FTM Frequently Asked Questions (Pre-Op) Denver

Do I have to have a letter from a counselor before FTM surgery?

It is our experience that more often than not, trans-men have undergone appropriate counseling for gender dysphoria for months or years before seeking to undergo the more significant step of (relatively irreversible) surgery, to enable them to fully function in the male identity. We feel that this is both appropriate and helpful in the pre-operative phase, and therefore counseling and/or functioning in the male gender pre-operatively is highly recommended. This is not formally required, however especially in mature, stable patients who have already made the lifestyle commitment by publically “identifying male” via binding and/or the use of testosterone. If a patient is transitioning under the age of 18, and demonstrates adequate maturity and understanding of the procedure, we will offer this procedure (age 16 minimum) with full parental consent, but also strongly recommend the involvement of (and, ideally, documentation from) an appropriate counselor pre-operatively.

Is this the equivalent to a mastectomy?

In short, NO. At least 10-20% of normal breast tissue is preserved in most patients, especially behind the central pedicle (by necessity), and peripherally by design, to avoid unnatural contour irregularities. In addition, the female genotype is generally still at play, and there is no evidence in the literature that the use of testosterone is protective against breast cancer. Therefore, we uniformly advise that all patients engage in self-breast exams (generally easier with less overall tissue remaining) and start getting mammograms when they would otherwise be recommended (generally starting at age 40), especially (and occasionally earlier) in patients with a strong family history of breast cancer, or positive genetic testing. If a breast cancer were to develop, this would likely be managed (by a surgical oncologist) as it would in any smaller-breasted patient.

Does it matter if I’m on Testosterone?

Generally, it will not affect your healing one way or another if you are not on T, just starting, or have been for many months/years (at least we have not seen any ill-effects, or advantages). If there is active acne in the chest area because of testosterone, however, it may be beneficial to have the dose adjusted by the physician who prescribed it. If T has resulted in dense chest hair, there is a chance we may have to shave some of it at the time of surgery, to facilitate incisional closure and after-care (but you should not do so before surgery, as this can cause microtrauma and increase infection risk).

Is there anything else I can do to improve my chances of healing/a good result?

Generally, patients can optimize their chances at good healing by engaging in a healthy, protein-heavy diet before and especially after surgery, managing medical problems such as diabetes as well as possible in the peri-operative period, and refraining from habits deleterious such as smoking, especially post-operatively. It is also important to be at a reasonable weight at the time of surgery if possible, as heavier patients generally have more risk of fluid collections, infections and healing problems, as well as potentially dangerous blood clots related to surgery (DVT = deep venous thrombosis in extremities and/or PE = pulmonary embolism to lungs), and to avoid major fluctuations post-operatively (weight gain may lead to central fullness, and significant post-operative weight loss may lead to relative laxity of the result, for instance). Finally, it is critical to follow Dr. Steinwald’s advice during the post-operative period in general, especially regarding incision care (generally taping for several weeks, then utilizing approved Vitamin E based products), and gradually working back towards fuller activity levels.

Is FTM surgery covered by insurance?

Generally, FTM chest recontouring is considered to be a sophisticated cosmetic procedure, and is therefore not covered by insurance. Because this procedure is being performed to dramatically change one’s appearance (and not for symptoms of back pain, etc., classically associated with “mammary hypertrophy”, which is being approved by insurance companies less and less frequently these days), and because Dr. Steinwald is one of the few surgeons in the country applying specialized techniques and taking on added risks to perform this surgery, we do not accept insurance – even if “available” – for this specialized procedure. Dr. Steinwald has pioneered the method of leaving the nipple attached (when possible) to retain as much sensation as possible, and spends extra time to achieve the best cosmetic results possible, in a great majority of the time in one stage. We have a staff which is well-attuned and sensitive to the special issues regarding gender reassignment, including helping with letters and legal documents peri-operatively, and we are happy to arrange surgery for out-of-town patients.

How much does FTM surgery cost?

Generally, as of 2014, the “flat rate” is between $6500 and $7500 (depending upon the extent of reduction necessary, and if liposuction of the underarm areas is necessary, for example), all of which includes a minimum of one year of follow-up. Additional facility/anesthesia fees are charged per the time necessary (averaging between 2 hours for smaller chests, to up to 3+ hours for fuller chests), which is where some patients may generate lower expenses than others. If additional significant cosmetic surgery procedures is desired at the same time (Dr. Steinwald is also an expert at abdominoplasty/tummy tuck and other liposuction/body contouring techniques; please see thecenterforcosmeticsurgery.net for details), this is often discounted at least 10-20%.

When are the fees due and do you work with payment plans?

A $500 deposit is required to hold a specific surgical date. The entirety of the balance is due to The Center for Cosmetic Surgery two weeks prior to the scheduled date of surgery, which is when a pre-operative assessment and clearance is often performed. We do not offer in-house financing, but do work with third-party financing companies, specifically CareCredit.

Can I get surgery at the same visit as my initial consult?

If a patient is able to communicate effectively by e-mail in advance with Dr. Steinwald, including sending appropriate (frontal, oblique and side-view) photos, and is otherwise in good health and a relatively obvious candidate for a single-step surgery (A, B, or C cup), Dr. Steinwald is willing to meet them in person 24-72 hours before surgery is scheduled, to have a personal meeting and physical exam (as no truly legitimate, individualized medical advice can be delivered “online”, either legally or ethically). The proviso is that surgery may have to be cancelled or delayed for an unforeseen medical issue (or if the doctor and patient just aren’t “on the same page” with regard to the surgical plan). Ultimately, nothing – including extensive online communications – can replace an individualized, confidential consultation, and therefore we discourage the former in favor of the latter. Funding must usually be arranged in advance as well, but would be considered refundable if the surgery must be cancelled in this circumstance.

Will you write a letter for me post-operatively to support formal gender/name changes?

Yes, we are glad to provide these letters as part of the course of your treatment. These are usually provided (often in triplicate) at least 3 months post-operatively, (or) when we know the patient is doing well and is otherwise functioning in the male gender. We have several versions of these free-of-charge letters available (some with more “legalese”, depending on your state’s requirements).

I live in another state. How does the fly-in for surgery process work?

Dr. Steinwald is a Nationally-recognized FTM Top Surgery expert. Many of our transgender patients come from other states. We will first schedule you to have a phone or Skype consultation with Dr. Steinwald. In order to do this, you will need to email the new patient paperwork and some photos for the surgeon to review prior to the consultation. After you speak with Dr. Steinwald, you will speak to one of our patient counselors. She will provide you with a price quote and discuss possible surgery dates with you. We will schedule a phone pre-op with you 2-3 weeks before your surgery. During this call, one of our clinical nurses will go over the consents with you, discuss pre and post-operative instructions, discuss your recovery time and answer any questions that you have. We will then coordinate a time with you to meet Dr. Steinwald in person and have your before photos taken by the nurse as well as sign your consents for surgery. Depending on your travel plans, these appointments typically take place a day or two before surgery.

How long do I need to stay in town following my FTM Top Surgery?

Dr. Steinwald requires his patients to stay in town for one week post op. Barring any unforeseen complications, you will be cleared to travel at your one week post-op appointment.

Where should I stay while I am in town?

There are several hotels near our surgical facility in Golden, CO. We do have arrangements with the following hotels to offer a discount to our patients:

How many FTM Top Surgery procedures have you performed?

Dr. Steinwald has performed this transformative surgery for hundreds of transgender patients from across the country and even abroad.

How soon can I work out after Top Surgery?

For the first two weeks following your FTM Top Surgery, you should be taking it easy and not doing any activities that will cause an increase in heart rate or blood pressure. At two weeks post-op, you may begin very light cardio (walking either outside or on a treadmill with no incline). You can increase intensity and duration over the next several weeks, as tolerated. At 6 weeks post-op, you are considered restriction free and may do any activities you wish, including resuming weight training – always using the “if it hurts, stop” guideline.

How old do I have to be to have Top Surgery?

The majority of Dr. Steinwald’s male transgender patients are 18 or over, however, in certain circumstances he will perform FTM Top Surgery on adolescents with parental consent.

What is Dr. Steinwald’s motivation for doing transgender related healthcare?

In 2002, Dr. Steinwald had a consultation with a female patient who wanted a breast reduction to be “smaller than an A cup.” During the consultation, he quickly discovered that this patient was transitioning to male. Dr. Steinwald agreed to perform a staged operation to help this patient to achieve a more masculine chest. From that time on, Dr. Steinwald improved upon his technique as he saw more and more transgender patients seeking top surgery, and would go on to pioneer the use of the “ultrathin” inferior method of chest masculinization, by which the nipple in most cases can remain attached, and retain a high degree of sensitivity that is just not possible with free nipple grafting (FNG). Dr. Steinwald continues to be inspired by the positive attitude and courage that his trans-men patients display. He considers it a great and humbling honor to play such an important role in the transition journey of his patients.

How do I choose a surgeon to perform my FTM Top Surgery?

After verifying that the surgeon is Board Certified by the American Board of Plastic Surgery (ABPS) and is a member of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS), you will then want to review his/her website thoroughly, paying special attention to the before and after gallery. Make sure that there are many FTM Top Surgery before and after photos displayed which show consistently reliable results, regardless of the patients’ breast size.

What if my surgical result needs “tweaked”?

While Dr. Steinwald’s revision rate is quite low, at times, it is necessary to return to the OR to refine a patient’s results. His policy is quite simple: revisions are done at no charge.

I’m a smoker, is that ok?

Nicotine can adversely affect the healing process because it constricts the small vessels that supply blood to the tissues and prevents the necessary nutrients for healing to get to the wound. The incidence of having a wound complication such as an open wound or skin death, as well as a post-operative infection is much higher in smokers. Dr. Steinwald requires his patients who are seeking gender reassignment surgery to quit smoking at least 2 weeks before surgery and for at least 4 weeks post-operatively.

Where will my surgery be performed?

At The Center for Cosmetic Surgery, we have our own surgical facility. Apex Surgical Facility is AAAHC certified. This means that we are held to the highest standards, ensuring the safety of our patients. We use only Board Certified anesthesiologists, and all of our staff have extensive experience and a heightened sense of discretion and sensitivity.

Does Dr. Steinwald use drains?

Yes, Dr. Steinwald does use drains post op. This is to keep fluid from collecting at the surgical site which could result in the need to return to the OR.

How long is surgery?

FTM Top Surgery takes between 2-3 hours to perform.

Will your office refer to the patient with their preferred gender pronouns and preferred name even if it is not on all of the patient’s official documents (They haven’t legally completed those steps)?

Absolutely! We will ask you what pronouns you would like us to use and the name you prefer to go by. Making you comfortable is our top priority.