The procedure is a day-procedure (outpatient procedure) performed under general anesthesia provided by an anesthesiologist. Gender-affirming Top Surgery (chest construction) is an MSP-funded benefit for residents of British Columbia and Yukon. Dr. Mckee performs the surgery at either Burnaby hospital, or at one of the outpatient surgery-centers in the Vancouver area (such as New Westminster Surgery Center, or False Creek Surgery Center .. also known as Clear Point Health Surgical Center).  Top surgery takes ~2 hours in the operating room itself, however with the preparation before surgery, and recovery from sedation after surgery, expect to spend several hours at the facility.

The most crucial things to remember for the day of surgery are: 1) to arrive at the correct location 2) to arrive at the correct time given to you by Dr. Mckee (the earlier the better), and 3) having nothing to eat or drink the entire morning of surgery. It is too dangerous if you have any food or liquid inside your stomach when it comes time to administering general anesthesia. The anesthesiologist will cancel the surgery if your stomach is not completely empty. This means no water, no coffee. Nothing.  The cut-off time to eat or drink is midnight the night before.  Go to bed the night before, and have a big meal before midnight, wake up the day of surgery, and go directly to the instructed location of surgery (while fasting).  The only exception is if you take medications regularly (such as testosterone, or blood pressure pills for example) in the mornings. In this case, take the medication as you do routinely, and you may use half a shot glass full of water only to swallow your medications.  

Like an international flight, arriving early for check-in is important, or else the surgery could be cancelled by the surgical facility.  Very rarely, the surgery can be cancelled on the day of the surgery (last minute) due to things that are out of our control. The best thing we can do to prevent the unlikely scenario of a surgery being cancelled - is to arrive early (at the time given to you by Dr. Mckee’s office), and be patient while waiting around in between seeing the different team members on the surgery day.    The first thing you do when you arrive at the hospital or surgery facility is to register at general Registration/Admitting with your healthcare card. You tell registration that you are there for surgery with Dr. Mckee, and they will instruct you where to go.

 On the day of surgery, you will meet with the different team members individually: Dr. Mckee, the surgical nurses, and the anesthesiologist. The team will help you get changed into a surgical gown. Your underwear that you came in with should stay on (it will never need to be removed). The team may set up an Intravenous (I.V.) prior to the operating room. No urine catheter (to the bladder) is required at our facility for this procedure.  There will be a bit of waiting in between these different meetings with the surgical team members, so please bring a book or something to occupy yourself.  We encourage you to have a support person present at any/all of your visits (consultation, day of surgery, follow-up visits) in order to help you take notes and remember any new information given to you. Certain facilities have policies on limiting support people to the waiting room, or lobby only. A support person must be available to pick you up from the facility after surgery.

 On the day of surgery but prior to your procedure, Dr. Mckee will:

• spend about 20 minutes answering questions and going over what to expect after surgery.

• write you a prescription for pain medications and antibiotics.

• book you a follow-up visit appointment roughly a week later for the first dressing change to be done together. 

• give you his office phone number to call for any concerns or appointment changes after surgery. 

• make some ink markings on your chest (in a private setting) while you are in a sitting position, in order to help guide the surgery technique.  You are invited to offer any of your preferences surrounding the size/shape/positioning of the nipple grafts (if nipple grafts are a part of your procedure), or position of the scar (straight vs. swooped/curved).  During the marking session, please also make a point to remind Dr. Mckee of your preferred surgical preferences; For example: (Double Incision vs Keyhole) (nipple grafts vs no nipple grafts) (size/projection/location of nipple grafts) (straight scar vs. curved/swooped scar along the side of the chest).

• If you require a note for work, Dr. Mckee can sign this for you during this time (if you request it), or at a follow-up appointment in person.

You will be brought to the operating room. You will lie down and be given some sedation in order to doze off to sleep. You will not feel or remember any of the surgical procedure.  This is a full general anesthetic. The procedure itself takes about 2 hours. Our team in the operating room consists of Dr. Mckee (main surgeon), 2 MD surgical assistants, 3 surgical nurses, an anesthesiologist, and occasionally a medical student trainee from the University of British Columbia.   

We do not use drains unless there is an extenuating circumstance.

We typically use all dissolvable stitches. Only occasionally, under special circumstances, do we use stitches that need to be removed later.

You will wake up with a large dressing and a compression vest over your chest, covering everything. You will be monitored in the recovery room for about an hour. You will not always have the opportunity to see Dr. Mckee right after you wake up from surgery (as he may be in another operation for example) , so make sure you have your plan set prior to surgery (with help from Dr. Mckee and your support person). When it is safe, the recovery room nursing team will call whoever is waiting to pick you up after surgery.   You will be unable to drive yourself home (it is too dangerous with the anesthesia that is still in your system). You will require another person that you know to leave the facility with you (you will not be permitted to leave alone). You will leave the surgery facility with a follow-up appointment to see Dr. Mckee (within 1 week of surgery).