6 months after top surgery

A couple of days ago, something suddenly dawned on me:  It finally clicked why things weren’t looking too good in terms of symmetry.  I previously had not paid attention, but my rib cage is actually fairly uneven.   I’ve known that my hips are askew for forever – I have mild scoliosis.  My waist is off – it goes straight down on the left side, and curves in on the right.  We all have these little quirks…  Other things:  my eyes are not the same – one eyelid is droopier than the other.  One nostril is a little bigger than the other.  You know that swirl everyone has within their hair (cowlick)?  It’s never dead center, is it?  – It’s over to one side.  Some people even have 2!  My point is, we’re all a little different, even on a structural level.  And I had been ignoring/avoiding my chest and rib cage – possibly because of the dysphoria surrounding that area.

I knew there was a weird dent on the left side, but beyond that, my ribs were pretty foreign to me.  Recently, I started poking around.  The bones are not in the same place, between my left and right!  The left side even juts out a little further than the right.

Despite this, my breasts actually had been symmetrical, but that’s probably because there was all that extra tissue as a buffer.  When the surgeon went to take that all out, bones were a hindrance as to what she could do, I’m finally realizing.  (And yeah, I am actually that skinny that my ribs stick out a little bit.  I wish I had some more meat on me there!)

I recently took some photos, so that finally, I could post my results on transbucket (you can check it out – you just have to create an account to access the website, first).  And I found that things don’t look as bad, through the camera lens, as they do when I’m scrutinizing every little thing in the mirror.  I had also taken photos of my chest, pre-op, and this was the first time I looked at those since surgery – my breasts seem a lot bigger than I remember them!  Haha.

Here’s what I wrote on transbucket (a summary of sorts):

“Had surgery in June of 2016.  Was reimbursed for 40% of the total cost, which I wasn’t expecting!  This surgeon and her staff were subpar with patient care and availability.  I have barely seen / spoken to Dr. Rumer during this process.  All follow-up appts. (been doing them through Skype) have been with a physician’s assistant.  The only other time to see her will be at the 1 year-follow-up.

I was not completely satisfied with the results (although these pics don’t look too bad).  The left side is larger than the right, and the nipples are uneven, a little sunken in, and (at 6 months) purplish in color.  It’s tough to see from the pics, but I believe some muscle tissue was taken out on the right side, and there’s a dent to the right of the nipple.  Sensation is touchy, but slowly improving.  I recently realized that my rib cage is not symmetrical, so that may have impacted my results.

I plan on seeking a nipple revision, at the least, in the future.  Since I would have to pay more for this, from Dr. Rumer, I will be looking at options elsewhere as well.

At the time of surgery, I was not on T.  I’d been on a super-low dose prior, for 2.5 years, but I do not think that impacted my musculature.

More information can be found at:  https://janitorqueer.com/category/top-surgery/ ”

Here are past updates about top surgery, documenting as I go:
4.5 months after top surgery:  4.5 months is an odd point – but it seems worthwhile to write now, mostly because within the last couple of weeks, sensation has been returning at a faster rate. and I want to make note of that. …
3 months after top surgery:  I did not expect to feel much different other than a cerebral satisfaction regarding being able to wear anything from now on.  But it’s more of a gut- level confidence. …
1 month after top surgery:  I can live with that for now, but I doubt things are going to change enough for it to actually look good.  I’m not happy with the results. …
2 weeks after top surgery:  Right now, there is not enough symmetry, in multiple regards. …
6 days after top surgery:  Everything went smoothly, except for the fact that the surgeon was about to do the wrong procedure. …

Top surgery consultation #2

Content warning:  discussion of self-injury.

On Monday, I traveled to consult with Dr. Rumer, and the appointment went well.  In stark contrast, I had a terrible consultation with a local surgeon, at a cancer center, yesterday.  She mainly works with breast cancer patients, and the mail / paperwork I received in advance reflected this.  (The center could easily draft up non-cancer related documents for trans-clients!)

I was there for a total of an hour and 45 minutes – lots of waiting!  When I got there, I filled out paperwork about my breast cancer diagnosis.  I just put N/A for a lot of it.  Here’s a sampling of questions I was prompted to answer:

– What do you know about your diagnosis?
– Previous breast history?- Some cancers are more prevalent in persons of different racial and ethnic backgrounds.  The following information will help us to better understand your potential risk in developing certain types of cancers and to understand your prognosis.  [Followed by questions about ethnicity.]
– What percentage of waking hours do you spend up and about?
– more than 50%
– less thank 50% – I am confined to a bed or chair
– I am completely disabled, totally confined to a bed or chair

On the phone, when I scheduled the appointment, the woman was sensitive to the reason I was coming in, and to the fact I hadn’t legally changed my name yet.  Regardless, that didn’t translate over to the present day, and I was called by my birth name and even, “Mrs. [last name].”  I don’t think I’ve ever before been called “Mrs. [last name].”

I finally was brought up to the breast cancer suite and my vitals were taken.  I waited in an exam room and a nurse came in and went over some of the questions with me.  She left for a while and came back, saying, “let’s fill out this paperwork.”  This one WAS relevant to why I was there.  I asked her, “Why was I filling out papers for breast cancer patients?”  She replied, “Oh, well, they just gave you the wrong one down stairs.”  No big deal… ???

She left and a doctor with an intern student came in.  The doctor asked if it was OK if the student was present, and introduced her.  She then asked, “Are you so-and-so?”  I said no I’m not.  She said, “oops, sorry, wrong room.”  I sat there waiting a while longer and finally the surgeon came in with TWO student interns.  At no point did she ask for my consent for them to be present.  They introduced themselves and we got started.  She started by putting words in my mouth – “So you’ve felt this way since you were a teenager.  That’s when you started feeling different…”  I just let her roll with that.  She asked about mental health, suicidal thoughts, and even self-injury.  I’m not sure why.  She asked very little about gender identity.  I answered her questions honestly, including that I’ve had vague suicidal thoughts, and I used to use self-injury as a coping mechanism.

She then said they were going to leave the room and prompted me to put the robe on.  They were gone a very long time.  They all came back, rubbing hand sanitizer into their hands.  I had a flash fear thought – are all these people going to be touching me?!!!  Fortunately only the surgeon touched me, but the presence of all these people was enough for me to check out for this part of the appointment.  A few things that registered:

– She commented on my tattoo, asking if that was magic marker – it looked like marker.  ???
– She talked a lot while I was sitting there half exposed.  She described the procedure she would do, and manipulated my breast in her hand to demonstrate it.  I looked down briefly, and seeing her grabbing my breast was totally surreal.  She was talking at my chest, and not to my face.  I was poked and prodded a lot more than seemed necessary.
– She actually said to me, “This scar, is this from cutting?”  I could not believe I was being asked this.  I was in shock.
– I was aware of interns in the background, watching this whole thing.  They were fuzzy.
– I said to her, “I’m just in the consultation phase, and I have some questions for you.”  This changed the dynamic and she wrapped up the part where I was sitting there, vulnerable.

When this part was finally over, they left and I got dressed.  I waited a very long time again.  When they came back, I went through my list of questions.  She has a year and a half of experience working with trans-patients (really?!!), and does chest masculinizing surgeries a couple times per month.  She requires patients to be off T one week before and one week after surgery.  50% of patients will immediately retain nipple sensation, and 80% will eventually over time regain sensation.  She could not show me any examples of her work that would be related to my surgery type.  She could not tell me how much it would cost, not even a ballpark estimate.

Before leaving, I gave her feedback.  I told her how I had been misgendered by the staff.  She conceded that they needed to work on that.  I also, in front of the students, said, “As someone who is transgender, I have gender dysphoria around my naked body.  These may not be the best types of appointments to have students present.  It felt like I had an audience, and I didn’t feel comfortable being partially exposed.”  She responded, “Thank you for that feedback.”  I understand she might not have control over when she has interns with her, but she could CERTAINLY ask for consent, or ask that the interns not be present for the naked part.  I wanted to give her more personal feedback, such as, “It’s not appropriate to comment on my body,” but in the end I didn’t go there.  I just couldn’t right then.

This surgeon and the staff could benefit from some trans-related training, particularly to the sensitivities trans-people may feel about their naked bodies, specifically chests.  Make it short and sweet!

Top surgery consultation #1

I traveled to Ardmore, PA and met with Dr. Rumer yesterday.  The consultation went well overall, and it’s prompted me to start looking at lots of top surgery photos online, something I’ve done in the past, but without much of a framework or focus.

She’s located in a college town / upscale suburb of Philadelphia, and her office / house(?) is a white brick old Victorian creepy looking place.  Very apt for visiting 2 days after Halloween.  There is street parking, and you have to get buzzed in.  I was envisioning a medical center of some sort, but this place had the vibe of a hair salon – everything was whites, greys, and black, very sleek and futuristic looking.  The receptionist offered me something to drink.  I arrived early and was seen by the nurse practitioner right away.  She also offered me some water or coffee.

We went over my medical history I had filled out online in advance.  I guess I forgot to add in testosterone under “medications,” and she understandably assumed I wasn’t on T.  When I said I am on a low dose, she added that information.  (Being on T is NOT a requirement for getting top surgery.)  She also asked about how I identify, if I could provide a letter from a mental health professional (required), if I have legally changed my name, am I out to everyone in my life, and how long have I gone by male pronouns.  There were no issues or clarifications with any of my answers: That I am not FTM, I identify as non-binary, I can get a letter, I have not legally changed my name, I’m out to everyone except work, and I’ve gone by male pronouns for close to 10 years.  (That got a “wow” out of her, haha.)  I’m glad she didn’t ask me about gender dysphoria or how I felt about my chest, because I wouldn’t have known what to say / didn’t have a statement prepared.  Even though it seems like if I’ve made it this far, I should be able to articulate that!!!

She made sure I understood that I would be putting on an oversized paper vest momentarily and that Dr. Rumer would be looking at my chest.  Was I OK with that?  I said yes I expected as much.

She said she’d be back with Dr. Rumer, and gave me a moment to put on the vest.  They re-entered, Dr. Rumer said, “Nice to see you again.”  (Presumably because I’d said I’d heard of her through the Philadelphia Trans-Health Conference, although I didn’t go to any of her presentations or actually meet her.)  She looked at my chest for literally one second (I’m glad it was so brief) and declared I could go with peri-areolar if I wanted.  Is that what I wanted?  I said yeah, probably.

From there, she showed me a few slides about what to expect, and she showed me two before and after pictures.  The only disappointing aspect of this appointment was I asked her, “Do you have more pictures?” and she replied that she doesn’t really because they are all the same.  I was pretty dissatisfied with that – it gave me the feeling that these were the two best that she had hand picked to present.  I would have liked to see a dozen examples of peoples’ chests; there aren’t that many online.

Other than that, she was very friendly and personable and she answered all my questions thoroughly.

  1.  What are the odds of retaining nipple sensation?  Only less than 1% will not retain sensation.  (Those odds seem too good to be believed; I’m not sure I totally believe her!)
  2. How many appointments are required?  A lot!  One a week before surgery, one a week after surgery, then a few at different intervals (I can’t remember) and one at the one year mark.  For people out of town, most of them can occur over skype if everything is going smoothly.  The only necessary travel is for the surgery itself, then a week after, and then a year after.
  3. Do you have to go off T before surgery?  Yes, you have to be off T 2 weeks leading up and 2 weeks post-surgery.  Why is this?  Because of risks of excess bleeding.  I feel resistant about this and still don’t quite understand, but I’ve heard it before and would have to accept it.
  4. How long can I be out of work?  I have a very physical job.  She would write me a letter to go back whenever I want, especially since I have sick time accrued and wouldn’t be on disability.  I’d probably look at 6-8 weeks.
  5. Do you resize nipples?  She resizes areolas, and nipples retract on their own.
  6. The total costs she quoted me, including staying 2 nights in her office(?) / home(?) / guest rooms is $7,480.  That seems on par with other surgeons, maybe a little on the high side.

I have another consultation on Thursday with a local surgeon.  I will be curious how the two compare.