CONSULTATIONS & FAQ

We no longer require a therapy letter or specific time on hormones prior to FTM or MTF top surgery or body sculpting. We use the informed consent model for those procedures.

If there are any doubts about someone’s ability, emotionally or mentally, to give informed consent for a procedure I will ask them to see a licensed mental health provider prior to considering an elective surgery – whether they are gender variant or not.

Homewatch CareGivers are our preferred post-surgical service provider.

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A family history of breast cancer does not prevent you from having FTM chest reconstruction. If you have a first-degree relative (mother, sister, daughter) with breast cancer you should have a mammogram 10 years younger than they were when they were diagnosed or between 40-45 years old – whichever comes first.

There are several breast cancer risk assessment tools you can use to estimate your overall risk. This is an easy one (Cancer.gov). It may help you determine if you want to get a mammogram prior to top surgery. There is also the possibility of sending the tissue from both breasts to pathology for examination. We can get you a price estimate for that. However, it is rarely indicated.

I was happy to see Jeff Taylor’s article in Qnotes exploring breast cancer risk and the transgender community. He makes an important point that we all, cis and trans men and women, have breast tissue which extends to the clavicles (collar bones) and into the axillae (underarms) and is retained after mastectomies in cis women and chest reconstructions in trans men.

During ten years as a general surgeon I coordinated the surgeries and oncological care for cis women with breast cancer, as well as 3 cis men with the disease. Now, as a cosmetic surgeon performing “Top Surgeries” for trans men and trans women, I am often the first physician who discusses transgender breast cancer screening with my clients. This is likely because, as Mr. Taylor notes, there are no guidelines for their primary care physicians to follow.

Given the current lack of research, I give my patients the following recommendations based on my own experience and our current knowledge of this disease:

1. Trans men who have not had chest reconstruction, and trans women on HRT should follow the same guidelines for breast cancer screening as cis women. These guidelines are evolving; but basically get your first mammogram at 40-50 years old and then annually. This may be continued annually, or reduced to every other year, after the age of 55.
2. Trans women on HRT whose anatomy makes mammograms difficult should follow the guidelines above substituting MRIs for mammograms.
3. Trans men who have had chest reconstruction, cis men, and trans women who are not on HRT, should have an annual physical exam by a medical professional which includes palpation (careful feeling) of the chest and underarms beginning at 40-50 years old. A CT or MRI should be obtained if, on self-exam or professional physical exam, any lumps, tenderness, nipple discharge, or other abnormalities are found. If there is a lump on palpation, CT, or MRI it should be further investigated by a needle or excisional biopsy.

The original article can be read here: Qnotes Breast Cancer Article. As always, I am happy to answer patient questions about this or other surgical issues in consultation at our private office and surgery center in South End Charlotte.

It is common for top surgery patients to avoid looking at areas of the body which cause dysphoria before surgery and then scrutinize their chests more closely after top surgery. Occasionally, our patients notice small bumps on their areola for the first time after surgery and wonder if they are abnormal.  

So, what are these bumps? 

1.Montgomery glands: The pigmented area of skin around the nipple is called the areola. On the areola there are little raised bumps called Montgomery glands and they are a normal part of breast anatomy. They are sebaceous glands which produce fluid (sebum) to moisturize the nipple. The actual glands are typically removed with a nipple graft procedure; but the small, raised areas where they connected to the outer skin remain. Incidentally, grafted skin can sometimes be dryer as a result of removal of these glands and require moisturizer. The glands themselves will usually remain in place with the buttonhole technique.  

 Everyone has Montgomery glands. If you have them and someone else appears as if they don’t, don’t sweat it. As with every other part of your body, there’s a lot of variation between different people.  Some may have large, obvious bumps, while others have very small ones that are barely visible. 

2. Your Montgomery glands could be blocked: Just like sebaceous (oil) glands on your face and the rest of your body, Montgomery glands can get blocked causing little, red, swollen pimples.  As with breakouts anywhere on the body, this is not a problem if it comes and goes. A blocked gland can be treated with warm compresses and exfoliation. If they are persistent and continue to increase in size and tenderness, treatments such as antibiotics, drainage, or steroid injections could be used, but are very rarely needed. 

3. You have an ingrown hair: You might also notice strands of hair in bumps on your nipples or areolae. This is also completely normal.  As with any other area where there are hair follicles, ingrown hairs are possible on any nipple, areola or nipple graft. When a hair curls back into the skin rather than pushing through, they are “in grown” and look like pimples or blocked glands, except the loop of hair is sometimes visible.  This can feel itchy or tender. They sometimes spontaneously resolve; but can also be treated with warm compresses and exfoliation. If they persist and appear infected, a dermatologist can aid in removing the affected hair.  

The Cosmetic Concierge (CC) is an office-based surgical center with AAAHC accreditation. To maintain compliance with the North Carolina Medical Board (NCMB) and American Society of Anesthesiologists (ASA), all patients must have a BMI greater than or equal to 18.5 and below 40.0 to qualify for a surgical procedure at CC. Patients seeking a body lift or abdominoplasty must have a BMI of less than 35.

At our practice, we do not routinely require a preoperative psychological evaluation for patients seeking gender-affirming surgeries. We follow surgical standards of care, which emphasize an informed consent model. Our goal is to respect the autonomy and decisions of our patients while ensuring their safety and well-being.

While preoperative psychological evaluations are not a routine requirement, Dr. Sherie may occasionally request a therapist’s recommendation if she feels it is in the best interest of the patient. This is done to ensure that all aspects of the patient's well-being are considered before surgery. In such cases, the recommendation helps confirm that the patient is emotionally and mentally prepared for the procedure.

Yes, for cisgender men seeking an orchiectomy, we do require a therapist’s recommendation. This is to ensure that the patient is making the decision for discernible personal reasons and is not under external pressure or influence. This added step is a precaution to protect the patient’s autonomy and ensure they are fully informed and committed to the procedure.

If a mental health evaluation is requested and you do not have a therapist, we can assist you by recommending mental health professionals who are familiar with preoperative evaluations and informed consent. We work with trusted professionals both locally and via telehealth, so you can choose the option that is most convenient for you.

In most cases, you will not need a mental health evaluation before surgery. However, Dr. Sherie will inform you if a therapist’s recommendation is recommended or required based on your individual situation at the time of your consultation. Any preoperative requirements will be given to you along with your surgical quote at the conclusion of your consultation appointment. Our team is here to guide you through the process and ensure that you have all the information and support you need.

If you have any further questions or need assistance, please don’t hesitate to contact our office. We're here to support you every step of the way!

The Cosmetic Concierge does not accept insurance or process reimbursements. As an office-based practice, our surgical fee includes all associated costs and services. Services are not billed separately, and invoices cannot be itemized.