FTM/N Top Surgery Myths

Throughout the following content we’ll be breaking down some f2m/n top surgery myths. Where the myths stem from is too hard to say, there are a variety of factors that contribute to a creation of a myth, some of which mind you have some truth. When navigating surgical knowledge, it’s best to know the truth that is involved as well as the

MYTH: You Will Regret Getting FTM/N Top Surgery

Regret after top surgery is extremely rare, and is almost never related to transition regret, but instead can be related to having had complications, or to results that are not optimal. Even in cases where the surgical result isn’t optimal, in most cases it improves quality of life. Many studies have shown that it improves self-esteem, body image, relationships, mental health, and life satisfaction. Rates of regret after a gender affirming surgery are actually much lower than those of many other surgeries.

Rare cases of top surgery regret are often due to:

  • A patient’s unrealistic expectations
  • Not choosing the procedure type they’d prefer
  • Rare surgery complications
  • Poor results executed by an inexperienced surgeon

Ways to minimize a rare case of top surgery regret

  • Research: Do your research so you can manage your expectations realistically, complications happen and a perfect result is not guaranteed.
  • Top Surgeon: Even if you have a highly rated FTM/N top surgeon who has great before and after FTM/N chest photos, that doesn’t always mean yours will look the same. Not because of the surgeon’s skills necessarily, but because all bodies are different and heal different.

MYTH: You Have to Be on Testosterone in Order to Get FTM/N Top Surgery

Dr. Scott Mosser does not require that a patient be taking hormones or identify as a certain gender identity in order to receive top surgery. Due to our gender inclusive healthcare model, many of our patients get top surgery without having been on testosterone.

There are also other clinics that provide transgender surgery in San Francisco that hold similar beliefs. Outside of gender reassignment surgery (now known as gender affirming/confirming) surgeons in San Francisco there are other doctors across the U.S that may hold similar standards.

As more trans affirmative care research comes out the more FTM/N top surgeons are realizing that being on testosterone shouldn’t be a requirement for getting top surgery.

The myth of having to be on testosterone to get FTM/N top surgery could be due to:

  • Outdated Knowledge: Previous versions of the Standards of Care (SOC) created by the World Professional Association of Transgender Health (WPATH) did state that you had to live as a certain gender identity or be on hormones for a certain amount of time in order to be approved. Thankfully with the new SOC 8 these are no longer a requirement
  • Breast Tissue Growth: A common misconception is that without testosterone, breast tissue will grow back. Though a little tissue is left to retain the contour of the chest, 93-95% is removed. The breast tissue will not grow back
  • Insurance Denial & Approval: It may come back that you are denied coverage for your top surgery. This varies by insurance companies, some of the common denial factors are based on age, not living in a certain gender identity, deeming the procedure as medically unnecessary or, not being on hormones (or a combination of all of those). This is not to say that you will need to start hormones to get top surgery, we have seen plenty of insurance approvals regardless of this factor

MYTH: Your FTM/N Top Surgery Will be Denied Through Insurance

The American Medical Association, World Professional Association for Transgender Health (WPATH), and many others consider gender confirmation surgery to be medically necessary and non-cosmetic. More and more insurance companies in the U.S. are accepting the medical necessity of GCS and covering FTM top surgery. Having said that, denials do occur but getting approved is much more common. If you do get denied there’s always an appeal process which sometimes results in an overturn of their initial decision. It’s best practice to stay positive, always try to obtain approval if you do have insurance, and appeal if you do get denied.

Insurance coverage for FTM/N top surgery, minimizing the likelihood of a denial

Research your insurance company and look at your policies so you can take proactive actions before beginning the approval process. For example, if your insurance company requires that you live in a certain gender identity for X amount of time ensure that your therapist is aware of this so they can write an appropriate letter.

  • Look for FTM/N Top Surgeons that accept insurance: Not all FTM/N top surgeons accept insurance, it’s important to note that Dr. Mosser does (including Medical). For folks who are trying to use their insurance for FTM/N top surgery, start by looking for FTM/N top surgery doctors who do accept insurance. The below insurance companies we have seen a good amount of insurance approval through, so if you have any of the below start by Googling:
    • Anthem BC top surgeon
    • Anthem Blue Cross top surgeon
    • Aetna top surgeon
    • Blue Shield top surgeon
    • Cigna top surgeon
    • United top surgeon
  • Insurance that Dr. Mosser has gotten successful insurance approval for: Note that if your insurance isn’t listed in the below list, we have an insurance concierge who works with other insurance companies to get folks approved
    • Anthem BC (Anthem Blue Cross)
    • Blue Shield
    • Blue Cross
    • Aetna
    • Aetna (Student Services for University of California System)
    • Cigna
    • United Health Care
    • Brown & Toland HMO
    • LA Care
    • Health Net
    • Health Plan of San Joaquin
    • Hills Physicians (HMO)
    • Hill Physicians IPA
    • Medi-Cal
    • Medicaid (some plans)
    • Mercy Medical Group
    • Meritage IPA (“WHA Medical Groups”)
    • Northbay Medical Group
    • Western Health Advantage (“WHA”)
    • UC Davis Medical Group

MYTH: You Have to Get a Therapy Letter in Order to Get FTM/N Top Surgery

There’s 2 important things to know about FTM/N top surgery surgeons before moving forward. Some FTM/N surgeons use the informed consent, and others do not. Dr. Mosser uses the informed consent model. So, what does informed consent mean when talking about FTM/N top surgery doctors? 

Informed consent: This basically means that your surgeon has had a full discussion with you and decides that you can make an educated decision on whether you want to have surgery or not. This means that a therapist intervention is not necessary and you do not need a therapist letter of approval in order to get top surgery

The WPATH SOC 8 doesn’t require you to have a therapist letter in order to get FTM/N top surgery. However, some FTM/N top surgeons require that you do and all insurance companies require a letter. So, if you’re wanting to obtain insurance coverage for FTM/N top surgery then the first step will be to begin seeing a psychiatrist or therapist to get a letter.

MYTH: You Have to Be a Certain Weight or BMI to Get FTM/N Top Surgery

Some FTM/N surgeons have weight or body mass index (BMI) requirements and some do not. Why is there a difference in opinion/practice? Some FTM/N top surgery doctors have a weight or BMI requires primarily because of literature studies that have revealed increased complications with tummy tuck surgery or breast reduction in patients with a higher weight or BMI index. At Dr. Mosser’s practice he hasn’t seen those risks carry over so he does not have a weight or BMI cut off. He has performed top surgery on folks with BMI’s as high as the 40 and 60 range with good results.

MYTH: FTM/N Top Surgery Eliminates the Risk of Breast Cancer

This seems to be a popular myth among all FTM/N chest reconstruction procedure types, especially when it comes to double incision bilateral mastectomy. FTM/N top surgery does not remove 100% of the breast tissue. It significantly reduces your risk of developing breast cancer, but you should still routinely check for breast cancer with your primary care physician.

FTM/N Top Surgery Myths in Conclusion

There are other myths to dispel around top surgery but we chose the above as they seem to be the most prevalent misconceptions. Remember to use critical thinking skills when source of information declares ‘absolutes’.

  • Regret is rarely reported from patients who have received FTM/N top surgery procedure
  • You can’t have a high weight or BMI to get top surgery
    • This isn’t always the case, there are surgeons who will operate on folks with higher weight or BMIs
  • You do not have to be on testosterone in order to get top surgery.
    • Although some insurance companies or surgeons may require it this conception should be challenged
  • Your top surgery won’t always be denied by insurance.
    • Although sometimes that is the case it is always worth trying, or appealing (if it gets denied).
  • You do not have to have a therapist letter in order to get top surgery from an FTM/N top surgeon. If the surgeon uses the informed consent model that means that they do not
    • You would need a therapist letter if you were seeking FTM/N top surgery insurance approval
  • Getting FTM/N top surgery does not eliminate your risk of breast cancer.
    • Since top surgery doesn’t remove 100 % of the breast tissue, you are still at risk