Chettawut

Doctor

WPATH member

Doctor’s name: Chettawut

Hospital Affiliation: WIH International Hospital

Email:

Telephone: +66 0-2078-8919

LINE wihhospital

wihhospital.com/procedure/UHJvY2VkdXJlOjI4MQ==

Cost of surgery.

Hotel costs: approximately 3 ~ 4 weeks.

Introduction to surgery

Chet’s technique is similar to Suporn, using the scrotal skin flap as the inner vaginal wall and labia majora, the foreskin and urethral mucosa as the vaginal vestibule and inner labia minora, the penile skin flap as the outer labia minora and the glans as the clitoris. In addition, part of the glans is also retained in the vaginal vestibule as a secondary sensitive organ, while Chet also attaches the corresponding nerves to the clitoral foreskin and tether, the labia minora and tether, and near the prostate. For those with insufficient material, Chet can also use the inguinal skin as a vaginal lining (at an additional cost). Unlike Suporn, Chet also accepts SRS with the colon and 0-depth SRS, and usually uses a single surgical shaping, which also results in a posterior labial union that cannot be resolved in a single operation.

Based on the same technique, Chet also has a higher risk of complications, sometimes granulation and vaginal stricture, and has a similar requirement for three 50-minute dilation sessions per day. Likewise, Chet also has the need for perineal hair removal. Overall, Chet’s technique is similar in appearance to Suporn and is a good choice as it is more conservative than Suporn in terms of vaginoplasty etc. and less likely to cause serious problems.

For patients who do not have sufficient scrotal skin due to previous orchiectomy, hormone replacement therapy and many other factors resulting in skin atrophy, additional skin grafts can be obtained from the groin and joined to the scrotal skin to complete the required skin graft. Thus, even patients with SRS who have a small and short penis size can expect to have a good depth of pubic area.

The urethral opening is set in the correct anatomical position above the vaginal opening to allow for the female urinary flow pattern. All the cavernous muscles surrounding the urethra are completely removed to prevent tissue engorgement during sexual arousal, which may narrow the vaginal opening or cause difficulty during intercourse. By retaining the specific secretory glands around the urethra and vaginal opening, individualised self-lubrication can also be expected.

To ensure that the grafted skin is 100% hair free, the prepared skin pieces are carefully examined by light and any hair follicles that may remain are meticulously extracted before the grafting tube is inserted into the newly constructed vagina.

Appointment matters

  1. To ensure the quality of the procedure, it is normal that Dr Chettawut will only schedule one procedure per day as the sole lead surgeon, so it will take a little longer to confirm the date of the procedure.
  2. Once the surgery date has been confirmed by both parties, a deposit of 20% will be required within 10 days. If the deposit is not paid on time, the surgery date will be postponed.
  3. Clients under the age of 18 or over 70 are not accepted. Clients between the ages of 18-20 need to be accompanied to Thailand by a parent or legal guardian who will sign the consent on the day of the consultation interview. Parents or legal guardians will need to provide notarised proof of relationship.
  4. As the procedure requires general anaesthesia, clients will not be able to undergo the procedure if they have the following medical conditions.
    • Heart disease
    • Lung disease
    • Kidney disease
    • Liver disease (including hepatitis B and C)
    • HIV carriers (whether symptomatic or asymptomatic HIV carriers)
    • Deep vein thrombosis
    • Cancer patients and all chronic diseases with the potential for complications
  5. BMI <= 33, colonic remodelling vaginal surgery BMI < 25

Pre-operative matters

  1. Two psychiatrists’ certificates are required for the operation
    One of them can provide a psychiatry certificate from your own country (in English, note: the certificate must say recommending surgery)
    Thailand Psychiatrist Price THB2,500.00 per person

  2. Pre-operative examination items (in English)

    • CBC full blood test report
    • HIV
    • BUN Kidney function
    • PT, PTT Coagulation
    • FBS Fasting blood sugar
    • Electrolytes (K, Na, P, Cl, Mg)
    • HCV Hepatitis C
    • Frontal chest x-ray
    • (ECG over 40 years)

Surgical schedule

Skin flap.

DayProgress
-3soft food
-2fluid food
1surgery
5Removal of drainage tube and discharge
8unpacking and first dilation
11Removal of urinary catheter

Colon.

DayProgress
-4soft food
-3fluid food
1surgery
5Removal of drainage tube and unpacking
6Discharge and ready to eat
11Removal of urinary catheter

  • Fasting for 5 days after colpotomy, eating after flap surgery.
  • Avoid chocolate and creamy soups for the first two days to avoid gastrointestinal distress.

Post-operative matters

Dilation

Dr Chettawut’s dilation instructions

Dilation schedule

Notes

(from the official website)

  1. Get plenty of rest during the first 2 months after surgery and also stay away from stress as much as possible.
  2. You may do light activities but do not lift heavy objects for 2 months.
  3. Do short regular walks for the first 2 months after surgery to help with the healing process.
  4. A gradual return to work is recommended, such as starting off with light duties or reduced hours.
  5. To ensure your complete healing, it is necessary to avoid any activities which may cause wound tear or wound complication.
  6. Do not stretch or spread the labia in order to see or take a photo for at least 3 months.
  7. Avoid sexual intercourse for at least 3 months
  8. Avoid exercises which are susceptible to acute overstretching of the genital area, including yoga, aerobic dancing, pilates, swimming, etc. for at least 3 months
  9. Strenuous activity (any activities which may put pressure against the genital area, like, hiking uphill, horseback riding, bicycling or motorcycle riding) for at least 3 months.