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Gender Affirming Procedure

Dr. Bartlett performs gender affirming top surgery for gender diverse individuals. Our patients come from the greater Boston area as well as other parts of the United States and overseas. In general Dr. Bartlett uses the WPATH guidelines to screen patients regarding their suitability for surgery. Dr. Bartlett’s staff takes pride in their knowledge and sensitivity towards patients seeking gender affirming care and makes every effort to make the process as straightforward as possible.
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What is a Gender Affirming Chest Surgery 

Gender affirming top surgery is intended to align the patient’s body with their gender identity.  

Top Surgery

There are two basic operations in top surgery: keyhole or double incision. For individuals with smaller breasts and good skin elasticity, a “keyhole” approach can be used. This involves making an incision at the junction of the areola and the lighter surrounding skin. Through this small incision, the underlying breast tissue is removed. Some patients also require a periareolar mastopexy, (incision around the areola), to decrease the size of the areola. The advantage of the keyhole technique is the inconspicuous scar.

For patients with larger breasts, or loose or lax skin a “double incision” technique is used. Both breasts are removed with formal mastectomies, leaving scars along the border of the pectoralis, (chest), and muscle. The nipples are removed, resized to a male dimension, and reapplied as “free nipple grafts”.  Although scars from the double incision are more visible, the technique is highly effective at producing a male contour with minimal chance of needing any significant secondary operations.

For individuals who are unsure of which technique would be best for them, a consultation with Dr. Bartlett will include counseling to determine the best procedure for you.

Gender Affirming Surgery Consultation

If you are considering gender affirming surgery, the first step is a confidential consultation with Dr. Bartlett. At this time, he will perform a medical evaluation and listen carefully to understand your goals. He will answer questions about the benefits and risks of top surgery, describe the treatment process, and may discuss alternative treatment options. 

Dr. Bartlett will create and personalize your surgical plan. He will give you instructions to prepare for your procedure. He will customize your pre-op and post-op instructions based on your medical evaluation. You will be asked to arrange for a friend or family member to drive you home after the surgery and to help out during your initial recovery. You may also be asked to stop or change your current medications as part of the preparation. This is because certain medications may result in increased bleeding and must be avoided. 

Patients must have realistic expectations and should be in good health, at a stable weight, and a nonsmoker. Smokers can have a higher incidence of unfavorable scarring. Patients who are still healing from recent surgeries or injuries would need to wait for complete recovery.

Gender Affirming Surgery – What to expect 

During your consultation, Dr. Bartlett will recommended either keyhole or double incision top surgery. Dr. Bartlett uses the World Professional Association for Transgender Health (WPATH) guidelines to screen patients regarding their suitability for surgery. All patients must have a therapist’s letter and a letter from their primary care physician.

If undergoing the keyhole incision top surgery, there will be an incision at the junction of the areola and the lighter surrounding skin. Through this small incision, the underlying breast tissue is removed. Some patients also require a periareolar mastopexy (incision around the areola), to decrease the size of the areola. Drains are placed on both sides of the chest and are usually removed within 1 or 2 weeks after surgery. 

If undergoing the double incision top surgery, both breasts are removed with formal mastectomies, leaving scars along the border of the pectoralis, (chest), and muscle. The nipples are removed and resized to a male dimension. The nipples are reapplied as “free nipple grafts” with bolster dressings which are removed at 1 week postoperatively. Although scars from the double incision are more visible, the technique is highly effective at producing a male contour and drains are not typically placed.

In both types of top surgery, a compression vest and band are applied and will remain in place day and night until your first follow up appointment with Dr. Bartlett.

General anesthesia is recommended for top surgery.

3 to 4 hours. The exact duration of surgery will depend on the treatment plan, techniques used, and if there are other procedures performed during your procedure.

Top surgeries are performed in our AAAASF Certified office operating room and in hospital settings in the Boston, Massachusetts, area.

Gender Affirming Top Surgery and Recovery 

Dr Bartlett and his staff will review the details of the recovery process, providing instructions and prescription medications prior to surgery.

A compression vest (similar to spandex) must be worn for 1 week at all times, day and night until your first follow up appointment. The vest is removed at the first follow up appointment to evaluate incisions and healing. Drains and/or nipple bolster dressings are typically removed at the first postoperative visit. If free nipple grafting was performed, you will be instructed on daily dressings to apply over the nipple grafts.

The vest is worn for 2-6 more weeks depending on your healing. During this time, (after one week), patients are allowed to remove the vest briefly each day to shower. No sports or vigorous activity are allowed for 6 weeks following surgery. Discomfort is mild and recovery is rapid. All patients are advised that the final result is judged one year after surgery.

“Thank you so much for everything you have done for me. Not only am I very very happy with my post-op results, but I am also very happy with how helpful and understanding everyone in the office has been. I have referred a lot of my friends to Dr. Bartlett. Thank you Joan, Christine and Sarah for making everything easy and being very helpful!”

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Cost

Cost is dependent on factors such as the time it takes to perform the surgery, the type of anesthesia used, and the techniques utilized. 

An estimate of the cost can be provided over the phone by the front desk administrator. After your consultation with Dr. Bartlett a specific, detailed quote will be provided.

Schedule a consultation

Dr. Bartlett’s staff takes pride in their knowledge and sensitivity towards patients seeking gender affirming care and makes every effort to make the process as straightforward as possible.

Contact our office to schedule a consultation regarding a gender affirming top surgery in Boston with Dr. Richard A. Bartlett. He can let you know if surgery is the best option for you and can provide you with outstanding results from your procedure.

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