Local doc is top provider of ‘top’ surgery

Brian Eichenberg, M.D. is a board-certified plastic surgeon specializing in female-to-male (FTM) chest contouring surgeries – commonly referred to in the FTM community as “top” surgeries. He completes approximately fifty of these surgeries each year, and that works out to about a tenth of his surgical practice.

Essentially, “top” surgery is the removal of breasts to take a female chest and make it a male chest – contouring the shape of the chest in the process. The surgery specifically addresses the discomfort that many trans men have with their bodies due to gender dysphoria.

Dr. Eichenberg practices medicine at the Renuance Plastic Surgery Center in Murrieta, Calif., and this means Dr. Eichenberg is the closest surgeon, specializing in FTM surgeries, to San Diego. Most of his “top” surgery referrals come from FTMs whom he’s previously treated and his surgical satisfaction rate is high.

While talking to Dr. Eichenberg recently, I asked him about surgical outcomes for trans men. One of the things we talked about was patient satisfaction. One thing I learned about patient satisfaction with trans surgeries was the link with reasonable expectations going into the surgeries. Patients satisfied with their surgical outcome have realistic expectations of what the surgery can and can’t accomplish, and that’s something of which he and his staff are very cognizant. Part of his practice is being aware of individual patients’ expectations and ensuring their expectations are reasonable.

We also discussed how androgens (male hormones) have a better effect at masculinizing trans men than estrogens have at feminizing trans women; but surgical outcomes for trans men are often said to be less satisfactory than the surgical outcomes for trans women. I wanted to know where he thought surgeries for trans men would be in twenty years – from a technical standpoint relating to patient satisfaction. He said in response:

“Typically in surgery there are no giant leaps and bounds. There are very small incremental steps. So I think twenty years from now there will have been multiple small level steps that will have made things better, but there won’t be one giant leap where one day we’ll say ‘Now we have this figured out because we’re doing this.’ It will be a bunch of tiny steps that happen along the way. It’ll be things like making people bleed less and making scars look better and making people recover faster.”

What Dr. Eichenberg and I are aware of is that some insurance policies are covering trans related surgeries, and the trend is upward. The market is going to function to help improve surgical procedures. Not only will trans related surgeries technically improve as more resources become available for these surgeries, but trans people’s individual lives will improve as they have more access to appropriate medical treatment.

I also asked him how he answers those who believe, as many (if not most) social conservatives believe, that those performing body modification surgeries on trans people are facilitating “perversion.” He replied:

“I think that’s a crazy notion to say [that surgical treatments for trans people are] perverted in any way. This surgery for me gives me a lot of satisfaction. It’s very rewarding surgery for me because I feel like I’m helping people become who they really are. If I can help them transform to be the person they’re supposed to be – that they feel comfortable being – I think I’m doing a really good thing. It’s nothing like perversion. I think that’s just a crazy notion.”

Gender dysphoria can in large part be alleviated through treatment, and the “top” surgeries performed by Dr. Eichenberg are appropriate treatment for trans men. Helping many trans men become more comfortable in their own skins isn’t perversion: instead it’s a great thing.