Warning: The following images are extremely graphic in nature. They show post-op
male genitalia, graphic surgical post-op healing photos which contain bloody
images.The T-Male
Monstrey Phalloplasty
Universitair Ziekenhuis Gent Kliniek voor PlastischeScheduling: contact Jan at: jan.smeyers@uzgent.be
Several Patient Photos, Personal Experience & Clinic Details
Sent to Nick by Owner, Daniel with permission to post. Images have been cropped and resized to save space, speed up loading time and to show specific areas of interest. Not all images are shown due to repetitiveness.
Patient Images shown to date: Patient A
Coming Soon: Patient B, Patient C, Patient D, Patient E
Warning: The following images are extremely graphic in nature. They show post-op
male genitalia, graphic surgical post-op healing photos which contain bloody
images.
Index: (click to go there)
A Monstrey Phalloplasty: Daniel's Experience
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Donor Arm Bandage 1 |
Artery Harvest from Ankle Day 2 |
Day 2: Dead skin removal from skin graft |
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| Day 2: Healing progress | Forearm where graft & nerve harvested | Inner thigh where skin graft harvested |
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Leg, arm & phallus Day 8 |
Phallus Day 8 |
Forearm donor site Day 10 |
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Skin graft Day 12 |
Phallus Day 14 |
Phallus Day 14 3/4 view |
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Phallus at 4 months |
Phallus at 4 months |
Forearm donor site 2 years |
The following is my account of my recent phalloplasty with Professor Monstrey in Gent Belgium in the fall of 2003. My hope is that the details will help those considering the same journey. I would encourage anyone reading this to keep in mind that procedures and protocols are ever changing. What may have been the case for me in 2003 may not be the case in 2004 and beyond.
HISTORY
FTMI
meeting several years ago
In 2001, FTMI hosted 2 Belgians, Axel and
Ken, at one of their monthly SF meetings, who were phalloplasty patients of the
gender team in Gent Belgium. At that time, Axel had his phalloplasty
approximately 5 years while Ken was still recovering from a very recent
phalloplasty. They very graciously showed off their surgeries and discussed the
procedures. I was very grateful to have the opportunity to see the phalloplasty
results firsthand and hear their own accounts of the procedure. The procedures
are ever evolving and the techniques used in 2003 have been enhanced and
modified from even Ken’s fairly recent surgery.
Research
Prior to my phalloplasty, I had done rather
intensive research into the phalloplasty procedures offered, particularly those
performed by Professor Monstrey in Gent, Belgium, Dr. Daverio in Switzerland and
Dr. Meynard in Montreal, Canada. For numerous reasons ranging from aesthetics to
size to sexual functioning to cost, I choose Professor Monstrey for my
phalloplasty.
Consultation
Appointments in August 2002
I first contacted the gender team in Gent
Belgium, in the winter of 2002 by email. I was sent a form letter explaining the
history and process for transsexual surgeries for FTM patients. The same letter
is posted on the internet in various FTM internet sites. The current letter
reflects the numbers of phalloplasty procedures performed, currently close to
200. The letter details the need for those coming from abroad, to meet with a
psychiatrist from their team to be approved to proceed with surgery. This is a
formality where your own doctors are to furnish your history, treatment and
diagnosis of transsexualism. I received my appointments for August of 2002.
THE MAIN DOCTORS
Dr. De Cuypere
Dr. De Cuypere is one of two psychiatrists
on the gender team. My one preliminary appointment with her lasted approximately
1 hour. I had some reservations about receiving her approval for surgery,
primarily based on hearsay from others. As it turned out, she was extremely
friendly and professional, reviewing my letters and discussing my life and
future plans. She is a wonderful doctor and I suggest accepting their process
and opening yourself to the information available. She has after all treated
hundreds of transsexuals and helped many of them with the surgical procedures.
She also makes weekly rounds on the surgery ward and can be a great asset to
help you through any tough times after surgery.
At the end of the appointment, she wrote a
short note approving me for surgery to hand carry to my next appointment with
Professor Monstrey.
I have heard good feedback regarding the
other psychiatrist on the gender team from some of his patients, including one
of my roommates during phalloplasty recovery.
Professor Monstrey is the head plastic surgeon on the gender team. The Gent phalloplasty procedure is really his. During my consultation appointment, I met with him for approximately 45 minutes. He went over the details of the surgery, the expected outcomes as well as the typical complications and their remedies. We also reviewed a photographic collection of surgery results on his computer. I had full confidence in his professionalism and his abilities. He is also extremely friendly with a good bedside manner.
I indicated my desire to schedule surgery
and was added to a waiting list with an estimate of one year, being told that I
would be contacted closer to the surgery date with an exact date. I also
indicated my desire to schedule, my friend, Travis for surgery around the same
date so we could recuperate together. Travis is a SF local, who also attended
the FTMI meeting and had a consult with Monstrey in 2001. We had decided to try
to schedule our surgeries together.
It is worth noting that the process is
somewhat routine for Belgian FTM’s to be diagnosed and move through the
surgeries and integrate back into society. With their socialized medicine, there
are really no other surgical choices, so our American attitude of shopping
around can be rather unusual for them.
Professor Hoebeke is the head urologist on
the gender team. He handles a significant part of the hookups as detailed in the
surgery section below. After I was
finished with Professor Monstrey, he called over and got me in to see Professor
Hoebeke. Professor Hoebeke, like Monstrey, is very friendly and I felt extremely
confident in his abilities and techniques. He drew a detailed diagram explaining
the vaginectomy and the urinary hookups as well as the schematics of the overall
procedure.
All in all, I spent the afternoon meeting
with the various doctors. It is possible to bypass this trip and coordinate the
psychiatrist approval prior to surgery, but I would not recommend this option.
It is beneficial to meet the doctors, the hospital and the surroundings ahead of
time to gain a comfort level for surgery.
SCHEDULING
SURGERY
Jan
Smeyers
The process and contact information has
changed since my process began, they now have one main contact and coordinator
for all Transsexual surgeries. This contact is nurse coordinator Jan Smeyers,
email him directly at: jan.smeyers@uzgent.be
for all appointments and questions concerning surgery in Gent.
There is a significant waiting list for
surgery, 1-2 years, as well as a significant wait for the required initial
psychiatrist review and consultation with the surgeons. There is very little
room for accommodating appointment changes and such, my best advice is to take
the dates you are given. I inadvertently indicated by email a preference for my
consultation appointment one week later than scheduled, only to have them cancel
my appointment and reschedule it 4 months later.
TRAVEL
Flights
There are many options for flying to Gent Belgium. The most common routing is to Brussels, Paris or Amsterdam. London is also an option. The flight is very long from the West Coast, 13-14 hours for a direct flight and even longer if there are stops. I found AirFrance direct from SFO to Paris to offer the best deals, as low as $350 roundtrip off season in February and as high as $800 roundtrip in the peak tourist season in August.
Trains
Once arriving at Brussels, Paris, Amsterdam or London trains, often high speed, are available to get you to Gent. The airports are very English friendly and train travel is a very popular way to travel throughout Europe. Online train information is available but tickets must generally be purchased in person. Remember you will be handling your own luggage through the airports and train stations so pack and use appropriate luggage. Wheeled luggage is good but there are very often stairs involved with train travel. Handicap access and accommodations like in the US are often nonexistent.
Frequent
Flier Miles
Since there are usually 3 trips necessary (one consultation, one phalloplasty surgery and one erectile implant surgery) it is best to think about coordinating your travel with one airline to take advantage of the high miles given on an international flight. On AirFrance, 3 trips from SFO earned me a free international flight.
Local
Buses and Trams
Once in Gent, there is an excellent bus and tram system to get you around town. Taxis are also available at the train station. Buses and trams are generally 1 Euro (E), or at a discount of 10 E for a weekly unlimited pass, all tickets can be purchased on the bus or tram. Exact change is not necessary.
ACCOMMODATIONS
Bed
and Breakfast
The gender team recommended a local B&B,
and I highly recommend it as well. The owner, Paul Snoeck, attended college in
California and is very fluent with English as well as very friendly and helpful.
The rates were also a bargain at 35 E per night. Please note that only cash is
accepted. Paul has several B&B’s to offer. I stayed in 2 of them, one on
Ijzerlaan, Verlaet, and one directly across from the train station. Verlaet is a
typical B&B with breakfast served from 8-9. The accommodations are
comfortable and homey. There is a TV in each room and access to kitchen
facilities but no phone. The train station B&B is actually for longer stays
with fully furnished apartments (no breakfast, however you have your own
furnished kitchen). Excellent for guests accompanying the patient. I stayed
there after surgery and found it was great to have my own apartment with kitchen
and bath. Paul can be reached at: bb.verlaet@pi.be
and the B&B’s are listed at: http://www.bedandbreakfast-gent.be/.
Paul may also be available for pick up to and from the hospital.
There are also numerous hotels in Gent with
the rates generally starting at 80E.
GENT
Tourism
Gent is a wonderful relatively small city. It has a historic background from the Middle Ages and some wonderful architecture. The main tourist area, the Korenmarket has beautiful cathedrals, a bell tower, a medieval castle, shopping, cafes and restaurants. The Korenmarket is walking distance from the Izerlan B&B and one of many trams or buses can get you there from the train station. The whole area has canals and boat rides similar to Venice. The food in Belgium is outstanding and a very good value. Belgium is also known for beers and chocolates. Gent offers a lot to see and do with flea markets, flower markets, and all kinds of festivals. It is worthwhile to visit the tourist office in the Belfort, the Bell Tower, to get valuable information. A tourist book is also a good idea to review before your trip.
Languages
Belgium has two official languages, French and Dutch. The hospital is located in the Flanders region of Belgium where Dutch is the official language. Fortunately, almost all the residents speak English. The most difficulty with the language will be in regards to reading menus in restaurants. Although an English/Dutch dictionary may help, because of the way the words are combined in Dutch a listing of common words is not very helpful.
Currency
Belgium is part of the European Union and uses the Euro for currency. The exchange rate is normally somewhat close to the dollar so mental translation is not really necessary. You can follow the exchange rate on numerous web sites, I liked www.oanda.com as the site will track and graph the exchange over time. The best exchange rate to get currency is to use ATM machines with your normal debit card. Any other exchange method such as traveler’s checks or cash exchange services generally charge surcharges of anywhere from 2-20%. Many places also take VISA and MasterCard. Research your options ahead of time and review your credit card’s terms for foreign currency charges.
Tipping
Tipping is not customary in Belgium although many do leave the loose change from the bill. You should review a Belgium tourist book on more specifics.
The telephone system presented many problems
for us upon our arrival. There are very few coin pay phones in Belgium, they
generally use a prepaid card that can be purchased in newsstands and such in the
train stations. However, we arrived at 9PM and everything was closed. We needed
to call the B&B to pick us up and check us in the to B&B. We could not
for the life of us figure out how to place a call. I won’t go into the
specifics of how to place a call as the specifics may change. Suffice it to say
it can be daunting. They are more cellular based than we are and the cell
numbers have one extra digit as compared to the land lines, confusing in itself,
and they have city codes not area codes, that must be used. Every call also
starts with a zero. We ended up asking a 12 year old skateboarder to use his
cell phone and call for us. We eventually figured out the system and I found
several coin phones in the train station with English instructions in the
internal memory.
There are numerous internet cafes available throughout Gent.
THE
HOSPITAL
Hospital
Accommodations
The University Hospital, or the UZ as locally named, is located about 5-10 minutes from the train station by tram or bus or a 20-minute walk. It is a very large sprawling campus with numerous buildings. The UZ is a teaching hospital. Parts of the facilities are rather old and dated, but any surgical areas were state of the art. The plastic surgery ward is located on the fifth floor in building K12. There is a check-in process on the ground floor, where you will be asked to sign a lot of documents in Dutch. I simply signed and indicated “English only” near my signature. They do have a welcome booklet in English to familiarize yourself with the UZ.
Typical
Double Room
The typical room on the plastic surgery ward is a double room. They always paired FTMs with other FTMs while I was there. There were approximately 5 FTM phalloplasty patients at any one time on the ward while I was there. Each typical room has a closet for each patient, one private toilet and sink to share with your roommate, one TV again to share, and two small seating areas for guests. Each fully electric bed has a nightstand/bed table with a locking drawer and a built in refrigerator below. Each patient also has a phone. All electricity is 220 V and most US appliances need both converters for the voltage and adapters for the physical plug to fit the Belgian sockets.
Communications
The hospital issues you upon check-in a
phone card to activate your phone. The rates were indeterminate. I did some
research ahead of time and found that friends and family in the states could
call me using 10-10-987 for only 3 cents per minute so the majority of my calls
were incoming.
We had hoped to hook up our laptops in the
hospital room to the Internet with a local provider but could not get past the
phone card security set up. The phone lines were also not the standard US phone
lines. It may be possible but we gave up trying.
THE
SURGERY
Pre-Surgery
Preparation
You are required to be off all hormonal
treatments for 3 weeks prior to surgery. You will be required to check-in to the
UZ the morning of the day before your operation. You may have some appointments
the days before this as well. This first day in the UZ will be to prepare you
for surgery. You will not be allowed any food and should have had your last food
the evening before. You will be given a cleanse to drink to completely flush
your system clean. This takes several hours and many trips to the toilet. You
will be able to drink black tea and coffee, which helps to alternate with the
cleanse drink. You will also be shaven from your kneecaps to your bellybutton as
well as your non-dominant arm. I did this ahead of time and suggest doing this
yourself ahead of time. If left to them they will dry shave you and your may
develop a nasty razor burn.
Professor Monstrey will stop by to mark up
your arm and your genitals and answer any last minute questions. An
Anesthesiologist will also come by to discuss your anesthetics, medical history
and pain medicines. This is a good time to advocate for appropriate pain
medicine, I had to advocate for lots of strong medicine while Travis advocated
for less, each based on our own pain and pain killer thresholds. We also asked
for a sleeping pill to help sleep the night before surgery. Both Travis and
myself also took sleeping pills the next several weeks to facilitate a good
nights sleep. This was more to sleep through the night, after all you are on a
different time zone and generally sleeping on and off all day. They will then
wake you up early for surgery and wheel you down to the Operating Rooms.
Surgical
Procedure Description
In layman’s terms, the Belgian
phalloplasty is made from the tissue of the non-dominant forearm. The skin,
tissue, two nerves, some veins and one artery are harvested down to the muscle
and formed into a tube within a tube. The inner tube has the skin surface on the
inside to form the urethra, the outer tube has the skin on the outside to form
the corona of the penis. The veins, nerves and artery are all redundant systems
in the arm, and the arm should heal with no lasting effects. The arm will be
covered with skin from the leg. The penis itself is formed on the arm with the
blood supply kept intact until it is transferred to the genital area. Meanwhile,
the genital area is prepared, the vagina is removed and the pelvic floor muscles
are sewn together. The scrotum is formed from the outer labia and brought
forward. The penis is then transferred to the genital area and the nerves, veins
and artery are connected. Cosmetic touches are then done to enhance the final
product.
In more technical terms, the Belgian phalloplasty is a radial forearm flap performed as follows:
If needed, a gynecologist performs a
complete hysterectomy/ovariectomy. I had this procedure performed while Travis
had his years before stateside. They are now recommending having the
hysterectomy performed at a minimum of 6 months prior to the phalloplasty.
Professor Hoebeke reconstructs the fixed
part of the urethra and resects the vagina. The pelvic floor is completely
closed and the outer labia are used to form the scrotum. They have enhanced
their technique on the scrotum formation to allow for a very forward and
dangling scrotum. I still can’t figure our exactly what they did to form the
scrotum so well.
The plastic surgical team meanwhile
pre-elevates a free vascularized flap from the non-dominant forearm (the left
arm is used if right handed, the right if left handed). This flap is transferred
to the perineal region by anastomosing the artery end to side on the common
femoralis artery and the vein to the greater saphenous vein. Two nerves of the
flap are also connected; the first to one of the dorsal clitoral nerves for
erogenous sensation, the second to an ilio-inguinal nerve for protective
sensation. The clitoris is denuded, directed up and buried under the base of the
shaft of the penis for additional erogenous sensation.
The radial forearm flap basically consists
of an inner tube for continuation of the urethra and an external tube for
coverage of the penis itself. Construction of the glans and corona of the penis
are also performed. The plastic surgical team also has modified the traditional
methods to optimize the vascularization of the phallus.
The donor site of the arm is then covered
with partial thickness skin grafts from the thigh area.
The operation requires 4-6 surgeons and
lasts from 6-10 hours.
Post Surgical Recuperation
Day 1
After surgery you are kept overnight in the
PACU (the post anesthetic care unit). You will wake up shortly after surgery and
be feeling extremely groggy and possibly sore. The doctors talk with you and
hopefully let you know everything went well. They keep the pain medicine flowing
and you will be very out of it and sleep most of the time. Guests can see you
sometime after 8PM for a few minutes. Every 15-30 minutes or so nursing staff
will come and check the pulse with Doppler along two places on the penis.
Hearing the heart beat coming through the speaker system is a very reassuring
sound. Overall the drugs are extremely strong and the after effects of the
anesthesia will keep this whole recovery ward as a rather foggy memory.
But you will remember rather vividly waking
up and looking down and seeing your penis for the first time.
The actual effects of the surgery are as
follows: you have plenty of IV connections into your dominant arm; the
non-dominant donor arm is bandaged in a cast like material; you have all kinds
of connections on your torso to monitor on your vital signs; your donor site on
the leg thigh is bandaged up thoroughly; there is a small bandage by your lower
ankle where a short artery was harvested; you also have a sub-abdomen catheter
(basically a tube coming out your belly area between your bellybutton and your
penis); and your lower body is under a metal cage like structure to keep the
covers off the penis. They also pump in hot air under the covers to keep the
penis warm. You also have a temperature gauge on your abdomen and on your penis
and the nurses will chart the temperature for several days. The penis and
scrotum are not bandaged and actually look amazingly good with very little
evidence of incisions from your vantage point. The penis is resting on a “penis
pillow” that is taped to your thighs. You will not be able to move much and
will now be lying on your back for many days and this pillow helps to keep
everything where it should be.
Days
2-10
Sometime the next morning, you will be
awoken for a bath. This can be very painful, as you will have to roll to each
side. It is then that you can feel the internal surgery. It goes by very fast
and then you feel relatively good, clean of sweat and blood that was left on
from surgery.
At some point that morning they will wheel
you back up to your room. The Doppler monitoring of your penis’ pulse
continues now every 30-60 minutes. Day by day this time frame doubles, first day
every 15 minutes, then 30 minutes, then every hour, then every other hour and so
on. It gets to be a mixed blessing
hearing the heartbeat as they always seem to be waking you. They will also be
taking and charting your vital signs regularly.
Days 2-3 you will hopefully have
plenty of pain medicine and sleep. While I was there each patient seemed to have
his own protocols on pain medicine. The nurses can only do what is prescribed so
advocate for appropriate pain medicine with the doctors. Day 2 will probably be the day you
really get to have a good look at your penis. You will not be able to move much
but the nurses are checking on you and lifting the covers off at frequent
intervals. It was actually not until day 3 that I could even move my right arm
across my body to press the bed’s control buttons on the bed frame. And that
was quite an accomplishment.
Once in your room on the ward, there is a
daily routine. You are awoken at about 8am for breakfast. You will start to take
light foods on days 3-5 or so. Then the morning is spent getting a bath and
having your dressings and linens changed. This is an exhausting process. The
bath feels incredible but it can be difficult to roll. They will wash your hair
once in a while if you ask and they have the extra time. It is a real luxury to
have clean hair as you will be sweaty and greasy from the narcotics and the
general recuperation process. In fact having a cold wet wash cloth to frequently
wipe your face with is nice. The hospital literature suggests bringing your own
towels but they have plenty available just make sure to ask for clean ones
daily. Sometime in the morning the doctors make their rounds and discuss any
issues you may be having. I found it was very helpful to write down all
questions as they came up so I would not forget them when the doctors made the
daily rounds. The pain medicine can effect your ability to remember your
questions. The doctors are generally the plastic surgery residents. Professor
Monstrey is kept informed at daily meetings with staff and will come if
necessary. He also makes the rounds at least once a week.
On day 5, the dressing on your leg
will be removed. The leg can be painful in places and itchy in others. You will
be instructed to use a moisturizer on it once any open spots are fully closed.
The bandage on your arm will also be removed and changed on day 5. The original
bandage has a plastic like wrap as the bottom layer that is held on with
staples. This may cause some minor discomfort when the staples and plastic are
removed. The arm can look rather shocking at this time, it is really at its
worst. Depending on the healing of the arm, various bandages will be used daily
from this time forward. They also might use an ultraviolet light source to
facilitate healing of the arm or leg. A physical therapist will begin coming
daily to work with you on your hand and arm movements, doing light movements and
weights until full movement returns. I had full movement almost immediately with
no adverse effects while others took longer to return to full mobility.
They will also be removing the penis
catheter by this time, it was really just a tube holding your urethra open, and
the sub-abdomen catheter remains in place for urine.
Sometime during the first 10 days your
bowels will begin to work again and this can be somewhat uncomfortable. It is
important to discuss this with the nursing staff as they can give you some oils
to make it more comfortable. You will need to use a bedpan, which can be
difficult in and of itself.
Towards the end of the first 10 days you
should be feeling rather good. We were fairly active, yet still confined to bed.
We watched DVD movies on our laptops and ordered local pizza for delivery in the
evenings. The hospital food although rather good, begins to wear on you by day
10 and snack and salty items were on our minds. You can either stock your
refrigerator and room before surgery or have family or friends bring you snacks.
As Travis and I traveled alone, we stocked our refrigerator and room ahead of
time and had everything within arms reach of our beds. We did feel rather guilty
using the emergency call button to have a nurse hand us a bag of potato chips
the cleaning crew had moved just out of our reach.
Day
10-14
By day 10 you should be feeling
pretty good, off most pain meds and anxious to get up and start moving around.
And Day 10 is the big day, you get to get out of bed for the first time. After
your bath, you are assisted to a special chair and hopefully you can begin to
shuffle around. I made it to the sink and saw my reflection and promptly went
back to bed for the day. I had lost almost 30 pounds and had a gray and sunken
look to my face. My legs were also extremely wobbly and my feet felt like mush
on the ground. The next day I was doing much better and starting making my
rounds around the ward and even venturing to the cafeteria and outside. Most of
the FTMs seem to find each other and visit each other on rounds around the ward
once up mobile. It helps to discuss the daily trials and tribulations with each
other. It was very apparent that despite the same surgery, some of the details
of the recuperation were not set in stone and your nursing staff had some
discretion based on their own experience and opinion.
The hospital furnishes some mesh shorts
daily that are then packed with bandages to protect the penis and scrotum and
keep him pointed up. These will be worn until discharged from the hospital.
Loose pajama pants and sweats work best at this time. A robe and slippers are a
good idea to bring as well. Prior to getting out of bed your clothes choices are
very limited, no bottoms and tops only after the IV has been removed.
The hospital grounds offer some good
exercise walking around. There are several cafeterias, which serve great Belgium
beer, a hair salon, a chapel and some nice park like areas. Directly across from
the main entrance to the UZ are a waffle shop and a bistro for off campus food
choices. Once you are mobile you can get permission to leave the hospital
grounds. I also found a barber and some snack shops.
They will soon clamp off your sub-abdomen
catheter and you will begin to train your bladder by opening the valve
periodically. A day or two later you will attempt to urinate with your penis.
This is not as easy as it sounds and takes some guys several days. The method is
to urinate with your penis then open your catheter to fully empty the bladder,
when you urinate more from your penis than your catheter, the catheter can be
removed. There are often fistulas at this time, causing ever-changing leaks from
your penis while urinating. These are considered very normal and the urine
sterilizes them and they generally close on their own.
Hospital
Discharge
Once you are able to urinate, your discharge
from the hospital is imminent. They generally like you to stay in the country
for some follow-up appointments over the next 1 to 1-1/2 weeks. The appointments
are generally with Monstrey in the plastic surgery clinic on the first floor of
K12. It is nice to stay in Gent to spend some time slowly gathering your energy
while sightseeing. After 2 to 2-1/2 weeks in the hospital you will tire easily.
The nurses suggest dressing your penis up
for another month, however Professor Monstrey seemed to indicate wearing your
penis in any direction, up, down or to the side is all OK. While you are
generally sensitive in the general groin area, you are surprisingly not sore or
irritated. It can be challenging to determine what kind of underwear to use at
this point and it is really an individual preference.
Various
Complications
It seemed in my stay and seeing
approximately 10 FTM phalloplasty patients that each of us had various kinds of
minor complications. These are considered normal and most require either no or
minimal intervention. The various complications include hematomas, low blood
sugar, painful bowels, fistulas, and various wound site healing issues on the
arm and leg.
There were however, two major complications.
One patient had part of his bowel nicked during surgery leading to a very
lengthy stay and several operations to correct the situation. On the positive
side, there were excellent specialists available in the UZ. This situation is
still pending a final correction. It is also worth noting that he had some very
unusual anesthetic and/or surgical issues that in fact prevented the Montreal
team from finding him to be a viable candidate for surgery.
And in my case, I had partial necrosis of
the left glans of my penis. This area needed to be debrided (cut away) and will
require another flap from my right arm to correct. My complication is also
pending the final correction later this year.
Both of these more serious complications were unique and each person contemplating such invasive surgery should be aware of the myriad of serious complications that may occur.
Other
Patients
During my stay in the UZ, there were approximately 10 other phalloplasty patients on the ward. They ranged in age from the early 20s to the mid 40s. Two were from France, three were from Belgium, one from the Netherlands, one was from Canada and three were from the US (including Travis and myself). As I have indicated we tended to gravitate towards each other and discuss our recuperation. I also met a phalloplasty patient of Daverio’s who was seeking to have Monstrey add a glans ridge on his phalloplasty. I also met several other patients further along in their recuperation in the Clinic. All in all everyone was very happy with their results.
The
Doctors
As I already mentioned, Professors Monstrey and Hoebeke are extremely professional, friendly and have a great bedside manner. However, they are also extremely busy and your time with them can be very limited. The plastic surgical residents make the daily rounds, often with other staff and students. The residents were generally pretty good, all of them relatively friendly some with great bedside manners and others perhaps lacking by our standards. You will see a cadre of residents. Travis and I had to slow them down, ask for introductions and often request they speak English. The residents’ English is all excellent however, they do revert to Dutch with instructions to the nursing staff and in discussions with each other. This is to be expecting seeking surgery in another country. But it can be very disconcerting as you have no idea what they are discussing. There would often be a lengthy Dutch discussion only to be translated to “it’s all OK” to us.
Plastic
Surgery Ward Nurses
There are three shifts for the nursing staff. You will have the most contact with the morning staff for dressing changes, baths and linen changes. They are often assigned to the same rooms for their work week so you get in a groove with them and they with your requirements. In general the nursing staff is very helpful, friendly, and professional. There will of course be personal likes and dislikes. I also imagine that as American patients we have a certain image as being demanding and aggressive perhaps. Most of the nursing staff speaks English, however there are some that have no English skills. Both Travis and I had our best experience with a non-English speaking nurse, we nicknamed “mom” because her care was so comforting. She was our nurse early on when we were feeling the most pain and general weakness and she made all the difference. The afternoon and evening shift will do evening dressing changes. And the late night shift will be all but invisible to you unless you need attention in the night. Overall, the staff was great and we got to know several of the nurses rather well.
The
Clinic
On the first floor of K12, there is a plastic surgery clinic that you will use to have any of your appointments after you are discharged from the UZ. Expect for some lengthy waiting time for any appointments.
Harry
Saelens
Harry works out of the Plastic Surgery
Clinic and supplies the elastic and silicone sleeves for your arm. Travis was
not informed of this practice and returned to the states in search of the proper
bandages. Harry does not directly work for the UZ and only accepts cash for the
products. There is a wait for fabrication as each sleeve is custom made so
inquire early for Harry to visit you perhaps before you are discharged. He
suggests getting 2 elastic sleeves, these are worn almost all the time. You have
two to alternate and wash one. He also suggests getting an elastic glove to wear
at night to help alleviate hand swelling. And finally you will get a silicone
sleeve to be worn under the elastic sleeve to facilitate healing and prevent
hypertrophic scarring. He also sells a lotion to be used with the silicone
sleeve and a cleansing solution for the elastic products. All in all I think I
spent 400 E on this necessity.
Food
The hospital food at first is rather fun,
experiencing a different culture’s cuisine. They serve 4 slices of bread with
various spreads for breakfast and again at dinner. The midday meal is generally
a hot meat dish with vegetables and desert. Several days into the bread and we
were extremely tired of it. As it turns out, you can request to speak to a
dietician and develop custom menus to suit your taste. I was able to request
cereal for breakfast, extra meat at lunch and pasta for dinner. It can take a
day or two for the food change to take place so ask to speak to a dietician
early on.
TV
The hospital television has CNN, MTV, the
BBC, the cartoon network and some miscellaneous American programming during the
day. They also have a good American movie channel in the evening and one or two
channels that have current American programming. You will become familiar with
all the American programming in short order while confined to your hospital bed.
Computer
Travis and I both brought our laptop computers and were able to watch our collection of DVD movies. It wasn’t until about day 8 that we even felt like trying to concentrate on a movie, preferring before that to zone out on the TV.
Mental
Stimulation, Books, Games, Hands on Toys
You will find yourself wanting for some kind of stimulation for your mind while confined to your bed. Think about various games, crossword puzzles, books and such to keep your mind occupied. Even some hands on art would help with the use of your fingers and dexterity of your left hand.
Arm
The arm heals over the course of a year. I find the skin has changed from bluish to reddish to pink and fleshy at 4 months. The silicone sleeve helps with hypertrophic scarring and is to be worn up to 18 hours a day the first year. An elastic sleeve is worn over the silicone and looks rather benign so not many eyes are drawn to it and questions have been at a minimum. I still have some significant swelling of my left hand and that is considered normal. I have full functioning, the back of the hand just remains swollen while the lymph system rebuilds itself to allow for drainage. I have been able to return to lifting weights at 3 months and occasionally ice my hand to reduce the swelling. There was never any pain of the arm during the recovery.
Leg
The leg skin graft site heals extremely well. In the first few weeks is can be both itchy and burny feeling. It also can turn beet red when you resume walking as the blood flow changes from being bedridden but over the course of a year the site should hardly be discernable. You must protect the area from sunlight the first year.
Scrotum
The scrotum will give you the most discomfort in the first weeks. It is a general discomfort and slight ache to the general area. While you are confined to your bed it is the worst. By day 10 when you start walking the pain level has generally subsided although the area can feel uncomfortable if you are on your feet too long at first. The scrotum is basically healed when you are discharged from the hospital. It remains sensitive for several weeks as you learn to adjust yourself to having a package between your legs. The process they use to pull the scrotum forward really creates a swinging package that is actually quite forward and not squeezed between your legs. I was able to ride my standard style motorcycle very comfortably at 3 months post op.
Penis/The
Final Product
When you leave the UZ, your penis is in
surprisingly good shape. The glans ridge softens with time and looks more and
more natural. If you had heavy hair on your arm, you will need to occasionally
shave. I find once a month is sufficient and that the hair grows in softer and
lighter than it did on my arm. I had thought of having electrolysis prior to the
nerves fully functioning in the penis shaft but do not see a need to at this
time. I actually think the shaving and hair follicles adds some texture more
like a natural penis, there does not appear to be any coarse stubble but that
may vary with the type of hair on an individual.
Overall the penis is a very ample size generally between 5” and 6” in length and the girth varies based on one’s inherit body composition and seems to be around 4” to 5” in circumference for the one’s I have seen. The glans looks very realistic with a fireman’s hat shape to the ridge, becoming less on the underside. The penis hangs and swings freely and does take some getting used to. It may also be that at first we are so overly aware of finally having a penis that we really focus on its presence. The penis also seems to take on some natural life and will hang to one side or the other which at first I wondered about as the surgery really seemed to make it all perhaps too perfect, but over time your penis takes on subtle characteristics of it’s own.
Although we were somewhat weak when first discharged from the UZ, our overall strength returned quickly. I was able to walk around Gent during my extended stay for complication follow-ups and in fact went hiking in the Swiss Alps at about 8 weeks post op. When I finally returned to the states, I began working immediately. I have a very strenuous and physically demanding job that I was able to do although I was aware of staying well rested and not pushing myself too much. Each day I was stronger and stronger. It was simply a challenge to be back at work and to get back in the groove after so much time off. Compared to my research on other bottom surgeries, this recuperation was relatively easy. There was no soreness or other significant issues.
Due to the construction of the penis shaft
on top of the clitoris, sexual functioning returns soon after surgery. The
nerves going along the shaft of the penis take approximately 1 year to fully
heal and develop but the buried clitoris allows for sexual functioning as soon
as you feel up to it. I was able to masturbate by jacking off, the movement
stimulates the buried clitoris, at approximately 6 weeks post op, even with my
complication and additional bandages.
Due to my complication, I still wear a
bandage around my penis and am now using a self-adhesive Ace bandage wrapped
around twice. This keeps my penis straight and stiff and I am simply able to
roll on a condom and have fantastic penetrative sex. I understand many of the
other patients I met there have been equally creative to facilitate penetrative
sex before they have the erection device installed. The mental connection to
actually be inside someone vs. various prosthetics or dildos is unbelievable.
Various other options like oral sex and hand jobs are also possible and very
satisfying.
My phalloplasty was estimated to be 20,000 E
and included my hysterectomy. I understand the price is actually determined
based on the detailed hospital bill but the estimate is generally fairly
accurate. This payment is to be made 30 days before surgery by wire transfer.
All the details for the wire transfer will be sent to you once a surgery date is
set. To avoid high exchange rates, I contacted their bank, KBC, at the New York
branch for the wire transfer and managed to avoid any additional fees above the
going bank exchange rate. Some banks can charge as much as 20%.
In addition to the surgery, you will need to
pay cash for the elastic and silicone bandages for your arm. This was about 400E for 2 elastic bandages, one glove, one
silicone sleeve, lotions and cleaning solutions.
The erection implant procedure is generally
not performed until one-year post op from the phalloplasty. This procedure is
using a new French device that is a 2-part system vs. the previous 3-part
system. The testicles are fluid
filled and are pumped to inflate two rods along the shaft of the penis. A
backflow valve keeps the fluid in the penis and when done the valve is pressed
and the penis deflates. The previous system used a more invasive procedure with
a reservoir located in the abdomen. Professor
Hoebeke has reported great success with this new product. The cost estimate for
the implant is 8-10,000 E and includes 5 days in the UZ.
Even with my rather serious complication, I
am extremely satisfied with my phalloplasty. I have no issues with my arm
scarring, it has simply become part of me. In hindsight, it was an easy
procedure. In fact compared to top surgery with Dr. Brownstein as an outpatient,
the recuperation was relatively easy. I finally feel like my body matches my
mind and it is great to have a significant package between my legs. I am finding
my constant turmoil the last many years over bottom surgery is over and life is
settling into a nice even keel. I firmly recommend the Gent gender team and
believe they have an excellent product.
I will be posting 40-50 photographs of the hospital, the B&B, some staff members and of course a collection of phalloplasty results to the FTMSurgeryInfo Yahoo Group. To join the group go to: http://groups.yahoo.com/group/ftmsurgeryinfo. For further information, I may be contacted at danielsgroups2004@yahoo.com but would prefer most questions go through the groups avenue so all can benefit from the dialogue.
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