While it is primarily the responsibility of the plastic surgeon to ensure that every patient is fully informed of the risks and possible complications of any plastic surgery procedure, there are additional responsibilities and considerations for expectations about FTM/N chest reconstruction and MTF/N breast augmentation surgery. The patient’s support team can be very helpful in ensuring that their loved one has reasonable expectations.
Transgender patients may seek plastic surgery to alter their body characteristics after mature and responsible consideration of before and after photos of other patients and candid medical opinions regarding what can be accomplished given the specific conditions. But there are often psychological aspects as well as possible hormone-influenced emotional responses that can also affect expectations. If already undergoing psychological counseling and/or hormone therapy with other physicians, the opinions of those medical professionals will clearly also be influential.
A concerned family member, supportive friend or a significant other can offer important support. If the patient is comfortable with members of their support team discussing the surgery with the plastic surgeon and grants permission to do so, the surgeon can gain added insight into the patient’s motives for seeking surgery and the family member and friends can alleviate their concerns regarding risks, possible complications and expected results firsthand. This support team member can take notes, collect facts, coordinate appointments and diffuse emotionally charged moments of expressing possibly unreasonable hopes and goals. It is even more effective if this same team member is also in touch with other attending physicians and counselors.
If the plastic surgeon is San Francisco Board Certified Plastic Surgeon Dr. Scott Mosser, patients will be pleased to find that he encourages his transgender patients to bring along a member of their support team for consultation. He is aware of the special considerations and collaborative nature of treating transgender issues and is willing to coordinate and consult also with the medical professionals involved in the patient’s past or current treatment programs. He and his team of professionals are familiar with the transgender community of support groups in the San Francisco Bay area, and can arrange for pre- or post-op accommodations for patients traveling to San Francisco.
MTF/N breast augmentation and FTM/N chest reconstruction surgery results both generally enjoy high satisfaction rates when performed by Dr. Mosser, but plastic surgery is first and foremost a physical alteration and cannot be assumed to also achieve a “cure” for psychopathic or social problems being worked out by counseling or psychotherapy. Dr. Mosser gets high marks for aesthetic results which can boost self-confidence and improve the comfort of wearing gender specific clothing, but plastic surgery cannot be expected to replace continuing long-term therapy to address emotional or psychological issues.
Most gender transitions occur as part of a 3 or 4 stage process as recommended in the World Professional Association for Transgender Health (WPATH) in their Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC), 7th version, published in September 2011. WPATH is an international organization which articulates a professional consensus regarding the psychiatric, psychological, medical, and surgical management of gender identity disorders. The WPATH SOC is an important reference to assist both individuals experiencing gender dysphoria and those in medical and other support roles who seek to understand the many and varied aspects of sex and gender transition. Any family member or friend assisting a patient seeking plastic surgery should read and become familiar with these Standards.
Dr. Mosser respects the WPATH Standards of Care and is sensitive to the complexities of obtaining letters of recommendation and referrals prior to surgery. He does not view gender dysphoria as a “disorder”, and acknowledges that Gender Identity Disorder (GID) is an outdated medical term. He views MTF/N and FTM/N sex reassignment surgery as ‘gender confirmation’ surgery, confirming what is already a reality. Surgery patients and their personal team members will find him to be welcoming and non-judgemental and very easy to communicate with.