Implant replacement surgery 12/23

[C_lab34]

I am tentatively scheduled for implant revision/replacement surgery on December 23rd in Indianapolis. Dr. Alex Tatem will be performing the surgery. I have an AMS CX 21 cm with 3 cm rte on one side and 3 and 1/2 rte on the other. My device stopped working about two weeks ago after four and a half years of use and needs to be replaced.

I am currently uninsured and most likely will be paying out of pocket. The full out of pocket cost of surgery at Tatem's clinic is 17,000. However, if I go with another CX, I will be reimbursed for the cost of the device, which is around 10,000, bringing my cost down to around 7,000. If I am only paying 7,000, then the cost is not a big deal, and I can pretty much pay for it right up front.

Tatem thinks a Titan would be better suited for me, both because of my size and my youth (he believes that AMS have a slightly higher tendency to break early, especially with younger guys. I don't know if this is based on studies or statistics or just his anecdotal observations). But, he still thinks the AMS CX is a good device and would go with whatever I choose. Now, on one hand, I am aware that the most important thing right now is to restore functioning. Ultimately, if I have a smooth surgery and get a CX that works and works for a long time, then I will be happy. Plus, the financial side will be easier to deal with if I choose a CX. On the other hand, there's that part of me, maybe it's nothing more than vanity, that thinks, what the hell, if I have to subject myself to this ordeal again no matter what, get opened up and deal with pain and discomfort and the risk of infection, I might as well go with the best possible device, even if it means an additional financial complication.

If I go with a Titan, I will need to find a way to come up with about 10,000 dollars by december 23rd. I am aware of Care Credit and am thinking of taking out a small loan. I also have family who could possibly help some. I feel selfish asking though. The other option is to explore healthcare marketplace plans during this open enrollment plan, and then get on a plan that will cover the surgery with a Titan, and push the surgery back some. Tatem's clinic also had January 13th as a surgery date, so if I could find the right plan and hold out just a bit longer, it might be a good way to save money and get the best possible device. Then again, maybe the device difference won't matter at all, and this is all in my head and I need to keep things as practical as possible. I need to come to a decision in about a week or I won't have my spot, so I'm going through all options as thoroughly as I can.

[indusvalley]

How old are you? You know I wanted LGX but Dr Hakkey in Atlanta told me the same stuff that he implants Coloplast Titan in young guys and LGX or CX in older guys. I think these doctors have a point, young guys tend to go wild in bed and use it more aggressively and often compares to old people, therefore Titan being made of stiffer material has more chances of survival long term.

[ViaSwiss]

You didn't seem too bothered by the CX is I remember correctly, so why not just go with that one since its $10,000 cheaper.

My understanding is that you will not find a plan in the marketplace in Indiana that covers IPP. I went through the struggle in 2018 and 19 trying to find one. Ambetter wasn't going to cover. I believe Anthem is going back into the marketplace in 21, but only in a few counties, so who knows...

If you do the LGX, Tatem does the AMS financing option. I'm def. going to be following as Tatem will probably be doing mine in Jan. If my plan doesnt cover I will also have to pay out of pocket. He will likely also recommend Titan to me (Im young), but I'd really like AMS as Idont like the kinks and large flaccid the Titan comes with.

[Gt1956]

Just thinking out loud here. I would suggest going with the CX because you've already had 1 & the cost difference.
As for Dr. Tatem. Even if he felt that the AMS might be better for you. Did he mean that the Titan is that much better than the CX. After all, the CX & the LGX are made differently.

[C_lab34]

I'm 34 years old. My first implant was lifechanging, but I was hoping to get a few more years out of it. Here we are with another lifechanger, going in the opposite direction. I was happy with my CX. When I first came out of surgery I had the usual neurotic frustrations. I was very sore for a couple of months, the pump was a bit high, I felt some tubing coiled up on the right side. I thought maybe the sizing was off. Six months in I had made my peace with it. Not only that, I loved it. I'm pretty sure I ended up with the exact same size penis I had before, only with erections that lasted as long as I wanted. I put all penis concerns and preoccupations out of mind.

For most of my implanted life, I was in a serious relationship. As far as I knew, we were getting close to marriage and children. Well, that ended early last summer. I had to move in with my parents. Then I met another woman at the beginning of the fall, and things were developing rapidly. She did not even know I had an implant, until I had to tell her that not only did I have one, but that it was broken. The stress and shock of this change has pretty much ended that fledgling relationship. And I don't mean to suggest that she ran away just because my dick won't get hard now. It's just a very heavy thing to hit someone with, especially when you have no idea and you don't even know someone that well.

So here I am, single, at 34, living with my parents, during what many people still believe is a raging pandemic, (sorry not trying to get too political, but at the very least we can all agree that it has massively overhauled human behavior, at least in the short term, if not the long) with a broken implant, without health insurance. I cannot have penetrative sex. And my first and overriding impulse was to get this thing fixed as quickly as possible, no matter the cost. Take out a loan, borrow from family, whatever it takes. Mostly, that is still how I feel.

Yet, there is a part of me that wonders why I am in such a rush. I mean, here I am, dumped twice in about a six month period, once when I had a functional penis, once when I didn't. I'm 34, unmarried with no kids, little money, uninsured, more of an artist by nature. So you know, broke, a little aloof from the practical matters of the world. I actually just finished writing a novel and want to get it published soon. But when it comes to women, sex, family, reproduction: maybe nature/god/the universe is trying to tell me something. Maybe this whole world just isn't for me. I actually don't want to go out and bang strangers from tinder or buy hookers. I want a real relationship of depth with someone I care about and who cares about me, who will stick with me through tough times. Why do I need the ability to have penetrative sex in three months? Maybe I can put it off some until I'm in a better financial position, with better insurance?

This is just musing, airing it all out on franktalk. Not trying to just sound mopey or morose. Not trying to be a downer. I had four and a half wonderful years of worry free sex. I know what it's like. I don't have to prove anything to myself. If I were with someone I loved, a trusted partner with whom penetrative sex was a symbol or expression of our intimacy, then I think I would actually have better reason to get fixed sooner. But I'm just floating out there, not sure if I'll even find what I'm looking for. If I do, why do I need to bang her for hours right away? Maybe if I were really at peace with myself, I would wait until I found someone who wanted to go on the journey with me, who accepted me in this condition, and then we could go forward together.

I really don't mean for any of this to sound preachy or judgemental, as if I am calling into question other men's motives for wanting to fix their ED. Believe me, I've been through it all. I understand the full range of emotions and interests here. Just something that has come over me lately.

[C_lab34]

Now, onto more practical matters. I also spoke with a Dr. Clavell in Houston. He also thought the Titan was a better choice, because he also believes they are more durable. He says he has seen more AMS pump failures and cylinder ruptures, and told me that if he were me, he would get a Titan. But at the same time, he did not say the AMS devices are trash or anything. Just gave his opinion on what he thought would be best. So if I am going to go for the surgery as soon as possible, part of me thinks that taking the 10,000 dollar hit on the Titan would be worth it, if it means a higher chance of making it more than another five years. If I kept living at home, I could pay that off in a year, maybe less. As I understand it, I have until monday, november 9th to finalize the december 23rd surgery date and to let them know which device I want. I have a lot to think about until then.

[ViaSwiss]

First of all, would you be thinking/writing all "morose" if you did was functional right now? Probably not. Get that thing fixed and get back on with your life.

If you do chose to do the Titan, Dr. Pollifrone in Fort Wayne quoted me at $12,800 out of pocket last year. He is more than qualified. It would save you about $5,000. Since that quote (2018) his clinic joined Parkview Hospital, so I don't know how that has effected the price, but I can email his team to find out.

The only reason I was probably going to choose Tatem (2 hr drive) instead of Pollifrone (in my backyard) was because (1) Pollifrone only does Titan and (2) I am worried that some of the nurses in the surgical center might end of knowing me or knowing of me.

[C_lab34]

I take your point about what I would be doing if I had a functional implant. Two weeks ago, I was just about to move to indianapolis again and help a friend repair a house so I could live there. He was going to teach me home repair and I was going to do basic maintainance for him and his real estate company. I would continue taking my prerequisite nursing classes and getting ready for a nursing program through a local technical school. I would have been able to spend more time with what I thought would be my new girlfriend. But all of that is now on hold, or cancelled, except the nursing school stuff. I'm still getting through my classes at least.

When life changes rapidly, I can't help but reflect. It seems to be my nature. It is incredible I was able to get this all scheduled so quickly in such a tumultuous time, but part of me feels very unsettled. And I don't want to just pity myself, or act like I have a completely unique situation. If this is the place to vent, let me just say I'd really rather be going through this with a supportive partner. I really would. I am not exactly looking forward to being single, even with an implant, in part because I am already weary of the dating process even under more stable or normal conditions, but these days it seems especially daunting. That being said, I can still admit that I would rather have a functional dick than not, even though it sometimes feels like such a grueling ordeal, and the weaker, defeatist part of me wants to give up. One way or the other, on monday I will make a device choice and will live with the financial, anatomical and psychological consequences and begin mentally preparing for the upcoming surgery. Part of me still does not feel ready to go through it again.

[merrix]

Hey there

Funny, how we on the surface seem to be so completely different, in terms of how we live our lives, but how I on the other side feel we're very much alike in some strange ways. I still remember those long talks 4-5 years ago, when I had just got my Titan with Eid and you were waiting for your AMS from Kramer. And later how we talked when you had your issues in the beginning.

Anyway, I am sorry to hear your story. Sorry for what? Sorry for whatever you are unhappy about. Implant of course, but bad luck with the women as well. From the bit I know you, I wouldn't expect you to have any issues in finding women.

I would like to say you should go ahead and get this done. Saying that "I'll wait till I am in a relationship where penetrative sex is important to me" isn't really a great way forward I think. And I am pretty sure that the day you suddenly are in that meaningful relationship, you'll agree that action should have been taken earlier.

Titan or AMS?
I first want to say that even though my financial situation right now seems to be quite different from yours - where I am now financially I wouldn't hesitate for a minute about 10 K, just get the implant I wanted - I haven't always been in that situation. I actually don't need to look further back than to when I was your age. I had a decent job, a decent house and a decent car. Bot no money. Not one cent in the bank. It was about your age things started to go well for me financially, all because my career kicked off.
But what this means is that I can still relate to your situation and whether I would think the extra 10 K was worth it.

First of all, you have to decide whether you even believe in the advantages of the Titan. If you don't, then the decision is already taken. Why spend 10 K on something you don't even know/believe is better? Of course not. Case closed.

But - is the Titan better for you? I don't know since I am not you, my dick is not your dick, and I haven't had an AMS. But I think I have some logic that speaks in favour of the Titan. Hear me out...
The only advantage, as far as I see, of an AMS is the flaccid. In case of the LGX it is shorter and softer than a Titan. In the case of a CX, it is softer.
But already here I think it gets fishy. Selling an implant to an impotent man on the basis of the flaccid being better than competition..?
That's like Sports Car X trying to win market share over Sports Car Y on the basis of it being easier to handle when parking. Who the fuck cares? You buy a sports car on the basis of how it feels when you drive it. When you push it. When you push it to the limits. And by the looks of it.
Likewise, I think most of us impotent bastards want a dick which is great to fuck with. A dick which is as big as possible. Thick and heavy. And many of us don't mind having a massive flaccid either.
If - and this is a huge if - the Titan would give us a flaccid pointing straight out, something that would hinder us in daily life, which would scare women and kids by the swimming pool, then it'd be different. But I don't believe that shit. When that happens it is because the doc fucked up. He installed it wrong. He left it inflated for too long after surgery, allowing scar tissue to form around a half full reservoir and hence making full deflation impossible later on. He installed a Titan in a too small penis not having enough length to let the cylinders bend and hang down. He installed a foot-long stack of RTEs pushing the fixed part out too long and creating an unnatural hang. Or whatever. But a properly installed Titan in the right dick will not create any issues with the flaccid. I am living proof of that as numerous pictures in my thread here on FT shows. viewtopic.php?f=6&t=6010&p=139366#p139366

So what do we have?
A fishy claimed advantage of the flaccid for AMS. But then?

We have a larger pump, that's a fact. That's good if you have some problems with your hand dexterity and strength. But otherwise, it is all bad. The smaller the pump, the better since it will be less visible and less uncomfortable.

We have the problem with the tubing insertion which in many cases forces (or makes) doctors use more RTEs to get the pump correctly placed. Meaning we get the rock or the hard place. Either too many RTEs or a high pump.

And why are RTEs bad? In my opinion (and Eid's as he told me 5 years ago), because it makes (on average, statistically speaking) the erection more "wobbly" than it otherwise would have been. How? Because the RTEs are thinner than the cylinders and don't create as firm base in the crus as inflated cylinders do. To make things worse, AMS RTEs are much thinner than Titan RTEs. Same goes for the fixed part of the implant, AMS is thinner than Titan. So all else equal, an AMS increases the risk for the erection to get "wobbly" or "hingy" as the years pass by.

Then we have the hardness. I think all docs are in agreement that a Titan, when fully inflated, is harder than a fully inflated AMS. Whether that is meaningful is an individual opinion. If someone inflates his AMS to 80% and thinks that is more than hard enough - well then fuck it. No point of the Titan's super hardness. But if someone is like me, and inflates my Titan with two hands, full force, till my fingers cramp. And just love the feeling of having a dick harder than any woman has ever been fucked with. Love the feeling of knowing that in my dick I have the implant which will give me the absolutely hardest dick possible. Then we have something with the Titan which an AMS can never achieve. And the great thing is with a Titan you can choose. Hard beyond human range and all the way down to a semi if that is what you want. With an AMS you don't have the possibility if wanted to go to those extreme hardness levels. Just a fact. What it is worth is up to each and every one to decide.

Girth. Another advantage (or possible advantage) for the Titan. Thicker cylinders fills up a thick dick better than thinner cylinders. Pretty fucking obvious. Of course, someone with a thin dick won't benefit from the extra cylinder diameter of the Titan. And someone who doesn't care about losing girth won't mind either. But if you have a girthy dick and you want to do what you can to keep that girth, then this becomes a major factor.

Reliability and time to failure? I thought this was a non-issue, as in no difference between the two brands. But several posts lately have referred to doctors saying that young guys, who on average will expose their implants to more frequent use and more stressful use, should get the Titan because it will last longer. That is of course a major factor in deciding between the two brands as well, and one more advantage for the Titan.

So... What does that mean to you? And what would it have meant to me if I try to put myself in your shoes?
Going back to where I was financially at your age, I would have struggled to convince myself to pay the 10K extra. Especially if I had already had a CX and I had been satisfied with it. But only you can decide what those advantages are worth. I don't think the reliability issue alone would have convinced me. Maybe the average time to failure for 1000 Titans is longer than it is for 1000 AMS devices. But I would guess that the the two normal curves have such a large over-lap that in the end pure luck is more important than which type we choose.

It would be about the potential advantages of the Titan. And again, only you can put a price on them. And if you believe in them or not.

Another more philosophical point is that the value of money is different to different people. I was and still am motivated by materialistic "success". I want a fancy car, a large nice house, a nice boat, a fast Jet-Ski, a cool motorcycle, expensive suits, nice jewelry and clothes for my wife, branded clothes for my kids, etc, etc. And blowing off a huge part of my starting capital when aspiring for those things would have sucked for me.
But if you are not even aiming to have expensive stuff in your life, if it isn't important at all, then blowing 10 K on a Titan wouldn't be as huge a problem as it would if building up capital, and doing it fast, was hugely important to you.

No clear answer on what I think you should do.
Just some food for your thoughts.

Whatever you choose, I wish you all the best.
I think I know you well enough to say that whatever happens, things will work out great for you in the end.

Take care.

[C_lab34]

I remember those long talks too, Merrix. You were immensely helpful and informative. And though we do live very different lives, I think we are of a similar cast of mind, at least in some respects. We are both analytical, reflective and thorough, especially about matters of deep concern to us.

I appreciate your condolences. My current mindset shifts from feelings of depression and self-pity (why did this happen to me, I don't deserve this, I deserved more time with a functional implant) to feelings of gratitude for what I was able to enjoy when I did have a working implant. I know it will be best for my moment to moment well-being if I remind myself of the good things in my life, though it can be difficult to do this.

After I fully healed from my first surgery, I put all implant concerns and minor issues behind me. I truly did not think about differences between the ams vs titan, length, girth, rigidity, anything. I just moved on. Maybe I moved on a little too fast and far, because I did not even want to come back to Franktalk to help other men. Maybe it was selfish. I was just happy to live in a world without any ED concerns.

But here I am again. And now I face tough decisions. I believe there are probably some small advantages with a Titan for a younger man with a larger penis. If I had a working CX, I was fine with it. I wouldn't dream of having surgery just to switch brands if everything was working. But my CX does not work, and I am going to have to be unconscious and cut into again, and have a complex device rammed inside of me.

Now, it could very well be the case that there is absolutely no significant difference between the two brands. But it is interesting how three out of four high volume implant surgeons have all told me I should have had a Titan, or that I should get a Titan now. Not that they think AMS is a piece of trash, just that the Titan would be better for me. That's what Eid thought, that's what my new surgeon Tatem thinks, and that is what Jonathen Clavell, another younger but high volume surgeon, thinks as well. He flat out told me, if it were his penis, he would go with the Titan. Maybe this is all bias, but maybe not.

The 10,000 dollar difference is a big difference. Is it worth it for uncertain advantages? It is an excellent question. But here is one way in which we majorly differ, Merrix, with plenty of respect of course. Money is not important to me. In fact, pretty much the only way in which money is important to me is in relation to my health, and more specifically, in relation to my implant/sexual function. I have never dreamed of big houses or nice cars or designer clothes. I do not even care so much to travel all around the world or eat fine food. I am not casting aspersion on anyone who does desire these things and organizes their life around obtaining them. Just stating as fact that these desires are absent in me.

Sure, I do not want to live in a hut with a dirt floor, but I'm just fine with thrift store clothing, cheap meals and modest housing/renting. And I do still want a family of my own, and want to be able to provide at least the necessities for children, but I do not think that requires as much as people sometimes believe. What I mean is that, maybe I will not be able to send my children to private school and give them expensive clothes, but I know I can feed and clothe them. For myself, all I have ever really cared about in life is love, artistic expression, free time to enjoy the simple things, and...having a working penis. I spend most of my time reading, writing, taking walks, hiking, working out, thinking, being with friends and family, and pursuing or cultivating romantic and erotic connection. All these things are not really monetarily expensive.

So the 10,000 dollars is a lot, in the sense that I do not make a lot of money and do not have much to spare. But at the same time, given my priorities, it is not that much, because this is one of the most important things in the world to me. As I alluded to earlier, in some ways I wish this weren't so important, but it is an inescapable fact that it is. Let's say I just renounced sex altogether and didn't do anything. Let's say I had 10,000 or 17,000 thousand now just sitting in my account. What would I do with it? I honestly don't even know. My material desires are so modest that nothing immediately comes to mind. Motorcycles, flashy suits, boats? No way. I guess it would just be money I'd save for possible children.

After my last long term relationship ended last July, I moved back home with my parents. I have a full time job (not high paying, by any means). I can already pay for a decent portion of the surgery. My parents are solidly middle class, and they have saved a lot of money over the years by being frugal in some ways (not eating out, not buying new clothes, etc) but even they have had their splurges. They have a boat and an inground swimming pool and my dad has a nice harley. But they have a decent amount of money saved. They have said they will help me with the cost of the surgery. Even if they don't expect or demand it of me, I will pay them back. And I could do it in probably 6 months if I stayed at home and worked the whole time. While it does set me back slightly, in the grand scheme of things I think it is a small price to pay for knowing I did everything I could to maximize a positive outcome with the best possible device. So as of now, I am leaning towards the Titan and the greater expense.