The Surgery Story

Or, how I got my chest done by Michaelangelo

April 2nd, 2015
A couple years ago I blogged about scheduling my surgery, and then never spoke of it again, leaving everyone in suspense. Truth is, it went off without a hitch, which is exactly what you want when undergoing invasive surgery, but it doesn't make for a riveting story. Where are the plot twists? Where is the dramatic irony??

So last I left you, I had looked through the pics on transbucket and settled on Dr. Garramone, talked with him and his secretary and gotten the go-ahead, then taken stock of my money/employment situation and scheduled a date in late May. It would involve a week in Fort Lauderdale, FL while I had the surgery and did my immediate recovery. The schedule, thereabouts:

Day 1: Arrive, pre-op appointment
Day 2: Surgery
Days 3~6: Sit in Holiday Inn and play Warcraft
Day 7: Post-op appointment, leave.

***

You need someone around to take care of you while you're recovering, and you're allowed to bring your own caretaker or hire a live-in nurse-type person. For me, there was never any doubt that Shelley, my best and closest of all friends, would be the one who came with me for that -- it is good that our friendship was so solid though, because it might have been sorely tested in that post-op week. If you've got a new boyfriend or girlfriend, I really don't recommend bringing them to be your caretaker, as you are going to be grouchy and in a lot of pain, leaking blood and pus, probably constipated (thanks, morphine!), and unable to bathe for a week. Bring someone reliable whom you don't have to front for. I asked for Shelley's input and she said:

Shelley: Yeah, you would have killed someone you like less than me.
Shelley: Make sure the caretaker knows not to take it personally.
Shelley: You snapped at me a bit, but it was the drugs and pain so I was like whatever.
Shelley: Oh, and tell them to bring books. Because you were in No Mood For light or noise.
Shelley: Well I had my DS too
Shelley: But you were Not Happy with the light

***

The pre-op appointment was easy enough. I met Dr. Garramone, who is slightly older and much taller in person than the picture on his website makes him look. There wasn't actually much to DO in the pre-op appointment, it was mostly getting to know the person who'd be cutting me open the next day, for him to double-check that all my parts were what the pictures had led him to expect, and to answer any last-minute questions. Shelley went outside while he took stock of my tits, but one of the administrative girls specifically came in for that part. I know it's probably the law, or at least a good habit for reducing his liability, but seriously, I'd just as soon not have an audience for this. Like my GP hauling in a nurse when he does my pap smears, seriously, must you? I don't want a girl there any more than some cis guy wants a girl chillin' out during his prostate exam.

That aside, it was unremarkable. I was still understandably nervous about what kind of results I would get (crooked nipples! it's not paranoia if you are going to have to live with the results for the rest of your life) and so I was trying to feel him out on how he determines nipple placement, and to delicately suggest that if he wasn't quite sure, could he maybe err on the side of spacing them too far apart rather than too close together?

"Well," he said when I asked how he determines placement. "I follow the line of the pectoral muscle... and then, uhm, I put the nipples... where they're supposed to be."

Which, for all that we want this to be an exact science, I actually found extremely reassuring. The man's an artist! His work speaks for itself. You might as well ask Michaelangelo how he placed David's nipples: he put them where they're supposed to be. And you know what, doc? There is no better place for my nipples than where they're supposed to be. Full speed ahead!

And that was it with Dr. Garramone. I went back into the waiting room to fill out a pound of paperwork, mostly to say that I understood the surgery, the risks, and that I wouldn't sue them if I died on the operating table. Top surgery isn't all that dangerous, as far as invasive surgeries go -- but yeah, see invasive surgery. It's sobering to be reminded of that risk, but ultimately... kind of pointless, because medical intervention and its concomittant dangers were something I resigned myself to when I resigned myself to being trans. Like travelling to Japan means accepting that you might die in a fiery plane crash, because there's simply no other way to do it.

***

I don't remember getting ready for surgery the next morning. I remember a medical taxi service picking me up in the morning (they would also drive me back to the hotel afterward) and taking us to the hospital. The bulk of the surgical fees go to the hospital, for use of their facilities and their anesthesiologist, so when I checked in I paid the rest of what I owed. There was a lot of waiting, punctuated by small steps bringing me closer to the surgery -- being moved to the back, being changed into hospital clothes, being assigned a bed. I was in that weird state between bored and anxious, nervous of what was coming but also weary of the anxiety and ready to have it over with.

I must have brought a book, but I have no memory of what I tried to read, only that it didn't distract me at all. I think at one point the person next to me was also one of Garramone's FTM patients, but I don't remember very well. (There's a lot I don't remember from that day, I wonder if the drugs I was on later wound up fuzzing out much of it.)

Dr. Garramone showed up at one point to do a last minute check on how I was holding up and explain specifically what was coming off from where. He took a sharpie and drew two curved, horizontal lines around each breast to show where the incisions would be (possibly the same markings he would use when I was actually in surgery), the center portion would be removed, breast tissue excavated, and then those seams would be joined together to create a flat chest. Since the nipples are in the portion that gets removed, they are cut out and reattached ("where they're supposed to be"). He explained that he would also be making them smaller, "...about the size of a nickel," he said, drawing a nickel-sized nipple on the back of his gloved hand, which I found really funny, considering he probably gives this explanation to all his patients, and therefore probably wanders around with nipples on the back of his hands all the time.

That was also when I asked how he'd gotten started doing FTM surgery, whether that was something he'd set out to specialize in. He said no; he'd been a young plastic surgeon struggling to get his practice established and make a name for himself in the field...

Garramone: "And one day this trans guy walked into my office and asked if I could do his top surgery. I said sure, I did it, and the next week, five more guys walked in."

I didn't ask him when that had happened. There was a time, not so long ago, when trans folk didn't have the option of being picky when it came to surgeons -- they were lucky to find anyone willing to do it at all, much less find someone who could do it well. But now that Dr. Garramone's fame has spread (and deservedly so), I'm under the impression that most of his practice now is FTM surgery, and he's got no shortage of that. Look sharp, people -- if you want your chest done by Garramone, there's a loooong waitlist, so book it well in advance. You're signing up to get your chest done by Michaelangelo.

With that done, the last step before surgery was to hook me up to an IV, which I remember (and Shelley corroborates) being cold. They led me to believe that it was just saline, but in retrospect I think they drugged me early.

Shelley: Then I was kicked out
Shelley: And I went to the mall
Shelley: Because you wanted a cookie sandwich
me: LOL. did I eat it?
Shelley: Yeah, the next day
me: awesome

Because despite all that anxiety, I wasn't the slightest bit nervous when they finally wheeled me into the surgery and strapped me down cruciform, so I suspect the saline had been laced with something more exciting. I remember bantering with the orderlies who were moving my bed and being like, lolz, when they transferred me onto the operating table and strapped my arms down.

Orderly: "Hah, don't worry, it's not that kind of party."
Me: "Hah, I've been to that kind of party."

Which isn't something I normally feel compelled to share with strangers. I can't tell if my memory of getting the anesthetic and being told to count backwards from ten is something that happened to me, or something planted from watching surgeries on TV, but in any case, the next thing I remember is waking up.

***

When I woke up, I was groggy, hella-thirsty, and my chest was really, really, really tight. Shelley was there, but the lights were half off and everyone else seemed to have gone home, just stashed me in a corner and forgotten about me. I had been Dr. Garramone's last op of the day, and the clinic was shutting down by the time I woke up. Shelley informed me that it was actually the second time I'd regained consciousness, sort of.

Shelley: After I came back from the mall I sat in the waiting room forever
Shelley: Then they took me into the recovery room when you woke up
Shelley: Well were conscious... you weren't really all there
me: how many hours did it take?
Shelley: Many hours. The clinic was closed before I got back into the recovery room
Shelley: And they explained how to take care of your pills and stuff

"And stuff," in this case, was the fact that I had tubes coming out of both incisions, draining bloody pus into plastic pouches that had to be emptied twice a day. These were going to be attached to me for the next week, 24 hours a day, until he took them out at the post-op appointment.

Furthermore, in order to keep the incisions from pulling open while the skin knitted itself back together, my chest was wrapped in the tightest binding job I had ever had the discomfort of wearing, worse than anything I'd done to myself during years of binding. In order to keep my permanently decreasing my lung capacity, I was to take a moment, two or three times a day, to inhale as deeply as I could, hold it, and let it out again a few times.

Also, I was on some kind of opiate, which I had no compunctions about using, but it turned out that pain from the actual surgery would be the least of my concerns.

The medical taxi took us back to the motel, where Shelley informs me that I was "sleepy and surly," and that I objected to the light coming from her DS when I was trying to sleep. Impressions from the days that followed:

- I had been warned that opiates can cause constipation, and I was advised to have lots of fiber-rich juice on hand. We stocked up on prune juice, but let me tell you, that did not cut it. Invest in stool softeners, if your surgeon says they're okay, because it's not fun.

- The opiates were fine for dealing with the pain in my chest. I'd take 'em, play Warcraft for a while, and around the time my next dose was due, my chest would be starting to ache again.

- ...What they did NOT help with was the excruciating back pain from having to sleep with that binding job. I'm used to sleeping on my side, but I couldn't that week, and worse, the binding was causing my back to arch at an unnatural angle, and the combination was nightmarish. It didn't bother me when I was up and moving around, walking/sitting, but lying down became miserable before the night was out.

- Consume lots of protein. It's what your body needs to repair itself, and you will never be doing more repairing than when you're recovering from being cut open. I bought a mini-blender for making shakes in the hotel room. Three years later, I'm still using it for my daily protein shakes.

- Tissue heals remarkably quickly -- consider that your skin will have done its preliminary knitting-back-together by the time the post-op appointment rolls around a bare week later. I was up and ready to go places by the second or third day. Specifically, there was an Ikea next to our motel and I had never been to an Ikea before. There's the issue of what to do with your pus bags when you go out in public, but weirdly I own (and brought) this shirt (courtesy of Zootzu, I am NOT the model there), which allowed me to carry the bags in the front pockets and have the tubes disappearing under the hem rather discreetly.

So I had a rather stoned first trip around Ikea and fell fuzzily in love with the place, because I am that kind of fag. The only issue was on the way back, when it had started raining and I needed to keep my bandages dry, so we bought one of their gigantic plastic bags for me to use as a poncho.

- Speaking of keeping your bandages dry -- this also means you can't bathe or shower. I wiped myself down as best I could, and Shelley helped me wash my hair in the sink a few times, but it's a less than ideal solution.

- Your pus bags will fill up and need to be emptied, initially quite often, tapering off with time. I forget the exact mechanics of emptying them (and yours will probably be different anyway), but it involved taking off a cap and squirting the contents into the toilet. It's pretty damn gross, but fortunately you don't need help for that.

- Second mention, because this was what gave me the most grief: my back hurt and I was still constipated. The former didn't stop until the bandages came off, the latter, not until I stopped taking the morphine.

Mostly we just played a lot of World of Warcraft that week. Flew all the way out to Florida, and what did we see? The inside of a Holiday Inn and the inside of an Ikea. Sorry for treating you to the worst Florida vacation ever, Shelley.

***

And then it was time for the post-op, which I was more than ready for. Dr. Garramone took me into the clinic, and apparently now that the tits were gone we didn't need his office girl for a chaperone. He carefully unwrapped the Ace bandages around my chest and the results were... pretty sickly-looking, I'll admit, though I was prepared for that. I'd looked through enough post-op pics on transbucket that I knew what to expect -- incisions inflamed, bristling black stitches running across my chest, nipples puffy and sitting unnaturally, looking pasted-on. But hey, they were where they were supposed to be! The rest would take care of itself in time.

My chest was also concave, in the manner of geeky adolescent boys everywhere, even though I'd been trying to build up my pecs before the surgery. Guys, take note -- muscle acquisition happens far slower than you think it does.

I was given the all-clear and let back out into the lobby, where Shelley was chatting with another young FTM. Brigitt came out and gave me her congratulations, plus a letter testifying that I had "undergone sex change surgery" in case proof of that was required for a legal gender change. Legal gender change isn't something I'm interested in pursuing, for a number of reasons (mostly that I dig dudes), and I'm not sure that top surgery exactly counts as a "sex change," but it means a lot to me that Garramone and his crew provide that without even being asked to. Like, "We know it's a bullshit system, but if that's what they want to hear a doctor say, then we've got your back."

I wore my Captain America t-shirt home, with the unfamiliar feeling of a breeze on my back.

***

The stitches were still in when he sent me home; I can't remember how many weeks I was supposed to leave them, but the idea was that when my skin had healed up they could come out. Well, unfortunately it's a Known Bug that my skin doesn't heal around stitches, I've got a scar on my back testifying to that, and accordingly, I wasn't really sure how long to leave the stitches on my chest in either.

I do know that I waited the bare minimum number of weeks that you're supposed to wait before resuming heavy lifting / arms lifting above head, and then jumped straight into my weight-lifting regimen again.

BAD IDEA.

I opened one of the incisions again and made the scar permanently bigger than it would have been otherwise. I know you're eager to start building those pecs up now that all obstacles are gone, but for the love of god, take it easy. It's one or two months of delay, to avoid worsening the scars that you'll have to live with forever.


Opened incision


I am about two and a half years post-op now. The scars are broad but substantially faded, and they don't cause me much (any?) self-consciousness these days -- I'm not shy about taking my top off with lovers. I don't swim, and I don't run around shirtless, but I doubt I'd be the type to do either even if I were a cis dude. I know that if I had more developed pecs, my surgery scars would disappear into the shadow of my pecs and all but disappear, but, well... I'm kinda lazy. I get tolerable results from the amount of effort I put out, and if I cared more I could exercise more.

I think it's crucial that you have realistic expectations for your post-op results. Too many trans folk go into surgery having talked themselves into believing that this is it, this is the last step, that once they do this they will be done transitioning. And they're setting themselves up for some bitter disappointment when they discover that's not the case.

And I'm not talking about just the scars. Truth is, you never stop being trans -- but getting surgery is one of those things that can make it so much easier to live with.

So don't go in thinking, "And after this I'll be done, I'll be NORMAL." You'll break your own heart.

Go in thinking: "And after this I can wear t-shirts and henleys and tank tops and those practically transparent summer shirts from Zara Men's. I can go swimming. I don't have to spend another summer sweltering in a binder. I don't have to worry about people noticing that I've got breasts. I will have more confidence in my body and be less afraid of letting lovers see it. If the scars really bother me, then I can build up pecs that'll disguise them or get a tattoo that'll cover them. I can work hard and earn myself a sexy male chest, one that I'm proud of, one that people would like to see."

Surgery isn't the endgame, but it's a hell of a step in the right direction.



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