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-  

5 MONTHS POST-OP HUNCHES

How about a short view of the results and of the general feel towards that new set of genitals -

Seems relevant enough to communicate as for informative purpose to those who are also aiming at phallo; I shall get a little graphic indeed -

Penis size is definitely fine , I have no doubt that the insertion of an erectile implant will be possible;

penis girth got more acceptable , in the sense that it felt really "fat" at first, and sligthly exagerated,

but that has settle along w/th the scarring, it got less thick and  more realistic -

As for testicles, that's  what i want to be talking about really; 2 things that have become obvious by now: they're quite rigid and hard to the touch, more than natural ones, and they won't go lower, one is closer to the base of the penis, and it doesn't feel like it's ever going to loosen enough to drop..

Scrotum construction can be done using different methods, mine was created all "at once", w/th the insertion of permanent medium-size prostheses, without any preparation of a scrotal bag;

Prostheses come in different sizes and you have the choice between permanent ones , (that are too rigid in my opinion, but that could suit guys that want harder balls) and expanders siliconthat you fill w/th e and that gradually strectches the skin - (over a period of several weeks ) - 

Some surgeons also prepare an empty scrotal bag for prostheses to be inserted later -  one of the advantage being that post-op pain is probably less intense and time of recovery shorter, but requiring added pre-operative organisation.

I also know that it is possible to change inital prosthetics for larger (or smaller..) at a later stage in surgery,( which I intend to do myself ) -

6 MONTHS POST-OP - PARTNERSHIP N GAY SEX

Right, so am back after a short period of standby - living - after several months away and separated from my present partner since pre-op last year -

Not sure how we managed that one but fact is that we've stuck together , regardless of the distance and unplanned events, added to the surgery that came after and w/th which I definitely needed to deal by myself.

I'd invited him on the 2nd week of my stay in belgrade, on immediate post-op mode, and he was awesome taking it all in , got to meet Miro and her assistant, and even helped to change donor site's bandages - We'd lived and travel together prior to the surgery but I was finding it really difficult to actually share the same space , considering the distance I'd already taken from my body long before i met him. I made a point not putting that aspect of myself too central as long as we were together but had to give it a break at one point so i could focus and deal w/th my own physical issues without the pressure or daily effort that comes w/th keeping up a close partnership.

There is no major difference in the way we relate to each other now that I've had phallo, except maybe that I can now appreciate the idea of sharing the same space, and that i can wake up with the tranquille reassurance of having achieved what had become the number one priority in my life.

Change of genitalia is a relief and has definitely lifted dysphoria - the anxiety and the anger that comes w/th it.

Sex is possible to a certain extent - remembering that I'm only first stage post-op and that insertion of an erectile implant should definitely heighten up the way I can use my new junk;

There is not so much sensation along the penis, it is more like a mental satisfaction as well as the shape and volume that comes into play -

However my partner managed to make it quite alive and slightly rigid, more than i would have expected at that stage of the surgery, flacidity does vary to a different level, and, hot water (like after a soak in a bath..) seems to make it firmer too - 

Penetrative gay sex is not so much conceivable right now, I feel quite keen on waiting for further intervention, 
Oral...well depends on guys, will wait for glanplasty for this one too.

    

10 MONTHS POST-OP - STRAIGHT SEX

hey guys, haven't been writing anything for last couple of months, not so good...
I might be a happier guy now that surgery happened last year, life is still the same uphill struggle !
Am still looking forward to stage 2 , especially for the clitoral covering, this is such a pain in the ..
I am loathing the sensation, really feels like unfinished work, I had to stop wanking because of that -
For years one of my prior issues alongside gender change was having a roof over my head -
I find myself travelling a lot, doing some back n forth between the country I grew up in and Uk just to try and fit somewhere and not be in someone else's place - daily survival is taking a lot of space in my schedule ..... am i trying to justify how come I still haven't been able to put stage 2 in motion?
Probably yes..
Anyway that blog is not about sucking issues like daily living, it's about the surgery and post-op impressions....so...... lets get back to it!

Last post was about gay interaction, which won't be possible until insertion of implants, like i said previously, penetrative gay sex is not that obvious, you need more rigidity -
However, my partner likes my cock and it definitely makes a difference to the way our bodies can relate - 
Still, I am quite obsessed with penetration to be honest, so I had to have a try w/th a woman, before that need to "get inside" would become frustrating and overwhelming to the point of dumbness..
I had not been with a woman for at least 2 years and it wasn't planned , I had no idea it was going to happen just a few days previously -
We spent a couple of nights together and took our time -
She was at that stage where she'd got really bored of regurlar sex w/th cis-guys, so she was quite happy being with a non-cis one and reciprocal experiment  was fine w/th her too -
It took me 3 sessions before I could actually get into her, w/th my knickers still on, for support -
Condoms are an issue if you don't have the XL size (!!!), standard ones are way too tight and i broke a dozen of them , trying to shove it in ...
But ......it does help a little for more firmness in the shaft - 
About firmness , it does vary, my penis goes from flaccid state to more rigid (never to the point of being "hard") and thickness changes too , along w/th tactile sensation -
Some guys choose Not to have any sex between stage 1 and stage 2 , i would easily be that type that prefers not to have sex at all than using a semi-rigid phallus ... still, there is no way I could spend so many months without having a go at it..
but hey thats also why I'm still living by myself , being prior surgery is ....undefinable.... and after that, being "in-between" stages is not a walk in the park neither, especially when you still have to make the cash for it to happen -
Coming back to that girl, we had good sex, respect and affection were present,
 and it's like a healing process to be able to share that with someone that you hardly know -
If I got one advice to give to anyone in such situations, bottom line is to Take your time , there is no need to rush anything, to feel uncomfortable, you're allowed to spend the night with someone without having to "perform" absolutely -
Once that trust is taking place, the body follows too, sex doesnt work if the brain interferes too much..

TIP: To achieve firmness, I used 2 condoms one over the other + a cock ring @ the base of the phallus
2nd TIP: To draw a glanplasty , I cut off the condoms at the head
to make it look more realistic n give it a cool shape   






 

Sensations - First Report after stage 1

I'll be quite blunt on this one; but  a lot of guys are asking about that on forums

In my case, is too early to give a proper feedback, still for those who wonder, you do Not get erotic sensation straight after surgery, it doesn't work like that..

MLD Phallus won't get sensitive to the touch before a good few months , and even then am waiting for 2nd stage to try and fix smtgh for more erotic sensations, which i know is possible -

Apparently Dr Miro can do a nerve hook-up during stage 2 ( if you ask for it) that should increase sensation in the penis -

A word about Pain management

Physical twinge can be one of concerns prior to making the decision to undertake phalloplasty;

I'll try and sound the most realistic without exagerating nor undermining the level of discomfort that you can expect whilst not be anguished by it.

I'd like to insist that it is quite important to feel in the right environement for time of  recovery, it plays a role in your mindset and mental readiness, being optimistic , trustful and positive about the outcome will definitely assure a smoother and faster healing. As much information you can read about post-op , Your body (and so does your mind) only in the end decides how to react to such an intervention, and as for other surgeries (such as chest or hysto or else), times of healing and tolerance to pain vary a lot and proper setting helps.

In my case, that included first of all having no outward pressure of any kind, so as not to feel helpless and guilty of not being physically capable of doing things and living as usual. Having someone around is recomforting and soothing as long as that person is neither stressing nor expecting you to get better by the day. The key is to accept being in a temporary position of mild incapacity, knowing that it won't last forever and neither pushing it nor get depressed by it because of social pressure. Along with a good deal of efforts (both mental and physical) to not remain inert and "beatened" by the post-surgery state, you still have to give your body a rythm, and make the best to get a coherent alimentation, as minimal as it can be sometimes.

I can't say it was a walk in the park but as intense as discomfort has been at times, it's already behind.

Phallus was what hurt the most at first, and felt quite heavy for 3 to 4 weeks, that goes as well , the weight reaches a tolerable level after a while -

Now Balls was something to handle, its plain and simple, there's no way you can stand up for more than a few minutes for almost 4 to 6 weeks - Its important to manage bouts of getting up and walk a little but you can't do it for very long at first -

I managed a walk for about an hour after 1 month but still had to wait another 2 weeks to make a full day out and about - Before that balls are really sore and best is to rest..and eat well too -

Medication is needed for the first 4 weeks , make sure you have your own antibiotics and painkillers;

they provide it for the first week in hospital but then you want to have your own -

Precisions on immediate post op (first 15 days to 4 weeks)

First month is the hardest part, it is quite intense and you want mental organization to remain cool n easy and medication is definitely necessary, but sound medication is what works best too -

TIP: Some painkillers are not strong enough on immediate post op and there's no point shoving too many in your throat at once, best is to ask your GP for slow-released painkillers so u only take one every 10 hours or so -

2nd TIP : Instead of getting some pills as antibiotics (Augmentin) I got them in powder (that you mix with water), and that was a lucky guess; not only that makes it easier to swallow but also helps a great deal to manage a toilet, and boy is that welcomed when you have stitches all around your genitals..

3rd TIP: Get some medication for muscle stiffness, its great for body relaxation and it makes you Sleep too, despite the pain -

Regarding physical recovery

It's now about 4 months since the surgery and i thought i would give a first impression about sensations and overall physical feel -
First thing i can say now is that yes, body did take a good shock even if i've been mobile for over a good 7 weeks now ; am still in the process of slowly getting back to sport, articulations do feel a bit rusted and overall strength have definitely lowered in capacity!
 I tried to cycle 3 months post-op  and that was too Early, i did have 2 or 3 really nice rides but then sitting was an issue and i got first soreness below testicles .. does that sound stupid? No 'cos on the moment, it was tempting and felt okay giving it a go.
After giving it a second thought I decided to give a try at swimming instead, (wearing a short top to cover donor site scar..) water is less brutal and can only be fine to stretch articulations n muscles;
Even that takes a lot of energy and u want to do stretching exercises as well if you want to avoid getting cramps.
It may sound obvious but it's actually not; the first weeks of getting mobile again, it feels as though you're back to normal and that you can just get on with it as before - But I've only found in Time following that first recovering, that my body still needed gradual strenghtening and that rushing into physical activities could still entail inflammation or soreness -
It's a tricky one finding the balance between the want to be fully active again and realizing that ur body is actually slower ..
Best for now being to taking it easy, acknowledge that it will take a few more months before  i get full energy back , exercise n stretch on a daily level while respecting physical limits.

To make peace w/th all that, I go for walks in the park, watch others sweat and run, sit on a bench..not quite a super-hero yet..

About stitches

A quick word about stitches and removal -

Visible Phallus stitches - the ones you see when you look down - are quite large and you should be able to have them taken out by a nurse, about 4 to 5 weeks post-op - I went to a local hospital on my return and it was done in 10 mins, without having to go through my GP -

Once you are clear about what intervention you went through, any hospital would just take you in and give you a hand with removal of stitches.

Then the nurse tried to take the ones from the lower part of the phallus, at the back, and that was too sensitive, there is NO Point in insisting, just have her stop if it hurts and come back later -

I was regurlarly checking mine myself up until the moment when i could pull on them without pain, thats when they're ready to go -

I waited another 2 to 3 weeks before taking the rest of the stitches out - under the phallus + around the testicles - at that point i was able to give the nurse a hand by holding the testicles and make space so she could access the stitches and make a clean and fast cut.

Make sure you check all the area before getting up so that there's no "leftover".

Its worth the waiting,

and it feels amazing once they're all out , wow -

TIP: As for any medical intervention, you are always given time approximation about how long you should or not keep catheters, stitches, or else, do bear in mind that you're the only one who can really tell how it feels and when u think is the right time -

Do allow yourself to wait a week more if it is still painfull, if ure not ready to void directly from your phallus,

there is no point rushing it and recovery will go faster even if you extend waiting time at first -

It's your body, it's your brain, no one else can know better -