FYI: Penile-Preserving, Laproscopic Peritoneal-Pullthrough GCS with Dr. Heidi Wittenberg in a month-ish

100
u/the_weird_stuff
Fri Jul 26 03:26:00 2019 UTC
*
(35 comments)

(obviously, throwaway. But I like the username so much I might use it more.)

Intro

I'll be having "Penile-Preserving, Laproscopic Peritoneal-Pullthrough GCS" at MozaicCare, with Dr. Heidi Wittenberg, in around a month. Yep folks, the peritoneal hype train just keeps coming!

The peritoneal tissue will be used for the vaginal canal, and the scrotal tissue for the rest. My penis stays as it is. It's 1-stage surgery but a labia revision afterward is on the table.

This post is 0) giving back to yall, because figuring out this stuff all really sucks without this sub & /u/HiddenStill , 1) to encourage me to discuss post-op stuff afterwards, and 2) to answer questions and address alot of nonsense to be found online about PPT. Because, goddamn, the amount of uninformed "information" flying around about PPT is pretty bad.

Why am I doing this specific surgery?

Why "Penile-Preserving"?

Before I heard that non-binary transfemme GCS was possible, I was pretty ambivalent about it. Of course, I'd much rather have been born with the traditional female parts, but after my orchiectomy last year, I didn't feel like it was worth going further with current GCS tech. I did/do have bottom dysphoria, but it was about not having a vagina, not about having a penis.

Hearing about non-binary transfemme GCS was mind-blowing, frankly. It was all of what I wanted. I am transitioning to binary female (albeit gender nonconforming), but I have my reasons:

  • As somebody once said: "if you can't join 'em, beat 'em"
  • Insert the "Why not both?" meme here
  • I'm autistic (ASD1), which basically means that rather than MtF (Male-to-Female), I am AtA (Alien-to-Alien)

Why "Laproscopic Peritoneal-Pullthrough" (PPT)?

This is the part that gets everyone's panties in a bunch.

Addressing the Confusion

There's been alot of noise about Dr. Ting & PPT, as well as some other people. It seems like, with most surgeons, the problem they have with PPT is the laproscopic part. A surgeon needs the training & equipment to use a special robot to go through your belly-button and do crazy stuff in there. Since GCS traditionally isn't done with robots, lots of surgeons don't have that experience/training. Also, there are different types/extents of PPT - as the surgeon for specifics.

As to the "surgeons don't recommend it because there's problems with PPT": hopefully you've read all about how PPT has been used successfully throughout the last few decades for cis women who needed work done down there. PPT is proven tech, just not-so-much for GCS. However! There's not alot of long-term data on PPT, whether for cis or trans people.

As to the "Dr. Ting/etc. stopped doing it": they actually haven't, AFAIK. Ask them yourself if you want a better answer :~).

All that said, it is new-ish tech for GCS, but I feel confident. I've talked with a past patient of Dr. Wittenberg's that had my same surgery, and things checked out. Also watch https://www.youtube.com/watch?v=73pkIWT95Pk (Dr. Wittenberg talks about PPT). Basically, she has a uniquely useful background to perform PPT GCS.

Pros & Cons for PPT GCS (with Dr. Wittenberg)

Pros:

  • More material to work with: if you don't have alot of material down there, or you're getting non-binary surgery, this is a nice alternative to traditional skin grafts.
  • Guaranteed no hair or other weird skin stuff!
  • Naturally secreting tissue with good characteristics for sexy times (not scary/smelly/etc.)
  • Theoretically, less dilation after healing. Not enough data to say for sure.
  • Theoretically, no douching! This one is big, because almost all constructed vaginas don't automatically clean themselves like cis ones do. PPT tissue should actually clean itself. That said, there isn't enough data to say for sure. (this was told to me by Dr. Wittenberg)
  • There's been some noise in the academic works about the tissues magically transforming into very-similar-to-vaginal tissues after several months or a couple years. Not really sure, but it sounds fucking great.

Cons:

  • Not much long-term data! You're a bit of a guinea pig. That said, alot of people have been having the surgery with Dr. Wittenberg, so she's quickly gaining experience.
  • It secretes 24/7...all the time. It's a reality I'm 100% fine with, but it's not for everyone.
  • Peritoneal tissue is more fragile than penile/scrotal tissue. From what I was told, all it means is that you can't be as rough. Since I'm gay-ish, it's not a big deal.
  • Added risk/recovery, since PPT takes abdominal lining. That lining needs to heal along with everything else.
  • The tissue isn't sensate like penile/scrotal tissue. Peritoneal tissue has no erotic nerve wiring!
So is PPT better or worse than the other methods?!

It all boils down to this.

I've been in the same boat as alot of you - obsessively researching and calculating esoteric Transgender Maths™ to determine what's best and yadahyadahyadah.

If you're keeping your penis, then yes, I'm pretty confident that PPT GCS (with Dr. Wittenberg) is the best option...no one else is even advertising non-binary surgery, let alone PPT. I'm guessing she has the most experience by a wide margin.

If you're not keeping your penis: I dunno, sorry. The big tradeoff seems to be secreting (good) vs. not penile-sensate (bad). However, I know some people (Dr. Ting?) just use PPT for a part of the canal, and used the good 'ole penis/scrotal tissue for the rest. I'd guess that would be the best of both worlds.

Soapbox time about PPT & its reception in the community

Alot of people don't want to admit that newer GCS tech could be (unilaterally) better than the stuff people were doing decades ago, because they've had the old surgeries done and don't want to feel that they're "missing out" on new stuff. Some of these people spread misinformation in an attempt to get affirmation that they aren't, actually, missing out on anything.

It's just simple insecurity, which is endemic in the trans* community, because transphobia & such. With the anonymity of reddit, this misinformation can spread as easily as the truth if one is relying only on the testimony of random users. Please, refer to more reliable sources , including: official surgeon stuff, actual pictures, verified testimony, academic work, and even common sense. Or at least explore a user's history - there's a few usernames who obviously have a bone to pick.

Older techniques have their place, but the recent proliferation of trans* awareness & respectability means that the surgery tech is getting better. PPT is part of this evolution, but I bet I'll have an outdated vagina in as soon as half a decade. This can't be such a big deal to people. Progress in this area will happen for the foreseeable future, and us outdated-vaginas shouldn't be insecure about it.

We all need to chill and not let insecurity or regret get in the way of providing accurate & useful advice to pre-op people.

Why did I choose Dr. Wittenberg?

  1. She does the surgery I want, unlike 99% (100%?) of other GCS surgeons
  2. She's covered by insurance somehow (I swear, all my luck in my life was used up for this)
  3. Her aesthetics are as good as any collection of GCS results I've seen. Fair warning, I've dated enough to be able to spot differences pretty easily, but I'm fine with that for me because, dudes, I'm keeping my penis.
  4. The in-person consultation was good. I've had bad consults, so this actually means something.

Surgery logistics & details (paraphrased from the materials given to me)

Finances, location, pre- & post-op appointments

  • In-network for my insurance & 100% covered (BCBS California), but it sounds like ~$30k otherwise (they don't take any insurance but mine right now)
  • Waitlist was ~6months out for surgery, ~1-2months for in-person consultation
  • She's in downtown San Fransisco
  • You stay in the hospital for 3 days afterward
  • There's 1 pre-op appointment a few days before
  • There's 3 post-op appointments in the 3 weeks afterwards (once a week, each week)
  • They recommend you stay ~30min near them until after your last post-op appointment
  • You can't leave the hospital without someone else, and they require you have someone helping you for at least the first week, if not your entire stay in SF

Pre-op preparation, medications

  • 3 months before surgery: No smoking/nicotine
  • 2 weeks before surgery: Stop all estrogen, start taking Gabapentin (I can continue progesterone though)
  • Two days before surgery: Bowel prep -> restricted diet
  • Post-op: Antibiotics, painkillers, anti-nausea, etc. for the first couple weeks (they even suggest trying CBD oil/edibles)
  • Can resume estrogens immediately post-op

Recovery & dilation

  • No work, strenuous activity, or intercourse for 3 months (pretty sure this is written for employers, hopefully it won't actually take this long)
  • Can't "submerge the groin area" for 3 months (e.g. baths, swimming)
  • Dilation 1x daily (10 minutes) for the first 6 months, every-other-day (EOD) after that (super chill, right?!)
  • Douching every day for first week, EOD second week, 1-2 times a week after that (negotiable IIRC)
  • Your mental ability/capacity is gonna be fucked for awhile, so even us computer people won't be able to return to work soon after. (it took ~1month after orchi to be in tip-top-shape mentally)

Important stuff to consider/bring

  • SF is super expensive, find an AirBnB outside downtown
  • IMO, assuming you cook - make sure your place has a proper kitchen, and bring your essential cooking stuff! (rice cooker, knives, ingredients, etc.)
  • Get a donut pillow to sit on, especially for the post-op commutes
  • You'll probably want one of those lap-tables so you don't have to rest your laptop/books/food on your lap
  • IMO you should download all the stuff beforehand (media, podcasts, books), because wifi is so often total shit at Airbnb's
  • Buy your own lube beforehand just to make sure you'll have enough, but they'll supply the dilators
  • Try to find somewhere that you can enjoy walking around, because that's basically all the physical activity you can do

EDIT: woah, yall. This (relatively) blew up. Good to know it's useful.

all 35 comments


7
u/Androgynoplasty
Mon Jul 29 12:49:40 2019 UTC
(2 children)

Hey congrats! It's nice to finally not be the only source of info on penile-preserving vaginoplasty. :D

If you're keeping your penis, then yes, I'm pretty confident that PPT GCS (with Dr. Wittenberg) is the best option...no one else is even advertising non-binary surgery, let alone PPT. I'm guessing she has the most experience by a wide margin.

For the record, of the three surgeons I know of that are offering penile-preserving vaginoplasty, two of them are openly advertising it on their websites. Of the three, only Dr. Wittenberg offers peritoneal pull-through.

I went with the other advertising surgeon for my surgery, so I had a skin graft from my abdomen. It would be interesting to compare experiences later.

Message me if you have any questions both before or after. Also let me know if you'd like a visitor when you are in the hospital, it would be nice to finally meet someone else like me.

Best of luck with your surgery and recovery!

5
OP
Tue Jul 30 04:17:35 2019 UTC
(1 child)

Yes haha you're the only source of information I had on this! Thank you for sharing and making it through all the anonymous people being shitty.

For the record, of the three surgeons I know of that are offering penile-preserving vaginoplasty, two of them are openly advertising it on their websites. Of the three, only Dr. Wittenberg offers peritoneal pull-through.

Oh I didn't know another was openly advertising, very interesting.

I went with the other advertising surgeon for my surgery, so I had a skin graft from my abdomen. It would be interesting to compare experiences later.

Yes definitely! It would actually be pretty useful info if we're the same demographic. How old are you?

Message me if you have any questions both before or after. Also let me know if you'd like a visitor when you are in the hospital, it would be nice to finally meet someone else like me.

Thanks, I will!

That means alot, and I agree that it would be nice to know someone else. It would be wonderful to meet, but (because I'm autistic) I'm pretty shitty at understanding when to trust strangers and when not to. If you're interested in meeting I'd like to direct-message with you a bit, if that's okay :).

6
Tue Jul 30 05:23:00 2019 UTC
(0 children)

You are very welcome! Showing that this is an available option for those that need it is the reason I shared what I have so far. I almost settled for a standard vaginoplasty (with Dr. W, actually, but then she changed offices) before it was confirmed to me that this was possible.

My surgeon has it offered on their page but doesn't have result pictures up yet because I'm not fully healed yet (just had a revision/labiaplasty last month). I'll go in to have pics taken at my next checkup in a few months.

I'm in my mid 30's.

Feel free to direct-message or start a chat with me, whichever is more convenient. :3

6
u/HiddenStill
Fri Jul 26 09:13:30 2019 UTC
(3 children)

Awesome post. I added to the wiki in several places.

Any idea what depth you can expect?

Any plans to post photos afterwards?

6
OP
Sat Jul 27 03:24:16 2019 UTC
(2 children)

Thanks!

  • Any idea what depth you can expect? : Oh, I asked about this and forgot to record the answer...it wasn't bad. I think like ~5in? Maybe a bit less? I'm confusing the discussion of depth without PPT, but I know PPT is deeper than just scrotal skin.
  • Any plans to post photos afterwards? : Ehhhhhhhhhhhhhhh. I'm not going to let her office use them on their website/etc., but I might take them for myself. They would be really useful to the community I guess...but I basically never post pictures online as a rule. If I do, I'd probably be taking a picture a day or something, and post here at a reasonable frequency. As long as I can properly anonymize the metadata it should be fine. So, 65% chance I'll do it.
5
Sat Jul 27 03:41:46 2019 UTC
(1 child)

There's software that will remove metadata, like this

http://www.digitalconfidence.com/batchpurifier.html

I'd not use an online service to do it.

3
OP
Sat Jul 27 15:02:48 2019 UTC
(0 children)

Thanks!

Yes, I'm still half-assuming I'll have to McJigger some pixel-by-pixel transference script or something.

6
u/letthisegghatch
Fri Jul 26 10:22:18 2019 UTC
(4 children)

It secretes 24/7...all the time.

Right there it is. That's the only thing I needed to hear to lose interest. I'm so glad this procedure is what you're looking for, but its not for me.

Fri Jul 26 16:56:32 2019 UTC
(1 child)

[deleted]

3
Fri Jul 26 16:57:59 2019 UTC
(0 children)

I talked to one of Ting's patients. She told me she has to wear panty liners all the time. No thanks. I don't care if some cis women have to also. That's not for me.

3
Fri Jul 26 15:09:14 2019 UTC
(1 child)

Wow, yeah. That would be really inconvenient.

6
Fri Jul 26 16:29:38 2019 UTC
(0 children)

I kind of wonder if when used in conjunction with penile tissue if the penile tissue would “soak up” some of the moisture.

7
u/2d4d_data
Fri Jul 26 11:47:42 2019 UTC
*
(1 child)

How long was it between reaching out for the initial consultation and now for you (was 2/6 what you experienced or current)? Did you have to go to SanFran for the consultation? Is that recommended? Anything you wish you had asked Wittenberg that you forgot?

Does it have the same electrolysis requirements? Any scrotal tissue used on the inside, where do they connect?

How much does it secrete 24/7?

While no erotic nerves would you still feel something in you?

Do you expect you will need a labiaplasty 9 months later?

And please do follow up with your results!!!

4
OP
Sat Jul 27 03:18:07 2019 UTC
(0 children)
  • How long was it between reaching out for the initial consultation and now for you (was 2/6 what you experienced or current)? : Eh, it was 1 month (maybe less) to book a consultation for me, but my time is super flexible. I think 1-2 months is the current consultation booking time, but I'd check. As for the surgery, she actually had a spot open 3 months after my consultation but it didn't work, so it was ~6mo.
  • Did you have to go to SanFran for the consultation? Is that recommended? : She does video consults but she does recommend in-person. She charges the same either way, but in-person is obviously more thorough and it's covered by insurance.
  • Anything you wish you had asked Wittenberg that you forgot? : I probably talked with her for ~1-1.5 hours, but the time went by too fast. My discussion was mostly about the details on penile-preservation & PPT, so I didn't discuss the classical GCS stuff (aesthetics, etc.) as much.
  • Does it have the same electrolysis requirements? No, you don't need to zap the penis shaft. Other than that, basically the same, but more relaxed. Since you don't have to worry about hair in the canal, you could actually continue with laser afterwards. My hair removal person is a doctor at a hospital with alot of experience - explaining this to her, she said that we might as well target the same requirements (~80% cleared by surgery) but it's not as worrisome.
  • Any scrotal tissue used on the inside, where do they connect? : This detail I'm going to discuss in the pre-op appointment. I plan to basically go over the surgery with her, and I'll probably remember to tell yall about it. From what I understand now, the join will be ~1inch into the canal, or less. As she continues to do these surgeries, she's updating her stuff.
  • How much does it secrete 24/7? : This is per-person. One patient had "alot" of secretion in the first couple months and it stabilised at a more natural rate after recovering for a bit. It sounds like it varies to person but you should prepare to need panty liners.
  • While no erotic nerves would you still feel something in you? : Yep! Not only will the erectile tissue & the base of the penis be around there & functional, it's not actually numb. I don't know alot about this, though, so I'll find out more at the pre-op appointment.
  • Do you expect you will need a labiaplasty 9 months later? : I am firmly requesting that she not throw out tissue when it could be used to provide more labia...I've never understood why people don't like "lippy" labia. So, I'm guessing I'll have alot of material to work with if I do get labiaplasty, but I honestly don't know. I haven't seen many/any GCS results where the target wasn't a "pretty pussy" with small labia.
4
u/winterberryx
Fri Jul 26 10:14:55 2019 UTC
(0 children)

Fantastic write-up. Thanks

u/[deleted]
Fri Jul 26 16:54:48 2019 UTC
(1 child)

[deleted]

3
OP
Sat Jul 27 03:26:39 2019 UTC
(0 children)

Hey, that sounds great! Very exciting!

Please report on your experiences :~). I'd be very interested in following your recovery & experiences.

3
u/wizrd411
Fri Jul 26 10:10:27 2019 UTC
(0 children)

This is amazing, thank you for such a detailed, wonderful post.

3
u/illyriarose
Mon Jul 29 18:21:23 2019 UTC
(3 children)

Awesome! I hope this goes really well for you. I'm having the same procedure for the same reasons scheduled for the start of October. I just created a Reddit account so I can eventually do an AMA after and maybe a post like this before because the community needs more visibility on this. Thank you for sharing your experience so far!

3
Wed Jul 31 02:15:17 2019 UTC
(1 child)

Oh, awesome! If you need to ask any questions to someone who has already gone through this (with another surgeon but not with peritoneal pull-through) my offer of DM or chat is open to you too.

3
Wed Jul 31 03:15:36 2019 UTC
(0 children)

Thank you so much! I'll definitely take you up on that offer at some point.

2
OP
Tue Jul 30 04:00:44 2019 UTC
(0 children)

Thanks!

Excellent, glad to hear you'll be sharing your experience. There definitely isn't enough good stuff out there.

3
u/SilveredFlame
Fri Jul 26 05:08:12 2019 UTC
(0 children)

Link for anyone curious: https://www.mozaiccare.net/

The more I look into PPT the more appealing it is.

2
u/proser30
Fri Aug 2 23:46:54 2019 UTC
(4 children)

Will you still be able to get normal erections? Will inside be very tight or can you have penetrative sex? Can you have the penis removed for a complete vagina if you choose?

3
OP
Sun Aug 4 01:51:48 2019 UTC
*
(3 children)
  • Will you still be able to get normal erections? : that's the plan
  • Will inside be very tight or can you have penetrative sex? : I don't know the dimensions of what can be fit inside, but I'd expect it to be tighter than normal. Length sounded around normal, as mentioned in OP. Since I'm gay-ish I didn't ask much about that. Of course, it's relative per-person and to your hip size, just like any other GCS method.
  • Can you have the penis removed for a complete vagina if you choose? : Nope

*EDIT: /u/illyriarose correctly noted that "penis removed" != "re-doing GCS". I didn't ask but from others' input and common sense, it seems reasonable to assume you can remove the penis later.

2
Sun Aug 4 08:22:08 2019 UTC
(2 children)

Can you have the penis removed for a complete vagina if you choose?: Nope

Really? When I asked her about it in my consult she said it should be possible to do a revision to convert the penis into a clit should my desires change down the road. Obviously it would be better to wait and heal before doing another surgery, but I don't realistically expect to ever want to anyway.

Did Dr Wittenberg explicitly tell you it couldn't be done or is your answer based on a guess?

3
Sun Aug 4 12:01:34 2019 UTC
(0 children)

For the record my surgeon also said this should be possible to do. However to my knowledge no one has gone that route yet so it just hasn't been attempted yet.

3
OP
Mon Aug 5 17:16:58 2019 UTC
(0 children)

Hm interesting. I didn't ask about penis -> clit, but she did tell me that you can't "have GCS a second time", basically.

The way things are constructed are different than when you get the normal GCS (obviously?). While "penis -> clit" sounds reasonable, I doubt it would be the same as normal GCS.

2
u/SomeGamerKid
Mon Aug 5 05:53:12 2019 UTC
(1 child)

That's amazing!

Assuming one has been able to keep their ability to have erections through HRT, would the penis still be functional in that respect after the surgery?

3
OP
Mon Aug 5 17:18:16 2019 UTC
(0 children)

would the penis still be functional in that respect after the surgery? : Yep. From what I've heard from her and other patients, you're expected to have the same functionality as before surgery (albeit, taking into account hormone changes if you haven't had an orchi).

2
u/Prototype1250
Wed Aug 7 16:39:36 2019 UTC
(4 children)

Can you elaborate on your experience with insurance? Is it being processed as a standard vaginoplasty, or did you have to do something to convince them?

I've been having a lot of trouble with my insurance since Dr Wittenberg is out of network, so I've been going back and forth with appeals for the last ~13 months. Their current argument is that it's "not medically necessary".

Also, I can at least contribute a little regarding cost. There are two major components: the surgeon's fee, and the hospital's fee. The surgeon's fee has been quoted to me by Wittenberg's office as about 60k for PPT, and the hospital charges as "100k+". I haven't managed to get further clarification on an exact amount, but her office is trying to get it from the hospital.

2
OP
Wed Aug 7 17:07:22 2019 UTC
(3 children)

Can you elaborate on your experience with insurance?

MozaicCare is taking care of all of it for me, so I didn't need to interface with the insurance company at all. Dr. Wittenberg is in-network for me. I don't really know about the process besides the pre-authorization was approved.

Is it being processed as a standard vaginoplasty, or did you have to do something to convince them?

That's what I'm assuming. I know they did mention the laproscopy (and maybe the peritoneal graph) in the pre-auth thingy though.

"not medically necessary"

If your insurance covers vaginoplasty, I don't see why they'd rule out this.

Also, I can at least contribute a little regarding cost...

Holy crap . Wow, that's alot.

3
Wed Aug 7 17:36:12 2019 UTC
(2 children)

If your insurance covers vaginoplasty, I don't see why they'd rule out this.

In a word, discrimination vs nonbinary people. I'm looking into possibilities for a lawsuit if the next (final) round of appeals doesn't pan out.

2
OP
Wed Aug 7 19:39:36 2019 UTC
(1 child)

Ah, yes. That's why I (and MozaicCare I'd guess) avoid mentioning nonbinary-ness ;~).

I'm looking into possibilities for a lawsuit if the next (final) round of appeals doesn't pan out.

Good luck! Having a pro-nonbinary court ruling would mean alot (assuming USA).

2
Wed Aug 7 20:42:57 2019 UTC
(0 children)

Unfortunately, Dr Wittenberg is out of network for me, meaning I need good reason to convince my insurance to allow the outside referral. Hiding my nonbinary status wasn't really an option (much like it isn't an option in the rest of my life...).

4
u/lumiya17
Fri Jul 26 05:30:46 2019 UTC
(0 children)

Wow! You learn something new everyday. Didn't know you could do this. Not for me, but very awesome for those who would benefit from it. :)

Hope everything goes awesome for you and that your recovery is super easy!

1
u/lightningflashjaz
Wed Nov 22 08:55:14 2023 UTC
(0 children)

any update?