The T-MALE Presents:

PROCEDURES & PRICING for Foerester, Menard/Brassard & Metzler - Raphael

Please note: Top Surgery can range from $6,000 to upwards of $8,000 + depending on the surgeon.

Phalloplasty & Metoidioplasty can range from $12,000 to upwards of $150,000 depending on the surgeon.

It's hard to give exact prices for each. There are too many variables.

If you have prices and information on your surgery, please submit it for this area.

Nick

Dr. Raphael Procedures Offered and Pricing (Valid as of May 2004)

Dr. Raphael (see his work in the Top Surgery area of this site) or Dr. Tex McFadden @ 972-543-2481 or drtexmcfaden@sbcglobal.net with questions.
FTM Top Surgery 
1600 Coit St 105
Plano, Tx 75075
Phone: 972-985-0434

Top Surgery: Price: Call for pricing Centurion Metoidioplasty, with associated surgery procedures. Pricing: Ask the office For more information on this procedure, visit this page on the T-Male site: Centurion & Centurion Posts

Addition: From the surgeons letter to me, Nick, July 23, 1999

The three-step conversion of female-to-male genitalia costs $10 000.00 which includes the operating room, surgical fees and silicone testicles, used in the reconstruction. In addition to this, anesthesia fees on two occasions are required (approximately [US] $600.00 each time for a total of [US] $1200.00). The second procedure in the three-procedure conversion is done under local anesthesia, and there is no charge for anesthesia. The [US] $10 000 is to be paid in two installments, the first half being due one week prior to the first procedure, the other half is due one week prior to the second procedure. You must plan on spending from ten to 14 days in Oklahoma City following the first surgical procedure, one day following the second, and five to seven days after the third procedure.

Before any surgery can be done, we would require clearance from two professionals in the health care field, with special interest in gender dysphoria. One of these must be a psychiatrist. Furthermore, this clearance must be obtained prior to any surgical scheduling. In addition, there is a requirement of cross-dressing and living as a male for at least one year, during which time hormone therapy is being given. These requirements are basically those of the Harry Benjamin International Gender Dysphoria Association. One final comment: prior to any scheduling of such surgery, it is necessary that you will understand what we can and
cannot do. This is all discussed in a consultation, for which we charge [US] $35.00. ..The third step (first two are breast removal and hysterectomy) is the conversion of the female-to-male external genitalia and should not be referred to as simply "phalloplasty",
as a male-appearing scrotum/testicle structure is needed, as well as a neo-penis or phallus. Three surgical procedures, two major and one minor, are required. The latter being done under local anesthesia.

The first procedure, done under general anesthesia, consists of formation of an inverted tube pedicle running vertically from pubis to approximately 4 cm beneath the umbilicus and incorporating the full thickness abdominal skin and soft tissue. By tubing this "raw" side out, a 4" * 8" split thickness skin graft taken from the anterior thigh can be wrapped around the pedicle for covering, pedicle will eventually form the shaft of the neo-penis and the grafted skin will mimic the loose skin of the natural male penis much more closely than other methods using nongrafted pedicles. The labia majora is then converted into a neo-scrotum by splitting each lip along its medial border, connecting the two together in the pubic area, thus forming an inverted V. The inner layer is sutured separately from the outer layer across the midline, so as to form a neo-scrotum. Attachment of the labia across the midline "hides" the clitorus and vaginal introitus from view, and when completely healed, will be available to accept two silicone testicular prostheses. This procedure is done in the office surgical suite. Recuperation can easily and safely be done in the hotel/motel environment and hospitalization is not required. Members of the surgical team see the patient the day after surgery for a postop
check and to do dressing changes as necessary. The same home care facility mentioned in the paragraph concerning breast conversion is available for patients arriving for this procedure without someone to stay with them during the hotel/motel recuperation period. Six to eight weeks at your home should be allowed to pass for healing and maturation of the pedicle and neo- phallus.

The second procedure, done under local anesthesia, is simply a "delay" of the abdominal skin between pedicle and umbilicus that will be used to construct the head of the neo-penis. The incisions are made, as indicated, undermined slightly and closed with simple skin sutures.

The third procedure is carried out approximately two weeks later, at which time the incisions are reopened and complete release of the abdomen is accomplished. The free ends of the pedicle are folded toward each other, the points trimmed bluntly and sutured together to form a conical head with central dimpling, simulating the male penile head. The abdominal donor site is undermined slightly and closed primarily. The upper bases of each labia are surgically opened in a traverse manner and each labia "hollowed out" by blunt dissection to accept adult size testicular prostheses. Once in place, the pockets are sutured and the neo- scrotum with testicles is completed, as the neo-penis.

Later, sexual functioning can be achieved by inserting a removable rubber rod (baculum) through the hollow tube in the neo-penis. In some cases, the neo-penis may be firm enough for sexual functioning without the need of a stiffening rod. The clitoris, near the base at the neo-penis, serves as the climactic organ, since the head of the neo-penis is usually without sensation. Hair must be shaved or removed by a depilatory cream from the head of the neo-penis, as well as through the shaft. Urination, at this stage,
is still through the female urethral opening and requires a sitting position. A urinary assist device can be utilized at this point in order to urinate through the penis, as the sitting position is not always available, particularly in a working position.


If you would like information about how to contact this surgeon, please contact their office.

-Nick

We are pleased to send you a detailed information package on metaidoioplasty, clitoridal release and testicular implants (female to male) 

After reading the content you may wonder why the price quoted for the procedure (s) is lower than in the U.S.A. Here is why: we own the hospital where the procedures are done. The cost for one hospitalization day at our hospital is around $ 400.00 canadian compared to U.S. $ 1200.00 to 1500.00 in the U.S.A.. For 4 to 5 days of hospitalization in the U.S.A., you spend U.S. $ 5000.00 to 6000.00 extra on hospital overhead which you do not have to pay for with " GRS in Montreal." Our modern and safe hospital care is personnalized and our staff has a high experience with transgender patients. Low overhead combined to favorable exchange rate are responsible for the low cost of procedures with GRS in Montreal.  

In choosing Montreal you do not settle for less. On the contrary you pay for state of the art procedures and unsurpassed results based on a vast experience with transgender surgery. Also with the residence, you benifit from a unique care concept which is not available anywhere else in the world. 

We and our staff would like to thank you for your interest in our surgical services and please do not hesitate to contact us if you need anymore information. 

DEFINITIONS AND SURGICAL TECHNIQUE  

METAIDOIOPLASTY: 

Metaidoioplasty is done under general anaesthesia at the hospital and is a 3 hour procedure. It is the operation where all the female genital parts, except for the vaginal cavity which is removed, are kept and used to construct the male genitals. The clitoris is released and becomes the penis, the labia majora becomes the scrotum, some of the vaginal mucosa and both labia minora are used to elongate the urethra thus permitting voiding while standing. A catheter is placed through the penis to the bladder for a period of two weeks. Testicular implants are not inserted during metaidoioplasty because there is an unacceptable risk of implant infection and loss. They are put inside the scrotum when it is well healed. This is usually done under local anaesthesia after approximatively 6 months. Metaidoioplasty can be done only if the hysterectomy and ovariectomy were done 6 months prior to the procedure. 

CLITORIS RELEASE: 

Clitoral release is done under general anesthesia at the hospital and is a 1 1\2 hour procedure. It is the operation where the clitoris is elongated by releasing its ventral attachment or chordae. Testicular implants are placed inside the labia majora on both side and only the anterior ends of the labia majora can become the new scrotum. Voiding is not changed and the vaginal cavity remains opened. 

TESTICULAR IMPLANTS:

The testicular implants we use are made of semisolid polymer. They are soft and cannot leak if broken accidentally. If this is the only procedure, for example: after a metaidoioplasty, it is done under local anaesthesia at the office and it is a 45-60 minutes procedure.

COST 

The cost for metaidoioplasty with vaginal cavity closure is 14,675.00 $ U.S. including surgery, hospitalization 4 nights, residence care 18 days and transportation.  

For clitoris release: 5,115.00 $ U.S. including surgery, anesthesia, hospital, residence care 4 days and transportation.  

Testicular implants insertion alone under locale anesthesia: 3,185.00 $ U.S. including surgery, operating room and residence care 3 nights after and transportation.  

Once a date has been set for the surgery, you must send a 1,400.00 $ U.S. dollars deposit within the following 15 days or the date will not be reserved. The balance due is payable two weeks before your surgery. All payments must be made in cash, certified check or bank drafts to CLINIQUE DE CHIRURGIE ESTHETIQUE ST-JOSEPH. If you decide to cancel your surgery less than 4 weeks prior to the date booked, your deposit will not be returned but will be kept for a later date. If you cancel completely, we will keep 500$ for administrative fees.  

After leaving the hospital, to make your stay more agreeable and secure, we have set up a residence specialized in the field of transgenderism. This residence is located at 20, Chemin des Iles Yales, St-Eustache, Qc, J7P 5M6. Your stay at residence is mandatory. Do not forget that post-operatively you will need help and this is the only place where you will receive adequate, professional care

Three weeks before your surgery, we ask you to confirm with the office if you are arriving in Montreal by plane, train or auto, the date of your arrival, airline or carrier, flight or train number. Will you be traveling alone or with another person who wants to stay with you at the residence? If a room is available the cost for this person to stay at the residence is $ 100.00 U.S. per night. When we confirm your date of surgery, we will send you a form to complete for these information's.  

CRITERIA FOR ELIGIBILITY 

To be eligible for these surgeries, one must, first of all, answer to the criteria of the "Standards of Care of the Harry Benjamin International Gender Dysphoria Association, Inc.". 

That is: Hormonal sex reassignment recommended by a clinical behavioral scientist.  

Full-time living in the social role of male sex at least 12 months. 

Two recommendations of G.R.S. made by two clinical behavioral scientists. One of the two

recommendations must be made by a person possessing a doctoral degree (e.g. PhD, Ed.D., D.Sc., D.S.W., Psy. D., or M.D.) in a clinical behavioral science granted by an institution of education accredited by a national or regional accredited board. The clinical behavioral scientist making the primary recommendation in favor of S.R.S. shall have known the patient in a psychotherapeutic relationship for at least six months prior to making said recommendation". 

The patient has the responsibility to see that the behavioral scientists have the necessary qualifications mentioned above and that they are clearly stated in the recommendation. Also, most important is the fact that one of these recommendations has been made by a scientist who has followed the patient for at least six months. 

MEDICAL HISTORY 

The medical history and the two recommendations for G.R.S. must be well detailed and must arrive at our office before a date can be set for pre operative consultation. Also, we wish a report from the doctor who is supervising the hormonal therapy as to the type of hormones being administered, the dosage and the duration of the treatment. Please note that the patients who have chronic diseases like diabetes, hypertension, cardiac problems, obesity etc cannot be operated. The patient who will undergo surgery must be in excellent health. Please also send us a recent photograph of yourself. 

PRE OPERATIVE CONSULTATION 

It is preferable to meet with the patient a few months prior to surgery. The cost of the consultation is $ 50.00 U.S. money payable cash, Visa or Mastercard. However, if the patient lives very far from Montreal, it is possible to meet a few days prior to surgery. If the latter is the case, the patient's file must be complete: the two recommendations, the laboratory reports and the medical history must be at our office before the visit. If a document is missing, the surgery could be cancelled.  

PRE OPERATIVE ANALYSIS 

As they are surgical procedure under general anesthesia, the patient must pass the following exams about two months before the date of the surgery and the results of these exams must be sent to our office three weeks prior the date set for the surgery. Without these test results, there will be no surgery. 

For testicular implants insertion alone, there is no obligatory testing.  

Following is a list of the obligatory tests 

- CBC (complete blood count)

- BUN (blood urea nitrogen)

- Glucose (blood sugar)

- Urine analysis

- Chest X ray (the report only)

- E.K.G. (over 40 years of age)

- H.I.V. 

PRE-OP CARE FOR METAIDOIOPLASTY AND CLITORIS RELEASE 

  You must: 

1. have no skin infection. 
2. not take aspirin or all medication containing acetylsalicylic acid (ASA) during the three (3) weeks preceding the operation. 
3. have passed the necessary laboratory tests. 
4. not take alcoholic beverages one week prior to surgery. 

 5. SHAVING 
Shaving of the skin is done the day before. The skin of the pubis, vulva and perianal areas must be included. 

 6. ENEMA 
One (1) or two (2) fleet enemas are administered 12 to 18 hours before surgery at the hospital. 

 7. YOU SHOULD CARRY WITH YOU: 

comfortable and loose shorts: 6 pairs   comfortable clothes (loose pants approximatively 100$ for pain killers and antibiotics personal material: umbrella, walkman, diary, reading material, address book, calling card...personal cosmetics: shower gel, hair brush,comb, toothbrush, toothpaste, shampoo, conditioner, etc... 

 
8. HYSTERECTOMY AND OVARIECTOMY 

If vaginectomy is done with a metaidoioplasty, the surgery is performed only when a minimal six (6) months interval has passed after total hysterectomy and bilateral ovariectomy has been done. However for clitoris release, this surgery need not to be done. 

If you wish more details, you may write or call my secretary.  

Yours truly, 

YVON MENARD M.D. F.R.C.S.(C)    PIERRE BRASSARD M.D. F.R.C.S.(C) 

 
1003, EAST ST-JOSEPH BLVD, MONTREAL, QUEBEC, Canada, H2J 1L2

TEL : (514) 288-2097 FAX : (514) 288-3547

WWW.grsmontreal.com

E-mail : info@grsmontreal.com 

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