How to Start Top Surgery Process

[AB]

Hello!

 

I am looking for some advice from people who have had top surgery. I think I know what surgeon I would like to go to but how do I begin this process? I have never had any type of surgery before so I am not sure on how to schedule one. I'm also curious to how I find out if my insurance will cover my surgery?

What should I expect at a consultation, and what questions should I ask the surgeon?  I have lots of anxiety so I am very worried about this but binding has become detrimental to my daily life so it needs to be done! Any help is greatly appreciated!

[JJ]

Surgeons in my state don't accept my medical coverage -Medicare and Medicaid - so I don't have information for you.

Most states have some sort of FTM group that would be familiar with the process wherer you are. I'd recommend googling to see if you can find one. Most also have an online presence -do a FB search under FTM  and your state.

Hope you are able to get your answers and start the process soon.

Johnny

[ChickenLittle]

I haven't had surgery yet but I'm scheduled for next month. Like you, I'm worried about the long-tern effects of binding. I started  my top surgery process by choosing a surgeon (looked at various websites, especially transbucket, for before/after photos of people with similar body types to me). Then I contacted his office to set up a consultation. They offered an online consult, which I did, then I sent them my insurance info so they could start negotiating with them to get coverage. I don't know if that's typical or not though! I decided I wanted an in-person consult too because I was struggling to decide which incision type I wanted, so I met with the surgeon and he helped me understand the pros and cons of each type. After about 4-5 weeks, my insurance sent me a letter telling me that my surgery was approved. (I have Blue Shield PPO through my partner's work)

 

Things to remember: most, if not all, insurance companies will want a letter from a therapist. Some doctors require this too, so if you don't have that done it would be a good first step. My therapist and I used this letter as a template: http://transcare.ucsf.edu/sites/transcare.ucsf.edu/files/Male Chest Reconstruction SAMPLE Medical Clearance.docx

 

Questions I asked during my consult:

Do you use drains? If so, how long do they stay in?

What incision types do you offer? What are the pros and cons of each? Which do you think would work best with my body type?

How is billing done re: anesthesia?

When do I come in for pre- and post- op appointments?

Will I be able to contact the surgeon after-hours if I have a problem during recovery? 

Do I need to stop taking any meds prior to surgery?

Is there anything you think I should know or do to prepare for surgery?

How many of this type of surgery have you performed? How common are complications (like graft rejection, etc)?

 

Good luck from a fellow anxious person!

[Wolfbane]

I had mine back in 2008.  I was born intersex, so a few things are a little different, but the top surgery is essentially the same.  I would ask the office of the surgeon you have chosen if they accept your insurance and if so, do they file for you or do you have to file yourself?  I went to Daniel Medalie, and back then, few insurances covered these surgeries, so I paid out of pocket.  Some top surgeons keep your nipples intact with little to no grafting, but reduce the size.  Others do not.  I didn't realize that back then, but I lucked out with Medalie because he did. I had some more pain initially, but it was well worth it because I have sensation in my chest whereas most of the FTMs I know do not.  My consult was done over the phone and online.  I sent in pictures of my chest for him to do some initial measurement/prep.  You can ask about the drains as ChickenLittle mentioned, but almost all surgeons use them.  Mine were in for 4 or 5 days.  The questions that ChickenLittle noted are helpful.  I would imagine most surgeons' offices have preoperative handouts or lists for you.  Mine had all the answers to those questions on preoperative information handouts.  The therapist's letter is crucial to get before you can schedule surgery.  Some want a letter from your primary care physician as well.  Mine did not require a letter, but he had a form for my doctor to fill out and tests he wanted done (blood and chest x-ray) before the surgery.  I had those done locally because I lived several states away from OH. Most surgeons schedule months in advance. If you don't have and can't find a local therapist, there are online therapists who are very good as well.  If you are traveling out of state, be sure to have a good place to stay post-operatively and someone to help you out.  My wife and I just stayed a week in an extended stay hotel, but there are usually several options. 

[Nykoli55]

Hey AB- Not sure if you will still read this forum but how are you in your process of getting surgery? I've been looking into it on and off for ever and am now trying really hard to take the necessary steps. It seems exhaustingly impossible some times. 

Anyways! I hope you are on your way! 

[AB]

@Nykoli55

 

I have my surgery scheduled for Aug. 23rd! Very excited even though I am still not sure how much it will cost me lol. Basically it is a LOT of phone calls, emails, and appointment scheduling. My surgeon required 2 letters one from my primary physician and then one from a therapist, but I got the Mazzoni Center to handle both of those for me. My insurance also approved the surgery as medically necessary so they should be covering most of it! Good luck with your journey!

[StrainAsylum]

On 5/21/2018 at 8:44 PM, Wolfbane said:

I went to Daniel Medalie, and back then, few insurances covered these surgeries, so I paid out of pocket.  Some top surgeons keep your nipples intact with little to no grafting, but reduce the size.  Others do not.  I didn't realize that back then, but I lucked out with Medalie because he did.

1

 

I've watched Dr Medalie's video of top surgery (double incision with nipple graft) over and over.  He seems very good.  Are you happy with your results?

[StrainAsylum]

On 5/8/2018 at 1:32 PM, ChickenLittle said:

I haven't had surgery yet but I'm scheduled for next month. I used this letter as a template: http://transcare.ucsf.edu/sites/transcare.ucsf.edu/files/Male Chest Reconstruction SAMPLE Medical Clearance.docx

 

 

Good luck from a fellow anxious person!

 

 

Best of luck on your top surgery!  Thanks for the letter template.

[Nykoli55]

22 hours ago, AB said:

@Nykoli55

 

I have my surgery scheduled for Aug. 23rd! Very excited even though I am still not sure how much it will cost me lol. Basically it is a LOT of phone calls, emails, and appointment scheduling. My surgeon required 2 letters one from my primary physician and then one from a therapist, but I got the Mazzoni Center to handle both of those for me. My insurance also approved the surgery as medically necessary so they should be covering most of it! Good luck with your journey!

That's awesome! Insurance isn't great in Wisconsin but I just told my psychiatrist who've I've had for like-8 years that I'm thinking of transitioning-Im sure she'll give me a letter. I'm excited for you. I can't wait for top surgery. It's hard to be patient....:/ 

[ChickenLittle]

On 8/5/2018 at 8:26 PM, StrainAsylum said:

 

Best of luck on your top surgery!  Thanks for the letter template.

 

Thank you! My surgery was June 28th and it went great!  

[StrainAsylum]

On 8/8/2018 at 7:47 PM, ChickenLittle said:

 

Thank you! My surgery was June 28th and it went great!  

Really glad to hear that!  How did the healing go?  Did your surgeon use drains or not?  I understand many are not, which sounds good, since it sounds like that's painful and may contribute to complications?

[StrainAsylum]

On 8/5/2018 at 8:35 PM, AB said:

@Nykoli55

 

I have my surgery scheduled for Aug. 23rd! Very excited even though I am still not sure how much it will cost me lol. Basically it is a LOT of phone calls, emails, and appointment scheduling. My surgeon required 2 letters one from my primary physician and then one from a therapist, but I got the Mazzoni Center to handle both of those for me. My insurance also approved the surgery as medically necessary so they should be covering most of it! Good luck with your journey!

Good luck on your surgery!  Let us know how it went and how you are, please?

 

[ChickenLittle]

On 8/19/2018 at 4:16 PM, StrainAsylum said:

Really glad to hear that!  How did the healing go?  Did your surgeon use drains or not?  I understand many are not, which sounds good, since it sounds like that's painful and may contribute to complications?

 

I got peri-areolar surgery, which makes healing a bit different I think since I don't have the big incisions.

 

The healing was great at first, then very anxiety-inducing. I had a fairly rare complication with my healing, where one nipple lost blood supply and some of the tissue died. It's not as bad as I was afraid it might be. I have some scar tissue on the nipple itself but I actually like the scarred one better than the other one! My pain was very minimal for the first two weeks, then my skin got VERY sensitive and wearing a shirt was painful. That's because of nerve regrowth. 

 

I opted for drains, and I think they helped a lot. I couldn't imagine having all that fluid under my skin. Without the drains, my swelling would have likely lasted a lot longer! With peri, I think drains are highly recommended. 

 

I'm now 6 or 7 weeks out and cleared to resume my regular activities. I'm happy with my results overall and am seeking a minor revision on the nipple that healed better (it has a bit more tissue and I want them to match).  

[AB]

On 8/19/2018 at 7:17 PM, StrainAsylum said:

Good luck on your surgery!  Let us know how it went and how you are, please?

 

Surgery went great and not nearly as scary as I expected. Healing has been relatively painless, mostly just felt like I went really hard at the gym for hours. Just got my drains out a few days ago and currently have to wear a surgical binder for 3 more weeks and then I am free!

[ChickenLittle]

4 hours ago, AB said:

Surgery went great and not nearly as scary as I expected. Healing has been relatively painless, mostly just felt like I went really hard at the gym for hours. Just got my drains out a few days ago and currently have to wear a surgical binder for 3 more weeks and then I am free!

 

Congrats on your surgery! I hope your recovery goes smoothly and quickly. Make sure to take it easy even if you're feeling great.  

[Jani]

Great news!  I'm glad to hear you're doing well.  

 

Jani

[Wolfbane]

Sorry for the late reply.  We've been busy all summer.  I am very happy with Medalie's surgery.  I go around shirtless on our ranch all the time.  Local people here never even guess I had the surgery because it is so natural.  I do have enough hair on my chest to help with that, but the surgical scarring itself is just not noticeable.  My wife loves my chest, which is the most important thing of all.  Wishing you the best!

[Werzle]

My surgery is scheduled for 10 October so this was an excellent thread to click on lol! I'm glad everyone is doing so well!!