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My main thoughts with shoulder reduction surgery, are that due to it being such a recently developed procedure, and with basically only 2 surgeons in the world doing it - it’s very much still an ‘experimental surgery’!
That’s not to say it’s ‘bad’ per se, after all it’s a technique that’s very much based on standard fracture repairs that are done all the time when people break their shoulders - but the difference is that in addition to the normal healing process of a broken shoulder - you’re also having a hefty 2cm chunk of bone removed from your clavicle (on both sides). Dr. Barry Epply claims that this is totally fine, since contrary to most other orthopaedic surgeons - he says that the clavicle does have a little space in the middle of the bone that holds bone marrow - that can help with the healing process. New anatomical bits and pieces are still often found in the human body - it’s a very complicated biological machine, and we’ve only really been cataloguing it for the last 500 years of history - but still, it often takes time and data to verify the existence of new anatomical discoveries across a wide spectrum of the population. Since the existence of this bone marrow space is central to the effectiveness of this current technique, and the healing time afterwards - I personally think that it’s still pretty radical to consider it. (That being said - I would have absolutely said the same thing regarding facial feminisation durgery procedures 15 years ago - but the evidence and decent time period of good results has bourne out a lot of the potential worries for that procedure).
Finally, while it’s a fairly ‘simple’ operation - in terms of taking out a chunk of bone and bolting the clavicle back together - it is by no means risk free! You have a major nerve highway (the brachial plexus) and major blood vessels (your subclavian vein and artery) running smack bang beneath the mid-point of your clavicle. These are very important, and also fairly easy to damage. Indeed, they are often damaged during normal clavicle injuries/ fractures, and can cause some long lasting side effects. Having an elective surgery makes it easier to prep and take necessary medical imaging to avoid these nerves and blood vessels - but if they DO get damaged, you could suffer some pretty severe loss of mobility and sensation to your arm, hand and fingers - which is difficult to heal.
Sorry for the super wall o’ text! tl;dr - It’s an exciting new procedure - and while it may well be shown to be perfectly fine and low risk over time - it’s currently still an experimental surgery procedure, with a fair amount of potential risk to the movement and feeling in your arms. I’m not at all trying to scare you (or anyone else) off - but personally I’d want to wait until it’s a much more established procedure before trying it on myself. I’m also a little worried by the total lack of discussion on possible side effects/ complications - and how the current technique avoids them on both Barry Eppley’s and Leif Roger’s sites! It’s always better to arm yourself with information - especially in health matters relating to your own body!!! If those risks sound acceptable to you vs the benefit of offsetting your personal dysphoria - then that will be the main factor for you in deciding to go ahead!! :)
This is a fair assessment. Dr. Eppley now does have a discussion of a complication on his site https://exploreplasticsurgery.com/technical-strategies-double-plate-fixation-in-shoulder-reduction-surgery and I was that patient. I can now say I've had the worst possible complication -- complete displacement -- and am fine. But when it happened I had the attitude you describe. I'm a numbers person and one has to understand there's no way to estimate complication rates with such a small sample size. The one thing we do know from the orthopedic literature is there won't be complications due to the actual shortening as long as it's <3cm.
Wow! The researcher in me is finding that super interesting from a medical perspective, but it’s obviously incredibly shitty for you to have to go through it!!
I was actually thinking while looking through the procedure description that a single plate seemed a little light for the job of supporting the bone properly under strain! So it’s cool that they seem to be recommending the double plate to secure the bone as standard of care now! I hope this isn’t too prying - but did you have any issues with the bone or the screws pressing back against your nerves or blood vessels? Or do the muscles pull the shoulder forward and down enough to keep the sharp ends of the screws away from the sensitive areas??
How did you find the recovery process was after you had to go back in for follow-up after your displacement?
I was in pain for one day after I woke up with the plate displaced. The distal end is pulled down by the shoulder and the medial end pulled up by the sternocleidomastoid, so the screws ended up below the medial tip of the bone if that makes sense.
I actually went two weeks after that before getting the x-ray that showed the bone ends weren't touching and had full use of that arm with no pain. It's pretty nuts how your clavicle is sort of unnecessary for arm function.
Since having it repaired with double plates, I've been totally fine. I do video follow-ups with Eppley and we're doing another x-ray in a few weeks.
I guess somebody has to help get more data and maybe she's volunteering? 🙂
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The hardware alone costs more than $3k. Ideally you'd use EIN, but that requires fluoroscopy so would need to be done in a hospital and be massively more expensive...as in more for the OR time alone than combined total costs in a private clinic.
The problem I had can likely be avoided entirely by double plating. It wasn't a matter of postoperative instructions since it happened due to rotational arm movement in my sleep. "Prescribing sleeping pills" doesn't fix that in any safe way. Bone remodeling is a slow process -- months not week.
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That's not the cost in a hospital, it's from a US manufacturer. Titanium orthopedic screws run $100 each here. They're massively more expensive than facial hardware.
It's not safe to fully sedate someone nightly for three months straight. You know that yet are arguing it anyway for some reason.
Thanks for your comments! I do agree with you on the most part, but it’s good to play devils advocate with new procedures, and be super sceptical of any possible thing that could go wrong.
I sincerely hope that since reduction surgery is so heavily based on standard fracture repair techniques - that it will be safe long term. However, people can only give proper informed consent to a procedure if they’re aware of any potential side effects and complications that can happen.
I was actually pretty impressed with how the technique has been developed and was laid out on both of the Dr. Sites... but I work in medical research, and if people tried to make ANY kind of document for a clinical trial , research study, or any medical procedure at all without even MENTIONING potential risks, every ethics-committee-reviewer in the hospital would descend on them with torches and pitchforks!! :p (I’ve seen in the comments since though, that apparently there IS a section on their sites about dice effects and complications. However I wasn’t able to find it with a cursory look at their site, I wasn’t able to find it with a specific google of their names, and ‘shoulder width reduction surgery complications’, and I was even hard pressed to find any decent peer reviewed literature about shoulder reduction surgery AT ALL on PubMed or Medline - because it’s so new!
Since I work in the industry and have to review this stuff for a living - that kind of thing may have more weight for my personal cost/ benefit analysis than it would have for someone else who suffers from super-super-severe shoulder dysphoria. But that’s why it’s just being responsible to know the benefits as well as the risks, and for each person to weigh them individually before getting a serious surgery :) )
I had it with Eppley a couple months ago. Recovery was actually much easier than I thought with the only real hard part being sleeping on my back since I'm a side sleeper. I had some muscular pain for a few days post-op, but not sure how of that was due to having an FUT scar repaired at the same time since I don't think other patients reported this. I also have migraines and neck pain so the trapezius is a problem area for me.
I had a complication (the only patient so far afaik) that required reoperation with double plating, but this shouldn't be an issue for future patients since Eppley said he's going to double plate everyone from now on. When we saw there was an issue on the x-ray he told me he'd fit me in for surgery literally whenever worked for me and ate all the costs, which were considerable given the hardware involved. I felt like that really showed his character.
I've had a ton of surgery in the US and four foreign countries and Eppley, who also did my FFS revision, has the best bedside manner I've experienced. Partially I think it's a Midwestern thing, which was a culture shock for me being from New York where we're all assholes.
Obviously this procedure isn't for everyone, but it does exactly what it says. You can measure your biacromial or bideltoid width and compare it to women your height using anthropometric data. I already have 39.5" hips so widening them further would look odd and make it difficult for me to fit into clothing. I'm also not interested in hip implants due to the outcome and relatively high complication rates.
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Eppley told me hip implants have a 30% seroma rate. I also would think one can palpate them a bit due to their subcutaneous position. And this is with Eppley's custom ones and him really knowing how to create the pocket. That said, I would imagine they're great for the right patient and I'm just lucky in that area.
I have had fat transfer previously with a different surgeon and gained weight for it. Really that was just to fill in the dips more than add width, which is difficult due to the tight skin limiting take. But the real effect is just from liposuction of the flanks which makes a considerable difference in shape on even most skinny patients. BBL is definitely a much harder surgery as far as recovery and discomfort than shoulder reduction, though.
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Go through Eppley's instagram. He's been talking about hip implants a bit lately. The finger thing does not make sense to me, but he does mention them "crumpling" and how that can be avoided in implant design.
There is that one from S. Korea that uses 3d printed metal extensions bolted to your pelvis. I've only seen one outcome of it so far, and maybe it was shot too early in recovery but it was way too round.
Don't those essentially augment the iliac crest tho? The point one wants to widen is centered considerably below at the hip socket. One of the keys to a good lipo result is not seeing the iliac crest. You need to remove fat below it, but too much and it juts out and you lose the smooth line from the widest point of the hip to the waist.
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Here is the earliest result they have put up. http://ysbarochuk.com/en/
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Like I said to another poster. Why lie? The results aren't that great. They could have done a much better job photoshopping.
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I know replies can get lost if it's not direct. I posted a link to it after darths reply
Do you have a link to that outcome?
I don’t think there’s any real results on that page.
Right at the top the first pictures?
I might be wrong, but Korean surgeons are famous for photoshop.
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Do you have photos? How much did it reduce your shoulders by? What about the foreward rotation? Does it look odd that you can't roll your shoulders all the way back?
I don't have photos. It reduces your shoulder width by exactly the amount of bone that's removed: 2-3cm per side.
You can roll your shoulders back, you just look a bit rolled forward right after surgery.
Thanks. Is Eppley still charging like 17k for this surgery?
How long did you need to take off work?
It was something like that. The hardware alone is very expensive.
I was working the day after surgery, but of course I don't have a physical job.
What made you go with Eppley over Rogers?
Price and the fact that he does many other procedures I'm interested in. I was going on consults for FFS revision before this and Eppley had blog posts describing many of the exact things I needed done. I liked that he is into explaining the technical details of his surgical plan, which many surgeons don't like doing or will even refuse to do. I didn't factor in geography, but that turned out to be a major boon especially during the pandemic.
I'll admit Eppley is an interesting guy. I have heard some negative things that would make me consider Rogers over him, though.
Would you feel comfortable posting a before/after of your posture? I'm struggling to understand how this doesn't just drag the scapula anteriorly around the sides of the body into terrible protraction.
Can someone explain to me the merit of shoulder reduction surgery? If you reduce the width of the shoulder a bit, doesn't the width of the chest cavity / torso remain the same? Would the upper body then look a bit out of proportion if you just made the shoulders narrower and not the chest (which I know is impossible rn)?
Having wide shoulders does not really correlate with having a wide chest.
It does correlate but correlation does not imply it holds for every single case. For example, income is correlated with education but that doesn't mean that every single rich person is educated, it just means rich people are more likely to be educated.
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Yes, you’re absolutely right. The clavicle provides a mechanical connection between the shoulder and torso, and changing the length will naturally change the orientation of everything connected to it.
From Dr. Epply’s website, he says that as long as the amount removed isn’t more than 30% the length of the clavicle - that the amount of movement of the scapula is minimal (he notes that since the average clavicle length of his patient population is ~14cm, that removing 2cm-2.5cm from each side would give noticeable reduction in shoulder width - while maintaining as similar a scapula position as the patient had before)
It’ would definitely be interesting to see how the technique develops over the next 5 years - and to see if there are any reports of significant issues with movement or posture long term after surgery.
As for the cartilage - it isn’t actually touched during the surgery. All material removed comes from the mid-point of the clavicle, not from the ends. Then, the two cuts are aligned to make a new mid-point of the bone, pulling the scapula upwards, forwards, and inwards. The idea seems to be that the glenohumeral joint itself doesn’t actually change its orientation much - as long as the amount of bone removed stays below that 30% limit. But I was thinking the same thing you are - it seems weird structurally that you could somehow move the scapula that much, without changing how the ball of the humerus sits in the socket! Perhaps it just wouldn’t be noticeable to you when you’re actually using your arms.
To be honest I never knew such surgeries existed.
There are cosmetic hip widening surgeries which could be an alternative in terms of giving you the silhouette you’re after. Might be easier/cheaper/less intrusive.
Might be easier/cheaper/less intrusive
Depends on how you define these terms, but I would say this isn't true.
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That 1/3000 figure is not anywhere near accurate with any competent surgeon. There are many who have performed over 3000 BBLs with no embolisms.
It's a great procedure for hip shape but not working miracles in trans patients that really need/want that.
The 1 in 3000 included reputable surgeons and was due to the technique everyone used. That technique has changed since, at least with some surgeons.
Lots on it here
https://www.reddit.com/r/TransSurgeriesWiki/wiki/hips-butt/introduction
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I’ve not looked for a long time, but I’m not aware of any statistics on safety since surgeons changed technique. Is it still dangerous or not?
I had it done with Dr. Leif Rogers. Unfortunately I currently still experience constant shoulder pain nearly a year after surgery. Sometimes it gets so intense that I can’t do any physical activity and have to just lie down and rest.
heyy, could you give us any update about your situation? I'm very curious, thanks!
This post has a bit of discussion and a link to another post with some more discussion. Not a lot of info out there though.
My shoulder width is 15 inches I’m 5 ft 8 , would that be considered wide ?
If it's bideltoid than no that would be tiny.
I can't wait for the day surgeries that involve making the ribcage narrowed (without damaging air/blood flow, and the heart itself) and hip widing to become popular.
Also, for SRS to become more advanced.
I rather spend the money on rib removal...
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True that. 🤛✌, i personally would start on my face and hair line, if i have a real FemFace i can have no tits 4 now. I will add them later 😊 A flat chested woman is better than a big tit women with a manly face. peace and love you all... xoxo good luck with your transition peers, may love and happiness be with you always.
Look in the wiki here.
Heads up, you missed the link - or at least it does not come up for me.
I didn’t want to take the time to find it, and it’s better for people to learn how to use reddit themselves. Providing a link doesn’t help with that.
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Does make me wonder why I bother with this.
Insane this is being downvoted. Look in the wiki.
Downvoting and not providing the link themselves... there a name for that.
how much does this cost? ive seen this surgery been performed on youtube
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I am planning on getting this one done as well, I cant stand my shoulders, and have a job now where I can actually pay for this.
Won’t try to dissuade you but will note many cis women also lament shoulders that are “too big.”
And there’s certain dos/do not do ways of dressing that can ameliorate that
For instance - spaghetti strap dresses - 👎
Anywho, something to think about
Cis women have potential for a masculine trait or two. But a lot trans women the unique experience of having to deal with multiple amount of masculine traits.
Like yeah cis women can have x trait but I'm experiencing x,y,z and more traits and if I could reduce x trait even a little it would help alleviate my gender dysphoria!
Understood.
Was thinking more along the “bang for the buck” and priority tho.
17,000 is a good deal of money
That's because Eppley has a monopoly on the market of well known surgeons offering this procedure. When competition pops up the price will go down significantly.
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