Choosing to undergo top surgery is a complex process shaped by internal feelings and philosophies as well as by external circumstances such as your overall health, your ability to travel for surgery and your current financial status. Sometimes the decision to have surgery is more of a process, which takes time and exploration.
As with any major life decision, it’s normal to be have some doubt and anxiety. At Dr Mosser’s San Francisco practice, we provide you with in-depth information on surgical techniques, recovery, safety and results so that you can make an informed final decision.
Start by learning about the typical top surgery journey.
The ultimate goal of surgery is to make you feel more comfortable with your body by better aligning your physical characteristics with your internal sense of self and the self you want to present to the world. The relief surgery provides can enhance both your feelings of self-esteem and body confidence.
Here’s what some of our patients had to say about their experience.
Individual risk for top surgery will depend on general health, age, weight, and other characteristics, but you can take steps to reduce chances of complications:
Your surgeon will give you specific instructions for medications, vitamins, clothes, food, and any other particulars a few weeks before surgery. (Take a peek at Dr Mosser’s pre-surgery guidelines for FTM Top Surgery or MTF Top Surgery.)
It is best to minimize any major changes in your life, and be in close contact with your surgeon’s office if anything comes up.
Although everyone expects to be ecstatic after surgery, it is not uncommon to go through a period of post-operative depression following surgery. If you already know you are prone to anxiety or depression, it might be a good idea to establish a relationship with a therapist to help with emotional support before and after surgery. We recommend scheduling a visit with your therapist 10-14 days after surgery, so that you are prepared with a support system in the event that you experience post-operative depression.
Top surgeries generally take around 2 hours. Once completed, you will be taken to a recovery area to be monitored. As you gradually wake up from sedation, it’s likely that you will experience some grogginess, soreness and in some cases nausea.
When you wake up from surgery, it’s normal to experience some discomfort, swelling and bruising. Your chest will be wrapped in gauze dressings and a compression vest for support.
Once you are cleared for release (typically the same day as surgery), you will need a friend or relative to drive you home. Your body will be exhausted at this point, and you should avoid significant physical activity.
Though the first few days of recovery should be spent resting, you are encouraged to walk around. However, you should initially minimize many other physical activities, especially raising your arms or lifting over 5 lbs. Taking it easy will minimize pain, discomfort and other possible complications after surgery.
Typically patients resume non-physical activities after 8-10 days.
Regular (cardiovascular) physical activity should be avoided for at least 3 weeks, and strenuous exercise for at least 5 to 6 weeks.
Pain can vary depending on your tolerance level. Most patients report minimal to no pain (usually a 3-4 on a scale of 1-10 for pain), and may take prescription painkillers the first day or two, afterwards Tylenol or no medication.
The most uncomfortable period is the first few days after surgery. Along with regular post-surgery fatigue, you may experience swelling, tenderness, and tightness in your chest due to the dressings. Moreover, you cannot sleep on your side and may have limited mobility in your upper body.
Yes, you will need to wear a compression vest for 1-2 few weeks after surgery to minimize swelling and to help the skin tighten. For FTM Top Surgery patients, this vest is not as uncomfortable or tight as a binder.
Most top surgery procedures do not require the use of drains to collect fluid buildup. Dr. Mosser currently uses drains in less than 20% of his patients. If used, they are removed within 5 to 7 days after surgery at your initial post-op visit with Dr Mosser.
The way that Dr. Mosser places drains in his patients avoids any discomfort from the drains, or any additional scarring or healing issues that could be caused by drains. Generally patients do not feel the drains that Dr. Mosser places (although they may be strange to look at).
Within 3 to 7 days after surgery at your initial post-op visit, Dr Mosser will remove your dressing, inspect the surgical area, and give you the go ahead to begin regular showers. Until that time, you can sponge bathe to keep clean.
You will need to take about a week off from work and other normal routines to rest and recuperate. Patients walk around immediately after surgery, and most patients feel up to resuming sedentary work and light physical activity and a desk job within 8 to 10 days. You can’t lift more than 5 lbs until three weeks after surgery.
Any physical activity that may cause your heart rate to increase or for you break out in a sweat should be avoided for at least 3 weeks. Heavy lifting and chest exercises should be avoided for at least 5 to 6 weeks.
Keep your scars out of the sun (or wear strong sunscreen) for at least six months. Though you can splash around in the water as soon as 3 weeks after surgery, it is recommended to avoid swimming for exercise (because of the arms-over-shoulders requirement of most swimming strokes) for 6 months following surgery.
Scar formation is a normal part of the healing process, but how your body responds to injury depends on several factors such as age, genetics, location on the body and skin color.
There are several options to help minimize scarring: stop smoking 3 weeks before and after surgery; eat a nutritious diet; use silicon sheet or tape; as well as intensive treatments such as steroid injections or laser scar removal. For many FTM top surgery patients, it is really important for you to avoid having your arms over your shoulders for as much as 6 months after surgery, in order to have the very thinnest, flattest scars you can have.
Dr. Mosser will provide you with personalized recommendations following your surgery.
Most patients only require a single surgery to achieve desired results. A small percentage (<5%) will choose to have a revision, which is typically a minor surgery with a much easier recovery than the original procedure.
Choosing to combine top surgery with body contouring or other procedures (such as hysterectomy) in the same surgical session can reduce costs related to surgery and ultimately shorten your total recovery time. You are recommended to schedule a consultation with Dr Mosser to see if you are a candidate.
Anytime after your surgery, our office can provide a letter for a legal gender change, stating you’ve had a surgical procedure for transition. We do it all the time.
Satisfaction with surgical results is closely related to the surgeon’s skill, patient safety, and matching the procedure to the patient’s expectations. What is clear is that transgender visibility has risen dramatically in recent years, along with the number of requests for transition surgery.
It is exceptionally rare for patients to regret transitioning genders. Although rare, regret after surgery is often due to the patient’s unrealistic expectations, or due to the very rare complications from surgery, or (unfortunately) due to a poor result executed by an inexperienced surgeon. This is why Dr. Mosser specializes in transgender surgery, and emphasizes coordination with the patient’s support team, including physicians, family members, partners, or close friends assisting in the transition
The ultimate goal of surgery is to make you feel more comfortable with your body by better aligning your physical characteristics with your internal sense of self and the self you want to present to the world. Some transgender people are comfortable with their chest as-is and do not feel that surgery is necessary for them. Many others feel that altering (removing / augmenting) their breasts is the next step in becoming their authentic self.
As with any major life decision, it’s normal to have some doubt and anxiety. We’ve helped many patients during their transition, and this website is designed to help you become comfortable with the idea of permanent change and answer important questions.
We have been able to secure insurance coverage from many insurance companies for transgender-related procedures. To learn more, read our page on Insurance Approval. Likely, in order to have insurance cover your surgery, you will need a letter confirming you meet the WPATH guidelines if Dr. Mosser has a pre-existing agreement with your insurance company. Dr. Mosser does not require a letter, but insurance companies usually do. Alternatively, there are ways to secure a Letter of Agreement (LOA) with our office and your insurance provider. Refer to this helpful graphic or contact our Insurance Concierge for more support in this process. To learn more, follow this link to read the National Center for Transgender Equality’s page on healthcare coverage.
Total out of pocket costs without insurance coverage for FTM/N top surgery at our office can range between $8,500 to $10,000. You can view our page on Fees and Financing to learn more.
You have options if your insurance company does not cover FTM/N top surgery. First, you can pay out of pocket for the cost of surgery. If this is not an option for you, we have developed a resource page for our patients to learn of alternate funding sources. Click here to view our resource page and learn more about the Care Credit program, crowdsourcing, and grants through groups like Point of Pride and the Jim Collins Foundation.
There is no scientific evidence that shows an increased risk for breast cancer associated with long-term chest binding. However, we recommend that all people still stay vigilant about their breast health whether they bind or not. Performing monthly breast exams on yourself and receiving ongoing mammograms are still best practices to detect and prevent the growth of breast cancer. Click here to view a detailed page on performing self breast exams (content warning for gendered language on this page). To learn more about breast health, please consult with your primary care physician.
Typically, the safest methods for chest binding involve using well-fitted binders and/or other materials specifically designed for binding. Often, compressing your chest with ace bandages, duct tape, or other materials not designed for binding can lead to intense constriction in the lungs and ribs or cause chest pain. If you are experiencing any of these symptoms, we recommend that you stop binding as soon as you can.
Some important safety tips are to bind for no more than 8 hours during the day (with breaks, if possible) and to take off your binder before sleeping. Click here to read about brands we recommend for chest binders and how to confirm the proper fit. If purchasing chest binders is out of your financial capacity or feels unsafe, you can layer shirts, use sports bras, or find some sports compression wear to fit your needs. You can learn more about breast binding safety on minus18.org or point5cc.com.
There are a couple important side effects of chest binding that are important to mention. First, once you find the safest, most reliable and convenient method for you, an important effect of proper breast binding is diminished gender dysphoria. We define this as feeling grounded in your body in a way that aligns with your gender identity and expression (gender euphoria is often used as a shorthand term for a reduction in feelings of gender dysphoria).
Aside from the positive outcomes of binding, there are some harmful side effects to watch out for. These include skin rashes or sores, chest pain, difficulty breathing, chest acne, and others. Often, these outcomes are associated with a binder that is too small, so we encourage folks to pay close attention to fit instructions found here at the links below). If you are experiencing any of these symptoms, you may not be binding in the safest way. We recommend talking to your primary care physician if you experience any of these more serious side effects, as they could have long-term impacts on your health. Practice harm reduction and read up to learn more on how to bind more safely. You can learn more about breast binding safety on minus18.org or point5cc.com.
We are happy to work with you to get your procedure covered by insurance. Please contact our Insurance Concierge to learn more about this process. While many insurance companies offer coverage for gender-affirming surgeries and treatment, some unfortunately do not. If you have a Healthcare.gov insurance plan, read this page on “Transgender Health Care” to learn more about insurance coverage for related to your gender-affirming needs. If you wish to make an appeal, that is, to petition your insurance company to cover the cost of a specific procedure or treatment that they do not already cover, follow this link to learn about the appeals process through Healthcare.gov. To learn more about your healthcare rights, follow this link to read the National Center for Transgender Equality’s page on healthcare coverage.
To learn about which companies we usually have success with, and to find out more about our insurance coverage policies, click here. To find out what Healthcare.gov recommends for trans, non-binary, and gender-expansive patients, read this page on “Transgender Health Care.” To learn more about transgender health coverage, follow this link to read the National Center for Transgender Equality’s page on healthcare.
We are happy to work with you to get your procedure covered by insurance. Please contact our Insurance Concierge to learn more about this process. All Healthcare.gov plans are required to cover the cost of preventative services, which often includes screening exams, shots, and other services. If you have a Healthcare.gov insurance plan, you can read up on your policy’s “Summary of Benefits and Coverage”. To learn more about other plans, follow this link to read the National Center for Transgender Equality’s page on healthcare coverage.
We are happy to work with you to get your procedure covered by insurance. Please contact our Insurance Concierge to learn more about this process. TRICARE, the insurance company that covers active-duty military and their dependents, does in fact cover some costs for gender-affirming healthcare. To learn more about the specifics of TRICARE transgender coverage, check out SPART*A’s resources on the topic and read their F.A.Q. document for trans military service.
This question has a few different aspects to it and ultimately, it is the patient who decides when the time is right, rather than our office. The only absolute requirement to return to driving, is that a patient has not taken pain medication within 12 hours of driving. After a patient is no longer under the influence of narcotics, a patient must evaluate for themselves if they believe they have all the necessary faculties to safely drive. These would include ability to completely rotate the neck and perform evasive maneuvers as needed, without hesitation. In this sense, once a patient feels comfortable to perform all the necessary aspects and duties of driving, they may consider doing so. For many individuals this occurs at approximately 10-14 days after surgery, although for some, depending on the nature of their operation and recovery, it may occur later.
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