Top Surgery FAQ

At Catalyst Surgical there are three kinds of referrals we accept for top surgery:

1. I already have OHIP pre-approval:

Please ask your gender-affirming practitioner to fax us a referral at 437-293-5760. Please note currently that chest contouring is required and that there is an additional cost of about $5300 + HST.

2. I don’t have OHIP pre-approval and don’t want it or am not eligible for it. I am going to pay out of pocket:

In order to meet the WPATH standards for surgery, your referring practitioner should fax a referral letter verifying the diagnosis of gender dysphoria. Please ask your referring practitioner to fax us a referral at 437-293-5760.

3. I don’t have OHIP pre-approval but I want to get it:

We are happy to see you in consultation without OHIP approval so you can decide if we are the right choice for you.

If you meet the OHIP eligibility requirements for funding, you will need a referring practitioner to complete the pre-approval form from the Ministry of Health of Ontario:

https://www.ontario.ca/page/gender-confirming-surgery

If your main health care provider cannot, will not, or is uncomfortable with being your referring practitioner for top surgery, you will need to find a practitioner who can do it for you. This can be challenging to find.

The Rainbow Health Ontario database is a good place to start:

https://www.rainbowhealthontario.ca/lgbt2sq-health/trans-health-knowledge-base/

Unfortunately, we don’t keep a database of practitioners who are accepting clients for pre-approvals because waiting lists open and close frequently.

Wait times from consultation to surgery vary dramatically, depending on your schedule. Part of your consultation with Catalyst Surgical involves discussing this timing.

If you are a student in a high-stakes program (e.g. the final year of an intensive fine arts program), it’s probably not a great idea to put your surgery in the academic year. If you are looking to book “the first available” date, that can be anywhere from weeks to a couple of months away.

There are also times of the year that are more in-demand than others. For example April and May tend to be highly requested as the academic year ends for colleges and universities. During those times, our surgery date wait times can be longer.

We want you to have surgery as soon as possible. We also want you to schedule surgery around your life, and not your life around surgery.

Surgery is a stressful experience and we know it’s urgent. However, we don’t want you to experience unnecessary turmoil, especially when stressors can be predictable or scheduled. We will work with you to find the date that works best for you.

Additionally, there are health issues that can cause your surgery day to be postponed. For example, we might need to follow-up on abnormal blood work, or to verify with a specialist that it’s safe to do your surgery at the Catalyst facility, as opposed to a hospital. Unforeseen health issues need to be treated or managed so that they pose as little risk as possible to your result and safety.

If you’re a smoker or use nicotine products, you can cut back or quit. This is something to consider right after your provider has submitted your application to OHIP. Don’t wait! Talk with your providers about how to quit and what options might be helpful for you.

You don’t need to “build up your chest muscles” prior to surgery, unless you were going to do it anyway.

You should consider starting to arrange your post-surgical plan:

• Who will help take care of you after (someone should stay with you for the first 24-72 hours)?
• Where will you stay (if you can’t stay at home)?
• Who will take you to and from appointments, especially on the day of surgery and the following weeks?

Please make sure your health card is not expired. It doesn’t delay or prevent surgery, but it prevents problems on our end, thanks!

Consider talking with your employer/teachers/professors now about time off (between 2 weeks and 2 months, depending on what you do). Figure out what paperwork you’re going to need (forms etc).

Closer to your surgery date, consider using a mask and/or limiting your social contacts. Your surgery will be rescheduled if you have symptoms of any illness on the day of surgery.

Since the Catalyst facility is not a full hospital, we have limits to who can have surgery safely here. This doesn’t mean you can’t have surgery. We just need to come up with a plan on how to make sure you’re safe if something goes wrong during your surgery.

BMI is not necessarily a great measure for health but some aspects of having a higher body mass makes surgery more risky.

If your BMI is higher than 35, we will need to perform additional evaluations and possible testing to make sure it is safe for you to have surgery at our facility.

Should we determine that the risk is too high for your surgery to be at the Catalyst facility, we will figure out how to move your referral to a surgeon who can perform the surgery in a hospital.

In the case of your BMI being 40 or higher, it is highly unlikely that we will be able to do your surgery at Catalyst Surgical.

This doesn’t mean you can’t have top surgery, or that you have to lose weight to have top surgery. If losing weight will cause you harm, either physically or emotionally, it is not something we are interested in forcing you to do. It does, however, mean that you might not be able to have surgery with us. We will do our best to find alternatives for you.

There are several reasons why we use before and after photos differently than other clinics:

1. Public photos are almost always only our best work

2. Your gender journey is not for us to use for promotion

Our highest priority is for our clients to not feel any pressure to share anything they don’t want to. We do routine photography for your medical records and will always ask your consent. On occasion, we might ask for photo consent for our marketing materials.

If you want to help others on the same journey, we encourage you to post your photos on your platforms. To make it easier for people to find results from us, you can use the hashtag #catalystsurgical and/or tag our socials @catalystsurgical. Keep in mind that we can’t monitor who uses the hashtag and what they post.

3. You don’t always see how features of the before body affect the look of the after photo.

We do our best to deliver the best results for your body, but we don’t control every aspect of the final result. Skin quality, individual physiology that affects wound healing, lifestyle habits, and pre-existing anatomic features are all factors that greatly influence your final result that are not within surgical control. An after photo that looks “bad” to you might be a very good result, given those surgically uncontrolled factors.

How your foundational anatomy affects your result is something that takes years of training and experience to see, and most of our clients do not have that experience, even if you see a before photo of a body that looks very similar to yours.

4. Just because you don’t like an after photo doesn’t mean the person in the photo doesn’t love it.

Generally, people who post their photos or who allow the use of their photos love their result enough to share it. Seeing examples of things you don’t like can give you an idea of your personal aesthetic preferences, or how your gender dysphoria uniquely speaks to you. Communicating your likes, dislikes and goals are much more important in the surgical process than what you see in other people’s results so that we can tell what’s possible, predictable, controllable and what is not.

5. We want you to always have ownership of your photos.

For us to post your photo, we need permission to do it. When you give us permission for a photo to be used, we gain partial ownership of the photo. The photos in your medical record are ONLY for your medical record and are under different terms of ownership.

If you post your OWN photos, you retain ownership over them and how they are used (also slightly modified by the platform you post them on.) You are in control of if it continues to stay published or not.

We understand that certain clients feel highly uncomfortable with proceeding without seeing previous work. It may be the case that we are not a good surgeon/client match for many reasons, and this may be one of them.

While there are case reports of serotonin syndrome interacting with both tramadol and ondansetron (both medications that we use before, during and after surgery in varying combinations), these reports are generally for high doses of tramadol and ondansetron and generally with repeated use.

We do not prescribe the doses of tramadol associated with serotonin syndrome and only give you a limited supply. Some people don’t need the tramadol at all after surgery.

We only give you one dose of ondansetron before surgery and sometimes a dose after, but do not send you home with a prescription for it.

The recovery time depends a lot on what kinds of activities are involved in your day-to-day life. Some people who do mostly desk work from home are ready to do some desk work in two weeks. People with heavy manual labour jobs should not expect to return to full workloads until two months after surgery.

Surgery is a stressful experience and energy management is an important part of recovery. You might not have much pain after surgery, particularly 2 weeks after, but you might not have the energy or attention to perform at your pre-surgical level. Most people take 2-4 weeks from work to give themselves the opportunity to recover. Our suggestion is to usually arrange for more time off work than the bare minimum, and if you feel great before that time, you can always re-negotiate with your employer.

Surgery timing is something we discuss as part of your consultation so that you can make a decision about when surgery is best for you, knowing that you’ve wanted surgery for a very very long time, and that “yesterday” is the time you would prefer.

Most folks find it painful to sleep in other positions than on their backs at first. You can sleep on your side if you can sleep without any pain. You can sleep on your front if there isn’t any pain and you aren’t putting your arms up in front of you (though not many people who front sleep can sleep with their arms down at their sides).

If sleeping on your back feels really weird and is affecting your sleep quality, you can try putting pillows under one side of your body to be at a “side incline”. While this will result in one side of your chest swelling more (the lower side) but it can mean the difference between better vs bad sleep.

The main limiting factor to having sex after surgery is pain. If it doesn’t hurt your surgical site during sexual activity, you’re probably fine to do it.

Most forms of masturbation are usually feasible after the first week. Partnered sex can be quite varied and if you participate in any kinks or fetishes, you might need discussions to avoid affecting your surgical result.