On June 3rd, did a scrotal augmentation of penile inversion vaginoplasty. Patient is doing quite well and her devoted fiance is in attendance. Lost very little blood intraoperatively but her strict vegetarian status is of course the lowest of 3 categories for wound healing, the intermediate being chicken and fish, but no red meats. She is now taking oral iron, Ferrosequels. She has her leg bag by her bedstand and tomorrow big out of bed and visit to the breakfast bar.
I’ll be making rounds at 6 AM, another MTF scrotal vaginoplasty in the morning.
Yesterday did a long in time (careful, careful), male chest reconstruction, D cup without question. Able to do a strict window-shade incision and avoid the vertical anchor which is not relished by most patients. Trimmed out most of the bulky nipple with a wedge resection and “pasted” a male looking nipple-areolar complex over a granular base. We are using saline soaks every 3 hours, to keep the graft moist. Some say this heals better. Many excellent surgeons do it dry and that works also. Specimen picked up for pathological examination as is recommended for all mastectomy patients. Again very little blood loss thanks to Arnica montana, Bromelain, Vitamin C, and adrenalin infiltration and packing. I had not thought we could do D’s so easily, but was tempted because the pedicle was very narrow based. Perhaps years of binding pushes the breast mass down.
After the inframammary incision is closed, the patient is again sat up on the table (under anesthesia of course) and everyone gets to look and comment. With great precision the chest is marked for placement of the center of the N-A complex. I like to keep in mind the male N-A complex is more lateral than the female and usually starts about 3/4 to 1 inch above the inferior mammary fold. To further insure accuracy, markings are done transversely on a grid as well as radially from the notch just above the sternum. X which marks the spot should coincide for both layout techniques. Patient had preoperatively determined the new diameter. We aim to please.
Patient seen this morning. Jackson Pratt (grenade) drainage nil, no pain and all smiles (all gone). The great flat expanse
Harold M. Reed, M.D.
Tags: Arnica montana, Bromelain, male chest reconstruction, mastectomy, MTF vaginoplasty, scrotal graft