What to Bring
If you are having GRS, gowns, undies, dressings and triple antibiotic ointment will be supplied by the hospital. We provide a quality set of three tapered and graduated stents for dilation- a critical part of your post-operative care.
You may want to bring the following personal care items: a couple of outfits for before and after surgery: a bathrobe, slippers, hair bands, a mirror for your bedside. Consider your favorite lotion, lip balm, and hard candy or throat lozenges as you are likely to be very dry after surgery while on pain medication. You will also need to buy additional lubrication for dilating such as Surgilube or K-Y along with sanitary pads.
If swelling occurs Dr. Bowers may suggest you wear tight-fitting underwear so bring your tightest fitting undies.
We suggest bringing books, music and/or movies to pass the time as you recover. The hospital provides complimentary wi-fi access so laptops and tablets are a good option.
Two to three days prior to surgery:
Arrive in California, make yourself at home here. There is much to see and do. You might want to think about how you’ll get to Dr. Bowers’ office for your pre-operative visit and to the hospital for your surgery.The office and Mills-Peninsula Hospital are less than 10 minutes from SFO so rental cars are only necessary if you wish to see the area, have guests or extra money. If staying at the Staybridge Inn and Suites, they offer a shuttle service which covers the office and hospital. Dash Limousine is available for all patients arriving into SFO and departing after GRS. See our Travel page for more information.
On the day of your pre-surgery visit:
You will see Dr. Bowers today for a pre-operative visit and examination. The encounter will allow you to ask questions of Dr. Bowers and her staff. You’ll also get to plant your flag in our global map board, documenting your journey! Your history will be reviewed and an exam will follow with Dr. Bowers. It is natural to have pre-surgery jitters but this visit should calm your fears immensely. You will pick your prescriptions up at the local pharmacy and begin plans for your bowel prep (always the day prior to surgery). You will be contacted prior to surgery by Mills-peninsula hospital for pre-anesthesia screening. A visit to the hospital for blood work usually follows your exam today. You will also receive your follow-up appointment dates for packing removal and dilation back in the office
On the day prior to your surgery:
You MUST restrict yourself to a clear liquid diet only all day long, darn it. No solid foods, not even breakfast. This is to clear things out and make surgery go more smoothly. The bowel prep is also very dehydrating so drink from the list below up until midnight. However, you are not allowed to have anything by mouth after midnight, even water. With some medications, we may suggest that you do go ahead and take these on the day of surgery with a very small sip of water but ask us if you think your medication is vital.
Clear liquids include:
- Water (duh!)
- Clear fruit juices with NO pulp (apple or white grape)
- Clear vegetable, beef, or chicken broth
- Coffee or tea with NO milk or creamer
- Carbonated or non-carbonated soda (Sprite, Mountain Dew, or 7-up)
- Plain Jell-O (Go ahead, name yo’ flav-O’!)
- Electrolyte drink such as Gatorade or Poweraid or Vitamin Water
- Popsicles (any flavor)
- Kool-aid (childhood flashback?)
- Ginger-ale (Hey! Pretend it’s champagne and celebrate your amazing journey!)
Admission will be the next morning although the time will vary if you are an AM surgery or PM surgery. We will let you know what time to be at the hospital. If the bowel prep is done and you wish to clean up, a shower or bath is recommended. We do ask that you to go ahead and shave the genital area, if you feel comfortable doing so. It saves nursing time in the OR and might be less hurriedly done if you are the shaver, not the nurse on morning duty the day of your surgery .
Day of Surgery:
Depending upon the time of your surgery, expect to arrive at the hospital early morning or later morning. Check in. Your family, friends or loved ones can be with you in the Pre-surgery holding area. You will be interviewed by nursing and anesthesia. Dr. Bowers will see you as well just prior to your departure for the OR. If you can, leave valuables at your hotel or with your support members. If not, they will be securely locked up for you. Your post-op room will be private and secure. Once you have spoken with anesthesia, you may ask for something for relaxation although that will typically be given in the OR once your IV has been started.
You may wake up in the OR recovery area, in your room, or somewhere in transit. After surgery, you might be sore, but many patients report little pain or discomfort. Ask for medication if you need it! There may be a sensation like needing to pee due to the presence of the Foley catheter. And there may be a full sensation, like needing a bowel movement, due to packing in the vagina. Pain medication can make you feel nauseous so go slowly. Typical post-op pain subsides quickly after 24 hours so listen to that. The less you take, the faster your bowels return to action and the more you will feel like being social, finishing that good book or catching up with I Am Jazz. Do not expect a bowel movement while hospitalized due to the bowel prep and pain meds. If you do, great! We will have you take stool softeners and have things pretty well managed there as things return. If you get desperate once you have left the hospital, Milk of Magnesia or mineral oil at bedtime can do the trick. Your new dilators will be given when you are discharged. These will be important to bring to your post-operative appointment.
Throughout your recovery, you will want to drink plenty of water. To reduce swelling, we will have you apply bagged ice to the area. The nurses at Mills-Peninsula are sensational and attentive. But, if you do not find your needs being met, simply ask them. Only rarely do complaints reach my eyes. But if you have one, let me know! Complaints are how we get better…
Day After Surgery:
Pain control and sleep are the primary prescription during your first day following surgery. You may be introduced to liquids during your first night. You will have your blood drawn. Breakfast arrives the first morning. Although this is no time to pig out, the hospital menu is a la carte, unlimited and pretty darn good. If you feel nauseous — and certainly prior to taking pain meds — eat something. Even a cracker or piece of bread can help. You may be switched over to oral pain medication today and, after 3 doses of antibiotics, your IV stopped. Shift a bit in bed. You are at rest (spa time!) but may sit up to 45 degrees and may lay a bit on your side with pillow boost. Ask for help! Your support and nursing staff can help. Hospital has free wi-fi. Simply click in.
Day Two After Surgery:
Your dressing comes off this morning if all is well, usually on the night shift before morning. If all continues to go well, you will be out of bed today. We will start you slowly, at the bedside at first, then maybe up to a chair and possibly then a short stroll. Have someone with you always when first up! A shower is not out of the question, late in the afternoon possibly. Run the water warm but not hot. You will be given a small estrogen dose today by mouth. For many, this may be your typical hormone dose going forward. Your usual medications should be in their prescription bottles and should already be with the nurses for safekeeping. These may be restarted. Simply ask. If bored, name your dilators — lemme see, Curly, Moe and Larry — Tom, Dick and Harry — Peter, Paul and Mary — the possibilities are endless!
Day Three After Surgery:
Graduation Day! You made it! If everything goes as planned, you will be released today! Expect Dr. Bowers sometime before 11 AM. One of the docs will remove the drain coming from your left butt cheek. No big deal! This is an odd sensation but normally not excruciating. You can take a pain pill ½ hour before they do this, if you just don’t want to tough out yet another surreal experience. Checkout is not rushed and should be with you completely comfortable with that next step of discharge. Have lunch if you wish although checkout is typically in the morning hours. Most patients choose to take a wheelchair escort to the waiting car or taxi although you may walk if confident enough to do so. We will cart your luggage and things with you.
Days Four and Five After Surgery:
These days are for resting and relaxing, usually at a local guest hotel or at home if you are lucky enough to live within driving distance. You should be ever more active each day. Don’t push yourself and certainly punctuate the day with naps but definitely do walk more. You may consider an outing like a meal or a movie but no power shopping please. A nice drive would also be ok if sitting on your stitches doesn’t sound too bad to you. Personally, I like the idea of sitting by a pool, dangling my feet in the water and diving into a good book.
Day Six After Surgery — Follow-Up Visit:
Today you will be returning to Dr. Bowers’ office for packing and catheter removal, and to be taught how to dilate. Please bring your dilators! Once in Dr. Bowers’ office, the Foley catheter is removed. There is occasionally a tiny trickle of blood (controlled by pressure) around the urethra when the catheter is first removed. The vaginal packing will then be pulled and you will be taught about dilation of the vagina (see discharge instructions). Spend the night in a local hotel. Although you are released, we normally prefer that you stay another night or two close by, to make sure there are no problems that arise and that dilating goes as planned with you completely in control.
Driving is not recommended, particularly while on pain medication. Taking advantage of friends or family, or taxi service for transportation seems pretty logical. If there are any issues you wish to discuss, it is possible to coordinate a visit later in the week. Please call ahead to the office if you feel you need additional support or questions answered. Most days, you can be easily accommodated for these visits.
If you have counted along, if surgery was on a Tuesday or Wednesday, discharge from the hospital would be on a Friday or Saturday and the packing/dilation visit would be on a Monday or Tuesday.
Day After Follow-Up Visit:
Spend today resting and relaxing in your hotel room. If you want to get out into the brave new world, go to lunch or do some light shopping, but plan on taking plenty of down time also. Work on getting plenty of rest for your travel day tomorrow. Don’t forget your thrice daily dates with your dilators — oh boy! Acrylic sex — who knew? Use lots of lube and try to laugh.
The Next Couple of Days:
You are welcome to remain in the Bay Area but can likely travel home today. Some like to remain longer or even sight see a bit. If there are any problems during this time, you are encouraged to call us or text Dr. Bowers.
This will probably be a long travel day, so get plenty of rest the day before. You already have our cellphones in your discharge instructions. We will call you about 6 weeks after your surgery to follow up, but again, stay in touch with us! Texting is the new norm as we have become busy so try that for starters but do feel free to call.
We will, hopefully, be able to send you home with your Surgical Declaration Letter. One per customer, but additional copies (in case yours gets lost, destroyed, or eaten by beaurocracy dogs) are available for a fee of $25 each. Letters are free if notarization is not necessary but most un-notarized letters are meaningless, sadly.
Please visit our Patients Page for links to some of our patients who have documented their experiences online. Like us on Yelp, Facebook and any other startup social media website that arises during my lifetime… and attack that goofy HealthGrades (who don’t even seem to know I’ve left Colorado). There is also a Yahoo Group that some of Dr. Bowers’ patients have set up to chat, trade notes, ask advice, etc.
Most importantly, we want YOU to be happy. This is only the beginning and we are here with you for the long run. Your happiness is our happiness. Be well!
Gender dysphoria is a state where the individual shows a strong and persistent identification with the opposite gender and a belief of being born in the wrong sex. Gender reassignment surgery (GRS) is a complex surgical undertaking. Although this group of patients is rapidly increasing worldwide, the literature is limited in terms of the outcome. Sweden has a long history of GRS in male-to-female (MtF) patients. In this study, we present the surgical outcome, mortality and short-term post-operative complications in MtF GRS surgery at our centre over a period of 14 years.
Material and methods
This is a retrospective cohort study on consecutive patients who underwent primary MtF GRS at the Department of Plastic and Reconstructive Surgery at Karolinska University Hospital from 2000 to 2013. Demographics along with surgical complications were registered and analysed.
During the study period, a total of 205 primary MtF GRS were performed. Median age of patients was 33 years (range 18–76). Major complications such as deep infection, rectovaginal fistula and pulmonary embolism were rare. Minor complications affected approximately one in four patients. The most common minor complication were bleeding and infection.
MtF GRS can be performed with a low rate of major complications. Our data indicate that increasing surgical experience leads to shorter operating times and less complications. This suggests that GRS surgery should be performed at few centres so that surgical experience and volume may be optimized.