7 Tips For Tackling Top Surgery

If the question of whether to take T inspires a lot of indecision and angst, the choice to have top surgery seems more straightforward. I rarely hear transmasculine folks agonizing about top surgery. It seems that many people just know they need to get something off their chests (or not). To that end, here are a few suggestions for those contemplating, planning and recovering from top surgery.

Yes, I am using an image of melons in this post. Source.

1. Pick a procedure. You are probably already looking into the available options. There are a few different procedures under the umbrella of top surgery for trans guys/transmasculine people. I had the double-incision with nipple grafts, a great option for people with a medium-to-large chest. I am very happy with the results. Smaller guys often opt for the periareolar procedure, which results in less scaring. There are also a few other options and a number of possible variations on these. This site has detailed info on procedures and other topics. A few things to consider when selecting a procedure:

  • What’s suggested for your chest size/shape?
  • Is nipple sensation important to you?
  • How do you feel about scarring?

Surgeons often specialize in one or two procedures, so you might want to choose your doctor based on specialty (if you know what you want) or choose your procedure based on the surgeon’s strengths (if you are seeing a specific doctor due to location, insurance coverage or preference). When comparing photos of procedure results, it’s important to look for folks who look like you. In addition to the size of your chest, your overall body shape and size, skin tone and other factors come into play.

2. Select a surgeon. Here again, you’re probably already doing research. If you’re not sure where to start, try browsing photos on transbucket and asking other trans people. Before moving forward with any surgeon, you should see photographs of their work and make sure other trans people have hade a good experience with them. If you are looking to change your gender marker to M, ask whether the surgeon will write you a letter stating you have had irreverisble gender confirmation surgery (or whatever language is required in your area). Another important factor is location–if there are any qualified surgeons in your area, you can save a lot of money by recovering at home.

I got my surgery from Dr. Daniel Medalie. This took me far from home, but it was a great choice for me. There are no surgeons specializing in chest reconstruction in my area, and Dr. Medalie is highly skilled, relatively affordable, and great with trans patients. He told me he does top surgery several times a week!

3. How the hell do I pay for this? Cost is a major concern when it comes to top surgery. If you live in the US (can’t speak to other countries), you will probably find yourself paying out of pocket. The surgery itself usually costs somewhere in the range of $6000-$8000. That number can skyrocket if you need to travel, pay for a place to stay while recovering, etc.

Many doctors offer payment plans or accept credit cards. I covered most of my surgery costs using a CareCredit card (a credit card just for medical expenses). I was lucky to get extensive help from my parents, and we paid it off within a few years. Many trans people raise money through donations or a benefit event. This is usually the hardest part, and of course it really depends on your situation. Don’t lose hope–you can find a way to make this happen.

Yours truly, about 3 1/2 years post-op. Thanks to Alma for taking the photo.

Yours truly, 3.5 years post-op. My nipples were a lighter shade of brown before surgery–no idea what’s up with that. I think Dr. Medalie does a great job placing the incisions so that the scars fit in very naturally. Thanks to Alma for taking the photo.

4. Waiting is the hardest part. You’ve worked your ass off, come up with some serious cash, scheduled your surgery, requested time off work…. Now it’s time to sit back and wait six months til the surgery date. Ahhhh! This phase of the process nearly drove me insane. Every day I had to put my binder back on, I cursed time itself. I tormented Alma with an incessant countdown updated several times a day.

I made myself totally miserable. Don’t be like me! Come up with some things you can do to make waiting easier. You might allow yourself a special indulgence during this limbo period or find a way to mark the time that’s actually enjoyable.

5. Get help while healing. In general, you can expect to be thoroughly laid up for about a week, and then functional, but still tender and healing, for a month or two. If at all possible, have somebody available to care for you during that first week. You are going to feel like shit, and it is really helpful if someone can feed you, take you to your follow-up appointments, and so on. Huge thanks to Alma and my mom for taking excellent care of me during my recovery.

The worst part of the recovery for me actually came from the presciption painkillers. I really needed them for the first day or two. By about day three, I started to feel horrible–a miserable nausea and weakness like nothing else. My mom suggested I ditch the percoset and start taking ibuprofen. Once the hard stuff was out of my system, I felt amazing. I was practically skipping when I went in for my follow-up a week after surgery.

6. Scars–a conversation piece? How will you navigate being a person with surgical scars? Some people opt to cover their chests at the beach and the gym to avoid revealing their scars. Personally, I take my shirt off at the slightest excuse. I’ve found that people very rarely say anything about my scars or even seem to notice them. I’ve occasionally had someone ask if I had a collapsed lung or heart surgery. As far as I know, I’ve never had anyone guess that I am trans based on my scars. So I wouldn’t stress too much about people seeing the scars or commenting on them.

That said, it’s a good idea to have a game plan. If someone asks, what will you tell them, and how much? I usually just say something about how I had surgery a few years ago and leave it at that. People are too polite to pry further.

7. Enjoy yourself. The most important part of getting top surgery–enjoying the results! Throwing on a t-shirt without having to scrutinize your chest in the mirror. The feeling of a summer breeze on your skin. Swimming bare-chested. Never wearing a suffocating torture device binder ever again. Freedom is so sweet.

Readers–what tips do you have for someone preparing for top surgery? If you are considering or planning surgery, what questions do you have?

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3 comments

  1. Clare Flourish

    I find your blog fascinating, on the similarities and differences between our experience. You answered my question on Binding. I find anything too tight round my breasts really uncomfortable. “Suffocating torture device” sounds about right.

    On nipple sensitivity, I found one of the delights of starting oestradiol was finding nipple sensitivity. I did not notice it while functioning on T. I would be interested in hearing men’s experiences of this.

    • rimonim

      Torture device indeed. Binding was worth it for the psychological benefits, but extremely physically uncomfortable, at least for me.

      Re: nipple sensitivity. I’ve never had erotic nipple sensation. Not sure whether this is just a personal thing or caused by dysphoria around my chest before surgery–I never liked being touched there til after chest reconstruction. I didn’t notice any changes in sensation when I started hormones, but then again, I was on T for less than a year before chest surgery. My nipple sensation now is very limited–I can feel pressure but not temperature or light touch. I don’t have erotic sensation at all; having my nipples touched just feels weird!

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