FTM: Mastectomy or Breast Reduction? (Photo)

HI,As you may be aware, I perform a great deal of FtM top surgeries. In regards to insurance you probably can not get approved for a reduction and then have a mastectomy instead. The insurance company will review the operative note and red flag it when the note doesn't match the approved procedure. They may then retrospectively deny the whole surgery and make you pay for it (as well as ding the doctor for possible fraudulent insurance activity). I do not take insurance but do provide letters with codes for you to seek insurance reimbursement. I am not sure if Ohio medicaid will pay for top surgery but would be happy to see you. I hope this helps.Regards,Daniel A. Medalie, MD

There are many options for gender affirming top surgery in transgender patients. For your anatomy, to get the most masculine chest contour, you would probably get the best results with a double incision, free nipple graft mastectomy. The disadvantages are that you would lose sensation and because you are darker skinned, there is a possibility that there would be some depigmentation (loss of skin color) int he nipple or areola. A breast reduction would improve your neck and back pain, but may not relieve your dysphoria. You should talk to the therapist who is treating you for the dysphoria to determine is you are ready for this step in your transition. I do not know if Medicaid covers gender affirming procedures, you would have to check your particular plan.
 It is best that you see a board certified plastic surgeon who is experienced with transgender patients for a consultation.  

A breast reduction could easily reduce your discomfort due to your enlarged breasts. As for the mastopexy option, I would recommend checking with your particular Insurance plan to see if it covers the procedure.