top surgery: the movie: the novel

i got top surgery 2019 june 26th with dr. alison shore at advocate illinois masonic.

please be aware: i’m including photographs of my chest, including some of the gnarlier bruising. there are no photos of my accursed flesh opened up or anything, but be forewarned.

part 0: about me

i think some context is worth including here — i am transmasculine nonbinary. i paid for everything out of pocket because i didn’t want to do the whole song and dance to get insurance to cover it/i wasn’t sure if i could get insurance to cover it at all, considering i wasn’t sure if i was going to start T. i ended up starting T just before my initial consult, but i already had the cash and wanted it done quickly. i have absolutely no insight as to how this goes with insurance — i know it takes a lot longer, but i don’t really know what “longer” entails.

part 1: before

in august or september 2018 i set up an appointment with howard brown to talk about my options wrt trans stuff. originally i said i didn’t want hormones but i definitely wanted top surgery. my provider went through some of the effects of various types of transition, then gave me a handout with a couple of surgery providers in the area.

i knew from other trans people that dr. shore tends to be recommended; i searched for her name on r/ftm and on the internet in general to see what people had to say about her, especially since she wasn’t one of the surgeons whose names i saw regularly in trans spaces. it turns out she’s THE surgeon for top surgery here in chicago; the pictures i saw of results looked really good.

in october 2018 i made a phone call to her office to set up an initial consult. i believe the original consultation fee is $150; this fee is either kept if you don’t get top, or goes to your overall top surgery fee. the earliest available time for a consult was in february 2019, so 4 months later. they took my legal name, but also my preferred name and pronouns.

i had my consult in february. dr. shore talked to me about my goals with top surgery, then did a short examination of my chest. due to the size of my chest (34DD originally) she recommended double incision. she warned me of the biggest potential drawbacks (loss of sensation, scarring); i was fine with that. she was very warm and friendly and made me feel a lot better — i didn’t exactly mean to get excessively honest about my conflicted feelings about my own gender, but i didn’t think she was going to use that against me/use that is a reason i couldn’t get top surgery. she and her nurse consistently used my chosen name and my correct pronouns without prompting or reminding. she told me the requirements for surgery, and i scheduled surgery with her for june 26th.

eta 7/28: i was quoted for $7400 all told, for dr. shore, the use of the surgical wing, and anesthesia. i haven’t gone through to total everything up, and that number ended up being practically speaking a little higher due to takeout/cabs/etc during recovery; if you’re going this route, i’d budget about $10k all told.

requirements

  • a letter from a therapist. i used my own therapist who i’d already been seeing; there wasn’t a specific therapist or psychiatrist dr. shore needed a letter from, as far as i’m aware
  • a letter from a medical doctor clearing me for surgery
  • i have von willebrand’s type I, a bleeding disorder; because of my special medical circumstances, i also had to get clearance from my hematologist. dr. shore and my hematologist spoke several times before my surgery to make sure my bad blood was under control.

i went off of hormones 2 weeks before surgery. i had a final consult a week before surgery with dr. shore, where she went through all the possible things that could go wrong, and reassured me that most of them almost certainly would not — she apparently has only ever lost a single nipple, and it’s because the patient was a smoker — and went through what to expect the day of surgery. i had been apprehensive pretty much right up until that consult, but afterwards felt a lot better. dr. shore took pictures of my chest, gave me prescriptions for opioid painkillers and anti-nausea pills to fill pre-surgery, and that was that.

part 2: surgery

note: a side-effect of anesthesia is amnesia; this is the best i can remember, but parts are a little hazy from anesthesia/drugs and also, you know, the mortal terror of being knocked out and sliced up.

my sister, emma, had agreed to stay in chicago to help take care of me for several days; my friend, fen, offered to drive me about to and from surgery. originally i told emma i’d be okay if she didn’t show up; that was a lie! have someone there physically!!!

surgery was at 10, with an arrival at the hospital by 8; i was not allowed to eat after midnight, and no water after 6 am. i woke up at 5:45 and drank a ton of water, then took a long hot shower. fen picked me up at 7 and we were off.

the hospital itself took my legal name, but also my preferred name and pronouns. everyone who came into the room was good about both of those things, at least for the time periods i was awake :v

by about 8:30 i was in a room of the surgery ward. fen was allowed in with me and kept me company while i started quietly unraveling. due to my blood disorder i was given an IV of clotting factors; this chugged away while i was introduced to a whole bunch of nurses and also both the anesthesiologists. they asked permission to put up a little picture that indicated i was getting a surgery related to gender to indicate to medical staff to be extra sensitive; i said yes (i think it was a sunset or something?)

(on a shallow side note, every single person on my medical team was hot?? like — one of the anesthesiologists was so beautiful i had a hard time making eye contact with her, and the other was hot and also funny and he kept making jokes that i was too freaked out to get; i have literally never had that many hot people fussing with my accursed meat form before and it was — disorienting.)

(also, on another shallow side note, one of my nurses was named aiden and, as dumb as it is to admit, the second he said his name i relaxed hah. i don’t think he was trans, even, it’s just a good sign, okay!!!!)

i went through a variety of forms to sign, with the various dangers of surgery, as well as telling people in my own words what surgery i was getting. dr. shore came in for one last meeting — she had me strip out of my (surprisingly flattering; it was a nice green color, paired with bright yellow nonslip socks) hospital gown to the waist to draw onto my chest where she was going to cut. she told me that, due to my bleeding disorder, i might have to stay overnight, but we’d talk about it once i was awake again. there was some minor excitement due to emma not understanding time zones — she thought she was landing at 10 AM chicago time because she looked at the flight times and didn’t convert from EDT to CDT, but she landed at 9 and barely made it to the hospital before it was time to go.

i was given some kind of drug that makes you really chill; about halfway down the hall to the surgery bay my eyes stopped focusing and i started telling one of my nurses very earnestly that the drugs were good. i vaguely remember getting the oxygen mask and the surgery light, and having one of my arms strapped down (they basically t-pose you for surgery), and that’s that.

i woke up in one of the recovery bays with ice packs sitting on my chest. i had already been put in a surgery vest and my drains were pinned to my shirt. my throat was INCREDIBLY dry — for me, the most unpleasant part of surgery by far was how dry my throat and mouth were from the combination of intubation and the drugs they use to bring you out of anesthesia. a nurse let me drink some water and then had me hang out for a little bit to make sure i wasn’t going to be sick before letting me have some graham crackers. my mouth was dry to the point i couldn’t eat the crackers without there being some liquid in my mouth.

the next parts are all a little hazy — at some point emma and fen showed up again. they said dr. shore didn’t think i needed to stay overnight. i sat around eating and drinking for a while until i had to pee (which, nurses get VERY EXCITED when you have to pee post-surgery; i had three people literally cheer when they saw me wheeled towards the bathroom). eventually they let me go home? and fen bought some juice and some snacks and i got put in the poang, where i basically lived for several days.

part 3: recovery

for the first week or so, you have drains and nipple bolsters. drains provide steady gentle suction to pull some of the fluid that gets displaced out of your body. part of recovery is emptying them into a collection beaker twice a day and checking approximately how much fluid has come out of you and what it looks like. nipple bolsters are little pillows sewn to your nips to keep them safe while they heal up a bit. on top of the bolsters, i also had two large bandages to absorb any extra fluid.

additionally, you have tape put over the incision scars along your chest. this stayed on for about 3 weeks for me. all of this gets stuck under a surgery vest — this stayed on pretty much whenever i wasn’t in the shower for 3 weeks.

i got pretty lucky — i was only a little nauseated from anesthesia and was able to eat right away. i had some pain, but it wasn’t bad — again, by far and away the worst thing was how sore my throat was for two days, and i wish i’d had lozenges on hand.

emma was an ENORMOUS help — i pretty much didn’t get up from the poang for several days except to pee (i slept there, even), so emma got ice packs and gave me water and then we watched a ton of television.

the first evening of drain collection i had a BLOOD CLOT in one of the drains, which was completely normal but also extremely terrifying; emma was a champ and got in there with her hands to get it free while i sat there and screamed very quietly for a while. it was — rough.

the day after surgery i saw dr. shore again and she took a look at my chest. she said i had a minor hematoma on the right half of my chest and to take it really easy for a few days. i was okay to walk around some, but it was so miserably hot i mostly didn’t — emma and i walked about a mile every day but that was about it. i didn’t shower; i used baby wipes to wipe the worst bits down.

sunday night i went to do my drains and discovered one of my nips had bled through the bandages. i called dr. shore in a panic and she said to come in first thing monday morning. turns out the bleeding was totally normal and no big deal; she snipped the bolsters free and took out one of the drains and told me i was allowed to shower.

for several days showering was kind of a pain — i had to safety pin the drain to a necklace in order to take my surgery vest off, then i couldn’t really wash my chest at all, but at least i was clean at all. after several days of this, i got my 2nd drain taken out.

for another week i had to keep my nipples bandaided over pretty much all the time, tape on my incisions, and the vest on. i was cleared to take the vest off on the 18th, and cleared to lift more than 10 lbs at a time.

now i wear the vest when i’m sleeping or if i’m having a more physically taxing day. i am doing scar care (silicone serums and silicone scar sheets) and moisturizing a lot. my nipples are a little scabby still but almost healed. i still definitely get tired more quickly than i do when i’m fully healthy, but i’m clearly recovering.

pictures

june 27 – one day after surgery
july 4
july 4
july 12
july 18
july 21
several hours after surgery. forbidden and sanctioned capri suns.

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