FTM Top Surgery | Dr. Charles Garramone | Board Certified | Asthetic Plastic Surgery Institute, PA

Dr. Charles Garramone
BOARD CERTIFIED PLASTIC & RECONSTRUCTIVE SURGEON

Aesthetic Plastic Surgery Institute, PA
Sunrise, FL | 954-752-7842

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TRANSGENDER
PROCEDURES

Introduction
About
Requirements

Procedures
FTM Top Surgery^SM Double Incision Method
FTM Top Surgery^SM Keyhole Method
ManSculpture^SM

Cost
Cost of Surgery

Resources
Transgender Resources and Websites

OFFICE LOCATION:

Aesthetic Plastic Surgery Institute, PA

Dr. Charles Garramone

12651 W. Sunrise Blvd., Suite 102

Sunrise, FL 33323

MAIN OFFICE:

(954) P L A S T I C

(954) 752-7842

Dr. Charles Garramone

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FTM Top Surgery^SM (Female To Male Transgender Chest Surgery) ManSculpture^SM (Body Masculinization)

Dr. Garramone only performs FTM Top Surgery^SM (Female To Male Transgender Chest Surgery) and ManSculpture^SM (Body Masculinization) for his Transgender Clients.

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About FTM Top Surgery^SM (Female To Male Transgender Chest Surgery) and ManSculpture^SM

Standards of Care referenced from "The Harry Benjamin International Gender Dysphoria Association's Standards Of Care For Gender Identity Disorders, Sixth Version" recently changed to "World Professional Association For Transgender Health". Dr. Garramone is an active professional member of the World Professional Association for Transgender Health.

According to the DSM-IV classification, patients, depending on their age, those with a strong and persistent crossgender identification and a persistent discomfort with their sex or a sense of inappropriateness in the gender role of that sex were to be diagnosed as Gender Identity Disorder (GID) of Childhood, Adolescence, or Adulthood.

Simply put, a person feels as though their phenotypical appearance (outside appearance) does not match their psychological sense of being. For example, a male to female Transgender (MTF) Patient may look like a man on the outside, but feel as though they are truly a female psycholgically; or vice versa for female to male (FTM) Transgender Patients. This is what has been designated "Transexualism" per medical nomenclature and has three specific criteria:

The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment;

The transsexual identity has been present persistently for at least two years;

The disorder is not a symptom of another mental disorder or a chromosomal abnormality.

The Transgender Patient has usually known or felt this difference for most of their lives, and first experienced their discomfort with their genetically determined gender at a very early age. Most Transgender Patients only come to understand their feelings and sense of identity during their adolescent and young adult lives. At this point some do not seek medical help, but others choose to undergo extensive therapy, hormone replacement, and surgical correction of the body appearance. Only recently has the acceptance of surgical modification of the body, to make the patient appear more like their self-identified gender, become more understood by our society. It still remains a "taboo" to many, but for those of us who deal with the Transgender Patient on a regular basis it is a life altering and life saving endeavor.

Sex Reassignment is Effective and Medically Indicated in Severe GID. In persons diagnosed with transsexualism or profound GID, sex reassignment surgery, along with hormone therapy and real-life experience, is a treatment that has proven to be effective. Such a therapeutic regimen, when prescribed or recommended by qualified practitioners, is medically indicated and medically necessary. Sex reassignment is not "experimental," "investigational," "elective," "cosmetic," or optional in any meaningful sense. It constitutes very effective and appropriate treatment for transsexualism or profound GID.

For female-to-male patients, a reduction procedure is usually the first surgery performed for success in gender presentation as a man; and for some patients it is the only surgery undertaken. When the amount of breast tissue removed requires skin removal, a scar will result and the patient should be so informed. Female-to-male patients may have surgery at the same time they begin hormones.

Dr. Garramone's Office Policies for Transgender Surgery Patients

All transgender patients are required to have a letter from their Gender Therapist, Psychiatrist, or Psychologist stating "surgery is the next step in their treatment for Gender Identity Disorder or Breast Hypertrophy", and "they are psychologically ready for this next step in their therapy". This is a WPATH guideline for standards of care. Be careful of surgeons not requiring a letter within the WPATH guidelines.

FTM (female to male) patients are NOT required to be on any hormone therapy.

All transgender patients over the age of 35, must have a normal baseline mammogram prior to surgery. A prescription for a mammogram will be provided to you from our office.

All transgender patients must undergo medical clearance by their primary care physician prior to surgery.

Insurance Coverage for Transgender Surgery Patients

Most insurance companies do not have written policies regarding coverage for transgender surgery, and for those insurance companies that state they do provide coverage, it is only on very select plans. This still does not guarantee payment to the surgeon for services provided. We are not contracted through any insurance company to specifically provide transgender services and therefore do not accept insurance coverage for payments of any transgender breast surgery. All FTM breast reduction surgery fees must be paid in full two weeks prior to the surgery date according to our current fee schedule listed at the bottom of this page. We will not request precertification, confirm benefits, or submit any claims to your insurance company for any procedures performed, either before or after surgery. You may arrange for your insurance company to reimburse you for the cost of surgery, but we will not negotiate a price for the surgery with your insurance company. Any attempt to submit a precertification, confirmation of benefits, or claim on our behalf without our prior knowledge will be considered fraudulent, and we will assist the insurance company with all investigations into the fraudulent claim.

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Procedures

Dr. Garramone performs two types of breast reduction surgery (FTM Top Surgery^SM) for his FTM patients.

FTM Top Surgery^SM Double Incision Breast Reduction (double incision method)

FTM Top Surgery^SM Peri-areolar Breast Reduction (keyhole method)

Dr. Garramone also performs ManSculpture^SM Body Masculinization for his FTM patients.

FTM Top Surgery^SM Double Incision Reduction (double incision method)
FTM Top Surgery^SM Double incision breast reduction can be performed on FTM patients presenting with pendulous sagging breasts. This usually requires a scar extending from underneath the existing breast fold to the lateral outside of the chest. The nipple is removed, resized, and replaced as a "free nipple graft" in a new position to give a "male" appearance to the chest. The scars are permanent, but most scars will fade and many patients are very happy with their new chest appearance.

Patient Examples

FTM Top Surgery^SM Peri-areolar Method (keyhole method)
FTM Top Surgery^SM Peri-areolar breast reduction is usually reserved for FTM patients with smaller breasts who have little breast tissue, breast skin that does not sag, or breast skin that is too tight to perform a double incision method. Dr. Garramone may recommend liposuction of the chest first to remove as much breast tissue as possible and then perform an incision along the lower border of the nipple-areolor complex. Through this incision the remaining breast tissue can be removed.

Patient Examples

Patient 7: "keyhole" or "peri-areolar" incision Reduction with liposuction of chest wall

Watch the first unveiling of "6Pak's" chest after his FTM Top Surgery^SM double incision reduction .

Here is "6Pak" almost 3 weeks after his FTM Top Surgery^SM double incision reduction .

ManSculpture^SM Body Masculinization
ManSculpture^SM Body Masculinization is commonly performed at the same time as FTM Top Surgery^SM. This consists of shaping the body to a more "masculine" form with the use of Power Assisted Liposuction techniques. By lipocontouring the abdomen (stomach), love handles, and the "saddle bag" area of the outside hips, we can give your body a more streamlined and masculine appearance. By performing ManSculpture^SM at the same time as FTM Top Surgery^SM, you can save money on the overall operating costs, as performing both procedures separately at different times will be considerably more costly. This is why Dr. Garramone recommends this procedure to be performed safely and concurrently with your chest surgery.

Patient Examples

Revisions of FTM Top Surgery^SM

Most patients will undergo only one procedure to obtain their desired chest or breast shape. Some patients may still require additional procedures to correct an assymetry or a complication from the surgery. Breast surgery has no guarantees and can be very challenging. The Transgender Patient must be well informed and willing to accept the possibility of future surgery to achieve their desired goal. With this in mind, the Transgender Patient has many options for their surgical care and after surgery can begin their life with a new sense of well being.

Scars and FTM Top Surgery^SM

We receive a lot of questions regarding scars with FTM Top Surgery^SM. Many questions ask about the length of the scar, the shape of the scar (straight or curved), widening of the scar, and color of the scar. You must remember, every patient is different and every patient requires a different scar and scar placement. How your scar heals depends a lot on your genetic makeup and inherent ability to heal. Dr. Garramone will discuss the potential appearance your scar and scar placement during your visit with him. We recommend the use of silicone based scar products for after surgery and have them available for purchase in our office.

FTM Top Surgery^SM Double Incision Vs "Keyhole" Surgery

Most patients usually know if they are a candidate for the Double Incision Method. This would include breasts larger than an "A-cup", sagging breast skin, or personal preference. We receive a lot of inquiries from patients about the "Keyhole" or "Purse String" procedure, and whether this is the right surgery for them. There are a few things that these smaller scar procedures cannot accomplish. First, nipple position cannot be controlled with the "Keyhole procedure. It is not uncommon for the nipple areolar complex to actually become lower on the chest once the breast tissue is removed. The nipple should be placed in the lower outer portion of the pectoralis major muscle to give the most convincing "Male" aesthetic chest, and this is unpredictable with the "Keyhole" procedure. Second, the size of the nipple areolar complex cannot be safely resized without potentially causing the blood supply to the nipple to become compromised leading to "death" of the nipple. Most female areolas are much larger than a biological males, and resizing the areola is a major consideration to be made for proper surgical results to occur. Third, even the slightest bit of excess breast skin below the nipple position can cause contour irregularities of the lower chest. Your skin contracts after surgery only to a certain extent, and the contraction is unpredictable. This leaves little control on how your final chest contour will appear. Also, the final chest contour may not be noticeable until several months after the initial "Keyhole" surgery, where as the chest contour for the "Double Incision Method" is more readibly noticeable immediately after surgery. All of these issues occur with the "Keyhole" or the "Purse String" surgery, and not with the "Double Incision Method". While some patients are good candidates for the "Keyhole" surgery, they may want to consider these few uncontrollable result outcomes and decide whether this is something they can find acceptable. Otherwise, the "Double Incision Method" may be the best option for them as this is the only surgery that accurately addresses the nipple position, areolar size, lower chest contour, most immediate apreciation of the final chest contour, and most aesthetically pleasing "Bio-male" outcome.

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Cost of FTM Top Surgery^SM (Female To Male Transgender Chest Surgery) and ManSculpture^SM

All top surgery costs are estimates for information purposes only and are subject to change without prior written notification.

All surgeries are performed as an outpatient procedure and do not require an overnight stay in a hospital. If you are traveling from out of town, Dr. Garramone requests you stay in our local area for at least one week so he may monitor you during the early postoperative period.

All costs include preoperative consultation fee, postoperative physician care, a letter written by Dr. Garramone, and revision surgery for up to one year after surgery. Revision surgery is only covered if related to the prior surgery performed by Dr. Garramone. If revisions must be performed in a hospital or surgery center, only Dr. Garramone's fee will be waived. The patient is responsible for all outside OR fees.

FTM Top Surgery^SM Double Incision Reduction with Free Nipple Grafts

$5,700: Includes Hospital OR Fees, Surgeon's Fee, all Breast sizes, liposuction and Pathology Fee

FTM Top Surgery^SM "Keyhole" or "Peri-areolar" Incision Reduction

$6,300: Includes Hospital OR Fees, Surgeon's Fee, liposuction of chest and Pathology Fee

ManSculpture^SM Body Masculinization (liposuction of abdomen, love handles, and outside hips)

$3,500 to $4,500 : This is in addition to Top Surgery when performed at the same time. Many patients choose to have this be performed at the same time to better contour their body to a more masculinized form. It is also more cost effective to have this performed at the same time as Top Surgery and Includes Hospital OR Fees and Surgeon's Fee

All preop labs, prescription medications, mammograms, and postoperative garments are not included in the above fees. We will provide prescriptions (to be filled by the patient) for all medications, labs, and mammogram studies.

All specimens of breast tissue removed during surgery must be sent to pathology for microscopic evaluation to rule out any evidence of breast disease.

If you are considering FTM Top Surgery^SM (Female To Male Transgender Chest Surgery) and ManSculpture^SM, schedule a private in-person or telephone consultation with Dr. Garramone today. Dr. Garramone has quickly become one of the worlds leading Plastic Surgeons in FTM chest reconstruction and is a vocal advocate in the media and within his surgical practice for Transgender rights. Our office is a private setting with your comfort in mind. All of our office staff maintain strict confidentiality and expert care personalized to you. Don't be shocked when we treat you like a person, and not just another patient. You can ask any of our Transgender clients who have been patients with us in the past. All of our patients, yes all of them, have been more than forthcoming to speak to all of our new patients. Call us today so we can help make your transition a positive experience.

Please email Dr. Garramone directly if you have any questions: drgarramone@drgarramone.com

Rate us at Susan's Place Transgender Resources:

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