Masculinizing Chest Surgery

Where should I start if I’d like to take the first step towards gender-affirming surgery?

We always recommend a discussion with your primary care and/or mental health provider to let them know this is a step you’d like to pursue. In most cases, we also require a letter from your mental health provider prior to proceeding with surgery. Being in the healthiest physical and emotional state will optimize your surgical outcomes.

Also, review your insurance policy and confirm that gender affirmation surgery is a covered benefit. If you are pursuing a consultation and future surgery through insurance, please call your plan’s member services and ask if the diagnosis code F64.9 is covered, and also if gender affirming surgery is a covered benefit. Patients sometimes discover that their office visit and surgery will not be covered, and it’s better to know this up front.

When you speak to a representative from an insurance company, always ask their name (first name, last initial) and the reference number for the call, that will be helpful to both you and to our office.

How should I prepare for my consultation, what should I bring?

Before your appointment, we will likely request that you send us a letter from a mental health provider. These letters describe your time under their care, your transition process, and their belief that you are a good candidate for surgery.

This letter is almost always a requirement from insurance companies to cover gender affirmation surgery. Referrals and notes from your primary care provider outlining your ongoing care or any medical conditions are always helpful too.

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The letter from your mental health provider (psychiatrist, psychologist, or licensed therapist) should include the following:

1. Please state your qualifications and your experience in helping people with gender dysphoria.

2. Are you familiar with and do you follow the latest WPATH (World Professional Association for Transgender Health) Standards of Care?

3. How long have you known your patient?

4. Please describe how you came to diagnose the patient with gender dysphoria.

5. Does the patient have any mental health conditions? If so, what are they, and how are these conditions being managed (with therapy, medications, or both)?

6. Does the patient have any mental health conditions that may interfere with their capacity to make an informed decision about gender affirmation surgery?

7. Has the patient ever needed a higher level of mental health care (inpatient hospitalizations, residential treatment, day programs, or substance abuse treatment)? If yes, please explain.

8. Is the patient stably housed and free of substance abuse issues?

9. Some patients have conditions or a combination of health conditions that make surgery too risky. Part of the consultation process involves assessing how appropriate surgery is for the patient at that time. In some situations, it will be advised that surgery be delayed until the patient is in better health. In rarer situations, surgery may be too risky and not advisable. We know that given the importance of gender affirmation surgery to our patients, hearing such news can be a disappointment! **Please describe how your patient navigates and handles unexpected news.**

10. Please attest that you are available to manage any unforeseen mental health circumstances from the consultation and throughout the surgical period.

Is hormone therapy a prerequisite for FTM/N top surgery?

If you are an adult interested in top surgery but are not on hormonal therapy, the first step is to speak to your healthcare provider and/or mental health professional and discuss what your transition goals are.

Most insurers now understand that the WPATH Standards of Care state that hormone therapy is not a prerequisite for FTM/N top surgery.

Unfortunately, there are still some insurance plans that require hormone therapy prior to undergoing surgery. We know that our non-binary patients may not wish to ever be on hormones, while others identify as transmasculine but feel that the main source of dysphoria is their chest, and they prefer to address this before considering hormone therapy.

When a request for surgery is denied by insurance companies due to the patient not meeting a plan’s hormone requirement, it may be possible to reverse that decision with an appeal, citing the WPATH guidelines linked above. We have had success with appeals in this regard.

Do you have a BMI restriction?

Yes. For top surgery, our patients needs to be below a BMI of 40.

Do you accept out-of-town patients, and what are the accommodations, if any?

We frequently receive requests from out-of-state patients. For your convenience, we can arrange a video consultation if this is more convenient for you than an in-person visit.

If you wish to proceed with surgery, we can provide suggestions for a hotel stay in the Columbus, Ohio area and request that you be available in town about 7 days after surgery for drain and dressing removal.

Will my insurance cover my top surgery?

Stratus Plastic Surgery is in-network with several major commercial payors: Anthem Blue Cross Blue Shield, UnitedHealthCare, Cigna, Medical Mutual of Ohio, and the OhioHealthy plan. We unfortunately do not accept Aetna, CareSource, Medicare, or Medicaid plans. Please check this section of the FAQ frequently as this can change and we will update accordingly.

***NEW as of 2/6/2024.***

Stratus Plastic Surgery and UnitedHealthCare have successfully come to an agreement. Stratus will remain in-network with UnitedHealthCare from 3/1/2024. We are very pleased with this news and grateful that our payor recognizes our value to the patients we strive to serve.

We accept the following insurance:

• Anthem Blue Traditional

• Anthem Blue Access (PPO)

• Anthem Blue Access-OH II

• Anthem Blue Access-OH I

• Anthem Blue Preferred Primary Plus (POS)

• Anthem Blue Preferred Primary (HMO)

• Cigna

• Medical Mutual of Ohio (and affiliates)

• OhioHealthy Medical Plan

• United HealthCare ***see above. Stratus will remain in-network with this payor.

If we are in-network with your insurance carrier, you will only be responsible for a copay at the time of consultation, and co-insurance to cover the out-of-pocket portion of the procedure. Post-operative appointments are usually covered for 90 days.

If we are out-of-network with your insurance carrier, we will ask for a $200 consultation fee at the time of your appointment.

In the event that insurance coverage is not possible, patients can opt to self-pay for surgery. Stratus also offers options for financing through CareCredit and Alphaeon Credit.

Do I need to stop smoking?

We kindly require that patients be nicotine free for at least six (6) weeks prior to surgery and will ask for a lab test confirming cessation prior to scheduling surgery. This requirement allows us to put your health first and to minimize controllable risks for wound-healing complications.

Is there any way to prevent or minimize scarring associated with masculinizing chest surgery?

Prospective patients who are concerned about scarring from top surgery are not alone. While this type of surgery will inevitably leave a scar, Dr. Okada takes pains to place the scar in as natural a position as possible, like the shadow of the pectoralis major muscle. Many patients are willing to accept such a scar, in exchange for a flat, masculinized chest and alleviation of gender dysphoria pertaining to one's chest. A subset of patients with very small chests might be candidates for a less noticeable scar made around the areola, by a keyhole or periareolar technique.

Dr. Okada also takes pains to teach patients about proper scar care. More can be discussed at the time of your consultation.