GCS Selection Criteria, Insurance, FTM and MTF

[EmmaLoo]

I'm just curious about this and it doesn't matter if you're FTM or MTF. My observation is strictly anecdotal at this point, but since the availability of insurance coverage started to grow over the last several years, it seems like there are more people choosing their surgeons based on location and insurance network coverage. There's nothing wrong with this at all and it seems to be driving more US surgeons into our shallow surgery niche. The downside might be faced with the prospect of having surgery with someone who has limited experience or in an unfriendly environment, although I haven't read very many stories that indicate this has become a problem.

Are we on our way to the point where GRS becomes so ubiquitous and consistent that people just stay in their own health-network and accept the surgical skill and experience of the local GRS surgeon? How many people are now making the location of their surgeon a priority because of insurance coverage?

I'd love to hear people's thoughts on this.

[Gail20]

Once I realized that I could get a cheap flight and hotel just about anywhere in the U.S. I opened my search up to the entire country.  I will have GCS the first week of August at NYU in New York city because that is where the Surgical team I wanted was practicing.  Yes, NY is a bit more expensive but convalescing over in Princeton, NJ will be about the same as anywhere else.

[FTMax]

I know many guys who have gotten coverage for the first time and do not want to haggle or fight with insurance about coverage, so they will accept whoever is in network regardless of experience.

On the male side of the fence - I do not think it is a smart thing to do. Our surgeries are very complex and the complication rate is already very high by default. I would not want to compound that risk by going to an inexperienced surgeon. It would likely cost more over time to correct any issues than it would have been to pay for an out of network provider initially.

Now, if the surgeon closest to you is a great fit for your needs, that's great. But I do see a lot of guys not even considering other options and just going with whoever is closest geographically.

[EmmaLoo]

On the male side of the fence - I do not think it is a smart thing to do. Our surgeries are very complex and the complication rate is already very high by default.

Heck, they are all pretty complicated but I would definitely make Phalloplasty the King in the dept. Would you approach top surgery the same way, or are there enough competent top surgeons available that selection by location is more practical?

[FTMax]

On the male side of the fence - I do not think it is a smart thing to do. Our surgeries are very complex and the complication rate is already very high by default.

Heck, they are all pretty complicated but I would definitely make Phalloplasty the King in the dept. Would you approach top surgery the same way, or are there enough competent top surgeons available that selection by location is more practical?

IMO, it would depend on the method. I think any experienced plastic surgeon out there has the skills to do a double incision bilateral mastectomy with free nipple grafting, and had my insurance agreed to pay 100% of the costs, I'm sure I could've found a surgeon I felt confident with locally (granted, I do live in a large metro area so my options are more extensive than someone in a rural area).

But the periareolar technique, I would not want to go to anyone who had not done it hundreds of times. With an inexperienced doctor, it's more likely that they would not take as much tissue or too much tissue versus a doctor who knows better, which would mean additional time/money for a revision. Whether or not insurance is paying for these things, you still have to consider time off work, copays, coinsurance, etc. and that can all quickly add up if you're having to do it multiple times to get it right.

It's a tough balance. As a community we definitely need more doctors learning these procedures and refining their skills, but for bottom surgery I can never in good faith recommend that someone be the guinea pig. If that's a choice they make for themselves based on their circumstances and goals, I'll be supportive and hope everything works out for them. But it's contrary to the advice I'd been given and contrary to the route I chose for myself.

[EmmaLoo]

It's a tough balance. As a community we definitely need more doctors learning these procedures and refining their skills, but for bottom surgery I can never in good faith recommend that someone be the guinea pig. If that's a choice they make for themselves based on their circumstances and goals, I'll be supportive and hope everything works out for them. But it's contrary to the advice I'd been given and contrary to the route I chose for myself.

I feel about the same way you do. There are specific procedures that could only be done well by a seasoned surgeon. Years ago in the beginning I went to some local consults with doctors claiming they did FFS work. I already knew what I wanted and what was involved, but these local plastic surgeons were just faking it. They had no idea about the aggressive nature of FFS. It was an eye-opener for sure. What's funny, is that 15 years later they are still making the same claims.

I will say this though. Sometimes the pieces fall into place and a highly skilled GCS surgeon decides to come to your city and set up shop. I live in a Top 10 city as well, and having just one high profile and experienced GCS surgeon arrive in 2015 has opened up possibilities for the Trans community across our entire State. This is the reason I brought up the topic of location. It may take another 5-10 years, but witnessing how much a single GRS surgeon can impact a region, I would be surprised if this didn't start happening in a lot more major cities.

[EmmaLoo]

Heck, they are all pretty complicated but I would definitely make Phalloplasty the King in the dept. Would you approach top surgery the same way, or are there enough competent top surgeons available that selection by location is more practical?


IMO, it would depend on the method. I think any experienced plastic surgeon out there has the skills to do a double incision bilateral mastectomy with free nipple grafting, and had my insurance agreed to pay 100% of the costs, I'm sure I could've found a surgeon I felt confident with locally (granted, I do live in a large metro area so my options are more extensive than someone in a rural area).

But the periareolar technique, I would not want to go to anyone who had not done it hundreds of times. With an inexperienced doctor, it's more likely that they would not take as much tissue or too much tissue versus a doctor who knows better, which would mean additional time/money for a revision. Whether or not insurance is paying for these things, you still have to consider time off work, copays, coinsurance, etc. and that can all quickly add up if you're having to do it multiple times to get it right.

It's a tough balance. As a community we definitely need more doctors learning these procedures and refining their skills, but for bottom surgery I can never in good faith recommend that someone be the guinea pig. If that's a choice they make for themselves based on their circumstances and goals, I'll be supportive and hope everything works out for them. But it's contrary to the advice I'd been given and contrary to the route I chose for myself.

Wait...what? There's a Periareolar FTM top surgery technique? Not that I'd be looking for that procedure, but I had no idea that was being done.

I can relate to some degree, because my BA was done using periareolar. I just didn't realize they did it in reverse.

I take it, it's new and not widely done yet?

I feel a bit enlightened now[emoji1]

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[AnonyMs]

Surgery is a lot of money for most people, and some have no choice. Depending on where you live many people have never traveled and will prefer local. There also to be many who think surgeons are all much the same and/or don't do much research. All of that does lead to picking local surgeons based on insurance, and I've noticed a large amount of it on various forums I look at, and it seems to be increasing.

Personally I believe there's a large variation between surgeons based on the photo's I've looked at (MTF GRS).

[FTMax]

It's a tough balance. As a community we definitely need more doctors learning these procedures and refining their skills, but for bottom surgery I can never in good faith recommend that someone be the guinea pig. If that's a choice they make for themselves based on their circumstances and goals, I'll be supportive and hope everything works out for them. But it's contrary to the advice I'd been given and contrary to the route I chose for myself.

I feel about the same way you do. There are specific procedures that could only be done well by a seasoned surgeon. Years ago in the beginning I went to some local consults with doctors claiming they did FFS work. I already knew what I wanted and what was involved, but these local plastic surgeons were just faking it. They had no idea about the aggressive nature of FFS. It was an eye-opener for sure. What's funny, is that 15 years later they are still making the same claims.

I will say this though. Sometimes the pieces fall into place and a highly skilled GCS surgeon decides to come to your city and set up shop. I live in a Top 10 city as well, and having just one high profile and experienced GCS surgeon arrive in 2015 has opened up possibilities for the Trans community across our entire State. This is the reason I brought up the topic of location. It may take another 5-10 years, but witnessing how much a single GRS surgeon can impact a region, I would be surprised if this didn't start happening in a lot more major cities.

I think a game changer would be the establishment of a formal fellowship in transgender surgeries. I'd feel much more confident considering someone who had invested that kind of time and had that kind of experience. I believe NYU is headed in that direction. I know they currently have a urology fellow helping with their phalloplasties and it would not surprise me given the huge demand for the program there that they establish something formal in the next few years.

Wait...what? There's a Periareolar FTM top surgery technique? Not that I'd be looking for that procedure, but I had no idea that was being done.

I can relate to some degree, because my BA was done using periareolar. I just didn't realize they did it in reverse.

I take it, it's new and not widely done yet?

I feel a bit enlightened now[emoji1]

And yes! They make an incision around the nipple, do liposuction, and then if necessary do some resizing of the nipples. It's been around for a long time, but most guys are not good candidates for it (you have to start as a small B cup or less, otherwise it's almost guaranteed that you will need a revision) so not all surgeons offer it.