When you’re transgender, you’re faced with many options and many decisions about how to express your gender that are unique to being transgender. One of the biggest ones is whether or not to undergo top surgery to reshape your chest in a way that matches your gender. For some transgender people, this is a no-brainer: they have gender dysphoria that requires medical intervention, or they’ve simply been longing to get top surgery as long as they can remember.
You, however, might be one of the people who feels unsure whether chest masculinization (double mastectomy) or breast implants are right for you. It’s normal to have doubts! Surgery is a major and permanent decision that involves some risks. It may also feel strange to think about your familiar body looking so dramatically different. You might question whether you’ll have the support or resources to do it, or whether you’re making the decision for the right reasons.
Whatever it is you’re feeling, let’s talk about some of the ways you can check in with yourself and determine whether you’re a good candidate for top surgery.
How Old Do You Have to Be?
Surgeons who perform top surgery may have different policies on age. Some will not do surgery on a patient before they’re 18, when they are legally minors. Others will, with necessary parental consent and usually some extra steps to make sure that the procedure is in the patient’s best interests at that time. This is our policy.
The reason surgeons are more cautious about patients who are under 18 is partly legal -- in the United States, parental involvement and consent is required for surgery for minor patients. But it’s also out of concern for the patient. At such a young age, you’re undergoing so many psychological, emotional, and physical changes and also may never have experienced a major surgery before. Your doctor needs to be sure that you really understand and are ready for what you’re committing to. Because you’re still under the influence of your parents and home situation, they also need to make sure they feel like your family is prepared to support you in the ways that you’ll most need, especially during your recovery.
Of course, even if you’re over 18, if you’re still living with your parents and are financially dependent on them, your surgeon may still have many of the same questions. In general, your surgeon will take your desires seriously and respect your agency over your body, but giving you the best care means taking the steps to ensure that you’ll have what you need -- within yourself and in your support network -- to have a safe and successful surgery and recovery.
How Healthy Is Your Lifestyle?
You don’t have to be in perfect health, able-bodied, or a fitness nut to be a good candidate for gender-affirming top surgery. However, your procedure will be safer, and your recovery will be a lot easier, if you’re maintaining a reasonably healthy lifestyle. It’s important to give your body every advantage in adapting to this important change.
What does “reasonably healthy” mean? Ideally, it means that you don’t smoke, are careful about how much you drink, and are responsible about any recreational drug use. It means trying to eat regular meals with fresh fruits and vegetables and especially with low-sodium foods (to minimize swelling). It means having good habits around moving your body every day, to the extent of your physical ability -- even just regular walks or seated stretches, if that’s as much as you’re able to do. You should be getting regular physicals and managing any chronic conditions according to your physician’s instructions.
If that’s not you right now, the good news is that you can change your lifestyle to support your surgery. If that’s financially difficult for you, that brings us to the next question.
Do You Have the Resources to Have Surgery Right Now?
It’s difficult to think about money getting in the way of the body that you want, but it’s a reality you may be facing. Some surgeons take insurance, but many do not, and often the insurance process requires appealing denials and dealing with red tape. Beyond the cost of the surgery -- which can be managed with financing options-- you’ll also have to consider the costs of recovery, including time off of work, home medical supplies, pet or child care, and travel and lodging to reach your surgeon.
There are ways to get the financial support you need for gender-affirming procedures, but the thing to avoid is cutting corners. Take the time you need to get enough money together that you won’t be stressed or anxious about funds at a time when you need rest and peace of mind.
Are You In a Good Place Mentally and Emotionally?
Gender-affirming top surgery, whether you’re having your breasts enhanced or reduced, is a big decision that comes with a lot of strong emotions and that will affect your everyday life from now on. At our practice, we require patients to provide a letter from your therapist or psychiatrist confirming that you understand your procedure and the effect it may have on your life, that you understand that it’s a permanent change, and that it’s a medically necessary intervention.
Most reputable surgeons will do something similar. It’s purely for your safety and wellbeing, to ensure that you’re fully prepared for this change in your life and that your care team includes someone whose job it is to protect your mental and emotional health.
Do You Want Top Surgery Right Now?
This may seem like an odd question since you’re investing a lot of time into thinking about it, but here’s why it’s important: You should feel pretty strongly that this is something you want for yourself at this point in your life. If you’re not feeling passionately about it, you can always wait and see how you feel later-- but you can’t go back to your pre-surgery state.
If you’re considering top surgery because you feel pressure to “pass” as your gender according to mainstream beauty standards, if you’re feeling pushed to it by well-meaning friends or family, if you simply think it’s a step you have to take to “really” transition-- those aren’t great reasons to go through with it. Your body is enough just the way it is, if you are comfortable in your skin. No one else has the right to tell you how you should look in order to have your gender honored and respected.
If, on the other hand, you feel like you have the support and resources as well as the desire to take this step, there is a whole community of healthcare professionals, community advocates, and other allies ready to help you prepare for your top surgery and give yourself the body of your dreams.
Have more questions? Feeling like you might be ready to move forward with top surgery? Download our Ultimate Guide to FTM Top Surgery, check out our “Top Tips for Gender-Affirming MTF Top Surgery”, or contact us for a consultation and let us talk to you about how your procedure can empower you to live in harmony with your body.
