Follow-up to Chest Reconstruction or Breast Augmentation

If you are in a support role for a loved one, friend or relative who is frustrated and dissatisfied living in the sex and gender identities they were assigned at birth, you will find yourself helping the person you care about to find gender satisfaction.

‘Transgenderism’ it is not currently classified as a diagnostic condition, nor is this term used in the WPATH Standards of Care, but is generally used as a catchall description for having a gender identity different from the one assigned at birth. Other terms, such as ‘transsexualism’, ‘gender diversity’, ‘gender variance’, ‘gender dysphoria’, and ‘gender identity disorder (GID)’ are interchangeably used by both the medical and lay establishment– as well as by transgender individuals themselves–to describe a physical, mental and emotional condition that can be altered in order to obtain greater personal satisfaction and an improved quality of life.

The Transition Process

A 3 stage transition process is recommended in both the internationally recognized standards of care (WPATH  SOC, VII Edition www.wpath.org) and two international medical standards for diagnosis and treatment of transgenderism (International Classification of Diseases-10, www.cdc.gov and Diagnostic and Statistical Manual of Mental Disorders, IV Edition, www.allpsych.com ). WPATH SOC refers to treating ‘gender dysphoria’ while the medical standards use the earlier term, ‘gender identity disorder (GID)’.

Whatever the preferred terminology, the transition process for achieving gender satisfaction begins with counseling and physical and mental evaluation to determine whether a person may be suffering from an endocrinological disorder or an underlying mental or emotional disorder.

 If mentally and physically fit, a period of hormone therapy may follow to either feminize or masculinize physical features. Often this therapy overlaps with a period of monitored living in the desired gender to test and adapt to social changes and pressures. This period is usually for at least a year to eighteen months to allow sufficient time to determine a comfort level and confirm the decision to make a medical sex and gender transition.

When the physical changes accomplished by hormone therapy and social changes which may include name, wardrobe, hair, makeup, weight loss or gain, and lifestyle are sufficient to accomplish gender satisfaction and improved quality of life, many transgender people are happy to settle at that stage of the transition process. Others will opt for plastic surgery to continue the physical transition.

Making a decision to undergo irreversible plastic surgery to permanently change secondary sex characteristics depends very much on individual circumstances. Some  patients cannot tolerate hormone therapy for medical reasons, making plastic surgery a viable option for masculinizing or feminizing physical appearance.  Others may find hormone therapy insufficient, or they have physical features which continue to cause them distress. In FTM transitions, large breasts may not have reduced sufficiently for a masculine appearance, and in MTF transitions hormones may not have produced sufficient breast size or shape for a feminine appearance.

How Much Surgery is “Enough”?

Those who opt for FTM chest reconstruction  or MTF breast augmentation surgery consistently report high levels of satisfaction with the results. Other plastic surgery procedures, such as hair removal, skin resurfacing, liposuction, Botox and facial filler injections, tummy tucks and body reshaping, can complete the transition to a more feminine or masculine appearance.

A certain percentage of chest reconstruction and breast augmentation surgeries will require follow up surgery, just as with all plastic surgery procedures, due either to complications or aesthetic concerns. Considerable weight loss or weight gain also can make follow up surgery necessary. Both MTF breast augmentation follow up and FTM chest reconstruction follow up surgeries are routine and low risk.

Many studies and surveys have reported that most transgender individuals do not opt to undergo the much more complicated and expensive sex reassignment genital surgery or removal of reproductive organs. Factors which affect the decision not to have further surgery include:

• Satisfaction with the results of the physical alterations accomplished by hormone therapy and chest/breast surgery
• Fear of losing sexual sensation or satisfaction
• Satisfaction in a current relationship, with no pressure to change further
• Financial cost of undergoing an expensive and time-consuming procedure and recovery
• Difficulty in finding a surgeon with skills and experience in genital SRS surgery

As a member of the support team for somebody contemplating plastic surgery, your best contribution would be in helping them make the decision solely for themself rather than being influenced by pressure from temporary relationships, peer pressure, or from incorrect or insufficient information concerning the risks and possible side effects.

A good source of information on FTM multiple surgeries is Hudson’s FTM Guide, an educational site with comprehensive and detailed information describing surgery, surgical procedures, costs, benefits and risks and general advice (www.ftmguide.org not a medical site), or, alternatively, The Transitional Male, an educational resource to inform transmen, their friends, family and their significant others (www.thetransitionalmale.com).

www.transhealth.vch.ca is an on-line guidebook to MTF multiple surgeries, with descriptions of surgical procedures; or the Transsexual Road map, a comprehensive information website covering every aspect of  MTF life, including surgical procedure descriptions. www.tsroadmap.com

The First Surgery or the Final Surgery?

Whether FTM chest reconstruction or  MTF breast augmentation surgery is the only plastic surgery a patient undergoes, or whether it is just one surgery among several planned surgeries, the most important determining factors are the level of gender satisfaction accomplished and whether an improved quality of life is achieved. Other factors such as age, general health, relationship status, finances, and time considerations will also factor into a decision to seek multiple surgeries.

Whatever the decision, it is very important to seek the services of a plastic surgeon with the special training and skills required plus experience and documented success in performing sex reassignment surgery.  Be certain that the surgeon chosen is a board certified plastic surgeon, which means they have had advanced training and adhere to high clinical standards. A surgeon chosen to perform FTM chest reconstruction or MTF breast augmentation may not be the one chosen to perform surgery to remove sex organs or perform genital reassignment surgery.

Transgender patients in San Francisco find a non-judgmental and understanding welcome in the offices of board certified plastic surgeon  Dr. Scott Mosser, who refers to transgender surgery as ‘gender confirmation surgery’.  Dr. Mosser has not only the training and specialized skills required to perform FTM ‘top surgery’ chest reconstruction and MTF breast augmentation, but an understanding of the transgender diagnosis and treatment process required to achieve gender identity satisfaction.  He and his talented staff are ready to join forces with the patient’s support team of medical professionals to ensure that both preparation and follow-up to surgery result in a successful outcome.