Introduction
Dr Goossen (Goss-en, not Goose-en) has recently moved over to Brisbane, Australia from the UK where he did a lot of work with Dr Ralph and the team over there; and is commencing Phalloplasty surgeries. His consulting rooms are in Mount Gravatt, and he works out of Greenslopes hospital.
Surgery
Dr Goossen uses the Radial Forearm Flap (RFF) method as a primary technique for phalloplasty, however did advise that he uses the Anterolateral Thigh (ALT) method if the RFF fails, or if the patient is not a good candidate for RFF.
The total phalloplasty is done in three stages with a fourth stage used only if it is required (note: surgical times are not set in stone and depend on how the body reacts during surgery/other variables that occur with surgical procedures):
First surgery: Creation of the phallus and urethral lengthening (6-12 hours of surgery).
Second surgery: Urethral hookup, vaginectomy. Scrotoplasty and some glans-shaping may occur – depending on how the body reacts (3-4 hours of surgery).
Third surgery: Prosthetic implant and glans-shaping. Any further ‘adjustments’ that might need to be made (3-4 hours of surgery).
There is a 2-3 week stay in hospital post each surgery, and patients should be able to fly (if required) after three weeks. Dr Goossen prefers to complete surgeries within 4-6 months of each stage being completed – this is due to the length of time required to heal from each stage, but also gives scar tissue time to become more malleable and easier to work with for the next stage.
There are some pre-surgical tests that need to be done – however they are just routine blood/urine tests.
Dr Goossen prefers to work within the ‘normal’ BMI range, however he recognises that BMI does not give an accurate reading on how healthy someone is (IE- it doesn’t take muscle into account). He advised that a BMI of over 35 would start to be a concern; however it depends on the person.
Prosthesis
The prosthetic used by Dr Goossen is inflatable. Semi-rigid is not recommended due to wear.
Surgery Costs
All surgery costings are in AU Dollars ($)
Consults – $170.00
Surgery – Approximately $50,000 – $70,000 depending on the technique used.
Please note that the costs detailed above are purely for the three surgical procedures, the surgeon and the assistant. They do not take into account hospital costs, pre-surgical testing or anesthetist fees.
Donor Site
Speaking purely from the RFF point of view, the tissue for the new urethra and phallus will come from your forearm. It is usually the non-dominant side (left in my case), however depending on other variables such as blood-flow – that could change. The tissue mainly comes from the underside of your forearm and moves around about 3/4 of the arm. Laser hair removal is highly recommended, and as soon as I get information regarding how much of an area needs to be covered – I’ll advise.
Now if they’re going to remove tissue from somewhere, they’re going to have to replace it with tissue from somewhere else. Where it comes from depends on the type of graft (either split-thickness or full-thickness); the skin will either come from the thigh, or from the buttocks. Again – it depends on the person.
Transport / Accommodation
Because I don’t have a date as such, I’m using a three-week period in June 2016 at the moment for costs of accommodation and travel.
Domestic flights to Brisbane return are currently between $100-$700 depending on who you fly with. Because it’s a city, there are usually some pretty good deals going on – you just have to keep an eye out for them.
Accommodation-wise I don’t really have to worry so much, as I have family that can look after me. However you can get some pretty good accommodation for quite cheap if you’re willing not to be right in the middle of the city. Brisbane has good public transport services – so you’re usually always able to get where you need to go pretty quickly.
Physical Activity / Restrictions Post-Surgery
It may or may not surprise you to learn that if you go ahead with Phalloplasty, you can expect not to be doing much working out for 18 months.
For the first month or so post each stage, you’ll be doing nothing at all. For the first two months post-op there is to be no strenuous activity at all. From there you can start building up again (just in time for the next stage!).
There will obviously also be restrictions on your donor sites -so you will be very sore all over.
Specialist Referrals / Other information
To go to my consult with Dr Goossen, I only needed a referral from a GP. To go ahead with the surgery though, you will need a letter of recommendation from your psychiatrist as a minimum – he will advise you of exactly what is required.
For me, I needed to get the psych recommendation, then get a full history of my treatment to-date from my GP (because I’ve just moved, there was a bit of a kerfuffle with my history).
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The prospect of having a surgeon in Australia able to complete this surgery is very exciting. I’m very happy with the results I’ve seen, and I have confidence in Dr Goossen’s ability – so I plan to go forwards with him for my phalloplasty.
There are a couple admin-type things that need to occur from here for my case, however hopefully there will be movement soon regarding a surgery date.
My Transition FtM 