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GENDER AFFIRMING SURGERY

Gender affirmation surgery, also referred to as gender reassignment surgery, sex reassignment surgery, or transgender surgery are procedures by which a transgender person’s physical appearance and function of their existing sexual characteristics are altered to resemble those socially associated with their identified gender. The goal of these procedures are to give you the physical appearance and functional abilities of the gender you strongly identify with. 

Our clinic works individually with each one of our patients to find a treatment plan that will produce the desired outcome. Many of our  patients report a re-affirmed sense of identity and improved quality of life after these procedures.

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What is Gender Affirming Surgery?

Gender affirming surgery refers to a set of plastic surgery procedures that are performed on individuals with gender identity disorder (dysphoria) to help them transition to their desired and chosen gender. During this treatment, the plastic surgeon will transform the patient’s primary and/or secondary sex characteristics (e.g., breasts/chest, external and/or internal genitalia, facial features, body contouring) to match the identified gender.

Who is a candidate for Gender Affirming Surgery?

During your initial consultation with Dr. Walker, he will listen to your goals and desires, ask questions, and discuss options for particular procedures.

Dr. Walker follows WPATH (World Professional Association for Transgender Health) standards of care for all procedures he offers to provide the best care possible. 

Per WPATH guidelines, for Top Surgery to reshape the chest/breast to your chosen gender, you should meet the following criteria:

 

  • The patient should have lived in their congruent gender role for over 1 year

  • Patients should have a mental health provider that has diagnosed them with gender dysphoria and present with one referral (letter of readiness) from that mental health provider stating they are a good candidate to proceed with Gender Affirming Surgery

  • Patients should be in good mental and physical health to allow for safe surgery and be able to give informed consent

 

For breast augmentation in patients desiring male to female Top Surgery, although not an explicit criterion, it is recommended that patients undergo feminizing hormone therapy when possible to allow maximize breast growth to obtain optimal surgical (aesthetic) results.

Our goal is to respect your privacy and make you feel well supported and comfortable and to answer all of your questions so that you can make the best possible decision to meet your desired outcome. 

 

What Gender Affirming Surgeries does Dr. Walker perform?
Dr. Walker performs Top Surgery (Both Cis Male to Trans Female and Cis Female to Trans Male),
Faci
al Feminization Surgery, and Facial Masculinization Surgery. 
(Read below for more detail. Before and After Photos available during consultation)

 

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TRANSMASCULINE (CIS FEMALE TO TRANS MALE) TOP SURGERY

(AKA GENDER MASTECTOMY)

During female to male Top Surgery, or Gender Mastectomy, the patient’s breasts are surgically removed and the chest is sometimes further contoured with liposuction to give a Masculine Appearance that conforms well to the pectoralis muscle. The surgeon will also alter the shape of the nipple-areolar complex in order to give it a natural male appearance.

 

There are several techniques performed by Dr. Walker and he will assist you in confirming which can deliver the best result.

 

In general, patients who have smaller breasts can have this procedure performed via an incision in the lower half of their areola and the breast tissue is removed through this incision. This is known as the "Keyhole Technique" and there is a variation of this technique that uses an incision all the way around the nipple to allow for reduction of the nipple size. this is known as the "Periareolar Technique)

More often, for patients with larger breasts, a Double Incision Mastectomy (most commonly performed procedure) is performed with the resulting scar placed under the chest muscle (pectoralis major) crease along with a free nipple graft.

 

As an alternative, we can sometimes keep the Nipple Attached to the lower part of the breast to preserve blood and nerve supply and put it into it's new place after skin and breast tissue is removed, but this will leave some mild fullness and breast tissue and possibly a vertical scar. These are known as the "Inverted T" and "Button Hole" techniques. 

It can be intimidating and confusing in choosing which technique is best for you. Dr. Walker will counsel you on which technique he recommends following a thorough evaluation and educate you on the pros and cons of each option to make sure you make the best decision to meet your goals.

FACIAL MASCULINIZATION SURGERY

The majority of female to male patients achieve male facial features after hormone therapy is administered (before surgery). However, some patients who are looking to achieve a higher degree of masculinity may benefit from facial masculinization surgery. This procedure may incorporate forehead augmentation (lengthening), cheek augmentation to create a more angular shape, rhinoplasty to create a larger or wider nose projection, jaw contouring, chin recontouring, and thyroid cartilage (Adam’s Apple) enhancement.

Examples of Different Techniques used in Top Surgery

(Click arrows to scroll through)

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TRANSFEMININE  (CIS MALE TO TRANS FEMALE) TOP SURGERY

(BREAST AUGMENTATION)

In this type of feminization surgery (breast augmentation), Dr. Walker will use an incision under the breast crease to insert breast implants to augment the male chest to give a more female appearance. This can be performed over the pectoralis muscle. If this is done, it can help to perform simultaneous thickening of the breast tissue with fat grafting or pre operative hormone therapy to allow for improved breast coverage of the implant to avoid a "stuck on" appearance of the implant. Alternatively, the implant can be placed under the muscle with proper release of lower attachments to let the implant sit correctly on the chest wall. 

FACIAL FEMINIZATION SURGERY

This is another gender affirming male to female surgery that incorporates cosmetic procedures that address the appearance of the eyebrows, cheeks, lips, chin, hairline, eyelids, and nose. The surgeon may also reduce the patient’s thyroid cartilage (Adam’s apple). Typically, the main goal of facial feminization surgery is to ensure that the patient’s facial appearance has distinct female characteristics.

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Can Insurance be used to cover my Gender Affirming Surgery?

Our goal is to provide the easiest path to our patients to obtain their goals. Navigating the possibility for insurance coverage of these procedures can be difficult and coverage can vary between insurance providers and plans. While many Insurance plans support Transgender health, many have common requirements such as referrals from a primary care physician for HMO plans, referral letters from mental health professionals, etc, and our team is happy to help you navigate this.  

At Walker Plastic Surgery, we are Credentialed with Dallas Fort Worth's largest Insurance provider, Blue Cross Blue Shield.

 

If you have coverage with Blue Cross Blue Shield and would like assistance in checking benefits for your Gender Affirming Surgery, please email the following information to our Insurance Concierge at Insurance@nickwalkermd.com

Please send the following information so that we can effectively check for coverage for your desired procedure:

  • Full Name

  • Date of Birth

  • Procedure(s) you are looking to have covered

  • A scanned copy of your insurance card (front and back)

  • Your contact number (where we can also leave a message)

How does the Insurance Process Work?

In general, we will be checking to see if your insurance provides benefits for the "codes" associated with your desired procedure. Each procedure has a code associated with it and each insurance will tell us whether they generally offer coverage for that code if a provider deems the patient to be a good surgical candidate that meets standard of care requirements of WPATH listed above. 

The following CPT codes are used for gender-affirming top surgery, and you can also check with your insurance provider to see if your plan has benefits for coverage:

3. Once we have deemed you have coverage for the desired procedure, we will contact you and help you to schedule an in person or virtual consultation. This will allow us to obtain the necessary information and documentation for your insurance to then obtain "pre approval". Once pre approved, you will have a window of several months and we will be able to schedule your procedure!

4. If you do not have coverage or are not pre approved, we can still offer you high level care and can provide you with a customized quote for your desired procedure as well as financing options. 

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What financing options exist for gender affirming surgery through Walker Plastic Surgery?

 

Walker Plastic Surgery has partnered with Care Credit to help our patients finance the costs of their surgical procedure. The CareCredit card is North America’s leading patient payment program. The CareCredit card is easy to use, includes no hidden costs, and can be applied towards both surgical costs and follow-up appointments.

Through their website, you can access tools like the payment calculator and even find out if you qualify for a CareCredit card by starting a commitment free, instant application.

How visible will the scars be after my procedure? Is the benefit worth the required scars?

 

​At Walker Plastic Surgery, we care about your scars almost as much as you do. As a Plastic Surgeon, Dr. Walker takes pride in optimizing every scar to its best potential. Each patient will naturally be prone to making a certain type of scar color, thickness, and width, but our promise at Walker Plastic Surgery is to do everything in our power to make the scars as hidden, as small, and as blended as possible to the surrounding skin. To do this, we use a multi stage evaluation and treatment method consisting of scar evaluations throughout your healing process. Using industry leading technology, we counsel and provide our patients with access to multiple scar reducing treatments including:

 

  • High quality, low tension skin closure and well designed scars

  • Early application of Medical Grade scar cream 

  • Medical Grade Suncreen to prevent sun damage to sun exposed scars

  • Steroid injections as needed for scars that are raised or thicker than desired 

  • Microneedling and/or Morpheus 8 Radiofrequency Microneedling for thickened scars or poor scar texture

  • Laser IPL Treatments for red pigment in scars

  • Hydroquinone lightening cream for brown pigment in scars

  • Scar revisions, usually under local anesthesia, for areas of scars less than optimal after final healing. 

The scar healing process takes approximately 1-2 years from surgery to final result, and therefore we offer our patients multiple evaluations during the healing process so that proper treatments at the proper times for the best healing possible. With this multi stage evaluation and treatment scar program, we continue to put emphasis into producing the highest quality scars possible for our patients. Don't let the fear of a scar prevent you from having the shape and contour you deserve!

 

 

 

 

Examples of Long Term Scar Results after Optimization

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To schedule an appointment, online consultation or learn more about a Gender Affirming Surgery, please Contact Us or call us at (469) 899-8758.

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