TYPE OF SURGERY - Description

MLD PHALLOPLASTY Stage 1

Including : vaginectomy, neophallic reconstruction - microvascular MLD free flap phallo, clitoral lenghtening and straightening with the fixation at the base of the neophallus, urethral reconstruction 1st stage and scrotal reconstruction with bilateral testicular prostheses.
Total cost was around 18 000 Euros + Stay (about 2000 E for 15 days , inc. food )
(To double-check depending on what your surgery includes)

OUTCOME RESULT - 5.5'- 2 months post op

 Vaginectomy includes total closure of the vagina and removal of internal tissues - "Mucosa and submucosal wall are removed and then a muscle is used to close the space and create perineum as in male." No complication whatsoever on that side, no inernal pain, skin has sealed around the testicles, scar is barely visible. Also one of Belgrade's team achievement, vaginectomy is a difficult  procedure but they somehow handle it in less than an hour without risk of extreme bleeding and possible blood transfusion.

Clitoral lenghtening and straightening  with fixation at the base of the neophallus;

as you can see on the photograph, the head of what's left of the previous clitoral glans is visible between the balls ; it feels like a small piece of skin, very sensitive at the touch and it will be covered by the phallus in stage 2 - As far a I am concerned this is the only small detail that I hadn't expected, I had asked Miro about it and he was honest on saying that it would be placed between the testicles but for some reason I had assumed that there would be no trace of it after the intervention - I did not actually specified for it to be buried at that stage and when i asked about it a few days after surgery , from the answer i got and from what i gathered , it is safer  to "leave it aside" and focus on the urethra first. It does seem sensible to give priority to internal functionning and intervention is huge enough not to take any risk regarding aesthetical results. Still I am looking forward to 2nd step so that the head can totally disappear.

Urethral reconstruction stage 1

Neo urethra - 7 weeks post op

 Miro definitely succeeded in extending the urethra up to  1/3rd of the phallus (as shown ) .

I could use it after 4 weeks and it is a nice feeling Not to have any tube or catheter inside to be able to urinate; No infection , hardly no pain when peeing

It does go a bit everywhere at first but then flow gets steady and I can pee standing up almost without having to put jeans down -

Scrotal reconstruction w/th bilateral prostheses (21ml)

Medium-size Eurosilicone gel-filled prostheses (will go for larger size on a next stage), still quite hard to the touch at that point but should get squeezier wth time - Very sore first 6 to 7 weeks, very tight too , getting better after 2 months, skin is loosening around, scar barely visible -

One is looking up, the other one is lower down , will take a few more months before they both settle down and feel 90% natural..

Add: They are Several ways of creating testicles area;

there is the possibility of gradually loosen the skin Prior to get placement of implants (Scrotoplasty),

place some tissue expanders and then place permanent testicles prostheses on a later stage - You will find good description of those procedures on Meltzer website, http://tmeltzer.com/Surgeries_Procedures/ftm_surgeries/lower/tissuex_ftm.html

 Expanding tissue and placing prostheses at once is possible but it is quite intense regarding post-op pain, and risks of complications or infections are to be considered too. Every body has its own immune defenses and reaction to medical intervention, healing process is essential..

SURGERY AND IMMEDIATE POST-OP - STAGE 1

Surgery being scheduled on the 15th of November, I stayed for 2 weeks around, leaving on the 1st of december -

Spent 6 nights in a small, private hospital, checking-in the night before the intervention, clean, quiet , the nurses had long shifts , with a touch of sense of humor and got to learn a few words in serbian -

                                  ST MEDICA CLINIC

 First night - got a visit from Miro checking out last details and ultimate questions + from the anesthesiologist who explained what to expect for the day after surgery.

Morning before the surgery - After a light breakfast, priority is given to emptying your digestive system, you're being given a suppository that makes you go to the toilet, not a very pleasant feeling but is necessary, do take it in and use it, that'll be something less to worry the day after surgery-

One detail that was much appreciated, I got a first numbing shot beFore being taken to the operative room, in my room, so actually saw and felt nothing of the journey through the corridors, excellent.

During the stay at the hospital, you're lying down and hardly moving for 5 to 7 days, genitals are lightly bandaged and checked everyday and you get liquid painkillers and antibiotics through a tube connected to your hand - Body liquids go into 2 bags on the side of the bed -

The week post-op at the flat is when you actually take the measure of what your body has gone through;

flat is for rental (60 + 14% tax per night), comfortable, with all the facilities and in a quiet area.

I did ask myself before going to Belgrade if I wanted to handle the whole stay by myself and eventually decided that it would be nicer to have someone around.

It is not too much having a close friend or your partner to be there to help for food shopping, cooking and daily tasks (like putting shoes on..). And for company also -

That first week after the intervention is quite heavy and your body does feel slightly out of control;

in my case but from what i can suspect to happen to guys after phallo you are not in total control of the way your body voids urine, I got wet several times, best is to organize your bed covers, (and spare pairs of shorts and leggings..) and accept the idea - it only lasts a while and that will go as soon as the phallus catheter is taken out.
You have 2 catheters coming out of your body after surgery

Once the phallus catheter ( "foley" catheter ) is out - 15 days post-surgery, you still have another thinner catheter (called supra-pubic catheter) placed in your bladder, coming out of your low belly; you then void through that one for around 15 days - At that point (15 days after surgery) it is still too early to try and void through the phallus itself, neo-urethra needs to settle; That 2nd catheter is not obvious to use at first but with an effort on the stomach muscles, piss will definitely come out, the flow is quite slow (remember that catheter is quite thin compared to larger ones) and is very convenient for immediate post-op - Keep it for 4 weeks post-surgery -And you can wear under shorts and pants without discomfort, best is to stick it along your leg with a piece of medical tape.

TIP - If you encounter difficulties peeing I recommend some.. whistling! It relaxes internal muscles and helps ease up , try it -

Then comes the day where you want to start peeing with your neo-phallus, and that's were Miro skills definitely comes into play, urethra extension is a very delicate process and was a success as far as I'm concerned. Remember that at stage 1, the urethra can only be extended up to a certain lenght , 1/3rd to half up the phallus, and hole is created at the back (like shown on the photo) , under the penis.

That area created around the new urethra looks very sore at first sight, skin needs time to gently close down , and it will (count at least 6 weeks).

I can definitely pee standing up, i haven't experienced any pain since the surgery on that matter; important to drink clear water so your piss stays healthy and clean -

Neo Phallus  - 2 n 1/2 months post op

TIP  One thing that helped a lot especially on immediate post-op mode was to go under a shower for first piss in the morning and use the shower head to soothe area while peeing -

DONOR SITE

Ok so that's what's my side looks like after 2 months n half following the surgery - Site couldn't be totally shut down , leaving only a long side-scar;

Miro had to perform a free skin-graft, skin was too tight to put it back together - That's called donor site dehiscence, it happens in very Few cases  they manage to shut and sew a nice long line in 80% of cases , and you get warned that it could be a consequence of the intervention, depending on your body , muscles shape and skin elasticity - The more athletic your body is , the trickier it gets to close back totally -  It is all the more safer if you take at least 2 months to prepare the area through professional massages and skin stretching;

I had  around 20 sessions of it prior to my arrival in Belgrade. Skin was looking elastic enough, still i knew mine was quite adhesive and that muscles might get in the way..I was half-prepared to it so didn't get too upset and best was to handle after-care so it would stay healthy and clean. As abrupt as it can look to the eye, it is totally Numb, no pain at all, a bit too close to the armpit maybe but hey nothing can come too easily I guess - So the one detail i had to deal w/th post-op being that instead of taking some skin out of my thigh (which would have been yet another sore area on my body) I was told that graft was made from what was left of the vulva, meaning in short that i got a piece of vagina patched on my side, is that cool or..scary? All depends on how u look at it -  I'd like to insist that it is one of the most important step Prior to surgery to actually take the time to prepare donor site area, with (at least) 6 to 8 weeks of massages - depending on your skin elasticity -
  MLD Phalloplasty Massage video
+ Some Good Infos on  musculocutaneous-latissimus-dorsi-flap.htm To Copy/Paste in Google ..!
SEE LINKS @ bottom page

TIPS :  I chose not to get mad about it and am actually quite okay with the idea, i still have the possibility to cover it with a tattoo once it'll be tottally healed and safe -
+ I double-checked the information: there is a point where your skin reaches maximum elasticity, and i had done what was necessary, so it is neither a medical failure nor negligence on my part. It is only one eventuality that you have to be ready to deal w/th, still i insist it rarely occurs-