top surgery

[Liam]

Originally Posted by The Oopster

Voloshin had a binder, just one of those wrap around ones, that they supplied and was on following surgeryl

Dr. Kim gave me an order for a surgical binder, and I walked down to Supply at General, and picked it up, taking it with me to the hospital, the morning of my procedure. It was the softest, nicest binder I have ever worn; it was from a plastic surgery supply place, I don't remember the brand name.

[DapperButch]

If you are thinking about getting top surgery, or have gotten top surgery, please fill out this survey. It is data being collected by micah who has the neutrois.me It will be good to have this data.

https://docs.google.com/forms/d/1JS6...wdiI4/viewform

[cathexis]

Need some advice about my upcoming appt. with a plastic/reconstruction surgeon within the next couple of weeks. Anyone have any advice of do/don'ts during the interview/examination?

As it gets closer, I get more frightened. Have this weird sense that my life depends on the appointment. It's silly, but that's how I'm feeling. I'm all shaky with my BP elevating.

Anyone know this feeling?

[DapperButch]

Originally Posted by cathexis

Need some advice about my upcoming appt. with a plastic/reconstruction surgeon within the next couple of weeks. Anyone have any advice of do/don'ts during the interview/examination?

As it gets closer, I get more frightened. Have this weird sense that my life depends on the appointment. It's silly, but that's how I'm feeling. I'm all shaky with my BP elevating.

Anyone know this feeling?

First question is to ask them how many top surgeries they have done. Make them separate out double incision versus peri/key hole method.

As them who trained them (hopefully a surgeon who's specialty is trans surgeries).

I am going to assume you are getting double incision.

I would ask them what size areolas they make. Old standard method is the size of an nickel...surgeons would literally draw around a nickel in the surgery. I personally have seen that when areolas are left too large (for my taste), it detracts from the look of the chest. I see "female", no matter what the chest looks like. It seems to me that the less experienced surgeons leave them too large (beyond the "nickel" size). I went to Garramone in Florida who makes them the size of a dime. They also stretch out. Ask to see photos and then tell them what you think of the size.

Ask if they do free revisions. This would mean not paying for the surgeons fee, but still would pay for the other costs of surgery. However, I am thinking you are using Medicare and/or Medicaid, so I don't know how it would fit into this. I paid out of pocket.

I think your emotional response is completely normal. For us with dysphoria, after the idea of having no breasts comes closer, we realize how important a male chest is to us. I hear this from a lot of trans people when they get closer to their surgeries. Often they (and I felt this way), have excessive worries something will go wrong and they won't be able to have the surgery that day.

Keep us updated!

[cathexis]

Thanks Dapper,
Your note has helped me calm down a bit, but still bouncing off the walls. No one knows anything about this guy. He took the place of a surgeon who had quit. My TG/IM/Primary Care doc said he has heard good things about him. Plan to approach this the way I do most other things...as a skeptic and a cynic. Will let you about the appointment on Monday night. Thanks for the empathetic, calming words. They do help.
cathexis

[cathexis]

Originally Posted by cathexis

Thanks Dapper,
Your note has helped me calm down a bit, but still bouncing off the walls. No one knows anything about this guy. He took the place of a surgeon who had quit. My TG/IM/Primary Care doc said he has heard good things about him. Plan to approach this the way I do most other things...as a skeptic and a cynic. Will let you about the appointment on Monday night. Thanks for the empathetic, calming words. They do help.
cathexis

Sorry, it took Saturday for me to get back. The doc is older with a very laid back, but knowledgeable demeanor. He seems like he has done a fair amount of plastic/reconstructive surgery with experience in trans. surgery ... top surgery at least. Sue and I perused his certificates on the wall, and were happy with his credentials.

Had pictures taken at various angles. He examined me, and questioned about how long I had been thinking about and why. I have a follow up in a month when he has all the WPATH documentation.

Will keep you posted, but I'm really excited about this surgery and the surgeon.

[homoe]

Originally Posted by cathexis

Sorry, it took Saturday for me to get back. The doc is older with a very laid back, but knowledgeable demeanor. He seems like he has done a fair amount of plastic/reconstructive surgery with experience in trans. surgery ... top surgery at least. Sue and I perused his certificates on the wall, and were happy with his credentials.

Had pictures taken at various angles. He examined me, and questioned about how long I had been thinking about and why. I have a follow up in a month when he has all the WPATH documentation.

Will keep you posted, but am

Good to hear! Thanks for posting and keeping us up to date.

[DapperButch]

Originally Posted by cathexis

Sorry, it took Saturday for me to get back. The doc is older with a very laid back, but knowledgeable demeanor. He seems like he has done a fair amount of plastic/reconstructive surgery with experience in trans. surgery ... top surgery at least. Sue and I perused his certificates on the wall, and were happy with his credentials.

Had pictures taken at various angles. He examined me, and questioned about how long I had been thinking about and why. I have a follow up in a month when he has all the WPATH documentation.

Will keep you posted, but I'm really excited about this surgery and the surgeon.

I'm glad you felt good with him. You mentioned "a fair amount of plastic/reconstructive surgery with experience in trans. surgery" I am not sure what that means. Did you ask him directly how many top surgeries he has done? Did you ask to see pictures of his work?

[cathexis]

Originally Posted by DapperButch

I'm glad you felt good with him. You mentioned "a fair amount of plastic/reconstructive surgery with experience in trans. surgery" I am not sure what that means. Did you ask him directly how many top surgeries he has done? Did you ask to see pictures of his work?

Did ask to see photos. He wanted the medical records (even though I brought some of them with me) before going into specifics. He was especially interested in getting the WPATH documentation, probably because I don't look very masculine.

This is our first meeting. Perhaps, he thought it might be an impulsive decision. Not sure his rationale for waiting to discuss the specific surgery (like 2 incision vs keyhole, when I'm obviously not a candidate for the latter). Appreciate his need to be certain , but a bit worried about how far into the summer I'll be healing if he waits too long. Don't tolerate summer as it is.

[DapperButch]

Originally Posted by cathexis

Did ask to see photos. He wanted the medical records (even though I brought some of them with me) before going into specifics. He was especially interested in getting the WPATH documentation, probably because I don't look very masculine.

This is our first meeting. Perhaps, he thought it might be an impulsive decision. Not sure his rationale for waiting to discuss the specific surgery (like 2 incision vs keyhole, when I'm obviously not a candidate for the latter). Appreciate his need to be certain , but a bit worried about how far into the summer I'll be healing if he waits too long. Don't tolerate summer as it is.

So did he show you any photos (you only said you asked)?

Did you ask him how many top surgeries he has done?

Did you ask him where/who trained him in top surgery?

I know you said that he replaced someone. Is he there specifically to do trans surgeries, or he just inherited this role from this last surgeon?

Based on the fact that he doesn't know anything about WPATH and didn't immediately start talking about double incision (your chest is larger than a small B with no droop to your breasts, right?), concerns me.

I'm sure he is a good surgeon. He might be an excellent plastic surgeon. What matters is if he is an excellent (or good) top surgeon. The question is if he had any training in top surgery and how many times he has done it.

I think you live in Michigan? I assume you have Medicare. You can go to the University of Michigan.

http://www.uofmhealth.org/conditions...ender-services

Since Medicare is a federal insurance, you can use it anywhere. Transgender health programs are popping up at all the University hospitals and they take Medicare.

It's true that every surgeon who does top surgery has to start somewhere. The question is if he had any training in it. I have seen too many guys in such distress over their results when using a non-seasoned top surgeon. I know travel is costly, but it might be worth it.

Yet, with all this said, there are many guys who don't care about how "good" it looks and just "want them off". There is nothing wrong with that, either.

[cathexis]

Guess I was a bit worried in the office. He told me the WPATH documentation he needed before going any further. You wrote that it concerned you when he seemed unfamiliar with WPATH. Please explain.

Didn't ask the questions you recommended, He seemed reluctant to discuss it any more in depth before receiving the WPATH and other medical records? Will print out the list for Jan. visit. Do many plastic surgeons take telephone questions?

You mentioned that you were familiar with other medical centers. I live in NY way up near Montreal, Canada. The closest large US cities are Burlington Vermont (3 hrs.) and Albany New York (5-6 hrs) . Yes, I truly live in the boondocks of a small dairy town. Don't ask how or why this Chicagoan got stuck here. I'll tell you sometime, if you're curious.

Thanks for all the advice. I'd be lost without it.
Btw, do you know of any trans support groups in either city. We are saving up for Albany, though.

[DapperButch]

Originally Posted by cathexis

Guess I was a bit worried in the office. He told me the WPATH documentation he needed before going any further. You wrote that it concerned you when he seemed unfamiliar with WPATH. Please explain.

Didn't ask the questions you recommended, He seemed reluctant to discuss it any more in depth before receiving the WPATH and other medical records? Will print out the list for Jan. visit. Do many plastic surgeons take telephone questions?

You mentioned that you were familiar with other medical centers. I live in NY way up near Montreal, Canada. The closest large US cities are Burlington Vermont (3 hrs.) and Albany New York (5-6 hrs) . Yes, I truly live in the boondocks of a small dairy town. Don't ask how or why this Chicagoan got stuck here. I'll tell you sometime, if you're curious.

Thanks for all the advice. I'd be lost without it.
Btw, do you know of any trans support groups in either city. We are saving up for Albany, though.

I'm sorry, I assumed you knew what WPATH was. WPATH informs the Standards of Care (medical care) for trans people. It is where all things spring when it comes to care for trans people. I looked back and I can't tell from your post if he had never heard of WPATH, or just wanted a letter from your therapist.

http://www.wpath.org/

Why are you saving for Albany?

I have to be honest with you. The number of people doing top surgeries have increased quite a bit in the last few years and I have not kept up with them. I could talk to you about bottom surgeons all day long, but not top surgeons.

I found this, however:

http://www.topsurgery.net/surgeons/medicare.htm

I would not assume all of these people still take Medicare and I would not assume that this list is up to date. There are probably more surgeons who take Medicare. I can tell you that Berverly Fischer no longer take Medicare.

Call your closest University hospital and see if they have a surgical trans health program. If they do, you can be pretty sure they will take your Medicare. It will be harder to find a private practitioner who takes Medicare since they pay so poorly.

Are you on FB? If so, the best thing you can do is join a top surgery FB group and the guys there will have everything you need to know. I can find out the name of the "main one", if you want. I bet that within one post of giving your location someone there can tell you the closest person to you who will take Medicare.

With all that said, it seems that you haven't asked the questions you need to ask your current provider in order to rule him out. But, his reluctance to discuss is a huge red flag. Why wouldn't a trans provider assume you would ask how many surgeries he has done and to ask to see pictures? YOU are the consumer. He is providing the service. I can't help but wonder if he has only done a couple and doesn't have any pictures. Anyway, I wouldn't move any further with this guy if he didn't answer these questions to my satisfaction. Don't let him intimidate you.

Remember, you want a surgeon who specializes, or at least has some decent experience in doing FTM top surgeries. Nothing else matters. Trans people often feel like they have to take crumbs. That we should be thankful that there is someone out there who will do our surgeries. Well, guess what? Shit has changed and there are now qualified people who will do them, who care about our community and want to do them. Unfortunately, some trans people still don't have a choice, based on their location, and that sucks (no money for travel). Insurance is often a sticking point, too. However, don't feel that you have to accept this provider without at least getting some of your questions answered to your satisfaction. With all of this said, I am not saying that one shouldn't accept a provider who is new to it and is eager to learn...sometimes that is the best you can get. Just DON'T forget to ask about free revisions. Do all your research about other providers before you next appt. with him so you know your options going in.

Good luck.

[cathexis]

The doc is affiliated with U Vermont, Montpelier (capital city). They have an active youth trans program. At least they are familiar with the care. Went to the Jan. appt. It was just a check in to tell me that everyone (therapist, surgeon) appeared to be onboard.

It lasted about 20 mins. He knows that I live 3 hrs. away. Every appt costs 100 dollars in out of pocket expenses that I don't think can be re-cooped. Next (hopefully last pre-op) hoop is that Anesthesia wants cardiac and IM clearance based on my medical hx before surgery.

He wants to see me again after getting that. Will call the office to see if we can Skype that visit. Really not thrilled about spending 6 hrs and the cost for a 20 min visit.

[Bard]

OK guys seriously now thinking about top surgery and do plan on talking with my endo on the next visit the binder is just a pain at times and even though being not um a lot I mean I can go with out but I just am getting to a stage where I am self conscious
I am also getting cysts from binding ugg most likely be able to do the keyhole just so much and well I am nervous so thought ??

[DapperButch]

Originally Posted by Bard

OK guys seriously now thinking about top surgery and do plan on talking with my endo on the next visit the binder is just a pain at times and even though being not um a lot I mean I can go with out but I just am getting to a stage where I am self conscious
I am also getting cysts from binding ugg most likely be able to do the keyhole just so much and well I am nervous so thought ??

Hi, Bard.

I am not sure what you are asking? I have never heard of someone getting cysts from a binder, so I would check that out.

You mentioned keyhole. The most internationally known/respected keyhole/peri areola surgeon is Beverly Fischer in Timonium, MD (close to Baltimore). Unfortunately, she no longer takes insurance. Her double incision is $9,500. I don't know what her keyhole/peri is, but it would be a bit more than the DI. She is also an amazing person. Has been doing top surgery since the 1990's.

Many guys think they can get keyhole who really can't. If there is any droop to your breast, you should plan on it not being a suggested procedure.

Also, I didn't know you were on testosterone. I didn't see it posted anywhere. Can I ask when you started? Congratulations.

I would suggest before you get super excited about a top surgeon that if you have trans health insurance that you call your insurance company first to see who is in-network. Hopefully, they won't have ANY providers and then you will have your pick of the litter (as long as your preferred surgeon is willing to work with your insurance).

[nhplowboi]

I am wondering if anyone knows much about Dr. Melissa Johnson? I would rather go to Dr. Garramone but would have to arrange time away from home if I choose him. Johnson is a short car ride away.

[Bard]

Originally Posted by DapperButch

Hi, Bard.

I am not sure what you are asking? I have never heard of someone getting cysts from a binder, so I would check that out.

You mentioned keyhole. The most internationally known/respected keyhole/peri areola surgeon is Beverly Fischer in Timonium, MD (close to Baltimore). Unfortunately, she no longer takes insurance. Her double incision is $9,500. I don't know what her keyhole/peri is, but it would be a bit more than the DI. She is also an amazing person. Has been doing top surgery since the 1990's.

Many guys think they can get keyhole who really can't. If there is any droop to your breast, you should plan on it not being a suggested procedure.

Also, I didn't know you were on testosterone. I didn't see it posted anywhere. Can I ask when you started? Congratulations.

I would suggest before you get super excited about a top surgeon that if you have trans health insurance that you call your insurance company first to see who is in-network. Hopefully, they won't have ANY providers and then you will have your pick of the litter (as long as your preferred surgeon is willing to work with your insurance).

Thanks Dapper been on for over a year now and taking my time with this as I do, yeah I had cyst before that was removed and when I had started feeling some pain and such had my doc check she feels small cyst but test came back clear soo just thinking this is the next or best step for me in the information gathering stage right now and will talk to my endo she had mentioned some surgeons in the area she works with for the trans community here for when and or if I wanted any being small if you will and no drop so I guess we will see I just want to make sure this is the best thing as it has been on my mind a lot thought I would reach out honestly I think it is all part of the processes that each goes through when becoming

[DapperButch]

Originally Posted by nhplowboi

I am wondering if anyone knows much about Dr. Melissa Johnson? I would rather go to Dr. Garramone but would have to arrange time away from home if I choose him. Johnson is a short car ride away.

Melissa Johnson is very good and carries a great reputation in the community. Check out transbucket.org for pictures of her work.

I assume you know you would only have to stay for 7 days in FL if you went to Garramone, right?

[DapperButch]

Bard,

I don't know if you have read my extensive ramblings to cathexis, but one thing I listed was this site: http://www.topsurgery.net/

It will give you a solid foundation when starting the process of looking into top surgery.

I forget to tell you that when you contact your insurance company for providers, you need to ask them to send you information on what is required for them to pay for your surgery. Look on your insurance website for trans health coverage which will also have the information.

Without a doubt both your insurance company and the surgeon will require at least one "letter" from a gender therapist saying that this surgery is medically necessary. Make sure that when you see said therapist that you give them a copy of what your insurance company wants in a letter and what the surgeon you have chosen wants in a letter. This way the therapist will make sure to have all of the information needed for both parties. Otherwise, you will find yourself returning for another letter.

If you don't have a gender therapist you can look for a gender therapist who will meet with you for an evaluation and write a letter for you. Usually this is out of pocket, rather than using insurance. Make sure you also find out the therapist credentials required for the insurance company and surgeon.

Let me know if I can help in any other way.

[kittygrrl]

i think top surgery is amazing..i am just not sure about the hormone therapy..dated a few guys in transition and ftm..nice guys but seemed unhappy..had a lot of fun with mtf, we sync..a lit experience