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

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?