location: Transition > Bottom Surgery > Revision Surgeries 4 & 5
This page picks up where Revision Surgeries 2 & 3 written experience leaves off. I have included a couple entries that are also on that page for clarity and consistency.
Thursday, September 10, 2009 - 2 Years, 3 Months Post-op : 1 Year, 6 Months Post-1st-Revision : 7 Months Post-2nd-Revision : 5 Months Post-3rd-Revision
The right implant still has not dropped properly, and it is definitely higher than the left one was pre-surgery (the higher of the two pre-expansion revision), and the right one now causes the same discomfort that the left one used to. I find this very disappointing. My surgeon was very surprised that it healed so high, because he said he really tacked it down and closed off the area above it so it wouldn't slip up. Even though the left implant is lower than the right one now, it is still very next-to the penis itself, not entirely below it as most testicles are. I had really hoped that after all the time and pain with expansions, that I would have ended up with a somewhat hanging scrotum with two testicles in it. The recommended plan of action is to repeat the entire two surgeries: one to put expanders back in, then another to replace the expanders with implants; although this time, we would expand the skin a lot to make sure there would be plenty. I really don't know if I'm up for all of that again at this time. However, if I were to pursue it, I would want to do it with the same surgeon as I already have an established relationship with him and the hospital.
Tuesday, January 19, 2010 - 2 Years, 7 Months Post-op : 1 Year, 10 Months Post-1st-Revision : 11.5 Months Post-2nd-Revision : 9.5 Months Post-3rd-Revision
I had another consult with my plastic surgeon who again agreed that re-doing the skin expansion and replacing the implants over another two surgeries was probably the best bet in terms of achieving a somewhat normal scrotum. As it stands, one of the implants sits almost completely above the penis itself, basically over the pubic bone. I don't think this is a satisfactory result. I decided to re-do the process of replacing the implants with tissue expanders, expanding the skin over a number of weeks, and then replacing the skin expanders with the implants. This time we decided that we will really overstretch the skin because it seems like my tissue there wants to recoil a lot. Hopefully I just won't end up with a huge saggy scrotum, but at least that wouldn't be as uncomfortable as one of the implants constantly over my pubic bone. Surgery was scheduled for early March 2010.
Monday, March 1, 2010 - 2 Years, 8.5 Months Post-op : 1 Year, 11.5 Months Post-1st-Revision : 1 Year, 1 Month Post-2nd-Revision : 11 Months Post-3rd-Revision : Day of 4th Revision
I arrived at the hospital around 10:00am, met with an intake nurse, and got dressed in the pre-op holding area. I met with the anesthesiologists who started an IV and the plastic surgeon. They gave me the pre-med as they wheeled me into the operating room, and I quickly fell asleep (thankfully before remembering getting the oxygen mask put over me, which makes me anxious). Similar to the previous revision when they put in expanders last time, they made small incisions in the inguinal area (one incision on each side) to put in the ports just under the skin over my lower abdomen. Unlike last time, he also made incisions over my original implant incisions near the top of the scrotum on each side - he removed the implants and placed the expanders through these incisions (last time everything was done only through the two inguinal incisions). There is a small tube that joins the tissue expander to the ports, which is where you stick the needle to inject saline into the expanders. I woke up with the four incisions, two covered in surgical glue and the inguinal incisions were covered with paper tape and small bandages.
It was done as an outpatient procedure so I spent a few hours in the recovery room, then went home. I ate well that night with no nausea. I had requested no opioid use, because they have historically made me extremely nauseaus. I slept OK that night, as well as I could have for having to be on my back.
Saturday, March 6, 2010 - 2 Years, 8.5 Months Post-op : 2 Years Post-1st-Revision : 1 Year, 1 Month Post-2nd-Revision : 11 Months Post-3rd-Revision : 5 Days Post-4th-Revision
The pain from this procedure was much less than the previous time they put in expanders. I was much more able to move around, using my abdominal muscles, than after last time; I think this is because the expanders were put in through the incisions on the actual scrotum, instead of being pushed through the inguinal incisions. The pain was managed fairly well with only naproxen. I was quite bruised on the underneath areas, especially on the right side (side where the implant was sitting too high), but the bruising began to resolve after just 4-5 days.
Tuesday, March 16, 2010 - 2 Years, 9 Months Post-op : 2 Years Post-1st-Revision : 1 Year, 1.5 Months Post-2nd-Revision : 11 Months Post-3rd-Revision : 15 Days Post-4th-Revision
I saw the plastic surgeon for a check up and the first expansion. 10 ml were injected into each of the two expanders. They had put in about 20ml of saline in each during surgery so each had a cummulative total of 30ml per side. I was expecting it to be fairly painful, but I actually didn't feel it much at all. He walked me through the procedure of doing it myself, because this time I decided to expand them myself at home as I will be away for 2 months of the expansion time.
Friday, March 26, 2010 - 2 Years, 9 Months Post-op : 2 Years Post-1st-Revision : 1 Year, 1.5 Months Post-2nd-Revision : 11.5 Months Post-3rd-Revision : 25 Days Post-4th-Revision
The second tissue expansion (first time doing it myself) was a nerve-racking experience. I was super paranoid about infection and how far to put the needle into the port and everything. But, it turned out to be very easy and not that bad at all. I put in 10 ml into each expander, for a cummulative total of 40ml in each.
Friday, April 2, 2010 - 2 Years, 9.5 Months Post-op : 2 Years Post-1st-Revision : 1 Year, 2 Months Post-2nd-Revision : 1 Year Post-3rd-Revision : 32 Days Post-4th-Revision
The third tissue expansion went well with no problems doing it myself. I put in 10 ml into each expander, for a cummulative total of 50ml in each.
Friday, April 9, 2010 - 2 Years, 9.5 Months Post-op : 2 Years, 1 Month Post-1st-Revision : 1 Year, 2 Months Post-2nd-Revision : 1 Year Post-3rd-Revision : 39 Days Post-4th-Revision
The forth tissue expansion went OK. Luckily, I had an extra butteryfly needle, because I missed the left port the first time I tried to hit it. I put in 10 ml into each expander, for a cummulative total of 60ml in each.
Thursday, April 15, 2010 - 2 Years, 10 Months Post-op : 2 Years, 1 Month Post-1st-Revision : 1 Year, 2.5 Months Post-2nd-Revision : 1 Year Post-3rd-Revision : 46 Days Post-4th-Revision
The fifth tissue expansion went the same as the others so far. I expanded on a Thursday instead of a Friday, because I had weekend plans and didn't want it to be painful all weekend. This means I had one workday immediately after an expansion, and it was much easier than I had anticipated, mostly because at the time I was working a desk job. I put in 10 ml into each expander, for a cummulative total of 70ml in each.
Friday, April 23, 2010 - 2 Years, 10 Months Post-op : 2 Years, 1.5 Months Post-1st-Revision : 1 Year, 2.5 Months Post-2nd-Revision : 1 Year Post-3rd-Revision : 53 Days Post-4th-Revision
The sixth tissue expansion went well. I put in 10 ml into each expander, for a cummulative total of 80ml in each. Each week's stretching hasn't been that painful, mostly just sensitive for a day or two after. Up until this expansion, both expanders were pretty well seated so that the expanded skin was going down towards my feet, and not out towards the front of my body. However, after this one, you can tell that the left expander is sitting higher than the right and that the expansion is now going to go out, instead of down. Hopefully this doesn't mean that the left will end up higher than the right...again.
Thursday, April 29, 2010 - 2 Years, 10.5 Months Post-op : 2 Years, 1.5 Months Post-1st-Revision : 1 Year, 2.5 Months Post-2nd-Revision : 1 Year Post-3rd-Revision : 2 Months Post-4th-Revision
The seventh tissue expansion went without problems. I put in 10 ml into each expander, for a cummulative total of 90ml in each. This was the first week that was very painful after the expansion. It was difficult to sit upright (as in the position of driving a car) as it would put pressure on the expanders and was extremely painful for about 3 days. Interestingly, this expansion marks stretching beyond what I expanded to the first time I had expanders (up to 80ml).
Thursday, May 6, 2010 - 2 Years, 10.5 Months Post-op : 2 Years, 1.5 Months Post-1st-Revision : 1 Year, 3 Months Post-2nd-Revision : 1 Year, 1 Month Post-3rd-Revision : 2 Months Post-4th-Revision
The eighth tissue expansion went well. I put in 10 ml into each expander, for a cummulative total of 100ml in each. I again experienced quite a lot of pain for about 3 days after this expansion. Also, I started to have trouble sleeping because I was so uncomfortable/painful at night while on my side - putting a pillow between my legs helped but didn't completely relieve the pain enough for me to sleep well.
Thursday, May 13, 2010 - 2 Years, 11 Months Post-op : 2 Years, 2 Months Post-1st-Revision : 1 Year, 3 Months Post-2nd-Revision : 1 Year, 1 Month Post-3rd-Revision : 2.5 Months Post-4th-Revision
The ninth tissue expansion went without problems. I put in 10 ml into each expander, for a cummulative total of 110ml in each. The sharp pains and general uncomfortableness after expansion began to last longer, up to 4 days after this expansion. Sleeping was still a problem, because sleeping on my side was painful and I have trouble sleeping on my back.
Thursday, May 20, 2010 - 2 Years, 11 Months Post-op : 2 Years, 2 Months Post-1st-Revision : 1 Year, 3.5 Months Post-2nd-Revision : 1 Year, 1.5 Months Post-3rd-Revision : 2.5 Months Post-4th-Revision
The tenth tissue expansion went well. I put in 10 ml into each expander, for a cummulative total of 120ml in each. The post-expansion pain again lasted for most of the following week, up to at least 4-5 days. The left is sitting higher than the right, although there isn't as much difference as there was the first time I had expanders. Still, the left side is expanding out away from my body, instead of down towards my feet.
Tuesday, June 1, 2010 - 2 Years, 11.5 Months Post-op : 2 Years, 2.5 Months Post-1st-Revision : 1 Year, 4 Months Post-2nd-Revision : 1 Year, 1.5 Months Post-3rd-Revision : 3 Months Post-4th-Revision
I had an appointment with my plastic surgeon to show him the results of my expanding at home for the previous 3 months. He said it looked very good, despite the left one being higher than the right and expanding more out than down. He said during the surgery he would use the same incisions from the previous surgeries (two inguinal incisions and one incision directly into each testicular sac) to remove the expanders and ports and put in the testicular prostheses. The past attempt at using expanders (Revision Surgeries 2 & 3) had left me with a joined scrotum with a small raphe, and we were both happy enough with those results to not attempt to make it more confluent.
He did one last expansion in the office of 10ml in each, giving a cummulative grand total of 130ml in each expander. We also discussed what size implants to put in, and he suggested using size large, or even extra large, as the weight of the implants would hopefully help keep them in the down position and not migrate up as they had twice for me in the past. While the extra large implants are the size of a "normal adult male," I chose to go with the large size - the larges would be slightly bigger than I had before, to hopefully weigh down the testicular sac more, but yet small enough to not be out of proportion for the size of the metoidioplasty. I scheduled surgery for the following week.
Monday, June 7, 2010 - 2 Years, 11.5 Months Post-op : 2 Years, 3 Months Post-1st-Revision : 1 Year, 4 Months Post-2nd-Revision : 1 Year, 2 Months Post-3rd-Revision : 3 Months Post-4th-Revision : Day of 5th Revision
Because it was an outpatient surgery, the procedure was scheduled for 1:30pm (instead of early morning). The anesthesiologists started the IV, and I saw my plastic surgeon before they wheeled me into the operating room. During the surgery, they removed the tissue expanders on both sides and put in new, size large Silimed silicone testicular implants (size 4). They used the same inguinal incisions as the previous surgeries so no additional scars were created. The bandages were minimal, only steri-strips and surgical glue over the incisions. I woke up in the recovery area in surprisingly minimal pain, and was discharged that evening.
Tuesday, June 22, 2010 - 3 Years Post-op : 2 Years, 3.5 Months Post-1st-Revision : 1 Year, 4.5 Months Post-2nd-Revision : 1 Year, 2.5 Months Post-3rd-Revision : 3.5 Months Post-4th-Revision : 15 Days Post-5th-Revision
My post-op appointment with the plastic surgeon went well. The left implant, similar to when the expander was in, was sitting higher than the right; however, it was definitely an improvement over pre-surgery, because at least you could tell there were two implants there (before surgery the left one was so high, it didn't even look like an implant was there). The left implant had already moved slightly higher than immediately after surgery so I had been gently pushing it down occasionally to encourage healing in the down position, or at least stretching of the capsule forming. The right side was sitting low, completely below the penis where I wanted it to be, and perfectly in place. Because two implants were visible, the joined scrotum looks very good and definitely more like a "normal" scrotum.
Stay tuned for more updates!