Once you’ve decided to pursue top and/or body masculinization or neutralizing surgery, the following is a general outline of the steps that you will follow in your transformative process:
Schedule a virtual or in person consultation to learn about surgery, discuss your expectations and your body type, and bring up any continuing concerns that you have about trade-offs, recovery, aesthetics, or any other issues that might come to mind. If you have questions, make a list. If you have ideal results for your body type, gather photos to show your ideal surgical outcomes while keeping your body type in mind.
Your consultation may be in-person or virtual. After sending in your photos, you should feel fully informed and very empowered at the conclusion of the consultation process. All of your questions should have been answered without being rushed. You should have a good idea of what will happen from that point on and a general timeline for all the milestones that follow.
If you are hoping to have insurance pay for your surgery, you’ll need to get approval. The surgeon’s office will send codes and, if needed, a letter from your therapist. Our office uses the informed consent model and therefore doesn’t require letters of support from therapists, but the insurance approval process usually requires it. Some surgical offices are more helpful than others regarding insurance approval. In the case of our office, we have a dedicated Insurance Concierge who handles the entire process of insurance approval for patients.
Once surgery has been approved by your insurance or you have decided to pay out-of-pocket, you can schedule a surgery date that works for both your and one of our surgeon’s schedules. If you are traveling for surgery you can plan travel, book airfare, request time off work for recovery, and if necessary, find accommodation.
About 3 weeks before surgery, you will have a preoperative visit when you can ask any additional questions you may have of your surgeon. You will sign consent forms that are part of the informed consent process. This visit can be virtual for patients who don’t live in the San Francisco Bay Area, or in person if you live locally. If your visit is in person, photographs will be taken. If virtual, photographs will usually be taken one day before surgery in The Gender Confirmation Center office. You’ll receive lots of information regarding what to expect around surgery, how to stay comfortable, what conveniences you should put in place to be ready for your recovery, medications to stop taking (if any), and your activity milestones after surgery. At the conclusion of your preoperative visit you should feel 100% comfortable with all of the details surrounding the surgical process.
For patients who don’t live in the Bay Area and have had their consultation and preoperative visit virtually, there will be an in-person visit with your surgeon 1 to 2 days before surgery. At this visit your photographs will be taken and a physical exam will be finalized to make sure everyone is on the same page with regards to surgical planning goals.
Once your surgery is completed, you’ll recover for an hour or so and then be able to leave the surgery center or hospital. Rarely, for medical or social reasons, patients are admitted to the hospital for one night and discharged the following morning.
During this first week after surgery, you’ll take it easy and keep comfortable. Your body knows how to heal. If you have any questions you can reach out to Dr. Mosser or Dr. Facque. It’s extremely important that you keep your first postoperative appointment visit, which is usually 6 to 7 days after surgery.
On day 6 or 7 after surgery, you will have an appointment to see your surgeon. If you have drains, they will be removed along with all of the dressings. You’ll receive instructions about what to do next, including care for simple dressings, if needed.
After that first visit, you can head on home. It’s a good idea to have help with any heavy luggage and make sure the trip is not too strenuous.
There is a routine schedule for follow-up appointments. These visits can be done in person or virtually. If done virtually, you will use our secure and private Internet-based portal where you can upload photos, ask your questions, and get responses from Dr. Mosser or Dr. Facque within one day.
You will receive comprehensive information about your recovery process and resuming activity during the educational process around surgery. But in brief: you should limit lifting to no more than 5 pounds until day 21 after surgery. On day 21, you can begin cardio activities such as running or cycling. You may then lift up to 20 pounds until day 42 (6 weeks) after surgery. After 6 weeks, there’s no limitation on how much you can exert yourself or lift. However, if you’ve had a procedure with a horizontal incision across the chest (double incision, buttonhole, inverted T, fish mouth), then it’s important not to lift your elbows above your shoulders for up to 2-3 months after surgery. This kind of movement can stretch your scars, causing them to thicken or widen. Most activities of daily life can be accomplished without lifting your elbows over your shoulders.