Archive for the ‘Surgery’ Category

FTM Top Surgery

February 22, 2010

This blog is about my experience with Dr. Beverly Fischer who is located in Baltimore, MD.

Scroll down for Photos – Note photos are graphic and are probably not appropriate for viewing in public or at work. …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

I had a really excellent experience with Dr. Fischer. I recommend her highly.

My top surgery, a peri-areolar (“key-hole”) double subcutaneous mastectomy, was originally booked for Wed Feb 10th, but due to a massive blizzard which dropped 48 inches of snow on Baltimore over 4 days, it was postponed eight days.


Those extra eight days gave me more time to reflect on it the procedure in detail, and as a result I was definitely a bit more nervous before the surgery than I would have been the week before, but in other ways I was more prepared. I had done a substantial amount of work coming to peace with what I was doing to my body and why. All in all, I believe the extra time was for the best, I was able to let a couple more friends know what I was doing, and as a result they reached out via text messages and emails to check in on me, which was very sweet. (Thanks friends)

I didn’t tell my parents which is a topic I may touch on at another time. I did tell my brother but he hasn’t called to check in on me yet, not sure how “okay” he is with it, but I think he’s doing his best to be supportive.

The night before the surgery after my wife was asleep next to me, I sat and thought about a lot of things, I knew I had found my peace with the fact that I could die from some kind of unforeseen complication. I also knew the odds were very, VERY low of that happening, but I had to at least acknowledge that I was aware of that, and if I died, I would be at peace knowing I lived a good life. I did the best I could, and that I have loved and lived bravely. I was a little bit afraid of the major changes in my life that were about to happen, but I also knew it’d been many years that I have been preparing for this, and now the day had come. I was good to go. I had made my decision, and I was happy with it. I was also incredibly grateful for the support of my wife, who really made this surgery possible. She has been so incredibly supportive, understanding, and kind. I feel like one of the most fortunate people on earth to have the privilege of having this surgery which stems from the privilege of having the financial situation and emotional support, and trans community support around me to make it all possible. There is no way I could have been able to do this 20 years ago. So I owe a great debt of gratitude to all the trans people who have come before me and “paved the way” so to speak for an easier experience for those of us pursuing this surgery today. I hope that this blog can be informative and helpful to those pursuing this surgery in the future.

I had chose Dr. Beverly Fischer in Baltimore, MD for many reasons that I am going to explain. I knew that there could be a huge spectrum of outcomes based on what I had seen on various websites. I have also had 4 close friends go through top surgery (two friends chose Dr. Brownstein in SF, CA, one went with Dr. Brassard in Montreal, and another decided on Dr. Fischer in Balitmore, MD).  Many trans guys show their results in photos and videos on various websites like, but not many show the before pictures, which has a lot to do with one’s outcome, so it’s been hard to know what results I might get given my B cup breasts. But I had confidence in Dr. Fischer. She consistently had the best aesthetic results of any doctor I had seen using the keyhole method which leaves the least amount of scaring. I was a full B cup, which was really borderline for the keyhole process but Dr. Fischer though I was young enough and my skin was elastic enough to handle it well.  When I met Dr. Fischer two months earlier (Dec 10th, 2009), I was pretty skeptical, and I was worried that I wouldn’t like her based on very superficial unfounded reasons… Her website is very female oriented. She does all kinds of cosmetic/plastic surgeries not just FTM stuff.

There are two nurses, Bettye and Shannon, at Dr. Fischer’s office who handle all the FTM patients. After about 15 minutes of waiting Shannon walked me to the exam room. I passed Dr. Fischer in the hall where she was talking to a patient,she was just saying good-bye and making some last remarks about a follow up appointment as the couple was leaving. I am 6ft tall, and Dr. Fischer seemed pretty tall too, close to my height, but she was wearing heeled.

The exam room was much more clinical than the waiting room. It was a typical doctor’s exam room with white cabinets, white walls, a sink, and an exam table with tissue paper on it. There were several photos of Dr. Fischer with various large dogs which was a nice touch, clearly she is an animal and nature lover. I don’t know why but that put me in a better mood.

When I actually met Dr. Fischer I was so pleasantly surprised. She was able to connect with me, look me in the eye, speak to me respectfully, and understand my goals and desires. She didn’t talk down to me at all, but she took care to explain the surgical procedures in detail and what was possible. I was left with the distinct impression that she was very smart, capable, and well trained.  I learned that she did her training at John Hopkins, and she regularly attended surgical conferences and perhaps more importantly she spoke and published on the subject of FTM surgery. I am sure this has a lot to do with her consistently great chest surgery outcomes. I really liked her disposition, and her friendliness didn’t feel fake. Her nursing staff were nicer in person (than on the phone) and clearly they had worked hard to get the pronouns right and had tried understand the FTM community more than most doctors I have met.

By the way, about two years before (Jan 2008), I  had a consult with Dr. Brownstein in San Francisco, CA. His offices were kind of strange, located in an loft apartment building in the Southern Potrero Hill area. He had no real exam room, just some divider screens to separate part of the room so he could use the space for exams. It felt rather odd to be disrobing in a space where I could still make eye contact with his nurses (over the 5ft screens) and he just sat there and didn’t leave the space and re-enter once I disrobed, as most doctors do when you have an exam. As soon as I took my shirt off, while he was still seated, he said, “Oh. Put your shirt back on.  You are not a candidate for keyhole.” and he went on to tell me I could only have the double incision procedure. At the time I really didn’t know of any other surgeons who did this surgery so I assumed he was my only option. Gradually I learned more about other surgeons around the world.  After analyzing as many of Brownstein’s results as I could find, both my friends, as well as on the web, I felt like he always put the nipples up rather high on the pectoral muscle, and that looked strange to me. I asked him about this, and he shrugged like he knew that but didn’t really care to discuss it.

At the time that I met with Dr. Brownstein, I was living in San Francisco, and he was local, and he had done what seemed like thousands of FTM chest surgeries so he had a lot of experience and knew what to expect, and hopefully how to get great results. The more I thought about this though, and reflected on my consult with him and all the information I had, I decided to keep looking at other options.

A friend of mine, Matt, who also lived in SF, told me that he went to a surgeon in Baltimore, MD, and was REALLY thrilled with his results. And that this doctor was able to get great results with the peri-areolar approach on people who Brownstein turned away saying they were way too large breasted for that procedure. So my ears perked up… I thought “Hmmmm… well, I should look into that.”

My life took a few big turns, I ended up moving to New York, and it took me a couple more years to really follow up on my intentions to have this surgery.

Now that I am living in NY, as opposed to SF, getting to Dr. Fischer wasn’t too far, I could just drive the 3 hours south and have that consultation and drive home all in one day.

So that is what I did. I came home from my consutation feeling really optimistic, I was positive that I would move forward with the surgery with Dr. Fischer. Nurse Shannon had given me a bunch of dates in January and February. My wife was supportive. So now it was just a matter of scheduling it around work and obligations and creating the right support system around me. (BTW the consult with Dr. Fischer was $100. The consult with Dr. Brownstein was free.)

My surgery was originally scheduled with Dr. Fischer for Feb 10th. But as it so happened there was a major blizzard that paralyzed the city under more than 3ft of snow, on the date of my scheduled surgery so we had to push out the date to Feb 18th.

Thursday Feb 18th 2010 Surgery Day!

My surgery was scheduled for 11AM, but I had to be at the office by 10AM. My wife and I had driven down the night before and stayed in a hotel so there was no risk of getting caught in traffic.

Dr. Fischer met with me in an exam room about an hour before the surgery. We talked about the options I had for nipple grafts or to leave the pedicle and glands behind it intact, and I chose to move forward with the grafts (which is not required when doing keyhole) because they could give me the best results in terms of a flat chest because she could take more skin around the areola (good for my larger breasts), the nipples would lay more flat as grafts, and because she would be able to take more breast tissue and glandular tissue from behind the graft which is even better for reducing breast cancer odds. All good. The down side to nipple grafts (which is where she totally removes the nipple and cuts it down to a thin layer of skin, and then reattaches it) is that you are highly likely to lose sensation permanently. Your nip may still contract when cold, but it may never have true erotic sensation again. I was okay with that.

Then Dr. Fischer marked up my chest with a green sharpie with all kinds of dotted vertical and horizontal reference lines. These were not cut lines, but rather guidelines to know where she was on the geography my chest even when the dressings were covering the majority of my chest. I think of them as lines of latitude.

Nurse Bettye fitted me with a binder for post-op use and she explained a lot of the necessary post-op care and do’s and don’ts. Bettye also photographed my chest for the “before” images. There was a photo album of before and after shots from both bilateral incision method as well as the keyhole (peri-areolar) method that one could look through. Frankly, there were much better results for Dr. Fischer’s surgery on Also in the photo album were a few thank you notes and testimonials from Dr. Fischer’s patients.

Robin the anesthetist came in to the exam room talk to me about the anesthesia. She was really cool, which was good because I was more nervous about the anesthesia than the surgery itself. I knew that I was prone to feeling nauseous that that is one of the known side effects of anesthesia. I also had heard horror stories of people waking up on the table, or dying from anesthesia. She had me take my anti nauseous pill (which is cherry flavored) by dissolving it on my tongue. (You get a Rx for this  and other prescriptions weeks earlier in the packet that Dr. Fischer sends you in the mail).  Robin said, she’d take good care of me and I asked her all kinds of questions. She said she be right next to me through the whole thing making sure I was fine. By the time I was done talking to her I felt like I trusted her and I would be fine.

Next they walked me across the hall to the operating room and had me lay down on the table. Robin put the IV in my arm, and she told me I should feel the calming effects of the IV meds right away, and I talked to her for a little while and then I was out.

When I woke up I was groggy, and could hardly open my eyes. My chest was sore, but not really bad, but it was that feeling of something major had happened to my chest, tight and numb are the best adjectives. I was packed up with lots of bandages and rapt up snug in the vest binder. My chest felt achy, but when I touched my chest it was not flat, it was big with all the gauze packing so it felt like I still had a woman’s chest, and I was like what? Why is my chest so big? I remember asking at that point, “Did it go okay?” And they said yes it went very well. As I felt around with my hands it just felt like a lot of bandages, it was a strange sensation. “I also remember saying, am I supposed to be more awake than this?” I was so groggy, I could hardly open my eyes. I learned later that I asked the same questions over and over, and they kept saying, yes, it all went fine.

I was told that I had more breast tissue on my left side so she had to take more time to get it all (2hrs 15 min as opposed to the usual 1 hour and a half). She said she went all the way up to my Clavicle (collar bone) and down to my Rectus (abdominal muscles) then out to my Lats, and in to the Sternum which ends up being a lot of area on my 6ft tall frame.

My wife, was so sweet, she was such a comfort and she answered all my questions over and over, she helped me get my clothes on, which I don’t even remember doing. Apparently she had some trouble with my boots. So I advise folks to wear shoes that are easy to slip on. Not boots.

Once I was home at the hotel and lying in bed, I took another anti- nausea pill and a pain pill. The pain pills, Lortab (aka Vicodin), they gave made me feel really sleepy at times, like I was nodding off even when I was walking or eating, and then at other times I felt fine and awake. Strange. I was told the pain pills and anesthesia make you constipated so I also took some Ducolax and drank tons of water to help get the anesthesia out of my system.

Dr. Fischer had prescribed sleeping pills but I didn’t take them, because I didn’t need them to sleep through the night. The pain pills were enough to keep me comfortable, and despite being propped up on about 4 pillows (45 degree angle is what we were advised), I slept fine. I was glad we brought our own soft feather pillows (with soft pillowcases) with us as they were nicer than the hotel’s.

We stayed at the Residence Inn by Marriot in Hunts Valley. Really close to Dr. Fischer’s surgery center (10 min drive), and having a little kitchen and extra TV room was such a nice luxurious convenience. I am so glad we chose that particular hotel as it was perfect for our needs. I requested a handicapped accessible room which was ideal because they had the hose shower thing so I could wash my lower half and not get my binder & bandages wet. The room was $139 a night. The place was brand new as of Jan 2010, so really clean. We stayed 3 nights but we could have cut it down to just 2 nights, but we decided to stay another day just to rest up since the next day was Saturday. They have free breakfast and a work out center with pool. The staff was nice. We ate at the nearby mall both nights, which had a California Pizza Kitchen and other chain restaurants. The day after the surgery we went to a movie at the mall and walked around a bit. The mall is not really an indoor space, so the majority of the walking was outside (FYI). It was cold out.

Friday Feb 19th

Friday was kind of a lost day. I slept a lot, watched tv, and only ate enough to take the pain meds and not get an upset stomach (soup and crackers), until dinner when we went to the mall I ate some salad and pizza again and went to a movie. I took my last pain pill Friday night at 6pm and then didn’t feel like I needed them after that.

Saturday Feb 20th

We got on the road by 10AM and drove back to NY. Uneventful. My wife had to make two trips to carry all the bags in from the car which made me feel bad, but she acted like it was nothing.  (thank you, love you)

Sunday Feb 21, 2010

I had my top surgery on Thursday, just 3 days ago. I am feeling good. I just sneaked a peek at my chest and I am really excited to have this new form. I have been looking at a lot of FTM chest’s online and I was starting to get a little freaked out that there were so many FTMs with really mangled looking chests. When I looked in the mirror just now, with my binder off and the bandages removed on one side, I realized that everything is going to be just fine. Even if I have a little bit of saggy skin for a little while, I can totally be at peace with that. Mainly I can’t wait to wear a T shirt. Work out, build some chest muscle and just feel like the person I am on the inside is showing through to the outside.  Yay!

I am also so relieved to have just reduced my breast cancer risk so profoundly.

Pre-Op chest: B Cup means I barely qualify for "Keyhole" procedure.

5 days post op

Close up of Free Nipple Graft, steri-strips still stuck on there (not allowed to remove for 2 weeks)

5 days post opp - Free Nipple Graft Close Up