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Awesome! I'm really glad your recovery is going well. I'm also happy to hear that this is now being offered in places other than California. I'm having my peritoneal pull-through in SF in less than two months and my surgeon only has photos of two patients who had PPT and there really aren't many personal accounts online. I'd love to hear more as you go through your recovery. I'm curious if your surgeon uses the same PPT technique as mine. Was yours done laparoscopic? With or without robot?
Cool! Well I guess that answers my question about whether I'm the first lol!
Mine was done laparoscopically. Dr. Koch made three small incisions in my lower belly area, and one in my belly button. The one in my belly button remarkably seems to have already healed (at least as far as I can tell from the outside), and the other three are well on their way.
Also, I noticed that you're getting a phallus-preserving form of PPT. Just curious, did those two patients you saw photos of have the phallus-preserving technique as well? Maybe I'm still the first person to have the non-phallus-preserving kind lol.
The photos I saw were some of each. PPT with PPV and some of just PPT with an otherwise traditional vaginoplasty. She did mention that the patients weren't local, so maybe they were international and you're still the first US person? Either way, you're the first person I know to make a public post about it! So thank you for doing that ^
Wittenberg has done these already, and I thought she wasn't even the first.
Yeah, I didn't know about Wittenberg. A friend of mine who has done a lot of research on this stuff told me that I would be the first in the US, so I believed her.
Right and you friend was incorrect, yet you keep repeating she was the first. What you should actually do is retract or correct your statement.
Just deleted the post
If you can tel, how does the texture compare with a cis vaginal interior?
I haven't had an opportunity to actually stick a finger in there and check. The first 3 cm of the vaginal canal are still penile tissue. I'll get back to you on that.
If it's not very similar to a cis texture now, it should be in a few months, though. We know from studies on cis women with MRKH syndrome who have had this procedure that the peritoneal tissue actually undergoes metaplasia , transforming itself into tissue which is indistinguishable from cis female vaginal tissue under a microscope.
I appreciate your willingness to poke yourself for science ^_^
Hi, sorry it took forever to get back to you.
Yeah, it feels very similar to what I remember a cis vaginal canal feeling like, the last time I felt one (it's been a couple years). Definitely very slick and well-lubricated.
No worries, thanks for the update ^_^
Aside from what you've mentioned, what is the aesthetic benefit from this procedure? Is it more of a natural look since there is more material to work with given the penis is not used for the canal?
As far as I can tell right now, there aren't any significant aesthetic benefits from this technique, at least the way Dr. Gallagher is doing it right now. The self-lubrication, self-cleaning, and less intensive dilation schedule are the main benefits. Of course, I'm not even two weeks out, and it'll take a while for everything to heal. But I don't think she did the vulva any differently from usual.
Thank you! Wish you well!!!
Has excessive lubrication been an issue? I've heard its a common complaint with that style of surgery.
I haven't noticed it being a major issue so far. I wear a pad most of the time and I swap it out about twice a day, but that's largely for the bleeding. There's a mix of blood, peritoneal secretions, and old lube from dilation. If I still have to wear pads most of the time after the bleeding stops, then that would be a problem. But I'll have to wait and see.
Nora is the first I know of to actually have a laparoscopic Davydov method used. I know because I helped gather the research to provide to Dr. Koch on the surgery. Dr. Gallagher had posted a YouTube discussing peritoneal surgeries as the next new idea coming into trans usage. I commented on her video and she replied. When I saw Dr. Gallagher for my consult in April, she was very interested in using the peritoneal tissues but she needed to get one of the university urologists on board. Up to that point one of the urologists was possibly willing to do what Dr. Zhao and Dr. Bluebond-Langer do at NYU. They simply connect the inverted penile skin tube to the abdominal peritoneum as an end cap. This anchors the inverted penial skin and provides some amount of internal moisture but lacks the benefits of making the vagina from peritoneal tissue. After talking about it with Dr. Gallagher she said she would try to get the urology department to look into this further. In May she met with the urology heads at IU. In June I got a call for a consult with Dr. Koch the urology chair at IU Health University Hospital. He had agreed to do what he could to help Dr. Gallagher look into this method. He and I talked and I emailed him my research citation links and annotations. While I was in the office with him he brought up videos from my list of Indian and European doctors performing the Davydov method on MRKH women. As he watched he was describing what the surgeon was doing. He quickly said that most every part of what they were doing inside the body he does when performing prostate removals. His initial thought was it should be something he would do. He said he would look through my research links. The middle of the next week he sent an email to me and Dr. Gallagher that he would perform it. Dr. Koch at IU Health sometimes performs as many as 3 prostate removals with robotic laparoscopic equipment in a single day. I for one feel lucky to have a urologist who has so much experience working in the peritoneal pouch.
So Nora got first dibbs on the new method. I get mine in less than 3 weeks. Dr. Gallagher and I have been discussing my goals and rather than begin her portion with a penial inversion, she is going to do a modification of Dr. Suporn's chonburi flap technic.
BTW I emailed with Dr. Wittenberg last fall about it being on her website. Her response then was that she would only consider doing such a surgery for special cases where penial inversion was not possible. Yes she is a trained gynocologist but she does not work inside the abdomen every week like a urological surgeon does.
Sounds like what you're really saying is Dr. Koch preformed the surgery and Dr. Gallagher assisted, and took all the credit for First-Ever. Sounds about right.
That's awesome! I might actually be able to get the surgery if the recovery is a lot better. Don't have much family who could be able to be there with me. It still will be a years before I could afford it but I would love to hear the progress as it heals for you. Congrats on getting the surgery and I hope the recovery goes really well for you.
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What happened with the rest of the donor material. I would assume because there is so much more left, the surgeon has a much better chance (better outcome) of creating labia minora, majora, and the clitoral hood.
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Is the peritoneal tissue 'strong' enough, just by itself? And what about the nerves? This type of tissue got no nerves as far as I am aware.
I know (from my own research) that this tissue is used for reconstruction of the vagina in cis women (where the patient was born birth defect, would have to look it up in PubMed to name it more concretely).
Some of the penile skin was used to make the labia minora and clitoral hood. There is also about 3 cm of penile skin on the front of the vaginal canal which was needed to make it connect with the peritoneal tissue, but it's 80% peritoneal. The labia majora is made of scrotal skin, which is normal at least for Dr. Gallagher. Any remaining material was simply thrown out, AFAIK. I suppose that because there was extra penile skin available, the risk of a bad outcome for the vulva was reduced. But Dr. Gallagher didn't tell me she was doing anything special with it. Perhaps in the future surgeons will come up with more creative uses for that tissue.
Yes, the peritoneal tissue is strong enough by itself. You're correct that this technique has been used on cis women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome for decades. We know from studies on these cis women that the peritoneal tissue actually undergoes metaplasia , transforming itself into tissue which is indistinguishable from cis female vaginal tissue under a microscope after a few months.
It's true that the peritoneal tissue has little to no nerve endings. On the bright side, this actually seems to make dilation easier. The only pain I ever have with dilation is when I hit the pelvic floor muscles and wait for them to relax. I understand why some trans women might want to have sensation inside their vagina, but we should also keep in mind that cis women have very little sensation in their vaginas. It's almost all clitoral stimulation. So on that level the peritoneal tissue is actually more similar to a cis vagina.
Even though my (external) clitoris is very far from being healed, I've actually been able to achieve a small orgasm simply by stimulating the rest of my vulva and putting pressure on the internal erectile tissue with a pillow. And we also know from the studies on cis women that they have no problem achieving orgasm. So there's no real concern that you might not be able to climax because of this.
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My insurance covered the surgery. My understanding is that the vast majority of Dr. Gallagher's patients pay through insurance, although they do allow out of pocket as an option. Because my policy has a $1.5k yearly out of pocket maximum, I only had to pay like $900 for the surgery. I have no idea how much the insurance got billed for. Since Dr. Gallagher was helped by another surgeon, Dr. Koch, along with significantly more residents than usual, it can't have been cheap.
What insurance do you have?
I have a student health insurance plan through Purdue University. Only students at Purdue can get it. It's quite a good deal since young people are generally healthier than the rest of the population.
brb enrolling at Purdue
Staff can get it as well.
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Dr. Gallagher's wait list in general is not very long. I had a consultation with her in December of last year. My initial surgery date was at the beginning of May, although it got delayed due to difficulties in finding a urologist who could help with the peritoneal pull-through. Now that we've found Dr. Koch, that shouldn't be an issue. So I'd expect 5-6 months between your consultation and surgery date, assuming you have flexible availability.
Her waitlist is short because she's a terrible surgeon for MTF bottom surgery. She was a bad surgeon for MTF bottom surgery in Indiana and she is still a bad bottom surgeon in Miami. She's also unethical. The idea that she had anything to do with the first MTF PVT surgery is laughable. This is patently false. When PPT started to blossom in late 2017, I asked Gallagher, face to face, about her feelings on PVT. I'll paraphrase her answer, she said, it wasn't ready for primetime. Gallagher didn't even get her Board Certification for Plastic Surgery until Nov of 2017, 7 months after my GRS and just days before my disastrous revision surgery.
I hate to be the one to tell you, but she's well aware that this PPT information isn't true because if it was, she would have written a paper on it herself. And, she would have plastered this accomplishment all over the latest iteration of her website and TiKTOK and Insta -- In giant letters. She's letting you run with this false information because it makes her looks good.
As of March, 17, 2022, she's not even a member of WPATH or the American Society of Plastic Surgeons.
She actually wanted to have an article posted about it on IU Health’s website or something but they wanted to take essentially before and after photos and I was like nahhhh
I just found out that my insurance got billed $80,215.83 for the surgery. Luckily, because of the out of pocket maximum, I only have to pay about 1% of that.
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This reads weirdly like an advertisement but I'm happy there's another surgeon offering the technique
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