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Top Surgery FAQ

• How do I know if top surgery is right for me?

• The decision to get top surgery is a quick and easy decision for some, and more difficult and slow for others. It can be helpful to hear from others who have had surgery about their decision-making process. Going to trans support groups, conferences, and discussing your desires for surgery with surgeons and a mental health provider, like a therapist, can be helpful guidance as well
  

  As with any major life decision, it’s normal to have some doubt and anxiety. At Our San Francisco practice, we provide you with in-depth information on surgical techniques, recovery, safety and results so that you can make an informed decision.

  Start by learning about the typical top surgery journey.

• What are the positive effects of top surgery?

• 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. Surgery can improve self-esteem and confidence; the acute recovery and healing process is worth it for the long term relief.

  Here’s what some of our patients had to say about their experience.

• What are the major safety risks and complications of surgery?

• Individual risk for top surgery will depend on general health, age, and other characteristics, but you can take steps to reduce chances of complications:

  • Make sure to discuss any comorbidities and your health history with your surgeon
  • Make sure you discuss your desired outcome with your surgeon
  • Follow pre- and post- op instructions carefully
  • Stop smoking completely 3 weeks before surgery

  In general, the risks of surgery are relatively small.Read more about safety and complications.

• How should I prepare for top surgery?

• 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 chest reconstruction top surgery or breast augmentation.)

  It is best to minimize any major changes in your life, such as a move or job change,and be in close contact with your surgeon’s office if if any issues arise.

• What should I do to prepare if I have a history of anxiety or depression?

• 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. If you are unable to or do not want to pursue therapy, having a robust support system of family, friends, and other community can be helpful. Easy access to things that make you happy (music, video games, TV shows/movies, short walks or sitting out in the sun, etc.) can be helpful during the short-term period of post-operative depression. It is important to remember that these feelings are normal and will dissipate throughout and after your recovery.
  

• What happens when I wake up from top surgery?

• 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. It is tempting to want to see your new chest right away, but these should not be removed until your follow-up appointment.

  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.

• What does recovery look like?

• 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.

• How much pain can I expect after top surgery?

• 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, After the first few days, many patients take Tylenol or no medication at all.

  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 or stomach and may have limited mobility in your upper body.

• Do I have to wear a compression garment after top surgery?

• Yes, you will need to wear a compression garment for 1-2 few weeks after surgery to minimize swelling and to help the skin tighten. For chest reconstruction patients, this is not as uncomfortable or tight as a binder.

• Are drains required? Do the drains hurt?

• At The Gender Confirmation Center, the patient generally gets to decide if they prefer drains for double incision surgeries, but drains are required for minimally-scarring procedure types such as keyhole and periareolar surgeries.

  There is a belief amongst some individuals without medical training that the placement of drains may cause additional scarring and pain, which is where the stigma against drains originates. However, our surgeons’ techniques do not cause any additional internal scarring.The only visible scarring that may result from drains would be very small scars (1-2 mm) under the arms for someone undergoing a minimally-scarring procedure. The discomfort that drains cause are minimal and the benefits outweigh the inconveniences

• When can I shower after top surgery?

• Within 3 to 7 days after surgery at your initial post-op visit, your surgeon will remove the dressings, make sure your chest is healing properly, and give you the go ahead to begin regular showers. Take care to let the water gently run over your chest and avoid any scrubbing until completely healed. Until that time, you can sponge bathe to keep clean.

• How much time do I need to take off work?

• Time off needed from work depends on your job. A week or two off is generally advised for a desk job, as well as 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 within 8 to 10 days.  You can’t lift more than 5 lbs until three weeks after surgery, so if you have a more active job, you may have to wait three weeks or more until resuming work.
  

• When can I begin to exercise?

• Any physical activity that may cause you to sweat or your heart rate to increase should be avoided for at least 3 weeks. Heavy lifting and chest exercises should be avoided for at least 5 to 6 weeks.

• When can I suntan / swim after top surgery?

• 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 3 weeks following surgery.

• What can I do to minimize scarring?

• Scar formation is a normal part of the healing process, but how your body scars 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 chest reconstruction top surgery patients, it is really important for you to avoid having your arms over your shoulders for as much as 3 weeks after surgery, in order to have the very thinnest, flattest scars you can have.
  

  Your doctor will provide you with personalized recommendations following your surgery.

• Will I need a revision or second procedure?

• Most patients only require a single surgery to achieve their desired outcome.  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.
  

• Can I get other procedures done at the same time of my chest reconstruction surgery?

• Choosing to combine top surgery with gender-focused body contouring or other procedures (such as a 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 our office to discuss further.

• Do you provide a letter to change my legal name or gender marker?

• Anytime after your surgery, our office can provide a letter for a legal gender change,
  

• How common is regret after surgery?

• The majority of patients do not regret surgery. Some people regret the type of procedure they undergo or do not have enough information prior to surgery, and thus do not have proper expectations set beforehand. Being well-informed and collaborating with your surgeon can ensure you are pursuing the correct procedure to meet your needs. Complications that can cause long lasting effects can unfortunately cause negative feelings associated with surgical outcomes;, however, the majority of complications can be managed to a positive end overall.

• How do I get my top surgery covered by insurance?

• We have been able to secure insurance coverage from many insurance companies for transition-related procedures. To learn more, read our page on Insurance Approval. In order to have insurance cover your surgery, you will likely need a letter from a licensed mental health professional confirming you meet the WPATH guidelines, given we have a pre-existing agreement with your insurance company. Our office does not require a letter, but insurance companies usually do. Alternatively, there are ways to secure a Letter of Agreement (LOA) if our office does not have a pre-existing agreement with 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.

• How much does chest reconstruction top surgery cost?

• Total out of pocket costs without insurance coverage for chest reconstruction top surgery at our office can range between $14,000 to $17,000 for cash-pay patients. Insurance coverage can drastically reduce these costs. You can view our page on top surgery costs and insurance coverage for gender-affirming surgery to learn more.

• What if my health insurance company doesn’t cover chest reconstruction surgery?

• You have options if your insurance company does not cover chest reconstruction 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.

• Does long-term chest binding lead to breast cancer?

• 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 chest health whether they bind or not. Undergoing age and risk appropriate screenings such as mammograms are still best practices to detect and prevent the growth of breast cancer. Click here to view a detailed page on performing self chest exams (content warning for gendered language on this page). To learn more about chest health, please consult with your primary care physician.

• What are the safest methods for chest binding?

• Typically, the safest methods for chest binding involve using well-fitted binders and/or other materials specifically designed for binding. Compressing your chest with ace bandages, duct tape, or other materials not designed for binding is dangerous and can lead to intense constriction in the lungs and ribs or cause chest pain. These methods are not recommended. If you are experiencing any of these symptoms, we recommend that you stop binding as soon as possible.

  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 you can’t afford to buy a binder or it is unsafe for you to buy one due to your current life circumstances, 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.

• What are some common side effects of chest binding?

• Some people experience difficulty breathing, skin irritation/chafing, and/or acne. Often side effects are associated with wearing a binder that is not the correct size or wearing it for too long. If you are confident you are wearing a binder that is a good fit for you and continue to experience issues, you should see your primary care doctor. 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.

• Can I petition an insurance company to cover gender-affirming surgeries and treatment?

• 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.

• Which insurance companies are known for better coverage for gender-affirming care?

• 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, nonbinary, 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.

• How can I find out if my insurance company covers transgender healthcare and surgeries?

• You can contact your insurance provider to get your “summary of benefits and coverage,” which is a booklet that will tell you everything that is and is not covered by your insurance plan (including gender confirming procedures). You can also call your insurance company and ask, although it is recommended that you speak to at least a couple of different representatives to ensure you are receiving accurate information. 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. To learn more about other plans, follow this link to read the National Center for Transgender Equality’s page on healthcare coverage.

• Does military insurance cover trans related surgeries?

• 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.

• When can I drive after surgery?

• The only absolute requirement to return to driving, is that a patient has not taken pain medication within 12 hours. 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.