Category Archives: Top Surgery

I am fortunate enough to have obtained partial medical insurance coverage for my top surgery with Dr. Medalie, which is scheduled for tomorrow (November 24th) at 7am at the Metrohealth Outpatient Surgery Center in Cleveland, OH.

Medalie has been my first choice since I began researching top surgery procedures.  The results I’ve seen are fantastic, especially on patients with similar body types to mine.  I like the position and results of the nipple grafts, and I like the contour of his incision lines.

For the entire procedure, I’ll only be paying $2500 out-of-pocket, which was miraculously and unexpectedly paid for by my family.  The post-surgical vest cost $89.  I paid $535 for two round-trip tickets to the Canton-Akron airport (Delta; non-stop), reserved an economy car with Thrifty rentals for 8 days at $165, and booked 8 nights at the Mentor, OH Studio 6 for $310.

Once I get back, I’ve been approved for 6 weeks of paid disability leave.  While money will be tight, this will give me the opportunity to travel during K’s semester break, spending part of the holiday season with his family, and part with my family (who live several hundred miles away, making our visits rare).  I’ll be returning to work on January 5th, if everything goes according to plan.

Dr. Medalie’s secretary Valerie was fantastic about answering emails promptly, answering all of my questions, and helping me navigate things with my insurance company.  During our phone consultation, Dr. Medalie was really helpful–and I had a lot of questions.  Here are some of the highlights:

My best friend E will be taking care of me for the time I will be here in Ohio.  Our hotel is small and simple, with two full-sized beds, a TV, a table and chairs, and a kitchenette.  It’s warm, though, thankfully; it’s freezing here.

Surgery is only a few hours away.  I don’t know if I’ll be able to sleep.  It occurred to me that I’m going to bind tomorrow morning for the drive to the surgery center… where they’ll 1) know that I’ve got boobs, and 2) be cutting them off.  Body dysphoria is weird.

Only recently have I been worrying about the results.  It’s the first time I’ve wished that I could come out of this with a “flawless” male chest.  It’s hard knowing my chest won’t be perfect.  I’m chubby and will probably have dogears because of that fact.  I may never feel parts of my chest again.  If it was just the scars, I could probably handle it a lot better–I’ll be furry enough soon that nobody will ever know anyway.  My nipples will probably never respond to touch or hot and cold.  It’s sad that I have to trade nipples I am self-conscious about for nipples that I will probably still be self-conscious about.

We made it to the surgery center perfectly on time.  I signed in and sat down in the waiting room.  For some reason, it was really strange to me that there would be a waiting room.  A nurse came and took me and E back, where my vitals were taken, and my street clothes and all my body jewelry were put in a locker.  I was taken even further back into the building and sat onto a hospital bed where E and I waited for Dr. Medalie.

The surgeon came in and we all made small talk while he drew on my chest in a purple marker.  I felt self-conscious of having E and some stranger seeing my bare chest, even though I knew it was silly.

Then, E went out to the waiting room, and the anesthesiologist came in to speak to me.  I was joking with him that, instead of being nervous about the surgery itself, I was more worried about the IV, since I figured I wouldn’t really feel anything after that anyway.

He said that, if I liked, I could just go back to the operating room, and I could be gassed on the operating table.  I was actually really curious about how the OR would look, so I walked back, trying to keep my bare ass covered by the gown.  It was pretty small, and clean, and there was a big table in the middle of it for me.  It had a big leather strap, which I assume was to strap my legs down; that made me nervous, so I stopped thinking about it.

I hopped up onto the operating table and laid my head back.  One of the nurses put these really warm things around my legs, presumably to improve circulation.  Then a mask was put over my face, and they turned on the gas–which smelled pretty gross.  I started to get really nervous, so I began to silently chant “Nam Myoho Renge Kyo”.  I made it through two of them, was too tired to start another, mumbled something to the nurse, and then nothing.

I think I woke up once in recovery, registered that I was alive and that I wasn’t in pain, exchanged a few words with a really nice nurse, and went back to sleep.  The next time I woke up, E was next to me.  He told me that the whole surgery had taken almost exactly two hours, and that Dr. Medalie had come out afterwards and told him that it was “a piece of cake”.  I think a little bit more pain medicine was given to me intravenously, and I was given two Vicodin.  I was really freaked out by the IV, and I was glad when it was taken out.

Soon after that, E helped me get back into my clothes and helped me put my body jewelry back in.  I waited for him to pull the car up to the door and help me outside and into the car.  I had never felt so tired in my life and I was freezing cold.  I remained awake for the entire drive back to Mentor (around 45 minutes, I think), because I was terrified of us getting into a car wreck and my chest being damaged.

I spent the rest of that first day sleeping in four hour shifts, only waking up to use the bathroom, empty my drains, and take more Vicodin. I noticed a rapidly purpling bruise peeking out of my post-surgical vest on the back left side, up by my armpit.  It was the only place I felt pain, because the foam that was between the binder and my chest stuck out a little on that side and would press into the bruise whenever I put my   My throat hurt massively, presumably from the breathing tube.

I was more coherent today, taking fewer pain killers, playing around on the internet, and even leaving the hotel for a bit with E for coffee and dinner.

I drained 30cc on each side. The fluid smells disgusting. It’s pinkish red, and often has a film of transparent clear liquid on top.

I can’t really wrap my mind around the fact that underneath this binder and the foam, there aren’t any boobs. I’ll never see those boobs again. I look an uncomfortable lot like a sausage in this binder.

I took something to help me poop, because apparently pain killers make one constipated. I also picked up some arnica gel for the bruise on my left side. E is putting it on me when we empty the drains.

There is a blood loogie in one of my drains. It’s so gross. It’s just dangling there, halfway out of the drain and halfway into the bulb–shivering.

Also, arnica gel totally works. My bruise is already several shades lighter than it was yesterday. When I woke up this morning, I hadn’t drained much, except my left side drain had 15mL of disgusting yellowish fluid (lymph?) in it.

I feel physically a lot better; I’m awake for longer periods at a time, and feeling less queasy. My throat still hurts horribly, and my torso is a bit sore, but I’m not in any pain, really.

Getting in and out of bed without using my arms is difficult. My abdominals are getting quite a workout these days.

I have never felt so disgusting in my entire life. I’ve never been the kind of guy who has to shower every day, or even every other day. Still, I’m wondering how much Great Clips would charge just to wash my hair. I’m already looking forward to my first shower, when I can just scrape the grunge off of my body.

My throat hurts and my chest keeps tingling weirdly–the nerves are reconnecting, I guess. The drains are driving me insane, but my left side is still draining about 30cc per day.

I did poop today, though. Supposedly, that’s a good thing. But I’d almost rather be constipated; it’s really difficult to reach around and wipe my own ass.

Cognitively, I know that surgery is over. But I can’t see my chest yet, so it doesn’t feel real. It just seems like I’m feeling really shitty and out-of-it, and surgery hasn’t happened yet.

And then sometimes, it sinks in briefly, and I get excited at the prospect of looking normal in a few weeks.

E and I went out again, and someone asked for my ID when I presented my card, since I don’t look like I could be [birth name]. But, I haven’t been able to afford to change my name yet, so I’ll just have to keep making that Johnny Cash joke for a while longer.

Over the weekend, I gradually felt better leaving the house more frequently. I felt bored and irritable and ready to be back at home. On Sunday (November 30th), E and I even ventured into Cleveland proper to meet up with some acquaintances and have dinner.

At one point during the weekend, the toilet in our room pretty much exploded. The hotel staff couldn’t find their plunger (?!), so we were just moved next door.

We checked out of our hotel in the morning, and headed into Cleveland to waste time before the follow-up appointment. The post-op appointment was actually at the main Metrohealth Hospital, which turns out to be the size of a small city.

After finding our way to the right waiting room, we waited for what seemed like forever. Then, we were taken back by Andrea, the nurse, and she undid the binder without much fanfare. I felt really delicate and exposed.

Then, she ripped off the foam. It was the most painful part of the whole surgery experience, and it was painful. Very, very painful. In the middle of my chest, I didn’t feel much, but on either side, under my armpits, I was very sensitive, and it was excruciating. I cursed, felt dizzy and nauseous, and lost a good bit of my chest hair.

Next, she removed the surgical tape, which didn’t hurt at all. And my chest was just… there.

I’m not going to lie: I freaked out. I had to lie back, and I was brought some water. Andrea was worried that I regretted having surgery, but I didn’t. It was just shocking. And it smelled bad, and it looked so raw, and like my chest was barely being held together. Andrea left me and E alone for a few minutes while she found another nurse to help her remove my drains, because she wanted to remove them both at the same time.

The drain removal itself wasn’t too bad. Andrea pulled out the right side, and I didn’t feel it at all. The other nurse didn’t do as good of a job, and I felt a sharp pain at the end and bled a little bit.

And that was it. I was given further instructions, and shown how to dress my incisions and my nipples, and helped back into my binder, which fit much, much more loosely than it had with all that foam under it. Then, I wobbled back to the car.

On the way to the airport, E and I stopped at a Goodwill, where he helped me try on some shirts, some of which I bought. Everything fit beautifully! We returned the car and waited for our flight to board. Our flight ended up being delayed for a few hours, and the plane was pretty small. By the time we landed, I was grumpy and aching and exhausted, but I was home!

K was waiting for me, and he ran up to me and hugged me (gingerly) as soon as he saw me. It was so great to see him again. It reminded me that I still have 5 more weeks off of work to heal, and spend time with him over the holidays.  We had dinner with E and his partner, and then K took me home.

My first shower felt great, but it was unsettling. I was really nervous about taking off the binder, and about K seeing my chest. He was a lot more comfortable with my chest than I was, and he helped me get the binder off, take off the bandages, and got me into the shower. He washed my hair and my back and arms, and then left me to spend some time with my chest. The shower helped a little; I felt more composed and a little calmer when he helped me put the Bacitracin on my incisions and nipples and helped get me re-bound.

I know I needed this surgery; I know I didn’t want breasts. I feel great whenever I have my clothes on. Without my binder on, though, I feel really disconnected from my chest, and really scared. I hope this gets better.

I hung out with some folks without my binder on, while it was washed. I left the stuff over my nipples, and then took those off right before I re-dressed them. I feel much more in my body.

Today, when I was changing the dressings and showering, I noticed that it does seem like it’s my skin holding my chest together, and not just the sutures, skin glue, and my binder. I’m feeling a lot more connected to my chest, as evidenced by the fact that I didn’t feel queasy while I was unbound and a little afterward. Anxiety and nausea without my binder has been persistent over the past few days.

Meanwhile, I have been perfecting the art of bandages. Four maxi pads seem to do the trick, and between me and K rearranging them, I can get them in a pretty comfortable place. The super-long “heavy flow” pads seem to be thick enough to make me feel safe, and keep me bound tight.

I’m hardly swollen at this point, although I have some faint bruising from the liposuction.  The rest of the skin glue came off today in the shower.  I can only see a couple of sutures left, and a bunch of purple marker that I’ll get off later.    

I could drive as of yesterday.  I’ve also been able to have sex, thanks to creative positioning.

My incisions are narrow, smooth, and pink.

My left areola has almost completely peeled, and it’s that creepy pink color.  My right areola just started shedding that disgusting, gooey grey scab/skin in the shower today, and it’s probably 1/3 pink.  I really hope that after this initial peel, there is no more scabbing/peeling.

The maxi pad bandages drive me absolutely up the wall.  After an hour or so, they itch like mad.  I’ve been spending an increasing amount of time outside of the binder between dressing changes.  So, today, I’m giving myself a break.  I’m covering my nipples, of course, but I’m going to leave off the binder for a few hours.  If I hurt or swell up, then I’ll put it back on.  Otherwise, I think I can handle binding at night and in the evening, but letting my skin breathe in the mornings and afternoons.

Sleeping in my binder and on my back is making me breathe funny–sleep apnea style.  I haven’t been able to fall asleep as fast or stay asleep for long enough since surgery, because I usually sleep on my stomach or on my side.  I’ve almost constructed a way to sleep kinda sorta partially on my side, by putting a pillow under half of my back.  It’s pathetic, but it helps.    

I just went to brunch with K wearing only nipple gauze and some loose shirts.  I felt like I’d left the house without pants.  And kind of angry and mournful about binding and breasts and access to surgery.  It’s so simple to just throw (or gently wrestle) on a shirt and go out.  It’s so painless.

I’m so glad that I’m post-op, even though my chest still freaks me out in its wound-like state, with its numb areas and hypersensitivity, and its limiting effect on my range of motion and reach.  But it’s the best result I’ve seen so far, especially on a chubby guy.  Maybe I only think that because it’s mine, but I think that’s valid.

It’s amazing to think that my medical transition is basically over, since I have no plans for a hysterectomy or genital surgery at this point in time.  I still have to change all my documents over, but that seems really minor after the past year.

My nipples are doing something that (I hope) amounts to turning back to their more usual brownish color.  My left nipple remains more prominent than my right one.

I stopped using the binder at 17 days post-op; I couldn’t take it anymore.  There’s still some swelling in places and some occasional fluid seeps through what’s left of my scabs.  On my side of the bed, there are little spots of blood and chest goop.

I’m having reactions to the sutures still.  They’re coming to the surface and poking out of the incisions, where I grab them and try to slide them out.  I pulled out like 3″ of suture from my left side a few days ago–which is a record length.  It was awesome and disgusting.

My incisions are thin, but getting redder, which is supposedly normal.  The scars are supposed to be at their reddest and hardest from now until 3 months post-op.K has been great about helping me with scar treatment.  He rubs shea butter on my chest and nipples twice a day.  At first, he was doing it because I was too freaked out by my chest to even look at it. Nowadays, it’s become something of a sweet romantic gesture.

Nowadays, I can sleep on my side fairly comfortably, so long as I can get my arms and the end of my incision in the right place.  I’m almost comfortable on my belly.

I am so happy with my chest.  It still freaks me out occasionally, but it’s becoming really rare these days.  I love just throwing on a shirt and leaving the house.  And being able to take off my shirt and not be indecent.  And the way I look in shirts, giant belly or not.

I’m just not stressed when I leave the house anymore.  I’m not in physical pain all the time from binding.  I feel happier than I’ve felt since I can remember.  Now, I’m just waiting anxiously to see the final contour of my chest, and waiting for sensation to come back in a couple of areas that are still holding out.

It’s the best decision I’ve ever made.

I’m going back to work on Tuesday.  At this point, my range of motion is almost completely normal.  I can sleep fairly comfortably on my stomach and sides.

I still have bruises on my sides from the liposuction, but they’re very light; I probably wouldn’t notice if they didn’t hurt sometimes.

I’m still having some gross suture reactions.  A few days ago, I thought I had a chest pimple.  But when I popped it, something like two tablespoons of pus and lymph and chest surgery shit came out of that one single pore.  It was truly disgusting.

The incision lines at the sides of my chest are soft and pliable, so I’m hoping I won’t have dogears.  There are some hard, thick areas of scar tissue on the incision lines below each nipple (the darker section).

Scar treatment remains the same: Palmer’s shea butter twice a day.  I also do some scar massage while in the shower, usually.

There’s a bit more fatty tissue on my left side than the right. My right pec is completely flat–almost concave.  If this doesn’t resolve itself over time, I may eventually have a revision.  Of course, everybody says my chest looks perfect; the flaws are only glaring to me.

Sensation seems to be returning slowly.  The left side is no longer hypersensitive, and I’m only numb for about an inch in each direction from my nipple.  My right side isn’t faring as well.  I’m numb from the incisions to a little past my nipple; it’s an area probably 2″ high and 6″ wide.

Aesthetically, my nipples seem good. Brown is starting to show up over the pale pink color that was there originally when the scabs came off. I have distinct nipples, although my left one is more pronounced than my right one.

I have a few chest hairs that seem to have survived the grafting and therefore come right through my nipple.  And I don’t mean around the edge of the areola–I mean they’re coming up between my nipple and the areola.  It’s really unsettling, and I hope those follicles die–soon.

So, I was walking into a store, and I felt something cold and wet on my chest. 

I stuck my hand under my hoodie and my shirt just to check on things–usually it’s nothing, or maybe a little bit of fluid from the gross suture reactions which are still happening in a few places along my incisions.

My hand came back covered in blood.  I ran to the bathroom, ripped my shirts off in the stall, and snatched up some toilet paper to catch the blood dripping down my stomach.  There was a lot of blood.  I cleaned up, stopped the bleeding, and shakily left the restroom to find a worried K.

The worst part is that I have no idea why that happened.  I think that there may have been some collected blood under one of the scabs, and it just burst randomly.

While it was disgusting, it fortunately doesn’t seem to have done any damage at all.  It just scared the living shit out of me, grossing me out profoundly in the process.

At 56 days post-op, I feel completely at home with my chest. I have a hard time imagining ever having had breasts, especially when I look at myself in the mirror. All that forcing myself to walk around shirtless has paid off.

I’ve been back at work for 2 weeks. My range of motion is 99% normal. I’m getting antsy to do all the things I couldn’t do before because I was self-conscious about my chest.

For now, I feel very much post-transition. I don’t have the money for a name change quite yet, but that just feels more like cleaning up a small mess after you’ve built something huge and intricate.

I still have some puffiness on my left side, but I’m hoping it will resolve itself over time.  If not, I’ll consider a revision.  

The left side has been healing better than the right side overall.   The scab visible in the left-side photo is the scab from which I poured blood the other day.

On the right side, sutures continue to surface, as evidenced by the angry redness in the photos.  I have about three dry, brittle scabs that I’m hoping will clear up soon.  At least the redness is beginning to thin out and remain concentrated around the incision instead of spreading out all over the place like it was doing.

My left nipple is less prominent than it was a few weeks ago.  The pigment is coming back to my areola quite fast.  Where the brown is returning, the nipple is also smoother and less raised than the pink parts.  In creepy news, though, I have a hair coming out of the spot where my nipple meets my areola.  That follicle had better die soon if it knows what’s good for it. 

No weird hairs coming out of my right nipple, though, thankfully.  There’s less pigment returning in this one, and it remains pretty raised.  I’m not too worried, though, since this one held onto its goo-scab for a lot longer than its easterly counterpart.

At this point, I consider my chest fully healed.  I’m finally comfortable doing all of the things I did pre-op.  I sleep on my stomach, I can reach high above my head, and I can lift heavy objects.

I had thought all the sutures had been excised, but I discovered one last centimeter a week or so ago.  It came out when I was scratching an itch on my left side.

Already, some sections of my scars have faded significantly.  The areas that bore the brunt of the suture reactions are red and slightly raised.  I’m worrying about it, of course, but I’m trying to bear in mind that this is supposedly the time when my scars are at the height of their thickness and redness.  Hopefully, it’ll all be downhill from here.

During showers, I massage my chest firmly, making sure to move the skin in all different directions.  I’m hoping this will increase blood flow and encourage nerve regrowth, as well as break down and smooth out the scar tissue.

I’m continually reminding myself that although I’m past the initial stages of healing, I should expect my chest to improve over the long-term.  Anecdotal evidence suggests that sensation returns over a period of years.  It’s much too soon to tell if I’ve suffered permanent nerve damage.  Much of my right pec is still numb, although I can usually feel pressure.  My left pec is a bit better, but nowhere near where I’d like to be.

At day 120 post-op, almost half of my incisions are mostly flat and pale pink.  There are a few pretty red areas, and there is a short segment on my right incision, under my nipple, that’s quite raised and red.

Contrast and redness are exagerrated in photos, especially in the case of my nipples.

I’ve been slacking a bit on the scar treatment; I’m down to shea butter once every day.

Almost all color has returned to my nipples. I’ve been thinking of getting my right nipple pierced at some point, because it’s not quite as perfect as my left nipple, and I suspect it’d distract from their differences.

It’s 153 days post-op. At this point, I don’t really mark the passage of time anymore. I am certainly not taking my new chest for granted, though. We don’t really get a spring down here; it’s always just summer all of a sudden. 

I’m not completely comfortable having my shirt off around strangers yet, but I occasionally drive home from work without a shirt on, or scurry out to check the mail in only some pajama bottoms.

But there’s nothing like walking or riding a bike or sitting outside on a hot day without four layers of lycra binding down over 6lbs of breast tissue.

Additionally, I think I’m starting to regain some sensation in my right nipple–although just barely. The only feeling I get is slight pain/discomfort when it’s pinched or rubbed firmly, such as when I am massaging shea butter onto my chest.

There’s a spot on my left nipple (just where the nipple meets the areola) which tends to be irritated due to a single hair that tries to push through in that area.

Today is 190 days post-op.  I’ve got sensation, at least a little bit, in most of my chest now, with the exception of my nipples and the area between my nipples and scars.  It’s improving slowly over time.

There are only a few tiny bits of my areola that are lacking pigment. Color is still returning, but more slowly than during initial healing. I actually got a zit/ingrown hair under my areola sometime last month.  It was really gross, and I got irrationally afraid of my nipple being fucked up permanently.  It’s fine now, of course, but I hope it never happens again.

I had intended to post pictures at 9 months, 12 months, or both. I apologize for that not happening. This is what my chest looks like now–a year and a half after my chest reconstruction surgery.

The scars are now almost completely flat.  A couple of areas which gave me the most trouble during healing are still in the process of flattening out.  They have faded to pale pink and white, and seem to be fading more and more with time.  Some sections seem close to disappearing altogether.  Until this point, I have mostly avoided exposing the scars to direct sunlight, though I will probably switch to using sunscreen.

Areolar pigment is still returning–slowly but surely. I hardly notice, really. For a while, I was having issues with ingrown hairs, but they’ve settled down–now I have 5-7 hairs that actually grow through the areola. That used to bother me, but I don’t even notice anymore. The scars from the nipple grafts have completely disappeared, and my nipples aren’t as raised off of my chest as they had been. My nipples look and feel–to my at least–like nipples that had never been grafted.

Sensation is a trickier matter. My chest is not as sensate as the rest of my body, and not as sensate as it was before surgery. I don’t have any particular patches of numbness anymore. I have some sense of hot and cold throughout my chest. I can feel light and firm pressure through most of my chest–though the areas just above my incision lines, just below both my nipples, and right around my left nipple are hit and miss with light touches. Most of my chest can feel pain, though in the number areas it registers as a discomfort i can’t really place, rather than as pain. It’s a very strange feeling, and not one I enjoy.

My nipples aren’t completely insensate, but the sensations I get there are unpredictable, and not usually pleasant. I don’t usually feel hot/cold, and I sometimes can feel both light and deep pressure. At this point, though, my brain seem to just fill in the information I’m not actually getting, so I rarely notice that my nipples–or any sections of my chest–are insensate.