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Vaginoplasty Techniques: Comparing Penile Inversion and Rectosigmoid Vaginoplasty

Published 07-9-2016 by Dr. Kathy Rumer .

The goal of Male-to-Female Vaginoplasty is to create a vagina that is functional, feminine looking, with normal voiding function, satisfactory sexual function, and minimal scarring. Ideally, the neovagina should be moist, flexible and hairless, and a minimum of 10 cm in depth and about 3-4 cm in diameter.

While a variety of surgical approaches exist for MTF Vaginoplasty, the two most widespread techniques are the Penile Inversion and Rectosigmoid methods. Penile Inversion Vaginoplasty is widely regarded as the “gold standard” method of male-to-female gender reassignment surgery.

Dr. Rumer performs a One-Stage Modified Penile Inversion Vaginoplasty which results in an authentic appearance with excellent depth, function and sensation. In addition, Dr. Rumer’s Vaginoplasty technique does not require electrolysis or laser hair removal of the genital area before surgery, and there is NO regrowth.

During the Penile Inversion procedure, the penile skin is turned inside out like a sock, and used to line a vaginal cavity created in the perineal area. The penis and testes are removed. Clitoroplasty and Labiaplasty are performed to create small but sensitive clitoris and the labia minora and majora. The urethra is shortened and the urethral meatus is relocated to an appropriate female position.

The Penile Inversion technique offers several advantages:

Less tendency for vagina to contract. (Postoperative use of vaginal dilators for at least 6 months is required after surgery.)
Excellent sensation
Excellent depth, provided there is sufficient penile skin. (If insufficient, scrotal skin flaps can also be used.)
Absence of hair on donor flap
Reduced risk of vaginal prolapse

Rectosigmoid Vaginoplasty uses a section of the Sigmoid colon to create the vaginal lining. Because this method doesn’t rely on penis size for vaginal depth, it’s often used for patients who lack sufficient penile skin for the Penile Inversion method.

However with a second major surgery site, Rectosigmoid Vaginoplasty is a much more invasive surgery that is more expensive, requires longer recovery and carries the heightened risk of serious complications like rectal fistula. Proponents of this method often cite the self-lubricating quality of the Sigmoid colon graft, but this benefit is typically outweighed by too much lubrication and an unpleasant smell that can persist for months. Furthermore, the Rectosigmoid graft lining the vagina is unlikely to provide the quality of sensation obtained with Penile Inversion. Lower risk complications can include colitis, vaginal atrophy, and constipation.

In the hands of Dr. Rumer, Penile Inversion Vaginoplasty more than satisfies the goals of her patients by providing a sexually functional and aesthetically pleasing vagina with excellent depth and sensation but without the higher risk of complications that the more invasive Rectosigmoid Vaginoplasty carries. During your consultation, Dr. Rumer will perform a full evaluation and together you will decide on a plan to meet your goals and maximize your surgery outcome.

Body Contouring and the Transgender Patient

Published 07-8-2016 by Dr. Kathy Rumer .

Body Contouring involves a combination of liposuction and fat grafting to reshape the body’s contours and create a more feminine or masculine appearance. It is important to note that Body Contouring is not a surgical weight loss treatment, but it can provide excellent feminizing or masculinizing results in patients who are close to their ideal weight.

Body Feminization

Many transgender women can benefit from Body Contouring. Fatty tissue can be removed from any part of the body to slim down or sculpt those areas to give you more feminine-looking curves. Two of the most common areas of the body targeted for feminization are the buttocks and hips.

Male and female bodies have different shapes. In general, male bodies are boxier and less curvaceous compared to female bodies. Aside from the chest, nowhere is this more apparent than in the buttocks and hips.

A MTF transgender patient who complained of having “the body shape of a man” sought out Dr. Rumer for help. While she had already had Breast Augmentation surgery and was pleased with the results of that procedure, she was not satisfied with the shape and size of her buttocks and hips. Following a full evaluation, Dr. Rumer suggested Body Contouring using a state-of-the-art liposuction system that would remove fat from the abdomen, the area below the buttocks, and the lower portion of the back to accentuate the buttocks and hips, and then transfer some of it to the buttocks and hips to enhance their shape and size.

The patient’s final results were apparent one month after surgery, and she was very happy with her new curves! Body Contouring is a safe and effective surgery for trans women seeking a more feminine body contour.

Body Masculinization

FTM Body Contouring aims to masculinize the body shape via liposuction sculpting, Abdominoplasty (aka a tummy tuck) and buttock fat grafting. Common areas targeted for body masculinization are the abdomen, waist, love-handles (lower waist and back), hips, buttocks, and thighs. Transgender men who are close to their ideal body weight and have good muscle tone but who are not satisfied with their body’s shape are ideal candidates for Body Contouring.

A FTM Top Surgery patient of Dr. Rumer’s who had been on HRT for many years was interested in learning more about how Dr. Rumer could help him achieve a more masculine body contour. Of particular concern to him was the shape of his waist, hips and thighs, which despite much effort had not reduced in size through exercise. Following a full evaluation, Dr. Rumer determined that using liposuction to remove fat from the abdomen, lower back, hips and inner and outer thighs would give him the results he sought.

The patient’s final results were revealed 6 weeks following surgery: the curves that had cursed him in the past were now gone and replaced with a straighter, more masculine body contour. Body Contouring is a safe and effective surgery for many trans men seeking a more masculine looking physique and for whom testosterone and exercise did not produce satisfactory results.

FTM Top Surgery Frequently Asked Questions

Published 05-24-2016 by Dr. Kathy Rumer .

How much experience does Dr. Rumer have with FTM Top Surgery?
Dr. Rumer is very experienced with Top Surgery. She performs approximately 150 Top Surgeries per year.

How much does FTM Top Surgery cost?
The cost of Top Surgery varies somewhat depending on your needs but you can expect it to cost in the area of $7000. Credit cards, checks and cash are accepted. Dr. Rumer also accepts insurance and medical financing.

I’m not sure which Top Surgery procedure is right for me. How do I choose?
When you have your consultation with Dr. Rumer, she will listen to your needs and give you her professional opinion about the best approach.

Do I need to be on testosterone to get Top Surgery?
No, Dr. Rumer does not require hormone therapy to be eligible for Top Surgery. However, if you are paying via insurance, your insurance company may require a minimum period of HRT to qualify.

Will I need to see a therapist to be eligible for Top Surgery?
Yes, Dr. Rumer is a member of WPATH and follows WPATH criteria, as well as the mammography protocols of the American Cancer Society. You will require:

Medical evaluation by primary MD or MD providing hormones
Letter of recommendation from a qualified mental health professional
Mammograms prior to Top Surgery are required (a normal baseline mammogram) for patients 40 years old or older who DO NOT have a family history of breast cancer, and for patients 35 years of age or older who DO a family history of breast cancer.

Will I need to stay overnight in the hospital for Top Surgery?
No, FTM Top Surgery is day surgery and you will be able to leave the surgery facility within a few hours of your surgery.

If you’re travelling from out of town for Top Surgery, inquire about Dr. Rumer’s Recovery Program. For $95/day, you’ll receive a daily check-up from Dr. Rumer and/or her Nurse Practitioner, staying at Dr. Rumer’s on-site recovery facility or a local hotel (at additional expense.) Top Surgery patients typically stay for 3 days after surgery.

Will I need to wear a compression vest after my Top Surgery?
Yes, Dr. Rumer’s patients typically wear a compression vest for 3-4 week after surgery. Post-operative compression minimizes bruising and swelling.

Will I have drains after my Top Surgery?
Possibly, it depends on the procedure you have. Dr. Rumer uses drains for Double Incision Top Surgery but not for the Peri-areolar or Keyhole procedures.

Will I need to have any stitches taken out after my Top Surgery?
Yes, you will see Dr. Rumer one week after your surgery to have sutures and drains removed, if necessary.

« Back to FTM Top Surgery

female-to-male-gender-reassignment-surgery

FTM PHALLOPLASTY

Published 05-24-2016 by Dr. Kathy Rumer .

WHAT IS PHALLOPLASTY?

Phalloplasty is a female to male gender reassignment surgery that provides transgender men with a adult-sized phallus. Dr. Rumer performs the Abdominal Phalloplasty procedure which uses a pedicled abdominal graft that is tubed to create the phallus. The lower abdominal arteries, veins and nerves are preserved in the graft, providing good blood supply as well as tactile and temperature sensation. The resulting horizontal scar across the pelvis is easily concealed. The ability to stand to urinate can be provided through urethroplasty, a procedure that extends the urethra to the tip of the phallus.

WHAT SHOULD I KNOW ABOUT PHALLOPLASTY SURGERY?

As a one-stage procedure, Abdominal Phalloplasty results in an aesthetically pleasing penis with tactile sensation and is associated with a low incidence of complications. Results can be further optimized with Scrotoplasty and Testicular Implants. Dr. Rumer will perform a full evaluation at your consultation and together you will decide on a plan to meet your goals and maximize your surgery outcome.

Phalloplasty surgery results in an adult-sized phallus.
No significant donor site defect.
The phallus can have an uncircumcised or circumcised appearance.
Hysterectomy is required and can be performed either before or along with Phalloplasty.
Complications can include: Tissue necrosis, migration and/or extrusion of testicular implants; urethral fistula or stricture; infection.

WHAT DOES PHALLOPLASTY INVOLVE?

Abdominal Phalloplasty is performed at the hospital and requires an overnight stay.

The phallus is created with abdominal skin and subcutaneous tissue that is separated from the muscle layer, tubed and rotated to hang down from the pubic area.

Scrotoplasty and insertion of Testicular Implants can be done during the initial operation. Dr. Rumer offers different Scrotoplasty techniques to choose from, resulting in either a bifid or joined scrotum.

Many Phalloplasty patients will also benefit from a pubic lift or “mons resection,” a plastic surgery procedure that removes fat from the pubic mound and pulls the phallus into a higher, more natural-looking position.

HOW LONG IS RECOVERY AND WHEN CAN I RESUME MY NORMAL ACTIVITIES?

You will experience some discomfort, swelling and bruising after your surgery. This can be minimized with pain medication and rest. You will be seen back in the office a week post-op. Patients should plan on staying in the area for 2-3 weeks after Abdominal Phalloplasty.

Be sure to inquire about Dr. Rumer’s Recovery Program which offers daily medical check-ups by Dr. Rumer and/or her Nurse Practitioner and optional on-site recovery accommodations. Most patients are ready to return to regular activities after approximately 6 weeks.

Also see: Metoidioplasty, FTM Body Contouring, FTM Top Surgery

METOIDIOPLASTY

Published 05-24-2016 by Dr. Kathy Rumer .

WHAT IS METOIDIOPLASTY?

Metoidioplasty is a female to male gender reassignment procedure designed to provide trans men with a phallus through a more affordable and less invasive procedure compared to Phalloplasty. Sometimes referred to as a “meta,” Metoidioplasty surgery takes advantage of Testosterone’s enlarging effect on the clitoris and results in a phallus of approximately 1.5-2 inches in length. Original sensation and erectile function of the clitoris is preserved, and the ability to stand to urinate can be provided through urethroplasty, a procedure that extends the urethra to the tip of the phallus. Metoidioplasty is discreet and does not produce obvious surgery scars.

WHAT SHOULD I KNOW ABOUT METOIDIOPLASTY SURGERY?

Dr. Rumer has a strong background in engineering and fine arts prior to becoming a plastic and reconstructive surgeon. As a result, she offers a few different approaches to Metoidioplasty. Dr. Rumer will perform a full evaluation at your consultation and together you will decide on a plan to meet your goals and maximize your surgery outcome.

Metoidioplasty surgery results in a small phallus. Phallus size is largely dependent on how much clitoral growth testosterone has caused.
Because of the small size, you will always get your best surgery result if you are close to your ideal weight before Metoidioplasty.
Understand your options and your needs: Each of the three Metoidioplasty procedures offer something a little different.
Complications can include: Migration and/or extrusion of testicular implants; urethral fistula or stricture; infection.
In most patients, the phallus’ glans will have a circumcised appearance.
Hysterectomy is required and can be performed either before or along with Metoidioplasty.

WHAT DOES METOIDIOPLASTY INVOLVE?

Metoidioplasty surgeries that include urethral extensions are performed in the hospital and require a one-night stay in the hospital. Metoidioplasty surgeries without urethral extension are performed in Dr. Rumer’s surgery center and the patient can leave the same day.

Simple Release or Simple Meta
This is the least invasive type of Metoidioplasty surgery and carries the lowest risk of complication. The testosterone-enlarged clitoris is released from the suspensory ligament and labia minora, and tissue is wrapped around the released clitoris to transform it into a phallus. Vaginectomy and Urethroplasty are not performed. (The patient will have a very small vaginal opening and will void from their native urethra.) If desired, Scrotoplasty and insertion of Testicular Implants can be done during the initial operation.

Ring Metoidioplasty
Ring Metoidiopasty is similar to Simple Release in that the testosterone-enlarged clitoris is released from the suspensory ligament and labia minora, and tissue is wrapped around the released clitoris to transform it into a phallus. Ring Metoidioplasty goes a step further with partial closure of the vagina and extension of the urethra. Patients with adequate phallus length (and not a lot of mons fat) are able to stand to void. Scrotoplasty and insertion of Testicular Implants can be done during the initial operation.

Full Metoidioplasty
In a Full Metoidioplasty, a Vaginectomy (colpocleisis) is performed to create an anatomically male perineum. The testosterone-enlarged clitoris is released from the suspensory ligament and labia minora, and tissue is wrapped around the released clitoris to transform it into a phallus. Urethral extension is performed by combining an inner cheek (buccal mucosa) graft and genital flaps. Scrotoplasty and insertion of Testicular Implants can be done during the initial operation.

Dr. Rumer offers different Scrotoplasty techniques to choose from, resulting in either a bifid or joined scrotum.

Many Metoidioplasty patients will also benefit from a pubic lift or “mons resection,” a plastic surgery procedure that removes fat from the pubic mound and pulls the phallus into a higher, more natural-looking position.

HOW LONG IS RECOVERY AND WHEN CAN I RESUME MY NORMAL ACTIVITIES?

Also see: Phalloplasty, FTM Body Contouring, FTM Top Surgery

Facial Feminization Surgery Procedures

Published 05-24-2016 by Dr. Kathy Rumer .

Facial Feminization Surgery refers to a collection of cosmetic and feminization procedures that are designed to provide a more feminine appearance of the face and neck. The selection of procedures is completely customized for each patient based on their transition goals. FFS has helped thousands of trans women look—and feel—more feminine and more beautiful.

Some of the most popular FFS procedures performed by Dr. Rumer include:

Hairline Advancement
Also referred to as Scalp Advancement, this is a procedure that moves your hairline forward, which can significantly feminize the shape of your face and make you look younger. Dr. Rumer makes a temple-to-temple incision along the front of your hairline, and then advances the scalp in places where it has receded. The fine incision follows your hairline and fades after surgery, leaving a natural-looking result.

Brow Lift
Considered to be one of the most effective FFS procedures to feminize the upper face, a Brow Lift moves the eyebrows to a higher, more female looking position. The procedure is performed by lifting the skin of the entire forehead (also know as Forehead Lift).

Forehead Contouring
Some women have a prominent forehead bone and the removal of excess bone combined with reshaping of the bone can dramatically transform a masculine looking face into a feminine looking face. The procedure may use a combination of approaches to achieve final results, such as bone shaving, filling and reconstruction.

Orbital Rim Contouring
Orbital Rim Contouring addresses the bones around the eyes, removing the orbital ridge and bringing out the eyes to maximize the feminine look of your face. Dr. Rumer is able to access the orbital rim through a thin temple-to-temple incision in front of your hairline which fades nicely after surgery.

Eyelid Surgery
Also known as Blephoroplasty, Eyelid Surgery helps your eyes look younger and brighter by addressing drooping upper eyelids, fine lines and wrinkles, and puffy skin under the eyes. Very fine incisions are made in the natural folds of the eyelids, excess fat and/or skin is removed, and very fine sutures are used to close the incisions, resulting in a naturally younger looking face.

Cheek Augmentation
Cheek Augmentation is a FFS procedure that can be done with fat grafting alone or a combination of grafting and cheek implants. Cheek Augmentation not only provides a pleasing “apple of the cheek” contour, but also adds sensuality to the eyes and decreases mid-face height, which is longer in men. The final result is a more beautiful and feminine shaped face.

Rhinoplasty
With the nose as a central focus of the face, Rhinoplasty is a procedure that is very key in Facial Feminization. Men’s noses are typically longer, wider, and overall larger than women’s noses, which are usually narrower, shorter, and slightly concave. Men’s noses are also angled downward versus upward like women’s. Rhinoplasty surgery changes the shape and size of the nose by modifying the underlying bone and cartilage, removing tissue and altering the angle of the tip of the nose. Done by a skilled surgeon, FFS Rhinoplasty can have a big impact on the femininity of a woman’s face.

Upper Lip Lift
An Upper Lip Lift is a procedure that is complimentary to Rhinoplasty. When the nose is made smaller through Rhinoplasty, this tends to increase the distances between the upper lip and nose. A small incision under the nose allows Dr. Rumer to reduce that distance, restoring balance to the nose to lip spacial ratio of a woman’s face.

Chin Reduction
Chin Reduction or Recontouring transforms a wider, flatter, longer and more square male-looking chin into a narrower, more pointed and shorter chin more typically associated with females. Chin implants can also be used to achieve more forward projection of the chin, also more common among women. The overall affect can dramatically feminize a woman’s face.

Neck Lift & Face Lift
The Neck Lift and Face Lift procedures are used to bring out a younger, more feminine appearance of the face. These procedures are also a good option for women who have loose facial skin as the result of other FFS procedures that removed and/or reshaped facial bones. While Neck and Face Lifts are typically identified as anti-aging surgeries, the features of the aging face can be fairly masculine in appearance making these procedures an important part of the FFS spectrum.

Tracheal Shave
The neck of a woman is characterized by its length and lack of a prominent Adam’s Apple (thyroid cartilage.) Removal of this cartilage is called a Tracheal Shave or Adam’s Apple Reduction. The result of the surgery is consistent: an elegant, feminine-looking neck.

Not sure about which Facial Feminization Surgery procedures are right for you? Not to worry! During your consultation, Dr. Rumer will listen to your objectives, evaluate your face and neck, and make a recommendation about a surgical plan that will help realize your goal.

« Back to Facial Feminization Surgery

Breast Augmentation Revision – Asymmetry Ardmore

Breast Augmentation: The Pros and Cons of Silicone and Saline Breast Implants

Published 05-24-2016 by Dr. Kathy Rumer .

Male-to-female (MTF) Breast Augmentation is a transgender surgery that uses saline or silicone implants to enhance the size and shape of your breasts, bettering the alignment of your body and internal sense of self.

One of the decisions that you will need to make about your Breast Augmentation surgery is the type of breast implant that you want. While this is best decided in consultation with Dr. Rumer, the following information will help you learn more about which implant might be more suited to your needs ahead of your appointment.

Silicone Breast Implants

Silicone breast implants have an outer silicone shell and are filled with a thick medical-grade silicone gel. Silicone breast implants are FDA-approved for augmentation in women age 22 or older.

PROS

Silicone gel implants are softer and feel more like breast tissue.
Recommended for women who are very thin or have little natural breast tissue to cover the implants.
Risk of leakage is lower compared to silicone implants made in the 80s and 90s or saline implants.
A leaking silicone implant will not collapse* like a saline implant.

CONS

*A leaking silicone implant will not collapse. This is referred to as a “silent rupture”. The FDA recommends patients receive a MRI every two years to detect any possible defections of the implant.
While a ruptured silicone breast implant won’t deflate it may cause pain or changes in breast shape.
Some silicone implants are shaped rather than round. These implants have more projection at the bottom and if one accidentally rotates, it can cause an unusual appearance of the breast.
Silicone implants are inserted pre-filled, which requires a larger incision.
Twice the price of saline implants.

Saline Breast Implants

Like silicone breast implants, saline implants have an outer silicone shell and are filled with sterile salt water. Saline breast implants are FDA-approved for augmentation in women age 18 or older.

PROS

In the event of a leakage*, the saline inside the implant will leak out and be harmlessly absorbed by the body.
Saline implants are initially empty and are filled after they are implanted. This requires a much smaller incision, resulting is less scarring.
Because saline implants are “custom filled,” they’re ideal for women with visible breast asymmetry.
There are more options as to where incisions are located with saline implants.
Saline implants are approximately half the price or silicone implants (and follow-up MRIs are not required.)

CONS

*In the event of a leakage, a saline implant will quickly deflate, visibly changing the appearance of the breast. Most women would want this to be fixed immediately with a replacement implant.
Like silicone, saline implants can shift, change shape, harden and ripple.
Saline implants are firmer and feel less like natural breast tissue compared to silicone.
While leakage is relatively harmless, saline implants have a higher risk of leaking.

In MTF Breast Augmentation, both saline and silicone breast implants have advantages and disadvantages. Your decision about which implants best suit your goals will depend on your physique and preferences, balanced by your willingness to accept both the pros and cons of whichever implants you ultimately choose.

FACIAL FEMINIZATION SURGERY (FFS)

Published 08-5-2014 by Dr. Kathy Rumer .

WHAT IS FACIAL FEMINIZATION SURGERY?

Facial Feminization Surgery (FFS) is a collection of male to female surgery procedures designed to naturally feminize a patient’s appearance, giving them the facial features they should have be born with. FFS can involve any combination of the following feminizing surgeries depending on each individuals needs: hairline advancement; browlift; forehead contouring; orbital rim contouring; eyelid surgery; cheek augmentation; rhinoplasty; upper lip lift; chin augmentation; neck lift; face lift; or tracheal shave. Learn more about FFS procedures here »

Facial Feminization can also include non-surgical injectibles like Botox, Juvederm, Radiesse,or Platelet Rich Plasma (PRP).

WHAT SHOULD I KNOW ABOUT FFS?

There are specific features that distinguish a masculine facial appearance from a feminine facial appearance:

Female

Hairline : gently curved
Forehead : shorter and flatter
Brow : delicate arching, minimal bony prominence
Eyebrow : thin, arched
Eyes : larger
Nose : narrower, shorter, delicate
Lips : fuller, curvier, top turned up
Cheeks : fuller, apple-like
Chin/Jaw : delicate, oval shape
Trachea : flat, smooth

Male

Hairline : M shaped
Forehead : higher and angled backward
Brow : flat, thick, heavy, bony prominence
Eyebrow : thick, bushy, flat
Eyes : smaller and deep set
Nose : long, strong, wide, prominent
Lips : thin, flat
Cheeks : flat, depressed
Chin/Jaw : angled, prominent
Trachea : protruding and bulky

FFS will transform those features that are more masculine and make them naturally feminine allowing you to feel authentic and to feel you are finally in the place where “THE BODY TOUCHES THE SOUL.”

WHAT DOES THE PROCEDURE INVOLVE?

The process will begin with a private consultation with Dr. Rumer. At that time, she will perform a complete evaluation and together you will devise a plan that will help you to achieve the exact results you are looking to obtain. Most FFS procedures are done under general anesthesia in the hospital or surgicenter and are done on an outpatient basis, so you will be asleep for the procedure and you will go home the same day. The amount of time you will spend in surgery varies from procedure to procedure and will be longer if you have decided to have multiple procedures done at the same time.

HOW LONG IS RECOVERY AND WHEN CAN I RESUME MY NORMAL ACTIVITIES?

Recovery times from Facial Feminization Surgery vary with procedures. Typically expect to be resting and relaxing the first week after your surgery. You have some swelling and bruising which will all go away quickly. You should be able to go back to work in one to two weeks or sooner provided your work is not too strenuous. You can resume strenuous activity in four weeks.

Also see: Breast Augmentation, Vaginoplasty, Body Contouring

MTF BREAST AUGMENTATION

Published 08-5-2014 by Dr. Kathy Rumer .

WHAT IS MTF BREAST AUGMENTATION?

MTF Breast Augmentation is a male to female surgery procedure designed to provide patients with expertly augmented and contoured feminine breasts – the breasts you were always meant to have.

A surgical procedure is performed to enlarge the breasts by inserting a breast implant either behind the breast tissue or partially or completely under the chest muscles. Incisions are made to keep scars as inconspicuous as possible, usually under the breast along your natural skin fold. The method of implant selection and size, along with surgical approach for inserting and positioning breast implants, will depend on your preferences, your anatomy and Dr. Rumer’s recommendation.

MTF Breast Augmentation increases the breasts’ size or shape with implants. Silastic (silicone polymer) is used for outer shell of all implants, but there are various fillers, including saline and silicone. Silicone gel is used predominantly these days to create the most natural feel. During the consultation, Dr. Rumer will suggest which procedure she thinks best suits the candidate.

WHAT SHOULD I KNOW ABOUT MTF BREAST AUGMENTATION?

Although most breast implants will last a lifetime, some implants may to be replaced after about 10 years.

There are two locations where the implant may be placed – submuscular and subglandular. Submuscular indicates between the chest muscle wall and rib cage, and is often used in small-breasted women. It provides extra padding, creating a natural look while decreasing potential scarring. Subglandular indicates in front of the pectoralis muscle and under the breast tissue. The subglandular procedure is typically recommended for larger-breasted women, as the outline of the implant may show through skin of smaller breasts, especially in thin-skinned women.

There are three types of incisions used for inserting breast implants – the inframammary, the peri-areola, and the axillary. Dr. Rumer recommends the inframammary incision method in that it is made under the breast, at the fold or crease line, which naturally hides the scar. This incision method also permits immediate access to the breast for precise implant placement. All sutures are under the skin.

WHAT DOES THE PROCEDURE INVOLVE?

Once general anesthesia has been administered and has taken effect, the inframammary incision, about 3 cm long, is made. A pocket is then made behind each breast (either submuscular or subglandular). The breast implants will then be placed in these pockets and positioned for optimal appearance and symmetry. After comparing both breasts to ensure proper implant placement, Dr. Rumer will close the incisions with stitches.

HOW LONG IS RECOVERY AND WHEN CAN I RESUME MY NORMAL ACTIVITIES?

Most patients can walk delicately and do light daily activities the day after MTF Breast Augmentation surgery. It’s advised to take it easy and avoid stretching and heavy lifting during the first seven to 10 days. You can return to non-strenuous work within three to seven days. Driving is possible after a week. Most swelling, bruising and soreness is gone within four to six weeks. You can return to strenuous activities in six to eight weeks. Plan on being cautious for the first two months. Your final bra size can be determined within 10 to 12 weeks. The scar will continue to fade for up to two years.

Breast Augmentation: The Pros and Cons of Silicone and Saline Breast Implants
One of the decisions that you will need to make about your Breast Augmentation surgery is the type of breast implant that you want. While this is best decided in consultation with Dr. Rumer, the following information will help you learn more about which implant might be more suited to your needs ahead of your appointment. Continue reading »

Also see: Facial Feminization, Vaginoplasty, Body Contouring

GENDER REASSIGNMENT SURGERY (GRS)

Published 08-5-2014 by Dr. Kathy Rumer .

WHAT IS MTF GENDER REASSIGNMENT SURGERY?

MTF Gender Reassignment Surgery (GRS) is the male to female procedure is for transgender women who wish to have the vagina they should have been born with.

WHAT SHOULD I KNOW ABOUT GENDER REASSIGNMENT SURGERY?

Dr. Rumer performs a One-Stage Modified Penile Inversion Vaginoplasty. Having a strong background in engineering and fine arts, she is able to design a result that has an authentic appearance with excellent depth, function and sensation – a result perfectly suited to your anatomy. In addition, Dr. Rumer’s GRS technique does not require electrolysis or laser hair removal of the genital area before surgery and there is NO regrowth.

WHAT DOES THE PROCEDURE INVOLVE?

GRS is done while you are asleep under general anesthesia. It takes approximately four hours to perform. Following your surgery, you will be admitted to the hospital for three days of strict bed rest while your new vagina heals. After the three days of bed rest, you will be discharged with a catheter in your bladder, some vaginal packing and two drains. One week from your surgery, you will return to the office in order to have the catheter, vaginal packing and drains removed. At that time you will be given your dilators with full instructions on the dilation schedule and lifetime instructions for the care of your new vagina.

HOW LONG IS RECOVERY AND WHEN CAN I RESUME MY NORMAL ACTIVITIES?

Patients are asked to rest and relax for the first week after MTF Gender Reassignment Surgery. It is very important to diligently follow your dilation schedule to maximize your results. After the first follow-up visit, patients can begin to get back to normal daily activities, but strenuous activity is not recommended until six weeks after surgery.

Also see: Comparing Penile Inversion and Rectosigmoid Vaginoplasty, Breast Augmentation, Facial Feminization, Body Contouring