De-Boobaning (Top Surgery)

I am NOT decided, but it’s possible I will under take some sort of de-boobaning in the future.
AKA chest reduction and/or removal. Top surgery.

There’s a LOT to navigate, in addition to even deciding if this is something that’s right for me! :open_mouth: Where to get it done, type of surgery, type of surgeon, and-- everyone’s favorite-- the American Healthcare System.

Creating this thread to rant as I deal with things and post questions and just generally flail about.

Please feel free to flail with me. :stuck_out_tongue_winking_eye:

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You are brave.

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I don’t have a lot of insight, but I am here to support you. :heart:

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First hurtle:

I called my health insurance company to get The Real Deets.

There were (2) main avenues discussed:

  1. “Prophylactic cancer treatment mastectomy” – not my situation
  2. “Sex reassignment surgery for chest reconstruction” – sort of maybe possibly my situation, and the avenue down which I would go if this was something I decided to pursue.

#1 is covered. #2 is covered under a (not surprising but frustrating) set of rules.

The rules as I understand them:

  1. A letter of medical necessity from a therapist who specializes in gender dysphoria
  2. A “recorded history” of gender dysphoria
  3. At least 12 months on hormone therapy

So there ya go. Technically covered, but a whole host of gatekeeping in the way, and a very binary understanding of why someone would want or need top surgery.

So even though this is still 100% unknown to me, if I decide to go down this path I do need to start a record of discomfort. SO I called to make a therapy appointment and to find a therapist who handles BOOBAGE FEELS.
No dice, because in the last year my insurance changed its rules and I need a referral to get into therapy now from my primary care doc.
ONLY my primary care doc left the state. And my primary care doc before THAT left the state. SO I need a new primary care doc first. Which, fine, whatever. Okay.
Long story short, now I have that set up for next Wednesday. At which point I’ll hopefully get a referral to see someone about what I actually want to talk about-- my guess is the new patient wait list is 2 months for a therapist but we’ll see.

ETA: I won’t be going through motions or decisions that aren’t right for me just to get this end-stage. I am lucky in that I have money. If I decide to do this after some therapy and T is not right for me, then I’ll find a clinic that does it without this bullshit and pay full price.

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I’ve waffled on my feelings about my boobs for ages and don’t have anyone in my IRL community who understand, so I’m glad to see someone else with similar feelings!

I’ll be following this thread not only to support but also to learn. And our medical system is such a bunch of bunk.

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I am not surprised, but I am also horrified that they require someone to be on hormones as a prerequisite to surgery. I mean, what the fucking what. JFC.

I would be super curious what it would cost with no insurance and paying in full.

It sounds like you are maybe leaning toward full top surgery vs a reduction? I would think you might be able to get a reduction covered by insurance without involving gender at all if you pushed hard enough. I mean, I imagine that a lot of women just want smaller boobs? Or maybe not. Maybe I’m just the minority there. Boobs are so damn complicated.

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I do know some people who got breast reduction due to back pain. I’m not sure what the health insurance situation for that would be.

Oro, following along and commiserating over health insurance and confused feelings. #TeamOro

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I should probably clarify that I have had a breast reduction and it was 100% covered by insurance. Oro has already heard about this at length. Haha. :slightly_smiling_face:

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Yeah. :roll_eyes: It’s, I think, to weed out the “real trans” ??? Because all trans people want to be MEN or WOMEN with the full compliment of hormones, of course. :roll_eyes: And also because what if the poor trans have REGRETS we must protect them from making IMPULSIVE DECISIONS.
:roll_eyes:

I have many opinions on all this.

(There is some evidence that getting breast augmentation-- going the other direction basically-- should occur after a trans person has undergone estrogen treatment, IF they plan on doing that, because that alters the skin on the chest a little bit. But like. This isn’t for that reason. This is just to control who gets access and who they determine is “trans enough” and I HAVE OPINIONS despite not even being sure I overlap the trans umbrella enough to even be there myself.)

I think this is one of those things that is true! BUT I don’t actually have associated back pain. And I’m not comfortable lying. :heart:

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I also have MANY OPINIONS about this and it involves SO MANY ANGRY EYE ROLLS. Like, so many.

I suspect your journey with this is going to involve a lot more angry eye rolls and I’m so sorry that the world is this way. It’s so fucked.

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I think it would be well worth your while to ask your surgeon of choice what the cash price would be. My last elective procedure (vasectomy) was quoted to me as $5,000 if billed to insurance, “discounted” to $2,500 with my specific insurer, or $1,000 in cash up front. I paid cash because it made more sense than paying 2.5x just to fill up deductible space.

Depending on what the price spread is, might very well be cheaper, especially with all of the prior care required by your insurance (which will incur OOP costs) unless your insurance plan doesn’t involve a lot of OOP payments.

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I think this is a wonderful potential legal test case (as the understanding of gender, sexuality, etc spectrum becomes more understood).

That said - you probably don’t want to be that case!

There is a pretty supportive medical group for LGBTQA people in my area. Just in case finding a supportive doctor becomes an issue.

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I’m definitely not decided on anyyyyything– I waffle every hot second. Hahahah!! I see three possible outcomes:

  1. I decide I’m cool how I am, just wearing binders
  2. I decide I want to keep a “female shape” but have as substantial as possible chest reduction
  3. I go full top surgery-- double incision, either graft or buttonhole.

At this point, frankly, any of these seem equally possible. :rofl:

I suspect this thread will be as much about me HAVING THOUGHTS as it will be about the financial aspect of it. Sorry ostensibly money related forum, lol.

Nods!
Totally. I’m not at all at the point of picking a surgeon, but yeah-- if I end up going that route there will be many options to consider-- including medical tourism. :slight_smile:

:heart: :heart:
I feel lucky that if I need to, I have the means to travel to get what I need.
I am so, so lucky in that regard.

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Hi. I am here. Technically I’m cleaning at work while my ride waits …so my thoughts and stuff wi wait, but I want my support to not wait

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A friend had top surgery (they are trans and so did the therapy and hormones also).

I also read a response a gender non-conforming model wrote to a mother whose child wants to bind - you may already know this, but apparently homemade binding can be very damaging. There is specifically designed apparel that is better and safer long term.

It is also an amazing example of fighting hate with love.

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You are a sweetheart. :heart:

Yes this is super true! I have (3) binders I try to rotate through (it’s my only form of chest undergarment right now) and they’re made from companies that know how to make binders safely. :+1: Not only do you not want to hinder blood flow and, like, breathing (lol) but if you intend to have surgery later, you don’t want them too tight as that can reduce skin elasticity, something that makes surgeries a little less effective.

ETA: HA! 2 of my binders are from the company the model references. :wink: I hadn’t read that article before. It’s really sweet. But WOW the emotional energy they put into doing outreach (inreach??? when people come to you? ihni lol) is incredible.

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I am most definitely neither patient nor kind enough to handle a situation that way. It is amazing and powerful and effective. I would be too upset and angry.

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So many thoughts on so many topics:

On surgically altering bodies: it’s a big deal for some people and cultures and not for others. You treat it as a big deal because it is a big deal for you. I think this is a wise thing.

[details=“continued rambles”]

I also think that if you figure out how to make your outsides please you more, it is okay to not have completely figures out all the inside pieces. Sometimes our heart sings and we know we have made the right life altering decision before we can articulate why it is right[/details]

On money and surgeons and aftercare.

Let the money rain down. If you are doing an elective medical procedure, find the right people to do it. There is a huge difference in surgical outcomes, techniques and approaches to surgery.

ongoing rambles

Medical tourism in elective surgery is something that I highly recommend. But not if the goal is to save money. Only if the goal is to go to the best equipped and most successful team. You need a doctor who will understand what you’re discussing especially in terms of masculine vs feminine shapes. They should have pictures to make sure that you agree with each other. There should be ugly and pretty scar pictures and scar placement discussions.

Aftercare should cost a fucking bomb. If I was getting my abdominal fat transferred to my bum, it would happen in Miami, and they would have me twice daily at a clinic for a week after getting manual lymph drainage before I went home with custom compression garments, a list of therapists to get treated by at home, and laser procedures to get after. In Miami, the Bay area, LA, Latin America* and eastern Europe elective procedures come with a serious and effective post treatment plan that probably costs another few thousand but makes the results work. I try to pimp out these post treatment plans to people getting non elective surgery. Usually there isn’t a single studied best practice, but instead a range of practices that doctors are reccomending based on their clinical experience. And many of the awesome doctors are probably within reach of the options available under health insurance, but if possible I wouldn’t want to be limited to doctors under health insurance.
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On Money and Insurance and stuff

35 year old me working in healthcare has more sympathy for the difficulty of insurers deciding what to cover, than 18 year old me does. I unequivocally think that life saving surgeries should always be covered by national health insurance schemes. I think that current legislation in most places makes this incredibly difficult for people

still rambling

who require alterations to internal and external primary and secondary sex characteristics when the person is not following a MTF or FTM path. I expect to see a gender queer person challenge these restrictions, and hope that they already have and have won.

Specific diagnostic requirements or pretreatment requirements narrow the definition of what type of procedure is being covered. Taking female hormones will change the body composition and may start to lay down breast or fatty tissue in the breasts. Taking male hormones may effect body composition and start to change how muscle growth patterns happen. If the intention is to continue these hormones, then you’d want to be on them 12-18 months pre surgery so that your doctor has an idea about how your body works before reshaping.

Counseling before major procedures mb isn’t wide spread enough, but the ways and places it’s enforced in my insurance system are gendered and patriarchical. To my knowledge it is mandatory only before IVF or gender reassignment surgeries. That’s fucking bullshit. But if you work with a good counselor, I’ve heard great things about the experience. Preparing yourself for outcomes, for recovery, for emerging as a new version of yourself. I’ve seen a lot of people who’ve had elective (and usually self funded) surgeries where counseling wasn’t mandated or done beforehand, who would have done well with counseling. Like knee replacements. Let’s get them all in therapy first.

Who should pay? I live in a country with national/provincial health care. I’m writing from that perspective. I find it hard to know which surgeries should and shouldn’t be covered, when we don’t all have dental, vision, and pharmacare. I see people with knee surgeries paid for by the government, where the money would have been better put towards an insulin pump. But we’ve decided that knee surgery is covered at the surgeon’s discretion. So maybe top surgeries should be at the surgeon’s discretion too. But what if your family doctor refers you to a plastic surgeon who doesn’t believe it’s medically necessary for you, but there’s a surgeon in another province who thinks that it’s medically necessary for everyone to choose their own body and is spending provincial money on purely cosmetic enhancements. It’s not wrong of either set of patients to want their surgeries. But neither physician is equipped to decide what’s covered and what isn’t. I could guarantee that if the province let providers choose who needs top surgeries, rich white kids would get a blank slate on reshaping and contouring, while native and recent immigrants were denied life saving surgeries.

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So I can see that somewhere we need to have a line drawn for top and bottom surgery between paid for and self pay. I can partially understand the current laws even though they are bullshit. I know it needs to be challenged and reworked, and that even then there will be cases where people don’t fit in their current body and don’t get funded for surgery and that decision is wrong.

*I’m an asshole, listing US cities and then chunks of continents. But like, I don’t suggest anyone go to Venezuela for surgery today, but I do reccomend going there 28 years ago for some feminizing procedures plus aftercare. And my eastern European patients will literally just say that they had the surgery “in Europe”. Because I guess they are sick of people not knowing anything about Croatia? Or because they left their country while it was still part of the Soviet Union?

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Such an excellent post @Elle :heart::heart::heart::heart::heart:

The law (and many other things) always lag technology and our beliefs and attitudes in society - that leaves these gaps that get imperfectly patches (or not), which sometimes makes it worse, but hopefully long term things get better.

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I got a therapy appointment with a therapist who has “gender” listed on her profile (along with anxiety :+1: ). That’s the good news. :stuck_out_tongue_winking_eye: The bad news is that to get this appointment (she was the first person available period for me on my insurance as a “new patient” to the psych department, as it’s been over a year since I last saw someone) is March 4th.
But the process is started for speaking to someone and helping me untangle some of my thoughts. :heart:

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