New information on transgender surgery is so welcome. We were delighted to spot an article in The Rainbow Times highlighting Boston Medical Center’s recent findings on gender affirmation surgery (GAS) from a patient study conducted through its Center for Transgender Medicine and Surgery. Here are some points we found especially interesting.
1. Today, a relatively small number of patients elect transgender surgeries.
Nearly 100 Boston Medical patients from a ten-year period of time agreed to have their charts reviewed. Of that group, just 35% had any form of GAS. All had chosen to have hormone therapy at the medical center’s Endocrine Clinic, noted Dr. Joshua Safer, hence their inclusion in the study.
One reason transgender individuals don’t choose surgery more often is that they’re typically short on resources, explained a transgender woman quoted in The Rainbow Times article. She noted that the community still faces discrimination in the workplace and other challenges that leave many people at the low end of the income scale. The situation is changing to some degree—with the governor of Massachusetts mandating insurance coverage for transgender surgery three years ago—but some level of disposable income is still required for a surgical transition.

2. Most patients aren’t choosing “bottom surgery” at this point.

For transgender individuals, genital surgery is still complicated. Another transgender woman interviewed said that it’s the most difficult, expensive and time-consuming option of all the procedures available. Many people prioritize surgery that impacts their outward identity, such as facial feminization and “top surgery.”
A transgender man added that the current risks of genital surgery outweigh the benefits for many. Even at Boston Medical, male-to-female surgery is available but the organization is still evaluating whether and when to offer female-to-male surgery.
3. Top surgery is one of the most popular procedures, particularly for transgender men.
Dr. Safer said “trans men seem to overwhelmingly be interested in chest reconstruction surgery.” He believes they want to at least walk around “confident that there is no feminine appearing breast tissue.”
Indeed, for several years we have welcomed transgender men to our practice in New York for top surgery. Male breast reduction to remove both fat and gland has been an important focus for us for thirty years. We are equally honored to work with teens, men and transgender men to help them achieve the masculine contours they seek. In addition, we will gladly perform breast augmentation for male-to-female top surgery candidates, whether with implants or fat transfer.

4. Almost everything about GAS has a long way to go.

Obviously, the medical community has much to learn about serving transgender people, especially when it comes to bottom surgery. Insurance companies need to do more to understand the varied needs of these men and women too.
For instance, one woman said to The Rainbow Times that her insurance company “has a big blind spot” when it comes to procedures related to hair. According to this patient, her company “will help a woman get breasts, a vagina and a well-sculpted face, but she will still have a beard, a hairy chest and back and be bald.”
5. But, the times they are a-changing.
Although there are still formidable obstacles for transgender people in current society, given media attention and the medical community’s growing desire to serve these patients, opportunities are increasing. There’s hope that one day transgender people will be accepted without hesitation no matter what choices they make about their lives.
One Boston Medical patient noted that things ARE starting to change for the better. She said that years ago people felt they had to fit one of two identity choices, whereas now people are accepting themselves for who they are. Sometimes this means every surgical option in the book, and sometimes it means no medical procedures at all.
If you’re considering top surgery, our New York plastic surgery practice might be just the right choice for you. Why not fill out our no-obligation, online form and tell us about yourself?

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