Transgender Plastic Surgery with Dr. Keelee MacPhee

Episode 22

Transgender Surgery with Keelee MacPhee, MD

In Episode 22, Erin Everett, NP-C, welcomes Dr. Keelee MacPhee, a transgender plastic surgeon in the Raleigh-Durham, North Carolina area, who specializes in various transgender surgical procedures. During the episode, the two discuss transgender surgeries including rhinoplasty and facial feminization, gender nullification, vaginoplasty, FtM top surgery, and insurance coverage/informed consent for transgender surgeries.

About This Episode

In episode twenty-two of Exclusively Inclusive, Erin Everett, NP-C, interviews transgender plastic surgeon Dr. Keelee MacPhee. Double board certified by the American Board of Plastic Surgery and the American Society of Plastic Surgery, Dr. MacPhee performs transgender surgeries primarily at the Duke Regional Hospital in Durham, NC.

During the episode, the two discuss Dr. Keelee MacPhee’s background as a cosmetic plastic surgeon and how her career evolved into specializing in transgender plastic surgery to help her patients become more confident and comfortable in their bodies. Dr. MacPhee highlights her affinity for rhinoplasty and facial feminization surgeries, as well as how she assists her patients in receiving preauthorization and maximum reimbursement from their insurance providers for the transgender surgical procedures she performs.

Furthering the insurance coverage discussion, Dr. MacPhee talks about how most insurance companies follow the WPATH standards of care (which they both believe to be outdated) when determining eligibility of coverage. This typically requires at least two mental health provider support letters affirming the patient has been living full time as their gender and/or have been undergoing hormone replacement therapy for at least a year. When insurance is not available, Dr. MacPhee uses the informed consent model and does not require mental health letters.

Later in the episode Erin and Dr. MacPhee discuss the emergence of older adults who begin their transition much later in life and the considerations for those patients when undergoing transgender or gender affirming surgeries. Dr. MacPhee explains her approach to patient education for vaginoplasty and the importance of dilation exercises for at least one year after surgery, as well as the need for transgender women to receive testosterone post-op to assist with sexual climax. Erin adds that the use of Tadalafil also helps promote sensation in the new clitoris post-vaginoplasty.

Further in the episode, the two discuss penile preservation vaginoplasty, as well as gender nullification surgery — the removal of the scrotum, testicles, and penis, but the patient does not opt to have vaginoplasty — and the need to re-route their urinary function and the associated health complications.

Rounding out the episode, Dr. Keelee MacPhee covers FtM breast surgery and how she determines what the best top procedure will be based on the patient’s ultimate goal for transition. Factors that come into play are the desire to preserve nipple sensation, breast contour, hiding of scars, etc. While Dr. MacPhee has done numerous periareolar procedures, she does suggest that bilateral mastectomy with nipple grafts typically provides the best results for FtM chest masculinization.

Episode Links:

Transgender Surgery with Keelee MacPhee, MD