The complications these girls have aren't just minor annoyances, either; they're major, life-altering issues. They can claim all they want that urinary fistulas, chronic and multidrug-resistant urinary tract infections, failed skin grafts, loss of upper limb function, and tissue necrosis are no big deal and within the realm of reasonable expectations, but the reality is that most of the outcomes we see are not acceptable in terms of function or cosmesis. It's not usual for multiple surgical revisions to be required in a healthy and well patient, except perhaps in the surgical management of traumatic injury. It's even less usual that the need for extensive revisions appears to be a foregone conclusion even before completion of the initial procedure. Outside of orthopedics, when an arthroplasty patient's anticipated life span may exceed that of an implanted prosthesis, or when internal fixation hardware is placed in a still-growing child, it's not often that a surgeon plans to have to do revisions right out of the gate. I'm explicitly excluding staged procedures, such as the series of
3 open-heart surgeries performed to palliate single-ventricle heart defects in young children, or
flap reconstruction following
traumatic or
iatrogenic loss of
soft tissue. In cases like this, multiple surgeries are the expectation for both patient and surgeon from the beginning, the stages are meticulously planned with a fairly standardized set of goals and end point for each, and the outcome justifies the added burden to both patient and surgeon. I know several of the phalloplasty butchers claim to do a staged phallus construction, but to me, it seems like the majority of the surgical "revisions" are intended to address major and unforeseen problems arising from the original surgery. Sometimes, multiple revisions are required. We've seen multiple examples of a woman experiencing severe complications following the first stage of phallus construction which require surgical revision and cause the subsequent stages to be delayed indefinitely. They always claim that the "next" stage is when the phallus magic happens, but often, the next stage can't happen until the surgeon has finished putting out all the little fires caused by the first. At least a couple of the women posted here have had so many complications and needed so many revisions after the initial surgery that they've opted out of further surgical intervention. I think it's one thing to consent to a 3 stage phalloplasty, but it's quite another to agree to a first surgery followed by an indeterminate number of revisions, with no guarantee of ever being able to proceed with the next step of the plan. I would not be surprised in the least if this were the primary motivation for many TIFs who choose single-stage phalloplasty despite the greater likelihood of major surgical complications. This isn't even touching the risks of repeated anesthesia or the mental toll of endless painful complications and recovery.
It's also noteworthy to me that the kind of "revisions" phalloplasty patients anticipate are in themselves fairly major surgeries. It's not just a little scar revision or other minor cosmetic tweak, it's full-on harvesting of grafts and reopening the neophallus. In many cases, the recovery from revision seems just as lengthy and brutal as the recovery from the initial phalloplasty procedure. It's insane to think about the number, type, and severity of the complications which are commonplace with phalloplasty. Even the riskiest and most complex legitimate surgeries don't have such poor outcomes. Ever. It's simply unacceptable in any other surgical discipline.
