Any surgeons who will modify / customize SRS?

12
u/VerucaGotBurned
Sun Jun 20 02:48:44 2021 UTC
(40 comments)

So I had my first surgical consult (for vaginoplasty) last month and learned that the standard method will destroy my frenulum sensation.

I really love that sensation. I've seen penile preserving Vaginoplasty, and other modifications so I know some surgeons will try stuff like that. I'm trying to devise a frenulum preserving method.

Drs Crane and Deleon at the Crane center in Texas have been suggested but I can't find any pics of Dr Crane's post op results and only like two for Deleon.

Can anyone suggest anyone else?

all 40 comments


6
u/Aromatic_Guest_6589
Sun Jun 20 03:18:45 2021 UTC
(1 child)

Please keep us updated!! I don’t see much talk about preserving the frenulum nerves, and I don’t know why that is. However, I think doing so means having to modify the pedicled flap, so I might recommend seeing a surgeon who can do that and has done it.

That said, I don’t know much about which surgeons preserve frenulum sensation. I’m seeing Bank at the Suporn clinic and I’m hoping they do (bc of the chonburi organ), but I’m not too hopeful, and I haven’t seen mentions of it. If anyone has any insight, please share!

2
Sun Jun 20 21:59:18 2021 UTC
(0 children)

Ya, I'm with you, even though it's too late, I want to hear from someone who can speak about this from experience.

5
u/eynhorn
Sun Jun 20 05:10:47 2021 UTC
(12 children)

I find this surprising, because I specifically asked my surgeon (Meredith Gray @ KUMC) about this, and her response was (a) we consider the frenulum part of the glans (b) we do our best to preserve all nerve endings in the entire glans tho some will be lost just because it's a crap shoot (c) this is standard, like most clitoral reconstruction that starts with a glans will do this and include the entire frenulum. I would find it ultra shady if a surgeon acted like preserving those nerves were strange or experimental. That being said, they do have to be bisected, so the sensation will be kinda split and then refused later, and that probably puts them at higher risk than other glans nerves of losing sensation for sure. But just not using them? That needs to not be a thing.

4
Sun Jun 20 21:55:35 2021 UTC
*
(8 children)

I got into this issue with Dr Joshua Roth at IU-Heath about this very thing. I'd had GRS previously and he was inspecting for a revision and I complained about the aesthetics of the of my clit and the glans nerves. Then he proceeds to tell me how with his method he can preserve and use the frenulum nerves. As you might imagine, I'm laying there hinged on his every word as he describes this, thinking to myself --is there some hope here?

Then a few weeks later, I attempt to revisit this conversation for obvious reasons and he acts like we never discussed this. His assistant just kept repeating, "He uses the glans nerves, that's the only way to do it". Hell, as if they hadn't made a mockery out everything else already, this was about par for the course.

2
Sun Jun 20 23:32:34 2021 UTC
(7 children)

What on earth? Did he do your GRS?

2
Sun Jun 20 23:37:15 2021 UTC
(6 children)

No I went to him to remove one of the large cyst from the top of my Vulva, compliments of Dr. Sidhbh Gallagher. She did my GRS.

2
Sun Jun 20 23:48:10 2021 UTC
(5 children)

Oh goodness. If she didn't use all the nerve endings I don't know that they can just be identified and moved up into the clitoris later on. Whoever did that would have to know whether she preserved them elsewhere or not, and if so, where.

3
Mon Jun 21 03:22:20 2021 UTC
(4 children)

It didn't matter, we weren't going there anyway. He bailed on me after removing the first cyst because he said he didn't have the skills to deal with the chronic wound his predecessor left me with, i.e the 2nd cyst right next to the first. He could do GRS, but,apparently removing another cyst in the same location as the first was beyond his comfort zone. I had to go to a different State to get it fixed.

In the end, I had it fixed by Dr. Ferrando at the Cleveland Clinic. She exceeded my expectations. Now, I wouldn't go anywhere else.

2
Mon Jun 21 03:54:23 2021 UTC
(3 children)

Ugh! I'm so sorry you had to deal with that! Did he expect you to just go to some rando surgeon?

3
Mon Jun 21 04:06:53 2021 UTC
(2 children)

No, he did absolutely nothing to help me find another surgeon. He even claimed he wasn't allowed to make referrals the last time I met with him. No one from IU-Health in Indianapolis helped me with referrals for surgeon to fix my problems for more than two years until Roth came back from his GRS training in fall of 2019. I didn't even see him until March, 2020. He made all kinds of promises about how we were "In this together" blah blah blah, then didn't follow through after the surgery wound dehisced, It was my insurance company that stepped in and found a surgeon for me.

It's all in my post history.

2
Mon Jun 21 12:10:05 2021 UTC
(1 child)

You've truly been through hell. I'm glad you've kept fighting and finally got somewhere. For the insurance company to help you find another surgeon means it must have been unimaginably bad!

3
Mon Jun 21 14:42:33 2021 UTC
*
(0 children)

Yes, it was bad, but it wasn't unimaginably bad. I lived through it. Every damn day of it and I wouldn't wish the experience on anyone but her.

3
Sun Jun 20 13:24:05 2021 UTC
(1 child)

Lol whenever I hear of that surgeon I always think of Grey’s Anatomy.

How does she preserve all the nerve endings though? Does she not downsize the glans? If not, does she just make the clitoris large or does she bury part of it? Downsizing the glans in mtf clitoroplasty is very common, so it would be more unusual if she didn’t.

I believe the frenulum is a slightly separate bundle of nerves from the top of the glans that’s usually used for the clitoroplasty, so keeping the frenulum intact would likely mean significantly modifying technique. I wouldn’t necessarily call it shady if a surgeon is upfront and says they can’t do that. Although I agree that surgeons should know how to do it.

1
Sun Jun 20 15:02:39 2021 UTC
(0 children)

She described what she does as kind of making a cape and drawing it in.

I can't say anything about the final size of the clitoris because I have only seen 1 photo at 6 mos or more post-op, but she does draw a lot of the glans tissue inside and stitches in such a way that it fuses together in a nice little clitoris-sized bundle and unneeded excess skin can slough off. Mine is still quite swollen but I expect it to be in line with my expectations when the swelling goes down, and am pleased to know that it has a lot more internal structure than I thought I was going to get.

All the nerve endings just kind of wind up packed a lot closer together than they are pre-op, including the frenulum bundle, which really is fed laterally by both dorsal and perineal nerve branches so it's not hard to bisect and no nerves necessarily have to be harmed in so doing (tho there is always a risk that some will be).

2
Sun Jul 11 17:05:44 2021 UTC
(0 children)

I want to see a surgeon named Meredith grey so bad

3
u/Forgetwhatitoldyou
Sun Jun 20 05:00:21 2021 UTC
(0 children)

Try Dr. Wittenberg in San Francisco. Her website talks about a number of options, including penile-preserving.

2
u/sourdoughsmitty
Sun Jun 20 12:36:40 2021 UTC
(3 children)

i know about the nerve bundle in the glans ,but what is the frenulum?

thanks phylis

3
OP
Mon Jun 21 03:46:00 2021 UTC
(0 children)

It's the line of tissue on the bottom side of the penis from the "split point" of the glans down to the point where the foreskin connects / was connected. It's super sensitive.

2
Sun Jun 20 21:40:41 2021 UTC
(0 children)

It's the Nirvana nerve.

1
Sun Jun 20 19:21:36 2021 UTC
(0 children)

what is the frenulum

Frenulum is the line between the bottom of your genitalia and the bottom of your anus.

If you are MtF, on estrogen and pre-op, it will very likely be a dark line & easy to see.

1
u/[deleted]
Sun Jun 20 04:49:59 2021 UTC
*
(6 children)

I have seen an interview with Sidhd Gallagher in Miami who describes a “custom clitoris” technique where they use the frenulum instead of or in addition to the glans for the clitoris. However, I’ve never seen photos or papers of this technique done, and she has quite a bit of mixed reviews (mostly negative) in regards to her MTF SRS results.

1
OP
Sun Jun 20 19:35:49 2021 UTC
(2 children)

She botched someone in my local community so I don't trust her.

1
Sun Jun 20 20:39:29 2021 UTC
(1 child)

Yeah, I’ve seen a post here from someone she’s botched. She isn’t a surgeon I particularly recommend, but the only one I’ve seen so far speak about a “custom clitoris” technique.

1
OP
Mon Jun 21 03:41:58 2021 UTC
(0 children)

Yeah that is a thing to consider, I'm not sure how I'd go about finding out how it's done though.

1
Sun Jun 20 21:56:21 2021 UTC
(2 children)

She is full of shit

2
Mon Jun 21 00:41:03 2021 UTC
(1 child)

Yeah, like I said haven’t seen photos or papers on the technique just the mention of it in an interview.

2
Mon Jun 21 03:30:19 2021 UTC
(0 children)

Oh, I'm well aware of her reputation. I have the scars to prove it.

1
u/transsurgerysrs
Sun Jun 20 19:22:59 2021 UTC
(1 child)

Ting is very accommodating of requests from my experience & knowledge. Right before go in for surgery, he specifically asks if you have any special requests for the surgery.

I know of at least one story that Ting cut back bladder muscles more than he already does by request. Also, Ting's academic specialty are nerves so he could be a very good candidate for what you are wanting.

1
OP
Mon Jun 21 03:43:38 2021 UTC
(0 children)

My next consult is with Avanessian. I wanted to consult with Ting also but Mount Sinai will only let you schedule with one surgeon.

1
u/AckbarIsAlwaysRight
Wed Jun 23 19:13:02 2021 UTC
(8 children)

I spoke with my surgeon (Wittenberg) about this for my upcoming surgery, as I have more sensation in my frenulum than just about anywhere else. Her reply was as follows:

The frenulum is usually removed as we decrease the size of the glans of the penis to form the new smaller clitoris, however, the nerves are preserved intact.

1
OP
Thu Jun 24 00:55:02 2021 UTC
(3 children)

But does that mean the sensation is preserved? I'm not convinced one equates to the other

1
Thu Jun 24 01:01:44 2021 UTC
(2 children)

Well, the context of the conversation was precisely that - whether sensation would be preserved - and she seems confident that it will be (within the bounds of recovery).

It’s likely that the sensation will be somewhat different due to the fact that the bits are being rearranged, but the sensitivity will still be there.

I’d honestly advise you ask specifically on these points to whichever surgeons you investigate.

1
OP
Thu Jun 24 06:25:36 2021 UTC
(1 child)

Yeah I had a consult with Bluebond last month and was basically alarmed bordering on devastated when I learned that all the nerves to the skin are cut.

She also was, short and unbending, not going to her

1
OP
Thu Jun 24 06:27:54 2021 UTC
(3 children)

Also, when is your surgery scheduled? I'd love to check in after and ask how it compares. If you're okay with that of course.

1
Thu Jun 24 06:33:37 2021 UTC
(1 child)

Totally. It’s setup for the end of September. And I’m happy to share. I plan to keep a recovery diary.

1
OP
Thu Jun 24 19:20:42 2021 UTC
(0 children)

Thank you that's super helpful. A recovery diary is a good idea too, I might try that.

1
u/quetzala
Sat Aug 13 23:11:29 2022 UTC
(3 children)

Wondering if OP has an update? The anxiety of finally getting bottoms survey but at the cost of losing frenulum sensation is strong. I’ve been looking for a surgeon who can help me, but I’m losing hope.

2
OP
Sun Aug 14 01:18:01 2022 UTC
(2 children)

Actually I found a potential surgeon team that divides the penis shaft so that the two thirds near the base are inverted along with grafted scrotal skin. The one third near the head containing the frenulum is flipped up and used to create the inside of the clitoral hood and part of the labia minora. Because it's more attach to the glans and not deep and inside the vagina it theoretically will retain more sensation.

Also they use a larger portion of the glans by cutting it basically in two strips which are then folded into each other and sutured into a little bundle. She said they would be will to use even more glans tissue if I wanted but it would make my clit very large.

It's a 3 surgeon team consisting of a gynecologist (the one I met with), a plastic surgeon who specializes in skin grafts and skin flaps, and a reconstructive urologist.

I want to meet with the other two before deciding on this team. But I'm very hopeful about it.

1
Tue Aug 16 14:58:10 2022 UTC
(1 child)

That sounds exciting! And promising! Thanks so much for this update. Gives me some hope about finding providers willing to work with my body. I had a consult with William Kuzon at U of Michigan due to proximity and instantly knew he wasn’t the surgeon for me. I’m currently set up for a consult with Bluebond-Langner but after reading what you and some others have posted, she doesn’t seem like she’s for me either. Can you share with me the names of your potential surgical team? Id love to look into them and see if they might be able a good fit for me too.

1
OP
Tue Aug 16 18:32:52 2022 UTC
(0 children)

It's KUMC (in Kansas). The surgeons are Drs Gray, Ponuru, and Broghammer.

My consult with Gray was pretty wonderful, it lasted like an hour and a half because I had some many questions but she seemed genuinely interested and also very confident that she could give me what I wanted. Also the wait time isn't that long.