Having an MTF vaginoplasty with reduced fees.

Last year (2008) and the year before (2007) we were very fortunate to have been a research resource for orchiectomy specimens.  Regretfully this relationship was concluded last year.   This was the sole basis of funds for our Grant project with one exception.  A very nice prospective MTF patient made a sizeable donation to help another have an operation.  She herself is on the schedule to be done soon.

What next then.  Well with Dr. Reed, there is always individual consideration.  This does not mean we can work for free, and surgery is a team approach and members of the team such as nurses and anesthetists expect a pay check at the end of their shift. 

However, we have always offered compassionate discounts to those who have enough reserves to cover contingencies and out of pocket expenses.  We do recommend a friend, loved one, or relative stay with the patient for at least 2 to 3 days.  That’s an added expense although we have the availability of attendants, but they bill at about $12 an hour.

Hotel and food for a week adds up to about $650, medications, ring pillow, anti-embolism hose, about $100, stents $350.

As is, our fees are easily about $5,000 below what most  are charging in the US and Canada, and we are busy.

Harold M. Reed, M.D.

We are continously striving to update our approach to create the most functional and virutal vaginoplasty vulvas possible.  Posted this past month are photographs 3/1-2 and 8/1-4  http://srsmiami.com/photography-m2f.html

The incidence of touch ups, all practices, may be as high as 35%  and we offer this to our one stage feminizing vaginoplasty patients gratis after 3 months.

Harold M. Reed, M.D.

Dear Harold

Happy new year to you too

my boyfriends parents has a jacuzi so i had a nice long bath.

i have had all the stiches removed, that is a big relief. urinating no longer hurts at all

it is getting more beautiful every day, and i am so happy now.

the dialating is progressing okay i think.. a little slower now but i dosent hurt at all anymore..

you have saved my life, i am very grateful.

sincerly R and M

This is the desired new standard for MTF surgery and something we strive to do with our patients such as examples 3/1-2 and 8/1-5 in our photo gallery   http://srsmiami.com/photography-m2f.html

Lubricious could mean:
1. Having a slippery or smooth quality.
2. Shifty or tricky.
3.
a. Lewd; wanton.
b. Sexually stimulating; salacious

However, before I knew of meanings 2 and 3, this was a familiar
urological term that describes a catheter with a hydrophilic suface
(loves water literally) that glides in a lot more easily than standard
catheters and is better tolerated by patients. They are more costly,
but for years we have only used lubricious catheters in MTF surgery
at our center.

This term has been re-coined by me to describe a technique that I
learned from Dr. Marci Bowers, using urethral mucosa for constructing
the vulvar plate. There is somewhat more lubrication there, but also
the color of the tissue is pinker and seems to resemble natal vulvas
a lot better than typical pigmented epithelium. The inner aspect of
the labia minora on natal woman are pink, whereas the outer aspect is
darkly pigmented. The vulvar plate is confluent with the inner
aspect of the labia minora. Marci uses a 2 layered suture to raise
the edge and quite frankly, I was inspired by her technique.

Harold Reed, M.D.

Our office receives periodic inquiries from patients often outside our
practice as what might be the cause and how best to treat.

The differential diagnosis includes, a suture remnant which might be
infected, but usually this will reabsorb after a while. I do not know
of any surgeons using non-absorbable sutures for vaginoplasty. Also a
space that has not closed in, a drainage tract. But in this case we
have to think of the nidus (or cause) and treat that. The drainage
tract is only the natural consequence of fluid (usually infected)
build up seeking to drain. Occasionally there may be a recto-vesical
fistula or a communication between bowel or bladder and the vagina.
This may close spontaneously, but if not, should be addressed for the
sake of patient comfort, as well as bringing the operation to a functional
conclusion, and to prevent possible worsening of an abscess and/or tissue
necrosis.

Drainage may be a sign of tissue necrosis, such as a devitalized
clitoris or neurovascular bundle or penile remnants attached to that
bundle. Distal nerves may regenerate, but the tract must be widely
opened first and any necrotic components must be debrided.

Smokers and diabetics and those with hyperlipidemia (elevated fats and
cholesterol), and older age patients are more prone to this unusual
situation. Inappropriate stent usage, trauma, and early sexual
activity also could be a factor.

Previous pelvic surgery can devitalize blood supply, so we cannot be
fooled by what may look normal, as skin that has been exposed to lots
of sunshine during adolescent may not bear signs of actinic effects
till years later on.

Lastly, we have noted one of the most common causes of continued pain, drainage
and irritation, is the retention of an epithelial surface under the vulvar
plate. In that the clitoris is formed from the glans penis, one has to be
assiduous about removing skin that is not intended to be exposed or hooded.
Skin exudes debris and sebum at times. Skin under skin will not heal and forms
epithelial cysts, all kinds of chronic reactions, and granulomas. Buried skin
may want to encyst. All this is highly inflammatory. The answer is to open the
area. Cauterize or apply in lesser instances a silver nitrate stick.

Harold M. Reed, M.D.

Thank you letter

To bad there isn’t any money for those of us who would like to FtM.
I  have been suffering my entire life in the wrong body. I do have my  PCP and other doctor behind me for what I want only my insurance  won’t let it happen [all I want at the moment is my top done].

guardianmax

Re: Grant Program, up and running, by popular demand

Hi “Max”,

Please write to our office and provide some background information.
If I personally cannot help you, I will refer you to doctors who know
what they are doing and whose surgery I have personally watched.

These very same doctors are mentioned in our letter to prospective
patients, as you should have many choices when it comes to selecting
your surgeon.

Have a restful Sunday and if it is not Max, don’t be shy,

All the best,

Harold Reed, M.D.
admin@srsMiami.com

This coming month we will offer an additional 5.  This past month all 5 were quickly taken by needy patients who are really caught in this recession crunch.

What’s included:  surgery, use of facility, private duty RN nursing care, anesthesia, any followup care provided by Dr. Reed, including touch ups under local. 

What’s not included:  consultation, stents, travel, out of pocket expenses,  some medications (the small stuff).  We do have Cipro samples enough for 10 more cases.

This means you may have feminizing vaginoplasty for as little as $5,000 and for no more than $8,500 if we can secure an allotment for you.   It all starts with an E-mail letter admin@srsMiami.com

Harold M. Reed, M.D.

305-865-2000

Dear SueEllen,

Yes, quite agree.  Scrotal grafting is the key to depth.  Please see our photographic examples, panels 6/1-5 for scrotal graft preparation and on lay.

Hope this is of help,

Harold M. Reed, M.D.

Re: Depth  (from http://groups.yahoo.com/group/MTF-SRS-FTM/message/40720)

The discussion started out by a patient saying her doctor was not able to make a depth of over 4 1/2 inches and  blamed it on her perineum which is short.

Reply from another…

The perineal flap is not that long regardless and does not play into depth but very important to provide a proper entree into the vaginal introitus or opening and of course provides girth at the opening or outer portion of the vagina. Girth not depth. It is sewn into the back wall of the vagina to funnelize the vagina. For depth, the scrotal graft with rare exception is unsurpassed as this skin when properly thinned stretches quite easily.

SueEllen, RN