I perform mastectomy (using many different techniques), breast augmentation and breast reduction. We are hoping to expand the range of gender-affirming procedures in the future.

In my practice there are two (well, technically three) kinds of referrals I accept for top surgery:

1) I already have OHIP pre-approval:

I am not currently accepting referrals for surgery.

2) I do NOT have OHIP pre-approval, but do NOT want it or am not eligible for it; and am going to self-pay:

In order to meet the WPATH standards for surgery, your referring provider should fax a referral letter verifying the diagnosis of gender dysphoria. I am not currently accepting referrals.

3) I do NOT have OHIP pre-approval, and I want to get it:

If you meet the OHIP eligibility requirements for funding, you will need a referring provider to complete the pre-approval form from the Ministry of Health of Ontario, which can be found here: https://www.ontario.ca/page/gender-confirming-surgery

If your main health care provider cannot, will not, or is uncomfortable with being your referring provider for top surgery, you will need to find a provider 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 do not keep a database of providers who are currently accepting clients for pre-approvals because waiting lists open and close quite fluidly.

Wait times from consultation to surgery vary dramatically, depending on your schedule. Part of your consultation with Dr. Chung 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 have the leeway 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 (e.g. April and May tend to be highly requested due to the end of the academic year for colleges and universities); and during those times, our surgery date wait times can be longer.

We want you to have surgery as soon as possible, keeping in mind that we want you to schedule surgery around your life, and not your life around surgery.

Surgery is a stressful experience and even though we know it’s urgent, we don’t want you to experience stress layered on stress, especially when stresses 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. Sometimes, we need to follow-up on abnormal bloodwork, or to verify with a specialist that it’s safe to do your surgery at the Mclean Clinic (as opposed to a hospital). And sometimes, that health issue needs to be treated or managed so that it poses as little risk as possible to your result and safety.

The main bottleneck to surgery tends to be the OHIP approval process. After you have approval, things tend to move much faster—sometimes too fast.

If you’re a smoker or if you 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 anyways.

You should consider starting to plan 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 first couple of weeks after?

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

If you have an employer or teachers/professors, consider talking with them now about time off (between 2 weeks and 2 month, 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. Even though COVID is not as much of an emergency as it was, your surgery will be rescheduled if you have symptoms of any illness on the day of surgery.

Since the Mclean Clinic is not a full hospital, we have limits to who can have surgery safely here. This doesn’t mean you can’t have surgery at all ever, but that we need to come up with a plan on how to make sure you’re safe if something were to go wrong in your surgery.

Even though BMI is not necessarily a great measure for “health”, there are aspects of having a higher body mass that make surgery more risky.

If your BMI is higher than 33, we will need to perform additional evaluations and possible testing to make sure it is safe for you to have your surgery at the Mclean facility.

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

If your BMI is 40 or higher, it is highly unlikely that we will be able to do your surgery at the Mclean facility.

This doesn’t mean you can’t have top surgery ever, or that you have to lose the weight to have top surgery. If it would be harmful to you, either physically or emotionally, to lose weight, this is not something we are interested in forcing you to do. It does, however, mean that you might not be able to have surgery here in the Mclean facility itself. We will do our best to find alternatives for you.

There are several reasons why I prefer not to use before and after photos:

1) Public photos are almost always only our best work.

This can create a false sense of expectation as to what your personal results will look like. Most people asking for before and after photos are looking for security and reassurance: Can your surgeon do the thing you want them to do? Surgery, however, is not a commodity. You are not a mass product made to spec. Although we have a set process for how you move through the surgical experience, we are not actually a factory and results are not uniform.

Top surgery is something I do a lot. I trained with some of the best breast/chest surgeons as well as the best gender affirming surgeons in the world. On average, I perform around 20 top surgeries a month.

2) Your gender journey is not for me to use for promotion.

It’s one thing if clients volunteer, of their own accord, to post their own photos; or to ask us to use their photos in our materials. The Mclean Clinic has an instagram account. However, in my practice, I do not want my clients to feel any pressure to share what I feel is not mine to share.

That being said, if you want to help others on the same journey, I encourage you to post your photos on your own platforms. If you want to make it easier for people to find results from me, you can use the hashtag #drbryantopsurgery (keep in mind that I don’t have power over who uses this and that if people decide to corrupt it, that’s not in my control)

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

We do our very best to deliver you the best result for your body, but we don’t get to 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) I want you to always have ownership of your photos.

For us to post your photo, we need permission to do it. When you give permission for a photo to be used, you give us at least partial ownership over 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.

I 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 of it.

This depends a lot on what kinds of activities are involved in work/school/life/recreation. Some people who do mostly desk work from home are ready to do some desk work at 2 weeks. People with heavy manual labour jobs should not expect to return to full workloads until 2 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. Sleeping on your front is allowed if you have no 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 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, specific discussion might be needed to avoid affecting your surgical result.