How Ben got his penis
When Bluebond-Langner began her rounds, she says, older surgeons warned, “Be careful what you are known for. Without considering it, she began assembling the training she would need to perform top surgery, vaginoplasty, phalloplasty, and metoidioplasty (a less involved surgery that constructs a smaller penis using only natal tissue from the clitoris ). This training took her all over the world: to Thailand and Canada to study vaginoplasty and to Mexico City, where she learned microsurgery, the technique that facilitates the transfer of the skin flap by connecting the nerves and vessels to the microscopic scale. She began performing complex urogenital surgeries, including phalloplasty for micropenis and trauma. At the University of Maryland in 2016, she performed her first gender-affirming phalloplasty. The operation, to his knowledge, was a success. (She and the patient lost contact after two years.) A few years prior, Rodriguez had moved to NYU Langone to be chair of the plastic surgery department. Eventually, he recruited Bluebond-Langner to come and start a transgender surgery program.
NYU’s transgender surgery program occupies its own suite on the sixth floor of a glass-walled office building in Manhattan. I went to visit for the first time in March 2021. Stepping out of the elevator, I immediately noticed how classy everything was. The waiting room had Keurig machines and orchids in vases and iPads with futuristic fingerprint scanners. A far cry from the age of the segregated secret site, the names of benefactors were plastered on the wall. Taking a seat on the mid-century couch (or the swivel leather lounge chair or the chrome side chair), a transgender reporter could be forgiven for feeling more than a little cynical. Trans people in America are in a complex situation with the medical establishment: on the one hand, there is the call to expand and improve care that has always been refused; on the other hand, most of us are not blind to the fact that our bodies are doing good business in a for-profit system. “We’re salaried,” Bluebond-Langner said, explaining that she doesn’t get more money for more patients. “Although they motivate us a bit. They will give us more resources.
Bluebond-Langner is smiling and straightforward and generally immune to the surgeon god complex. When she came to NYU in 2017 to start the program, she had only two colleagues – Zhao and Jamie Levine, a microsurgeon. Over the years, the team has grown to include an administrative staff, a research department, a physiotherapist, two social workers and two nurse navigators. More than half of the team identify as trans, including two surgeons-in-training, who Bluebond-Langner hopes will one day succeed in succeeding each other and Zhao.
Medical transition is an endless to-do list. In order to be approved for phalloplasty, applicants must obtain separate referrals from two mental health providers. They need laser hair removal at the skin flap donor site and support during the recurrent (and often immobilizing) stages of healing. “Unfortunately, many of our patients have been marginalized,” Bluebond-Langner said. They cannot always depend on their job or family to support them. She considers the program’s care team to be essential to achieving a strong surgical outcome. Although transgender rights have been advanced on paper, many of his patients still experience adversity — poverty, unstable housing, social ostracism — that makes recovery more difficult. “If it’s hard to get a job because you’re trans, that won’t help you with surgery.”
“People understand the compromise. But we wouldn’t necessarily accept that complication rate in other procedures.
Walking down the hall to Bluebond-Langner’s private office, we passed people walking back and forth in custom NYU Gender Surgery track jackets. (The program’s logo is a shy vine leaf.) Inside, above a consultation table, hung an autographed poster of “Pose” actress Dominique Jackson. On a shelf, back issues of Plastic and Reconstructive Surgery leaned next to a stack of coffee table books: “The Vagina Bible,” “The Great Wall of the Vagina,” “A Celebration of Diversity of the vulva”. Bluebond-Langner makes three vaginas for each penis. She sometimes finishes three vaginas in one day; each penis usually requires at least two surgeries, but often four or more. “The demand is much higher for vaginoplasty,” she said. “I think it comes down to the fact that it’s a one-step reductive procedure. The risks are lower.
The NYU program has performed just over 150 phalloplasties to date. During the initial surgical consultation, Bluebond-Langner tries to understand what type of sex the patient likes to have, to better recommend what combination of procedures could best improve quality of life while minimizing the risk of complications. In the early days of formalized transgender medicine in the United States – a period between around 1960 and 1980 – phalloplasty was rare and almost unique, its goal being to replicate the idealized form and function of an imaginary standard. American penis. Although this is still the hope of many patients, Bluebond-Langner itself, and medicine in general, have begun to move away from this benchmark as an objective measure of surgical success.