Low Dose T Transition

Do you have a BMI requirement?

Do you require a mammogram?

How did you get involved with trans healthcare?

Have you attended any transgender conferences?

How many Top Surgeries have you performed?

How many Top Surgeries do you do regularly?

Will you be doing the surgery yourself or will less experienced surgical residents take part? If so, how will they take part?

Will you provide a letter for getting my gender marker changed on ID documents?

PROCEDURE

What types of Top Surgery procedures do you offer? Tell them what you prefer and why.

Is there a Top Surgery procedure that you prefer?

What Top Surgery procedure do you think would best suit my needs and goals?

What are my options for scar shape and placement? What dictates the angle of the scars? Can I choose straight vs curved? What will my incisions look like? Will they meet in the middle?

Where will the nipple/areola complex be positioned? Mention AND use your photos here.

With Peri-Areolar/Keyhole, can you do a nipple reduction during the initial surgery?

Will you perform Double Incision without nipple grafts? (No-Nipple Result) What is the success rate for nipple grafts? / What is the complication rate?

Do you use Drains? Why/why not?

Will my surgery include male chest contouring/liposuction? Is there an extra "cosmetic fee" for this?

What techniques do you use to reduce the chances of Dog Ears?

How long will the surgery take?

What type of facility will my surgery be performed at? (Ex. Ambulatory/Day surgery clinic, local hospital, academic medical center.)

Do any of the nursing staff at the facility have specific training for working with transgender/gender-nonconforming patients?

Will I be provided with a compression binder or do I need to buy my own? + where to purchase one if I need to?

Will I need to stop hormones or my other medications prior to my surgery? Or after? For how long?

What is the recommended scar care?

How many post-op appointments should I need? Are included in the fee? How many and at what interval?

What is cause for concern in the healing during weeks 2-8 versus what is "normal" healing?

What is the most common complication/complaint during recovery your patients report? What is the best way to help prevent that?

What aftercare products (if any) do you recommend and at what point in recovery would I begin using them?

What fraction of patients seek a revision and for what reasons? How frequently are revisions needed?

How much nipple sensation should I expect?

COMPLICATIONS

What is the chance of developing a hematoma?

What is the chance of developing a seroma?

What other complications am I at risk for?

What symptoms should I be on the lookout for?

Who do I contact if I think I have a complication?

If a complication happens, what is the protocol for managing it?

There is a family history of breast cancer. What do I need to know about this with regards to Top Surgery?

Do any of my medical conditions or medications increase complication risks?

PREPARING FOR SURGERY

What should I bring with me from home on the day of?

Do I need to stop taking Testosterone before surgery?

Do I need to stop taking any other of my medications before surgery?

Will I need to have any blood work done or do any other lab tests prior to surgery day?

Will you be providing detailed, written pre-op and post-op instructions?

Is there a pre-op appointment prior to surgery day?

How long can I stay post surgery?

Will I be able to go home the same day as my surgery?

If being released the same day: How long will I need to stay at the surgery center after I wake up?

Does the surgery facility have an on-site pharmacy where my caregiver can pick up my post-op medications? Discuss any prescriptions you may need and bandage treatment with your surgeon.

RECOVERY

Is there any outpatient care? Rehabilitation service or place to stay for care after surgery? Does insurance cover this?

If coming from out of town: How long will I need to stay in town after surgery?

If coming from out of town: Do you have arrangements with any hotels for reduced-cost stays for patients?

When will my post-op appointments be?

What medications will I be prescribed after surgery?

I can't take opioids. What are other options for pain management?

When will I be back to normal daily activities?

How soon after surgery can I be on a plane?

When can I go back to work with a [desk job/physical job]?

What do you recommend for scar treatment?

C. Riley Snorton

Gender: Transgender man

Sexuality: N/A

DOB: 28 April 1982

Ethnicity: African American

I spoke to Mr Christopher this week. He confirmed that he is still not operating and does not know when he will start bottom surgeries again. He says that the 18 months without operating has cause a major backlog.

His team are currently trying to move all patient files to the new hospital so this will take some time. He also said that he currently has around 1,500 patients already in the system not including those that have not had any bottom surgery stages yet.

He said that he will be seeing people in terms of urgency and said this means things that need urgently fixed, like if someone can’t pee due to their bottom surgery complications. He said that bottom surgery is an elective surgery so therefore no-one is considered urgent by the NHS unless complications are life threatening etc. So everyone will be seen based on when they were put on the waiting list.

He was very honest with me and told me that even though I am already a few stages in, I shouldn’t expect to have a surgery date next year at all. His team will be starting to make contact with those already in the system (those between surgeries) from this month on. But that is just to confirm details and what stages everyone is at so that they are on the new system correctly.

He also confirmed that he will no longer be travelling to Glasgow to see Scottish patients, so those in Scotland will be required to attend all their appointments in London. You will be able to claim travel and hotel expenses for this however.

Unfortunately it was a very disappointing chat with Mr Christopher who basically said that despite this new team, it really won’t improve the waiting lists at all.

This is obviously not good news for those waiting on bottom surgery. But this is straight from Mr Christopher himself.

BUT, it also says 'the surgical team that will work at New Victoria are highly experienced specialists in this field' - do you think there's any hope this means the St. Peter's surgeons are just going to work at this new locale?

Hi Anon,

***UPDATE: I have spoken to St Peter’s and they have confirmed that Mr Christopher’s team are in discussion with New Victoria hospital. They cannot confirm how these talks are going, simply that the NHS will confirm in “due course”. ***

It is still unknown why some are getting letters with updates while many have received nothing the whole time.

It would be interesting to know which of our followers have had letters and whether those who have received these letters have had any stages of bottom surgery yet.

In April of 2020, my partner and I decided that we wanted to have a baby together, and so began our journey. I stopped taking testosterone and fell pregnant 7 months later, November 2020, with our perfect little man.

In May 2021, I got to marry my wonderful partner in front of his parents, my grandparents and friends/family over Facebook Live. It was a beautiful wedding and we enjoyed our honeymoon in New Hampshire.

Overall, life has been a wild ride, but we are loving every minute with each other and our little prince, Rowan. 🥰❤️

If anyone is interested in learning more about my pregnancy/parenting journey, please come follow me @transwithchild on Instagram and Facebook, as well as my blog at www.transwithchild.com. There are photos of my labor and delivery, our wedding and blog posts about my experiences.

I would also recommend asking your surgeon about it during your consultation! From what I can tell, fishmouth is similar to double-incision (DI) in versatility- chest size and sag matters less- but leaves less anatomically positioned scars, which is less desirable for some folks.

[Fishmouth is sometimes considered a "nonbinary incision", but I think it looks cool af, and I didn't want grafts, so I went for it!]

The vibe I got was that it's a step up from keyhole and donut incisions, and other size-limited surgeries that do not remove as much excess skin:

[Keyhole left; donut right]

Or buttonhole, which includes pec incisions and an incision around the nipple, but does not actually remove the nipple- and grants less control over skin removal and nipple placement:

For folks who's nipples are not already in an ideal male nipple placement, fishmouth and DI allow greater control over the lateral placement of the nipple- which is a large part of why they're more versatile.

[DI looks a lot like buttonhole, but removes the nipple entirely to re-graft it; known as a free graft.]

I would have qualified for keyhole due to my size, but my breasts sagged enough that my nipples were below the pec line just a bit. Fishmouth allowed my surgeon to place the nipple more ideally, while still being a less intensive surgery with a shorter recovery than DI- and avoiding the need for a free nipple graft.

It might be an option for you, if it does happen to be available for larger chests.

There's also T-anchor, which is most like buttonhole in that in involves an incision along the lower pec line:

But allows greater control over nipple placement and skin removal. T-anchor also does not cut the nipple stem; this is a good way to avoid nipple grafts (which do sometimes fall off), and try to retain more sensation in the nipple. If you have a longer stem (which larger chests tend to have), it may end up bunched under your skin in a way that might not be desirable for you specifically.

Lollipop is much like the donut incision, but for folks who have more excess skin. It seems to provide more control over excess skin and nipple placement, and can be a good alternative for folks with larger chests that don't want the more dramatic scars involved in DI, T-anchor, and buttonhole incisions.

Lollipop can remove a moderate amount of skin, and is a good option for folks who would prefer keyhole, but don't qualify due to size. It's a newer method for sure, so definitely talk to your surgeon about it if you're interested. It might also not be available to folks with much larger chests.

Here's a handy chart for figuring out which methods you might be choosing from!

All of this information is from The gender Confirmation Center.