Six months post op – note from Doc

I may have a revision next month. Doc is talking about working on my scrotum some more and doing some fat grafting. It would be right after the Philly trans health conference before I go back to the school year. That would be nice.

I wrote to him and told him I don’t like how one side of my scrotum is deflated and sad ever since the infection, and since I don’t have testes or the pump in there yet, are we doing the revisions at stage 3? He said no– we don’t want to do revisions at the same time as stage three since we don’t want to introduce bacteria into the scrotum at all. Very finicky, the need for sterile conditions to prevent rejection of the pump. So, maybe we can fit it in a few months before stage 3. (To recap, I lack the erectile prosthetis and the one testicle. The other testicle is the pump apparatus.)

I also asked him how many chambers I would get in my pump. The cis version has two. We get one cyclinder. I asked which side. He says it goes on the opposite side of his microsurgery. So, for me, I think that’s leaning to my left.

Here’s his email– and I had written to him with some post op depression bummed about the split in my scrotum and about there not being hair on my arm.

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J-

Thanks for the welcome back. Not quite back to my old self yet but I couldn’t take not working any longer. The hand sanitizer is great.

Late widening of the thigh scar is probably from tension when walking. If it bothers you I can re-excise it and suture it closed and try putting in deeper, slower absorbing sutures. Hard to predict whether it may get wide again. Your scarring process is always a bit of a gamble. If you want to give it a try I’m fine with it.

As far as the full thickness grafts go, as you might guess, the grass is always greener with whichever one you don’t get. The picture you sent doesn’t look like a full forearm phalloplasty-it looks very short and doesn’t go down towards the wrist (which is where things get bad with full thickness grafts). They have way more healing problems and it is common for there to be wounds over the tendons that take a long time to heal. It’s also butt hair which doesn’t really look like arm hair (this is more apparent in person than in photos). It also leaves a fairly major deformity on your butt (the “crease” at the bottom is largely obliterated and so you have a flat butt-thigh instead of a normal looking one). Etc etc.

Hopefully the forearm will become more acceptable to you as the scars mature and it becomes a better match for the rest of your arm. If it still bothers you in the long term, it may make it easier for you to know that we could (in theory) do hair transplantation to it. We would certainly want to do any lasering well in advance. I don’t know if the percentage of grafts that would take would be as high as usual, but I’m pretty sure it would be possible to get hair on there. There are some people I know who do a lot of hair transplantation who I can get involved.

The prosthetic “jumps” off the side of your pubic bone (since it can’t be right in the middle) up into the penis so that usually adds a pretty good amount of girth/rigidity. Fat grafting is also a possibility either to the shaft or to the forearm if we need to. Color changes will keep going for up to a year or more. It may always be a little darker but it definitely won’t be so red/purple.

We usually use 1 cylinder. The only reason they use 2 for natal penii is that there are two separate corporal spaces to fill up with the prosthetic. Which side the pump goes on usually depends on which side I did your microsurgery/nerves/etc on (i.e., the opposite).

I can’t tell for sure without looking at it if I can merge them together at the same time as the IPP. It basically comes down to whether I can remove some stuff in the middle and bring them together while maintaining a completely separate pocket to put the testicular implant/pump in (don’t want anything communicating between TI and outside world to avoid infection).

We could also do some fat grafting into the scrotum. But as you know (second hand), IPPs can easily be infected/extruded and an IPP infection is a real disaster. There is a threshold beyond which it would be unwise to mess around with the tissue that is going to contain the IPP at the same time as we put it in. I would seriously consider whether you want to discuss trying to fit in an “aesthetic adjustment” prior to December. We could do a brief outpatient thing where downtime would only be a few days, with scrotal pocket revision, fat grafting, and other odds and ends. Maybe even after Philly Trans.

The tattoo artist sounds like quite a find. I haven’t heard of someone with that level of detail about matching all the different parts. Let me know how it goes-maybe we should send others to him as well. You should keep the picture log of your tattooing journey (I’m sure you are!). The pigment bottle looks oddly like a bottle of sriracha sauce but I assume tastes not as good.

Glad to hear people are happy. Makes it easier to drag myself back to a day of mumbling through a swollen jaw in clinic.

D

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