How To Prepare For Top Surgery?
What is top surgery?
Top surgery, or mastectomy, is a common gender reassignment surgery for transgender men and transmasculine individuals, who want to reconstruct their chest. A surgeon will remove breast tissue, sometimes using additional liposuction, and can graft nipples from the areola for the aesthetic of a flat chest. This is usually done to alleviate gender dysphoria in trans men and gender non-conforming people, as part of a gender medical transition.
Before getting surgery
My endocrinologist had cleared me to undergo this reconstructive procedure after one year of testosterone as part of my hormone therapy, but I waited for about two years. While I was sure that I wanted this surgery, I felt it important to be logistically compatible with my student schedule, have a financial safety net and be well-informed on techniques, surgeons and the recovery process.
Thankfully, my insurance was able to cover my top surgery, as supported by my doctors as medically necessary due to gender dysphoria. The best way to get an estimate on cost is to contact both your insurance and the medical team that will be responsible for your care.
Picking the technique was fairly easy as I was mentally prepared for a double incision, which I knew left visible scar tissue contouring the pectoral line. Since it is a widely used technique, my choice of possible surgeons was flexible. I ended up going with someone I felt was competent they could operate with minimal needs for revision afterward and would be accessible and responsive in case of complications. I also asked for before-and-after photos from my surgeons to see his work, particularly on other people of color.
How to recover from surgery
I came home from this outpatient operation very sore with drains and a postoperative binder to keep the swelling controlled until my next appointment at the clinic. After surgery, I laid down… a lot. My instructions were to keep everything in place and to sleep on my back for the remainder of the immediate recovery time. It took around a month to achieve general mobility, and 2-3 more weeks before being cleared to resume all activities (working out, carrying heavy objects, etc.).
Recovery is boring. Taking time to enjoy the little mobility I had was important in order to still be active. Most of the day was spent in bed, either lying down or sitting up, watching a lot of TV shows. I had an appointment every week for a bandage change and to get updated on the scarring progression.
My biggest discomfort during recovery was discovering that I was allergic to medical adhesive. Nurses noted an extensive redness around bandage sites, but never put it together. I was so miserably itchy for about 2-3 weeks that at some points made me unable to sleep. Unhooking the binder a few times a day for about 30 seconds was the only relief I felt, as it wasn’t pressing against the glue of the scar bandages. I ended up wearing a T-shirt under the binder, to relieve some of the friction.
Unfortunately, I only realized it was the medical adhesive that was causing an allergic reaction at the end of my recovery. The recommended post-op care, after being cleared to regular activities, for scar treatment is silicone tape. After one night, I had the same reaction and I figured it out. Talk to your surgeon if this is something you experience.
After 1 year!
Fast forward to now, it’s been one year and some change since my month of healing. The scars are visible, but the redness has been fading darker and slowly, more aligned with my skin tone. I kept them out of the sun as recommended, but nothing more. Sensation has been coming in waves, though there’s still a lot of numbness. It will be a tingly or stinging sensation that lasts a millisecond.
Overall, it’s been well worth the month-long recovery, considering this lifelong decision. My dysphoria has been alleviated a lot, and everyday activities have become more enjoyable because of it. In a way, it feels like my body has always been this way now. A new but long-awaited normal.
