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Surgery Patient Policies
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Dr. Fischer's Office Policies for Transgender Surgery Patients All transgender patients are required to have a letter from their Gender Therapist, Psychiatrist, Primary care Physician, or Psychologist stating "Transgender surgery is the next step in their treatment for Gender Identity Disorder or Gender Transition", and "they are psychologically ready for this next step in their therapy". This is a WPATH guideline for standards of care. Be careful of surgeons not requiring a letter within the WPATH guidelines. FTM (female to male) patients are NOT required to be on any hormone therapy. All transgender patients must undergo medical clearance by their primary care physician prior to surgery.

Dr. Fischer performs two types of chest masculinization surgery (FTM Top Surgery) for her FTM patients.
   • Double Incision Method
   • FTM Top surgery ® Peri-areolar or Keyhole Method

Double Incision Method
Transgender Surgery FTM Top Surgery ® Double incision method can be performed on FTM patients presenting with pendulous sagging breasts. This usually requires a scar extending from underneath the existing breast fold to the lateral outside of the chest. The nipple and areola are removed, resized, and replaced as a "free nipple grafts" in a new position to give a "male" appearance to the chest. The scars are permanent, but most scars will fade and many patients are very happy with their new chest appearance.

Peri-areolar Method
Transgender surgery FTM Top surgery ® Peri-areolar or ("Keyhole Method") is usually reserved for FTM patients with very small breasts who have little breast tissue, breast skin that does not sag, or breast skin that is too tight to perform a double incision method.

Double Incision vs Peri-areolar ("Keyhole") Surgery
Most patients usually know if they are a candidate for the Double Incision Method. This would include breasts larger than an "A-cup", sagging breast skin, or personal preference. we receive a lot of inquiries from patients about the "Keyhole" procedure, and whether this is the right surgery for them. There are a few things that these smaller scar procedures cannot accomplish.

1. First, nipple position cannot be controlled with the "Keyhole procedure. It is not uncommon for the nipple areolar complex to actually become lower on the chest once the breast tissue is removed. The nipple should be placed in the lower outer portion of the pectoralis major muscle to give the most convincing "Male" aesthetic chest, and this is unpredictable with the "Keyhole" procedure.

2. Second, the size of the nipple areolar complex cannot be safely resized without potentially causing the blood supply to the nipple to become compromised leading to "death" of the nipple. most female areolas are much larger than a biological males, and resizing the areola is a major consideration to be made for proper surgical results to occur.

3. Third, even the slightest bit of excess breast skin below the nipple position can cause contour irregularities of the lower chest. Your skin contracts after surgery only to a certain extent, and the contraction is unpredictable. This leaves little control on how your final chest contour will appear. Also, the final chest contour may not be noticeable until several months after the initial "Keyhole" surgery, where as the chest contour for the "Double Incision Method" is more readily noticeable immediately after

All of these issues occur with the "Keyhole" or the "Purse String" surgery, and not with the "Double Incision Method". while some patients are good candidates for the "Keyhole" surgery, they may want to consider these few uncontrollable resulting outcomes and decide whether this is something they can find acceptable. otherwise, the "Double Incision method" may be the best option for them, as this is the only surgery that accurately addresses the nipple position, areola size, lower chest contour, most immediate appreciation of the final chest contour, and most aesthetically pleasing "Biological Male" outcome.

Scars and FTM Top Surgery
We receive a lot of questions regarding scars with FTM Top Surgery ®. Many questions ask about the length of the scar, the shape of the scar (straight or curved), widening of the scar, and color of the scar. You must remember, every patient is different and every patient requires a different scar and scar placement. How your scar heals depends a lot on your genetic makeup and inherent ability to heal. Dr. Fischer will discuss the potential appearance your scar and scar placement during your visit with her.

We also recommend the use of silicone based scar products for after surgery and have them available for purchase in our office.

Revisions of FTM Top Surgery
Most patients will undergo only one Transgender surgery procedure to obtain their desired chest or breast shape. Some patients may still require additional procedures to correct an asymmetry or a complication from the surgery. Transgender Surgery has no guarantees and can be very challenging. The Transgender Patient must be well informed and willing to accept the possibility of future Transgender surgery to achieve their desired goal.
Dr. Fischer does not charge for a surgeon’s fee. The only cost that the patient would be responsible for would be: Anesthesia, Supplies and Facility Fee.

Costs of surgery (effective February 1, 2012)
All top surgery costs are estimates for information purposes only and are subject to change without prior written notification.
All surgeries are performed as an outpatient procedure and do not require an overnight stay in our facility. If you are traveling from out of town, Dr. Fischer requests you stay in our local area for at least two days or more, so that we may monitor you during the early postoperative period. All costs include preoperative consultation, postoperative physician care, and 2 Notarized letters written by Dr. Fischer stating you have had irreversible sexual reassignment surgery.

Financial Info
The Aesthetic Plastic Surgery Institute accepts cash, personal checks, and most major credit cards including visa, Mastercard, American Express, and Discover.
We offer multiple options to finance your upcoming surgery with the following companies. We recommend applying for financing starting from the top of our list, and only go to the next company if you are unable to get an approved loan. while not everyone can get financing through all of these companies, they may be able to get financing through one of them. If you are running into problems or would like us to help you with the application process for any of these companies, our office staff will help walk you through the process.
As a service to our patients, we are pleased to offer the CareCredit card, the nation's leading patient payment program. with CareCredit you can finance 100% of your cosmetic surgery and there are no upfront costs, no annual fees, and no pre-payment penalties. so, you can schedule your procedure today and conveniently pay with low, monthly payments.

CareCredit offers a full range of payment plans so you can find one that works best for you. with the popular No Interest Payment Plans* there are no interest charges if you pay your balance in full within the specified time period. Monthly payments can be as low as 3% of your balance. For procedure fees from $1,000 to $25,000, carecredit offers 3 month no interest or 48 month low interest plan options with low monthly payments available.

CareCredit can be used for future surgeries without having to reapply. And by using carecredit for your cosmetic procedures, you can save your other credit cards for household or unplanned expenses. It only takes a few minutes to apply for CareCredit, and you'll receive an online decision in seconds! Apply NOW or see our staff for more details.
*Terms and conditions may apply

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