The office location is indicated by the red cross. | Return to Surg. Page | |||
| Contents | Last update - 10 March 1997 |
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| 1. Neenah, Wisconsin | 6. Monetary Policies | ||
| 2. Requirements | 7. Male to Female Pricing | ||
| 3. Pre-Operative | 8. Female to Male Pricing | ||
| 4. The Surgery | 9. Informed Surgical Consent Form | ||
| 5. Post-Operative | 10. Post-operative Results |
The transgender operations are done at Theda Clark Regional Medical Center located in Neenah, Wisconsin. The town has a population of about 25,000 people and is located about 100 miles north of Milwaukee and thirty miles southwest of Green Bay on Highway 41. The city is covered by air service out of Appleton airport eight miles to the north. For excellent service, you can call Lynn Bult at Integrity Tour & Travel (1-800-944-0885). Lynn knows the most convenient and least expensive arrangements that you can make to come to Neenah.
The office location is indicated by the red cross.
Map of the area around the office. The office location is indicated by
the red cross (Note: The map recently changed and I haven't confirmed that the location
indicated on the map is correct), the hospital by the blue cross.
Theda Clark Regional Medical Center is located on the Fox River at Lincoln and First Street and one block from my office which is at 125 Forest Avenue, just North along First Street and left on Forest Avenue for two blocks. If the Appleton Airport is used, cab transportation is readily available by a phone conveniently located at the airport. The numbers is 414-832-8890 and the cost is around $11.00, also, the Velley Inn provides a Shuttle service. If the Green Bay Airport is used, patients have told us the "Fantasy Limousine Service" for $45.00 would be less expensive than renting a car since they take you to the hotel and it would not be necessary to drop a rented car off at the airport. Their number is 730-3866.
| Valley Inn | +1 (414) 725-8441 | |
| Twin City Motel | +1 (414) 725-3941 | |
| Taxi service (Appleton) | +1 (414) 832-8890 | +1 (414)-734-4546 |
| Fantasy Limousine Service | +1 (414) 730-3866 |
We must have two psychiatric evaluations which specifically recommend SRS or specifically state that you are a candidate for SRS or any sex change procedure such as augmentation mammaplasty. These are to be done by Psychiatrists or Psychologists who are recognized, licensed workers in the gender or sex-oriented field. A letter is required from your Endocrinologist outlining the history of your hormone therapy. We strongly recommend and advise that you do not call to schedule your SRS operation until you have completed at least nine months of psychiatric evaluation and understand that the final evaluation for SRS is done by me the day before surgery.
Because we live in an age of high technology, computers, etc, it has unfortunately come to our attention that psychological evaluations can be and have been falsified. Since we have no way of knowing the credentials of every psychologist and psychiatrist who refer patients to us, we must CONFIRM the fact that you are indeed a candidate for SRS. If your evaluations are in doubt, we will have our own Clinical Behavioral Scientist evaluate you on a one time basis either at her office in Chicago for $250.00 or, if it is more convenient for you, at my office here in Neenah for which she charges $500.00. Because this surgery is irreversible, we do not want you to enter into a situation which you will later regret. Dr. Randi Ettner's interview will be on a one time basis and keep in mind that this is necessary for your protection as well as ours. If it so happens that you have one psychological workup, Dr. Ettner will be asked to evaluate you as a second opinion which may take several sessions or even a complete course of evaluation may be required. In any case, great weight will be placed on her final recommendations.
Very little lab work is necessary which will be done together with an AIDS test at Theda Clark Regional Medical Center the day before the operation. SRS will not be done for anyone who is HIV positive, has Herpes or any other venereal disease.
The matter of the overweight patient has come up on a number of occasions. Without having seen you prior to surgery, it is impossible for me to determine the feasibility of doing your surgery if you are markedly overweight. SRS can be done on most people, however in the morbidly obese, the operation is virtually impossible and will not be attempted by me. In those individuals who are very overweight but not morbidly obese, the operation is still very difficult and the final results are compromised because of the presence of great amounts of fat tissue. Overweight people simply do not do well during and following surgery and the results of our efforts are not as good as they would be if the person were of normal weight. Some obesity can be dealt with, but I just want to emphasize that anyone over 200 pounds may have a very difficult time. I realize that 200 pounds on someone over 6 feet tall is not a problem, but 200 pounds on someone 5 feet tall is a weight problem very difficult for any surgeon to overcome. The final determination of whether or not your surgery can be performed because of your relative weight, will be determined at the time of your physical examination. If you are markedly overweight, do not be disappointed if your surgery is postponed giving you a chance to lose some excess poundage.
Blood loss is not unusual during or after SRS but blood transfusions are not generally given unless necessary. Should you choose to donate two units of your own blood, which is a very worthwhile idea, they will be administered back to you after the operation. Please contact the blood bank of your local hospital for details and we will do what we can to help in this matter.
Much discussion has evolved around the discontinuing of hormone therapy prior to SRS surgery. When the genetic female undergoes routine surgery, nature has provided protective mechanisms (not entirely understood) against the formation of thrombotic emboli (which can cause death) that are not present in the genetic male taking female hormones. Therefore, even though the likelihood of this dreaded eventuality is remote, we STRONGLY RECOMMEND for your own safety, that you discontinue taking hormones three weeks prior to and three weeks after your surgery - ANY SURGERY! Withdrawal symptoms are uncomfortable, but temporary, and much better than dying. Also, please stop taking Aspirin as well.
It would be a good idea to bring only the necessities which you will need in the smallest and lightest carrying case you have. This is to prevent tearing of the sutures and damage to the new vagina following surgery. You will spend most of your time in bed and therefore will not need numerous changes of clothes. It is also suggested that you bring only one outfit and wear it both arriving and departing. It is advisable to wear something loose fitting as there will be some tenderness and swelling following surgery. Tight fitting jeans and panty hose may cause discomfort. There is certainly the possibility that there will be some discharge and light bleeding in the genital area after surgery. Although you will be required to use sanitary napkins to absorb the blood, there is a chance some will leak through, therefore, dark clothes will help conceal any stains on the return trip. You will need to bring your personal toiletries and a robe if you want to leave your room after you are up and around. The hospital provides gowns which you will be wearing while you are confined to bed. Personal items to entertain you such as cassette players, reading material, are suggested but we strongly recommend that you keep your baggage light as possible.
As mentioned before, if you have not been evaluated prior to hospital admission, it will be necessary for you to be seen in my office early in the afternoon before the day of surgery. At this time you will be interviewed and undergo a physical examination. You will sign consent forms, have your photograph taken, receive instructions and take care of any remaining financial matters.
If you have never been seen by me, you will be evaluated in my office around one o'clock in the afternoon of the day before your surgery. It would therefore be advisable that you arrive either that morning, or, if you wish, the day prior which would give you an opportunity to get a good night's sleep before you are seen in my office.
The hospital staff is courteous, friendly and competent and although they will be as helpful as possible, any technical questions regarding the surgery are best reserved for me.
It is most important to prepare the patient both inside and out, therefore, you will be given a thorough bowel prep to make the inside body as clean as possible for the operation. You will be asked to take a shower with a shampoo. There will be a perineal and perianal prep which amounts to having these areas of your body shaved. This will be followed by painting the middle part of your body with an antiseptic solution to keep the bacteria count down. A liquid supper is served around 6:00 PM and you will be given a sleeping pill around 10:00 PM.
In the morning, you will be given your pre-operative medication which will make you feel groggy. You will then be taken down to the operating suite where a general anesthetic will be administered. You will remember nothing until you wake up in the recover room.
Depending on what is done, the operation can last anywhere from three to five hours. If you are having additional work such as a skin graft, more time, of course, is required.
You must understand a basic, fundamental problem regarding the final depth of your new vagina. I try to make the neo-vagina as deep as I can - up to six or seven inches is common, and obviously, the longer your penis, the more skin will be available to line this newly created opening. If future sexual intercourse is in your plans and your penile length is adequate, the standard genital procedure without a skin graft would be done. On the other hand, if your penis has relatively little length, I would suggest that a skin graft be used to help make the vagina deeper, unless of course, you have NO plans for future intercourse. Full-thickness grafts are usually taken from the right and left sides of the abdomen which leave line scars that look like hernia repair scars. A split-thickness skin graft can be taken from the area beneath the umbilicus and above the pubic hair or it can be taken from the thigh or buttocks. In selected cases, Laser technology can remove hair from the scrotal skin which can then be used as a source of skin graft material which obviously avoids abdominal scars. A physical examination will determine whether or not a skin graft will be necessary. In general, the shorter your penis and the greater your desire for future intercourse, the more likely a skin graft will be considered. If you have a relatively short penis and insist on SRS without a skin graft, the inadequate depth of your vagina for future intercourse must of necessity be YOUR RESPONSIBILITY.
Regarding Secondary Genital surgery to correct problems from a previous operation; experience has taught us that Sex Reassignment Surgery to correct cosmetic or functional problems occuring at the time of or after the first surgery are FAR MORE DIFFICULT the second time it is done because distorted anatomy and scar tissue interfere with meticulous surgical disection. Complications such as operative and post-operative bleeding are more common and patient stay in the hospital can be prolonged over the usual 8 days. For these reasons, the surgical fee for an SRS redo is $8 100.00. The hospital and anesthesia fees will remain the same as primary SRS, HOWEVER, there may also INCREASED OR ADDED HOSPITAL, ANESTHESIA AND SURGICAL CHARGES if complications arise necessitating more surgery or if the eight day stay is exceeded. Any additional charges will be the patient's responsibility, so please come prepared to pay these extra costs at the time of your discharge. I will continue to be responsible for my own patients and will do whatever I can to improve upon any complications that may have arisen from surgery that I have performed. This however, does not make the degree of difficulty of any additional procedure less, but I would prefer that other surgeons deal with their own complications. Also, keep in mind that my Labiaplasty is designed to compliment MY SRS - if I am asked to do a Labiaplasty on some other surgeon's SRS, an added $1,000 will be charged because experience has again taught us that much more must be done because so often the SRS has been inadequately performed (the clitoris has not been constructed or the urethra is poorly positioned, etc.).
The question of secondary scarring from the skin graft donor site is always raised -- Yes, there is a mark where the skin graft is removed. The color of this area varies in intensity from person to person and in some patients it can become red, raised and last a long time. Although it invariably fades out in time, this involution process can be hastened by applying sheets of silicone to the area for several months. Again, the response of this new technology varies from patient to patient.
We expect our results to be good to excellent; However, complications can occur. Although most problems can be readily and successfully dealt with, the Recto-Vaginal fistula is the most serious possible problem that could happen. Should the rectum be inadvertently entered, the opening would be closed, but a future fistula could result. Your bowels are cleansed thoroughly before surgery to help prevent this problem but if a fistula does form, it would be necessary to do a temporary diverting Colostomy until the fistula could be adequately closed at a later date. Keep in mind that the dissection of the Neovagina is delicate and hazardous with the possibility of rectal damage always present.
I want to emphasize as strongly as I can that the first surgeon to do the SRS with or without a skin graft has the best chance for success. Experience has taught us that redo's to deepen the vagina can be (but are not necessarily) very difficult and run the risk of being unsuccessful. The rectum could be entered due to the fact that scar is present in the deep vagina making secondary dissection perilous. Once the secondary dissection is complete, a skin graft must be used to line the newly created, deep vaginal area which had previously contracted. This newly created opening has the TENDENCY AND GREAT ABILITY to contract again and obliterate itself in spite of diligent dilating on the part of the patient resulting in NOTHING GAINED. Therefore, we suggest for anyone who has had SRS done elsewhere and develops a vaginal contracture that they return to their original surgeon for treatment.
Since the operation cannot be performed completely in one stage, some patients elect to have the Labiaplasty portion done three months later. This is intended to feminize the operated area and cannot be done at the time of the SRS because important blood supply would be cut off to vital tissue. Whether or not to have the Labiaplasty is your option.
While in the recovery room, we will make every effort to avoid the feeling of nausea and vomiting which we do with both drugs and the administration of oxygen. You will have a Foley catheter in your bladder which may give you a feeling of wanting to urinate. This feeling will pass. Once you are awake, you will be returned to your room where you will sleep for much of the remaining day. The IV in your arm usually stays until you no longer have pain which is about five or six days. Your pain medication (Demerol or Morphine) is given through the IV. Sleeping pills will be given every night that you are in the hospital.
Not counting the day of surgery, you will be confined to bed for six days. Foe example, if your surgery is one Tuesday, you will not be able to get up and out of bed until the following Monday. Since this may seem like a long time to you, it is best that you bring reading material or paper work to occupy your time.
Constipation is not unusual and you may not have your first bowel movement for three or four days. Of course, it will be necessary for you to use a bed pan as we cannot allow you out of bed until more healing has occurred.
Ice packs will be applied to your groins continuously; your sanitary napkins will be changed as necessary and sponge baths will be given while you are in bed.
You will find a large suture tied over a roll of cotton in your pubic area - this along with your urinary catheter and drains will be removed on the sixth day after which you will take a show or bath. At first you will feel weak but your strength will recover rather quickly.
If urination is difficult, it is because of swelling and the presence of the vaginal pack. Should you be unable to urinate, the catheter will be temporarily replaced.
You will be leaving the hospital on the eighth day. For example, if your surgery was done on Tuesday, you will be discharged on Wednesday of the following week. The day you leave, your vaginal packing will be removed and you will receive instructions how to keep your own vagina dilated. If you are sent home on additional drugs, they can be obtained at the hospital pharmacy but be prepared to bring enough money to cover costs.
In order to make your trip home easier and more pleasant, especially if you live far away, we STRONGLY SUGGEST that you stay in one of the area hotels for several days after your hospital discharge.
Because we have experienced non-payment of our fees in the past, we have formulated the following fee policy. If you consult with me in my office any time OTHER THAN the day before your surgery, I charge $75.00 for this time and the $75.00 is to be paid in ADVANCE BEFORE YOUR CONSULTATION IS SCHEDULED. To avoid cancelations, "no shows" and people who are not serious, this fee is NONREFUNDABLE.
The basic fee for the genital surgery is $5,000.00. If your penis is so small as to warrant a skin graft procedure along with the usual inversion technique, there will be an additional $500.00 charge.
Once we set a surgical date, whether or not you have been seen by me in my office, we require a $500.00 deposit to RESERVE that time. The $500.00 is to be received in our office NO LATER THAN ONE WEEK FROM THE DATE THAT YOUR SURGERY IS SCHEDULED. Once we set the surgery date and cancel for any reason whatsoever, the $500.00 is ABSOLUTELY NONREFUNDABLE. The only exception to this would be if I determine, at the time I first see you in my office, that you are not a candidate for transsexual surgery. Only then will your $500.00 be refunded. Remember the $500.00 advance deposit is to secure your surgical time. If you deposit is not received per our office policy, you may lose your surgery date to someone else.
The remainder of your bill is to be paid by at least two weeks prior to your surgery and no personal checks please.
Hospital and anesthesia fees MUST LIKEWISE BE PAID IN ADVANCE. Please have separate cashier's checks made out to each provider in the designated amount. The hospital fee should be made out to Theda Clark Regional Medical Center and the anesthesia fee should be made out to The Association of Hospital Anesthesiologists, Inc.
If procedures are staged, such as orchiectomy followed later by SRS, the inital procedure will be full price. A price break is given for the second procedure; we will reduce the SRS fee by subtracting 1/2 the price of the initial procedure. This policy applies only if the inital procedure was done by me. If done by someone else, the full price for the SRS will still be charged.
If more than one operation is done (for example: Genital Transformation plus Augmentation Mammaplasty), it is customary for the surgeon and the anesthesiologist to cut the cost of the lesser procedure in half. The hospital reduces the second procedure by 25% and the third by 50%. Everyone has discounted their prices well below the standard going rates as a special favor to cosmetic and transsexual patients.
Please remember that all hospital quotations for ANCILLARY cosmetic and transsexual surgery are for ONE DAY STAY ONLY. There is an additional $80.00 to stay overnight if I feel it is medically necessary for you to be observed for another 12 hours; the charge will increase to $225.00 if you elect to stay overnight for no other reason than it would be a convenience for you. If you remain in the hospital longer than 24 hours, - no matter what the reason - your quoted fees will no longer apply and you will be charged A GREAT DEAL MORE than those original quotations. Therefore, I suggest you limit the procedures you want to a sensible number. There is a limit to how many different operations I can do on one person at any one time. I will determine how much surgery will be judicious and prudent on a one day stay basis.
All fees are subject to change.
Experience has taught us that insurance does not pay for cosmetic surgery nor Gender Dysphoria problems. There always is, however, that rare exception but since the hassle with insurance companies is so great, we ask that if you have insurance which will cover your procedure, PLEASE HAVE THIS FACT NOTED IN WRITING from your insurance company and we will then, and ONLY THEN, send what forms you give to us ; however, WE WILL STILL ASK FOR PAYMENT IN ADVANCE and any monies received later and owed to you, will be refunded to you. Lastly, please do not ask this office to send letters to insurance companies trying to convince them that your problem is medically necessary. This is just the hassle we wish to avoid. We suggest that this be done by you in advance of your being seen by me.
Last update: March 1997
Money type: US Dollars
| Procedure | Schedule A[1] | Schedule B[2] | Hospital[3] | Anesthesia[3] |
|---|---|---|---|---|
| Genital Surgery (SRS) | 5 000 | 5 200 | 5 600 | 1 150 |
| Genital Surgery (SRS) with a skin graft | 5 500 | 5 700 | 5 600 | 1 300 |
| SRS without graft plus augmentation mammaplasty | 6 150 | 6 400 | 6 200 | 1 585 |
| SRS with graft and augmentation mammaplasty | 6 650 | 6 900 | 6 200 | 1 585 |
| Mucosal Flap | 1 050 | 1 100 | - | - |
| Later deepening of Vagina with a skin graft (for stenosis) | 8 100 | 8 400 | 5 600 | 1 120 |
| Fistula Repair - Vaginal/urethral | 1 300 | 1 400 | 600 | - |
| Orchiectomy (unilateral) | 1 050 | 1 100 | 750 | 460 |
| Orchiectomy (bilateral) | 1 750 | 1 850 | 750 | 460 |
| Labiaplasty | 1 600 | 1 700 | 790 | 550 |
| Labiaplasty -- if SRS was done by another surgeon | 2 600 | 1 700 | 790 | 550 |
| Chin Shave | 1 600 | 1 700 | 250 | 550 |
| Tracheal Shave | 1 400 | 1 500 | 475 | 550 |
| Malar Implants | 1 400 | 1 500 | 705 | 550 |
| Augmentation Mammaplasty | 2 300 | 2 400 | 715 | 570 |
Implant fees are not quoted due to constantly changing prices. They are sold to you by us -- not the hospital -- at our cost in order to keep the price down for you.
[1]Schedule A - Surgical fee if paid by cash, (cashier's check or money order) and received before or no later than 14 days prior to surgery.
[2]Schedule B - Surgical fee if received within the 14 days prior to surgery or if paid by any means other than cash.
[3]If you wish to pay the hospital and/or anesthesia by any means other than cash/cashier's check (such as by credit card) you must contact them for permission to do so.
[5]The prepay hospital fee allows for coverage of unexpected, hospital expenses incurred over and above the usual charges. However, should your operative and post-operative courses be uneventful and you do not require additional, costly medical care or if you are medically able to be discharged one day early, a rebate in an amount up to $600 will be refunded to you within five working days after you are discharged. In the past, added expenses were absorbed by the hospital and the patient was never billed for them; now, the hospital can be covered without having to collect from the patient after she returns home. Nevertheless, if hospital or Doctor bills over and above even this are incurred, the patient is expected to pay for them.
Amounts are in US dollars. Prices subject to change. Eugene Schrang is not responsible for errors, omissions, or out-of-date information on this page.
Last update: February 1996
Money type: US dollars
| Procedure | Schedule A* | Schedule B** | Hospital*** | Anesthesia*** |
|---|---|---|---|---|
| Total Reduction Mammaplasty (female to male) | 3 800 | 3 950 | 1 450 | 636 |
| Testicular Implants | 1 300 | 1400 | 600 | 160 |
* Schedule A - Surgical fee if paid by cash, (cashier's check or money order) and received before or no later than 14 days prior to surgery.
** Schedule B - Surgical fee if received within the 14 days prior to surgery or if paid by any means other than cash.
*** If you wish to pay the hospital and/or anesthesia by any means other than cash, such as by credit card, you must contact them for permission to do so.
Amounts are in US dollars. Prices subject to change. Eugene Schrang is not responsible for errors, omissions, or out-of-date information on this page.
I FULLY UNDERSTAND ALL OF THE ABOVE. I HAVE NO FURTHER QUESTIONS. I DO AUTHORIZE EUGENE A. SCHRANG, M.D. TO PERFORM ANY OR ALL OF THE PROCEDURES OUTLINED IN PARAGRAPH ONE, OR SPECIFICALLY THE FOLLOWING:
___________________________________________________________________
___________________________________________________________________
Date: __________________
Patient: _____________________________________
Witness: _____________________________________
The images below are thumbnail links to the full-size images. Select the image to retrieve and view the full image. The full-size images range from 13 .. 34KB, averaging about 20KB.
| 1. Post-op SRS but before labiaplasty - No labia minora and the labia majora diverge above the clitoris. | |||
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| 2. At labiaplasty before the operation - Note the skin bridge between the uretra and clitoris. | |||
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| 3. At labiaplasty - cutting of the skin bridge or uretero-clitoral fistua. | |||
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| 4. At labiaplasty - uretero-clitoral fistula has been cut. | |||
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| 5. At labiaplasty - after the operation. Note the convergence of the labia majora above the clitoris and the presence of labia minora and pink mucosa between the clitoris and urethra. | |||
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| 6. These last photos are all post-op SRS and labiaplasty. | |||
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| This document was retrieved from the Sex Change Indigo
Pages. Page layout and some icons are Copyright © 1996-1997 Perette Barella. |
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