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location:  Transition  >  Chest Surgery  >  Choosing a Surgeon

Ever since I first thought about medically transitioning, I knew I wanted chest surgery. I spent about two years researching surgeons and their results at True Spirit, Transster, and FTM Surgery Info on Yahoo, but I had a lot of difficulty finding any results from guys who were previously my size (small A) and had a subcutaneous mastectomy, which is usually the keyhole or the peri-areolar procedure. After looking at results from many surgeons, I eventually narrowed it down to three surgeons who seemed to have the most accessible keyhole and/or periareolar results: Dr. Brownstein, Dr. Fisher, and Dr. Menard at GRS Montreal. I quickly eliminated Dr. Fisher because she consistently leaves too much tissue for my liking.

It was clear both Dr. Brownstein and Dr. Menard had good and bad reports from patients, they both snail-mailed me lots of great information upon request, and they both said, because of my small size, it would be difficult to mess up my chest. I went around in circles trying to outline the pros and cons of them both in order to make my final decision. These are the factors I considered, and the most important ones are elaborated on below:

Brownstein Pros
- hospital is in the U.S.
- excellent bedside manner
- free consultation at True Spirit
- no language barrier
- would not require a letter
Brownstein Cons
- location: California, far from Vermont
- cost: about $8,000 total
- no aftercare included
- not as much experience in subcutaneous mastectomy

Menard Pros
- location: Montreal is close to Vermont
- cost: about $5,000 total
- included aftercare has great reputation
- most experience in subcutaneous mastectomy
Menard Cons
- hospital is in Canada
- possible language barrier
- harsh bedside manner
- $50 consultation (deductable)
- no results pictures available in office
- would require a letter

I was able to get my chest surgery recommendation letter fairly easily so that did not have a significant effect on choosing the surgeon. Likewise, Brownstein's consultation was free, but the $50 for Menard's is deductible from your surgery expenses if you end up having it there.

I liked that Brownstein is located in the United States, because I am familiar and confident with the U.S. hospitalization system. Menard's office and hospital is in Canada, which worried me at first. However, I do know many people who have have surgery in Canada, and it shouldn't be a real concern. Montreal is only two hours from Burlington, Vermont, and California would require plane tickets and much more travel stress and expenses. So far -- Brownstein: 0, Menard: 1

If you add up the cost of Brownstein's fees, the hospital fees, travel, lodging, and food expenses, it would total about $8,000. This includes the cost of a revision, but only for Brownstein's fees. If a revision is needed, you would still have to pay the hospital fees, travel, and food expenses. On the other hand, the quoted approximation of $5,000 from Menard includes the surgeon's fees, anesthesia, hospitalization, and a 5-night stay with meals at the Convalescence House. This does not include a revision, but the quoted cost for a revision, including anesthesia and two nights with meals at the Convalescence House, is $1,500. Travel costs to Montreal for me would be minimal. So far -- Brownstein: 0, Menard: 2

Bedside Manner:
I had a wonderful experience during my consultation with Brownstein, as he is very personable and has a great bedside manner. I left Brownstein's consultation upbeat and confident. During my consultation with Menard, I felt very awkward; it was as if he didn't have any personality whatsoever. There were weird silences and somewhat of a language barrier, and I left his consultation worried and nervous, though I couldn't put my finger on exactly why. So far -- Brownstein: 1, Menard: 2

Since Brownstein treats chest surgery as an outpatient procedure, you do not spend the night in the hospital. This means the only ones left to take care of you are those who accompany you to California. I liked how GRS Montreal has you stay in the Convalescence House the night before your surgery, in the hospital the night of your surgery, and then three more nights in the Convalescence House after your surgery. Since there are nurses on staff 24-7 in the House, it made me feel better about Menard's lack of personality/personal care attitude toward the patients. So far -- Brownstein: 1, Menard: 3

Experience with Subcutaneous Mastectomy:
Perhaps the most important factor for me was the surgeon's skill at the specific procedure. I had originally decided to go to Brownstein, because he seems to have the most consistent results for the double incision procedure (normally used for size B-cup and larger). However, when I started to look more closely at his results for his subcutaneous mastectomy procedure, I was definitely not nearly as impressed by what I saw. The results I saw were not consistent at all, and as a generalization it seemed that he tends to take out too much tissue and/or fat, commonly leaving diagonal indentations on the chest below the pectoral muscles; this is not readily fixable by a revision. He claims it is necessary to take out all of the breast tissue, even though genetic males have some breast tissue, because of the possible long-term effects of testosterone on the tissue.

I was very impressed by the Menard results I found, and they were very consistent. Menard says that he tries to take out as much breast tissue as possible, but he tries to leave fat in places to match the body shape. He does not leave breast tissue to try to contour the chest, to appear as pec muscles, but just to compliment the current fat distribution on the torso. If anything, he leaves a little too much (for my liking), but that can be easily fixed in a revision after the initial healing. The only thing I don't like about some of the results I have seen is the resulting nipple placement and size. However, that is determined by the individual's healing process and can also be readily fixed by a revision. At my consultation, I questioned him about this, and he said that "is not [my] situation, and [I] should not need a second surgery." But even if I did, it would still end up costing less and requiring less travel.

Overall -- Brownstein: 1, Menard: 4

After outlining it, I realized that really the only thing holding Brownstein in my mind was his bedside manner, his charisma. While this is very important, I chose to weigh the other factors equally, based on the fact that Menard has his staff do most of the aftercare. Despite the slight language barrier, I felt confident that Dr. Menard understands my needs and wants, due to his experience with both FTMs and MTFs. And both the cost and location were right. I had my chest surgery done with him on August 27th, 2003.