So remembering how daunted I felt when I first set out on the road to top surgery in terms of educating myself, making the right choices, finding the right surgeon etc, I thought it might be a good idea to write up a few key points now that it’s all behind me.
At the end of the day, I’m very happy with my result and extremely glad that I did really take the time to thoroughly explore all of my options.
I wouldn’t say it was a smooth or straight forward process and it was a solid year of research, traveling to the other side of the globe, a bunch of consults with different surgeons all of whom told me VERY different things, and a whole lot of money even before I went under the knife. There was also the emotional rollercoaster of feeling hopeful, terrified, excited, defeated, angry, frustrated and scared but ultimately now, extremely joyful and happy with the outcome.
In my specific instance, what confused and complicated the process, was that I wasn’t sure if I should go peri or double incision and was getting vastly varying opinions on this from surgeons from “you’re on the fence” to “no way peri will work for you” to “you’d be an idiot not to go peri as you’re a great candidate for it.”
I myself was very keen to go peri, even if it meant multiple surgeries, and in the end, that’s what happened.
Some things I learned along the way and which I’d like others who still have this ahead of them to be aware of and think about:
Surgeons can have very fragile egos. It’s super important that you ask a lot of questions in a consult, but be aware that in order to get the best responses, you more often than not, have to do some very serious ego massaging. They absolutely don’t like to admit that they may not know everything and put up defenses very quickly if you phrase something in a way that they perceive to be challenging their skill/knowledge/omnipotence.
Surgery in this field still has a long way to go. And that’s pretty much just a supply and demand thing. If chest surgery for trans men was as common as breast implants, we’d be getting amazing results, but as it currently stands, the few surgeons that are doing this kind of surgery aren’t necessarily great surgeons (though some of them are!) so really do your research and homework! I found transbucket.com was a great resource not only for figuring out which surgeons got great results but also, which ones to definitely stay away from. I do see the calibre of surgeons that are doing this kind of surgery getting better and better over the coming years as we gain more social acceptance, and even over the past two years, it’s been great to see some new players come onto the field, my surgeon included.
Know your deal breakers. Such as when one Sydney surgeon said to me after I asked her if she enjoyed working with the trans community, “Oh, yes I love working with the trans community! They have such low expectations.” (yep, that’s a verbatim quote…) Yours many not be quite as overt as this, but trust your gut instinct!
Stick to your guns! If you’ve done your research, you should be able to engage in a well informed dialogue with your surgeon, so if he suggests something that you don’t agree with or have reservations about, DON’T JUST GO ALONG WITH IT! Had I done this, I definitely would not have gotten the results I did. This can actually be really difficult especially when they do it to you right before surgery to just say “yeah okay, whatever you think” but do not let them put you under unless you 100% agree with what they’re about to do to your body!
Don’t just choose “close to home.” This is the first day of the rest of your life after all, and if there just are no good surgeons doing this kind of work near where you live, see that as an opportunity to broaden your options even if it means traveling all the way across the country or even the world.
If it HAS to be close to home, but you don’t feel there’s any great options, then research information from the absolute best in the world and get your surgeon to take it on board (much easier said than done believe me, as this was the route I went.)
Be prepared for more than one surgery. Though this mainly applies to peri, it’s often also the case with double incision. In my instance it took three, though probably could have been done in two and if I was really picky, I’d have a fourth as then you’d never be able to tell I’d had surgery.
So in summary, seeing my research extended globally, I’d like to just compile a very short, world wide list of the surgeons that, had time and space and money been no obstacles, I would have chosen for surgery based on result I have seen and interactions with their offices:
Dr Cori Agarwal* (Salt Lake City, United States)
Dr Miguel Delgado (San Francisco, United States)
Dr Janken Hoffmann (Munich, Germany)
Dr Daniel Medalie (Cleveland, United States)
Dr Richard Bartlett (Massachusetts, United States)
With this list, please keep in mind that my bias was towards finding surgeons that would do peri, so had I known that I would definitely go double incision, this list would have looked different. Had I gone double incision, my decision would have been clear cut:
Dr Andy Ives (Melbourne, Australia)
Out of every surgeon I saw, Andy was by far my favourite in the sense that what I said earlier about surgeons having fragile egos, simply doesn’t apply to Andy. He is extremely open to taking on new information, is very interested in working with the trans community and actively seeks to improve his knowledge and skill in this area at every opportunity.
In the end, the surgeon I ended up going with was Dr Steve Merten in Sydney. Steve is still pretty new to this type of surgery, though he has a very solid background in breast augmentation and gynecomastia surgery (and I very much felt in the end that him being new to this surgery was a good thing, as unlike other surgeons in Sydney that are doing a pretty sub par job at this surgery because they don’t think they have anything left to learn, he was still receptive to understanding that there could be a better way.) As long as he stays receptive, he’ll only get better and better from here on in, so I’d definitely highly recommend him.
I will also include some before and after shots here, though you’ll need to click this link to access them. I was very reluctant to post these but understand the importance of them in terms of being able to make informed decisions. I ask that they please NOT be circulated in any other context other than this article!
The results look amazing, you did well for all the hard work and research.
If I can add one good surgeon to the list for the knowledge of others, then add Mr Oliver Fenton, UK.
I say this because he fixed a hideous mess I was left in after an incompetent surgeon left me looking like a butcher block. He made a normal chest out of what was essentially very, very wrong.
Having said that, I would warn all comers to avoid Miss Victoria Rose. As you say, very confident and full of herself. She ‘forgot’ to do hair removal, leaving me with hair on the inside, so that my left ariola and nipple went necrotic and died. This also left polynidal cysts that seeped gunk and wounds that could never close – for years. She was supposedly trained in microsurgery, but instead left stitches like a teddy bear and scars over an inch wide. Besides her stitching, she also cuts like a drunk; one side was very lop sided with an overhanging ‘shelf’ of skin. I spent what at the time was my life savings going to her privately so could not get this fixed for years, while she was very non-chalent about the results, which destroyed all my confidence. Of course I couldn’t ‘do’ anything about it, like sue, because I am in stealth and wrecking that would take away the rest of my confidence in day to day life.
So having said that, I finally was able to save that, and did research into microsurgeons – and Mr Fenton was a life saver, he was also fuming/ furious at Miss Roses’ work (we did not know why I had so many issues with wounds, seeping and cell death until his surgery revealed the mess she left on the inside) and I could honestly say that I can now work shirtless and look normal.
Hopefully its OK to add my own little life story, I know you are reaching out to help others rather than making a personal blog – so hopefully it’s OK to share mine back.
i don’t know if you are still on here but i can’t find any results for fenton and wondered if you had any photos you would mind sharing
Your chest looks great! I think one of the things that you had going for you was that pre-surgey your areolas look to be further to the sides of your chest, rather than more towards the middle, which is a significant difference between male/female chests. It seems to me that this is a big (if not the biggest), problem with peri and keyhole is the inability to move the areolas over (or very far, anyway, since they stay attached). To me, this is what makes the peri/keyhole transman chest stand out from a natal male’s chest and not look as good as double incision (if we took DI scars our of the equation). Your chest looks very different than any other peri/keyhole I have seen. Is that your chest at the top of this article, or just in the links? Fantastic due. I can see how it was worth all the “trouble” of looking and multiple surgeries!
Dogman, thanks for the useful input and feel free to post any pic links etc if you’d like to. And Nate, pre-puberty, male and female nipples are located in the same places, but yes with breast growth, women’s tend to move more centrally. My problem was actually more the positioning vertically as about twice as much needed to be taken out at the top than the bottom. This is something a good surgeon should be able to do. And no, that’s not my chest at the top (just a stock photo). Mine is just the link.
“Just the link” = amazing chest! I think you should put your own chest at the top of the article!
Ha! Thanks :) I already did that in the previous “I’m giving away my binders” post so thought it would look odd twice in a row :)
Hi! I’m not sure how to post photos here. I have a picure of the mess that Miss Rose left, and I can always take a current though it was very recent so the (very thin) scars are still red. I don’t have pre-surgery pics but the area was a ‘C’ so anyone can either imagine that or look it up. My issue prior to surgery was that I had massive ariolas that, when flattened, where bigger than the bottom of a large coffee mug (yuk) so obviously that had to be normalised. The only thing I am waiting on now is a breif local anesthetic surgery to stretch out the the remaining tissue from what is left of the nipple/ariola that died thanks to Miss Rose – I can pass it off as an ‘infected nipple ring gone wrong’ even though I never really had one – but hopefully with the next surgery it won’t be noticeable.
You can’t really post pix on here, but you can upload a pic to somewhere like transbucket or any other site that allows you to upload pix and then just post the link. Just really glad you did manage to undo the damage this surgeon did to you. Sounds absolutely awful.
I haven’t been on many trans sites because of the being in stealth, and because of bad experiences with people here in the UK on the genderqueer spectrum who felt it was their duty to ‘out’ me because they believed all trans people should spend their lives being proponents of the cause, there only to continuously justify and explain to an uncaring public, rather than opting to live a normal life. It made me scared of social sites even though these were people I knew in person. I like the anonymity of this one. You also seem a very cool guy.
I’m wondering how exactly you got the surgeon to do multiple prosecuted for the price of one? It seems to get my desired results I’ll have to go that route but I haven’t got the faintest idea how to approach a surgeon with this plan and and they be willing to spend that time on me, especially in the U.S. Any tips or advice?
Good question. I actually imagined that I would have to pay for subsequent touch ups, but he basically did them at cost meaning, my healthcare picked up the bill for all the subsequent surgeries. It was in Australia so our system probably works somewhat differently. Basically, for the first surgery, I only got a little re-imbursed from the health fund, but subsequent surgeries were done under our “no gap” scheme, meaning you don’t have to pay the gap between what your surgeon charges and what your health care is prepared to re-imburse you. Worthwhile doing some research to see if something similar exists in the states :)
Your results are amazing Alex! I’m going for a consult with Dr Steve Merten, pretty much purely based on your results, since I can’t seem to find much else out there from people who’ve been to him. Just wondering over what kind of time period the subsequent touch-ups were done? I imagine you had to heal and let it all settle a little before going in again. I’ve got my heart set on peri and know that if that happens, I will definitely need touch-ups, but I don’t live in Sydney. Was Dr. Merten happy to do the touch-ups or did you have to really push him for it? I’m borderline peri, and I’m just wondering if he’ll be less likely to want to do peri on me because I’ll probably have to go back for touch-ups.
Thanks heaps for sharing the process!
Yes, he did make me wait 6 months from the initial surgery before he considered doing any touch ups. Then because I told him I would be heading to the sates he did do the subsequent touch up with less wait, but probably best to ask him all these questions personally in a consult. I did have to push him for touch ups, but I think in the end, he also wanted to see the best result :)
Hi Alex, thank you so much for making such great STPs! I had the Peri done (based on your results), and I had smaller breasts than you. I look exactly like your1st post op pic; I will have to pay out of pocket to fix it, my insurance explicitly states it covers reductions, but not of the areola (what BS). Why did it take two additional surgeries? The final result is awesome on you! I am a US Federal employee, openly (now) trans at work, and being able to use the urinal (every time!) gives me so much more credibility and normalization with my fellow law enforcement officers. I haven’t been using the gym at work because I feel like my areolas are still too feminine looking. :/
Wow!! Those results are incredible! That seems like really good advice though I don’t imagine I’ll be able to travel (it’ll be hard enough getting the 10k minimum i need for the surgery, I can’t afford plane tickets and a couple weeks in a hotel on top of that) I’m not sure where I’ll be living when I can finally afford looking into surgery, but at the time being I’m in Chicago and it seems like there are a couple decent surgeons here
Just to add to your praise for Dr. Agarwal: She did peri on me almost six months ago, and my experience with her was phenomenal. The results are great, as have been my interactions with her, her PA, and everyone working in that clinic. I was nervous and thought I wouldn’t even qualify for peri. She put me at ease and assured me that I was a perfect candidate for peri, and was very explicit about what I could expect the results to be.
Her skills are in high demand, and I’ve heard of people spending 4-6 months on a wait list just to see her. I only had to wait 2 months for a consult and another 2 months for surgery (though it would’ve been a shorter wait if not for my own packed schedule). Personally, I would’ve been willing to wait much longer if it meant having the results I got.
That’s a great result, and makes my more hopeful about being able to get peri. What did the second and third surgeries actually entail? Was it liposuction, or was more skin taken off once the existing skin had shrunk and smoothed out?
Yes, refining the contour and taking out more skin.
Hey thanks for sharing! I noticed you mention that it’s common for peri to have multiple procedures but I haven’t been ably to find anything about this online. I’m planning to have peri done in Jan 2020 and the surgeon never mentioned multiple procedures. Can you tell me a bit more about this? Is it just a high rate of error / revision needed? Or something else? TIA!
Yeah they usually don’t get it perfect the first time, so you often need to take out extra bulk or skin. Ask you surgeon about this.
I’ve seen some horrible photos of post-op results from doctors near me. Seeing a result like yours is one of the reasons I hope I’m able to get surgery one day, and also proof that I’ll have to shop around in other states, or even other countries if I’m ever able to afford it.
Yes, it’s definitely worth taking the time to do the research and saving for the right surgeon!