#mtx surgery

So my revision with Dr Shubham Gupta was about 2 months ago, and everything went well! I had about 15cm of depth after the revision and it's been holding steady at 12cm for the last 6 weeks or so. At first I was dilating twice a day, but I had to stop for 3 days while in the hospital for my FFS. I didn't have any loss of depth at that time, so I've gone down to dilating every other day, and it's still holding steady. I'm very happy with the results, though I hope I can get some more width through dilation to accommodate my partner for vaginal sex. I may also seek out a vulvoplasty next year or so for a more natural look; we'll see. The one thing I'm not happy about regarding the experience was paying the bill. The cost was about $120k, of which I've paid half and half is due in a few months. My insurer decided about 10 days before surgery that it wasn't medically necessary, and that they weren't going to reevaluate until after the surgery date, or else I'd have paid I think 20% of that amount -- less, probably, due to out-of-pocket maximums on my plan. I'm still talking with my lawyer and Dr Gupta's office about getting the appeal together so I can be reimbursed.

I also had the rest of my FFS about 2 weeks ago. Procedures included rhinoplasty, removing the Adam's apple, narrowing the chin/jaw, removing some fat from the chin/neck, and adding a small amount of fat to my cheeks. This was mostly covered by insurance but I did have to pay for some procedures that weren't considered medical necessary by my insurer. This was okay, because the amount came up to about 5-6% of what the vaginoplasty cost (sub-$10k). I'm pretty happy with the results, though they won't have their full effect for a few months when the swelling finally goes down. I did have to go on a liquid diet for 2 weeks due to swelling in my mouth and throat, but that's done with now.

Overall, I'm very relieved to have the surgeries over with. The only pressures left are getting a successful appeal through to my insurer, keeping up with dilation, and waiting for the swelling to go down on my face. I think these are all manageable, though.

Partial FFS went well, though the changes are subtle so far. Not unhappy, but wish it could have been all been done at once.

Just got off the phone with my vaginoplasty revision surgeon. Date got moved to the second week of April (~1.5 weeks later) but he gave good reason for it. For safety reasons he wants to include a laparoscopic part of the procedure, so it needed to be rescheduled to fit the availability of the robot.

It looks like Kerecis is going to be the technique used, possibly augmented with some more peritoneum, depending what's available down there. Starting to feel a little more optimistic about the potential outcome of the revision.

Rest of FFS is scheduled for the 4th week of May, just long enough after my revision for the surgeon to allow it. This way my FMLA time will overlap and not get all used up.

Might know more about the revision in a week or two.

So I'm having partial FFS (covered by insurance) in about 2 weeks. My bottom surgery revision is already scheduled 3 months after that and that surgeon requires 3 months between any previous surgery and the revision. The FFS surgeon requires only 6 weeks between procedures, so it's likely that I'll schedule something 6ish weeks after my revision to do the rest of the FFS. Hopefully my insurer will have realized by then that doing all the remaining procedures at once saves money, stress on my body, and most especially healing time.

Also, while my lawyer was helping with the appeal for the revision, they asked me to resubmit the referral to my insurer. Upon receiving their response, my insurer gave preauthorization. Go figure. I can only assume that my having pulled out a lawyer in the past has influenced their revised decision.

Scheduling for FFS is set for December, vaginoplasty revision in March.

My health insurer has denied my referral to Dr Gupta. I'm working with a lawyer and we've caught a technical snag because the referral/denial were mistakenly for office visits, not for surgery. My PCP, who made the initial referral, is on vacation, so I met with a primary care doctor with my insurance who was surprisingly accepting and professional about my nonbinary goals, not something I have come to expect from most doctors.

So the proper referral should be in place and when it gets expectedly denied, lawyer stuff can proceed.

Meanwhile FFS is mostly covered (apparently some procedures to relieve my dysphoria are considered "beautification" rather than "facial feminization") and everything is in place for that. I plan to make a claim for the uncovered parts after surgery.

My understanding now is:

* It's not really possible to revise a PPT vaginoplasty with more peritoneum.

* There is a chance that some part of the canal is still present even after stenosis. Exploratory surgery is needed to find out, as it doesn't show well on scans (MRI, etc).

* If there is some remnant of a canal, it may be possible to use NTFS or Kerecis or other techniques to extend the canal. This could be done in the same session as the exploratory surgery if something is found.

* Due to my upcoming FFS (still not scheduled; I've asked for an update), I will have to wait 3 months before another major surgery (such as this revision) so that my jaw can heal enough to have a tube put in my throat during surgery.

* I don't have an estimate for when Dr Gupta might be able to perform the surgery; I will get this once I have a date for FFS.

* I don't have a cost estimate from Dr Gupta yet. It depends on whether my insurer is stubborn again or not. If they are, I may have to self pay and submit a claim afterwards, but I am prepared to do so assuming the costs are reasonable.

* If the revision fails or there is no canal left to augment, Dr Gupta spoke as if colonic transposition was the only option left for me, which I do not think I want -- that will be a last resort. In this case, I will likely consult with Dr Ley in San Francisco, who I know has done at least one PPT PPV revision using a skin graft.

Plan of action:

1) Seek approval from insurer for revision.

2) Check with FFS surgeon until they give me a date. If it is some ways in the future (I don't think this will happen), ask if there is any problem doing the revision first.

3) Check with Dr Gupta's office to schedule a surgery date 3 months after FFS, or an appropriate amount of time before FFS. Get a quote for insurance and self-pay separately.

Meanwhile after wallowing in depression for over 2 months, I've finally made an appointment with a surgeon who might be able to do a revision for a PPT vaginoplasty. That's a couple months out, so more waiting there, too. This particular surgeon uses a technique called Kerecis which utilizes fish skin in constructing the canal (not sure if this is the same thing as NTFS). Over time, the scaffolding provided by the fish skin is grown over with human tissue. Apparently the results are pretty good, if anecdotes from other patients are valid.

On to next steps, which are tracheal shave, FFS, and revision for my PPV. I've already consulted about all three.

Tracheal shave is already covered by insurance. FFS should be covered by my insurer by this summer hopefully. I will have both surgeries at the same time when everything is in place to do so.

Probably better answered through consultation with a surgeon, since I didn't ask about it. For me, recovery was a breeze, but I live a pretty sedentary life, so I wasn't longing for exercise. I actually lost weight anyway because I wasn't going out to eat anywhere due to both recovery and Covid, and ended up eating healthier stuff at home.

It was a bit rough the first week or so, where I still had the catheter and packing in and was fairly drugged up and needed someone helping me with basic tasks. I was able to take care of myself by the second week though. I had essentially no pain (except tenderness when dilating), but this is apparently not very common.