Stage 2- Phalloplasty - Part 2

The next day, another surgeon in the operation came to see me. I was not able to pick up his name. He check the operation sites and my drains and catheter. He said everything looks well and I would discharge today if I want. 

I will be going back home with the drain and catheter. I will have to get the urethra (penis) catheter and the drain remove one week after the operation and the suprapubic catheter three weeks after the operation. Due to Christmas and New Year holiday, I had to wait for 4 weeks before removing my suprapubic catheter. The suprapubic catheter will need to be removed in London Clinic while the urethra catheter and drain can be remove either by district nurse or my GP nurse.

The nurse that looking after was very nice, he prepared lots of catheter bag for me to bring home. He gave me about 5 leg bags, 4 night bags and a few other dressings. I then told him I would like to stay for another day just to make sure everything is okay before I leave the hospital.

I ate and drink normally on the second day onwards. The physiology girl came to see me on the second day as well and walk with me to make sure that I can walk okay. I felt pain around the vagina wall and slightly sore at my bottom area. 

My penis was tape upwards and it have to stay that way for one week until the drain and urethra catheter is remove. 

I was discharge on the second day after my operation. I was again given one leg bag and one night bag from the nurse as she wasn’t aware that I have been given a few the day before. 

**This is where you need to be careful, if I wasn’t given those bags on the day before I would have requested for more as this bags will need to be change regularly to avoid infection. 

Now, the nurse that was in charge of my discharge is again the same nurse who discharge me when I had my stage 1. She just bad at doing dressing and did not re-dress them according to how it was in the first place. She is a very nice person but I think she is just bad in her job… Anyway, after changing all the dressing and getting a new vacuum bottle for my drain, I left the hospital around 12pm to catch my train back home.

Stage 2- Phalloplasty - Part 1

I'm lying in my hospitals bed now recovering from my stage 2 Phalloplasty operation.

I had
1. Vaginectomy
2. Join up urethraplasty
3. Glans Sculpting
4. Fistula repair
5. Clitoris buried  and...
6. Tidy scars from stage 1.

My operation was yesterday morning. I was admitted on Monday afternoon, I was allowed to eat until 5pm. After that, I was just told that I could have soup and bread if I want. Around 9pm, I was given enema and told to hold it as long as I could. I didn't know what to expect after that. After a while I felt that I need to go to the toilet for some businesses and I guess that they procedure.. I went to bed feeling hungry... I woke up at 6ish told to shower and change into hospital gown. I then get back to sleep while waiting for Mr Christopher and anesthesia to pop in and ask me questions. Both came around 8 ish. I then brough down to the theatre and both the anesthesia was chatting with me while getting me prepared.. I remember nodding off looking at the clock about 9.30am..

I was woken up around 2.30pm then fall back to sleep as the anesthetic is still in my blood... I vividly remembered that they asked for my nurse to bring me back to my room. I went back to my room around 3.30pm and my gf was waiting for me there. Mr Christopher came to see me and say everything went well. He said I could discharge the next day if I'm not bleeding heavily.

I basically sleep until about 6pm. I was told to drink lots of water. My catheter bag was filled with blood and I was told it will clear once I start drinking water. Around 7pm I was asked if I like to have my dinner, I was not feeling very hungry but I just ate slowly...

Post Op Preparation

Post Op Preparation.

I have tried to prepare as must as possible before I become ‘disable’ for few weeks. I was told to have my thigh sutures remove two week post op and phallo sutures three week post op.

Word of advice: Make sure your GP and the nurse is nice and supportive! If not change immediately. Make appointment with your GP and the nurse to chat about your operation and book with that nurse for at least 1 hour appointment for your sutures removal.

Now back to my experience, I make appointment and speak to my GP about my surgery and post op care that I need. I told my GP I need longer appointment and he said he will book double appointment (30mins). At the time, I didn’t know that it takes more than 1hour to remove those sutures on my thigh (or arm). My GP ring me the day before my surgery and assure that he have make the double appointment with the nurse for me.

So I went to my nurse for suture removal after 2 weeks post op… and my nurse remove my dressing and she went into panic mood. There were more than 50 sutures to remove and it was covered in blood crust. She then tell said I was only booked for 15mins appointment and she have to book me back on Monday for 1 hour appointment and she will get my GP to involve helping me to remove the sutures. She removed all the staples and it feel so good to have them removed!
I then checked with Mr Christopher if I could remove my thigh sutures when I am going down for my 3 weeks post op sutures removal with the clinic nurse. He said that’s find so I leave it to that. I think my phallo was not supported properly and it create a ‘folding line’. Over there where the blue nylon sutures were start to get slightly infected.

I could have let my district nurse or my GP nurse remove the sutures on my phallo (after 3 weeks post op). However I opted to go to London and let the clinic nurse remove to sutures to have a peace of mind to know that everything is ok.

3 weeks post op and I am in the nurse clinic with Fiona. I told her that my thigh sutures need to be remove and she wasn’t aware of that. She remove my dressing and start removing the blood crust and the sutures came off easily. She insect and clean my thigh then told me that those are dissolvable sutures and I don’t have to worry about it.  She then removed all the blur nylon sutures the along the bottom of the phallo and around the phallo. She then pass a tube though my neo urethra to check that there isn’t any blockage. She then told me that everything is okay and my phallo does not need to be support with dressing anymore. I was wearing boxer when I went down as my phallo was supported with lots of dressing… and now, the phallo is hanging in my pants… I felt very insecure, felt like the phallo will drop and etc. It is definitely a very weird feeling to have something hanging in between your leg.

So I went back with my phallo sutures removed, fully expose and not supported, my left leg still cover in dressing and my right leg looking good without any dressing on it.

To be continue…

Day 6, 7 & 8 - 1st stage thigh free flap phalloplasty

 Day 6
4th day post op
My blood pressure, temperature and phallo pulse were checked every 6 hours now.

Mr Christopher finally visits me after 4 days post op. He checked my phallo and said it looks good, healthy, soft and warm. He is very happy with the outcome. He also have a look on my left leg flap donor side where the PICO vacuum dressing wasn’t working properly as there is a leak and oozing a lot. He said not to worry about it and it cannot be change as changing it will risk my skin graft coming off. I walked around the ward today as I was told to move around. I was told to try and walk more normal as I am leaning more towards my right because my my left is still very painful.

Today the nurse came in and told me that she will leave my right thigh expose to air (AGAIN?!) for 2 hours. The pain was unbearable, I could not do anything apart from sitting on the chair and trying to ‘accept’ the pain. After 2 hours, the nurse came in a dress my right thigh. I tried to walk but it was too painful for me to move around, I just get back to bed and rest.

My catheter was remove today. Huge relive however I have to keep going to toilet as I drank lots of water.

Day 7
5th day post op

Nothing much were being done today. My nurse said that he heard I was in extreme pain last 2 days when they expose my right thigh so he will not do it today. The dressing wasn’t changed as well as my right thigh wasn’t oozing badly anymore.

He was the Ward Manager and he seems to liaise with Mr Christopher patient a lot. Overall I am feeling okay. I have good bowel movement and I pass urine without any problem. My phallo looks healthy as well.

Day 8
6th day post op
I am supposed to discharge today however I asked if I could stay until Sat in order to wait for my gf to pick me up. I was then told that I would have to pay for the cost of the additional 2 days if I chose to stay for the extra 2 nights.

I have got no choice but to travel back on my own. I pack everything up and get a taxi to London Euston. From there I took 2 hours train back and my girlfriend then pick me up from the train station. I felt okay as I am able to walk with my walking stick but I am walking very slowly.

In the morning, the nurse came to change my dressing on both my thigh. It was a nightmare. She was very (extremely) inexperience. It was so painful that I cried like.. I don't know what is the words I could use to describe that.. (Keep reading and you might be able to understand the pain..)
My wound dried up on the right thigh as it wasn’t changed yesterday, so the dressing stick to my wound. At first she refuse to uses water to wet my wound and attempt to rip the dressing from my wound (bare in mind that I have been feeling the pain since they expose it to the air). I scream and cried like I was in hell, I then told her to wet it, she refuse telling me that my wound should keep dry. Then after trying a couple more tries to peel the dressing of my wound, she reluctantly opened one packet of water to wet my wound. Previous nurses uses at least three packet to wet my wound!! Then she try to rip them again while it's partly dry and partly wet. I cried and grab the bed as she was doing that. She then stop for a while and add the last drop off water she have left in the packet, then she just continue ripping the dressing apart. I was crying until I could not breathe. Then she just left those 'stuck' to my wound there without any attempt to remove them as she sees me in such pain. I'm glad she decided to leave it or I might just cried in pain and fall to unconscious although I'm slightly worry that those dressing are still there. She then proceed to my left thigh, I was about to tell her to leave it and I'll get it change when I'm back but I let her do it anyway. Thank God, the left wound is covered with slightly wet and greasy type of dressing (mepitel). So no pain at all. She then covered up my left thigh ith mepitel and then some dressing and move back to cover my right thigh. I would say overall she did a horrible job in dressing but I wasn’t entirely bothered about it. All previous nurses uses 4 massive piece of 'tape' to cover it while she uses nearly 7 or 8. She then change the pads around my phallo however it did not support my phallo properly. Not only that, she have invite one other colleagues to come in and have a look and start explaining to her about how my phallo was being build. After standing there watch the nurse cover my dressing and listen to explanations by the nurse, she thanked me for allowing her to be there and left before the dressing were done. I think the nurse have been extremely unprofessional to invite some other colleagues for show and tell without my consent. However I have no intention of complaint about the nurse. I don't mind if someone is interested to learn about phalloplasty but I think that is very inappropriate.
Around 1pm I pack up all my stuff in my backpack and went to ask for a taxi. I took taxi to the main train station and then get a train back on my own.

I was given a bags of goodies with some pain killers, dressings, undies, pads and stuffs. She asked for my GP contact and  gave her my district nurse contact number instead. She then filled a form, fax them over with instructions and gave me a copy of the form.

15.5 weeks post op - Stage 1

It have been a while since I last update this blog. I will try my best to post something each month about my progress of the phalloplasty and my transition.

15.5 weeks post op for stage 1 with no complication. I think I have been really lucky that everything went well for me. I have decided to booked for my stage 2 before Christmas and have my recovery time over the Christmas.

I have been actively reading about people's experiences and getting as much information as possible as the post op care by the team is not brilliant. Honestly, I am little worried and nervous about having my Stage 2 before Chritmas with my GP and Mr Christopher office close for  9 working days. *touch wood* if there is complication and I have to go to emergency room, I doubt they will know what to do with me. So I can only pray that everything will go well like my Stage 1.

My thigh have been healing well and I have start to apply bio-oil or Cetaphil moisturizing lotion. I have been struggling to find a compression garment for my thigh and I end up using a knee support garment for it. My GP have been very helpful on trying to get the right thigh compression garment however to no avail.

Meanwhile for my phallo, it looks great apart from being girth(y).. I was suppose to lose fat on my thigh and I guess I did not do it that well. It is about 16cm/6inch in diameter and 11cm/4.5inch in length. To be honest, I was a little disappointed with the length but I am telling myself that at least I have got a penis now and there are various size and shape out there! I am already lucky compare to some trans-guy which do not have the opportunity to have this surgery. While for the girth, I am planning to get it reduce slightly when I am having the penile implant. I tried to put on a normal condom but it's just too tight. I have asked Mr Ralph and Mr Christopher if that could be done and they have assure me that it could. So I will just wait and see what happen next.

I suppose that's one of the problem with human in general. For trans-man ,we have been looking at all the photos/images and have create a prefect body shape/chest/penis that we want. Lot's of time surgery results will varies and some times people falls into depressing when the ideal body wasn't achieved. I have been watching lot's of straight porn and at times, it does make me feel very sad and depress about the length of my phallo but I just need to get over it! Obviously those guy in porn star have above average penis!!

I can't wait for my stage 2 now that my date is set. Fears and anxiety is taking over me... less than 4 weeks to my Stage 2.

Day 4 & 5 - 1st stage thigh free flap phalloplasty

Day 4

2^nd  day post op

My skin graft donor site still oozing a lot. The nurse had to change my dressing again. My right leg (skin graft donor site) was in stinging pain. I would score it 5/6 from the scale 1 to 10 where 10 is the most painful. I don’t particularly feel any pain on my left leg but it’s very weak. I am not able to lift my left leg up and down from the bed and need help from the nurse to do so.

Today I finally get out of bed with the help of the nurse. The nurse help to wash me while I am sitting in the washroom.

The physiologist visit me today to show me how to do exercise and how to walk again. She bring some walking frame for me after gauging how much support I need by holding her hand while walking. She also told me to do breathing exercise as well. Standing up and take a deep breath so that my lung will expend to the maximum. She was with me for around 20mins I think.

I lost my appetite after breakfast. I think it was because I get out of bed, I feel sick as well. I was controlling my breathing to stop myself from throwing up. I then just lay on the bed to rest and felt a lot better later in the evening. I have some biscuits and tea around 4pm.

I also open my bowel for the first time, it was done with a little struggle. I felt very sleepy and tired.

I spend my time watching the TV and lying on bed.

I have my blood pressure, temperature, O2 level and phallo pulse check every 2 hours.

While I was in pain and lying down on the bed helplessly, I actually question myself. I asked myself why did I put myself through all these. I was a healthy fit young lad 3 days ago and now I am a helpless guy lying on the bed with so much pain. I guess I wasn’t mentally prepare for all these post-surgery effect. It just too much to take.

Day 5

3^rd day post op

I felt a lot better today and my appetite is back to normal. My blood pressure, temperature, O2 level and pulse were checked every 4 hours instead or 2. My neo-phallo is strong and healthy.

The physiologist visit me in the morning after the breakfast. The physiologist suggest me to use crutches instead of frame today, and it turn out that I would do with just walking stick. She teach me how to walk with walking stick and tell me try to walk around more. I could get out of bed more easily today however my left leg is still very weak.

I decided to wash my hair as my hair was very greasy. I sat on the chair in the toilet and wash my hair by leaning over to the bathtub and used the shower.

I was told that the doctor suggest to expose the skin graft area to the air. Well, that was… hell… It was so painful. I score it 20+++ on the scale 1 to 10. I was grueling on my bed, it was too painful that I had to buzz the nurse and ask for more pain killer. I tried to listen to music and calm myself down, I tried to sleep to ignore the pain but it was just too much. Initially the plan was to expose it for more than 2 hours but the nurse cover it earlier as she see that I was in so much pain. After the covering the wound I still can feel a very strong pain in there. I would scale it 7 / 8. 

My right leg which have horrible pain. Skin graft donor site.

Day 3 - 1st stage thigh free flap phalloplasty

Day 3

1^st day post op

I did not have a great sleep throughout the night as I was checked by the nurse every hour. The vac dressing on my free flap donor site wasn’t working because there is a leak somewhere. The doctor took the free flap about 13cm x 25 cm to create the phallo on my left thigh and uses skin graft from my right thigh to cover the free flap wound. So the vacuum dressing will remove any air or liquid to create an environment which ‘force’ the skin graft to ‘stick’ to the area. My skin graft donor site were oozing a lot. The nurse check both my thigh and then called Mr Christopher for advice. He said change the dressing on my skin graft donor site but leave the dressing on my free flap donor site as changing the dressing there will risk the skin graft to fall off. Changing the dressing for my skin graft donor site wasn’t too bad as the wound is still wet, the dressing came off easily.

I am still wearing the special legging and both the shin area were wrap in a special massage 'thing' which will massage my leg to reduce the risk of getting blood clog. I also have injection on my tummy area where it will thin my blood, again to reduce the risk of getting blood clog.

I was antibiotic through the IV drip and some sort of pain killer through the drip as well. I wasn’t given any morphine pump where you can press the button and it will release some morphine into the IV drip. I could feel the pain in skin graft donor site but not much pain in the other. However the free flap donor site is a lot weaker than skin graft donor leg.

I start to eat and drink normal now. I have catheter in and I still could not get out from the bed. The nurse came and help me wipe my whole body on the bed.

Today the nurse came and check me every 2 hour instead of one hour. 

PS: Please do not use the photo without permission. Thank you

My lovely thigh before surgery.

After Surgery.

Left Leg: free flap donor site with vac dressing, Right Leg: skin graft donor site.

Day 2 - 1st stage thigh free flap phalloplasty

Day 2

Operation Day

I woke up around 5am. I first went to have a shower and wash myself with the pink antiseptic soap.

After shower, I change to the hospital gown and continue my sleep while waiting for the nurses, anesthetists and mt surgeon to visit me. The nurses came in around 7am to check if I am ready. Then around 8am the anesthetists came, introduce himself and asked me pre-surgery question then left. After a while Mr Christopher came and explained to me again what he is going to do and get my consent. He told me he will be creating the flap from my left thigh, I was surprise and shock because during all the consultations I had with him, he has always checked my right thigh and I think he briefly mention before that he will take it from the right however if there is no suitable blood vessel and etc, he will move it to the left thigh. However I could not confirmed this so if you are reading this, make sure you ask him clearly and noted it down properly. He mention that it is easier to harvest it from the left thigh. I was a little worried as my left thigh is slightly thicker than my right thigh and I do not want to end up with a big fat phallo. I think this happen because when I have my consultant with him, he hardly done any full thigh phallo yet.  He then asked me if I have any preference of the leght of my phallo, he said he will make it 13cm which is about 5inch which is the average size and if it's bigger than that I might have a big bulge in my trousers later on. I don't know why I agreed to him at that point because I was hoping for 5.5inch. He asked me if I have any question for him I said no and he get me to sign the consent form and left.

Around 9am the ward manager came and walk me to the theater. He asked me if Mr Christopher have draw on my thigh and I said no, he then inform Mr Christopher'd colleagues that he haven't draw on my thigh. Mr Christopher colleagues came over and spoke to me and confirmed with me that my donor site will be from my left thigh, I said yes and he seems confuse. He then spoke to Mr Christopher and both walk over to me and confirmed it with me that he will be using my left thigh. I took the opportunity to ask him if he going to use my right leg because it's thinner than my left. He then pinch my left thigh and say that is fine, he will be able to thin it a little after harvesting the flap. Then both of them leave me with the anesthetists. To be honest, I am a little confuse with the reaction from Mr Christopher reaction. I guess that happens because I am Mr Christopher's first few patients which have a thigh phallo from scratch.

The anesthetists and others than came over and speak to me. He is extremely nice and funny guy. The nurse (I think) start placing the IV drips on my left hand. Sara, Mr Christopher clinic nurse was also there which I have communicate with her over email a couple of times but never meet her before. The anesthetists then chat with me and Sara. The anesthetists then suggest me to inject all them myself, I though he was joking and he place it to the IV drip and told me to press the syringe. When I am injecting myself with the second or third massive syringe with white stuff in it, I then slowly doze off.

The next thing I remember was being call to wake up and told that the surgery was over. I think I keep murmuring 'what is the time? what is the time' because I don't want my gf to be waiting for me. I fall back to sleep and wake up a couple of times. I remember vomit at first and I saw some blurry image around the recovery room while I awake in between. I also remember they were cheering when they hear some sound. - Which later I found out it's the pulse from my phallo.

After x o'clock, I was sent back to my room. All I could do is just sleep as I was still recovering from the anesthetics. My gf arrive not long after and spend some time with me, I then told her to go back to hotel to get some rest as I would only be sleeping. The nurse came and check my blood pressure, O2 level in my blood, body temperature and used a special device which magnify the pulsing sound in my phallo every hour.

I did not eat anything on that night as I don't have any appetite at all. 

Day 1 - 1st stage thigh free flap phalloplasty

I have been given green light for lower surgery since February 2011 however due to some reasons I have to put it off until recently. I will write about it later. Below is my experience going through my 1st stage phalloplasty. I have opt for Radial Artery Phalloplasty (thigh free flap phalloplasty) by Mr Christopher from St Peter's Andrology Centre London.

Day 1

Admission to hospital for 1st stage phalloplasty

After researching and reading through other people recommendation and experience, I brought with me some toiletries, towels, comic books, playbook, one t-shirt, one shirt, jumper, one tracksuit bottoms, baby wipes and slipper. 

The St John and St Elizabeth hospital provides shower gel, shampoo, towels and etc. So if you are reading this for surgery preparation, I would advice only bring a nightwear for your first night, slipper and something to entertain yourself. You only need to wear your own clothes when you arrive the hospital and leaving the hospital. The rest of the time you will be wearing hospital gown. 

I arrived at the hospital about 6 o'clock in the evening. I then spoke to receptionist at main reception, after through the files and system, I was told to take the lift to second floor to St Francis ward. I went in to my room, feeling really weird as I always travel and stay in hotels. After 5 minutes or so, a nurse came in and speak to me. She check with me my details and place a tag around my wrist. After that she take my blood pressure reading, weight, height and ask me those regular pre-operation questions. She also measured my leg to get the right size legging to reduce the risk of getting blood clog.

I then told to fast stating from midnight. I will need to fast for 8hrs before the surgery. I was also told that Mr C would come and speak to me tomorrow morning before the surgery. I asked her roughly what time I'll be back in my room as my girlfriend will only come and visit me tomorrow, she said the surgery might finish around 3 / 4 o'clock but I'll have to stay in recovery room due to being on general anesthetic for long hours, so I'll be back to my room around 5/6 o'clock. 

Around 6.30 pm, a guy came in to take the menu card from me. I quickly place my order and told him I would like to have the dinner now. He refuse to serve me food as he thought that I was going into the theater tonight. I then told him that I am only going to the theater tomorrow morning and he bring my dinner over after a while.

Around 7.20pm, a doctor came in to do my admission check-in. He asked those usual health questions again, then check my pulse and breathing. We chatted a while regarding the surgery as he is curious about it. He did mention that I could choose not to answer him if I'm not feeling comfortable at all.

Then around 7.45 another guy came in and took 4 tubes of my blood for some blood test. I was then left alone for the rest of the night.

PS: If the nurse ask you where would you prefer the wrist band, make sure you place it on your right wrist instead of left because the drips will fix on your left hand.