Gender Confirmation Surgeries

First and Foremost, I want to say sorry for not being as diligent about this as should have been/intended to be. I know people were counting on this and needing information and I totally dropped the ball. That being said, life got in the way, recovery got in the way, etc. I want to take the time now to do a major update.

Starting with the easiest:
Breast Augmentation
So I had breast augmentation with Dr. Ting on 06/07/2017. At first I was extremely happy with the results. I am still happy-ish but I want to explain what happened. Going into surgery I was heavy lol, weight wise. Like the heaviest I have ever been in my life. I was 190ish I think and 26 years old. I am tall 5'11"-6', so I was not like obese or anything but for the body type I like and how I like myself, I was fat. I gained a lot of weight 2014-2017 because again I was in LSchool, I was stressed out, dealing with a big move from NC to NYC, etc. etc. Lots of excuses lol. How this relates to my breast augmentation is that no one explained to me how weight loss can affect your breast augmentation. My implants are different sizes because I had asymmetry. If Dr. Ting had put in the same size implant in each breast, it would not have fixed the asymmetry. So my right breast has a smaller/less filled implant. After surgery, I gained a lot of weight. I ballooned up to 229lbs at my heaviest. I try not to be so hard on myself because I realize it was a consequence of having three surgeries, being on so much bed rest, stress, etc. However, in January 2018, I decided to fix it and I started to get back to my ideal body. Happy to say that as of August 2018, I have lost 54lbs and I am now at 175lbs on average. Unhappy to say my boobs were affected. Left boobs is fine. Right boob has severe rippling. Dr. Ting said it was because I lost weight and thus lost breast tissue that was covering the implant.
I will say I am unhappy with Dr. Ting's response. I like Dr. Ting, don't get me wrong but he is a busy guy I guess and I was just not happy with his response. I expressed my concerns on 08/10/2018, when I was having my 1 year checkup for my FFS, BA, and SRS/GCS. I may be over exaggerating because the rippling is not that bad (I guess). For me any rippling is bad. This rippling is on the upper portion of my right breast in the cleavage area. In most instances, you can't see it. However, if I put my body in certain positions it looks horrible. It knocks your confidence and I was just very unsatisfied. Dr. Ting basically said, "it's cosmetic, most people wouldn't even be able to tell you have implants and you should be happy with them." I am happy. They do look great and super natural. It was also at this time that I discovered my implants were not under the muscle. This really shocked me. When I had the procedure, based on the research I was doing, I had assumed most implants were placed under the muscle. I did not have much breast tissue in my opinion, so I assumed that is was the natural/standard placement and from my research, seemed to be the preferred placement among surgeons. I cannot say for certain if I discussed this with Dr. Ting prior to surgery. However, I believe had the implants been placed under the muscle, this likely would not be an issue today. I have not decided what I am going to do about it. Most of the research I have found says that implant removal and replacement is the best option and possibly insertion of a dermal matrix. I do not think insurance will cover it again. I may try for insurance coverage but ultimately that is what I am going to do, and pay for it out of pocket, if that is what is it requires. I have come across a surgeon where I am located who does what is known as the "Vampire Breast Lift." I think this may be a viable solution for my problem. I am going to consult with that doctor in early 2019 and I will update.
Key Take Aways: Make sure you ask about placement prior to surgery, ask about weight loss, and ask what options you have prior to surgery if you are dissatisfied. Obviously, I had to learn the hard way lol but overall I am fortunate. My breasts look great and I am satisfied for the most part minus the rippling.


FFS
I updated my FFS post, please feel free to check that out for more details. In sum I was completely fine with what Dr. Ting did. The outcome was great and the healing was decent however I want complete FFS. I mentioned in my initial post that I wanted to start out conservatively because this is my face. Dr. Ting was also very conservative about it as well. Now that it has been a year, I just want to go through with it all. I will be posting about my new doctor and that experience soon. My surgery date is 11/21/2018.


Why I Removed Pics
Unfortunately, some privacy issues arose and I felt that I had no other choice. I was naive initially in posting identifiable pics. Be careful ladies and gents. My pics were for educational purposes but this is the internet. I want to post more pics but I am going to have to take the time to edit them and make sure only what I am trying to show is visible. Thanks for all of the kind words though for those who did see my initial results.

SRS/GRS/Vaginoplasty
This is the big one lol. We all know that this is a big surgery and I do not think you can ever truly prepare yourself mentally for the recovery/change.
I believe that I am at a place now where I can talk about it.
Overall, I am happy. More than happy. My life is changed and I would not take it back, ever. The 1-year phase was extremely difficult though. First was the bleeding complication that I spoke of previously. That was really a really scary time for myself, my friends, and my family. Again, that was unpredictable and it all ended up okay but it was still scary.
My results did not come out as expected. From both an aesthetic standpoint and functional standpoint. I noticed early on when I was dilating, that (1) my vaginal entrance/vestibule was extremely high up. You could not even see it from the back or the side, only when I was laying on my back. The distance between my anus and my vaginal entrance/vestibule was extremely wide and this was troubling, namely because I was limited to one sexual position, on my back; (2) I had developed a skin bridge at the bottom of my vaginal entrance/vestibule which was obstructing entry into my vagina. When I dilated I literally had to stretch that skin down and then put the dilator in at an almost 45 degree angle and scoop it under the muscle. There was literally no way that I could have sex and this skin bridge was in effect trapping urine when I peed as it formed basically a little pouch covering my vaginal entrance/vestibule. Needless to say I was worried. I couldn't have sex and I was getting a bad smell from the trapped urine. Of course this makes you feel regret. Not because I did not want surgery but because my sex life and health were being impacted by this and it is scary because it SRS/GRS is irreversible. Anywho, at my 08/10/2018 1-year checkup with Dr. Ting, when I complained about the breast implant rippling, I also complained about this. He recognized there was a big problem but assured me he could fix it. I had to wait until October 12, 2018, because he was filled up. He assured me that the skin bridges were common, he routinely fixed them, and then after that I would see a major improvement.
I had the revision surgery on 10/12/2018. This was a 45 minute, outpatient, local anesthetic procedure. He numbed me really well so I totally did not feel a thing. It is quite disconcerting to be in a room with your legs in stir-ups, 5 people standing around looking at your vag, and seeing and smelling smoke from the cutting laser as he uses to cut off skin. The revision was basically labiaplasty and I will tell you, it's been 3 weeks, and the difference is amazing. Everything he promised has come true. The incisions have healed remarkably, barely visible. It is now a straight shot into my vag including from the back lol. The pee isn't trapped anymore. I am terribly excited. Dilating is so much easier now. It is just wonderful. Obviously I am only 3 weeks out and I have still not had penetrative sex but I know when I am able to, after 6 weeks, things will be great.
It was a very stressful year dealing with all of that but again, healing problems happen, it is not your fault, you can do everything right and still have a complication. You just have to stay strong, be open with your doctor, and get it resolved no matter what.
I should say that at first my insurance company denied coverage for the revision. Dr. Ting was going to charge me $500.00 for the revision. I will say this put a bad taste in my mouth because I think revisions should be free. Especially if you did nothing to cause the issue. However, literally 2 hours before the procedure, courtesy or myself and David Moldanado on Dr. Ting’s staff, the insurance company changed their mind on appeal and covered it.

Vaginal Appearance
Right now, I am still a tad swollen and bruised from the revision surgery. However, aesthetically, I am quite pleased with my vagina. As a POC, I have always dealt with inflammatory hyperpigmentation on my inner thigh from shaving. On advice from my dermatologist I have quit shaving as of this year and I only wax. It has helped. I am also using a bleaching cream and some minor chemical peels to lighten that area. As far as my vagina though, I am happy.

Dilating/Depth
Dilating is no problem now. I hate it of course lol, but I still do it religiously. Every 2 days for an hour. I can get the orange one in, in less than 3 minutes I would say. It hurts a bit but nothing out of this world. I do believe I have lost depth. When I look back at pics I took when I first had surgery. I could get all the way past the 5th dot on the purple and up to the 5th dot on the Blue and Green. Now I just get to the 4th dot. So, I think that is like 1/2-3/4 inch of depth loss. Not sure why exactly. Again, as I have not had sex, I do not know if this is going to impact my sex life. I do plan on having sex soon lol. I have just had a longer recovery time than most but the waitlist is long. Kidding, kinda. lol.
I will say Dr. Marcy Bowers does a procedure called Vaginal Re-Opening Procedure (VRP) for those who had depth but lost it. This is an outpatient procedure and the recovery time is not bad. I have kept this filed away if it becomes an issue. I think other doctors can do it too but Bowers is the gold-standard.


Bleeding
Up until January/Feb/March of 2018, I would have these weird random bleeding episodes. That time period was 7/8/9 months post-op, respectively. It would happen 1-2x a month and it would be about 1-2 teaspoons of bright red blood. I had no idea what was causing it. It wouldn't happen after dilating, it would just happen randomly it was always between 3-5pm and would last 24 hours. Obviously after my bleeding complication and my general disdain for blood lol, it terrified me. It hasn't happened again since March so I think it may be over lol? I told Dr. Ting and per usual lol, he seemed unconcerned. His general affectation I am coming to understand.

Overall, I am happy. I am so blessed and once I finished with this final surgery on 11/21/2018, I will be able to put all this surgery nonsense behind me. I am going to try and respond to comments/my inbox in the coming weeks. ??Thanks all!

Please forgive me ladies for the delay. I have been super focused on my recovery. I have so much to talk about so bear with me.
Complication
Unfortunately, I had a complication on June 23, 2017, a few days after my 2nd week post-op appointment. We are still not entirely sure what happened but the top theory is that I had a tear in my vagina which clotted. That evening, June 23, 2017, I got up to do some light cleaning and I bent down to pick up some trash. After standing back up, I immediately felt wetness running down my leg. I legitimately thought that I had peed myself but when I looked down I was gushing blood. Now let me be clear, I am not exaggerating by any means. I was literally gushing blood. I freaked out at first as I was bleeding through towels and I am just not a blood person. However, I collected myself, (this all happened so fast but it seemed like slow motion at the time), and I laid down. I called 911 and the EMS came. I was taken to the ER that night. Trust me ladies, the ER is no fun place. Tons of people, staff is stressed, tons of gross smells, loud voices, moaning, screaming, etc. I think the ER was even more traumatic than my bleeding episode. The doctors could not figure out why I was bleeding so it came down to a wait and see approach. I honestly think the bleeding kept up for so long because I had been taking such a high level of ibuprofen. I have a fear of hardcore pain medication, like the Percocet I had been prescribed. So, I was just taking a lot of ibuprofen and I really think that thinned my blood a lot and made clotting difficult. Friday night into Saturday morning and afternoon, my blood level just kept dropping. I ended up requiring a blood transfusion. One bag and it took well, no side effects. Late Saturday night I was admitted to the plastic surgery wing for monitoring. Fortunately, my two best friends from LSchool were with me the whole time. Everything was on the up and up, so I was discharged Sunday around 1pm. It was a traumatic time ladies. That's all I can really say. It was scary. I do not have any regrets. I took the risk in having the surgery, I knew it was a possibility. That is what I want to emphasize ladies, all surgeries have risks. Even if you are the healthiest person in the world, anything can happen. I say that to say again I am so happy with my results and have no regrets. After I was released from the hospital, I was extremely weak/tired for the first week. I actually fainted that Monday and hit my head, my fault for trying to do too much. However, after much bed rest I am so much better. My strength has returned. My blood levels are normal. I am not on any pain medication either, ibuprofen or the Percocet. Dr. Ting has chalked it up to just a freak bleeding episode. Now that we are past the 4 week mark and into the 5th, the bleeding and complication risk is significantly lower. So, I feel fine and safe. Just glad everything is over and I am feeling like my old self.
Vaginoplasty
My vagina is doing well. The incision on the left side has healed completely. The incision on the right side is about 85% healed. I have a little opening in the incision, which Dr. Ting assures me happens in 80% of cases, and it is healing from the inside out. It is called dehiscence. The swelling has gone down dramatically. At the four week mark, July 5th, 2017, Dr. Ting told me I could start masturbating. I haven't lol. My clitoris is extremely sensitive. Like direct contact is just not enjoyable for me right now, it's like over stimulation, like I have been zapped. However, all around my clitoris and my mon pubis, it feels wonderful lol. I am up to the green dilator now. The purple and blue go in with no problem and no pain. The green is not super comfortable, borderline painful at times. However, I am just working my way into it. I get all 5 dots in with the purple and blue, and right now I can get up to dot 4 with the green one. Some other things I would like to talk about, kind of uncomfortable is smell lol. Smell was something I was worried about. I have never been with a cisgender woman sexually. Completely vagina-phobic unless it's my vagina lol. So, I always wondered if my vag would just smell. I can honestly say there is no smell associated with my vagina. There had been this fishy smell but one day a large piece of tissue came out of my vagina when I was using the restroom (pic attached). Of course I was freaked out when I first saw it. However, Dr. Ting let me know this was excess skin graft and that it was good that it came out. That piece of tissue is where the fishy smell was coming from. Since then the only smell is associated with the drainage from the incisions on the side which is super minimal. So, I am pleased with that. I still haven't been shaving or trimming down there. Just being extra careful. Hmmmmm what else? I have started experimenting with like putting a finger in there and it feels nice aha. I am also walking normally now for about a week. There is still some swelling and some heaviness down there, but for the most part I don’t think people can tell anymore when I am walking. Sitting is also no problem either. I just still try to avoid sitting on hard surfaces for long periods of time. All in all I am super pleased. If there is anything I left out please comment and I will answer.
Breasts
My boobs are doing quite well. I am so happy with them. I still don't have my nipple sensitivity back, which is a bummer, but I read it can take 3-6 months. However, they are super squishy, they are no longer tender. The incisions are fine and healing well. They are a little dark to me. Dr. Ting said they will lighten over time but honestly, I don't care that much. They are usually hidden so it's not a big deal to me. My scars are what made me haha. I still can't wear underwire. Dr. Ting told me to wait until the 6-7-week mark before I start. I am still completely satisfied with the size. They look so natural to me and just really balance my body out. Not much to say about the girls. So I will just post a few pics.
HRT
I am not on hormones right now. I was taking 4mgs of estrogen. However, I just can’t deal with the weight gain from estrogen anymore. So, I want to take a break until I can get back to my ideal body weight. I’ve literally gained 20-30lbs in the last year from being on 8mg of estrogen (my fault, I requested the highest dose because my dysphoria was so bad, I wanted my breasts to go and I just wanted my face to be more fem). I have an appointment with my primary care doctor on July 20, 2017. He will take my blood levels and I will talk to him about post HRT life. I will post all the info he gives me. I am hoping he will let me stay of the estrogen for awhile and then ease back on.
FFS
Now finally, FFS. It’s happening ladies. I am trying to contain my excitement. I got my insurance confirmation yesterday, July 11, 2017. I am scheduled for July 26, 2017. So, 2 weeks away now. Now a couple things. I have decided to go with Dr. Ting for the FFS. Right now, we have just talked about the brow ridge/forehead bone reduction. Dr. Ting doesn’t think that I need too much, which makes me feel good. I have been on hormones since 18-19 and I am happy with my face for the most part. The parts I hate the most are the brow ridge and sort of my jaw bones, I feel like my face is square. However, when I lose weight I don’t mind it. I think that because my face is fatter it just seems larger and squarer. I am not going to post pics right now but I will update once I have the final procedures list. I am hoping for some jaw bone reduction too. I know for sure that he billed a couple codes dealing with facial reconstruction, so I am going to see what we can do. I am so so so so excited. Of course, my family and friends are scared, they think it’s too soon, think I don’t need it, etc. However, they just don’t live in my body or my life. I can’t explain how crippling my facial dysphoria has been at times. I want to start my career confident and having resolved my dysphoria. So, I am dedicated and committed. I will of course update very soon as the date approaches. Right now, the goal is to get cleared by PST. It’s been 5 weeks and I had the complication, but I really feel that my body has returned to a pretty healthy state. One more thing, Dr. Ting says more than likely the procedure will be out patient, so I can go home the same day. Which makes me feel great. He also said the worst of the bruising and swelling will be gone after 2-3 weeks. So, fingers crossed.
Cost
So, I have gotten a few inquiries about cost/how am I affording everything. Insurance Insurance Insurance. So obviously overseas things are a bit different. You all don’t have individual insurance policies. Which is fortunate in a lot of ways, to have universal healthcare, but unfortunate in this situation. So, I can’t give much advice on that. However, because I am in NY, because of the Affordable Care Act, and because of my insurance provider, Cigna, through my school, all of procedures have been covered. In total I will pay between 4-5k for everything. My out of pocket max is 5k, so everything after that is covered in full. I can’t stress enough to check your insurance policy to see what is covered. To get my procedures covered, back in February I sent my insurance company over 200 pages of medical records. Including all my documentation for all the years I’ve been on HRT and transitioning, all my medical records, all my mental health records, and literally every page of medical records I could get my hands on. I went to a psychiatrist and I flat out told him I needed three separate letters, each attesting to my gender dysphoria related to my breasts, my face, and not having the correct sexual organ downstairs. I told him I needed the letters to attest to the medical necessity of my procedures. I wrote my insurance company a very long brief, outlining the procedures I am looking to have, their medical necessity, as well as citations to New York Insurance Law, WPATH, American Society of Plastic Surgeons statement on transgender care, etc. I just made sure I had all my ducks in a row. When Dr. Ting’s office submitted for prior authorization I made sure to stay on top of my insurance company. I told them that if they denied it I would be appealing with the New York State Department of Financial Services. There are just so many options if you are super driven. These surgeries were literally life saving for me. I won’t go into too much detail but my anxiety and depression around my gender dysphoria had gotten bad prior to my surgery. So, I really needed all of this. It’s not just for fun or cosmetic purposes. Even if your insurance company tells you that you do not have coverage for gender confirmation surgeries, you can challenge that. Let them know that you want to appeal the determination. Most insurance companies have internal appeals processes and if that doesn’t work, see if your state has an external insurance appeals process (New York State is through the NYS Department of Financial Services). All insurance is regulated by state law so each state typically has an agency that handles external appeals of denials of coverage by insurance agencies. I know it seems difficult but it is worth it ladies. If anyone needs any help or has questions about insurance please do not hesitate to contact me and I will help as much as I can. Just know that where there is a will there is a way. Also, the biggest thing is documentation, documentation, documentation. Make sure you are getting all your medical records from every type of doctor/social worker/psychologist/etc. that you see in relation to your transition. If the documentation is there and you meet the guidelines, then denial of services is hard.

Hey ladies, it has been awhile since my last update. Apologies, I have just been focusing on my recovery. First off, thank you for all the well wishes! So jumping right in:

Breasts
My breasts are doing really well. I seriously love them, they don't look augmented to me at all. Dr. Ting did an amazing job with placement and sizing. I posted some pics of them and my incisions in this update. They are healing nicely for 2 weeks out. My skin is a bit dry but there is virtually no pain. There is soreness when I press on them but that is all. The incisions are fine as well. They don't itch or anything. I am wearing sports bras now. I will include the link to the ones I got. I love them. They are so soft and only $7-$8 on Amazon: https://www.amazon.com/dp/B00H9MWYY2/ref=twister_B01EJRV8R8?_encoding=UTF8&psc=1
My nipples have regained some of their sensitivity but definitely not full sensitivity like before. I think that comes back 4-6 weeks post-op. Overall I am incredibly happy with them.

Vagina
So on to the good stuff. I have included a pic haha. Don't judge me. She isn't the prettiest little thing right now but we have made a lot of progress. It has truly been an emotional rollercoaster haha. So right off the bat I am very sensitive to like looks and smells and all the sensory stuff. So these first two weeks have been rough for me. The stitches, the swelling, the blood, the ripeness, it has all been a bit much for little ole me and my sensitivities. My 2nd post-op appointment was 3 days ago on Monday June 19, 2017. Dr. Ting said everything is healing wonderfully and my concerns are just natural parts of the healing process. Again however, I have had my woozy fainty moments lmao.
The swelling really has gone down alot. There is still some bruising and discoloration all over my pubic area. I can honestly say I am in 0 pain most of the time. The only pain I have comes from the stitches. They are just so tight and itchy and if I move too much they get irritated and raw. So I have really learned the importance of just laying still as long as I can. I am showering everyday to keep everything clean. I have also started douching with just water, which is a big help. There is a lot of discharge but it is from the metrogel and bits of blood mixing with it. One drop of blood makes it look like a river of blood ladies, it's insane. After awhile the metrogel breaks down from a more viscous form to a liquid and it just leaks out. Douching has really helped me feel better and has helped with cleaning out all of the old metrogel from dilating.
Dilating is a breeze. I started using the blue dilator on June 18, 2017 (11 days post-op). I put the purple one in for 10 minutes and then the blue one in for 10 minutes, 2x a day. I have so much depth ladies. I have no problem getting past the 4th dot immediately and then after a few minutes the rest of it pops on in a bit past the 5th dot. I am extremely excited about that. I have had literally no pain from dilating. Some days I don't feel like doing it but I just make myself.
I still can't shave down there. The hair removal really took. I don't have hair below where my clitoris starts, so when it is time for shaving it will be super simple just shaving the skin above.
I change pads 3-5x a day, just to stay clean. I am using the Always number 2 with wings. The wings reallyyyyyyy help.
I am walking almost normally, I'd say another week and people won't think I am a grandma when I am running errands. I am able to get up and get out whenever I need to but I am making sure to really rest and allow my body to heal.
My BMs are still kind of out of whack. I have 1 every 2 days now. I am still taking the stool softener every day and eating healthy. Speaking on that I am down about 6-7lbs which is nice haha. Hoping the weight keeps coming off.
I have also been getting [RS bleep] lately lol. I have sensation in my clit but it's almost too much for me right now so I avoid touching it. However when I am thinking about sex and guys, I get this feeling down there. I want to describe it as almost like a buzzing sensation and definitely like a swelling rush. I just want to touch myself. It's like my body knows if I touch myself everything will be better haha. It's nice but at the same time frustrating because I just don't want to even attempt to masturbate while everything is healing up.
Okay ladies I think that is all I have to report for now. If you have any questions about something I didn't address please post them below and I will reply!