Hello! I had my top surgery October 26th, 2012 with the amazing Dr. Kathy Rumer of Philadelphia, Pa. I just wanted to make sure I posted some things for any ftm dudes seeking top surgery out there to consider BEFORE your surgery. These were just some things I learned along the way, so I hope it helps! Good luck! If you have any questions just leave a comment and I will get back to you! Also, if you are a post-op ftm and there is something I missed or something unique to your experience, please feel free to mention it in the comments.
Considerations
Going off Meds, including testosterone and antidepressants:
I’m not sure if this is unique just to my surgeon or not, but I had a list 3 pages long of of food and medication that I had to avoid two weeks prior to surgery. You can check that list out here.
This is protocol for Dr. Rumer, but I have no idea about other surgeons. You will find out when you go to your pre-op appointment to discuss the surgery and fill out your paperwork. You just may want to be prepared to go off some medication, including testosterone and antidepressants. If you have to go off antidepressants, it may be a good idea to have a trusted friend or online network available to talk if you feel depressed, or be in touch with your therapist or a maybe a drop-in (and usually free) peer counseling group if you’re not in therapy. Also, if you suffer from depression (as I do) and you have to go off your meds, it’s a good idea to have a crisis prevention number saved in your phone. Self care is sexy!
Fortunately I do not take any medications regularly, so that did not affect me. However, I am vegetarian and some of the vegetable diet restrictions were really challenging (garlic and onions?! really?!) and I ended up eating meat out of desperation. I joked that I was surviving on turkey sandwiches, oranges, and water.
Time:
If you saved up all your pennies or Grandma finally kicked the bucket and you have enough money for your surgery, unfortunately you can’t just stroll into your surgeon’s office, throw the dough on the table and say “Take me, I’m ready!” Even if your surgeon (and the surgery center they operate out of) has a crystal clear calendar, you will have to get blood work, a physical, and your surgeon may want you to restrict your diet and medications for up to two weeks before your surgery. I was financially, spiritually, physically, mentally and socially/work ready for my surgery the second week of September, and with all the pre-op work and scheduling and I had to do, the earliest my surgery could be done was October 26th.
“HIDDEN” COSTS/BUDGET CONSIDERATIONS
You might get a quote from your surgeon that the price of your surgery is say, $7,000. Make sure you have at least a couple hundred dollars beyond that for anything else you might need. If you write your surgeon a check for $7,000 and you have $5 left in your bank account, that’s bad news. Here are some things I didn’t expect to have to pay for, and some things that I even expected and want to share with you.
Breast Cancer Screening/Lab
My cost: $500 (?)
My surgeon (and I feel like this is probably universal) required my breast tissue to be sent out to Quest diagnostics to be tested for breast cancer. If you have insurance, your insurance will cover this (although you may have to navigate complications if you are listed as male on your insurance but I’m not sure). Since I don’t have insurance, I have to pay out of pocket. Nobody could actually give me an exact quote for this. My surgeon guessed that it was around $500. I am being billed from Quest and am actually still waiting for the bill to come in the mail. I will update this post when I find out how much it actually costs.
Pre-op Blood Work
My cost: approx $100 through a low-cost lab called Any Lab Test Now Philly.
Any surgeon worth their scalpel is going to make you get blood work done before your surgery. This is to make sure you are healthy enough for surgery and to see what your blood type and clotting factors are. I had to get a full metabolic profile done and a urinalysis. As a low income person in Philadelphia I have access to amazing free health care through the city, however only some of the testing I needed could be done for free. My pre-op blood work ended up costing me around $100 through a low-cost lab called Any Lab Test Now Philly.
Your surgeon might automatically recommend a lab, like Quest for example. Or perhaps they suggest that you get the blood work done through your primary care provider. However, I would ask them if, to better fit your budget concerns, it was OK for you to “shop around.” Better yet, I would do your shopping beforehand and go into your pre-op appointment knowing exactly which lab you want to use. The tests are exactly the same, and any lab is simply just going to fax the results anyhow, so what lab you use should be, under general circumstances (assuming you are healthy and excluding special health risks and concerns) irrelevant. The only difference between one lab and another sometimes is price. My advice would be to do an online search for low cost blood work or labs. Even if you have to travel, it might still save you some money.
Pre-op Physical
My cost: free
Again, any surgeon worth their sutures is going to make you get a cleared by a doctor with a physical prior to surgery. You may just go to your family doctor for this. Now, this won’t work for everyone, but if you live in or near a big city you might be able to follow my example.
I would have paid a $35 copay for my physical if I would have gone through my primary care office. Instead, I went to an open LGBT community health night that was free and you could get seen on a walk-in basis. I got just a good of a physical and care had I gone to my primary care, got my paper signed, and it was free!
(Philly folks: I went to the Washington West Project Community Health Night, held every first and third Friday of the month from 6-9pm at the Washington West building, 12th and Locust. Look up Washington West Project on Facebook for the info).
Medication
My cost: Approx $95 for two antibiotics, Percocet and Tylenol PM.
If your surgeon isn’t a masochist, they will prescribe you pain pills and antibiotic to stave off infection. I was prescribed percocet for pain and Keflax as antibiotic, which cost me $40. I picked up some tylenol PM to help with sleeping at night, since your first week post-op you can only sleep sitting up and it’s hella uncomfortable. Then, on my fourth day post-op the Keflax made me sick with nausea and a low-grade fever and my Dr. had to call in a script for a less intense version of Keflax called Cefadroxil, which cost me $27.
Anesthesia and Surgery Center Costs
My cost: $2000
My surgeon built these costs into the initial price she quoted me, but make sure you ask your surgeon if these are included in the price they quote you. It would really rain on your parade to find out after the fact that you still owe a few grand. Also, note that anesthesia is paid by the half hour that you are under it. I only paid for two and a half hours of anesthesia (my surgeon said that 2 1/2 hours is the common time it takes for top surgery), but if your surgery is complicated you may end up paying more. It might also be a good idea to ask if you will be billed if your surgeon goes beyond the amount that you initially paid for.
Other pre-op needs
There are other miscellaneous things to consider into your budgeting. I spent about $70 on surgery groceries: juice, soup, snacks, etc. Also consider transportation to and from appointments, travel and lodging if you aren’t local, supplies like gauze or surgical binders (I spent about $20 on nonstick pads for my nipples and I also needed neosporin but I had some at home already). We bought new pillows because I could only sleep propped up for the first week and our pillows were old and worn out. Your first week post-op you can only wear button-down shirts because you can’t lift your arms to pull a shirt over your head, so I spent an extra $10 on two whacky hawaiian shirts because I thought it would cheer me up. Other friends of mine borrowed button-down shirts from friends. You may spend extra money on renting movies or a Netflix subscription (I borrowed from the library). The list could go on, but the point is to just have a little extra put back for the things that will make your recovery smoother and happier.
Emergency Needs
Believe it or not, my partner and I actually did incur some emergency costs because Hurricane Sandy hit when I was 3 days post-op and we had to buy water, batteries, etc. just to be safe. It was a blessing that my apartment had no damage and we didn’t lost heat or electric, but some people in my neighborhood did. If we lost heat and electric we would have been in a world of trouble. We don’t own a car, so we might have had to rent a car or gotten a ride to a friend’s or a hotel. Also, what if you have to visit the ER? I’m not saying that you should take out a thousand dollar loan or something “just in case,” but you should have a plan. Make sure you have a credit card or that your partner or mom or someone close can afford to loan you the money if you need it up front. One time I got a concussion and went to the ER and incured a $3000 bill, which was paid for 100% through the hospital’s charity care program for low-income individuals. If you have the time, it might be wise to just do some research of what hospitals in your area provide these kind of services. You could call billing and most likely easily find out in one phone call.
There are also a lot of ways to cut down some of these costs. Discount food stores like Save-A-Lot, thrift stores, house-sitting, swapping or room renting or subletting if you’re traveling for surgery, community health initiatives, borrowing, libraries, and pre-op party with a wish list are just a few. If you have relatives or friends who didn’t donate to your surgery fund because they either couldn’t afford it or didn’t think you’d go through with it, maybe they could donate supplies or money toward medication.
It’s been my experience that a little patience and creativity can go a long, long way! Also, if you’re getting bummed about spending all this money on surgery, think of it as an investment rather than a cost. You are investing in your comfort, happiness, and lifelong dream!
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