Everything you’ve ever wanted to know in one place.
For many trans or gender-nonconforming people, top surgery is a significant milestone on the road to living life as one’s authentic self. But, like any other major surgery, it can be overwhelming knowing where to start and what to expect.
And if you're younger, this may be the first time you've had to advocate for yourself in a hospital setting or deal with navigating health insurance — that's a lot to deal with. We asked BuzzFeeders who have already gone through the process to give you their best advice on preparing for and recovering from top surgery.
BuzzFeed LGBT also spoke with experts Dr. Rachel Bluebond-Langner, associate professor of plastic surgery at NYU Langone Health, and Gaines Blasdel, a medical case manager with the Callen-Lorde Community Health Center, to help you keep all the facts straight about this big step.
Warner Bros Television
First things first, you need to find a doctor. You shouldn’t feel guilty for shopping around — find a practice and surgeon with experience performing gender-affirming surgeries.
“Different surgeons have different training and think different things are the best way to go for valid reasons,” says Blasdel. “So, you might get different answers from different surgeons. I advise everyone to go to multiple consultations — getting a second opinion will make you feel more secure in your decision.”
It will also help to find a practice where staff are sensitive to gender markers on ID cards as well as to preferred names and pronouns, says Bluebond-Langner. “I do think it's important to go to a board-certified surgeon, someone with experience in gender-affirming surgery — understanding that chest masculinization is not just a mastectomy.”
You can read about the various types of top-surgery procedures here. You and your doctor will have to discuss which is the best fit for your particular case.
Know that you will (most likely) need a letter of support from a therapist or mental health provider.
Once you find a surgeon, your provider will send a request to your insurance company to confirm that payment will, in fact, be covered. This is when they'll use letters of support from a mental health provider, explains Blasdel.
For practices which follow the World Professional Association for Transgender Health's standards of care for chest-masculinization surgery, it will be required that you have at least one letter of support. If you're on hormones, explains Bluebond-Langner, it can help to also have a letter from your hormone subscriber — though hormones are not a prerequisite for surgery.
Having a letter of support ensures that you, as the patient, are fully capable of making informed decisions for treatment. This entire process, confirming coverage, can take anywhere from one to several months. And if you get denied at first, don't get frustrated — just appeal.
“If they deny you coverage for any reason, you should request that in writing,” says Blasdel. “You will use this to appeal. I always tell people to expect to be denied and you have to call their bluff. People will get denied even if, eventually, they will be able to receive coverage.”