Reader Ramblings: The Process of Getting Top Surgery

I recently added an Ask box to the blog – you might want to check it out!

Question

I was looking for FTN pictures on google and came across this, so I’m sorry if you’ve already answered (I haven’t read all of your stuff), but how did you go about getting the surgery and was there any other transitioning you did and how?

I’m neutrois and a bit hopeless, though surgery wouldn’t be soon regardless.

Hope!

First of all, don’t be hopeless – there are definitely big obstacles along the way, but there’s a lot we can do to get around them.

I actually started the blog in efforts to document my top surgery, and to prove that you don’t have to be binary (male) identified to get it. You can start by reading the series of posts I wrote pre-during-and-post surgery.

While they’re quite insightful in terms of providing my thoughts and emotions at that moment, which was my goal at the time, they are however lacking in details on how I got to that point. In the past few months I’ve also received some emails from a couple of people who are looking for more specific information on the process of obtaining top surgery, and seeing as more of you might find this useful, here goes (finally).

Discovering Top Surgery

It took me a very long time to realize that I too could label myself as transgender, and that I too could get top surgery. I belive the pivoting moment came after attending the Philadelphia Trans Health Conference, where I adamantly decided that within a year I would get surgery. After that I fervently began researching all the possibilities.

Even though there are very few resources for the nitty gritty of a non-binary transition and surgery, you can still get access to useful information targeted at transmasculine folk. There are a few important differences, which I will be sure to point out.

Initial Research

First, I joined the FTM Surgery Info and FTM Surgery Support Yahoo groups. It’s basically a listserve where people ask any kind of question you can imagine about surgery, and you can ask yours too. Reading specific and detailed accounts of the day of the surgery and how others scheduled their consultations was a big boost to get me going.

Pictures

The biggest advantage of these groups was the ability to browse the picture gallery – there are tons of pictures, and I looked at them all, over and over and over again. You can also go to TransBucket and look at more pictures, or do a google search on FTM Top Surgery, or browse the Tumblr top surgery tag (lots of people post pictures and accounts of their experience). You can also go into individual surgeons’ websites and look at their galleries.

One of the things to look for when evaluating pictures is somebody with a similar body type, body build, chest size, and skin color as yours. A lot of FTMs who get top surgery have already been on testosterone for years, which means their muscle and fat distribution in the chest area is different than if you’re not on T, as well as hair, so keep that in mind as well.

Cost

The cost depends on the surgeon. Roughly it varies from $3500/4000 to $8000/9000, plus travel and other expenses. You can browse through the archives of the surgery group for particular costs for each surgeon.

Some people have had their insurance cover it either directly or indirectly. But if you are non-male identified then the chances of going around your insurance and finding a loophole grow slimmer; in this case you’ll need your insurance to specifically cover transgender surgeries, which unfortunately most insurances have specific exclusions for (though I’m certainly no expert on this).

There are also opportunities for fund-raising such as selling some cool stuff, or running a race for a cause (in this case, you), or applying for a scholarship.

Decisions

After being drowned in research, I realized I had to make some decisions at some point. I had to decide that I definitely wanted to go through this, how I was going to finance it, who I would include in my support circle, what location and other restrictions I foresaw, and most importantly, I had to choose a surgeon.

For me the deciding factor was results. After seeing tons of pictures of top surgery and even tons of people in person I chose a surgeon who I identified as doing the best possible job for what I wanted.

Cost and location are the often major influencers as well, although personally this was secondary for me. Other elements to consider are experience of the doctor (how many years practicing, or how many FTM top surgeries, or how many other types of surgeries?), does the surgeon operate in a clinic or in a hospital (and what kind of staff is around?), what happens with complications both while operating and afterwards (are there horror stories of other people who suffered through unforeseen and unattended complications?), responsiveness (do they answer all your questions?), and even general vibe (if you don’t feel it’s right, it might be best to wait).

A word of caution here: there are a handful of surgeons who are the “go-to” doctors for FTM chest masculinization right now. However, the fact that they are popular does not mean they are any better, or any good for that matter. For example, after reading personal recounts of their experience, and seeing many many pictures, both user posted and on the doctor’s site, along with seeing several people’s chests in person, it was clear to me that this surgeon has consistently substandard results, and is even one of the most expensive options. The converse is also true – if a surgeon is not well known it doesn’t mean they can’t give you the results you are hoping for.

In sum, stop and think for yourself; actually analyze all the options available to you, weigh in your wants and needs and present circumstances and what figure out what is best for you.

Coming Out

I think because a lot of non-binary transpeople don’t start their transition by taking hormones or changing names or pronouns, surgery is often the first major step they take. So to me coming out (both to others as well as to myself) was deeply intertwined with the process of getting surgery.

For one, even though I could have done it without them, I didn’t want to get surgery without telling my parents. I would’ve felt terrible and guilty, and surgery is not like cutting your hair – it’s a big step. In short, I felt I had to tell them. Other than that, I told my brother and my best friend (and of course my significant other who had been supporting me since the start).

To a lesser degree I had to “come out” in a way to doctors and other people involved in the process, which to me was a first, because as I’ve mentioned I hadn’t been actively identifying as transgender for very long, and certainly not outloud. It was also strange suddenly being very open about this with my father, who was very supportive and came along for the surgery.

It’s important to realize that not everyone has to know about this. For instance, I didn’t tell anyone at work what my surgery was about, and I didn’t tell any of my acquaintances. However I do plan on telling some of my close friends when I get a chance to see them face-to-face again.

Counseling

A lot people have asked me about counseling: whether they need it, whether they should get counseling, or what sort of therapist to look for.

Curiously enough I was in counseling for all of 6 months during the time I was discovering everything trans*, and gender never came up, at all. Overall I didn’t get much out of it anyway. In terms of finding a good therapist to help me explore my gender identity, I figure I’m more knowledgeable on my gender than any random therapist.

Of course, it always helps to have someone else to talk to. You might need a therapist to help you deal with the emotional issues of transition or surgery, or other stuff going on in your life. Counseling can help you sort out a temporary issue or it can be ongoing.

If you are looking to get some counseling or therapy, my advice would be to shop around until you find someone you are comfortable with. Pick someone who is smart and is open to learn. Chances are they’ve never heard of it, so be prepared to explain. If you have a feeling it’s not working, just leave, search for someone else. But if you simply cannot find the right person, try to find an online option, or a support group instead.

That said, you don’t need counseling.

If you are only concerned about obtaining the necessary papers for surgery, don’t bother. Most doctors do require a letter from a psychologist validating your gender identity and your need to transition. This letter can be particularly difficult to acquire if you don’t have access to a therapist for whatever reason. But it can be especially tricky for non-binary transgender people, who must often confront a backwards psychologist, or must pretend to be male identified, and some even unwillingly take hormones in order to convince their therapist of their need for surgery.

And this is a good segue to…

Informed Consent

You should look for a doctor who operates under informed consent instead of one who follows the strict WPATH Guidelines of Care. Doctors who are experienced with the transgender community are learning more and more that people are not always binary identified, or don’t follow the “usual path.” My surgeon didn’t give a crap what my gender was; seriously he didn’t even ask, which was a good thing for me.

I had another consultation with a local doctor, who was not as experienced, so he did take the time to ask me if I was living as male, etc. He was definitely confused when I told him I wasn’t male identified, but he didn’t say that he would not do the surgery. I guess he was just thrown off, but he was certainly open to learning and being flexible.

Then I emailed a third doctor. Her nurse responded with what I take is the generic FTM chest surgery response, and it said that you do need a letter from a gender therapist. I told the nurse that I was not male identified, not living as male, nor seeing a therapist, so this letter would be impossible to get. The nurse basically said that as long as she had a letter from some physician stating that I “understood the consequences of this surgery,” that was fine.

Basically, I took this to mean that most doctors just want to cover their ass because this “gender thing” is very new. I’m guessing that the number of informed consent doctors is growing – either those especially familiar with FTM’s, or those that would be willing to be a little more flexible.

Get the Ball Rolling

Actually scheduling a consultation can be scary and intimidating, but this is in fact the easiest step. Compile a list of your preferred surgeons and investigate those along with other potential options. I contacted my top choice doctor, along with two other local doctors, and lastly a doctor whom I wanted to consult for the possibility of getting a peri instead of a DI (different types of top surgery depending on size).

Then draft a generic intro letter and just start emailing them! In the email you should include basic questions (especially if the website is vague) such as experience with this kind of surgery, general cost, more pictures of previous patients, and if you should send pictures of yourself for evaluation if it’s not a local surgeon. Also try to schedule an in-person consultation, even if it’s not with the doctor you’ll go with. These are usually not that expensive ($50-$100, and some are free) just to get a sense of how a consultation goes, what the doctor looks for, and what questions you get asked and should be asking.

Scheduling

After your consultation, whether in person or online, sit on it. Think about it. Evaluate the pro’s and con’s of your situation, or re-consider other options. And finally, make up your mind, which by this point I’m guessing is probably beyond made up.

Then, it’s time to Pick Up The Phone and make the appointment. Yep, that’s it, you choose a date, call, make the deposit, and schedule. After that, get your paperwork in order, and just show up on the day of your surgery. Next thing you know you’re waking up with a tight bandage around our chest and a smile across your face.

Next Steps

So if you’re seriously considering surgery, there’s your roadmap. Get crackin! But always keep in mind that top surgery, while nice to have, is not the end all be all of transition. There are many things you can do in the meantime, such as binding, or changing your name and pronoun, if this is not an option for you.

What Happens Now?

Honestly other than surgery I haven’t been through much transition-wise. After many years of struggle I am finally very comfortable with how I generally look and dress, though it took me a while to find my style. I’m trying to be out as trans* – or at least more visible – whatever that entails. And I’m writing the blog, which helps discover new ideas in myself and others.

But I guess I’m still trying to find out what transition means for me, and hopefully we can help each other discover it. So please feel free to share your thoughts and tribulations on this.

17 responses to “Reader Ramblings: The Process of Getting Top Surgery

  1. Thank you SO much for this post. I’ve been more and more seriously considering top surgery, and after a few weeks of general angst this has been a huge confidence-booster for me. And all of the information you provided was awesome, so again, thank you!!!

  2. I think this is a great post (and of course, echoes the very helpful e-mail you sent me a while back).

    The biggest thing I have to do, besides getting a job and saving up the money, is probably researching doctors. Though that’s a couple years off. But this reminded me I should be very thorough about the search.

  3. Thanks so much for this post! This was super-helpful. I’ve been seriously considering top surgery (in the future, no money or insurance at the moment), but had no idea where to even start.

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  7. Hey Maddox,

    I am a FTN seeking top surgery and your website has been a sort of godsend for me. I’ve been looking for someone who feels even remotely similar to me for years now, but my significant other was the one who found this page, not me. Anyway, your section on informed consent is very new to me. Would you be open to an email exchange about your experience with a doctor that performs top surgery with informed consent? I haven’t really been able to find information anywhere else. Thanks for reading and thank you so much for this blog. I can’t tell you how glad I am that you have documented so much of your experience.

      • Hi this info was a lot of help thank you so much. I am a ftm and i have my surgery date for top surgery. I am so happy i can’t wait i just need to tell someone and i am trying to meet other guys

  8. Thank you so much for this post. I have been struggling with dysphoria concerning my chest for a long time, but because I am not male-identified, I assumed that there wouldn’t be any way for me to do anything about that, beyond binding. Whether or not I decide to go through with top surgery, I feel so much better knowing that I have the option to do it.

    • You have many options open to you, including top surgery, but also hormones, name change, gender change, social transition, etc. Keep exploring and you’ll find what’s best for you.

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  10. in Finland we have free healthcare that also covers top surgery. the problem is that you get it covered if are diagnosed 64.0 (transman) but not always if you have diagnose 64.8 (other gendered/qenderqueer) also the doctors can put you into “time-out” for months for no legal reason if they think you are not “ready for the process.” you usually get penalty if are genderqueer or there is problems with personal chemistry. I hope my process will go smoothly when I get to see psychiatrist…

    • That’s the double-edged sword of nationalized healthcare – they pay for it, but only if you adhere to strict requirements.
      Good luck on your process!

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  12. I’m glad the scars have faded so much. Did a lot of the textural difference happen with the laser? Or was it the silicone sheets and time?

    • The laser helped mostly with color, from dark purple to light pinkish white. It probably had a smaller effect on the rough texture, softening them up a bit. The flatness is due to cortisone injections, which I highly recommend.

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