How To Choose a Surgeon

[ghostwhisperer]

Hi! I'm a transman, I've been on T for over four years, been living full-time for the same amount of time, and I am very happy with my life. I've finally decided to take the next step and have my top surgery done, but I have no idea how to go about choosing the surgeon. I am in college with student debt, so price is a concern, but I'm not broke enough to have it done in a back alley with a butter knife. I'm kinda small (I think), probably an A, maybe a B, and I am good physical shape, and I am very active. I am looking for a surgeon on the West Coast, preferably California, and I don't know if this matters, but I am in my early twenties.

I also have some general questions about pre-post surgery. I do have high anxiety about medical procedures, and I usually take Xanax before getting my blood drawn, etc, but obviously, I'll be going under for this. Does anyone have any advice on how to deal with the pre-surgery freak-out?

Once the deed is done, I read that you don't get to shower for a week or so afterwards. Is that true? How is that dealt with? When do you start getting to lift your hands above your head? Also, I am an active person, so how long, in general, does it take before you can go jogging/running/lift weights, etc? I will be going back to work, hopefully in a few days after the surgery, but I'm arranging not to lift anything (office-type jobs). Is it safe to lift 5 pounds after surgery? How long does the in-bed recuperation take? Also, after surgery, do most people wear their binders and if so, when can we take them off?

If the surgeon requires a letter of recommendation from your doctor, how does one go about writing the letter of rec for them to sign?

Sorry for the overload of information and thanks in advance!

P.S. I'm very tough -- my primarily goal is to get it over with so I can go back to college and led a (more) normal life in August.

[Kreuzfidel]

Hi! I'm a transman, I've been on T for over four years, been living full-time for the same amount of time, and I am very happy with my life. I've finally decided to take the next step and have my top surgery done, but I have no idea how to go about choosing the surgeon. I am in college with student debt, so price is a concern, but I'm not broke enough to have it done in a back alley with a butter knife. I'm kinda small (I think), probably an A, maybe a B, and I am good physical shape, and I am very active. I am looking for a surgeon on the West Coast, preferably California, and I don't know if this matters, but I am in my early twenties.

I live in Australia, but I'm sure some West Coast guys here can give you suggestions regarding surgeons.

I also have some general questions about pre-post surgery. I do have high anxiety about medical procedures, and I usually take Xanax before getting my blood drawn, etc, but obviously, I'll be going under for this. Does anyone have any advice on how to deal with the pre-surgery freak-out?

It can be a tense time for a lot of us.  I don't know that they'd give you something to relax before putting you under - there are a lot of self-control and self-calming techniques that can be useful.

Once the deed is done, I read that you don't get to shower for a week or so afterwards. Is that true? How is that dealt with?

I'm sure there are some surgeons out there who would have you not shower, but I think it would depend on how they wrapped your chest.  At the very least, you can sponge-bathe.  I was in the shower the next day - they wrapped my chest with waterproof bandages.

When do you start getting to lift your hands above your head?

I was barely able to lift my arms after 3 weeks.  I think it was more like a good 6-7 weeks before I was comfortable enough to be doing that - even then, I didn't do it often.

Also, I am an active person, so how long, in general, does it take before you can go jogging/running/lift weights, etc?

Jogging/running - that's probably highly personal.  I'd give it a week or two.  As for lifting weights, I wasn't back lifting until 8 weeks post-op.

I will be going back to work, hopefully in a few days after the surgery, but I'm arranging not to lift anything (office-type jobs). Is it safe to lift 5 pounds after surgery?

I think that will be up to your surgeon to decide. 

How long does the in-bed recuperation take?

In-bed - probably 2 days.  I had a lot more pain than some guys, so I wasn't up and about much - but wasn't bed-ridden either. 

Also, after surgery, do most people wear their binders and if so, when can we take them off?

3 weeks I had to wear mine for.

If the surgeon requires a letter of recommendation from your doctor, how does one go about writing the letter of rec for them to sign?

Do you mean as in psychiatric clearance?  I just told my psychiatrist the basics of what the surgeon needed to hear - that I was free from any delusional or psychotic disorder that could have been spurring my desire to transition, etc. and that surgery was the next viable step in the treatment of my gender dysphoria.

Sorry for the overload of information and thanks in advance!

No need to apologise!  That's what this place is here for 

[FTMKyle]

Are you North Cali or south? I am sure that there are tons of surgeons in California, but I've only heard of 2. I went to Dr. Eichenberg, http://www.renuance.net/ He's located in Murrieta near Temecula, so if you are in the San Diego or Los Angeles areas, then he would be a good choice. He is really good and confident. His staff is friendly. They all greet me by name during all of my check ups. He does require quite a few check ups, so it's a lot of driving. Make sure you have someone to drive you for the first few. You can't shower for a week. You can sit in a tub of shallow water to wash all of your lower parts, but that was too difficult for me to get in and out, so I started just wiping myself down with a wet rag. Have someone help if you can.

I am 10 days out of surgery, and even if I could, I would not dare to put my arms over my head. As far as your anxiety goes, they will prescribe meds for that. The nurse told me I could take a valium the night before but I didn't. Plus, the anesthesiologist puts something in your IV that calms you down. You won't even remember much after that. Within seconds I was off in la la land. Before I met the anesthesiologist, the nurse talked to me the entire time, and there was a tv for distraction.

Depending what you do, you might not want to go back to work in a few days. But the surgeon will determine that. You will be at home sitting on your butt for at least two weeks. I've got six. And honestly, the longer the better for you to heal. After surgery I drank so much water, and peed so many times. I lost count. I didn't slow down on the water until the fourth day. They will give you a vest that you have to wear forever. Naw just kidding. But I do think you have to wear it for six weeks. I'm still waiting for the doctor to tell me I can stop wearing it. You only get one, so if you can swing it try to find another online so you can alternate. Otherwise you can wash it with your clothes and let it air dry in front of a fan or something. It takes like a half hour to dry. I was told to take an hour break from my vest morning and night, so that should give you plenty of time to wash it and shower. Dr. Eichenberg does not require a letter of recommendation. And I'm not sure if you really need one in California at all.

I was also probably your size. Maybe. I really don't know cup sizes or anything. But I wasn't that big. Right after surgery the nurse had commented, "I don't know if it was because you didn't have much breast tissue, but your surgery looks really good." That made me happy even though I was all groggy.

I pretty much just saved every penny I could and looked for ways to lower my bills. You can have your government student loans lowered based on your income, but if you are still in college, you are probably not paying it back yet. I paid for half of my surgery with my savings and half with care credit. Make sure you have enough to live off of too, and for your hotel and gas. You will have to stay at least one night. Maybe more. Dr. Eichenberg does not leave the drains in very long at all. As a matter of fact mine were taken out the very next day no problems. But I am apparently not a bleeder. It all depends on how you are doing.

The other surgeon is Dr. Crane in San Fran Cisco. http://brownsteincrane.com/ He took over for Dr. Brownstein when he retired. Dr. Brownstein was a very well known and popular top surgeon, and he personally trained Dr. Crane. I can't say much for Dr. Crane, but I have personally seen Dr. Brownstein's work on other guys, and he was phenomenal. I can only imagine that Dr. Crane is as good since Dr. Brownstein trusted him enough to leave his practice to him. I don't think Dr. Crane uses drains. Other than that I can't tell you much about him.

I hope this helps. Good luck.

[aleon515]

Look at the site www.topsurgery.net. There are several surgeons in CA. You might look into insurance coverage if you have it. California may require insurance to cover your top surgery, unless you have a very limited plan (only serious illnesses).

Anxiety: It's usual to have anxiety about surgery. It's a big deal. Not to worry. Talk to your surgeon as they can give you something the day of surgery if you need it. I found out I was actually LESS anxious the day of surgery. It was really odd. You can also ask if you can take xanax the day of surgery. They are going to want to know about this.

No shower for a week: Yes, for me it was. I was bound up in bandages. You can supposedly wash your lower parts, I suppose if you had help. I didn't have that much help. I got baby wipes and used those. And also sponge baths for lower end (wet wash cloth and so on).  I also got my hair cut super short (1 razor, I think). I don't really like it this short. But someone could help you get your hair washed a few days after surgery. You can use deodorant and so on.

Hands over head: not sure actually at least 3 weeks. You will gain range of motion so it starts out quite limited and in 2 weeks or so you can do about shoulder high. I got very happy each time I could get them higher.   It's the hardest thing as well as not being lift stuff. But I set up my place ahead of time to be able to do stuff around the house with this limitation.

Jogging etc.: Probably 3 weeks or so. I took walked about a mile 4-5 days after surgery. But it was not a fast walk. Usually weights and so on are about 6 weeks. I actually waited a few months. You have top surgery once and not pulling or stretching is a good idea.

Work: Well depends on how active your work is. A sedentary job is usually 2-3 weeks. 5 lbs yes. But more than 5-10 lbs probably 6 weeks. Just seems like a common number.

In bed?: Well didn't really have that much in bed. Perhaps a couple days? I know I was up and around by day two. I was more knocked out by the anesthesia than the surgery. I was uncomfortable but not in a lot of out and out pain. You are not in any way bed ridden. After a few days I didn't spend more days in bed than usual but if you do too much you probably will be more tired than usual.

Binder: Dr Garramone doesn't have you wear a binder but he gives you a tensor bandage to wear and says to wear for 3 weeks. I didn't actually do this because the point is to remind you that you had surgery. I figure that I am old enough not to do stupid stuff.

Letter: Actually even if you are not going to Dr G. You might take a look at this guideline. My therapist thought it was really helpful as to what to say. I've seen these ridiculous letters where therapists felt that they had to give someone's life history. Your surgeon doesn't need (or care) to know this stuff. Basically the surgeon is trying to protect his or her arse. He wants to know you are sane, have Gender dsyphoria, that you can make decisions, understand consequences, able to make adult decisions, that it's a logical step in your transition, etc.  Find out if your doctor requires T, most do not.
http://drgarramone.com/pdf/apsiftmrecommendation.pdf

Saving money: Well I am fortunate to be an older adult with a stable income over years. But you can save money in terms of transportation and lodging. If you can find a place you don't have to fly to that's great. Find a place with a refrigerator/freezer. YOu can do most all your meals in and only go out for recreation. In a few days it would be nice to get out and do something. Something like Extended Stays are good for that purpose but there are other possibilities.

You have excellent questions. I imagine they will help someone else looking for info.

--Jay

[Arch]

I can't say much for Dr. Crane,

Whoa, careful there. You just said that you don't think he's very good! I think you mean that you can't say much ABOUT Dr. Crane. There's a big difference.

With that said, I planned to do absolutely nothing for a solid week although I did go to therapy and a men's group meeting five days later--but I had someone else drive me. I needed the support of both meetings or I wouldn't have gone.

I have a sedentary job and technically would have been able to teach again by that point, but it would have been an awful stretch, and college teaching does not require a lot of classroom hours on any given day. I think I would have run myself into the ground if I had tried to teach that soon, and an eight-hours-a-day job would have been out of the question. Even if you are young and fit, two weeks might be more realistic. A physically demanding job will require more time off, and I was told not to exercise for about six weeks--and to play it by ear when I did start. Oh, and I showered in a day or two.

[ghostwhisperer]

Thanks for the responses, guys! I'm doing some more research, but given that I return to college in August and go back into physically demanding classes, I may have to postpone surgery another semester, which isn't good for my health, since I wear my binder 15+ hours a day and I do not have the option to remove it, or my mental health -- if I don't get these stupid things off soon, I'm going to insane, but what can you do? I'm in SoCal, but I'm looking at Dr. Crane in San Fran. Thanks for all the advice and well-wishes! I appreciate it!

[Bimmer Guy]

I just wanted to make a comment about the "letter".  It depends on what the surgeons requires, and some are loosening up on their expectations.  For example, I know that 3 years ago Garramone expected a letter that included everything that the WPATH SOC suggested at the time.  At some point after that this changed, requiring only a check off list that said you were sane, etc (see aleon515's post).

Also, I think that you will have a hard time scheduling surgery, getting it done, and getting back to the swing of things by August.  Most surgeons are scheduled a couple of months out.  Maybe you should consider getting this done over Christmas break?

Good luck to you.

[FTMKyle]

Woops. You're right I did say that. Didn't mean it. Sorry.

[aleon515]

I just wanted to make a comment about the "letter".  It depends on what the surgeons requires, and some are loosening up on their expectations.  For example, I know that 3 years ago Garramone expected a letter that included everything that the WPATH SOC suggested at the time.  At some point after that this changed, requiring only a check off list that said you were sane, etc (see aleon515's post).

Also, I think that you will have a hard time scheduling surgery, getting it done, and getting back to the swing of things by August.  Most surgeons are scheduled a couple of months out.  Maybe you should consider getting this done over Christmas break?

Good luck to you.

I was NOT suggesting that other people use the checklist (on the link). But my therapist thought it was a very good guideline. IF your surgeon gives you no guideline at all, writing a letter based on the lower part of the form he provides should get you a pretty good letter. The common info is basically that your primary problem is gender dysphoria and a persistent history of it, that top surgery is a logical (next logical) step in your transition, that you can make decisions and understand consequences, that you can make a fully informed consent (that if someone tells you what the risks are you would understand this), perhaps the degree to which you have transitioned, etc.   You don't need a complete blow by blow of your gender issues from childhood.

It's best if you ask the office of the surgeon you are going to if they have any guidance, but my therapist thought it was a really excellent guideline if you don't have anything else to go off of.



--Jay

[Bimmer Guy]

I was NOT suggesting that other people use the checklist (on the link). But my therapist thought it was a very good guideline. IF your surgeon gives you no guideline at all, writing a letter based on the lower part of the form he provides should get you a pretty good letter. The common info is basically that your primary problem is gender dysphoria and a persistent history of it, that top surgery is a logical (next logical) step in your transition, that you can make decisions and understand consequences, that you can make a fully informed consent (that if someone tells you what the risks are you would understand this), perhaps the degree to which you have transitioned, etc.   You don't need a complete blow by blow of your gender issues from childhood.

It's best if you ask the office of the surgeon you are going to if they have any guidance, but my therapist thought it was a really excellent guideline if you don't have anything else to go off of.



--Jay

Hey, Jay, my post wasn't a comment on what you were saying.  I was just referencing the fact that surgeons can adjust what they require over time, and I was using Garramone as an example of this.  I nodded to your post simply because you spok about Garramone.

[Arch]

In June a few years ago, I was looking into surgery dates and was hoping to be recovered enough to start moving out of my old house by September first. So I guess I was looking at surgery dates no later than mid-July, and that probably would have been a stretch if I wanted to lift boxes and such.

The prominent surgeons on the West Coast were scheduling September dates by then--about two and a half to three months out. Unless someone cancels, you are unlikely to book a surgery much sooner than that. And I suspect that people higher up on the list are given the option of taking those canceled dates. So it does indeed look as if you are stuck with December.

However, summer is an excellent opportunity to write e-mails of inquiry, take snaps of yourself for long-distance presurgical evaluation, maybe get one or two in-person consultations, and get a pre-surgery physical (see how long it is good for; you don't want it to expire right before your surgery date). In other words, get your ducks in a row now and book your appointment as soon as you can. It's quite possible that a lot of other people want surgery in December when they have vacation time, so jump on this now.

Oops, June, not May.

[aleon515]

Hey, Jay, my post wasn't a comment on what you were saying.  I was just referencing the fact that surgeons can adjust what they require over time, and I was using Garramone as an example of this.  I nodded to your post simply because you spok about Garramone.

No problem, clone buddy.
Some docs don't really give good guidance re: the letter, so in leu of that you could use the guidelines Dr G has. I bet my therapist copied them, because he said they were really excellent. I'm sure he had a good lawyer helping him out.

--Jay

[Bimmer Guy]

However, summer is an excellent opportunity to write e-mails of inquiry, take snaps of yourself for long-distance presurgical evaluation, maybe get one or two in-person consultations, and get a pre-surgery physical (see how long it is good for; you don't want it to expire right before your surgery date). In other words, get your ducks in a row now and book your appointment as soon as you can. It's quite possible that a lot of other people want surgery in December when they have vacation time, so jump on this now.

Oops, June, not May.

Arch, makes a really good point, ghostwhisperer.  Surgeons really fill up during the school breaks. Garramone told me that he get packed from December through February every year, quite quickly.  If you only have a short Holiday break in December, I would book as soon as you do the assessment of surgeons as Arch suggested you begin now.