Top surgery question

[momijizukamori]

Because I know some of my mutuals have gone through this already, or are further along in the process than me! Basically - I am at the point where I have to pick a surgeon and I am very 'how the fuck do I even do this???'. Like, I am going to try to get insurance to cover this which automatically narrows down the field somewhat, but I have no idea what a reasonable amount of research is or where to do it, and it's a bit paralyzing.

(comments screened, feel free to let me know it's okay to unscreen your's - I figured I'd play it safe. And this is fine to signal boost etc)

Comments

[mathemagicalschema]

The thing you want to know is, "will this surgeon do a good job at performing the procedure I want, on me?" And that breaks down into three basic questions:

1. Is this surgeon competent in a general sense? Are patients generally pleased with their experience and results? Any formal complaints or disciplinary actions on their license? Try searching and asking around in places like r/FTM.
2. Is this surgeon good at performing the specific procedure you want? Do you like the look of their results? (check transbucket) Ask how many times they've performed the procedure, rates of complications and revisions, etc.
3. Can you communicate effectively? After a consultation, do you feel confident that they understand your goals and priorities, and does the surgical plan seem like a good fit?

Your preferred top surgery technique will be a major factor in your choice of surgeon. Double-incision is the best/only option if you have lots of skin and tissue to remove. However, it leaves you with larger scars and lower odds of preserving nipple sensation than other methods. If you have a smaller chest and good skin elasticity, or if your top priority is maintaining sensation or minimizing scarring, you might prefer a different method. topsurgery.net and Dr. Mosser's site have good info on different techniques.

Many top surgeons only do double-incision. That's fine if you're sure you want DI, but if you want a different procedure or you're not sure, I strongly recommend choosing a surgeon who's experienced with multiple methods. Even if you definitely want DI, different surgeons have different opinions about incision shape and placement, areola size and positioning, and so on. Do you have an opinion about those variables? Do you want to keep your nipples, or would you rather skip dealing with free nipple grafts? If you don't really have a preference, you can just go with what your surgeon recommends as long as you trust them.

Depending on the procedure you want, your insurance, and your location/willingness to travel, you might have lots of surgeons to choose from or just one (or none - in which case you'll have to widen your net somehow.) Even if you have very few options, do not let a surgeon do something permanent to your body if the vibe seems off! I don't have any particular advice for winnowing down too many options, as that wasn't part of my experience. Idk how to effectively research surgeons who don't have much of a web presence; I suppose the best you can do is call them with your questions and see what they're like in a consult.

My experience: I wanted (and got) liposuction-only top surgery paid for by Medicaid in Washington State. Lipo-only is an uncommon method because not many patients are anatomically suited to it - I expected it to work for me because I had good skin elasticity and my chest volume was mostly fat. None of the in-network surgeons seemed to have experience with lipo-only top surgery, but one of them (Geoffrey Stiller in Spokane) advertised that he does keyhole top surgery and seemed to have plenty of experience doing lipo for gynecomastia. His pictures looked good to me and other patients seemed to have very positive things to say about him, so I booked a consultation and after a quick exam, he agreed that lipo was a good fit for my goals. I had my surgery in late December 2021, had a very smooth recovery overall, and got pretty much exactly the result I was going for.

I hope this has been helpful; if you have follow-up questions (about any aspect of top surgery) I'll do my best to answer.

(feel free to unscreen)

[momijizukamori]

That is definitely helpful, thank you!

[cmdonovann]

yep, i'm seconding all of this. my first step was to figure out what i could afford, because i did not have insurance and paid out of pocket for mine, but after that it's a factor of finding a surgeon who does the type of top surgery you want, is nearby or has travel accommodations nearby (ie there are hotels/airbnbs you can stay in for the first week after surgery before the post-op check and bandage removal), and who has good reviews from previous patients and has pictures available of results. if you are trying to get insurance coverage, you may want to also find out if your insurance covers different types of top surgery; it's my understanding that some only cover double incision, and if you want a different type you'll need some kind of paperwork to get it covered. (i'll be honest, idk if this is common nowadays, but i remember several people complaining about it when i was first looking for info on top surgery in 2016.)

(also yes you can make this comment public if you want!)

[(Anonymous)]

Seconding everything that mathemagicalschema said!

In addition, one of my best resources was my therapist. They specialized in trans stuff and wrote letters of support for lots of trans people in the area. Through their clients, they were familiar with all the local surgeons. They helped me decide who to go to and gave great practical advice for navigating the healthcare system.

Also, if a few surgeons seem equally great and you can't decide between them, you can reach out to all of them and see what their schedules are like. Different offices might have wildly different predicted surgery dates. Speed isn't the best priority, but if everything else is equal it can be a good way to narrow things down!

Unscreen if you want!

[momijizukamori]

Yeah, my therapist has been helpful with like, the general flow of things and what steps need to be done when, but didn't know any surgeon names offhand (she doesn't specialize in trans stuff specifically, but more generally in queer/LGBT stuff)

And ha, that's a good point! Sometimes it's good to have some minor criteria to help with final narrowing, for sure :)

Thank you for sharing your thoughts!