This scares me. Out of pocket or not. I want the bottom surgery but will probably opt for the top first. I watched some YouTube video with some trans girl having a breakdown because she almost bled to death.

I should elaborate more on "out of pocket", one needs to pick a surgeon with a great track record and accommodates patients well.

My surgeon was Marci Bowers who does surgery is an excellent hospital. After surgery I spent a week in a hotel where all the staff were well versed with bottom surgery out patients.

My hospital stay was great, Marci checked in on my three hours after surgery and also the next day. After five days in the hospital I was released for the weekend and then a visit to Marci for a check-up. Was given the green light and went back to my hotel for another seven days which is recommended.

Throughout the time spent in California there were zero complications.

One last thing, Marci provides you with her personal cell phone number in case of any issues or questions.

I'm now post-op for two years, I did contact her several times and always a quick response. One time thought I had an infection, she asked for a photo, she responded with this is normal, if it does not clear up in several days let her know. The issue cleared up three or four days later. Another time, was having O's several times a day,  she referred me to a OBGYN, in the end there was nothing to be done but happy to say many people I've told this too said they wish they had that happen to them.

So going back to "out of pocket", one can pick a surgeon that is not a good choice for this surgery and/or have it done out of country with little or no support. Going with support, I had two friends fly in from Oregon to be with me (one from this site) and my brother's girlfriend from 30 years ago so I had support. 

The person I spoke of had zero dollars and was boxed into one surgeon and did not heed my warnings I had reservations for the surgeon, wish I was wrong but ended up being right.