TOPIC: Any experience with Texas Phalloplasty?

eqstudent wrote:

londonlad wrote: 'Even though the surgery didn't work in terms of gains, I am glad I was left with nothing rather than a dodgy alloderm graft years later'

I am truly sorry your scaffold procedure did not work out. However having said that, for the slightly lower surgical procedure risk (IMO) with Alloderm you would not end up with a 'dodgy graft years later'. You will know within the first 90 to 180 days if there is a problem. Most (non penis) Alloderm studies show infection/rejection rates to be very low on the order of < 2%

thanks for your concern. I don't know if it is a slightly lower risk surgery really? the methods vary but alloderm can be inserted after complete degloving or by stuffing it from the base or the circ scar or both so on which method is your opinion based on? Plus to my knowledge only urologists do/did the scaffold not plastic surgeons which is the case with many of the alloderm surgeons.

Also these guys seem to have found a study talking about how 8% of patients requiring alloderm mesh explants. I can't find the study but maybe you can ask them for it since it interests you in particular and will be of benefit to all of us

www.hernia-patchlawsuit.com/failure/mesh-explant/

and this study says that almost half of alloderm patients experienced diastasis and if it was in me I'd consider it a "dodgy" graft

www.ncbi.nlm.nih.gov/pubmed/16924395

I'm pretty sure I've ruled out alloderm because the gains are modest at best and risks get dodgier with subsequent surgeries not to mention all the real horror stories that managed to get shown on the various boards over the last few years. However, if you are seriously considering this surgery you could consider Dr Reed as he can give you good advice being pro-alloderm but bear in mind he is conservative and will not stack sheets and will make you wait a hell of a time before he decides if you are suitable for a second round


Can't read this one but sounds interesting
www.ncbi.nlm.nih.gov/pubmed/17255646

This one gives information about the popular surgery types
books.google.co.uk/books?id=GahMzaKgMKAC...omplications&f=false


Lastly to show how much of this data gathering by the actual professionals is so damn unhelpful this report shows 100% satisfaction and no-complication rate with silicon liquid injections, and also a much more positive outlook on plga than any of us actually had in the real world (where is bonehead??)

www.eu-acme.org/europeanurology/upload_articles/Gruenwald.pdf

keep it coming

@hoddle10 we will agree to disagree on Scaffolds vs. Alloderm. One important note, the scaffold material (PLGA, ePTFE, ') is more likely to cause a foreign body reaction than Alloderm, remember Alloderm is an Acellular dermal matrix. Also the task of combining one's cells with the scaffold material and ensuring survival and growth is daunting. I am very confident that if you ask 100 surgeons today on the safety of Alloderm vs. Scaffolds all 100 would pick Alloderm. Now in 7 to 10 years that may change. As the CMO of the firm where I work said about the emerging scaffolding opportunity 'let them continue to experiment on people in Eastern Europe and the Far East where no one seems to care'.I am very aware of most of the discussions that took place on the old board so let's leave it at that.I am extremely concerned about the overall complication rate of all these procedures. If you have any links or data on said rates I would very much appreciate you pointing me towards them.I hear you on the FFT. Your extreme caution is noted, heard, and very much appreciated. If there only 3 doctors in the US who doing it that is 3 more than are doing PMMA in the penis!

eqstudent wrote: @londonlad ' Hernia Repair is the new hotbed for Alloderm usage and is very controversial, Breast Reconstruction is the other but less contentious. journals.lww.com/plasreconsurg/Abstract/.../pubmed/18847657What will make your head spin is that Alloderm has gained popularity as a hernia repair option because Alloderm does very well, and much better than tissue repair or artificial meshes, in contaminated (infected) wounds at resisting infections! www.ncbi.nlm.nih.gov/pubmed/17071174 Agreed on the gains. Current state of the art for Alloderm penis girth increase is 0.75" max. If you want more than that I would look elsewhere!

noted, just shows that in the end your decision might have to be based on emotion and trust in the doctor rather than true evidence if past papers is all we are going by.

that 0.75" gain (if that ) is in flaccid, not always erect by the way

eqstudent wrote: @hoddle10 we will agree to disagree on Scaffolds vs. Alloderm. One important note, the scaffold material (PLGA, ePTFE, ') is more likely to cause a foreign body reaction than Alloderm, remember Alloderm is an Acellular dermal matrix. Also the task of combining one's cells with the scaffold material and ensuring survival and growth is daunting. I am very confident that if you ask 100 surgeons today on the safety of Alloderm vs. Scaffolds all 100 would pick Alloderm. Now in 7 to 10 years that may change. As the CMO of the firm where I work said about the emerging scaffolding opportunity 'let them continue to experiment on people in Eastern Europe and the Far East where no one seems to care'.I am very aware of most of the discussions that took place on the old board so let's leave it at that.I am extremely concerned about the overall complication rate of all these procedures. If you have any links or data on said rates I would very much appreciate you pointing me towards them.I hear you on the FFT. Your extreme caution is noted, heard, and very much appreciated. If there only 3 doctors in the US who doing it that is 3 more than are doing PMMA in the penis!

I know you want to agree to disagree, but I do want add some more as what you've posted is key to the point I'm trying to make. We are talking about the safety of the products regarding PE and not in general use. I'm sure if your CMO were aware of what type of surgery the two products were being used in, he'd have a different opinion and the same would be true of the hypothetical 100 surgeons. The penis is a dynamic organ and therefore having a less pliable material grafted onto it can cause real problems, such as shortening and curvature. Obviously this wont happen with the scaffold material. You also have to worry about long term encapsulation, which again wont happen with the scaffold. And of course if Alloderm gets infected and needs removing you are in real trouble. The makers of Alloderm specifically point out that they don't recommend its use for penis enlargement. The scaffold is specifically made for penis enlargement and in theory is far more suitbale. I don't recommend the scaffold, as results are inconsistent to say the least and the main surgeons doing it have caused their fair share of problems, but in terms of your safety criteria, the scaffold itself is definitely superior to Alloderm. Sorry for harping on after you'd requested we take it no further, but I really want to stress the point that it isn't a case of simply comparing the materials themselves, but their application in penis enlargement surgery.

londonlad wrote: 'Even though the surgery didn't work in terms of gains, I am glad I was left with nothing rather than a dodgy alloderm graft years later'

I am truly sorry your scaffold procedure did not work out. However having said that, for the slightly lower surgical procedure risk (IMO) with Alloderm you would not end up with a 'dodgy graft years later'. You will know within the first 90 to 180 days if there is a problem. Most (non penis) Alloderm studies show infection/rejection rates to be very low on the order of < 2%

hi guys just thought i'd chime in to clarify some bits and bobs

eqstudent wrote: One important note, the scaffold material (PLGA, ePTFE, ') is more likely to cause a foreign body reaction than Alloderm,

in my understanding this foreign body reaction is what causes new tissue and blood pathways to grow within any matrix

eqstudent wrote: remember Alloderm is an Acellular dermal matrix.

again in my understanding this is a good thing when compared to implanting someone elses unprepared cellular tissue which could be rejected but irrelevant as a negative when compared with other acellular matrixes such as prepared pig dermis or synthetic scaffolds
When compared to synthetic (also obviously acellular) scaffolds such as PLGA I believe it is at a disadvantage for the following reason
According to my understanding and experience, the PLGA scaffold dissolves completely with only the new tissue remaining. (Unfortunately there is little to no gain and no guarantee of consistent tissue creation). With the alloderm or any other material that is not guaranteed to completely absorb there are dangers. Not only can the graft contract in unusual ways, as Hoddle has mentioned, it is grafted to the fascias and can cause limitations in Erection length and twisted appearances not to mention blood flow issues.The major danger however is if new vessels are not grown through the graft quickly, which is more difficult with thicker or multiple sheets, and the graft does not either "take" (ie become cellulariesed) or completely dissolve, the body is left with this acellular material that is now prone to harbouring infections. The body has less chance of fighting the infection because of the very fact that the graft is acellular and porous

eqstudent wrote: Also the task of combining one's cells with the scaffold material and ensuring survival and growth is daunting.

Daunting, yes, but applies to alloderm too.

eqstudent wrote: I am very confident that if you ask 100 surgeons today on the safety of Alloderm vs. Scaffolds all 100 would pick Alloderm. Now in 7 to 10 years that may change.

Not sure if this is useful...better to ask 100 urologists. Also find out how many doctors have had to take out alloderm grafts. Urologist Dr Gary Alter can give some good advice regarding this.

eqstudent wrote: As the CMO of the firm where I work said about the emerging scaffolding opportunity 'let them continue to experiment on people in Eastern Europe and the Far East where no one seems to care'.

Your CMO sounds unethical at best and it also seems that the company you work for are not going to win any awards for pioneering efforts or breakthroughs any time soon . Perovic and his team were world renowned. At least in the UK all the top urologists I had consulted respected the work that the Serbian team did. Also I doubt any doctor anywhere really cares about us the way we are supposed to care for ourselves. There is limited sympathy when things go wrong especially with penis surgery whether in serbia, uk, thailand, us or mexico
Even though the surgery didn't work in terms of gains, I am glad I was left with nothing rather than a dodgy alloderm graft years later. Being Circumcised is a major drag too but that would have happened with any surgery regardless.

I would not recommend either procedure and in hindsight would never recommend anyone taking a scalpel near their penis unless absolutely required.
However, even though no urologists are going to appreciate anyone inserting PMMA in their penis, my interest is still piqued and I enjoy reading the studies that you gopher out so keep it up please. More information both negative and positive regarding the procedure is better and thanks to all.

(disclaimer: just an average joe with no medical background yada yada, read as opinion only)

hoddle10 wrote: ...In my opinion, based on cases I've followed pre the actual surgery (ignoring those who only joined the forum and told of their woes after they had surgery), I'd say short term success (under 2 years) of these procedures is about 75%. Long term I'd say this drops to below 50%. I'm not including the Elist Implant in this.

I am very comfortable in using those numbers, based on your 14 years' experience in this field, in lieu of established studies. I would suggest you create a sticky post with this info so that newbies such as myself can see what they are really up against before they undertake these elective surgeries!

@mikehok ' the touchups for FFT if needed would not be an issue for me. I agree that Alloderm has a high risk just from the surgery so I would not be surprised that there are bad outcomes. There are also some very good outcomes like soma. I will continue to research.@justabitmore ' Conservative staged FFT is my leading option based in small part on your testimony. I will ask the doctor for 10 to 15 references that I can speak to who have had the procedure.

EQ, FFT I can understand because of it's safety profile. Personally I wouldn't do it because I don't want to do constant top ups and there appears to be some disagreement over the firmness of the result.

But alloderm would concern me, I've heard too many bad stories. it's interesting how we all assess risk in different ways. I think somewhere you described yourself as more risk averse than me and yet you're prepared to consider something I wouldn't. Seems we all have a bias when weighing these things up. After my previous experiences I'm trying to avoid having a scapel anywhere near my Dick and so the idea of a quick in and out with a micro cannula appeals. Each to their own I guess

@hoddle10 ' thanks for your opinion. I don't believe I am operating on any 'gut feeling'. I am trying to do detailed analysis of the viable options as I see them. I do believe there are other viable options than Newplastic injections see my options here phalloboards.websitetoolbox.com/post/sho...401713&postcount=16I am not sure why you included FFT in the surgery category. IIMU that it is an injectable filler option much like Newplastic or Artefill. Am I mistaken? I have stated in the past that I see all the PE procedure options as investigational or experimental. There are no safe procedures, everyone needs to weigh the risks against their own personal situation.

mikehok wrote: I agree with Hoddle. Seems to me that sparticus/eq concentrate their attacks on PMMA and play down the risks with other procedures. I don't know why...

Since you have made an issue with my posts I would like you to find and quote a single post I have made on this or the other site where I have "played down the risks with other procedures".

"You remind me of Sparticus and he couldn't seem to grasp that there simply is no safe option that anyone having this surgery needs to accept this and then make a decision based on the overall risks of the procedure itself and not so much the material being used."
Thank you for your astute observation. I apparently lack the ability to read medical studies, despite my education, and am irrational in concluding that NO procedure has enough evidence to support its efficacy or safety. I will take your advice and just accept the risks and get it done ASAP. Thank you for clearing up what I could not understand on my own.

@londonlad ' Hernia Repair is the new hotbed for Alloderm usage and is very controversial, Breast Reconstruction is the other but less contentious. journals.lww.com/plasreconsurg/Abstract/.../pubmed/18847657What will make your head spin is that Alloderm has gained popularity as a hernia repair option because Alloderm does very well, and much better than tissue repair or artificial meshes, in contaminated (infected) wounds at resisting infections! www.ncbi.nlm.nih.gov/pubmed/17071174 Agreed on the gains. Current state of the art for Alloderm penis girth increase is 0.75" max. If you want more than that I would look elsewhere!

I agree with Hoddle. Seems to me that sparticus/eq concentrate their attacks on PMMA and play down the risks with other procedures. I don't know why.
The fact is there are risks with ANY procedure. There are different types of risk. Personally I am convinced the risk of a deformed Dick is much greater with alloderm than PMMA.
The death of the Argentine beauty queen following a PMMA procedure is constantly cited. But what does that prove ?
Perhaps we should avoid the dentist since death can occur therehttp://www.telegraph.co.uk/news/1358962/Parents-sue-over-death-at-dentists.html
And whatever you do don't have a routine knee ophttp://www.dailymail.co.uk/news/article-1386050/Mia-Amber-Davis-Road-Trip-Actress-plus-size-model-dies-36.html
Surgery to Repair an achilles tendon can be lethalhttp://profootballtalk.nbcsports.com/2010/07/22/former-nfl-player-dies-after-routine-surgery/
The list of deaths from routine surgery is endless. Obviously we need to assess the risk before proceeding with any procedure, but let's at least take a balanced view.

eqstudent wrote:

hoddle10 wrote: 'I couldn't agree with many of your rankings and it seemed as if you'd already made up your mind and your chart reflected what you wanted to be the case.

Incorrect. The chart was my way of presenting my current thinking. If you have been following the thread you should see that I have already changed cells based on opinions from Dd71, justabitmore, Skeptical One, and mikehok. I have presented detail on my thinking/analysis and asked for, welcome, and incorporated feedback.

hoddle10 wrote: 'For example, you have the scaffold as higher risk than any of the dermal matrix products, which doesn't make much sense.

I ranked scaffolds higher risk because it carries the same or slightly higher surgical risks as the allografts plus the scaffolds/tissue engineering piece is highly experimental with few actual successes while the allografts particularly Alloderm have 20+ years of successful procedures all over the body and is standard for burn replacement, breast reconstruction, gum replacement and hernia surgery amongst others.

hoddle10 wrote: 'Basically what i'm saying is that side effects such as granulomas etc aren't all you need to worry about. I can't begin to explain the mental devestation that happens to a guy when he see's his penis is deformed, be it by uneven, lumpy, soft fat or necrosis, or material rejection, or scarring or shortening'

Since this seems to be about why I haven't chosen Newplastic (PMMA) I believe that most of the complications you cite have occurred in the face of PMMA patients just check realself or makemeheal sites. See also the independent studies I have cited.

hoddle10 wrote: 'The reason I specifically singled you out is because in another thread you said you considered a 1.4% risk with an injectable too much, which immediately made me wonder if you were fully aware of just how frequently the surgical options go badly wrong. '

Incorrect. In this thread the hypothetical 1.4% was referring to Alloderm surgery infection rates not injectables! phalloboards.websitetoolbox.com/post/sho...338552&postcount=113
I also posted this phalloboards.websitetoolbox.com/post?id=5385417 so I am well aware of the risks.

hoddle10 wrote: 'FFT is definitely surgery. Liposuction on it's own is surgery'

You are absolutely right. I completely forgot the lipo component. I will update FFT procedure risk to medium even though I believe lipo is a very low risk procedure and FFT is also a very low risk procedure. Thanks! I think this segment should be moved into the "PMMA or nothing thread".

Scaffolds are much safer than Alloderm as they aren't foreign bodies, but using your own cells. The scaffold itself will disolve within 6 months, whilst Alloderm may or may not reabsorb after 2+ years. Also alloderm is grafted, so can cause scarring and shortening and as a foreign body can be rejected encapsulated years later (as happened to the infamous Chad Hedman). In terms of surgical technique I can't see much difference. Alloderm has a much higher chance of getting infected and seeing as the matrix is semi permament it will require removal. The key difference between the two is that Alloderm offers far more consistent results, but as I've pointed out, at a higher risk.

It's not your fault as the threads get so big, so we can't expect people to know what has been discussed before, but many of the studies you've posted were already discussed at length, as were the posts on realself and makemeheal on the old board. The complications I've pointed out that occur in PE surgery which, you've compared with PMMA in the face, but this again has already been spoken about (again i understand that you wouldn't be aware of this.) You can't really compare facial injections of PMMA with penis surgery, but even if you did, complication rates would still be way lower.

Sorry I confused Alloderm and injectables for the 1.4% rate, but the general point I'm making still remains. If a 1.4% infection rate is worrying you, then overall complication rates from these surgeries should cause you much more concern.

As for Texas Phalloplasty you know fat transfer surgery is very easy compared to most plastic surgery procedures and you also know that the demand for penis enlargement in the US is very high. Yet despite this demand and simplicity of procedure I think only 3 Dr's in the entire US do it! You have to ask yourself why this is. And why do they offer both Alloderm and FFT. Alloderm is much more expensive, involves more intensive surgery and yields only modest results. Yet they still offer it. It doesn't make sense they'd offer a more expensive and riskier procedure if they truely believed in the quality of the results they are getting with FFT. I think there are some pretty obvious red flags here in the same way there was when Dr Elist came onto the scene.