What I Wish I Knew Before I Had Top Surgery

Among other things, I didn't expect for it to feel terrifyingly lonely.
Jameson Hampton

For anyone who’s going through a gender transition, there are certain moments that stand out.

I remember the moment five years ago when I decided to change my name to Jamey, to be consistent with my gender identity. I remember seven months after that when, for the first time, my mom used my chosen name and then four months after that, the first time I saw it printed on my driver’s license. In 2015, my partner gave me a greeting card that I still treasure that said, “Happy birthday to my wonderful boyfriend.” And during the summer of 2018, I was getting ready to experience another of those big moments: seeing my new chest for the first time after undergoing top surgery.

Top surgery, a common term used in the trans community to describe a double mastectomy, is a common part of gender transition for transmasculine folks like myself. It’s definitely an investment — the surgery itself is fairly intrusive and if you have to pay out of pocket, it can cost easily over $10,000. Thankfully, more health insurance plans are starting to pitch in for medical transition costs, and I’m very fortunate that my surgery was covered by my insurance.

Top surgery can feel like a necessity for many of us who experience a lot of gender dysphoria centered around our chests, both because of how it makes our bodies feel, and because of how it causes other people to perceive us. I had been coping by binding my chest, but binding is not only a huge burden but also unsustainable long term for health reasons. In 2015, I contracted pleurisy ― inflammation of chest tissue ― as a side effect of frequent binding. I longed to be free, both of my dysphoria and the hassle of chest binding.

“The morning after my surgery, when my surgeon came back to the hospital to take my bandages off for the first time and do the grand reveal, it wasn’t really the memorable moment I was expecting.”

My top surgery was a long time coming. It had been about four years since I realized top surgery was a necessity for me, and a full year since I had gotten myself onto my surgeon’s waiting list. But even all the time in the world to prepare couldn’t stop me from being nervous. I had never had any kind of major surgery before; I didn’t even know what it felt like to be anesthetized. Plus, I’m the kind of person who keeps themself busy all the time, and spending most of my summer bedridden was a nerve-wracking prospect. But my supportive friends and the thought of finally being able to jump in the lake without constricting my unwanted chest were enough to keep me optimistic in the weeks leading up to the procedure.

Before my surgery, I talked to tons of trans folks who had been through the same experience. I was given a lot of clinical facts about what it would be like — how long to expect to be bedridden, how to keep the surgical site clean, what arm motions could damage the stitches — as well as what a relief it would be to finally be free of all the dysphoria that my chest caused me. But the morning after my surgery, when my surgeon came back to the hospital to take my bandages off for the first time and do the grand reveal, it wasn’t really the memorable moment I was expecting.

I was expecting to savor the moment when I finally got to look down at myself and see my chest, for the first time, finally the way I knew in my heart it should look. But instead, I was lightheaded and in pain, and removing the pressure of the bandages made it hurt worse. Not only were my scars still raw and unpleasant, I was actually so distressed that moment never happened at all — I didn’t even have the presence of mind to look down at them! My surgeon took a photo so that I could see it when I was ready and reassured me, “I’ve seen hundreds, maybe thousands, of post-surgery chests and yours came out really great. Trust me, once you’re feeling better, you’re going to be so happy with it.”

“I was expecting to savor the moment when I finally got to look down at myself and see my chest, for the first time, finally the way I knew in my heart it should look.”

In the days and weeks following the surgery, I thought about that conversation often, almost obsessively. I was terrified I wasn’t healing properly. Why did I feel so… bad? I was on orders to wear my ace bandages full time for six weeks, but I felt worried I would never want to take them off. The purpose of the compression bandages, it was explained to me, was to prevent liquid from pooling under my skin that would stop me from healing flatly. But after binding my chest for the past four years, the tightness of the bandages also felt comfortingly familiar. In fact, I hated taking them off even to change them — it was new and weird and made me feel exposed in a way I had never experienced and could barely understand. I kept them wrapped so tight out of anxiety that I continued to get light-headed and in risk of fainting every time I took them off, which of course only exacerbated the issues I was having.

My surgeon’s office ended up ordering me to check on the progress of my scars at least once a day so I wouldn’t miss the early signs of infection. My scars were treated with glue instead of traditional stitches, which meant I was medically cleared to take a shower as soon as the day after I got out of the hospital, but it took almost two weeks before I felt comfortable keeping my bandages off long enough to actually do it. I was squicked out by my own surgical sites, and the combination of physical discomfort and general newness and weirdness was brutal, emotionally. (Eventually the desire to have a proper shower won out over my anxiety.)

Additionally, I was experiencing unpleasant tingling sensations where my nipples used to be, despite the fact that I had opted not to keep them after the surgery. I called my surgeon’s office (again) and was surprised to hear them suggest that I was experiencing a kind of phantom limb syndrome of sorts. “Well, you have a bunch of nerve endings that used to go to your nipples that just kind of go nowhere now,” they explained. “So of course it feels weird.” I felt like a medical oddity. I found myself thinking, If this was a normal symptom of recovery, why was this the first time I was hearing about it?

In fact, I had seen dozens of post-op photos of trans guys and nonbinary folks joyfully seeing their chest for the first time. It seemed like none of them ever looked like mine: distressed, disoriented, in pain. So what was wrong with me? Or if this was normal, again, why had nobody ever warned me about how it would feel?

“Being honest about our feelings doesn’t make us any less masculine, and struggling with difficult parts of our transition doesn’t make us any less trans.”

Even when I was feeling at my worst, I didn’t actually think that I had made the wrong decision or that I would regret having the surgery. But I was terrified to say anything that might make people, even my friends, perceive that I was having regrets. I knew I was lucky to have so many supportive people in my life, but it felt like everyone I talked to wanted to congratulate me and ask how I was doing. “Don’t you feel great, now that you’ve finally had your surgery?” I felt like if I told them how difficult of a time I was having, I’d be undermining my identity as a trans person. Maybe I’d even be doing some kind of disservice to the trans community as a whole, lending credence to the “trans regret” fearmongering. I didn’t expect to feel terrifyingly lonely.

Luckily, time has a tendency to heal physical wounds. As I healed, it became increasingly clear that my body didn’t feel wrong because I had made the wrong choice or had been wrong about my gender dysphoria — it felt wrong because I was recovering from major surgery, obviously. About halfway into my six-week recovery period, I started to be able to get out and about again, although more carefully than normal.

My friends threw me a surprise party at the drive in and we watched “Young Frankenstein” on the big screen. There was a cake with a post-op photo of me, and they brought a bubble level, gleefully measuring how “flat” I was now. It was probably the first time I could honestly say I felt really good. And I kept feeling better after that. As I feared, at the end of my recovery period, I wasn’t quite ready to shed the comfort of my ace bandages. But at around the seven-week mark, I finally took the plunge and gave them up, feeling more like myself than I had in a long while, or possibly ever.

The author with his friends at his surprise party.
The author with his friends at his surprise party.

In the end, my top surgery was one of the best things I’ve ever done. Now, a year later, the memories of how difficult dealing with my chest used to be are becoming more distant. Things like going to the beach that used to be painful and anxiety-inducing now finally feel fun and exciting, like they should. In many ways, I’m so much freer now than I ever was before.

But the surgery itself was also a hard experience that was made even harder because I wasn’t prepared for it. My trans friends swapped surgery stories about how much it sucked recovering and not being able to do things for yourself, but nobody ever really told me about how bad they felt in a genuine way. I understand why they didn’t; I felt vulnerable too! We live in a society where trans people have to beg for respect. It doesn’t leave a lot of room to be honest about your experiences, when we know straying from the typical trans narrative will cause some people to question our credibility. Even within the queer community, some people are always ready to claim that others “aren’t trans enough.”

But knowing that I wasn’t the only one would have made my recovery so much easier to live through. We deserve the space to be able to talk authentically about our experiences: being honest about our feelings doesn’t make us any less masculine, and struggling with difficult parts of our transition doesn’t make us any less trans.

The author.
The author.

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