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Transgender Surgery in Cleveland, Ohio

Transgender Surgery| FtM top surgery|MtF breast augment|tracheal shave | Cleveland OH
For more detailed information about FtM mastectomy surgery and how to proceed with scheduling, please download Dr. Medalie's informational PDF by clicking on the button below.
If you would like to schedule an evaluation of your chest to determine what type of operation may be necessary, please e-mail front and side photos to his secretary at vrowan@metrohealth.org. Before you contact her please download the HISTORY FORM by clicking HERE, and send it along with the photos.She can also answer most of your logistical questions.Typical fees for "top surgery" are $6500-7500 (this includes anesthesia and facility fees and all post operative care).
All mail should be sent to:
Dr. Daniel Medalie
Division of Plastic Surgery
MetroHealth Medical Center
Mail stop H953
2500 MetroHealth Drive
Cleveland, Ohio 44109
Dr. Medalie in Cleveland, Ohio is an internationally recognized expert in the field of Female to Male chest or "top" surgery. He has been featured in several documentaries about transgender surgery including ones on MTV and LOGO tv.
To see him on MTV please click here
To see him on the LOGO network please click here
To see some more of his patient photos please click on this link to Transbucket. You may have to create a free account if you are not already a member.

Female to Male Chest Surgery

The procedure is based on the following:
  • Size and shape of breast
  • Elasticity of skin
  • Patient's needs and preferences
Transgender Surgery| FtM top surgery|MtF breast augment|tracheal shave | Cleveland OH Transgender Surgery| FtM top surgery|MtF breast augment|tracheal shave | Cleveland OH
Before
After
This is an example small subcutaneous mastectomy with peri areolar purse-string closure.
Transgender Surgery| FtM top surgery|MtF breast augment|tracheal shave | Cleveland OH Transgender Surgery| FtM top surgery|MtF breast augment|tracheal shave | Cleveland OH
Before
After
This is an example of double incision and nipple/areolar Grafting
In general, patients who have smaller breasts can have the entire surgery performed by having a small amount of skin removed (in a doughnut pattern , also known as-"peri-areolar or "purse-string" mastopexy"). A subcutaneous mastectomy is performed and then the outer edge of the skin is closed with a purse-string to the newly down-sized areola . By necessity the edges of the incision around the nipple will be "scalloped" or bunched up initially. This settles down to a great degree over time. If the patient understands that scar revision may be necessary, this is a very reasonable approach. The nipple may experience compromise of its blood supply and also have sensation or erectile capacity changes.
In those patients with a large amount of breast tissue with excessive skin of poor quality and droop, it is usually recommend to remove the excess skin and breast tissue in the crease of the pectoralis muscles (elliptical or double skin excision mastectomy) and put the nipples and areolae back on as grafts. This surgery has the advantage of immediate and predictable results. I can contour the skin flaps and place the nipples where I want to. It has the disadvantage of permanently altering the sensation and erectile capacity of the nipples, and it leaves larger scars on the chest. Over time they fade and flatten out. At each end of the scar, "dog-ears" may form. These are small bunches of tissue created by the closing of the ellipse as a straight line. They tend to settle down over time, but may need to be revised. I can try and address the dog ears at the time of surgery but this can extend the length of the scar.

Scheduling Surgery

I frequently perform operations on FtM patients who live out of town and are unable to easily to see me in consultation prior to the procedure.  I have several requirements for these patients:
1)I must have a therapist letter.  This letter must adhere to WPATH standards  and state that you meet the criteria for gender identity disorder and are a good candidate for this irreversible and life-changing surgery. This must be sent to us (e-mail, fax or mail) before we schedule the surgery.
2) I must see pictures prior to scheduling surgery (front and side with arms down). Please do not hold the camera yourself.
3) Patients need to go to the top of this page and download a history form (there is an easily visible link to the form), fill it out, and send it to my secretary, Valerie.
4) There is a $65 consultation fee that will be charged to you once you have all of your material gathered. This fee covers the time spent by my secretary and myself to evaluate your information. To pay, please call Valerie at 216-778-4575. This fee gets applied toward your surgery fee if you proceed with scheduling.

Typically I will perform a phone consultation several weeks prior to the procedure (or I can see them in my clinic the day before the surgery). I will then perform the operation and see them back in my clinic in 5-7 days to remove drains and change the dressing.  This means that the patient will spend around 1 week in the Cleveland area.  Patients who live far away, but can drive to Cleveland (2-6 hrs.), can go home the next day and drive back to see me for their first post-operative appointment.  I will then follow the progress of the patient via e-mailed pictures on a weekly basis. Occasionally I have had patients who have gone home and had their primary care doctor remove the drains and perform the first dressing change. I do not prefer this but do allow it if I the patient can assure me of good care. My secretary has information about hotels in the area as well as financing. For all logistical details she is the best person to contact. Her e-mail is vrowan@metrohealth.org.
All mail should be sent to:
Dr. Daniel Medalie
Division of Plastic Surgery
MetroHealth Medical Center
Mail stop H953
2500 MetroHealth Drive
Cleveland, Ohio 44109

Insurance Coverage and Fees

For more information please see my informational PDF by clicking on the button at the top of this page. Some patients are able to obtain insurance coverage for this surgery. This is typically quite rare and labor intensive for my secretary. I kindly ask all patients to be polite when interacting with my staff. We have a standard letter with standard codes that we send to insurance companies.The codes for the surgery will be simple mastectomy and nipple reconstruction (CPT 19303, 19350) and the diagnosis codes will be gender identity disorder (ICD-9: 302.85). Prior to sending this letter we require prospective patients to fax or e-mail to us some evidence that their company will cover the procedure. All insurance work must take place prior to surgery-we will not submit a letter or codes after the procedure is completed.
I typically perform chest liposuction on the sides,central chest and pre-axillary region during surgery. This is cosmetic liposuction and is used to enhance the aesthetic result. This is not covered by insurance! The fee is typically $1500 extra for this part of the procedure.Please do not ask us to submit this to your insurance-it will not be covered.

Other Procedures

Many patients ask whether other procedures can be performed concurrently with the top surgery. The most common procedure asked about is liposuction of the flanks, hips and abdomen. I do this frequently to help contour the whole trunk and would be happy to discuss this with any prospective patient. Please include the whole trunk (front and back) in the photos sent to me so that I can effectively evaluate you. The cost is variable and depends on the extent of extra liposuction performed and the anticipated time that it will take.

Metoidioplasty Surgery

In this operation, the surrounding skin of the clitoris is removed and it is released from the pubis to give the appearance of more length. The glands will appear circumcised in most patients. The final result is a normal appearing, but very small, penis. Actual result will depend on various factors as described below. The outcome is largely dependent upon how much enlargement of the clitoris has occurred with Testosterone. The best results from the metoidioplasty are in patients who are near their ideal body weight and do not have an overhanging mons pubis. In most patients, removal of some skin and liposuction of the fat of the mons will also improve the result. The principal advantage of the metoidioplasty is that it is noninvasive, maintains the sensitivity of the clitoris, and does not create apparent surgical scars. Furthermore, it does not prevent future genital surgery from being done at a later time should one decide. The penis will not, however, appear adult in size, and it is not large enough for vaginal intercourse. Dr. Medalie does not perform urethral lengthening with metoidioplasty. Dr. Medalie typically performs simple metoidioplasty as an outpatient procedure. If a patient desires scrotal construction from the labia majora and insertion of testicular implants, this procedure can be done simultaneously with the non-urethral metoidioplasty.
Before Metoidioplasty Intra-operative markings
Transgender Surgery| FtM top surgery|MtF breast augment|tracheal shave | Cleveland OH Transgender Surgery| FtM top surgery|MtF breast augment|tracheal shave | Cleveland OH
Labia Minora Incisions and Clitoral Release Labia Majora Incisions and Insertion of Testicular Prosthesis
Transgender Surgery| FtM top surgery|MtF breast augment|tracheal shave | Cleveland OH Transgender Surgery| FtM top surgery|MtF breast augment|tracheal shave | Cleveland OH
Completed Metoidioplasty with pubic lift andscrotoplasty with testicular implants Metoidioplasty with pubic lift and scrotoplasty with testicular implants-6 months
Transgender Surgery| FtM top surgery|MtF breast augment|tracheal shave | Cleveland OH Transgender Surgery| FtM top surgery|MtF breast augment|tracheal shave | Cleveland OH

MtF Chest Surgery

In those male patients who desire female breasts the first treatment that can be of benefit is the female hormone, estrogen. The results are extremely variable, but almost all patients have some growth of breast tissues. The more definitive and predictable way to achieve female breasts is through implant surgery. This surgery is no different for genetically male patients than genetically female patients. I encourage readers to see my breast augmentation section as well as examine the information at the American Society of Plastic Surgery at www.plasticsurgery.org.
Transgender Surgery| FtM top surgery|MtF breast augment|tracheal shave | Cleveland OH Transgender Surgery| FtM top surgery|MtF breast augment|tracheal shave | Cleveland OH
Before Breast Implants
After Breast Implants