Dr Danielle Dauria or Dr Bruce Cusenz

[Sordesco]

Hello. I have a rare opportunity to get my top surgery covered by my insurance but they referred me to a few doctors that are local to me that are willing to perform the surgery. I have spoken with Dr Dauria and she stated that she has done work on three other guys which I feel is a bit inexperienced. And I have yet to speak to Dr Cusenz.

Can anyone who has worked with either of these doctors give me more info or let me see the work that was done on you?

Thanks

[Sordesco]

Thank you very much. Dr Medaille was one of the doctors that my insurance company recommended as well. I have seen his work all over the internet so I know it is good. I am just too financially strapped and have other issues that would make travelling for my surgery incredibly difficult so I am trying to opt for a local surgeon.

I can't travel for my surgery because my wife is disabled and I usually have to lift her and her wheelchair any time we go anywhere. If I travel out of my local area, we would be stuck for a month until I could lift again. I can't take that much time off work or pay to stay in a wheelchair accessible place for that long.

So you see my dilemma. Do I choose between two local doctors who are not well known for doing top surgery?  Or do I risk destroying a well known surgeon's work by traveling and lifting too soon? Either way I could end up with a chest that looks like a hot mess.

[Alexthecat]

You can't be lifting her for at least 8 weeks after surgery anyway. You need to find someone to do it for you or she will be stuck at home for those 8 weeks.

Consider the price of travel compared to how much a revision will be if you choose someone close that doesn't do experienced work.

There is a trans group called transfamily up in Cleveland they may be able to hook you up with a place to stay. I know one of the members deals in apartments but I don't have her information.

[Bimmer Guy]

Hello. I have a rare opportunity to get my top surgery covered by my insurance but they referred me to a few doctors that are local to me that are willing to perform the surgery. I have spoken with Dr Dauria and she stated that she has done work on three other guys which I feel is a bit inexperienced. And I have yet to speak to Dr Cusenz.

Can anyone who has worked with either of these doctors give me more info or let me see the work that was done on you?

Thanks

Where do you live?

[Sordesco]

Thank you all very much for the information. I live in Western NY near Buffalo. I have weighed the costs of travel vs revision and I am almost certain that it will be much easier for me if I stay near home.  Like I said, I am more likely to do damage to the work of a more experienced surgeon if I travel.

My wife has a personal care attendant that will be able to lift her wheelchair when I can't but he won't be able to travel with us. I am afraid that if I travel we will be stuck somewhere for 6-8 weeks. I can't afford (time off from work wise) to be away for 8 weeks and planned on going back to work after 2 or 3 weeks because a have a VERY sedentary job.

I had my consult with Dr Cusenz and he has much more experienced doing top surgery than Dr Dauria but neither doctor has examples of their work. 

Because of this, I looking into getting a mastectomy without the nipple graphs done by a surgeon in the oncology center of my local hospital.  They work with plastic surgeons who will be able to reconstruct nipples later if I want and all would be covered as a cancer prevention measure.  I think I will be much more comfortable with someone who does nothing but mastectomies every day than I will with a doctor that has performed maybe 3 or a dozen or so top surgeries in the past few years. 

[SWNID]

Can you leave her at home with her care attendant, and bring a friend with you to travel for surgery? I'm in upstate NY and went to Medalie for surgery and returned home the next day.

[aleon515]

Because of this, I looking into getting a mastectomy without the nipple graphs done by a surgeon in the oncology center of my local hospital.  They work with plastic surgeons who will be able to reconstruct nipples later if I want and all would be covered as a cancer prevention measure.  I think I will be much more comfortable with someone who does nothing but mastectomies every day than I will with a doctor that has performed maybe 3 or a dozen or so top surgeries in the past few years.

I'd wonder about this one. I don't know first of all if it's actually cheaper. It probably is not. Unless you have coverage in your insurance for the braca gene, I think such a mastectomy is rarely covered and can be $10-10K. (Funny how people always think that trans guys are scalped. Not actually true. I'm sure this doctor will have done many mastectomies but the purpose of them will be to get cancer, not modify a chest in a masculine way. So the experience is more in getting cancer than really the surgery per se.

Second, I doubt that this mastectomy is like the chest reconstruction that most of the guys here get. Most guys have quite a modified procedure with changes in the procedure, which are more similar than someone with severe gynecomastia. I doubt the surgery would be exactly to your liking. I know sometimes guys say they wouldn't care, but I would not be so absolutely sure of this.

The nipple grafts is really part of the procedure. I think the other possibility is more like tattooing the nipples later. I'm not sure how you do a mastectomy, it's quite a radical procedure, without removing  the nipple. An oncology surgeon is not going to know alternative procedures like t-anchor which spare the nipple stalk.

I feel you'd be better off with a doctor who has done many gynecomastia and other chest surgeries.


--Jay

[Sordesco]

Thanks for the insight, Jay. I have put over a decade of thought into the difference between top surgery and a general mastectomy for cancer prevention and have a multitude of reasons for investigating the latter. I know that the results of the mastectomy will not look the same as it would if I had a surgeon who specializes in top surgery perform the procedure. I am not concerned about having nipples right away as I don't plan on going shirtless except in my home. I have darker skin and scar very badly so I am going to have oddly colored, raised scars to deal with for a very long time, no matter who does the work.  I am going to feel too self conscience about my scars to expose my chest to strangers anyway.  I am more concerned with how my body looks in clothes than without them since that is how I will be presenting myself to the majority of the world. Any of the surgeons can fulfill that need, but with my mother, at least 1 aunt on both sides, and my grandmother all having to deal with breast cancer at some point,  the oncologist feels that I am a suitable candidate for the cancer prevention mastectomy. 

SWNID, as for leaving my wife at home while I have major surgery, that is not an option. I want her there when I wake up. It is preposterous to even think about leaving my life partner of almost 15 years who has been by side every step of my transition at home while I am experiencing a major life changing event.  She also takes care of me and can do so much more easily in our specially equipped wheelchair accessible home.

I unfortunately only have 2 friends in this area that know I am trans but they live 2 hours away(and in another country). My wife's care attendant doesn't even know, or I would just have him drive us to Cleveland and back.  I have been living deep stealth since moving to this area and have not felt comfortable enough to tell anyone. So I am not planning on showing my bare chest to anyone but my wife, my doctor, and maybe my close friends.

[aleon515]

This isn't my area really...lol ...but I have a good friend who's F2M that told me, my FFS doctor... Dr Medalie, is very good at doing male top surgery. He's on the other side of PA ....actually located in Cleveland OH. If you consider him, I can give you advice ...and a recommendation of on where to stay. 

He has an excellent reputation, and actually I think one of the best top surgeons. I didn't even know he did FFS. Learn something new every day I guess.

--Jay

[Jessica Merriman]

Sordesco please don't take this the wrong way, but you will most certainly have to have some lee way if you want this. You sound like you don't realize just how little you can do immediately after. I know you want your partner there, but it seems it is not possible with the restrictions you will be under as far as lifting, etc. No one is saying to desert her of course, but I don't see how you can have everything you want met. 

[Sordesco]

Thank you for looking out Jessica.  I will have help for the first few weeks because my mother and father-in-law will be coming to town.  After that, my wife's care attendent will be doing all of the liftting and stuff for me until I am able to. My wife is disabled but not so much that she can't help me with small things (food, drinks, dressing, etc) especially in our home which has been specially modified for her to be able to get around. And the care attendent knows that I am having surgery but I just haven't told him for what. So I will have plenty of help immediatly after the surgery if I stay near home.  I could also to Dr Fischer(my parents live in Fischer's area)but as I stated before, traveling is much more difficult with a disabled spouse. I would have to bring her attendent with us but I am unable to incur the cost of putting him up in a hotel while we travel. And because of the nature of my relationship with him, I can't just share a hotel room.

Hence you see my dilemna.  It will cost less for me financially, time off work, and stress wise to choose of the the surgeons near my home.  Medalie is only about 4 hours away from me so going to him would just be a day trip.  My insurance says that they will cover his work as well so I will look into going to him as a possibility. 

[Bimmer Guy]

Thank you for looking out Jessica.  I will have help for the first few weeks because my parents will be coming to town.  After that, my wife's care attendent will be doing all of the liftting and stuff for me until I am able to. My wife is disabled but not so much that she can't help me with small things (food, drinks, dressing, etc) especially in our home which has been specially modified for her to be able to get around. And the care attendent knows that I am having surgery but I just haven't told him for what. So I will have plenty of help immediatly after the surgery if I stay near home.  I could also to Dr Fischer(my parents live in Fischer's area)but as I stated before, traveling is much more difficult with a disabled spouse. I would have to bring her attendent with us but I am unable to incur the cost of putting him up in a hotel while we travel. And because of the nature of my relationship with him, I can't just share a hotel room.

Hence you see my dilemna.  It will cost less for me financially, time off work, and stress wise to choose of the the surgeons near my home.  Medalie is only about 4 hours away from me so going to him would just be a day trip.  My insurance says that they will cover his work as well so I will look into going to him as a possibility.

DEFINITILEY consider Medalie.  He has a very good reputation.

[aleon515]

I know you feel you won't want to be shirt-less ever post-op, but there is another consideration. I believe in a mastectomy they normally cut diagonally. Its not at all going to look like a male chest, say in front of your mirror.

Another thing is that if this is a regular doctor, this is going to be rather high in the "feminizing level" (being referred to as female, gendered incorrectly, called dearie, etc.). I passed about 60% of the time when I had top surgery, but EVERYONE gendered me correctly. Perhaps this is okay for you, but you should really get ready for this when you go in, should you go for this option.

It doesn't sound like your spouse and caretaker could not take care of you. I wouldn't necessarily worry about that, as long as you keep to the lifting restrictions. But I really would consider Medalie, and see you if you can think of ways to get you to go. There are also ways to reduce scarring, if you know ahead of time that you do this.


--Jay

[Sordesco]

I know you feel you won't want to be shirt-less ever post-op, but there is another consideration. I believe in a mastectomy they normally cut diagonally. Its not at all going to look like a male chest, say in front of your mirror.

Another thing is that if this is a regular doctor, this is going to be rather high in the "feminizing level" (being referred to as female, gendered incorrectly, called dearie, etc.). I passed about 60% of the time when I had top surgery, but EVERYONE gendered me correctly. Perhaps this is okay for you, but you should really get ready for this when you go in, should you go for this option.

I have already spoken to the doctor doing the mastectomy and he is willing to make the cuts however I want.  I will, of course, have them placed at the bottom edge of the pectoralis just like any regular top surgery.   The major differences will be that they remove 99.999% of the breast tissue (no doctor can remove it all) and try not to leave any behind like they do in top surgery and I won't have nipples right away.  With my family history of breast cancer, I feel this is the safest route for me to go medically.  My insurance will cover the nipple reconstruction at a later date if I choose.  As for it not looking like a male chest, I have built my chest muscles and plan on building them more after surgery that I will have the outcome that I want. 

My major concern with my outcome is actually my nipple placement. I have seen a lot of pictures on the internet of work done by many experienced doctors where the nipples seemed to me like they were either too big or in the wrong place.  I will have more control over where my nipples are if they are put on after I have a chance to shape my chest by working out. 

I have even viewed Medalie's work online and based on what I have seen, his method for larger guys(I am 5'11"and 250lbs with a very large chest) does not look aesthetically pleasing to me. 

As for any of these doctors feminizing me, that is not a problem.  I have been to the oncologist's office twice and Cusenz and Dauria's office once each. Everyone in these offices refers to me as male, because after being on hormones for 13 years, I present fully as male.  The only thing in their offices that refers to me as female is the paperwork which has to for insurance reasons.  Everyone has been very respectful. 

[Bimmer Guy]

Sordesco, it sounds like you are clear on what is most important to you in all of this.  Good luck to you and I hope you get the result you hope for.

[aleon515]

Don't mean to be argumentative here. I meant that people should know what kind of services that they would get into, especially if they do some alternative to the standard sort of DI (or peri,etc.). Good luck to you.

--Jay

[Sordesco]

Hello,

Just wanted to let anyone know that may be wondering, I ended up going with Dr Danielle Dauria.  I had my surgery on Oct 31 2014.  I was able to have the surgery performed at the hospital 20 blocks from my home.  I received the exact results that I wanted and I am happy with the look of my chest.  I am very glad that I went with a local doctor because the after care has been amazing.  She has seen me not only for the day-after-post-surgery and for drain removal, but has also seen me at 2 weeks, 2 months, 6 months and I have another appointment for 1 year post op.  All of these post-op appointments are included with the cost of the surgery and they are for scar maintenance.  The doctor has even offered steroid injections if the scars become too hypertrophic which my scars have the possibility of becoming because of my ethnicity. 

Going with a local doctor for my surgery has meant that I get personalised follow-up attention from the doctor who performed the surgery for up to a year after my surgery at no additional cost.  Also, my wife was able to be there for the surgery and my recovery.  My parents did travel here from Washington DC up to help. They took me to and from surgery and assisted me and my wife for about a week until I could get around on my own.  This was easier than having them drive all the way here, get me, take me to Ohio, stay there for a few days to a week, then drive me home, and then drive themselves back to DC.  Had I gone to Baltimore which is closer to my parents, the surgery would not have been paid by insurance. That may also have been the case if I had I chosen to go to Ohio for my surgery and my parents would not have been able to help me out.