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Reassignment surgery

My reassignment surgery took place on 14th November 2003 with Dr. Suporn at Aikchol Hospital in Chonburi, Thailand.

Contents

  1. Introduction
  2. Why Dr. Suporn?
  3. Preparation
  4. Costs
  5. Advice
  6. Things to Take
  7. Diary
  8. Other accounts of reassignment surgery with Dr. Suporn
  9. Intra-Op Photographs
  10. Results and Reflections

Introduction

Reassignment surgery is a complex and hugely invasive surgical procedure., and when we commit to undergo surgery we place our lives in the hands of our surgeon and his or her team.

Anyone contemplating surgery would be well advised to research not only what they want from their surgery, but also which surgeons are likely to be available to them.* Although the basic surgical techniques are well defined, each surgeon has their own technique, strengths and (unfortunately) weaknesses. By doing so we can at least know the questions to ask of our potential surgeon, which in turn will help us to form our own opinions of whether going to them is the right choice for us.

    * Unfortunately, as ever money talks...private patients like myself are likely to have access to much wider options than those undergoing NHS (State funded) treatment within the UK. In particular, most Gender Identity Clinics do not seem to give their patients a choice of surgeon. Quite frankly, I find that unforgiveable, given the intensely personal nature of the surgery and the widely differing techniques and results obtained by different surgeons.

TS Roadmap is a pretty good sources of information on the available surgeons and how to contact them. I'd also recommend joining the Yahoo Trans-Surgery group and asking lots of questions!

That's exactly what I attempted to do while planning my surgery. I was acutely aware that although reassignment surgery is now a well-developed surgical procedure things can go badly wrong. Although the risk of death is very low (I only know of two cases where patients have died after surgery, both as a result of a pulmonary embolism and neither in the UK), complications can happen - and indeed minor complications are fairly common.

Fortunately, major complications (such as a perforated bowel or necrosis of the clitoris) seem to be fairly uncommon. It does vary from surgeon to surgeon however, which is yet another reason to learn as much as possible before committing yourself.

The other thing to remember is that this is a surgery that you are likely to only have one opportunity to get right. If the results aren't what you hoped for you are likely to have to live with it for the rest of your life - as some rather disturbing accounts I've read can attest.

I certainly didn't go into this blind. My whole life was at stake, after all. 
 

Why Dr Suporn?

 In late 2001 (several months before I started transition) I became aware of a Thai surgeon by the name of Dr. Suporn, who seemed to be offering reassignment surgery techniques and results which weren't available in the UK. Several of the girls I'd met in the TS Chat Community had undergone surgery with him, and although I'd not seen the results firsthand what I heard was very encouraging - in terms of aftercare (incredibly important when you consider you have to fly out to Thailand!), sensitivity and depth (being sensate and having a natural appearance and penetration angle are all hugely important to me, although depth is less so).

The reasons why I've chosen to go to him for reassignment surgery rather than to one of the surgeons performing it in the UK are sufficiently complex that I feel I should discuss them separately. See the article Why Dr Suporn? for details.

If you're considering going to the Suporn clinic, I'd strongly recommend you join the Dr S Club Yahoo Group, which can answer all of the common questions about undergoing surgery at the clinic, including details of accommodation, travel, etc. Incidentally, aside from flights, the clinic arrange virtually everything for you.
 

Preparation

Surprisingly little needed to be done to arrange my surgery. The first thing was obviously to write to the clinic and agree a date (helped by the fact that they have a scheduling calendar on their website), and send them a deposit (I sent 20% - 78,000 Baht or about £1200).

That aside, my preparation mainly consisted of talking to others who've already been to the clinic about their experiences, what to take etc.

The other things I've had to do are:

  • Apply for a new passport (mine had expired, and showed my former self anyway). Fortunately, in the UK there's no problem getting a passport in a female name with the right gender code. Sadly, those in Ireland and the US aren't so lucky.
     
  • Book the flights. After recommendations from friends I decided to fly with EVA Airlines - they do an "Evergreen Deluxe Class" ticket which gives lots more legroom than an Economy class ticket for not much more (£655 for Evergreen with EVA compared to £590 Economy with Quantas).

    Another plus was the flexibility to change the return flight without penalty (useful in case there are any unexpected complications).
     
  • Obtain the all important letter from my consultant psychiatrist (Dr. Russell Reid) referring me for surgery.
     
  • Have a medical and ask my GP to prepare a letter to the clinic stating that I was fit for surgery.

As requested, I sent scanned copies of all documents to the clinic, and took the originals with me when I flew out to Thailand.
 

Costs

By Thai standards Suporn certainly isn't cheap now (even less so as the exchange rates are now far less favourable than they were in 2003). It's possible to find Thai surgeons who charge less than half what he does - but as ever you get what you pay for. In terms of quality of result, aftercare etc. he's hard (if not impossible!) to beat - and the costs are still generally lower than in the UK, even taking into account flights etc.

I obviously didn't know the total cost of my surgery in advance, since as well as the cost of the surgery itself (370,000 Baht), the costs for airline tickets, hotels, food, spending money etc. all have to be considered. As my friend Kazzy was travelling with me and I was and paying for her airline tickets, meals etc. I knew the costs would be higher than if I'd travelled alone, but that didn't matter. Not being alone through such an amazing experience did.

All told, I was expecting it to cost me about £8500. Here's how it worked out in practice:
 

    Description

    Cost in Thai
    Currency

    Cost in UK
    Currency

    Comment

    Surgery

    370,000 Baht

    £5,826

    Rather than take cash, I transferred the funds electronically from my own bank. The process was quick and easy, the exchange rate good and the charges far more reasonable than those for currency exchanges.

    Hotels

    52,300 Baht

    £780

    This includes not only the cost of the room but phone/internet calls, meals etc. The room cost in the Mercure was 1100 Baht/night (about £17), and meals/drinks typically added 500-1000 Baht to that.

    Flights

    -

    £1,310

    £655 each.

    Cash

    37,380 Baht

    £612

    We did splash out a bit - this includes a makeover/photoshoot for each of us and three made to measure dresses! Amazingly, guest meals for Kazzy during our 8 day long stay in Aikchol hospital were just 1397 Baht - about £22.

    Total

     

    £8528

    It looks like I wasn't too far out in my estimate!

Bear in mind that the rate for each transaction varied, with currency exchanges back in the UK getting the worst rate (61 Baht/£) and hotel bills toward the end of my stay the best (67 Baht/£). I didn't need to do so, but apparently UK debit cards work in cash machines in Thailand - and I suspect the exchange rate you'd get for a cash withdrawl that way would be far better than from a conventional currency exchange in a UK bank.

Since I had my surgery, the costs involved have risen substantially. As of summer 2013, the best information I have is that the cost of the reassignment surgery I had had risen to 545,000 Baht. With the exchange rate (around 47 Baht/£) now much worse than it was in 2003, this equates to a nearly doubled cost (£11,600) for the surgery alone over that I incurred at the time.
 

Advice

The biggest two pieces of advice I can give are to:

  1. If possible) bring someone with you when you travel to Thailand - particularly for the first two weeks. Reassignment surgery is is major surgery and can be very painful, and the extra moral support helps massively.
     
  2. Learn what you can, and listen to what the clinic staff and Dr. Suporn tell you - particularly about dilation. They know what they're talking about, so don't be afraid to ask questions if there's something that doesn't seem to make sense or you don't understand.

If you are contemplating Male-to-Female genital surgery, you should also definitely familiarise yourself with the article Zen and the Art of Post-Operative Maintenance, which deals with the subject of looking after yourself (dilation, hygene etc.) after surgery. It's absolutely essential reading for any trans woman.
 

Things to Take

The most important medical equipment you'll ever ownTravel as light as possible - especially if you travel alone to Thailand. You really don't want to be carrying more than you need to. Aside from the usual stuff (clothes, toiletries etc.) here's a few things you might not have thought of:

  • Friends recommended taking a screw-top jar to keep the Betadine solution in used while cleaning up after dilation. I didn't bother and just used a glass in the hotel - apparently leaving it open to the air is no problem.
     
  • A sports bottle or cheap imitation such as a Sunny-D bottle. Not only is one useful in the hospital for drinking while lying down, but once you reach the Mercure the shower heads are fixed and such a bottle lets you squirt the bits you need to!
     
  • A small pill box for keeping pills in once you're discharged from hospital (Boots sell them, although they are expensive there so it's worth shopping around).
     
  • It's useful to bring a few painkillers as a backup - but please be extremely cautious about mixing them with the medication provided by the clinic - especially in hospital. I brought some co-codamol (one I know how to handle, stronger than paracetamol but weaker than the Tramadol given to me by the clinic) and co-proximol (which I didn't intend to touch unless absolutely necessary and with the clinic's agreement in an emergency. In the event, I never used them).

    Don't take any anti-inflammatory or blood-thinning drugs (e.g. aspirin or ibruprofen) prior to travelling out for surgery.
     
  • A couple of adaptor plugs for hairdryer, laptop or whatever. I also took a 4-way extension block, which proved very useful for plugging in bulky items like mobile phone chargers.
     
  • A travel kettle, as although they are provided in the rooms at the Mercure (now Chon Inter) Hotel in Chonburi, the same may not be true for any other hotels you stay at immediately before returning home). If you're a tea drinker you might want to think about taking tea-bags too as apparently they're hard to find. Of course, you could just rely on room service (although we used our head and collected the sugar and whitener provided at the hospital, so we only had to buy coffee and milk...).
     
  • A digital camera if you have one. Believe me, you won't regret it - this is the experience of a lifetime.

What you do not need to take are any other medical supplies, or equipment for dilating. You'll be given everything you'll need by the clinic - notably stents, betadine, hibiscrub, a large syringe (for douching) and a rubber doughnut to rest your tender bits during the immediate post-op recovery period.

Finally, if you are planning to take a laptop with you, prepaid phone SIMs or internet access can be bought when you arrive - just ask the clinic staff. If you are relying on dial-up, a modem extension cable (RJ-45 both ends) and straight through adaptor to extend the cable in the room (which may well be glued into the socket) may also be useful. The cable in the room we stayed in after my surgery (307) was very short, and there was no way I could make it reach the bed. To go online (a good way of killing time while dilating!), I had to get out of bed!

Eventually I figured out where the phone was plugged in and used that instead - I did have to dig a bit to find it though!

As I understand it, broadband wi-fi is now available in the Hotel and Hospital (for a cost) which obviously makes things far easier.
 

Diary

During my stay in Thailand I kept a detailed diary of my feelings and experiences, which I gradually wrote up as an illustrated web page. If you want to know more about the "Suporn Experience", why not take a look?

Although many people have written such an account, each tells a different part of the story of the once in a lifetime experience that is reassignment surgery, and I hope that mine will add something to what's already been published. As it was written at the time rather than later, it's pretty detailed!

The picture on the front of the notebook I wrote my diary in Chonburi

I've largely left it as I wrote it in my notebook at the time, so some of it is rather raw and emotional. Nevertheless, I hope you'll find it a useful and informative account which also conveys the sheer range of emotion I experienced which is in my view an integral part of the experience. I've broken it into several pages in order to make it more manageable and load faster:

  1. The trip to Thailand, my consultation with Dr. Suporn and the transfer to Aikchol Hospital on my last day as a pre-op trans woman
    (11th - 13th November, 2003)
     
  2. My big day arrives, and my immediate recovery in hospital
    (14th - 20th November, 2003)
     
  3. The packing is removed, learning to dilate and discharge from the hospital
    (21st - 22nd November, 2003)
     
  4. Immediate recovery at the Mercure Hotel, and my first check-up at the clinic since surgery
    (23rd - 25th November, 2003)

  5. The second check-up, further recovery, a couple of setbacks and learning a few things
    (26th - 30th November 2003)
     
  6. Some good news about the haematoma, and finally getting mobile
    (1st - 7th December 2003)
     
  7. The final check-up, shopping in Bangkok and my homecoming
    (8th - 12th December 2003)

If you have any questions about my surgery or anything connected with it, I'm be happy to answer them, so feel free to send me an email via the Contact page.

Finally - and a very important point for anyone writing an online diary like this - everyone I've written about and/or posted pictures of has given their consent. The last thing I want to do is "out" anyone when they're trying to carve out a new life for themselves.
 

Other accounts of reassignment surgery with Dr. Suporn

You may also want to look at the pages discussing vaginoplasty with Dr. Suporn on TS Roadmap.
 

Intra-Op Photographs

While my surgery was taking place Dr. Suporn's staff took photographs of the procedure, some of which were given to me before I left Thailand. Be warned that these images show male to female genital surgery in detail and are definitely not for the squeamish!
 

Results and Reflections

When I left Thailand I was still very swollen (more so than most, presumably due to the haematoma I suffered) and in a considerable amount of pain. I'm pleased to be able to say that both the swelling and pain steadily decreased over the following weeks, and the results now look quite natural. If you really want to see how they developed, you can do so here.

Dr. Suporn has truly done something amazing for me. Not only do my genitals now look right, but they feel right too - as soon as the T-bandage was removed I could feel that I was rather sensate (which is very important to me), and I went orgasmic at 10 weeks and 3 days post-op - ironically just 5 days after my FFS!

I also I find that although I can remember how my body looked and felt before surgery, I can't relate to it. My mind has adjusted remarkably quickly to my new body shape.

Of course, everybody's different so don't expect you're results to look exactly the same as mine...but if my experience is anything to go by I'm pretty sure you'll be very happy with the results if you go to Dr. Suporn. If you choose to go to another surgeon, I hope your experience is as amazing as mine has proved to be.

 

 

Postscript: I returned to Dr. Suporn for Facial Feminisation Surgery on 21st January 2004.