When to get top surgery?

[meatwagon]

I badly want top surgery, of course, but I am not sure when is the best time to try to get it done.  What should I have done and out of the way before I try to do this?  Some background:
-I have been on T for over a year.
-I am not in great shape, due to a history of health problems and other factors.  I need to lose some weight and gain some muscle, but I don't know if this would impact my surgery results or if I can work on these things later without worrying.
-I have insurance through my spouse for now, but I will be trying to get my own as soon as possible, and I don't know what I will be able to afford.
-I have been experiencing a lot of skin problems (acne, blackheads, and worst of all, heat rash/prickly sweat that has become nearly unbearable) and of course it's mostly concentrated in the areas covered by my binder.  I don't think any of it will be able to clear up until I stop binding all the time, but I don't have that option.  I also don't know if the skin problems would prevent me from getting surgery for whatever reason.
-I don't know if it's binding or stress or another health problem causing it, but I have been having some issues with pain around my ribs and a little trouble breathing.  Even if it's stress, I know binding doesn't help that, either.
-I am hugely dysphoric about my legal name but have not had the opportunity to get it changed due to the amount of time it takes and especially the fact that it requires two witnesses.  I don't have friends nearby who can help me with this.  Going to the doctor and being called the wrong name constantly is not something I want to deal with if I can avoid it.

Combined with the fact that I don't have protected time away from work and would have to go through quite a lot of red tape to try to get time off, I feel really lost on whether surgery is an option for me or what I need to do before I can make it happen.

[Ryuichi13]

I badly want top surgery, of course, but I am not sure when is the best time to try to get it done.  What should I have done and out of the way before I try to do this?  Some background:
-I have been on T for over a year.
-I am not in great shape, due to a history of health problems and other factors.  I need to lose some weight and gain some muscle, but I don't know if this would impact my surgery results or if I can work on these things later without worrying.
-I have insurance through my spouse for now, but I will be trying to get my own as soon as possible, and I don't know what I will be able to afford.
-I have been experiencing a lot of skin problems (acne, blackheads, and worst of all, heat rash/prickly sweat that has become nearly unbearable) and of course it's mostly concentrated in the areas covered by my binder.  I don't think any of it will be able to clear up until I stop binding all the time, but I don't have that option.  I also don't know if the skin problems would prevent me from getting surgery for whatever reason.
-I don't know if it's binding or stress or another health problem causing it, but I have been having some issues with pain around my ribs and a little trouble breathing.  Even if it's stress, I know binding doesn't help that, either.
-I am hugely dysphoric about my legal name but have not had the opportunity to get it changed due to the amount of time it takes and especially the fact that it requires two witnesses.  I don't have friends nearby who can help me with this.  Going to the doctor and being called the wrong name constantly is not something I want to deal with if I can avoid it.

Combined with the fact that I don't have protected time away from work and would have to go through quite a lot of red tape to try to get time off, I feel really lost on whether surgery is an option for me or what I need to do before I can make it happen.

Since I don't know your entire backstory other than what you have said here, all I can say is what I would do if I was in your situation.  I hope, if nothing else, it gives you some kind of idea as to what your options are.

The first thing I would do would be to change my name.  My dysphoria is around my deadname as well, so I get it.  I would contact the courts and as if there is another option other than having two witnesses.  Maybe the judge can have you do something else.  I've heard some places want you to take out an ad in a local newspaper stating your name change, but I also hear that is not a popular as it was due to safety issues.  Either way, you can look into it.  Maybe your spouse and a friend would work as witnesses.  Do you have a name chosen?  If not, I'd start trying out names until you find one for yourself.

There are plenty of men that have had top surgery pre-T, it all depends on what your surgeon requires.  If you have found one you like and that takes your insurance, it wouldn't hurt to ask him (or his office) what is required before they will do top surgery.

Not everyone is in "perfect shape" before top surgery.  Plenty of men have had theirs and were overweight.  Again, ask your surgeon if they want you to lose any weight beforehand.  Its sometimes done so that anesthesia is more effective if your BMI is under a certain percentage, but again, ask your surgeon.

If your spouse's insurance will cover it, then I'd simply use theirs.  Call the insurance company and ask.  Only they can tell you if they will allow it.

Skin problems I really don't know much about.  Maybe look into a dermatologist, or again, ask your surgeon if it makes a difference.  The rib pain is also something I'd ask your surgeon about.  Maybe they have some suggestions, like putting on a undershirt first, then your binder.  I'm no expert, but I've heard of men doing that.

Sure, you'll have to go through red tape to get your top surgery done, but we all have had to do it for nearly everything that pertains to transitioning.  Trust me, you're not alone. 

Feel free to keep us up to date as to how things are going, okay?  I too am preparing for top surgery, but I have other issues I must deal with.  I get it.

Good luck bro!

Ryuichi
 

[Kylo]

Try and lose weight before surgery for better results, that's what they tell you. If you can improve your pecs first as well that may help them sew you back up after in a shape that better fits the shape of the pecs.

I could have been skinnier when I got surgery, it's not a massive problem unless you are significantly overweight first, more important to get a good surgeon I think. But you will be helping your cause if you get in better shape beforehand because the reconstruction is easier when they have less skin deformation, subcutaneous fat or excess to deal with. 

[The Flying Lemur]

Different doctors seem to have different criteria for who is a good candidate for top surgery.  A friend of mine went to his grave without top surgery (he died young and suddenly) because he was fairly overweight and he couldn't get a surgeon to work with him.   On the other hand, my BMI is pretty awful--45 or something like that--and I found a surgeon who was fine working with me.  I didn't have bad results either.  I understand that most surgeons want you to either be on T at least 6 mos to a year or else never plan to go on it.  I guess your body changes quickly in those first months on T and it can mess up surgical results.  If you have skin irritations it could be a problem.  The dr. I saw warned me that bad acne in the area they'd be operating on could postpone surgery.  Fortunately, I was clear the day of.  If you know that's going to be a problem area for you, consider seeing a dermatologist.

As for your name, some dr's offices will allow you to give them a "preferred name," which is what they will call you, even if it's not what's on your driver's license.   Any surgeon who works regularly with trans people should be capable of remembering to call you by your preferred name.

How soon you want to do things is entirely up to you, of course, but if I were in your position I'd start researching surgeons now.  You may have to wait a long time to get in to see a consult, and the earlier you start, the better.

[meatwagon]

Thanks for all the replies so far; it's been very helpful.

I think prioritizing name change will still benefit me, though if I'm unable to get it done due to lack of witnesses (the only people I know who live in this state do not share my work schedule and/or live far away, so organizing any kind of meeting is difficult), I'll have to just give the doctors a preferred name.  My experiences with doing this have only been about 50/50 so far, but hopefully someone who works with trans patients will be more understanding.

Aside from that, seeing about the skin problem and getting into better shape are the main goals.  I'll give it another week or two to see how the products I've been trying work out before pestering my doctor about it, since I'm pretty sure the only other thing left to try would be antibiotics.  The real answer would be to stop binding or to stay indoors doing less physical work, but neither of those is happening any time soon.  If/when I do go to a doctor, as I probably will whether it starts clearing up or not just to make sure, I might bring up the chest/rib pains and see if he thinks I should have that looked at. 

I've been getting back into better food habits, but not really had the time to exercise outside of work.  I still need to cut more calories, but I have trouble with that since my job leaves me pretty hungry and I always end up buying extra stuff during my break...  I can't go to a gym or anything, and work has me too sore and tired most days to do anything else.  I can try to do smaller exercises at home on my days off, though.  It would be a lot easier if I had my own place, but no idea when that will be, so my time and space are even more limited than they would be otherwise.

I'll probably leave the insurance alone until I get moved, since I've already missed my chance to change it before tax season.  I also really want to have my name changed before I take on new insurance and new bills. 

And looking for a surgeon in the meantime will definitely be helpful since I don't know how long it would actually take to get the surgery even after I've found one.

[Alexthecat]

Make sure you are hand washing your binder and hanging to dry more often. It could just be dirty and causing skin issues.

[meatwagon]

Does hand washing vs machine washing make a difference in how clean it gets?  I usually put mine in on low setting and it doesn't seem to have hurt it any.