Account of chest surgery in the USA with Dr Beverly Fischer in Baltimore, MD, USA - From London, UK. - Updated 07/2009
I wanted to write a bit about my experience of travelling from the UK for chest surgery with Dr Beverly Fischer in Baltimore, Maryland. Fairly often I hear from other trans guys in the UK who haven't even considered surgery out of this country or continent. I personally feel that surgery in the US is currently aesthetically superior to that in the UK, and generally more consistent in terms of result quality. Although I am not saying anyone who chose a UK surgeon made a bad choice (as what is right for one person is not necessarily right for everyone else), I wanted to write a bit about my experience to give other people an idea what it's like; and perhaps help them make the decision on whether to consider surgery outside of the UK, or to assist those who are already seriously considering it.
Contents
Who are you, and what led you to choose a surgeon in the USA?
I am an ftm (female to male) transsexual guy. At the time of writing (mid 2007) I am 19 years old. I began saving for surgery at the age of 16.
I did a lot of research after realising about the possibility
of having chest surgery. In the UK, as you are probably aware if
you live here, it is possible to get surgery covered on the NHS,
with a limited choice of surgeons. This however, requires an
approximate 2 year wait from the time of referral to a gender
identity clinic. At 16 I knew I was unable to get a referral to
an adult clinic before the age of 18, and was not willing to wait
a further 1-2 years after that for surgery (especially as I was
unimpressed with the majority of NHS results I had come across),
so I knew immediately I would have to go private if I wanted
surgery within a reasonable amount of time. I also knew if I went
the NHS route I would have to start testosterone before surgery,
and at the time I was much more keen on having surgery
pre-testosterone for various reasons, which only private doctors
seemed to be willing to consider. (I eventually started
testosterone before surgery anyway, but it's worth noting that
this is a possible route with some private surgeons, Dr Fischer
included.)
I started investigating private surgeons on http://www.transster.com - a
website where those who have had FTM surgery can submit photos of
their own results. This website is no longer active, but has a recent replacement at http://www.transbucket.com. Most of the contributions on the original website were
from American surgeons, but there were a few from the more well
known UK surgeons (Dai Davies and Lena Andersson). It seemed
clear to me that the results from Davies and Andersson were not
quite up to the same standard as those from surgeons like Dr
Fischer. Her results were consistently good, and generally looked
very natural, with minimal scarring, less need for revisions and
little to no major complications reported.For UK results, it is also worth checking out the galleries on the FTM-UK yahoo group.
The size of my chest and type of surgery I wanted to have also had a part to play in my decision. I was on the larger end of an A, possibly a B (I'm not entirely sure as I never measured.) I was very keen to have the peri-areolar / keyhole technique, as I did not want the large scars of double-incision if I could avoid it. It seemed to me that, despite a variation of peri being Lena Andersson's only type of surgery she would perform, she did not do it to a standard I felt comfortable with, especially after comparing it to results from surgeons such as Dr Fischer and Brownstein in the USA. Dai Davies seemed to be mostly comfortable performing peri on very small patients - small A or AA - the peri results I had seen by him on full A /small B chests were not as satisfactory, and even on the smaller chests it seemed to me that Fischer did a better job. She seemed very competent at dealing with those on the 'borderline' between double incision and peri-areolar, and it soon occured to me that if I wanted the best peri result with my chest size, she was the one for the job.
Wasn't surgery in the USA really expensive?
Actualy, no, it wasn't. Private chest surgery in the UK is generally between £4200 - £5500 depending on who you go to, with additional cost for revisions. However, thanks to the exchange rate and the fact that most US surgeons operate out of their own practices and don't require overnight hospital stays, the actual cost of surgery is less. However, there are flight costs to consider (for the person having surgery and one person to care for them as well, as it's mandatory you have someone with you after surgery), and accomodation. Even with all that, the full cost of everything for me came to less than it would have done if I'd gone to Lena Andersson who was less than an hour away from me. She usually charges towards the top end of the scale (£5500), and often requires at least one revision, which further adds to the cost.
Below I have provided a breakdown of costs, with currency conversions where they were relevant. All conversions are calculated on http://www.xe.com/ucc and are correct at the time of writing but are subject to change as the exchange rate does (it was varying between $1.8 to £1 and almost $2.1 to £1 in the time leading up to my surgery, obviously this was beneficial as it meant it was cheaper than it would have been a year beforehand.).
| Additional Info | Cost (£) | Cost ($) | |
| Surgery with Dr Fischer | 10% of the surgery balance was paid when I booked in order to secure the date. There was an additional $100 (£51 approx) for the consultation, which I had the day before surgery. | £3746.95 | $7400 |
| Return Flight (for 2) | Direct flight from Heathrow - Baltimore for myself and the person accompanying me. | £802.60 | - |
| Accomodation | 4 nights at Extended Stay
America in Timmonium. I arrived 2 days before surgery, stayed locally 2 days post op before going to stay with a friend an hour or so away from Fischer which saved money as I only had to pay for 4 nights accomodation out of 14. The rate at the extendedstay however does get cheaper the longer you stay. |
£235.54 | $474.56 |
| Travel Insurance (for 2) | I got this from Nationwide building society. We chose to opt for travel insurance that covered us in all trips we made worldwide for an entire year (called 'World Traveller' insurance, I believe), as we knew we would be travelling back for another friends surgery later in the year. Insurance for a single trip is usually cheaper, but this saved us money in the long run. | £117.00 | - |
| Taxi rides | I only used taxis from the airport and during my stay in Baltimore. The taxi fare from the airport to the hotel was $65, it cost about $5 each time to go from the hotel to Dr Fischer's office, and the same to return. It would have been an additional $60 had I needed a taxi on return to Baltimore airport, which I didn't as I stayed elsewhere shortly after surgery. | £47.00 approx | $95.00 approx |
| Prescriptions | Dr Fischer prescribed me a number of things to take
before and after surgery - anti nausea medication,
antibiotics and sleeping pills in case I had problems
sleeping post-operatively. I was able to get both the
antibiotics and sleeping pills on the NHS but still had
to pay the prescription charge for each. I could not
obtain the nausea medication in the UK for various
reasons, so I paid for that in the US, which was approx
£20 ($40) per pill (I only got one). I also would have
had to pay for the pain medication in the US as they do
not give those prescriptions out in advance, but
fortunately I was given this by Dr Fischer for free as
she had some left over. This would usually have cost
around $30 (£15, ish). Sorting out the prescriptions
was, initially, quite confusing for me due to numerous
differences between the US and the UK - in terms of drug
names, commonly used drugs, strengths and cost, etc. If
you would like to ask further questions about this feel
free to email me. Costs: Note: American doctors tend to write prescriptions for brandnamed drugs, most of these brandnames are not used in the UK. I have written the American brandnames in speech marks above (i.e "Ambien"), but if you intend on getting surgery prescriptions from a UK doctor it may be worth referring to the proper drug name (i.e Zolpidem Tartrate), as that will be what they have on the NHS computer system. |
£32.40 approx |
Aren't you really young? How could you afford to do it? Did your parents pay for it? If not, how did you manage to save the money?
My parents did not pay for any part of my surgery or travel
expenses, however they did let me continue to live with them
whilst I was working to save money, so I did not have expenses
such as rent to pay. My parents also lent me their credit card so
I could pay for it on there, as sending cheques from my account
in US dollars would have added additional bank charges of around
£20 per cheque. But all of the money for it came from me.
As I said earlier, I learned of the possibility of surgery when I
was 16 and made an active effort to save from that point on. This
included taking a gap year between college and university to
work. I had about 20% of the money I needed when I started, due
to some money I'd inherited from a relative, but still needed
about £4000, which I managed to save over about 2.5 years,
though only 6 months of that was working full-time.
I feel I was very fortunate to be able to book surgery at only 18 - I know not many people are able to be in my position. It is however, possible to earn a significant amount of money in a short amount of time if you are living with parents. I do very much appreciate the fact that my parents allowed me to continue living at their house without contributing to household expenses, without this I would not have been able to have surgery when I did. I suggest though that any young trans people who are lucky enough not to be paying rent should take advantage of it by earning as much as they can during that time, as it makes a significant difference to the amount you are able to save.
How did you book your surgery? What happened after you booked it?
Firstly I contacted Beverly Fischer's office by email in 2005,
long before I actually booked my surgery. Her email address is
available on her website, http://www.beverlyfischer.com
(there is no mention of FTM surgery on the website, but
information is available through email). I was given information
on the booking time (2-3 months in advance), price, length of
stay, etc, in the initial email, which gave me a general idea of
how I needed to go about things. I was also able to send photos
of my chest beforehand to get an idea of my options, which was
really helpful as I obviously wasn't local enough to just have a
consultation.
Once I had go to the point where I had enough money and had
discussed it with my parents, I phoned Dr Fischer's office and
enquired about available dates. I had already looking up flight
prices on Expedia and
found the time period which was cheapest to fly, and luckily they
had an afternoon slot available on the ideal day I could have had
surgery (2 days after I flew in). This gave me a day arrive and
sort things out, a day to have a consultation (which is a
requirement before surgery), and then surgery the following day.
I booked surgery on the phone that same day, leaving a deposit of $730 (£365 approx) to secure the date. I did this almost exactly 3 months beforehand, which gave me plenty of time to sort everything else out. Shortly after I booked the surgery I received a pack of information and consent forms from Dr Fischer's office, which included a number of instructions on what I needed to do beforehand (have blood tests, sign forms, get a pre-surgical clearance from my doctor.) I was able to get help from my NHS GP on all of those things, as despite the fact it was a private surgery, my GP was willing to let me get the pre-op tests done on the NHS.
What happened when it came to surgery itself?
Surgery itself was fairly uneventful - I met Dr Fischer and her staff at my consultation the day before surgery. All of them were really friendly and generally made me feel relaxed about the whole thing (I'd never had surgery before, so was somewhat nervous). They took photographs of my chest for surgical purposes, we discussed my options and it turned out I was an easy candidate for peri-areolar surgery. Immediately before surgery, I had to change in to a gown and had my chest drawn on by Dr Fischer. I went in to the operating room and don't remember a huge amount after that. When I woke up I was disorientated and in some pain (but not much). I stayed there awake for I suppose about 45 minutes, in which time I was able to phone my mother who was still in England, and then I was wheeled out to the taxi and back to the hotel.
What happened with your recovery? How long did you stay in the US?
In total I spent 14 days in the US - I flew in in the evening, 2 days before surgery, and left 12 days post op.
Recovery was really easy for me. I definitely didn't feel great immediately after surgery - but I was mostly just slightly nauseous (not nauseous enough to stop eating), my arms and sides hurt, and I generally felt a bit pathetic. When I woke up the day after surgery however I was much better, just slightly sore - but I didn't take any painkillers after that first night immediately post-op. By day 3 I was able to go out shopping, I spent the whole of day 4 out with friends without feeling tired. I wasn't 100% back to normal but I was definitely able to have a pretty good holiday despite being recently post surgery. I had my drains out on day 8 and probably could have gone back home as soon as then - but I was grateful to have a few extra days to be 100% sure everything was settled.
Wasn't it really hard to travel post surgery? Wouldn't you rather have been able to recover at home?
I had no real problems with travelling post operatively. I stayed in the US for 14 days, 12 of which were when I was post-op, so I left myself plenty of time to recover. My drains were out at day 8 (but could have come out day 6), and I was physically almost back to normal even before I had my drains out (almost because I was still unable to lift my arms high up, or lift heavy things, but I was otherwise fine). The only complication with flying was that the person accompanying me had to carry the majority of the luggage, but as we both had suitcases with wheels it was not a big issue. I flew directly from London to Baltimore and back with British Airways, and had I needed extra assistance I could have easily requested it from them, but I chose not to as I didn't feel it was necessary. It's good to know the option is available, though.
Of course, ideally, I'd have loved to have been in my own bed at home immediately post-surgery. But I think of it this way: the results I've achieved are, in my opinion, far superior to what I feel I could have achieved through surgery in England. My chest is going to be with me for the rest of my life, so one slightly uncomfortable post-op flight wasn't going to hurt me worse than a lifetime of regret that I expect I would have had if I had picked someone I considered to be an inferior surgeon and recieved a result I was less satisfied with.
Do you have to travel back to the US to see Dr Fischer again for revisions, follow up appointments, etc?
It is not required that I travel back to see Dr Fischer for any kind of follow up appointment. Of course, if I wanted a revision, then I would have to. Dr Fischer doesn't charge a surgeon's fee for revisions so it is cheaper than the initial surgery, but it is still required that you pay for the anesthesia fee and fee for use of the surgery centre, so there is some cost.
Before I had surgery I quite often had people say to me things like: 'Did you not think about what might happen if you had to go back? It would be so expensive! Stay in the UK or you'll regret it later!' It is something to consider and is of course a disadvantage of seeing a surgeon abroad - they are not easily and cheaply accesible if you need them again. I wasn't convinced by these arguments however - I was more inclined to take the risk of possibly needing a revision in the states and end up with a result I was happiest with, than go to a surgeon I considered inferior and have them available to me more locally. As it stands I don't feel I will need a revision, so it is not something I am worried about.
I want to contact you to ask more questions about your experience of going to the US for surgery. Can I email you?
Yes. I have an email address exclusively for surgery related enquiries, which is here: trans.stuff@gmail.com. Please ensure your question isn't already answered on this page before emailing.
I'm writing this 2 years post surgery. In general, I am satisfied with my results. They're probably not the best peri results I have ever seen, but overall I had few problems. The main issue I have with my chest is that shortly after surgery (within a month or two), my areolas stretched. Fischer had resized them to approximately the size of a 10p piece, but they stretched, particularly on the left size, to closer to a £2 coin. I'm not sure how much this is the fault of the surgeon or due to me doing too much too soon, or just what happens naturally sometimes. EVen so, I don't intend on seeking a revision for this. My chest 'passes' without question to those who don't know my status, although I occasionally (like many guys who have had peri) get comments on the size of my nipples being larger than most guys, but only usually from people who spend a long time looking at my chest (usually those who I have intimate contact with, so those who know already or will know soon why my chest is unusual.)
I also feel like there is potentially a small amount of extra skin on one side, but I'm the only person who seems to notice this. In terms of sensation, I have erotic and tactile sensation although the area immediately above my nipples still feels slightly strange/uncomfortable to touch. The erotic sensation is definitely different to before and occasionally can be slightly unpleasant due to feeling slightly 'overloaded', but for the most part is fine and I'm totally satisfied. I definitely have better sensation than I ever expected.
Understandably with the current economic situation, which evidently was not an issue when I had surgery, the exchange rate has suffered and surgery in the USA is less of competitive option in terms of expense than it used to be. However, if I had to do it all over again and pay an extra few thousand pounds, I would, because I still 100% believe that the results I was able to get with Fischer were far superior to anything I have seen from a surgeon in the UK.
I am still happy to answer questions about my surgery, particularly to those in the UK looking to pursue this option.