My second implant - hard to call it a revision....

[rlm1818]

High volume can be a great advantage, if it's paired with high quality conscience. So every operation with thorough concentration, as if it were the very first one. The problem arises when a high volume guy starts being sloppy, careless and lightheaded.

Here are some of my thoughts on "high volume" vs "low volume".

First, the lower volume implant guys I visited were actually very "high volume" and busy with respect to their overall practices. Fewer implants but lots more other stuff going on. Most really good doctors are normally very busy. I don't think the volume of implants a guy does tells you much of anything at all about how much time and attention he (or she) will devote to you and your implant surgery. The lowest volume implant guy I visited ("5-10 per month") had the least amount of time for pre-op consult and questions, was late, cut off our appointment due to other higher priority stuff. And, I learned, he left ALL the followup to a PA.

Dr Eid claims to be the highest volume implant guy. Not sure if that's true. But if you do the math, if all he did was implants, even at his "high" volume, he wouldn't actually be all that busy. And in fact, he was the surgeon who had the most time, made the most time and was the most accessible of the other surgeons I visited. I see no reason to believe a "high volume" implant surgeon is any more likely to be "sloppy, careless and lightheaded" than any other lower volume implant surgeon who is doing as much or likely even more surgeries and procedures, but just other things than implants. The way a surgeon runs his overall practice is much more important, I would think, than the sheer number of implant surgeries he does or doesn't do.

I read many medical journal articles, including several behind paywalls that I had to shell out money for, before I had my surgery. There's no question in my mind that this surgery requires quite a few judgement calls. Everything is not just neat and precise. A good surgeon who takes advantage of lots of experience should tend to make better judgement calls over time. But, just because he's high volume doesn't mean he's a good surgeon. Its just that experience gives an advantage to a good surgeon. And even with lots of experience, it doesn't mean he makes every judgement call right. If he could make every one exactly right, it wouldn't be a judgement call at all.

So, when someone has a bad outcome, its understandable to be angry and frustrated. Somewhat understandable, but possibly wrong, to blame the surgeon though. It could indeed be that the surgeon is not very competent. True. It could be he's a great surgeon that had an off day. True. It could also be, though, that he's a good surgeon, at the top of his game, making his very best professional judgement calls, and still he didn't get it quite right. Seems to me that's the nature of this or any surgery. There's risk. Even the best guy doesn't and can't get it perfect every time, and that doesn't make him a bad surgeon.

Unfortunately when you're the guy with a bad result, its hard to know the reason. Bad surgeon, good surgeon and off day, or a good guy's best judgement just wasn't good enough in your one isolated case. Even the top docs warn (at least Dr Eid did with me) that a revision surgery was a real risk. I took that risk seriously, and not just as a CYA statement. A good doc, it seems to me, should also have a better chance of getting it right when a revision is needed since there is a benchmark for what was right and wrong the first time around. Needing a third surgery (second revision) is really really unfortunate.

[Olivero66]

First, the lower volume implant guys I visited were actually very "high volume" and busy with respect to their overall practices. Fewer implants but lots more other stuff going on. Most really good doctors are normally very busy. I don't think the volume of implants a guy does tells you much of anything at all about how much time and attention he (or she) will devote to you and your implant surgery. The lowest volume implant guy I visited ("5-10 per month") had the least amount of time for pre-op consult and questions, was late, cut off our appointment due to other higher priority stuff. And, I learned, he left ALL the followup to a PA.

Dr Eid claims to be the highest volume implant guy. Not sure if that's true. But if you do the math, if all he did was implants, even at his "high" volume, he wouldn't actually be all that busy. And in fact, he was the surgeon who had the most time, made the most time and was the most accessible of the other surgeons I visited. I see no reason to believe a "high volume" implant surgeon is any more likely to be "sloppy, careless and lightheaded" than any other lower volume implant surgeon who is doing as much or likely even more surgeries and procedures, but just other things than implants. The way a surgeon runs his overall practice is much more important, I would think, than the sheer number of implant surgeries he does or doesn't do.

I read many medical journal articles, including several behind paywalls that I had to shell out money for, before I had my surgery. There's no question in my mind that this surgery requires quite a few judgement calls. Everything is not just neat and precise. A good surgeon who takes advantage of lots of experience should tend to make better judgement calls over time. But, just because he's high volume doesn't mean he's a good surgeon. Its just that experience gives an advantage to a good surgeon. And even with lots of experience, it doesn't mean he makes every judgement call right. If he could make every one exactly right, it wouldn't be a judgement call at all.

So, when someone has a bad outcome, its understandable to be angry and frustrated. Somewhat understandable, but possibly wrong, to blame the surgeon though. It could indeed be that the surgeon is not very competent. True. It could be he's a great surgeon that had an off day. True. It could also be, though, that he's a good surgeon, at the top of his game, making his very best professional judgement calls, and still he didn't get it quite right. Seems to me that's the nature of this or any surgery. There's risk. Even the best guy doesn't and can't get it perfect every time, and that doesn't make him a bad surgeon.

Unfortunately when you're the guy with a bad result, its hard to know the reason. Bad surgeon, good surgeon and off day, or a good guy's best judgement just wasn't good enough in your one isolated case. Even the top docs warn (at least Dr Eid did with me) that a revision surgery was a real risk. I took that risk seriously, and not just as a CYA statement. A good doc, it seems to me, should also have a better chance of getting it right when a revision is needed since there is a benchmark for what was right and wrong the first time around. Needing a third surgery (second revision) is really really unfortunate.

You know that 5-10 per month would be a top level volume guy around here? Anyway, I think you stated it right: High volume is a good prerequisite for excellent results, at least it implies experience. Experience is not everything, but without experience everything is nothing.
The crucial point is the level of concentration and focusing they are willing to invest in your op, and that can be as high with a mass producer as with someone doing implant surgery from time to time, among many other things. Another crucial point is rapidness, speed. This derives directly from amount of experience and can be of great importance, too.
Fr. JF Eid as well as Paul Perito are running private operation centers, not being part of an institution like a university. Thus their interest in caring for their patients who are customers is naturally high, and consequently they are well organized and don't have to cancel appointments due to some higher prioritized stuff. That's an advantage.

What I do decline is the practice of elder Professor Wilson to make tours abroad, sleepin' in a hotel and operating next day on a penis whose Owner he never met. That's really bad, bad practice. It's only accepted because german implant surgeons are extremely unexperienced and hence totally devoted to master Wilson. He's doing showroom operations,
most of them with little interest for the patient being showcased and therefore error-prone.

It should be a minimal standard that the sorgeon consults his patient preoperatively and explains all the measures and possible alternatives he might take during operation. The one I'm talking with before op MUST be the same doing the op.

[Charlie999]

Dr Perito is a very gifted surgeon. He did my implant this week, and I am doing very good. Praise God that He was able to give you a way to go. From what I have heard, and my own personal experience, I would highly recommend Dr Perito.

I,too, would like to see NAMES of doctors, good or bad, so that we can all benefit from the experiences of others. Had it not been for this forum, I would not have known about dr Perito.

God bless the boys who make the noise on FT!

Blessings,

Charlie

[TEBozo]

No kidding. Bash away, that's precisely why everyone is here

[Olivero66]

Dr Perito is a very gifted surgeon. He did my implant this week, and I am doing very good. Praise God that He was able to give you a way to go. From what I have heard, and my own personal experience, I would highly recommend Dr Perito.

I,too, would like to see NAMES of doctors, good or bad, so that we can all benefit from the experiences of others. Had it not been for this forum, I would not have known about dr Perito.

God bless the boys who make the noise on FT!

Blessings,

Charlie

Thanks, Charlie. Was it a revision? Did he make it by infrapubic approach?
The only thing I don't understand is how they place the pump when intruding infrapubically. That's true artwork!
On the other hand, infection risk with infrapubic approach on revisions is significantly lower than penoscrotally. Therefore usually an irrigation is required after taking away the old implant before putting in the new one. That's a standard on penoscrotal approach for minimizing infection risk.

[stringerbell]

Panhead,
Never mind who the 2 guys who "botched" it was… who's the young guy w/ the great rep who's doing the 3d surgery? I'm curious about who this guy might be-
Sounds promising. I hope 3 is a charm! But I'm curious who's out there doing good work- so on a positive note, who's this guy?

[Charlie999]

Hi olivero
Mine was not a revision. First time out for me. By the way, I had post op consult with dr Perito, and all is good,thanks to God. Dr Perito is very accommodating, as well as being a most gifted surgeon. I live approx 5 hours away, and would have to return to remove stitches, but the good dr gave my wife, who is an MD, a suture removal kit, so she will take care of that at home, thus sparing us a long trip. Very generous and most considerate of the dr.

Hope all goes well for you, and keep us posted on your progress

God Bless

Charlie