what to expect when getting top surgery as a FTM FTX Transmasculine transgender man

Road to Top Surgery: What to Expect & Survival Tips

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I recently hit a major transition milestone: I got top surgery. Release the celebration balloons! 

It took me a few years to get comfortable with the idea of getting surgery. Binders were kind of reassuring at times, like a portable weighted blanket, so I started to feel like it wasn’t that important for me to get the ol’ teetus deletus. As I got more comfortable with my gender expression and aesthetics, I realized how limiting it was to wear a binder. I wanted to be able to wear what I wanted without judgemental eyes (or the security risk) of being a man with boobs.

It didn’t hit me how important top surgery was until I got my surgery date. I was getting undressed to take a shower, and I caught a glimpse of myself in the mirror. I pushed my chest up and out, trying to simulate what a breast-free chest would look like. Well, I burst into happy tears.

“Finally,” I literally said to myself. 

It’s been a long, long road. 

The process before top surgery is very dependent on your location in the world. Each surgeon works differently, so I’ll largely omit this and focus more on the actual healing process. As I was laying in the guest room bed at my parents’ place in the country, healing and high from the painkillers, I realized just how different my experience of top surgery was from my expectations. 

Kind of a confession from the anxiety part of my mind: I actually expected the worst. I know, not a great attitude to have, but I was trying to brace myself for pain and complications. In reality, I got extremely lucky and my top surgery healed quicker than I expected. 

I also never imagined I’d be sleeping next to a massive six-foot-tall nutcracker. That was a bit of a horror story in itself. Still, despite that early leftover holiday horror, my experience of top surgery has been very much a dream!

But first, let’s start off from the top (surgery, ba dum tss! ).

First off, what the heck is top surgery?

For those unaware, top surgery is the term medical professionals call “a double mastectomy”. It’s when a surgeon removes the breast tissue and excess skin to make the chest appear much more traditionally masculine. Top surgery also involves removing the nipples, trimming them to become smaller, and sticking them back on. Ta-dah! Medical magic.

There are a few different types of top surgery “styles” you can get. Most people opt for a “double incision”, where two incisions are made above and below the pectoral muscle. This allows the plastic surgeon to remove the breast tissue and any excess skin that would sag, then stitching them both together in order to make the chest smoother. The nipple is removed and placed back in a more natural position. A double incision is most often recommended for people who have medium to larger chests, but really anyone can get them.

After surgery, you’re bandaged up and sent back home to recover. 

You know what’s kind of ironic? You know how almost every trans person yells about how dangerous it is to bind with ace bandages? Well, guess what you wake up wearing? Yup! Ace bandages. This is their time to shine, baby.

You’ll be wrapped up in them to keep any build-up of fluid or blood from making your chest as flat as a board. Your surgeon might recommend that you keep the bandages on for a few weeks to a month, other surgeons prefer their patients to get a post-surgical binder to act as a bouncer keeping unwelcome fluid out.

The worst part of top surgery…?

So if the pain isn’t horribly painful, and you’re able to chill at home for four to six weeks watching reruns of Avatar the Last Airbender… What’s the worst part of top surgery healing?

The drains. Oh, sweet catastrophic astronomical dust particles… the drains are the worst part of healing.

I know. Every part of your body might be clenching in fear. Have no fear, and release your understandably tense butthole for a moment. It isn’t horrific pain! Just really awkwardly uncomfortable, and can be what doctors call psychologically “icky”.

Drains are little tubes put into the surgical site to help release fluid build-up from the body, in order to prevent those nasty seromas and hematomas we mentioned earlier. Every few hours, you drain the healing liquid out of the drains, measure it, and clip them back onto your person. It’s like having two medieval coin purses attached to your person, but filled with blood! So… coin purses for vampires?

Comic by… ME! More @Ashzdavis

Not every surgeon uses drains, and some patients specifically seek out doctors who don’t use them. There are many who have their own techniques to avoid using drains, and to those people who don’t have them? Damn you lot were lucky. 

After a few days to a week, you can see a medical professional who will remove them. You will feel the sweet release, and as a good friend once told me, “now you finally are beginning the healing process”. 

What kind of pain and discomfort should I expect?

I won’t sugar coat it: top surgery is surgery so you will have some discomfort. Personally, I wasn’t in any massive amounts of pain to the point where I couldn’t get relief from the medication I was given. The largest amount of pain I had was from the drains, and once they were removed by a nurse in a clinic, I finally felt like I was healing.

Tips and Tricks

There are some tips that most people know like: fill your freezer with lots of easy to microwave foods, wear only button-ups, and place your needed items lower on shelves for easier access. 

Here are a few other tips I’ve learned along my own top surgery journey. They’ve been passed down from other trans people, who I am eternally grateful for, or they’ve been things I’ve learned the hard way. Hopefully, they can help you out too!

1) Get Tilted with a Wedge Pillow

For the first couple of weeks, you’re going to spend a decent amount of time laying in bed, and a wedge pillow can help you make that time much more comfortable. A wedge pillow is a big foam pillow that’s shaped a bit like a delicious piece of cheesecake; you lay on it to prop yourself up while sleeping or doom scrolling to pass the time. 

Since you won’t be able to use your upper body or your arms to get out of bed, the wedge pillow gets you halfway there so you only have to swing your legs out of bed to catapult yourself up (please be careful!). 

2) A Cushion for the Road

Remember when you were a kid, and the strap of the car seat felt so restrictive and painful? Yeah, be ready for round two after top surgery. You’ll inevitably have to be driven home from top surgery, and you’ll absolutely want a cushion between the seatbelt and your fresh incisions. The part that hurt most after top surgery was my sternum, which makes sense since it’s a bundle of nerves!

Do yourself a favor, and no matter where you’re headed, bring a simple cushion or pillow for the car ride. Your stitches will thank you!

3) Prepare for Intense Emotions

The time after surgery can be a period of intense emotions, even when you’re extremely happy with the outcome. Your body is doing its darndest to heal after major surgery, and allocating all thrusters to healing instead of keeping your mood up.

To prepare for this period of sadness and possible “oh no why did I choose this pain” circular thinking, write yourself a note or record a video to yourself. Explain what your feelings are, reassure yourself, and give plenty of things to look forward to like tank tops!

You can even ask your friends to write a note to you to help perk your mood up!

Avoid watching things that might be too serious for your mindset at this moment. This isn’t the time to focus on the news, or listen to My Chemical Romance. Comfort yourself, and let your body heal.

4) But No One Expects Postoperative Anxiety!

For the first couple of days, I felt eerily fine. I wasn’t sleepy during the day, so I sat next to my mom and watched worryingly large amounts of each Real Housewives franchise. 

Then, the anxiety hit me.

Suddenly everything was terror-inducing for me. Sure, I have an anxiety disorder (no surprises here) but on the regular, my anxiety is pretty well managed. I have my breathing techniques, I have my medication, I have my weighted blanket.

The anxiety felt rational, which was extra tricky! What helped me the most was to verbalize my concerns to a transmasculine support group online and to have regular sessions with my therapist. 

5) Find an Online Group of Trans Pals

During my entire transition timeline, one of the most invaluable resources for me has been the trans masc Discord server I’ve been a member of. They have been a source of constant support, and I’ve developed many close friendships through the server! (Hi friends!)

It’s very soothing to have a fellow trans guy commiserate with you about how sore your back is, or calm you down to explain that yes it’s normal for you not to be able to sit up straight for a few weeks. 

So definitely jump on Discord, Reddit, or Facebook and introduce yourself! You never know what support you can get, and then give back to people just like you.

6) Forget About Being Productive

This might sound a bit… neurotic, but I had a to-do list of things I wanted to get done while recovering from top surgery. Yes, you heard it. I wanted to be productive after going through major surgery. (I know, I have a problem.)

It wasn’t like I wanted to start a business, or take up yoga though! I had a month to recover, and just wanted to smash in all sorts of recreational relaxing activities I found difficult to indulge in during my regular days filled with work, chores, and doom scrolling, you know?

Just… forget about it. Stop planning to write the world’s finest novel during your recovery, or “figure out why you keep dating emotionally distant people”, or your issues around food.

The time you have after surgery isn’t meant for anything other than recovery. That means eat as much or as little as you are able, sleep as much as you can, and totally give yourself permission to watch reruns of Girls if you want. 

Your only job right now is to give your body a fighting chance to recover!

 


 

Good luck on your journey, if you choose to get top surgery!

It’s a wild ride, but nothing fills me with more joy than realizing that I get to be topless in the summertime or feel the breeze under my t-shirt.