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src="https://marcibowers.com/wp-content/uploads/sites/3/2013/09/masthead_image2.jpg" alt="" style="max-width:100%;" /></div> </div>  <section class="main container"> <div class="column span-3"> <div class="column-box" style=""> <article id="post-2209" class="post-2209 post type-post status-publish format-standard has-post-thumbnail hentry category-blog category-slider"> <header class="entry-header" style="margin-bottom:0;"> <h1 class="entry-title">Peritoneal Skin Grafting for Vaginoplasty</h1> </header> <div class="entry-thumbnail"> <img width="150" height="78" src="https://marcibowers.com/transfem/wp-content/uploads/sites/3/2018/11/slideshow-dr-bowers.jpg" class="alignleft wp-post-image" alt="" decoding="async" style="margin:5px 20px 5px 0;" srcset="https://marcibowers.com/transfem/wp-content/uploads/sites/3/2018/11/slideshow-dr-bowers.jpg 1920w, https://marcibowers.com/transfem/wp-content/uploads/sites/3/2018/11/slideshow-dr-bowers-300x156.jpg 300w, https://marcibowers.com/transfem/wp-content/uploads/sites/3/2018/11/slideshow-dr-bowers-768x400.jpg 768w, https://marcibowers.com/transfem/wp-content/uploads/sites/3/2018/11/slideshow-dr-bowers-1024x533.jpg 1024w" sizes="(max-width: 150px) 100vw, 150px" /> </div> <div class="entry-content"> <h4>Mt. Sinai-New York Eye and Ear, Denver Health, University of Toronto and other teaching facilities</h4> <p>Because Dr. Bowers has a 10% faculty position at Mt. Sinai-New York Eye and Ear since 2016, patients frequently ask if they can avoid the long queue for surgical care in California. In other words, some try to have Dr. Bowers work on them but at her faculty sites. Indeed, this is possible although it must be realized that Mt. Sinai and Denver Health are teaching facilities. Although surgery would be performed to Dr. Bowers’ standards, the primary surgeon may be the Transgender Surgical Fellow or a Mt. Sinai faculty member–medical students and residents are present in the OR but are involved in minor portions only.</p> <p>In California, Dr. Bowers is exclusively your surgeon. Obviously, teaching is essential if surgical care for transgender patients is to be available globally. Dr. Bowers believes very strongly in this teaching goal and established the first comprehensive transgender surgical teaching fellowship in the world in conjunction with Mt. Sinai-New York Eye ear and Vagina in New York in 2016. Other locations in Denver and Toronto are replicating this success and Dr. Bowers will be a part of those initial teaching efforts but likely not an ongoing faculty member except in New York.</p> <p>If patients do indeed wish to have surgical care in non-California locations where Dr. Bowers will be teaching, you may contact our office and make them aware of your wish. You are also allowed to remain on our California waitlist. Keep in mind, pricing may vary substantially in teaching locations, particularly for those paying cash where other institutions are likely much more expensive.</p> <h3>Peritoneal lining, skin grafting and other considerations for adolescents seeking surgical care</h3> <p>Adolescents seeking surgical care but without enough skin for a traditional outcome is an emerging problem as more trans kids on blockers come of age. Not all kids on blockers are prescribed these early enough to prevent genital growth. In fact, many blocked kids do have enough. But, there are many others who simply lack adequate skin when blocked early. Additional options are clearly needed.聽<em><strong>Consultations which may aid in surgical planning are strongly advised for all families with trans kids and as early as 13 years of age!</strong></em></p> <p>To clarify, <em><strong>at this time</strong> <strong>we do not offer surgery on 17 year olds</strong></em>. That being said, an in-person consult is always advisable though for all kids who鈥檝e been on blockers to assess whether there has been enough growth of genital material and may be scheduled as young as age 13 for surgery at 18. Family dynamics, stability and maturity of the prospective surgical candidate are also assessed. Moving towards final genital surgery is a major step at any age. We want this to be right for all but feel strongly that age 17 is an ideal age for final surgery, so we are hopeful that WPATH will affirm 17 as an acceptable age for GAV in the near future.</p> <p>Another significant concern is the ability to orgasm following surgery on the adolescent鈥攖his is a basic human function and this sense needs to be developed/recruited/embraced BEFORE FINAL SURGERY IS PERFORMED. If a child has never experienced orgasm prior to scheduling GAV, please consult with your pediatric endocrinologist as there may be options.</p> <p>Traditional methods of grafting best use groin skin or lower abdominal skin. New procedures like聽<strong>peritoneal grafting </strong>and other sources of vaginal lining are exciting and important but still relatively new鈥擠r. Bowers does have a fair amount of experience with use of the peritoneal lining and confidence that this will be a major breakthrough.</p> <p>There are residual concerns when using peritoneal lining, which has properties that are very thin making it vulnerable to friction. That said, it has been used in more than 25 vaginoplasty cases in New York at Mt. Sinai. We see the preliminary results as promising, in some cases wonderful, though the issue of graft contraction, tearing, etc. still may remain. Conventional vaginoplasty with modified penile inversion technique still remains the gold standard though for widely ranging reasons with peritoneal lining reserved for those with limited skin (and not other sources of squamous epithelium). Squamous epithelium is still the definitive cis-vagina that is emulated–the peritoneal addition adds lubrication and possibly some depth and that is how it is being used.</p> <p>An alternative to the peritoneal lining option is to utilize an anatomic structure called the聽<strong>Tunica Vaginalis</strong>—available to Dr. Bowers with all orchiectomies. Small strips–2 x 4 cm typically can add a small amount to the graft available—and can be done even in California in lieu of peritoneal lining.</p> <p>However, Dr. Bowers does all of her peritoneal lining vaginoplasties with Dr. Jess Ting, Bella Avanessian, Dr.Pang and the gender services team that we have created at Mt. Sinai in New York City. 聽However, unlike our California office, all NY cases need to be coordinated with Mt. Sinai. Contact us, then we will start the process through Dr. Ting’s off ice. Elsa Quinones is Dr. Ting’s coordinator. My faculty agreement with them allows me to operate, consult and teach but the actual care, payment and scheduling is via Mt. Sinai.</p> <p>If you wish to pursue care in New York, please let us know and we will put you in touch with Dr. Ting鈥檚 staff for scheduling.<br /> If California is an option, please contact our California office as it is never too early to begin planning with our long queue for surgery in California.</p> <p><strong>While peritoneum continues to draw interest for its potential lubrication, the lubrication is not sexually triggered. Furthermore, all peritoneal procedures utilize some aspects of penile inversion. They also do not address the external vulvar aesthetic concerns that Dr. Bowers views as essential. Don’t be fooled into thinking that peritoneal pull-throughs are the newest mousetrap and are, therefore, better. <em>Peritoneum is an alternative</em> process normally reserved for those lacking in skin tissue.</strong></p> </div> <footer class="entry-meta"> </footer> <div class="entry-meta"> </div> </article> <nav class="navigation post-navigation" role="navigation"> <h1 class="" style="color:#d3d3d3;border-bottom:1px solid #d3d3d3;font-size:1.2em;font-weight:normal;font-style:normal;padding-bottom:.25em;"></h1> <div class="nav-links"> <a href="https://marcibowers.com/transfem/i-am-jazz-season-5/" rel="prev"><span class="meta-nav">←</span> I am Jazz, Season 5</a> <a href="https://marcibowers.com/transfem/callen-lorde-community-health-award/" rel="next">Callen Lorde Community Health Award <span class="meta-nav">→</span></a> </div> </nav> </div> </div> <div class="column span-1 last"> <aside> <div> <ul class="socialicons clear">  <li class="icon facebook"><a href="http://www.facebook.com/GenderSurgery" target="_blank">Facebook</a></li> <li class="icon linkedin"><a href="http://www.linkedin.com/pub/marci-bowers/5/377/343" target="_blank">Linkedin</a></li> </ul> </div> <div> <div class="tertiary sidebar-container" role="complementary"> <div class="sidebar-inner"> <div class="widget"> <aside id="search-2" class="widget widget_search"> <form role="search" method="get" id="searchform" action="https://marcibowers.com/transfem/"> <input type="text" class="text" placeholder="Search this site" name="s" id="s" /> </form></aside><aside id="nav_menu-2" class="widget widget_nav_menu"><div class="menu-footer-navigation-container"><ul id="menu-footer-navigation" class="menu"><li id="menu-item-68" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-68"><a href="https://marcibowers.com/transfem/privacy/">Privacy Policy</a></li> </ul></div></aside> </div> </div> </div> </div> <div> </div> </aside> </div> <footer class="footer-main"> <div class="column-box clearfix"> <div class="column span-3"> <span>Copyright ©2024 Marci L. 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