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FTM Top Surgery FAQ

For information about the types of top surgery procedures offered, please see FTM Top Surgery Procedures.

Frequently Asked Questions About Top Surgery

The visits include an appointment on the fifth or sixth postoperative day at which time the grafts are inspected (if the procedure is a mastectomy with nipple areolar grafts).  The only visible sutures for removal are around the grafts; the inframammary incision is closed with an absorbable subcuticular suture which does not require removal. For this reason, “stitch marks” should not occur along this incision line. Patients are welcome to come to the office at any time other than routine scheduled appointments should they have questions or concerns they wish addressed with a visit.

A binder is to be worn for one week following the date of surgery. Following the Keyhole procedure, support should be worn for at least 1 month. This need not be a binder; an elastic shirt would suffice.

You may shower after post operative day 6 or 7 when the sutures around your grafts are removed. You will receive instructions that you should shower from behind to protect the healing grafts from the direct stream of the shower water. Carefully pat the chest dry and reapply ointment and dressings (supplied) to the graft sites to protect them from the binder, and then your clothing for approximately two additional weeks.

You should be able to resume most normal activities within two weeks of your top surgery. If your goal is to return to or begin a strenuous exercise program, weight training, or other similar body building programs, you should wait at least one month.

This will depend on the type of work in which you are engaged. Clerical type work can sometimes be resumed after one week. Work requiring the lifting of 20 to 25 pounds can be resumed after two weeks. Heavier types of work duties should not be resumed until one month following surgery.

It is recommended that you wait at least a month, and then only go into the tub for very brief periods. After six months you may resume your normal hot tub sessions.

Initially tape is placed on the incisions. This is worn for one week, unless it is not tolerated by the skin. It keeps tension off the incisions and provides a modicum of pressure, which is helpful in lessening the degree of scarring. After the tape is removed, several preparations may be used on the scars and samples of these will be provided to you.  Silicone tape or sheeting has been used with success by a number of patients. Avoid sunburn or prolonged sun exposure for a minimum of one year and use a strong sunscreen when exposed to protect the incisions and grafts as they heal.

There are no specific preparations, vitamins, or foods that will necessarily enhance the healing process in an otherwise healthy individual. Maintain a good, balanced diet. Avoid smoking for at least two weeks prior to surgery and avoid alcohol, except in small amounts, for those same two weeks. Of course, it is best if smoking is stopped altogether as much before surgery as possible. If there are specific health problems, consult with your physician to assure that they are under control.

This depends on where you live and what the requirements are in that particular jurisdiction. After your surgery, at your request, and for a modest fee, I provide you with a letter(s) indicating you have had surgery that may change your status, but these letters will not necessarily allow you to change your gender on all official documents. You should check with those entities where you wish to change documentation as to whether these letters require notarization and what specific information they will require for documentation. In some instances we cannot fulfill these requirements.

With any procedure there may be some benefit derived from a revision performed at a later date. This may be done to improve the appearance of scars, remove residual excess tissue, adjust areolar and nipple dimension, or improve symmetry. These revisions are required more often with subcutaneous mastectomy (keyhole) than with mastectomy and nipple areolar reconstruction with grafting. These revision procedures, if required or beneficial, can occasionally be performed under local anesthesia, but more often are performed under general anesthetic. Any sedation, or anesthesia does require the presence of an anesthesiologist. There will be a reduced surgical procedure fee for revisions, the amount dependent upon the extent of revision. There is a cost imposed by the surgery center though it is at a rate less than that for the initial surgery and there is an anesthesia fee if the anesthesiologist is required. There is generally no pathology fee.

Revisions should not be performed before six months to one year after surgery. This allows for maximum spontaneous healing and improvement and will undoubtedly lessen the extent of revision needed.

There are weight considerations with Top Surgery. The surgery center has established weight restrictions for anesthesia based upon height to weight ratios. Health and safety are of prime concern and excessive weight, as related to ideal weight, may limit the accurate contouring of the chest as a protuberant abdomen and prominent underarm fat and skin will be part of the overall appearance of the torso.

If one has determined that they need to lose weight and knows they can do it, they should do so prior to top surgery. Some, because of genetics, habit, lifestyle, etc. realistically know they will not lose the weight they want to lose. They, if in good health, can proceed with top surgery and still reach their ultimate goal, a male appearing chest.

In those patients who are excessively obese with markedly high BMI (body mass index) and/or with extremely large breasts, the usual surgical fee may be increased.

This is an individual variant. Some report very little pain, others report moderate pain or even considerable pain for short periods. Strong pain medications are prescribed for the postoperative period and it is recommended they be used. Pain usually subsides considerably once the drains have been removed. Pain is not a major factor in the recovery period; discomfort does persist for a while as the required binder is restrictive for it to be useful in limiting swelling and preventing fluid accumulation.

It does not hurt, because we don’t typically use drains!

We ask that patients stay in town for 5-6 days after top surgery. Some patients stay up to 10 days. Once the sutures are removed at 5-6 days post operation, there should be no reason not to return home, unless a complication occurred.

A non refundable $500 scheduling fee is required to confirm and reserve a surgery date. This fee may be paid by personal check, cashier check, cash, money order, or PayPal. The remainder of the surgical fee is due 4 weeks prior to the surgery date and may be paid by personal check, cashier check, money order, but this portion cannot be paid through PayPal. Fees due to the surgical facility, anesthesia department, and the pathology department are due on the date of surgery. The surgical facility and anesthesia departments will accept credit cards.

The scheduling fee for meta and vaginoplasty is $1000.  The phalloplasty scheduling fee is $2000.

Top Surgery does not require hormones. Many of the patients over the years have not been on hormones and never plan on taking hormones. A male contour can still be achieved.

Yes, we require a surgery referral letter from a mental health professional. However, some exceptions are made for patients that transitioned years beforehand and have had legal documents changed reflecting their true gender.

Most frequent complications include haematoma, infection, and wound dehiscence. However, these rarely require operative intervention. Some haematomas, cellulitis, isolated wound dehiscence, and partial skin necrosis, especially at the nipple-areola complex, can be managed with compression, antibiotics, or wound care. Enlarging haematomas and abscess formation can require operative evacuation; haematoma is most common reason for operative re-exploration. – From an article by Dr. Crane on Nature.com.

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