Transgender Surgery

Transgender surgery or gender affirmation surgery describes a group of procedures which help patients achieve their true gender identity.  Some patients are looking to transition from male to female, female to male or have no gender identity (non binary) and would like to remove or blunt certain secondary sex traits.

The process involves many health care professionals including internal medicine physicians, psychiatrists, endocrinologists and surgeons.

Surgery can divided up into facial or body procedures.  Facial procedures work to either feminize or masculinize the facial features.  This may include modification of the cheek bones, jaw, nose (rhinoplasty) and shaving the Adam’s apple.   Body surgeries are further split into “top” and “bottom” surgeries.  Top surgeries involve the creation of breasts (breast augmentation) and the removal of breasts (mastectomy).  Bottom surgeries involve the creation of a penis (phalloplasty) or vagina (vaginoplasty).

I perform both breast augmentation and mastectomy for transgender patients.  Breast augmentation is performed similarly to standard breast augmentation, although the technique varies slightly. Most often silicone implants are used and can provide a natural, feminine result. 

For patients looking to transition from female to male, I perform transgender mastectomies.  The technique I use most often is called the “double incision” with a free nipple graft.  This involves the removal and reduction of the nipple and areola.  The breast is then removed with an incision above and below.  The skin is then closed, placing the incision at the normal male pectoral crease. The nipple is then sutured in place, in a lower, more lateral male position. 

In very exciting news, my colleagues at the Lahey Hospital and Medical Center have started a Transgender Surgery Program which offers phalloplasty and vaginoplasty.

In the state of Massachusetts, coverage of these procedures by your health insurance company is mandated.  However, as with all surgery, patients must be appropriately selected and healthy enough to undergo surgery.  Medical problems such as obesity, smoking and other conditions are taken into account.  For more information, please make an appointment to meet in person.

Breast Reduction

It’s been a while since I posted a blog and we are now approaching a full crazy year of COVID-19.  But the operating rooms are open and we are performing elective cases. One of the most common cases I perform is breast reduction, sometimes 2 or more per week.  As many women are seeking out this surgery, I thought it would he helpful to post some information on the procedure.

Breast reduction is one of the more common surgeries performed in plastic surgery.  It is often covered by insurance.  The goal of the surgery is to reduce the size of the breasts to alleviate back and neck pain.  Besides reducing breast size, the surgery can often improve breast shape and reposition the nipple, similar to a breast lift. 

The surgery is done as an outpatient, meaning you go home afterwards.  It is done under general anesthesia, with you asleep.  The procedure takes about 3 hours.  The central portion of the breast and nipple are kept and the excess breast tissue and skin is removed.  This requires an inverted T or anchor incision which remains hidden in a bra or swimsuit. 

You will be sent home in a surgical bra and dressings, with a prescription for pain medication.  Usually, you will need this medication for only a day or two. You will be able to shower after two days.   Most patients will take 1 to 2 weeks off from work. After the surgery you will have to take it easy for a month or so, with no heavy lifting or strenuous activity.  Within 6 months you will be fully healed.

What I hear most after the surgery is “Why did I wait to do this!?”  Patients are always so happy with this life changing procedure. Don’t wait. Call for a consult!  I spend an hour with all my patients, going over all this information and answering all your questions.  I look forward to meeting with you soon.

Body Contouring

What is body contouring?

Body contouring refers to a group of procedures that can improve the shape, or contour of the body, arms and legs.  As we age, we gain weight in the form fat and our skin stretches out or becomes lax.  Certain things can make this even worse.  Pregnancy can lead to significant stretching of the abdominal wall, its muscles and skin.  And often it results in some residual weight gain.  This stretching and laxity does not go away after the baby is born or the weight is loss.  Patients who had been overweight and then lose weight can have similar results.  There are many patients who lose hundreds of pounds through surgery or diet and exercise.  Let’s take a look below at some procedures that can address these problems.

Liposuction

Liposuction is one of the most common plastic surgery procedures. It involves making very small incisions, a quarter of an inch long, and sucking out fat with long tubes or cannulas.  This is a great procedure for patients with excess fat and can be performed on the chin, arms, legs and torso.  Although, your skin will tighten a little after the fat is removed, patients with significant lose skin will need one of the procedures below. 

Panniculectomy

A panniculectomy removes the excess skin, or pannus, around the waist.  This can help  the patient feel more comfortable, fit into clothing and may help with any rashes or other problems they may be having.  Panniculectomy can be covered by your insurance. 

Abdominoplasty

An abdominoplasty also removes excess skin at the waist but it also involves a few other steps.  Abdominoplasty tightens the muscles of the abdomen, bringing them closer together.  The procedure also allows for the removal of more skin and re positioning of the belly button.

Lower Body Lift

While panniculectomy and abdominoplasty can treat excess skin and laxity in the front, you may have the same problems on your back.  A lower body lift continues around, 360 degrees, to remove excess skin and tighten your lower back. 

Breast Lift

A breast lift or mastopexy, raises the nipple back up to its natural position and re positions the breast tissue higher on the chest.  It is common procedure, particularly after breast feeding.  This procedure can also be combined with breast augmentation with implants, if the patient desires to increase her breast volume.

Arm Lift

An arm lift, or brachioplasty, removes the excess skin that hangs under the upper arms.  Excess fat can also be removed directly or with liposuction.  The incision is hidden on the inner part of the arm.

Thigh Lift

Often patients can accumulate excess skin along the inner thighs.  This can be disfiguring and uncomfortable.  The skin can rub together and fitting in clothing may be difficult.  A thigh lift removes this excess skin and tightens the upper, inner thigh.

While these procedures all share common principles there are many differences between them.  Often, they can be combined to save time under anesthesia and shorten your recovery. They are also appropriate for both men and women.  At your consultation we will review your personal surgical plan with pictures and drawings, as well as go over the recovery, risks and any questions you may have.

How do you choose implant size?

Choosing the right breast implant size

Breast Augmentation has become the most common plastic surgery procedure performed in the United States.  According to the American Society of Plastic Surgeons, a total of 300,378 breast augmentations were performed in 2017 alone!

If you are one of the many patients thinking about getting breast augmentation, the first question is usually:  What size should I get?  The selection of the correct sized breast implant depends on a few things.

Implant Diameter

First, the diameter or width of the breast implant should closely match the width of your natural breast.  This is a measurement that your surgeon should make.  Keeping this relationship in mind will lead to the most natural breast augmentation. A narrow implant will not fill out the breast. Too wide an implant will push out from the normal footprint of the breast and may appear unnatural or cause complications.

Implant Volume

A common misconception is that breast implants are sized by bra cup size.  In fact, implants are sized by their volume in cubic centimeters (cc).   Conventional breast implants range in size from 120cc to 850cc.  Using cup sizes can make things confusing since each country and bra maker have different ideas what one cup size is.   But in general, for the average sized woman, 175-200cc will increase your breast one cup size.  A much better way to determine the size you want is to discuss with your surgeon the look you want to achieve.  When visiting the office for your consultation, there are sizing implants that you may try on to get a sense of how they look and feel. 

Projection

The final measured part of the implant, after the width and volume, is the projection.  Projection is how far from the chest the implant sticks out.   Different model breast implants will have different projections.  Choosing the projection depends on your anatomy, your desired look and cleavage, as well as the other measurements we have discussed.

While there are a few things to consider when selecting your implants, the process should be exciting. The ideal implant size is the one that makes you feel happy and confident in yourself!