gender reassignment surgery toronto

Raw Talk Podcast: “Trans Health: True to Self” In April 2020, Dr. Brown spoke on Raw Talk Podcast about the Transition-Related Surgery Program, the first public hospital-based surgical program in Canada focused on providing safe and timely access to transition-related surgical care. His segment begins at the 28-minute mark. document.createElement('audio'); https://www.torontoplasticsurgery.com/wp-content/uploads/Raw%20Talk%20Podcast%20-%20Trans%20Health.mp3

Top Surgery – Feminine Chest Contouring

The creation of a female chest contour means different things to different people. Most commonly, this involves augmenting the size of the breast to create a breast shape that is in better proportion with the rest of the body. This is typically performed with the use of breast implants, although in some patients, the breasts can be augmented with the use of transferred fat.

Often transgender women begin the affirmation process through the use of feminizing hormone therapy, which can stimulate breast growth. This growth is often inadequate to meet the patient’s goals. It is important to recognize that breast augmentation performed for trans females has unique differences from a breast augmentation performed on a cisgender female. Not only is the underlying muscle anatomy different but there will be other aspects of feminization to address including appropriate size of the nipple and areola complex as well as the removal of unwanted hair and chest wall fat. There is a myth that transgender patients typically seek unnatural breasts; in reality their requests are as varied as those of cisgender women, ranging from a subtle and natural change to a look that is fuller and more obviously surgical.

There are several important anatomic differences between cisgender female and transgender female augmentations that often go unrecognized by patients and surgeons:

Transfemale Breast Augmentation with smooth round gel 450cc implants, Before and After 6 Months

Transfemale Breast Augmentation with 485cc implants, fold incision, Before and 10 months After

Trans-female breast augmentation with 420 cc implants, fold incision, Before and 3 Years

Trans-female breast augmentation, 280cc implant, fold incision, Before and 4 Years

Fat Injection for Transgender Breast Augmentation

Many transgender patients enquire about liposuction contour the waist and hips and help feminize the torso. Sometimes this fat is transferred into the buttocks or outer thigh. This fat can also be used for the breast. In most patients, fat alone does not produce a breast of adequate size, but it can help widen a breast that responded very well to hormones. It also can be used in conjunction with an implant to conceal the implant edges and make the breast look more natural than it might with an implant alone.

Click here for more information on breast augmentation.

Top Surgery – Chest Surgery

For many transgender and nonbinary individuals, chest surgery is essential and medically necessary to alleviate gender dysphoria. Thus, many patients request mastectomy with or without nipple areolar reconstruction. The goals of chest surgery are to create an aesthetically pleasing chest contour through the removal of breast tissue and excess skin. Chest surgery often includes reduction and repositioning of the nipple and areola. With many more patients identifying as gender fluid and nonbinary, chest surgery has evolved into a procedure that is tailored to meet a patient’s own goals. This will be discussed with you in detail at the time of your initial consultation.

The type of surgery offered will depend on the amount of tissue that is to be removed, the position of the nipple and the quality and amount of excess skin. Every effort is made to perform the surgery with as few visible scars as possible. The most common approaches include the “Keyhole” or “Periareola” procedure that involves a small incision made around the border of the pigmented areola skin, or the “Double Incision” procedure that involves the removal of the excess breast tissue and skin with or without the repositioning and resizing of the nipple and areola. This approach leaves a scar in the crease at the lower border of the pectoral muscle and a second scar around the border of the new areola if nipple areolar reconstruction is requested. Delete this line: In larger breasts a small vertical scar may also be recommended.

Adjunctive procedures, including lipocontouring of the chest wall and the use of internal shaping sutures, may also be indicated to optimize the appearance of the chest and meet your specific goals.

Top surgery is performed under general anesthesia and you will be able to go home the same day. Drains are typically used and you will be asked to wear a thin compression garment for several weeks to assist with your recovery.

Following surgery, patients often state that they have an improved level of confidence and quality of life. Surgical satisfaction is reported to be very high and a significant improvement in gender dysphoria-related mental health conditions has been found.

Transmale, double incision free nipple graft. Before and After 6 months.

Transmale, Keyhole Mastectomy, Before and 4 months after

Transmale, Double Incision Free Nipple Graft, Before and 6 Months

Transmale, Double Incision-Free Nipple Graft, Before and 3 Months After

Transmale, Keyhole Mastectomy, Before and 6 Months After

Facial Procedures

Patients will often consider a variety of facial procedures as part of the process of transition. These procedures may be either surgical or non-surgical. The specific treatment plan will be tailored to the individual’s goals and needs. Examples of common procedures include:

Bottom Surgery

Genital surgery (also referred to as “bottom surgery”) is an involved procedure requiring the participation of several health care professionals. It is important that this be performed in a center with experience managing patients undergoing transition. This option is now available in the Province of Ontario at Women’s College Hospital in Toronto.

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Canada Finally Has Nation-Wide Funding For Gender-Affirming Surgeries

With last week’s announcement from the Government of Nunavut confirming that the territory will pay for mental health services and transition treatments for transgender and non-binary residents, Canada will now have nation-wide funding available for gender-affirming surgeries. Nunavut’s Health Department is partnering with GrS Montréal to provide the surgeries.

Health care in Canada is delivered by the provinces and territories and funding for gender-affirming surgeries varies depending on where a person lives. This patchwork of coverage has resulted in barriers to accessing care that have disproportionately affected people living in Canada’s territories in the North, which includes Yukon, Northwest Territories and Nunavut. While expansion of surgery funding in Canadian provinces has continually progressed over the last decade, comprehensive coverage has only been established in the territories over the past three years.

Nation-wide coverage is obviously a very positive development but advocacy is still needed to continue the work of dismantling barriers for Canadians to access surgical care. Current challenges include:

Getting coverage across the country for Facial Feminization , Breast Augmentation and Male Chest Contouring , procedures that are excluded from funding policies in some jurisdictions.

Surgeons who practice gender-affirming genital surgery are only located in Montreal, Toronto and Vancouver. This means that many transgender and non-binary Canadians need to travel great distances to access surgeons for primary surgeries, follow-ups and specialized care for complications, incurring significant expenses that aren’t universally covered or subsidized.

Wait times are a problem that is not unique to gender-affirming surgical care in Canada but with few experts performing these surgeries patients can wait up to three years just for a consultation with a surgeon.

With the Government of Nunavut’s funding commitment, the goal of nation-wide coverage for gender-affirming surgery in Canada has been achieved. Improvements to provincial and territorial funding policies are still needed but this is a milestone to be celebrated.

Review Funding Policies by Province and Territory:

Toronto’s Women’s College Hospital launches new program for gender-reassignment surgery

This article was published more than 3 years ago. Some information may no longer be current.

Janet Macbeth, seen here, was the first patient in Canada to receive a vaginoplasty at Toronto’s Women’s College Hospital. Womens College Hospital

When Janet Macbeth underwent surgery in Toronto on Monday, it was a milestone not just for her, but for Canada.

Ms. Macbeth, 40, was the first patient to receive a vaginoplasty – a four-hour operation that gave her the female genitalia she had always desired – at Toronto’s Women’s College Hospital (WCH), the only public hospital in the country to offer the complex surgery.

“This is such an amazing program and it has so much promise,” Ms. Macbeth said in an interview before her surgery. “It’s something I feel honoured to be a part of.”

As awareness and acceptance of transgender rights has grown, so, too, has the demand for gender-reassignment surgeries, also sometimes called gender-confirming surgeries.

But until now, transgender Canadians have had to travel to the United States or to a private clinic in Montreal to receive any kind of bottom surgery, as procedures replacing a penis with a vagina, or vice-versa, are known.

The formal launch of the vaginoplasty program at WCH should begin to alleviate the Montreal clinic’s waiting list, which has grown substantially since the Ontario government loosened its rules for approving public coverage of gender-reassignment procedures three years ago, according to one of the surgeons who operated on Ms. Macbeth on Monday.

“That was the impetus for this program,” said urologist Yonah Krakowsky, medical director of the new Transition-Related Surgery program at WCH. “How can you open up these assessments and have so many people now approved for surgery without providing any access to surgical care?”

Toronto’s Women’s College Hospital (WCH) is the only public hospital in the country to offer the complex surgery. Michael Wong/Womens College Hospital

Before Ontario’s former Liberal government made a regulatory change in 2016, the Ontario Health Insurance Plan (OHIP) paid only for gender-reassignment surgeries for patients who had first received approval from one overburdened clinic at the Centre for Addiction and Mental Health (CAMH) in Toronto.

After the Liberals expanded approval-granting powers to health-care providers across the province, the number of gender-reassignment surgeries that OHIP covered in Montreal and outside of Canada jumped from 158 in 2015-16 to 414 in 2018-19, according to the Ministry of Health and Long-Term Care.

At the same time, the province began tracking the number of transition-related surgeries that were already being offered inside Ontario, including chest surgeries and the removal of the uterus or testicles.

Such surgeries nearly tripled from 204 in 2016-17 to 548 in 2018-19, the ministry said.

Other provinces have also seen an increase in demand for genital surgeries, including British Columbia, which is planning to offer bottom surgeries soon at Vancouver General Hospital.

Dr. Krakowsky and his surgical colleagues operated on Ms. Macbeth on Monday under the experienced eye of Marci Bowers, a world-renowned California surgeon who flew in to guide the Toronto team through its first three vaginoplasties at WCH this week.

Dr. Bowers has a transgender history of her own, having grown up as Mark before transitioning more than two decades ago. She has since performed transition-related surgeries on nearly 2,000 patients.

“Many of them consider this life-saving,” Dr. Bowers said. “They’ve battled this for most of their lives. The concept of gender identity is just now coming to light as being a core element of your soul, if you will.”

For Ms. Macbeth, the dawning realization that she was a girl trapped in the wrong body was one of her earliest memories.

Growing up in a conservative family in California and Georgia, she had little choice but to bury her frustrations about her gender identity. The Jerry Springer Show, where transgender people were treated like freaks, shaped her view of the future that awaited her if she came out.

“There were no role models,” Ms. Macbeth said. “There wasn’t anyone saying, ‘Hey, look! Here’s somebody that’s transgender and they have a career and they have a family and they’re living a great life.’ That’s not the representation that I would see.”

Nonetheless, Ms. Macbeth said she partly came out of the closet as a student at the University of California, Santa Cruz, declaring herself queer and trans to some close friends, including the Canadian woman she would go on to marry in 2005.

When the couple moved to Walpole Island First Nation, near Windsor, Ont., Ms. Macbeth, afraid of being shunned in her new country, returned to the closet. She lived as a man until just before their second child, a girl, was born in 2017. Her son is now 5 and her daughter is 2.

“I wanted to be able to show my children that you can be yourself. How can I model that type of behaviour if I can’t even do it myself?” Ms. Macbeth said.

Ms. Macbeth was approved to travel to Montreal for a vaginoplasty, but she chose to wait until the Toronto program – which was already providing other transition-related surgeries – was ready to add vaginoplasties to its repertoire.

Dr. Krakowsky is hopeful that Women’s College Hospital will eventually recruit a surgeon capable of performing phalloplasties, the even-more-difficult feat of constructing a penis.

“Going through surgery – whatever the surgery is – is disruptive and difficult enough as it is,” he said. “We know medical outcomes are better if you don’t travel for health care.”

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Everything you need to know about getting top surgery in Canada

It can cost thousands of dollars more out of pocket to get top surgery in Ontario compared to B.C.

Credit: Getty Images, Brian Wong/Xtra

Top surgery. Chest construction. The tit eviction. The ol’ nip-nop chip-chop. The teet yeet. Whatever you call it, it can be a life-changing and affirming procedure for trans folks of all stripes.

While it’s not necessarily important for everyone’s gender journey, the gender-affirming procedure colloquially known as “top surgery” is a big part of some trans folks’ medical transition . The COVID-19 pandemic gave many trans people the space to explore their identities and come out , and now they may be considering surgeries.

But a number of first-person accounts and guides for getting top surgery in English-speaking countries focus on the United States, which has a vastly different medical system from Canada. South of the border, the procedure can run up huge medical bills—well into the tens of thousands of dollars. And doctors like Florida’s Charles Garramone can garner thousands of online followers and celebrity-level name recognition amongst trans social media users.

@drgarramone The official TikTok channel for Dr. Charles Garramone #ftmtopsurgery #mansculpture #mansculpting #transgender #nonbinary #lgbtq #gendersurgery ♬ original sound – Dr. Charles Garramone

But here in Canada, it’s (mostly) free if you need it. Gender-affirming top surgery is covered in most provinces under our public health care system. And while that’s great news for trans folks, it doesn’t mean the process is totally easy. Not every province and territory currently has surgeons who perform the procedure, and the exact process of getting referred and paying for it ranges from jurisdiction to jurisdiction. Some provinces like British Columbia have centralized trans health care networks, while it’s the wild west in others.

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Here’s everything you need to know if you’re considering top surgery in Canada.

What is top surgery?

Top surgery is a procedure some trans and non-binary folks assigned female at birth choose to undergo in order to achieve a flatter and more traditionally “masculine” chest. It is technically different from a straight-up mastectomy, in that it usually involves some level contouring or intentional scar placement to create that “masculine” chest.

There are several techniques used to achieve this, and they vary based on patient preference and chest size. Smaller chested individuals may be able to have tissue removed without damaging or moving the nipple and areola, while larger chested folks usually require the nipple to be removed and reattached (or they may choose to go nipple-less).

A subcutaneous or periareolar mastectomy involves small incisions at the base of the nipples from which the tissue, fat and extra skin is removed. A double-incision mastectomy involves multiple incisions made on the chest in order for excess tissue and skin to be removed. The incisions are then closed together and the nipples can be reattached.

You can talk about which technique is best for you with your surgeon.

How do I get a referral for top surgery in Canada?

In most provinces, it starts with speaking with your family doctor or nurse practitioner. If you don’t have access to either, you can reach out to a local LGBTQ2S+ health group to discuss options for finding affirming medical professionals, or even to be directly connected to someone who can refer you. Rainbow Health Ontario or T hree Bridges Community Health Centre can connect you to top surgery referrals in Toronto and Vancouver, respectively.

Gil Goletski, who lives in Metro Vancouver, didn’t have a family doctor when they started their top surgery process, so they went through Three Bridges. They say it was helpful to have all of their transition-related medical care filtered through the same place—and it be an affirming place at that.

“Originally when I wanted to start hormones and they set me up with a doctor, I went to a couple of appointments with her and she started me on that process, doing the referral for surgery,” Goletski says.

During your referral appointment, you can expect to be asked questions around your feelings about your body, gender identity, dysphoria and goals for surgery or other aspects of medical transition. You’ll also talk about whether you’re able to take time off of work for the surgery and what sort of support networks you have in your life—it’s important to have a close friend, partner or family member who can pick you up from the hospital and help you out with tasks like bathing in the weeks post-op.

You’ll also be asked about your health habits, particularly smoking. Some research has shown that smoking cigarettes can increase your risk of surgical complications, including nipple necrosis (the horror situation of your nipple falling off).

While the process varies from province to province, your assessor will usually provide a determination either for or against surgery after your referral appointment, and then you move on to a surgeon.

What requirements must I meet to get top surgery in Canada?

Barriers to accessing top surgery mostly come at the level of individual surgeons. You do not have to be on HRT (hormone replacement therapy) to get top surgery, though some surgeons recommend it in order to achieve a certain look. Similarly, weight or BMI (body mass index) should not technically prevent you from getting the surgery, but internalized fatphobia in the medical system can lead to certain surgeons rejecting you.

Many surgeons will perform top surgery on anyone, regardless of size, though they may warn you about some risks and possible complications.

Some surgeons also recommend chest-related strength-building in the months ahead of surgery in order to give some muscle definition to guide the incisions.

It’s important to remember that if a certain surgeon isn’t a fit for you, there is usually an option to see another. Goletski was initially matched with one Vancouver-area surgeon, who said they couldn’t do the procedure due to their history with marijuana smoking.

“My referral was rejected because I said that I smoked cannabis, and they rejected me outright not because I wouldn’t stop before surgery but just because I smoked cannabis at all,” they say.

However, when matched with another surgeon, Goletski was told that wouldn’t be an issue as they stopped around the surgery date.

“When I eventually got surgery, it wasn’t a problem,” they say. “I was just told to stop smoking when I was healing and to do edibles or vaping instead of smoking. And that was all fine.”

Goletski also recommends that folks not be afraid to switch surgeons if a particular waitlist seems to be taking a long time, particularly in a province like B.C. where everything is centralized through an authority like TransCare B.C. They were matched to a second surgeon and languished on their waitlist for months, before getting on a third waitlist and getting in right away.

Nico Mara-McKay got top surgery in Ontario during the pandemic, and they say that the variance between medical professions means that you should be prepared to advocate for yourself.

“Do your research beforehand to know what you want because they won’t tell you what you need,” they say. “Even if you think they might, do your research.”

They said they ended up in a situation where they had to essentially dictate their referral to their doctor because the practitioner wasn’t well-versed in trans issues. They also point out that even knowledgeable doctors may not be up-to-date on the latest requirements.

“I’m not on hormones, that’s not part of my journey,” they say. “But doctors might have that old information. Make sure that you know what the rules and regulations are, or whatever health care options you have within your specific sphere, because they do change.”

How much does top surgery in Canada cost?

Ostensibly, it’s free across Canada, just like other medically necessary surgeries. But there can be unexpected fees in certain regions.

Mara-McKay got top surgery from a popular Ontario surgeon earlier this year, but say they were hit with a “contouring fee” part way through the consultation process that caught them by surprise.

“For the removal of breast tissue, there’s no fee,” they say. “But if you want contouring to get rid of ‘dog tags’ that are on the side of the chest or, you know, shape the chest, then you have to pay for it. For me, it was about $3,000.”

It turns out that’s very common in Ontario. When reached by Xtra , Rainbow Health Ontario confirmed that, unlike in other provinces, the entire top surgery procedure is not covered by the provincial health plan; most Ontario surgeons will charge the contouring fee to the patient, in addition to the top surgery cost they bill to the province.

Provincial funding from the government of Ontario only covers the basic mastectomy. However, it is usually not an option for a patient to get “just the free part,” which means Ontario patients like Mara-MacKay end up footing some couple thousands of dollars worth of surprise bills. According to Rainbow Health Ontario, this “contouring” fee is a result of public health policy in the province, and a decision to only fund part of the procedure at the provincial level.

It’s good to ask your referrer or surgeon about any fees early in the process, so you can understand your options. For example, some Ontario patients actually choose to see surgeons elsewhere, such as in Montreal, in order to get publicly-funded surgery while avoiding the contouring fee.

You should also be prepared to budget for the time off of work, which will vary depending on your job, as well as for any bandages, pain medications or other healing process needs recommended by your surgeon.

Where can you get top surgery in Canada?

In most Canadian provinces, the procedure is covered, at least partially, by public health care, since it is a medically necessary procedure for some people to alleviate gender dysphoria. Most provinces also have surgeons who will do top surgeries, though their availability can vary.

The process of accessing the surgery can vary based on provincial public health policy, funding and the number of forms you need to fill out. Here’s where you can learn more about getting top surgery in each province and territory.

British Columbia: TransCare BC

Ontario: Rainbow Health Ontario

Quebec: GRS Montreal

Alberta: Alberta’s Gender Reaffirming Program

Saskatchewan: Saskatchewan Trans Health Coalition

Manitoba: Sexuality Education Resource Centre MB

Nova Scotia: Nova Scotia Health

New Brunswick: New Brunswick Health

Prince Edward Island: PEI Health

Newfoundland and Labrador: Trans Support NL

Yukon: TransCare BC

Northwest Territories and Nunavut: NWT Health

Senior editor Mel Woods is an English-speaking Vancouver-based writer and audio producer and a former associate editor with HuffPost Canada . A proud prairie queer and ranch dressing expert, their work has also appeared in Vice , Slate , the Tyee , the CBC , the Globe and Mail and the Walrus .

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IMAGES

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COMMENTS

Transgender / Gender Reassignment Surgery in Toronto
“Top surgery” is a common term for our Toronto transgender community, more specifically my female-to-male (FTM) patients. It refers to the removal of breast
Transition Related Surgery
WCH is dedicated to supporting the health and wellness of our transgender and gender diverse clients. The surgical team of the Transition-Related Surgery (TRS)
Gender confirming surgery
How to apply for gender confirming surgery (also known as sex reassignment surgery) in Ontario. If you are eligible, this service is covered
Gender Identity Clinic (Adult)
Primary care providers can diagnose for gender dysphoria, prescribe transition-related hormones, and refer for transition-related surgeries.
Private Clinic vs Hospital for Gender Reassignment Surgery
In 2019, Toronto's Women's College Hospital (WCH), based in Toronto, made headlines for being the first public hospital in Canada to offer transition-related
Toronto home to first public hospital in Canada that offers transition
Last Monday marked the first time vaginoplasty, a surgery that constructs a vagina out of penile tissue for trans patients, had been performed
Transition-Related Procedures
For many transgender and nonbinary individuals, chest surgery is essential and medically necessary to alleviate gender dysphoria. Thus, many patients request
Canada Has Nation-Wide Funding For Gender-Affirming Surgery
Surgeons who practice gender-affirming genital surgery are only located in Montreal, Toronto and Vancouver. This means that many transgender
Toronto's Women's College Hospital launches new program for
As awareness and acceptance of transgender rights has grown, so, too, has the demand for gender-reassignment surgeries, also sometimes called
Everything you need to know about getting top surgery in Canada
But here in Canada, it's (mostly) free if you need it. Gender-affirming top surgery is covered in most provinces under our public health care