Extremely small breasts, not sure what type of top surgery

[Charliedogist]

Like the topic says, after being on T for five months, I'm pretty sure I've have close to no fat left in my breasts (I'm also underweight for my height and had very low body fat to begin with).

One side is of course bigger than the other, despite me yelling at it to shrink more. The other side, I could wear an undershirt and a t-shirt and no one would notice, and when I'm laying down and put that arm above my head, there's no breast there at all, and could pass as a male chest. The other side is a little more obvious. I don't like the results of the peri as far as nipple placement, but less scarring sounds better to me than weird scarring. I'm pretty sure my breast size would be like AAA (72cm around the largest area of my chest, a month ago)

Currently I'm looking at Garramone and Mendalie as far as surgeons go, but I'm also moving to CO in the next month, so while I'm in GA, Garramone is closer and who my therapist recommends, but if I'm going to be flying wherever instead of driving, I want to pick the person who's best suited to work on such a small chest, and finding pictures of work done on people with chests like mine is next to impossible, because it's such a small group within a small group. Even transbucket doesn't have what I'm looking for, unless I'm overlooking it completely somehow.

I can't afford to pay a bunch of consult fees to have different surgeons look at my chest over the internet right now, and while scarring is an issue for me, it's not as big as proper nipple placement. I don't care about retained sensation really because I don't want people touching my chest anyway, but I definitely don't want to lose a nipple or part of one like can happen in a free graft.

I'm planning on a loan from my bank, and using Care Credit to cover the rest of the cost in around six to eight months.

Can someone point me to a surgeon who has results up from such a small chest. They're all extremely proud of the chests that were triple D's or E's, but finding ones from chests that are almost flat at this point except for the stupid breast buds, and a little bit of fat left is annoyingly hard to do.

[EchelonHunt]

When you say very small breasts, I was instantly reminded of Ethan Daniel, who had small breasts before top surgery.

If you haven't seen his site already, jump over to FTMTransition.com, look under Transition then Chest Surgery - you will be able to find the pictures under Photo Documentation. Ethan does a pretty awesome job of documenting his results over time!

Hope that helps!

[Charliedogist]

Thank you! I had not seen his site before. I looked all over, but I couldn't see where he says why type of surgery, I could only tell it wasn't a DI. He seemed to have a lot of issues with his surgery as far as revisions go.  That sucks.

The end results look great though. I have slightly more breast tissue than that, but not by a whole lot in his pictures of pre op, three months on T. It's also reassuring that Garramone isn't the be all end all of top surgery lol. Not saying he's not excellent, but it's good to know that other doctors can also give great results, even if a revision or two is required. There are a couple surgeons in Atlanta that I could go to while I was here, but I'm still saving up money at this point, and I'll be in Colorado by the time I've got enough.

I am still considering Garramone, even though he seems to cost the most, just because of the hotel chain that works with him. I use a Service Dog for a variety of things, and being able to bring her with me would be a huge deal, without me having to worry about figuring out how to drive to the OR and get back to the hotel room with her in a crate there, ect.

[EchelonHunt]

This link explains the surgeon he chose and how he came to that conclusion. Interestingly, he's had similar issues as yourself in terms of finding any top surgery results of those who have small breasts. Also in the link, he mentions subcutaneous mastectomy, which is keyhole/peri-areolar procedure. It is a bummer that he's had to have two revision surgeries but that's his experience. It may not necessarily happen to you.

I'm from Australia so I'm not much help in advice about surgeons in America but I'm sure there will be somebody else who is more educated than I am. It does sound like Garramone will be more convenient. Have you double-checked with his office whether it's okay to have her with you?   

[Bimmer Guy]

Like the topic says, after being on T for five months, I'm pretty sure I've have close to no fat left in my breasts (I'm also underweight for my height and had very low body fat to begin with).

One side is of course bigger than the other, despite me yelling at it to shrink more. The other side, I could wear an undershirt and a t-shirt and no one would notice, and when I'm laying down and put that arm above my head, there's no breast there at all, and could pass as a male chest. The other side is a little more obvious. I don't like the results of the peri as far as nipple placement, but less scarring sounds better to me than weird scarring. I'm pretty sure my breast size would be like AAA (72cm around the largest area of my chest, a month ago)

Currently I'm looking at Garramone and Mendalie as far as surgeons go, but I'm also moving to CO in the next month, so while I'm in GA, Garramone is closer and who my therapist recommends, but if I'm going to be flying wherever instead of driving, I want to pick the person who's best suited to work on such a small chest, and finding pictures of work done on people with chests like mine is next to impossible, because it's such a small group within a small group. Even transbucket doesn't have what I'm looking for, unless I'm overlooking it completely somehow.

I can't afford to pay a bunch of consult fees to have different surgeons look at my chest over the internet right now, and while scarring is an issue for me, it's not as big as proper nipple placement. I don't care about retained sensation really because I don't want people touching my chest anyway, but I definitely don't want to lose a nipple or part of one like can happen in a free graft.

I'm planning on a loan from my bank, and using Care Credit to cover the rest of the cost in around six to eight months.

Can someone point me to a surgeon who has results up from such a small chest. They're all extremely proud of the chests that were triple D's or E's, but finding ones from chests that are almost flat at this point except for the stupid breast buds, and a little bit of fat left is annoyingly hard to do.

Dr. Beverly Fischer is well known as specializing in peri and keyhole.  People go to her for that more than double incision (although I personally think she does a good job with that, as well).  I met her and liked her very much.  Her consultation fee was $125 face to face, which of course would go towards the cost of surgery.  Maybe a phone consult is cheaper?  I don't know.  She is located in Timonium, MD, which is close to Baltimore.  She actually has her own surgi center/operating room.  All female staff (if that matters).

http://www.genderreassignmentcenter.com/index.html

Check out transbucket again with her name.  I thought I saw some of her peri/keyhole work there.

[aleon515]

Dr Garramone doesn't do keyhole or peri, okay may *say* he does it. I've never heard of him doing it, and he will try and talk anybody into getting Di. Call it a whim or little surgical quirk or whatever, but he does not like to do it. I don't think he costs so much, in comparison, but I don't think he likes to do minimal procedures.

--Jay

[anibioman]

Fisher is great for small chests doing pedi or DI. Her peri is better than most

[Rossiter]

I had a small chest pre-op and went with Dr Medalie (more for location reasons than anything). The incisions were just around the outer third of the areola. The incision size is very much a case-by-case basis thing, but something along those lines seems to be the most common option for really flat-chested people.

chest pre-op

post-op:

I'm not sure what you mean about nipple placement on peri. If you have a very flat chest then I'm not sure where else you could put them, plus they'd presumably be in an okay spot already.

[aleon515]

They can change the size of the areola and/or nipple to some extent, but not like in a DI for obvious reasons. Usually with small chest size comes smaller nipple and areola size, which is a happy thing. Sometimes to do more they can do a revision and get them smaller if that's needed. I'd guess it is usually not needed esp with such a small chest, you almost might have what would be called puffy nipples if you were a cis guy.

BTW, Rossiter, that looks amazing and very natural.


--Jay

[Bimmer Guy]

Great chest, Rossiter.  Thanks for posting the before pic.  A lot of guys don't, and I think it can be helpful when someone is trying to decide on a surgeon and are trying to envision what their chest may look like.

[Charliedogist]

Thanks everyone! I've been looking at both Medalie and Fischer, and I've found I by far prefer Medalie's results vs Fischers for whatever reason.

And you're right, when I'm laying down stretched out, my nipples are in the correct position from looking at photographs. I guess it's different when you're looking down at them lol. It always seemed to me they were too close to the center of my chest vs down to the side like natural. Based on Medalie's Youtube video of a Peri/Keyhole mine are pretty close to being male sized anyway.

My other question is, seeing as I have very little fat (anywhere on me [and I'll ask this in a consult as well]) would it be worth the extra 1500 to have the liposuction done under my armpits and down the sides like I've seen in Medalie's videos or just let that fat go away with working out and eating correctly (which I've already started doing, though the downside is developing actual pecs makes what small growth that's there stand out more, though I know it'll give a better result when I can get surgery)

I'm asking because if it's generally considered something to go ahead and do to get rid of (though I also worry about removing TOO much, because I want a contoured chest, not a concave or completely flat chest) I'll have to budget more money. As it is, I'm not sure how I'm going to be able to do it unless I can talk one of my friends in CO into coming out with me (and paying for their airfare out as well) which again increases costs. I'll be living way away from home, and it seems like most of them will not budge on releasing you into a competent adults care for the ride back to your hotel. And I don't know anyone in Cleveland I don't think that could drive me from the surgery center to the hotel.

Thanks for the pictures Rossiter! We seem to have a pretty similar build as well as pre-op size. Results like yours are exactly what I'm looking for as well. I also have that happy gene that keeps me from keloiding or developing bad scarring. All my scars (even extremely deep ones) fade to near white after a couple of weeks, and then flatten out pretty well (have a bad one on my leg that probably needed stitches from a couple months ago and a run in with barbed wire, it's flat and white now) though I've never had actual surgery before, so I guess we'll see.

I don't want the DI, but everyone seems to hype up that Peri is absolutely going to require revision, and DI is the way to go, ect, but if I can get away without a DI (and with my chest, I absolutely can) I would want to go that route first. Revisions all seem to be for nipples and nipple size, but with such a small chest and nipples to begin with, I'm thinking that a revision is probably low on the list unless I do something stupid while I'm healing up to screw up the placement or exacerbate scar tissue.


And after researching a TON into Garramone, you're right Jay, I can't seem to find anyone that's done a peri with him, though my research could be lacking, or they could just be hiding :p

[aleon515]

@Charliedogist:
I doubt your research is lacking. I'm very good at my research, and I would say that Dr G has done peri. It is a guess more so, than finding anybody who has had it done. Not too much and it is not what he prefers doing. He will try to talk you out of peri. I would guess he would do it if he thought you were absolutely perfect as a candidate. I would not go to someone who did not like to do the procedure I wanted, esp if I were not an iffy candidate for peri . He's an excellent surgeon, no doubt, but he has his speciality, which is DI, and which he only wants to do (with a bit of lipo on the side).

--Jay

[Charliedogist]

@Charliedogist:
I doubt your research is lacking. I'm very good at my research, and I would say that Dr G has done peri. It is a guess more so, than finding anybody who has had it done. Not too much and it is not what he prefers doing. He will try to talk you out of peri. I would guess he would do it if he thought you were absolutely perfect as a candidate. I would not go to someone who did not like to do the procedure I wanted, esp if I were not an iffy candidate for peri . He's an excellent surgeon, no doubt, but he has his speciality, which is DI, and which he only wants to do (with a bit of lipo on the side).

--Jay

Yeah, DI seems to be his specialty and deviation from that doesn't seem to be something he wants to do or is comfortable with perhaps. Medalie seems MUCH more comfortable and open to doing Peri/Keyhole surgery on good candidates and his consult fee is not terribly bad. I may do a consult with him and see what he thinks as far as Peri/Keyhole goes, and if he feels like he can't do a good job with a Peri/Keyhole, I may go with a different surgeon, but everyone seems happy with either procedure he performs, so I may stick with him. And as a happy coincidence, I found a friend of a friend who lives about thirty minutes from Cleveland, so I may just pay her (she's a very nice person that I do know in passing) to stay at her house and have her pick me up/drop me off if possible. Would be a lot cheaper than a hotel room for sure.

Looking at the surgeries Medalie has done, he seems to do lipo with most of them, but I'm not sure I'd need that myself (seriously underweight here, 5'9 and 112 pounds) so that may save a bit on the cost of surgery, and if I did need a revision and wasn't happy with the fat leftover, I guess I could always opt to have lipo done then, or later without a revision.

It's all pretty mind boggling trying to get your ducks in a row with something so huge in your transition. I'm starting to feel like I've got a handle on what I want, who I want to go to, and how to go about getting it done. I'm aiming at getting it done within the next six to nine months with a loan from my bank, just a regular loan. I don't like CareCredit, and I already have a credit card I can put the down payment on, so covering the rest of the surgery is what I'm saving up for. I could probably pay off my entire credit card which would shoot my credit score up with my savings account, but I'm reluctant to do that at this point.

Budgeting is not my strong point, and I'm proud of myself for just getting what I've got into savings. The other 6k will come in time, or with a loan, so I don't know if paying that card off and getting a high limit would be the way to go, or just saving as much as possible and getting the smallest loan possible would be the best way.

CO IS trans inclusive with their healthcare, but I'm not sure I'd be able to select my surgeon, and I'd rather select who I want than go to someone who's going to screw it up. There's a local surgeon in ATL that I'm not going to name, but the results he produces are NOT something I want at ALL.

Like I said, getting to this point has been a long road, and it still seems like it's lightyears away from actually getting done. Talking everything out helps quite a bit, just getting input from people who've had both procedures done, different surgeons and recommendations is extraordinarily helpful. I tend to overplan and over think things and work myself into a frenzy, and it doesn't help that I want it NOW, not nine months from now. :/

[SWNID]

Lipo is part of Medalie's routine procedure for top surgery (both DI or keyhole/peri) and it costs $1500 (old info, not sure about now), so if it is decided that you don't need, good chance you can get the price down.

[Charliedogist]

Lipo is part of Medalie's routine procedure for top surgery (both DI or keyhole/peri) and it costs $1500 (old info, not sure about now), so if it is decided that you don't need, good chance you can get the price down.

Yes, it still quotes 1500 for the lipo on his website currently. I've been looking a lot of before/after pictures on transbucket of Peri/Keyholes that he's done, and most of them seem to go with lipo as well, but they also tend to have that fat pocket under their armpit area that I don't have, there is literally no fat in that area, so I think my next step will be to set up a picture consult with him with the caveat that it's going to be around six to nine months before I can afford surgery, but that I do want to go to him, and see what his thoughts are on my chest at this point in time. T has helped an amazing amount with losing that fat/softness in my body, as well as working out when I can, so all the weight I've gained (I'm up ten pounds since starting T) is muscle in my arms, calves and thighs. My torso has squared out a bit, and I've lost that side thigh fat (what little I had) so if I could get away with no lipo that would be a huge huge weight off of the financial burden.

I guess I could always tell him that I don't want lipo unless he gets in there and determines it absolutely necessary, and then set up a payment plan, or have that money in backup just in case.

[aleon515]

Just a guess, but doubt he'd do it if you didn't need it. You seem to be lucky that you will require quite a minimal procedure. But unfortunately doesn't quite mean it will be cheap. Strange how that goes.

Doesn't appear anyone would go wrong with Medalie. (I'd take exception to the word "open" though, I think he must like doing it and so does it.) I would call his office and ask about this but may be something covered in phone consult. I don't know how Dr Medalie works it, but some surgeons (like Dr G) have a phone consult. If you don't live nearby you mail photos. For me it was rather a dysphoria producing thing. But there's no other way I can think of doing this. (In retrospect I really like that I have these awful photos. No other way I would have ever taken them. They are amazing to me, that I ever looked like this.)


--Jay

[aross1015]

Don't limit yourself to just looking at top surgeons who work on only trans men.  Surgeons who do gynecomastia surgery on cis men can often have a cheaper cost, especially if they are less well known.  I get the feeling that top surgeons who are very popular can jack their prices up to ridiculous amounts and still have customers out the wazoo because they are a "name brand" basically, case in point Garramone.  I also would not suggest going to someone who does not regularly perform peri or keyhole procedures, and if you do, you are most likely to need or want a revision. 

[Bimmer Guy]

Don't limit yourself to just looking at top surgeons who work on only trans men.  Surgeons who do gynecomastia surgery on cis men can often have a cheaper cost, especially if they are less well known.  I get the feeling that top surgeons who are very popular can jack their prices up to ridiculous amounts and still have customers out the wazoo because they are a "name brand" basically, case in point Garramone.  I also would not suggest going to someone who does not regularly perform peri or keyhole procedures, and if you do, you are most likely to need or want a revision.

People seem to be talking about Garramone's prices being high lately.  I thought he was on the lower end?  Isn't he lower than Fischer, Leis, Crane for example?

[aross1015]

No idea.  He's higher than the two surgeons I've looked into though. 

[SWNID]

If you can cut the $1500 lipo, you are looking at around ~$5k, which is one the lowest price I know.
Garramone is not expensive, about in the middle. The price generally has a lot to do with the location. I accompanied a friend to have his top surgery in NYC at it was over 10k (surgeon's fee $7500, hospital charged almost 3k)