Dr. Gallagher on FTM Top Surgery FTM (double incision / keyhole surgery)

Dr. Gallagher on FTM Top Surgery FTM (double incision / keyhole surgery)

A discussion with Dr. Gallagher about FTM top surgery FTM for transgender men both keyhole surgery and double incision chest surgery.

In a conversation with Dr. Gallagher, I asked her about her process with transmen getting chest surgery. I have captured that conversation in a question answer format here.

What types of procedures do you provide for transmen seeking chest surgery?

The three options for chest surgery are:  double incision procedure, keyhole surgery. and breast reduction.

Is there anything about your chest surgery that separates you from other surgeons?

The three most distinguishing features of ftm top surgery with Dr. Gallagher are:

  • No drains used in surgery, including larger transmen  (which means less pain and fewer complication rates)
  • Quick recovery post surgery regimen
    • Most patients can shower within 48 hours of their top surgery ftm
    • Typical return to most normal activities within a few days of procedure
    • Recovery care is very straight forward
  • Special effort to avoid “dog ears”
    • Dog ears are “pouches” of tissue which can be left behind when the breast tissue extends back around the patients sides.
    • Dr. Gallagher states, “We always do our best to take care of these at the first surgery.”

What determines whether transgender men have ftm top surgery using the double incision surgery, keyhole surgery or a breast reduction?

The three key variables affecting surgery style are, skin elasticity, chest size and preference.  According to Dr. Gallagher, if the patient has any “sagging” of the skin, the keyhole surgery is not advised.  The sagging skin will remain, creating a less desirable outcome. Chest size is another variable. Realistically transmen with a size A cup or small a small B should have a double incision procedure. A masculinized chest is of course not for everybody and some non-binary patients may prefer just a reduction, which can be accommodated also. Dr. Gallagher explained, “We will look at photos and determine what is right for each patient.”

Dr. Gallagher, Dr. O'Mara, Michele O'Mara

How long is the typical hospital stay post-chest surgery ftm?

Only about 10% of Dr. Gallagher’s top surgery patients require an overnight stay. All patients are afforded that option, but it is rarely necessary, unless there is travel involved.  Patients travelling in from out of town are advised to stay locally for first night after the surgery.

What is your surgical policy about smoking?

There is a strict policy of no smoking for 6 weeks before surgery.  Dr. Gallagher states that they will nicotine test and if the results are positive surgery will be cancelled.

How much recovery time does the typical patient need before returning to work?

Depending on the demands of their job, most patients will be able to return to work in 1-2 weeks. No heavy lifting for 4-6 weeks.

Do you take insurance?

Yes.  For information about benefit coverage and your out-of-pocket expense for top surgery with Dr. Gallagher, visit this article on Surgery, Insurance and Scheduling with Dr. Gallagher.

Do you have photos of BEFORE AND AFTER top surgery ftm?

ftm top surgeryftm top surgery ftm keyhole surgery chest surgery ftm top surgery dr. gallagher

Is there anything else you would like to share about ftm top surgery?

Dr. Gallagher said, “This is a very gratifying procedure for both surgeon and patient!”

There is a low complication rate even in larger patients. While a very small amount of breast tissue is left behind, a trans-man will never require a mammogram after the procedure. We will recommend you have a mammogram within one year before the surgery if over 40 or if there is a strong family history of breast cancer.

Do you require that a patient be on HRT (testosterone) to undergo top surgery ftm?

You do not have to be on testosterone to undergo top surgery.

Dr. Gallagher on FTM Top Surgery FTM (double incision / keyhole surgery) - Michele O'Mara

Letter of Recommendation for GRS / SRS, Chest Surgery, HRT

Letter of Recommendation for GRS / SRS, Chest Surgery, HRT

Gender Services Inquiry Form

Frequently asked questions for getting a letter of recommendation for HRT, GRS / SRS, and top surgery with Michele O’Mara, PhD

A referral letter, also called a letter of referral, is typically required by surgeons who perform gender reassignment surgery (GRS), hormone replacement surgery (HRT), and chest surgery. In the case of gender affirmation surgery, also known as SRS, two letters from a mental health professional are typically required.

How long does the assessment and referral process take?

The quick answer is, typically the process takes one to four session(s).  A combination of variables affect how quickly this process goes. If you would like to get a reliable estimate of how many sessions you will need to get a letter of referral for a first letter of referral for GRS / SRS, a second recommendation for GRS, chest surgery, or hormone replacement therapy (HRT), you can complete this form here.

What is involved in getting a referral from you for gender reassignment surgery?

letter of recommendation, referral, GRS, Chest Surgery, HRT, SRSFirst you will need to register on my HIPPA approved, confidential client portal at www.omaratime.com and secure a time for us to meet on my online scheduler which is also in this portal.

You will be asked to complete a autobiographical review and a sexual history with me. This involves completing two separate forms on my website, and then we review your responses together in session, whether that is in-office, or online (via Skype, FaceTime, or my HIPPA approved client portal). The process is designed to effeciently gather the history and development of your gender from birth until present.

All of my forms are available online and do not need to be printed.  Once you register with me for a session, let me know, and I will mark your account “gender related,” on my end, and these forms will be accessible to you.

Once this is completed, we will review what are called “readiness factors,” as outlined in the Standards of Care.  The Standards of Care are the guidelines set forth for professionals who work with transgender folks. Readiness factors are the variables that help determine your ability to succeed with the next step of your process.  For example, to be “ready” to begin HRT, you must have the means (insurance coverage or income) to afford the hormones and the associated doctor’s visits.

It is rare that someone comes to me for a letter of referral are able to receive one.  My goal is to determine in advance if there are any concerns that will prevent you from getting this letter.

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What is the difference between a first letter of recommendation for GRS and a second letter?

Typically, the first letter of recommendation is completed by the therapist that has worked with you the longest and knows you the best.  This is usually the same therapist who referred you for hormone replacement therapy (if applicable).  The first letter tends to be more thorough, and the second letter is an endorsement for the original assessment and letter of referral. Many surgeons require a letter from both a master’s level therapist as well as a PhD level clinician.  I am typically able to write a letter to satisfy either requirements.

Do you write letters of recommendation for youth?

Generally I do not provide assessment and referrals for anyone under 18.

Yes.  I do quite a bit of work online.  Some states, however, have strict limitations for out-of-state counselors providing services to their residents without being licensed in that state.  It is always an option for me to provide online services to Indiana residents, as this is where I am licensed to practice.  For information about your state’s laws, you can view this document.

Have you written a letter of recommendation before?

Yes.  I have written several hundred letters of recommendations for multiple gender-related procedures such as chest surgery, hormone replacement therapy (HRT) and gender reassignment surgery (GRS) also known as SRS or vaginoplasty.

I have written numerous letters of referral (all accepted) to the following gender reassignment surgeons (this list does not include retired surgeons to whom I have referred over the years):

I have referred to these surgeons for chest surgery:

As for hormone replacement therapy, I refer several folks per month to local providers, as well as MD’s and endocrinologists in other states where I provide online counseling.

What are the costs for sessions?

A 50 minute session is $130.

Do you accept insurance?

I have chosen to be out-of-network for all insurance panels.  What this means is, your benefit coverage for my services will be based on your out-of-network rates.  I request full payment at the time of the session and receipts can be printed from the client portal to submit for reimbursement from your insurance company.
The actual amount of reimbursement you receive depends on your out-of-network benefits. To find out your exact level of benefits, contact the customer care # on your insurance card and request the following information:
  1. What are my out-of-network mental health benefits?
  2. What is my out-of-network deductible?
  3. How many sessions am I allowed per year?
  4. Where do I send claims for reimbursement?
  5. What is the typical length of turn-around time it takes you to reimburse a claim?

I do offer the use of MC/Visa to offset the delay between payment and reimbursement.

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Gender Services Inquiry Form

Bilateral Orchiectomy MTF with Dr. Gallagher for Transgender Women

Bilateral Orchiectomy MTF with Dr. Gallagher for Transgender Women

Dr. Sidhbh Gallagher, SRS, GRS, orchiectomy

IU West Hospital

Bilateral Orchiectomy MTF for Transgender Women – An  Interview with Dr. Gallagher

A bilateral orchiectomy is a great option for transgender women.  This is an outpatient surgical procedure that involves the removal of testicles. Some refer to this as castration. The purpose of this procedure to reduce testosterone production.  Today’s post is based on an interview with Dr. Gallagher about her philosophy, style and approach to this procedure.

What are good reasons for a transgender woman to have a bilateral orchiectomy?

According to Dr. Gallagher, A trans woman may choose to have an bilateral orchiectomy MTF when she is not yet ready to undergo bottom surgery- be it for financial, medical reasons or that she is not yet ready to do the involved postop care a vaginoplasty involves (dilation, douching). Vaginoplasty is of course not right for every trans woman and she may only choose to undergo a castration.

Once a transgender woman has her testicles removed, she will not require a testosterone blocker (eg. spironolactone ) and her estradiol doses requirement will drop.

If the patient does not plan to undergo vaginoplasty in the future the scrotal skin can be removed at the same time to help improve the contour.

A before and after photo of the removal of testicles by Dr. Gallagher:

bilateral orchiectomy mtf, transgender, dr. gallagher

How long does this procedure take, and what is the typical recovery time?

For surgery with Dr. Gallagher, this procedure involves a local anesthetic and sedation. It is completed in 30 minutes and a patient will need a ride home afterwards. Most patients experience some soreness for a day or two but return to normal activities within a few days.

What are the benefits and/or disadvantages to having a bilateral orchiectomy MTF if a transwoman plans to have vaginoplasty in the future?

Most women who have a vaginoplasty by the penile inversion technique will require the scrotal skin to be used to help make a deeper vagina. After the testes are removed, there may be some shrinkage of the scrotal skin over time. When considering the benefits of removing testicles, Dr. Gallagher believes it “still safe for a patient to undergo orchiectomy,” if the ultimate goal is vaginoplasty.

What, if anything, is helpful for transwomen to know about having an orchiectomy?

Compared to vaginoplasty this is a much simpler and faster procedure. For a patient without benefits it can be a much more affordable way to help surgically relieve her gender dysphoria. In patient’s who have difficulty with hormone levels/ testosterone blockade it can be extremely helpful.

Is there anything else you would like to share about this procedure?

It is done via a short two inch incision, leaving a scar that is hidden in the midline of the scrotum. Skin glue is applied to seal the incision, and a patient can shower the next day. Pain is usually minimal.

Are erections the same after an orchiectomy MTF as before?

Because the goal of this procedure is to reduce testosterone, an bilateral orchiectomy will have the similar impact on erections as an anti androgen will.  Erections are more difficult to achieve with a drop in testosterone.

Is a letter of referral necessary for this procedure?

 

 

Dr. Gallagher’s: gender reassignment, consultation, gender pronouns

Dr. Gallagher’s: gender reassignment, consultation, gender pronouns

Gender Reassignment Access: insurance, consultation, gender pronouns, and more

Dr. Gallagher's: gender reassignment, consultation, gender pronouns

Nicole Jackson, Transgender Surgical Program Coordinator

In today’s post, I will discuss the steps involved in getting from inquiry to gender reassignment surgery with Dr. Gallagher.

The first person you’ll meet when you begin to to explore your options with Dr. Gallagher is Nicole Jackson.  Nicole is the Transgender Surgical Program Coordinator.   She will help you with insurance and scheduling, among other things.

Upon my visit to meet Dr. Gallagher, meeting Nicole was my first stop.  I found her to be not only helpful, she was informative and easy to talk to. One of my first impressions of Nicole came from the tagline in her email to me.  Under her name and contact information, she listed her preferred gender pronouns “she/her pronouns.”  This may not seem like a big deal, but how many professionals have you interacted with that have done this.  I’m going to guess none. This simple tag-line with her preferred pronouns underscores that none of us should assume another’s preferred pronouns, even if it seems obvious.

For a cis-gender female to note her preferred pronouns is a strong statement of understanding for gender variance. I now include my gender pronouns in my tag line because of her email.  (I encourage you to, also!).

One of the biggest obstacles to gender reassignment is finances.  Fortunately, more and more insurance plans are covering gender-related care, including gender surgeries.  Therefore, a big part of choosing a surgeon for GRS, SRS, chest surgery, and orchiectomy, revolves around insurance coverage and copay.

When considering Dr. Gallagher for your gender care, there are a few important steps you will need to initiate through Nicole first.

STEP ONE:  Email Nicole Jackson

Contact the office here.  Email is the quickest, most efficient way to explore costs for self-pay, or to learn your insurance coverage, if applicable.

To receive the quickest response, be preparted to provide the following information in this initial email:

  • Your name (both legal and preferred, if different)
  • Date of birth
  • Preferred gender pronouns
  • Copy of front and back of your insurance card (if applicable)
  • Indicate your desired type of gender reassignment surgery
  • Describe your current transition status:  length of time on HRT, dates of legal name change, gender marker change and FT living start date as well as any prior procedures, if you have a letter(s) of referral (necessary for surgery but not for inquiry and consult)

STEP TWO: Receive surgery cost quote

Wait patiently for your response.

They will determine your benefits and coverage.  Then she will respond by email with details about your out-of-pocket responsibility for the desired surgery.

STEP THREE:  Scheduling Consult

Once the financials are established, Nicole will schedule a consult for you to meet with Dr. Gallagher.  Not surprisingly, scheduling with Dr. Gallagher is taking longer as her schedule is rapidly filling.  Scheduling a new consultation is currently up to two to three months wait.  Scheduling is expected to eventually become a three to five month wait before long.

STEP FOUR:  Consultation

Consultation Fee

If you are using insurance, your insurance will be billed for the cost of the consultation.  You may be responsible for the copay at the time of your visit.  This can be clarified with Nicole prior to your consultation.  If you are self-pay (no insurance coverage), Nicole can also inform you directly of the fee for this consultation.

Consultation Length

Consultations for top surgery are 30 minutes.  For GRS, consultations are 45 minutes. You will see a presentation covering the surgery process, and you will  meet with Dr. Gallagher and Nicole both separately.

STEP FIVE:  Pre Determination Request

Using Insurance

After your consult, Nicole will submit your Pre Determination request to your insurance.  This is necessary for approval and pre-authorization of your surgery. This can take 30 to 60 days. Once an authorization/approval is received, surgery can be scheduled. Dr. Gallagher is currently scheduling 1 to 2 months out for surgery.

Self-pay

If paying out-of-pocket, Nicole will discuss forms, amounts and process for scheduling. Self-pay surgeries are also booked 1-2 months out. Payments must be made in full two weeks prior to surgery date. There are no payment arrangements or financing within IU Health or Plastic Surgery.  Any loans, credit lines or payment arrangements will need to be made outside of IU Health.

STEP SIX:  Gender Surgery

Location

Surgery locations vary based on insurance parameters, availability of scheduling and the selected surgery.  Currently, all vaginoplasty surgeries are done at Eskenazi. Top surgery and orchiectomies are typically performed at Senate Street Surgery Center, IU Health West Hospital and Eskenazi Hospital. Other IU Health locations are also used in certain circumstances.

IMPORTANT NOTE:  No smoking for 6 weeks before surgery. You will be nicotine tested and surgery will be cancelled if you fail the test.

Dr. Gallagher's: gender reassignment, consultation, gender pronouns - Michele O'Mara

Dr. Gallagher Discusses Vaginoplasty (surgical construction of mtf vagina)

Dr. Gallagher Discusses Vaginoplasty (surgical construction of mtf vagina)

Vaginoplasty (constructing a mtf vagina) with Dr. Gallagher

During my visit with Dr. Gallagher, she took me through the presentation she shares with patients who are considering a surgery to create a mtf vagina.  In this post, I will share with you some answers to commonly asked questions when shopping around for a surgeon to perform your vaginoplasty.

General Vaginoplasty Procedure

  • The first step of this procedure usually starts with an orchiectomy (testicle removal).
  • For most patients, Dr. Gallagher states she uses a penile inversion procedure.  This involves using both the penile skin and usually the scrotal skin to line and deepen the new vagina.
  • The new clitoris is then created from the glans (head of the penis) and the labia is shaped using the remaining tissue.
  • Another option offered by Dr. Gallagher is a “zero depth” procedure where the penis/ testicles/ scrotum is removed and a new clitoris formed without a passage for the new mtf vagina.
  • Vaginoplasty with Dr. Gallagher is considered a “single stage procedure.”  This means, every effort is made to complete the procedure during the first visit.

Labiaplasty

As state above, Dr. Gallagher’s goal is to perform vaginoplasty surgery in a single stage procedure, in an effort to prevent the need for additional surgery.  Some people, however, wish to pursue a labiaplasty.  If desired, Dr. Gallagher will perform a labiaplasty once everything is healed. When asked what is involved in a labiaplasty, Dr. Gallagher stated, “It usually involves a ‘nip tick’ to bring the labia majora together in the midline.”

Vaginoplasty Surgery Requirements

  • Dr. Gallagher states that she adheres to the Standards of Care, Version 7.
  • Three letters of referral are required for surgery. Two from mental health professionals and one from your hormone prescriber.  I am able to provide most clients with a letter of referral after one 85 minute session if you’ve been living FT for at least 5-6 months. This is true for folks outside of Indiana, too, if you live in a state that recognizes my license and allows telehealth – online sessions.  Email me for more information.
  • Patients need to be physically fit, which means your BMI is best suited for surgery when it is under 35.
  • Genital hair removal by either laser or electrolysis is required before surgery.
  • HRT is stopped for 2 weeks prior to surgery to prevent blood clots.

 

Procedure and Recovery Time for Vaginoplasty

When asked about the length of time surgery will take, Dr.Gallagher stated, “Depending on the patient, the procedure takes 4-6 hours.”  The average hospital stay is 3-7 days.

Vaginal packing stays in for 7 days and the catheter (tube in the bladder) stays for about 14 days. Once the packing comes out of the new vagina, the next step is to teach the patient how to dilate the new vagina. Dilation is necessary a few times a day during the initial healing process, then it decreases to 3 times a week once healed. Penetrative intercourse counts as dilation also.

The typical time required off of work for this procedure is roughly 4 weeks.  According to Dr. Gallagher, this varies from person to person.  Swelling can remain for a few months, thus you may not see the final results for quite some time after surgery.

Post Vaginoplasty Orgasmic Capabilities

A very common question about creating a mtf vagina is whether or not it is possible to continue having an orgasm after surgery.  I asked Dr. Gallagher what she estimates the odds are for a patient to resume orgasmic capabilities after surgery and she stated, “about 80-90% of women can resume orgasmic capabilities after surgery.”

She said that she is, “very carefully preserve the nerves to the new clitoris, which for most trans women will be the center of sexual pleasure.”  She did clarify, however, “After surgery there will be a lot of swelling so most women do not have their first orgasm for several weeks afterward.”  As for penetrative sex, Dr. Gallagher estimates that the typical patient can consider penetrative sex 8 weeks after normal healing from the procedure.

mtf vagina, vaginoplasty, mtf surgeon

Meeting Dr. Gallagher: Indiana Surgeon GRS, Orchiectomy, FTM Top Surgery

Meeting Dr. Gallagher: Indiana Surgeon GRS, Orchiectomy, FTM Top Surgery

Meeting Dr. Gallagher: Indiana Surgeon for GRS / SRS, Orchiectomy and FTM Top Surgery 

Gallagher: Indiana Surgeon for GRS / SRS, Orchiectomy and ftm Top Surgery Indiana has been gifted with a new option for transgender folks seeking to align their bodies with their authentic gender.

Yesterday, I had the privilege to meet Dr. Sidhbh “Sive” Gallagher. She is an Indiana surgeon who specializes in gender affirming procedures such as: SRS / GRS, orchiectomy, and ftm top surgery.

From Ireland originally, she is a graduate of the University of College Dublin (in the top 3 percent of her class, I might add). She completed a general surgery residency at Abington Memorial Hospital in Pennsylvania. After which she came to Indiana University School of Medicine to complete her plastic surgery fellowship.  She did additional training in Australia and Belgium, too.

As an artist who enjoys drawing and painting, she considers plastic surgery art. In talking with her, she is not only passionate about the technical aspects of her surgical craft, she also has a keen sensitivity to, and appreciation for, the dramatic impact her surgeries have on her patient’s emotional, social and psychological well-being. While showing me some of her before and after photos of top surgeries, Dr. Gallagher commented on how incredible it is to see the relief her patients feel after receiving gender affirming procedures. She understands that this is not a procedure, it is a gender-validating, life-changing step for transmen and transwomen. I found Dr. Gallagher to be easy to talk to, and she has, what I call, “good energy.”

The two most requested surgeries by gender variant clients with whom I work, are ftm chest surgery and gender reassignment surgery (GRS). Prior to 2016, the closest surgeon providing ftm top surgery to transmen was Dr. Daniel Medalie in Cleveland, Ohio. This involved a six hour drive for most Indiana trans guys.

In her first year here, five of the transmen with whom I worked chose her to perform their chest surgery. Feedback I have received following surgery has be resoundingly positive.

As for SRS (vaginoplasty), the closest surgeon my clients could find for GRS was Dr. Christine McGinn in New Hope, PA.  That is a ten+ hour drive from Indiana, making the post-surgery drive or flight home very uncomfortable.

Last year, when the option to see Dr. Gallagher became available, I had a transfemale client ask me to refer to her for a vaginoplasty. In follow up communication with my client, she is also quite pleased with both her experience and the outcomes of her bottom surgery.

Finally, Indianapolis, Indiana is now providing SRS / GRS, orchiectomy and ftm top surgery.  What a gift.

To continue reading more about my visit with Dr. Gallagher, look for the following posts: