American Society of Plastic Surgeons
For Medical Professionals
2 years ago

What should I expect?

I’m a transgender man and I haven’t yet received top surgery but I am looking into it. I read that the surgeon will want to know about my transition progress. What exactly does this mean? Will they want to know about HRT or about the questions I’ve answered in therapy? If it is the latter, what are those questions? Thank you!

Procedure: Gender Confirmation Surgery
Location: Mount Shasta, CA

Replies 3

Aaron Stone
ASPS Surgeon

Their Criteria for mastectomy and creation of a male chest in FtM patients are:

1. Persistent, well-documented gender dysphoria;

2. Capacity to make a fully informed decision and to consent for treatment;

3. Age of majority in a given country, (earlier preferably after ample time of living in the desired gender role and after one year of testosterone treatment).;

4. If significant medical or mental health concerns are present, they must be reasonably well controlled. A letter from a qualified mental health professional should suffice to meet this criteria,

Hormone therapy is not a requirement for top surgery.

Debra Johnson
ASPS Surgeon
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When transgender patients come in for a consultation, I want to know if they have been following WPATH guidelines: living, working, dressing in their gender; hormone replacement therapy;and psychological evaluation to determine fitness for surgery.

I then want to assure the patient is healthy, and has a family/friend support system to assist with recovery. Although there have been articles published regarding the benefit of gender confirming surgery in adolescents, some insurers still require patients to wait until age 18. Also, Medicare will not cover top surgery for MTF patients, as they (mistakenly) feel that estrogen will grow adequate breast tissue. They do cover FTM mastectomy. You should consult with a board-certified plastic surgeon to determine your options, Kadence. Use the Find-A-Surgeon tool to locate an ASPS member near you.

Arian Mowlavi
ASPS Surgeon

Dear Kadence,

The plastic surgeon will not necessarily need to know details relating to your hormone history, etc. The most important decision making that you should do is to make sure that your chosen surgeon has experience performing your female to male transformation. Your ideal surgeon should appreciate the nuances regarding male chest aesthetics and have experience creating a more armour plate appearance. This is achieved by flattening your breast, yet keeping the borders of your chest linear and bold in appearance.


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