DESCRIPTION In most cases, bilateral mastectomy and reconstruction of the nipple and areola by grafting of native tissues affords the best chance for symmetry and proportion. This is what I believe to be a most important goal of your surgery and it can be accomplished in a single surgical procedure. This technique is the most popular and accepted surgical procedure for chest modification. It amounts to a three to four hour operation, performed under general anesthesia on an outpatient basis at a modern, gender sensitive San Francisco facility. As I indicated, my preferred technique, in most instances, employs grafts of existing nipple and areolar tissues to construct a symmetrical, properly positioned and sized male nipple/areolar segment. In certain circumstances, where the breasts are quite small, other techniques may be applicable, such as the "keyhole" or subcutaneous mastectomy through a small periareolar incision, occasionally facilitated with liposuction. If you are not uncomfortable doing so, sending preoperative photos of your chest may be an aid to me in determining the appropriate procedure to fit your particular situation, prior to a personal consultation. The keyhole technique is suitable for those patients whose breasts are quite small naturally. In this situation, a periareolar incision can be made, and all the breast tissue removed through this very same incision. The advantage, of course, is the smaller incision and the lack of need for skin grafts. It is important to be aware that a good result will require residual skin to contract naturally so as to leave no excess of cutaneous tissue. Also, there are limitations in sizing the areolae while insuring their viability. Hence, I advise such patients that there may be a need for secondary surgery in the future to achieve the best possible result. Of course, this may be the case, no matter which procedure is utilized. These procedures have inherent risks and the possibility of complications, as does any surgery, though these have been uncommon in my experience. There is the risk of blood collecting under the skin, which requires removal for safety and to achieve a good outcome. Additional risks include infection, poor scarring, failure of grafts to "take", should grafts be utilized, changes in sensation of the tissues, accumulations of serum under the skin which require removal by needle and syringe, and the possibility of a need for additional treatment or surgery. As with any surgery, no guarantees can be made regarding the final outcome. If revisions are deemed appropriate and potentially beneficial after six months to one year from the time of surgery, I am pleased to perform these at no additional cost to my patients, as your welfare and peace of mind are my goal. The only time a professional fee may be charged for revision is in those cases where a secondary operation is a predictable necessity. There is a charge made by the surgery center, in any case,for the use of their facility, as well as a charge for anesthesia services, if used.. These charges are generally significantly less than the original charges. I do require a personal consultation with patients prior to surgery. In those cases where individuals come to San Francisco from other areas of the country, this consultation can be provided just a day or two before surgery, as I have considerable correspondence with my patients long before I finally meet them. On an individual basis, I may, or may not, prior to surgery, require a letter of referral from a therapist, indicating the appropriateness of the procedure and timing of this stage of your transition. The taking of hormones prior to surgery is also not a mandatory requirement, if approved by or recommended by your therapist. Treatment, including surgery, is carried out on an outpatient basis. The surgery is performed at the the California Pacific Medical Center or the San Francisco Surgery Center, both located in the city of San Francisco, where the staff is accustomed to my patients, sensitive to their concerns, and capable and eager to provide care and assistance. Followup care is routinely administered at my office. I do recommend that patients bring a friend, family member, or partner to assist them with the early postoperative care. In cases where this is not possible, a visiting nurse may be arranged at some cost. Another option is a post operative care facility. I am pleased to provide the names of prior patients who may be helpful in answering the questions you may have relative to their personal experiences with these operations. Please feel free to contact any of them. Rob at (925) 417-7401 Ryup@aol.com Frankie at firebird13@earthlink.net pjmears@megalink.net Woodstock47@aol.com (Brad) OuttaZN@aol.com BuckNovak@aol.com Matt at MtMatt@aol.com
	For prospective patients interested in pursuing a future surgery date, a questionnaire is provided that may be filled out and returned to my office by email or postal mail. It contains information necessary to schedule surgery at the facilites where I have operating privileges.