I traveled to Vancouver this week for a consultation with Dr. Cameron Bowman to discuss FTM Top Surgery. My time at his office started by filling out some paperwork, then I met with his assistant Ali to answer some preliminary questions. These were mostly about my personal health and family health history, along with a few gender-related questions.

Dr. Bowman then joined us and we discussed the answers I had given Ali. He made it clear that his questions were not meant as a put-off, but that in addition to the psychological sessions I have done, it remained necessary to discuss gender identity related issues to ensure that I fully understand the non-reversible and life changing nature of my request for male chest reconstruction surgery.

Next, I stripped down and donned a paper vest for a physical exam. Dr. Bowman took my blood pressure and evaluated the size of my breasts and the elasticity of my chest skin, with Ali taking notes.

After I got dressed, they joined me again to discuss his assessment and to talk about the risks of surgery. I was a little surprised that Dr. Bowman did not recommend the double incision with nipple grafts method, as Dr. Brownstein had in his review of chest photos that I sent to him in December. Instead, Dr. Bowman said that the peri-areolar method would be ideal for me, due to my smaller breast size (A/B) and good skin elasticity.

I expressed a little concern about this technique and that might not make my chest flat enough. Dr. Bowman explained that peri-areloar is not the same thing as the keyhole method. He explained that with peri-areolar, not only is the breast tissue removed, but so is the inframammary fold. (This is not the case with the keyhole method.) The areola will be cut smaller, but in my case, no grafts will be needed. The nipple will be left intact, which means that there is a great chance that I’ll regain most, if not all, sensation. (Interestingly, Dr. Bowman insisted that it’s not possible to regain sensation with nipple grafts. The patient will have sensation under the nipple, but not in the nipple itself, which remains numb. He also said that the skin quality of a nipple graft is akin to parchment paper.) Scarring with this technique is limited to a circle around the areola, plus some possible puckering in the area immediately around the areola. About 40% of patients opt for revisions, either for areola reshaping or scar corrections, but these can typically be done under local anesthetic. (Revisions incur additional expense, usually in the area of $1000.) Ali showed me some before and after photos of previous patients who had been treated with the peri-areolar method, and the results looked very good. I felt reassured by all of this, and started to get excited about the possibility of much less scarring (compared to the double incision and nipple graft method.)

We continued by discussing the risks of the surgery, and what I can do to minimize risks and maximize results. The mantra is: eat right, keep fit and don’t smoke! Then we ran through the questions I had brought with me:

What are the recommendations for best healing?

Most importantly, stay healthy. Keep up with hydration and mobility.

The steri-strips will naturally fall off at about 2-3 weeks. After that, taping the scars with 3M paper tape is recommended. Use nothing else for 8 weeks. At that point, I’ll have a check-up. If all is well, I could proceed with using cocoa butter or aloe vera on the scars to promote good healing, if desired, but this isn’t necessary.

What about binding post-surgery?

Yes, I will be provided with a compression vest to wear. It won’t be worn until about 5 days after surgery, then will be worn for up to 6 weeks.

How long until I can be back at work? Lift weights? Chop wood? Back at 100%?

Many guys are back at work within days. Of course, it depends on the nature of employment. If you do manual labor, you’ll be out longer. The average time to be back at work is about 2 weeks. To lift weights and chop wood, I’ll need to be back to 100%. That typically takes 8 weeks.

How long until I could get a pectoral tattoo? How long until I can swim in the ocean or at the lake? What about exposure to sun?

For tattoos and swimming, wait until I’m back at 100%, 8 weeks.

As for sun exposure, the key is to not get sun on the scars, so use a 45 SPF sun block for 1 year. (I tend to use a strong SPF block anyway because I am fair and burn easily.)

How long are the drains left in?

This varies person to person, from 3-12 days. My family doctor can remove the drains.

How many nights will I need to spend in Vancouver?

I think I could have the pre-op consult the day before surgery. (I’ve emailed Dr. Bowman’s office for clarification on this.) The procedure itself only takes 2-3 hours, and I can leave the clinic that day. The next day, I can have the post-op consultation. Theoretically, I could go home that day, but considering that it’s about a 6-7 hour trip back home for me, I think I will opt for a third night in Vancouver, and leave the city on day 4.

Provided there are no complications, the first check-up I would have with Dr. Bowman would be at 6-8 weeks. I would have another check-up at about 3 months.

What are the most common complications?

Less than 4% of patients experience complications. The most common are infection (considerably higher risk with smokers), seroma (build up of fluid), hematoma (internal bleeding), poor scarring, asymmetry and loss of sensation.

What kind of painkillers are required post-op?

Just Tylenol 3’s for a few days, then regular Tylenol as required.

What is the drug used to anesthetize?

A combination of drugs is used, with about a 1/3 of that cocktail being Propofal.

If I start testosterone before surgery, would this change anything?

Typically, they ask you to stop taking testosterone 1-2 weeks prior to surgery. Considering this, and the fact that I should be able to get surgery relatively soon, I will wait to start on T until after the surgery is complete.

What happens to the breast tissue that is removed?

It is incinerated.

I was left to finish up my paperwork, then Ali returned with some reading materials for me to take home, and with the quote for my surgery: $6048. I was anticipating around $6K (and hoping that wasn’t just wishful thinking), so this was very pleasing!

Originally, Dr. Brownstein was my first choice of surgeon. However, because he doesn’t practice peri-areolar and because of the proximity of Vancouver (which is not only a financial benefit, but also very desirable should I experience any complications), I have decided to have this procedure done with Dr. Bowman. At the rate that I have been saving, I should be able to schedule a surgery date for this April or May!

Update, March 14: I don’t know how I will concentrate on anything for the rest of the day, I’m just too excited: I have a surgery date! I will be having a peri-areolar double mastectomy and male chest reconstruction on Tuesday April 29 in Vancouver. I have a pre-op appointment by phone on April 9, plus two post-op appointments in Vancouver on May 1 and May 6. I… AM… SO… STOKED!!

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