24x7 Transition:
Breast Augmentation Surgery

After dealing with the FFS surgery consultation and scheduling, it was time to deal with the second item on my list: the boob job. I asked the Dechamps-Braly office for a referral, and they recommended Dr. Leonard Gray, also of San Francisco.

I was already reasonably familiar with breast augmentation. My life partner (SheDaddy) has had two; her sister had one, so I had an insider's view of how it worked, the recovery period, and how it affected your life. I'd also researched, and Dr. Gray's name always came as one of the best. Plus, I knew he and Ousterhout had worked together on cases, so I wasn't surprised that he was Dechamps-Braly's first recommendation.

Dr. Gray is a world-class plastic surgeon who does much more than breast implants, but he's been interested in them since he was a student. He patented the collagen-coated breast implant in 1983 when he was at Stanford. This innovation significantly reduces contracture in breast implants and is still used. He also invented the non-surgical laser breast lift and several other things. An amazing person, and I think his biography makes great reading.

There are far more people doing breast implants, so you have plenty of options. I'm sure I could have found someone closer to where I lived who would have done a fine job. But considering that Dr. Gray is one of the very best and has years of experience with transgender women, it was a no-brainer to go with him.

I wrote his office and told them I would be in San Francisco for a day, with a consultation scheduled with Deschamps-Braly in the afternoon. I asked if it would be possible to schedule a consultation with Dr. Gray that morning. It all worked out beautifully. They told me that Dr. Gray did two consults, one virtual and one in person. They said he had time free when I was there, and we set a time to meet. Both consultations were free of charge.

The Virtual Consult

The first consult lasted about 30-40 minutes. Dr. Gray spoke for most of that time, delivering a masterclass in breast augmentation. He explained the different types of implants and various ways to do the procedure and gave his recommendations. He also discussed what could go wrong and shared his statistics with me, which are pretty impressive. I mostly listened, although I did have one question at the end. There seemed to be a dispute among plastic surgeons regarding hormones. Some believed taking them for a year before the implant procedure was important, while others did not.

The main reason to take hormones is for the physical changes. It seems they work well up to the time you are 30. After that, their effectiveness dwindles. And taking hormones comes with side effects. I've observed the effects of hormones on many of my friends over 35, and while I do see some changes, they are not enough to make me want to take the risk of hormones. I do take testosterone blockers. Dr. Gray felt that, as far as surgery was concerned, it was utterly irrelevant whether I took hormones or not. He said if I had more breast tissue, that would affect the choice of the implants, but that was about it.

The San Francisco Consult

The consult for the day I was in San Francisco was equally impressive. It took about 30 minutes and was essentially a fitting. He took my measurements and found that I am slightly asymmetrical: The left side of my rib cage projects forward a few centimeters more than my right. He suggested using a slightly smaller implant in my left breast to compensate and make the breasts appear even. He put me in a bathing suit, taped it tightly in the back, and then placed implants inside so I could see how I would look. He started small and moved to larger. I liked how I looked with the Mentor, smooth round Xtra High Profile implants in the 700-790cc range.

Besides being asymmetrical, my rib cage is also on the large side. Dr. Gray explained that he could not determine the precise size of my ribcage until he made the incisions. The implants I chose at the fitting might not look good if it's a different size, and I'll be asleep, so I won't be able to comment. He suggested we develop a few alternatives in case our first one didn't work out. High-profile implants (my first choice) have a height greater than the circumference, while low-profile implants are the opposite. If my rib cage is much wider than expected, the high-profile implants will look too far apart, which is not a good look for cleavage. So we developed several plans: Plan A, my first choice, and then plans B, C, and D, each of which has lower profiles but larger overall volume and wider bases.

The Method

To install the implants, he will make an incision that will end up underneath the breast fold (this is known as an inframammary incision). It tends to be hidden by the breast mass. This incision also allows for more precise implant placement with lower rates of side effects. There are different ways to make the incision, but this is his preference, and after hearing his reasoning, I agreed with him.

He will place the implant underneath the pectoralis major muscle, creating a pocket for it. This method should give the best appearance. He closes the incisions with absorbable sutures and glue. I will have to stay in San Francisco for about a week for follow-ups, but the other follow-ups can be virtual. The glue lasts about three weeks before falling off, and the sutures dissolve naturally. They will give me an underwire support bra for two weeks and then switch to a more supportive underwire bra for a bit more time. I will have virtual follow-ups at two weeks and then each month for four months.

I don't worry about this procedure and feel I am in the best hands. I'm looking forward to ditching my prosthetics for the rest of my life.

The Billing Procedures

I want to say how happy I was with the billing procedures at Dechamps-Braly's Clinic and Dr. Gray's practice. In the U.S., the surgery cost is always more than they tell you it will be. You pay a lot beforehand, and multiple bills arrive after the surgery. Sometimes it's unclear who is billing you since it can come from an accountant's office. I typically get three or four substantial bills, sometimes more. You always end up paying several thousand dollars more than they told you the surgery would cost. Most Americans expect that.

I don't know if California has different laws or if these doctors are better, but that was not my experience this time. Each doctor listed the procedure cost, how much they would charge per procedure, and the anesthesiologist and hospital costs. They also explained that the anesthesiologist and hospital costs would increase if the procedure went longer than expected. They told me exactly how much. Of course, if it is quicker, I would pay less.

It is a relief to know exactly how much something like this will cost. I wish this would become a model for the U.S.

That's it. Let me know if you have any questions, have had implants, or have experiences you want to share.