Anna's Place

Reassignment Surgery

A card I was sent by a friend after my surgery. It wasn't very subtle, but made me laugh anyway!

On 14th November 2003 I underwent reassignment surgery with Dr. Suporn at Aikchol Hospital in Chonburi, Thailand.

Contents:

1. Introduction
2. Why Dr. Suporn?
3. Preparation
4. Costs
5. Advice
6. Things to Take
7. Diary
8. Other accounts of surgery with Dr. Suporn
9. Intra-Op Photographs
10. Results and Reflections

Introduction

Reassignment surgery is a complex and hugely invasive surgical procedure, and when a patient commits to undergoing such a major surgery they place their life in the hands of the surgeon and their team. As such it's not a decision to be taken at all lightly, so anyone contemplating surgery would be well advised to research not only what options are available to them, but what sort of outcomes they would ideally like.

Unfortunately, as ever money talks...UK private patients (as I was) are likely to have access to much wider options than those undergoing NHS treatment. Needless to say very fortunate, and highly privileged.

Although the basic surgical techniques for reassignment surgeries are well known now, each surgeon has their own techniques, strengths and (unfortunately) weaknesses. While I was making decisions about my own surgery I felt I had to at least know the questions to ask of any potential surgeon, which in turn will help me to form my own opinions of whether going to them was the right choice for me.

At the time I found Andrea James' TS Roadmap site (since renamed as Transgender Map) to be a pretty good sources of information on the available surgeons and how to contact them. I also joined the (now defunct) Trans-Surgery Yahoo Group and learnt from the experiences of others.

I was acutely aware that although reassignment surgery is now a well-developed surgical procedure things can go badly wrong. Although the risk of death is very low (at the time I only knew of two cases where patients have died after surgery, both as a result of a pulmonary embolism and neither in the UK), complications can happen - and indeed minor complications are fairly common (as it turned out I would have firsthand experience of the latter myself).

Fortunately, major complications (such as a perforated bowel or necrosis of the clitoris) seem to be fairly uncommon. It does vary from surgeon to surgeon however, which is yet another reason to try to learn as much as possible before committing yourself.

The other thing to remember is that this is a surgery that you are likely to only have one opportunity to get right, so if the results aren't what you hoped for you are likely to have to live with it for the rest of your life.

I certainly didn't go into this blind. My whole life was at stake, after all.

Why Dr Suporn?

In late 2001 (several months before I started transition) I became aware of a Thai surgeon by the name of Dr. Suporn, who seemed to be offering reassignment surgery techniques and results which were not then available in the UK. Several of the other trans women I'd met in the TS Chat community had undergone surgery with him, and although I'd not seen the results firsthand what I heard was very encouraging - in terms of aftercare (incredibly important when you consider you have to fly out to Thailand!), sensitivity and depth. Being sensate and having a natural appearance were all hugely important to me, although depth was less so.

The reasons why I chose to go to him for reassignment surgery rather than to one of the surgeons performing it in the UK are sufficiently complex that I fett I should discuss them separately. See the article Why Dr Suporn? for details.

It's now 2020 and Dr. Suporn is now close to retirement - but his clinic is still running, and two other surgeons (Dr Bank and Dr Prae) now practice there under his guidance. If you are considering going to the Suporn clinic, I have no doubt that you will still be in very good hands.

Preparation

Surprisingly little needed to be done to arrange my surgery. The first thing was obviously to write to the clinic and agree a date (helped by the fact that they had a scheduling calendar on their website), and send them a deposit (I sent 20% - 78,000 Baht or about £1200).

That aside, my preparation mainly consisted of talking to others who've already been to the clinic about their experiences, what to pack etc.

The other things I had to do were:

• Apply for a new passport (mine had expired, and showed my deadself anyway). Fortunately, in the UK there was no problem getting a passport in a female name with the right gender code. Sadly, those in many other countries aren't always so lucky.
   
• Book the flights. After recommendations from friends I decided to fly with EVA Airlines - they offered an "Evergreen Deluxe Class" ticket which gave lots more legroom than an Economy class ticket for not much more (£655 for Evergreen with EVA compared to £590 Economy with Quantas). Other pluses were the fact that the flight was direct (Heathrow - Bangkok) and the flexibility to change the return flight without penalty (useful in case there are any unplanned complications).
   
• Obtain the all important letter from my consultant psychiatrist (Dr. Russell Reid) referring me for surgery (back then only one referral was needed).
   
• Have a medical and ask my GP to prepare a letter to the clinic stating that I was fit for surgery.

As requested, I sent scanned copies of all documents to the clinic, and took the originals with me when I flew out to Thailand.

Costs

By Thai standards the Suporn Clinic certainly wasn't cheap (and is even less now so as the exchange rates are now far less favourable than they were in 2003). It is possible to find Thai surgeons who charge much, much less than he does - but as ever you tend to get what you pay for. In terms of quality of result, aftercare etc. he's hard (if not impossible) to beat - and the costs are still generally lower than in the UK, even taking into account flights etc.

I obviously didn't know the total cost of my surgery in advance, since as well as the cost of the surgery itself (370,000 Baht), the costs for airline tickets, hotels, food, spending money etc. all have to be considered. As my friend Kazzy was travelling with me and I was and paying for her airline tickets, meals etc. I knew the costs would be higher than if I'd travelled alone, but that didn't matter. Not being alone through such an amazing experience did.

All told, I was expecting it to cost me about £8500. Here is how it worked out in practice:
 

The exchange rate for each transaction varied, with the currency exchanges I made in the UK getting the worst rate (61 Baht/£) and hotel bills toward the end of my stay the best (67 Baht/£). I didn't need to do so, but also learnt that UK debit cards would work in cash machines in Thailand - and I suspect the exchange rate you'd get for a cash withdrawl that way would have been far better than from a conventional currency exchange in a UK bank.

Since I had my surgery, the costs involved have risen substantially. As of summer 2013, the best information I had was that the cost of the same surgery had risen to 545,000 Baht. With the then much worse exchange rate (around 47 Baht/£), this equated to a nearly doubled cost (£11,600) for the surgery alone.

Advice

If you plan to overseas for reassignment surgery the biggest two pieces of advice I can give are to:

1. If possible) bring someone with you - particularly for the first two weeks. Reassignment surgery is major surgery and can be both tiring and painful, and the extra moral support helps massively. Going through it is also a very emotional experience, and having someone to share with also helps from that perspective.
    
2. Learn what you can, and listen to what the clinic staff and surgeon tell you - particularly about aftercare and dilation. They know what they're talking about, so don't be afraid to ask questions if there's something that doesn't seem to make sense or you're not clear about something.

As far as post-op aftercare (dilation, hygene etc.) is concerned, the article Zen and the Art of Post-Operative Maintenance is still well worth a read.

Things to Take

The most important medical equipment you'll ever own...

Travel as light as possible - especially if you travel alone - you really don't want to be carrying more than you need to (especially on the way back). Aside from the usual stuff (clothes, toiletries etc.) here are a few things you might not have thought of:

• Friends recommended taking a screw-top jar to keep the Betadine solution in used while cleaning up after dilation. I didn't bother and just used a glass in the hotel - apparently leaving it open to the air is no problem.
   
• A sports bottle or cheap imitation such as a Sunny-D bottle. Not only is one useful in the hospital for drinking while lying down, but once you are discharged back to the hotel such a bottle lets you squirt the bits you need to if your room has a fixed shower head.
   
• A small pill box for keeping pills in once you have been discharged from hospital.
   
• If you use any medication with you please be extremely cautious about mixing them with the medication provided by the clinic - especially in hospital. Don't take any anti-inflammatory or blood-thinning drugs (e.g. aspirin or ibruprofen) prior to travelling out for surgery.
   
• A couple of travel adaptors for hairdryer, laptop or whatever. I also took a 4-way extension block, which proved very useful for plugging in bulky items like mobile phone chargers.
   
• A travel kettle, as although they were provided in the rooms at the Mercure Hotel (since renamed as the Chon Inter) in Chonburi, the same may not be true for any other hotels you stay at immediately before returning home). If you're a tea drinker you might want to think about taking tea-bags too as apparently they're hard to find. Of course, you could just rely on room service (although we used our heads and collected the sugar and whitener provided at the hospital, so we only had to buy coffee and milk...).
   
• A smartphone or digital camera to take photos.
   

You'll be given everything you'll need by the clinic - notably stents, betadine, hibiscrub, a large syringe (for douching) and a rubber doughnut to rest your tender bits during the immediate post-op recovery period, so you do not need to take are any other medical supplies, or equipment for dilating.

Diary

The cover of the notebook in which I wrote my diary - Spirit of the Night by John Atkinson Grimshaw

During my stay in Thailand I kept a detailed diary of my experiences and feelings, which I gradually wrote up as a set of web pages. If you want to know more about my experience, feel free to take a look.

Although many people have written such an account, each tells a different part of the story of the once in a lifetime experience that is reassignment surgery, and I hope that mine will add something to what's already been published. As it was written at the time rather than later, it's pretty detailed.

I have largely left it as I wrote it in my notebook at the time, so some of it is rather raw and emotional. Nevertheless, I hope you'll find it a useful and informative account which also conveys the sheer range of emotion I experienced (which is in my view an integral part of the experience). I've broken it into several pages in order to make it more manageable:

1. The trip to Thailand, my consultation with Dr. Suporn and the transfer to Aikchol Hospital
   (11th - 13th November, 2003)
    
2. My big day arrives, and my immediate recovery in hospital
   (14th - 20th November, 2003)
    
3. The packing is removed, learning to dilate and discharge from the hospital
   (21st - 22nd November, 2003)
    
4. Immediate recovery at the Mercure Hotel, and my first check-up at the clinic since surgery
   (23rd - 25th November, 2003)
    
5. The second check-up, further recovery, a couple of setbacks and learning a few things
   (26th - 30th November 2003)
    
6. Some good news about the haematoma, and finally getting mobile
   (1st - 7th December 2003)
    
7. The final check-up, a little shopping in Bangkok and homecoming
   (8th - 12th December 2003)
    

If you have any questions about my surgery or anything connected with it, I'm be happy to answer them. Feel free to send me an email via the Contact page.

Finally, it goes without saying that everyone I have written about and/or posted pictures of has given their consent. The last thing I want to do is "out" anyone when they're trying to carve out a new life for themselves.

Other accounts of reassignment surgery with Dr. Suporn

• Susanna's SRS account. My friend Susie's account of her surgery in May 2002.
   
• Sex reassignment surgery by Dr. SUPORN WATANYUSAKUL 14th May 2002.
  An anonymous (but very comprehensive) account of reassignment surgery at the Suporn Clinic in Thailand.
   
• SRS & FFS with Dr. Suporn Watanyusakul [MD]
   
• My GRS with Dr. Suporn 13/Jun/2003
   
• MTF UPDATE: SRS with Dr. Suporn (video diary)
   

You may also want to look at the pages discussing vaginoplasty with Dr. Suporn on Transgender Map.

Intra-Op Photographs

While my surgery was taking place Dr. Suporn's staff took photographs of the procedure, some of which were given to me before I left Thailand. Be warned though that these images show genital surgery in detail and are definitely not for the squeamish!

Results and Reflections

By the time I left Thailand I was still very swollen (more so than most, presumably due to the haematoma I suffered) and in a considerable amount of pain. I'm pleased to be able to say that both the swelling and pain steadily decreased over the following weeks, and the results now look quite natural. If you really want to see how they developed, you can do so here.

Dr. Suporn has truly done something amazing for me. Not only do my genitals now look right, but they feel right too - as soon as the T-bandage was removed I could feel that I was rather sensate (which is very important to me), and I went orgasmic at 10 weeks and 3 days post-op - ironically just 5 days after my FFS!

I also I find that although I can remember how my body looked and felt before surgery, I can't relate to it. My mind has adjusted remarkably quickly to my new body shape.

Of course, everybody's different so don't expect you're results to look exactly the same as mine...but if my experience is anything to go by I'm pretty sure you'll be very happy with the results if you go to Dr. Suporn. If you choose to go to another surgeon, I hope your experience is as amazing as mine has proved to be.

Postscript: I returned to Dr. Suporn for Facial Feminisation Surgery on 21st January 2004.