I had top surgery late last year.
“Top Surgery” is the informal language we use in the trans community that encapsulates the idea of “a surgery done to alleviate gender dysphoria relating to the appearance of the chest.” Which specific surgery it refers to can vary. The term is used to refer to the addition of silicon breasts in addition to the removal of homegrown ones.
But, the term sees the most use amongst people who have, for whatever reason, grown breasts that they aren’t super into keeping.
Clinical phrases for top surgery include “double mastectomy with male chest reconstruction” or sometimes “female to male chest surgery.” But either way, before the surgery there’s boobs, and after the surgery there aren’t, and that’s really the most important thing.
One of the first questions that Mom and I had after the surgery was “I wonder how much they weighed.” We didn’t dwell on it for very long. There was a lot of other stuff to be done while we were holed up in a room at The Orchard Hotel, near Union Square in San Francisco. For instance: I needed to sleep.
We did eventually get an answer to that question. It came the next week, when I received a digital copy of the pathology report. Breast tissue is sent to the lab before it is incinerated, and they check, just in case, for signs of breast cancer. Just in case.
“RIGHT BREAST,” it says. “640 GRAMS.”
“LEFT BREAST,” it continues, “685 GRAMS”
I scanned down under each item.
“NO EVIDENCE OF MALIGNANCY.”
I had to Google the unit conversion. We were home at this point, and I had set up shop in my bedroom, where my cats kept a watchful eye on me. I waddled into the hall with my new information, walking carefully to minimise discomfort. “Mom! I got the labs back and it says they took about three pounds of boob.”
“That sounds right,” she said. I thought it sounded small, but I had never weighed them, so I took her word for it.
At home, sleeping large parts of the day, suffering from the absolute hell of not being able to side-sleep, and with the surgery about a week and a half behind me, I definitely did not regret having gone through with surgery. But my chest did not yet feel like it was mine.
It felt, in fact, LESS like it was mine than it had before the surgery. I’d had, if not affection for, at least a sort of companionship with my boobs. We went everywhere together. I didn’t miss them, exactly, but they sure were gone, and it was weird. It didn’t help that, so soon after the surgery, everything looked super funky. Most of my chest was scabs, or red, or both.
Once the dressings were removed, I was allowed to take my compression band off so that I could shower. I took showers only as necessary to change my nipple dressings. With the compression band off, the entire chest felt tenuously connected to the body. The best description I have come up with for it- and please hang in with me here, because I know how it sounds, but it’s accurate- is it felt like someone had placed a bunch of slices of bologna onto my chest. There was a bunch of bologna, and it had been placed there, without any adhesive or anything, and I was just, supposed to keep it from falling off.
I knew, and continue to know, cognitively, that my skin was Very Much Attached To My Body. Amongst other things, the cuts were only at the bottom- everything was still firmly, definitively attached near the collarbone. The stitches were firm, and internal, and the scars were, at one week, already well on their way to fully healed.
But that feeling of impermanence was strong, and it went away only very slowly over the next two months.
My ownership of my new chest remained- and remains- hit-and-miss. This is in part because of the shape of my scar, and its relationship with the nipple grafts, activates my pareidolia. It looks like two eyes, and a little mouth, which bears some resemblance to a face. I think of it as sort of a smirking monster. Like the “:3” emoticon but stretched.
It is also in part because I just don’t see my chest very often. When I am out of the house, I am wearing shirts. I don’t like the way I look in shirts, now, but I appreciate not having to worry about my boobs. I am more comfortable going shirtless in my own home, and running out to the car or mailbox without a shirt, but I also am often not looking in mirrors during that time.
There’s certainly no regret about my decision to have top surgery, but it had not been my plan for myself.
I had, as I’ve mentioned, an ambivalent relationship with my chest. My boobs weren’t bothering me, and I liked the way I looked in a binder (which is a compression garment used to conceal the shape of the breasts.) Everything was fairly proportional, and my biggest issue buying shirts was with my hips (as opposed to now, when my biggest issue buying shirts is my everything- my shoulders and chest are an entire size smaller than my belly and hips).
I had been planning on maybe doing my surgery after I got my degree- when I might have a little bit more time to spare for recovery.
That was the plan, until our yearly trip to Knott’s Berry Farm in October of 2016.
There’s a ride we go on every year, called “La Revolución.” It’s a pendulum ride, with a spinning component. On the downswing, I heard- or maybe felt in such a visceral way that it seemed like hearing- a pop in my back. A flash of pain. I grit my teeth through the rest of the ride, all the fun sucked out of what was usually one of my favorite experiences. I had a family member pick up my glasses from where they had been set, carefully, on the ground for safekeeping. I walked, bent-over, until we reached a place along the fence that was safe for stopping, and stretched.
I took the binder off that night and did not put it back on again until we were home, a few nights later.
I used primarily my larger binder for the next several months. Which binder I wore was usually something I played by ear. Regular day? Correctly fitting binder. High-impact day? Broken in, size-too-large binder, perfect for gyms and visits to the pool. Highest impact day? No binder, but like three huge t-shirts.
But after the injury, I had to back off. Big Binder Always. No Exceptions, unless maybe I was going to a formal event where I knew, with certainty, that I would not be lifting anything.
By summer 2017, I made the decision to stop binding entirely. My back pain alleviated immediately- no more waking up in the morning with a sore rib. I switched to the extremely dysphoric option of “wearing three t-shirts and hoping people just assume these are man-boobs.”
This option had a huge negative impact on my mental and emotional health. I passed with less regularity. (“Passing” is a word used colloquially to talk about how frequently strangers misgender you, or identify you as transgender, or sometimes both. It’s one of those things that different people apply different levels of importance to. I fall somewhere in the middle- I take no offense to being misread as a woman, but the more often it happens, the more eroded I become as a person.)
I still passed more than half the time, but even my burgeoning, scraggly beard could not save me from a well-meaning “Can I get you ladies anything?”
Three t-shirts, in a job with any amount of manual labor, in Davis during the summer, in a building with an air conditioner which breaks like clockwork every year, is a recipe for feeling like hell.
I was called in to man the Goodwill truck that serviced Quarto when the students moved out for the summer. In the interest of keeping cool, and aware that this particular assignment was lower-impact than my regular donation-collection work, I wore my too-big binder. Fewer layers, with one of the layers being more breathable than cotton, seemed like a safer pick than the three-shirt solution. And the shift was short- maybe three hours.
I re-injured my back right away, lifting a not-very-heavy box. A sharp pain shot along my back, and around to the front along my bottom rib on the left-hand side.
I started looking into top surgeons again. If my options were “bind and injure myself,” “don’t bind and be very depressed,” and “bite the goddamn bullet and get top surgery even though I wasn’t entirely sure that I wanted it,” then the choice was clear: it was time for top surgery.
Research took several weeks- cruising websites, trying to suss out who had acceptable post-op examples, who might be in my insurance network, and which doctors I thought I would get along with.
I knew that I did not want to see Dr. Satterwhite at Brownstein and Crane. The waits there are atrocious (6+ months for a consultation! Up to 2 years for a surgery appointment! That’s unacceptable! That’s way too much time to flounder! More than enough time to second guess yourself out of a necessary surgery!) I am also not super fond of their handiwork- or what little of it I was able to find. There aren’t many photos of sufficiently healed surgeries, and not many body types represented in those photos. And just as icing on the “don’t like this” cake, their website is kind of outdated.
I eventually picked Dr. Scott Mosser, who, like many top surgeons in California, works out of San Francisco. I liked the language used on his site, and his videos explaining the pros and cons of each type of surgery. I liked how his was the only website I had ever seen addressing the emotional recovery process after surgery. I liked his example photos, featuring a wide variety of body shapes (including several people who looked enough like me to give me an idea of what I could expect) and I liked his website, and it seemed, from the info I had found, that he accepted my insurance.
I reached out to his staff in September of 2017. His staff was prompt, responding to me within the week, and verifying that my insurance would completely cover the all of the costs associated with both Dr. Mosser and the hospital. By September 30th, having already talked with Dr. Mosser about my online consultation, his staff contacted me to schedule the surgery.
They tried to schedule me for October 26, one day before my mother’s birthday. More importantly, it was during the fall semester- I could not afford to be out of school for a few weeks in my last year before transfer.
I had figured I might need to wait, at that point, for January. I had never met a doctor who didn’t take a lot of time off around Christmas. I mentioned this assumption in passing, and found out that I was wrong: He absolutely had dates available in December. We agreed on the 28th.
This is, if you remember the timelines for Dr. Satterwhite, blazingly fast.
But even then, three months is still a long enough time for your own neuroses to really get up your ass.
I got right up against the edge of surgery, in the pre-op area, my arm weird and cool with IV fluid, wondering whether or not I was going to regret this.
“It would be a very expensive mistake,” was the way I had been putting it, when I felt comfortable enough to express even that much uncertainty.
There’s this thing, in the media, where the “accepted” story of the transgender experience is something like “I’ve known my gender since I was a small child, and have fought tooth and nail to assert myself since I learned to talk.”
That is not my story- my story is more like “did not know trans men existed until I was 20.” My story is “Did not entertain the idea that I might be a man until I was 23.” My story is “I could probably have kept living as a woman and been fully capable of living a reasonably full, reasonably happy life.” Not my fullest life, maybe. Not my happiest one. But not a bad life. Not one I would have regretted.
Inherent to those stories are the ways they are not the same: the idea of body dysphoria is anchored solidly into that first narrative, but its place in mine is so small as to nearly be absent. And because of the way we have, as a culture, accepted that first story– because of the way that I saw, and see, other men expressing pure, physical anguish at the shapes of their bodies, it was and is very hard to express any amount of trepidation about the surgery. Rather than risk making waves, I did not bring up my concerns at all.
The last thing I remember before the surgery was singing along to “Wonderwall” with my anesthesiologist while she started the process of putting me under.
The recovery room was dimly lit. A nice touch, I thought. The nurse tending to me was a man, and he was kind.
The first thing I remember, other than the state of the room and the kindness of the nurse, was being aware that I would not be able to talk well. I decided that instead of talking, I would sign to the nurse who was looking after me.
I then remembered that I had only taken one semester of American Sign Language. I realised that it was likely he didn’t know any sign, either.
(This information did not quite stop me from trying, but moving my arms around at that point was kind of a chore, so I’m sure it didn’t look like much.)
I remember telling him that I wasn’t in any pain, which I thought was neat. I have memories of being in incredible pain after my only other surgeries (lens removals, at 8 years old,) and this lack of sensation stood in stark contrast.
The nurse said, “You must have a high pain tolerance.”
Mom told me later that I had been in the recovery room for a long time before they called her back. She had been worried. We learned later that my heart rate had been a little high, and the nurse was making sure I was okay.
Mom greeted me, asked how I was. I answered, and then gasped.
“Mom!” I said
I whispered urgently, “My tiddies is gone.”
My chest, for the next week, was a mystery. Dr. Mosser had said, when I’d driven down the week before for my pre-op appointment, that he might need to incise all the way across my chest, to get the nicest contour. Had he? We wouldn’t know until the bandages came off, a week after the surgery.
Maybe more importantly, where had he placed my nipple grafts? I could guess, but I could not know.
The week was spent mostly sleeping, punctuated by clearing the bulbs attached to the end of my drains, taking norco (acetaminophen and hydrocodone) every 4 hours, and being told, sternly, to “stop moving so much” by my concerned mother, who was staying with me in San Francisco.
“There could be anything under there,” I told my mom. “What is it? A ghost?” and she would laugh.
I was not regretting the surgery, but I was worried that I might right up until the bandages were off. With all of them still on there, and my chest Entirely Unknown, the surgery wasn’t real yet.
January 3, 6 days after surgery, we checked out of the Orchard Hotel and drove around the block to Dr. Mosser’s office. One of his assistants- I do not remember who- walked me through the process of removing the dressings.
I would not bring myself to look down at my chest. The nurse stepped out of the room for a moment, so Mom took a picture and texted it to me.
It was gross.
Just under a week after the surgery, there wasn’t any other way that it could look. Gross was the option.
But it did not look bad, just different. And I did not regret it, and I have not regretted it since.
“3lbs” was written for UWP 101, “Advanced Composition”, taken at the University of California, Davis, in Fall of 2018. The original paper was due October 31, and was revised before being posted here.