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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