Serious Complications, Inadequate Aftercare, and Permanent Chest Deformity One Year Later

**One year after gender-affirming chest surgery: serious complications, inadequate aftercare, and permanent contour irregularities**

One year after my gender-affirming chest surgery with Dr. Marco Carmona, I am living with extensive scarring, severe contour irregularities, and very deep indentations across my chest. There are areas where an enormous amount of tissue was removed and other areas where very little tissue appears to have been removed, leaving my chest markedly uneven.

There were problems with coordination before the surgery. A driver arranged by the practice was supposed to take me to my preoperative appointments and confirmed with me the night before. The next day, he never showed up. I was left waiting until Dr. Carmona's assistant ultimately came to pick me up herself and take me to the appointments.

I also had concerns about my experience at the surgical facility itself. During my time there, I did not observe staff handling my IVs and needles wash their hands with soap and water; instead, I repeatedly observed the use of alcohol-based hand sanitizer, including what appeared to be sanitizer applied to gloved hands.

I also had an extremely painful experience when a staff member attempted to place my IV. After she was unable to place it successfully, she repeatedly moved the needle in and out of my arm while continuing to attempt placement. The pain became severe enough that I was screaming and ultimately had to tell her to stop. I waited until I was in the operating room, where the anesthesia provider took over.

Immediately after surgery, I was told that Dr. Carmona had needed to remove much more tissue than he had expected. I was shown photographs of the tissue that had been removed. I did not understand then why so much tissue had needed to be taken.

Within approximately five or six days of surgery, I developed a significant seroma. At this point I learned that Dr. Carmona was no longer in Cancún. I was told that he had left to speak at a conference related to gender-affirming surgery.

More concerning to me than his absence itself was that there appeared to be no postoperative coverage for his patients while he was away. When I developed an acute complication only days after surgery, I was told there was no physician or other clinical backup from his practice who could evaluate and treat me.

Initially, I had to independently hire and pay a nurse who worked with Dr. Carmona to drain the seroma. The problem did not resolve. The seroma repeatedly filled again—approximately three or four times—and I ultimately had to seek care from a different surgeon in Mexico City. I underwent ultrasounds to evaluate the fluid accumulation, and the recurrent seroma had to be drained multiple times. I remained in ongoing medical care for approximately a month following my surgery as a result.

At the same time, I was dealing with four separate areas of significant skin necrosis across my chest. These areas eventually had to demarcate and slough off as the tissue healed.

Through the separate medical care I obtained, I ultimately received a clear regimen for managing the necrotic areas. The physician caring for me consulted with a skin specialist to assess the condition of my skin and determine how it should be managed.

During the entire period in which I was dealing with recurrent seromas and four areas of necrosis, I never spoke directly with Dr. Carmona. Other than my single postoperative visit with him, all communication about these complications went through his assistant, Danny, who is not a medical provider.

I do not view this as a criticism of Danny personally. If anything, I believe she was placed in the inappropriate position of being the intermediary for serious postoperative medical complications that should have involved direct communication with my surgeon or another qualified medical provider.

The guidance relayed to me from Dr. Carmona's practice regarding the necrosis was largely to continue very tight compression with the binder. Ultimately, it was the outside medical professionals I independently sought and paid who evaluated my complications, performed imaging and repeated drainage, and provided the medical management that got me through that first month.

Communication with Dr. Carmona's practice essentially stopped within the second week after surgery, while I was still dealing with recurrent seromas and skin necrosis and remained under the care of outside medical providers. I have not spoken with Dr. Carmona or his team since.

The long-term surgical result has been equally concerning.

The amount of tissue remaining across my chest is dramatically uneven. Some areas are profoundly hollow, with deep depressions where a large amount of tissue was removed. Other areas retain considerably more tissue. I also have extensive scarring across my chest that remains very prominent one year later.

This was supposed to be gender-affirming chest surgery. My experience and my surgical result have left me with serious questions about Dr. Carmona's level of specialized experience and understanding of gender-affirming chest reconstruction.

Gender-affirming chest surgery involves more than simply removing breast tissue. The amount and distribution of remaining tissue, chest contour, scar placement, symmetry, and the overall aesthetic construction of the chest are integral to the surgery. In my case, I was told immediately afterward that substantially more tissue had been removed than anticipated, and I am now living with profound indentations alongside areas where significantly more tissue remains.

There is an unfortunate reality that transgender people are an increasingly profitable market for surgeons, including surgeons who may offer gender-affirming procedures without having sufficient specialized experience performing them. Based on what happened to me—the surgical result itself, what I was told about the unexpectedly large amount of tissue removed, the complications, and the postoperative management—I have serious concerns about whether I received surgery from someone with the necessary specialized expertise in gender-affirming chest surgery.

A year later, these are no longer questions about swelling or early healing. The deep indentations, dramatically uneven contour, extensive scars, and areas of remaining tissue are still present.

The impact of this outcome has not been limited to the physical complications and permanent changes to my chest. It has also caused me significant psychological distress. I sought gender-affirming surgery with the expectation that it would bring my chest into greater alignment with myself; instead, I have had to live with a visibly altered and irregular surgical result that I did not anticipate or consent to. I have carried the emotional burden of that outcome for the past year, as well as the additional burden of needing support to cope with its psychological impact.

I am deeply dissatisfied with both the permanent surgical result and the postoperative care I received. I would not choose Dr. Carmona again for gender-affirming chest surgery.