Me: Do you do an Allen test to confirm if someone is a good candidate for RFF?

Dr Crane: Yeah, we can do that…. You know it’s like less than 1% of the population that has a bad one. ***Test showed positive signs for me being a good candidate***

Me: What’s the incision like for implanting the erection pump/rod?

Dr Crane: It’s real easy, I go through a previous incision that’s already healing at the base of the phallus – no new scars.

Me: What are you’re complication rates looking like for pumps?

Dr Crane: I’ve had about 2 infections, and 1 erosion. Pretty low, about 5%, maybe 10%.

Me: Do you wrap the pump in anything?

Dr Crane: Yes, it’s gets wrapped in a Gortex sheath.

Me: About how many years do you think a pump will last?

Dr Crane: At centers around the world that do free flap phalloplasty they say that a pump will last 3-5 years. The rod however, will last 10, 15, sometimes 20 years. For that reason most of my patients opt for the semi rigid rod because they don’t want more surgery.

Me: On an RFF would the main incision down the phallus be on the underside?

Dr Crane: Ventral, yes – AND for the ALT, as well. We used to do it for the top and bottom on the ALT because we had concerns about the urethra, but we made some adjustments and we were able to modify so that it’s only ventral.

Me: When you take a split-thickness graft (the one that will eventually cover the phallo donor site) typically the hair follicles don’t come with the graft, correct? Even though you said you take a substantial graft to cover the arm (for RFF) or leg (for ALT)?

Dr Crane: No, the hair stays on the leg.

Me: Can you construct a frenulum during glansoplasty?

Dr Crane: We always try, but it depends on how it scars and flattens out. We can control pretty much everything in the operating room, but the real complications come from how people heal. Sometimes we make a REALLY nice glans, and the whole thing is lost 9 months out. Fortunately that’s only about 10% of the time. Usually by 6-9 months if it’s still there then it’s gonna stay.

Me: If you want a REALLY well define glans, do you suggest waiting to do that at stage 2 with the implants?

Dr Crane: We’ve gotten really great results with doing it at stage 1. I’ll do it at stage 1 and then if someone needs a touch up, I’ll do it again. That way it gives me an opportunity to do it twice.

Me: So there’s no benefit to waiting to do it at stage 2?

Dr Crane: No

Me: What can you tell me about likelihood of shrinkage. Like losing length or girth?

Dr Crane: I’ve only had 1 patient really complain about that. When I looked at pictures though it looked the same to me.

Me: When you measure how long the phalloplasty is going to be, like I said I want 5 inches, do you measure right on the arm itself? I ask because I know depending on where you put a ruler on a penis be it along the top or underneath you get a different measurement.

Dr Crane: Yes, we measure on the arm.

…………

Well, that’s the bulk of what I can remember and in looking back at the questions I had printed out to ask him. I really wanted to go as in depth in possible for a couple reasons. First I know how important it’s been for me to get answers to these questions but sometimes when you hear other people’s questions you get answers to things you didn’t even think to ask and then those questions/answers will generate new questions for you all together. And it’s been my goal for myself to really research and look at this from every angle possible so that I am as prepared as possible and will have the least amount of surprises post-op. But also, I imagine it would be easier on Dr Crane (and any surgeon) if their consults weren’t filled with answering the same questions over and over. It seems like that precious consultation time could be spent on more personal questions that aren’t so overreaching and relate to everyone or a general technique that’s performed.

I hope this has been helpful to someone out there.