For FTM’s, top surgery is a commonly sought-after procedure. No matter what size our chest is pre-op, no matter our body type, no matter if we get the double-incision bilateral mastectomy or keyhole, top surgery is a very big deal for those undergoing the procedure.
I am a week post-op. I am very proud of how I look now, but there was something that plagued me in the months before I went under the knife- how to prepare.
I wish there was a go-to guide for top surgery. But since there isn’t let me contribute to the variety of articles and posts out there on how to get through top surgery, at least based on my experience.
PICKING A SURGEON:
First of all, you need to think about your insurance policy, if you have insurance. Call your provider and ask about their policies regarding transition-related surgeries. A lot of major health insurance policies in the US these days do cover care for transgender people, though some consider certain surgeries as “cosmetic.” Be sure you understand fully what they’re telling you.
Whether or not you have insurance, your next step is to find a surgeon. Depending on where you are, finding a surgeon could be easy or take some time. If you need help, post on trans-friendly forums and chats, find groups on Facebook, or even seek out LGBT services in your area or near your area. I personally had someone who works for a transgender clinic who I’ve known for a while assist me.
When you figure out some possible surgeons, if you have insurance, you need to find out whether they take yours or not (If they’re out-of-state, you also need to be sure you have out-of-state coverage. I do not, so that made my searching a lot harder). Do some research on these surgeons; find out what their credentials are, how long they’ve worked, what their past patients say about them, what their infection rate is like. Can you find any reviews on their work with top surgery? If so, check those out! (Note: not all doctors who perform mastectomies for transgender people will have that listed as such on their website. But make sure they are certified in that area of surgery in general!). Don’t be afraid to ask friends or on forums or groups if anyone has used the surgeons you’re considering and what they thought of them. When meeting said surgeons, it’s important to ask any and all questions, such as what letters they’d need to approve you for surgery and from whom (usually from a psychiatrist, therapist, and/or your GP), what pre-surgical testing they’d need, if they want you to stop testosterone in the weeks before surgery, (if applicable) if they have any pictures of past patients they can show you (you’ll want to know what kind of job they do, after all!), and any questions you have. Remember, certain questions may feel stupid, but you’ll feel more comfortable knowing everything!
You’ll also want to contact your insurance company regarding whether they’ll cover surgery with any of your options included and how much they’ll cover with each surgeon. You’ll likely still have to pay a sum out of pocket, keep in mind!
IN THE WEEKS BEFORE:
Okay, so you’ve picked a surgeon, they take your insurance, you like their work. Now what?
Before you can set a date, the surgeon might need letters from mental health providers saying you’re in the right frame of mind, can make decisions on your own, and that this surgery is necessary for you. If you already have a gender therapist (and I highly recommend having one in general), they can be one of the people to write a letter. Once you set a date, make sure you go any pre-surgical testing needed and then begin preparing for the big day.
Make sure you have at least one trusted person to accompany you to the surgery and bring you back home afterward. You will be under general anesthesia, so driving right after is one-hundred percent out of the question. At home, gather things that you will need- ready the bed, couch, and/or chair that you plan to spend time resting in. Have comfy pillows and soft blankets. Remember- you will need to be sleeping on your back, especially while the drains are in! One thing that I did was to get a pillow with armrests attached to prop me up in bed.
For clothing, have a variety of zip-up and button-up shirts and sweatshirts, as well as sweatpants (you will be spending a lot of time resting at home), You will not be able to put on anything that goes over your head for a while.
Recovery is also boring. Make sure you have whatever will keep you occupied- books, TV shows, movies, games, whatever you think you can do while resting! I even went so far as to get some crafting supplies for myself. Also, having loved ones come over to be with you is usually a good idea for things to do when you’re more awake.
In terms of food, it is best to stock up on healthy options. Fruits, vegetables, and non-processed foods can help the body heal.
Prepare your body- exercise regularly and avoid alcohol two weeks before surgery (or however long your surgeon tells you).
THE DAY OF:
Be there on time. Make sure you’ve followed all pre-surgical instructions. Most surgeons will want you to shower and not eat or drink after midnight. Wear sweatpants with a button-up or zip-up shirt.
After the surgery, you will wake up with any variety of feelings- I felt really cold and nauseous. Be prepared to not be able to hold down any food for the first few hours, or even the rest of the day. This includes water.
You will more than likely be prescribed pain medications. Use it as you need it. Don’t let the fear of addiction scare you into suffering- if you feel the pain after surgery is unbearable, by all means take the medication (if down the line, you fear you may be taking it longer than needed, be open with your doctor about it.)
RECOVERY:
Everyone has different experience. Everyone has different levels of pain tolerance. Don’t compare yourself to others, you’re going to need to let your body heal at its own pace! Take it easy. By this, I mean stay in bed, stay on the couch, get up as little as possible, and if you feel tired, don’t fight it, just sleep! Any activity you planned to keep you busy should be readily available and done sitting down.
If you have drains, you will need to empty them twice a day and record how much fluid has accumulated. The drains will be squeezed flat before they’re closed, and when you pull out the plug, it will inflate back to its bulb shape. Take note of the measurement in the bulb before emptying it. Over time, you should have a lighter red, and even some yellowish fluid in your drains. This is normal.
Don’t raise your arms and don’t lift heavy objects. You don’t want to stretch the scars or cause yourself more pain.
REMEMBER:
Surgery and recovery may be painful and may make you impatient, but once it’s done, you will be relieved and a lot happier. All the pain and time that it takes are worth it!
