i heart chemicals and surgery

May 2025 - Consultation! He only took a peak for less than 30 seconds. Surgeon's office let me know they would send out the pre-authorization before scheduling.

June 23/24th 2025 - Oops! I forgot to ask my PCP (primary care provider) for a referral to my surgeon, so my insurer couldn't approve surgery*. I make an appointment for my regular doctor ASAP to ask for a referral. Later that day, I messaged the surgeon's office to let them know it was sent out. June 27th 2025 - Insurance accepts the referral and pre-authorization! Surgeon's office will call me in a few days to officially schedule surgery.

July 7th-9th 2025 - I get one call asking me what I had in mind for a surgery date (November or December). Then I get another call asking if December 3rd would be ok. I accept it! Surgery is officially scheduled!! I let my employer know immediately when I would be out, and immediately start budgeting & saving up for surgery. Mid July - I get a package in the mail with my Pre & Post Op instructions & Hibiclens! Later July 2025 - FMLA documents filed for my leave. October 2025 - I start buying supplies for recovery & schedule my pre-op exam with my normal doctor (make sure to ask your surgeon's office for the fax number!). November 2025 - Planning when my caretakers will be coming in to help me! November 12th 2025 - Surgeon's office calls me to go through the pre & post op packet. November 17th 2025 - Pre-op exam with doctor. Late November 2025 - Last day of work. I am taking a few days off before surgery to meal prep & prepare my room for recovery.

Dec 3rd - Surgery! A week later - Post Op 1 (Foley cath. removal) Late Dec - Post Op 2 (SP cath. removal)

6 months later - Stage 2

*Don't do what I did!

First, I googled & researched surgeons near me. I looked at what other people had to say on them on Reddit. There are lots of threads on r/TopSurgery. I also looked at what people posted on transbucket. There are other websites that go through what kinds of top surgery methods there are, and how they're determined.

I called my insurance provider to see if the surgeons I looked at were in my network before continuing. If they're out of network, you'd have to pay much more. If you don't have any top surgeons in your network, you can go to your Primary Care Provider (PCP) and ask for a referral to one. Your insurance typically honors this as a "network gap exception". Something worth noting is that some surgeons have BMI limits. If you are on the higher end, a surgeon may not work with you. Some surgeons (with or without limits) can be fatphobic, just like any other doctor unfortunately.

In April/May 2024, I called to schedule consultation for one surgeon I was interested in. They scheduled it for March 2025 (lol). I felt like that was such a long time away, so I called another surgeon for consultation, and they scheduled me for Oct 2024. Much more manageable for me.

I was also interested in the 2nd surgeon because he performed nipple preserving DI on someone else. I don't think I would have been eligible for keyhole tbh. Even though I was an A cup, I felt like I was a borderline case.

When I did go to consultation in October, I forgot to bring a surgery letter so I couldn't immediately schedule surgery! Don't make the same mistake I did!! Look up therapists who can write same-day letters of support (you may need 2 depending on your insurance, check with them as well), so you have it prepared.

Surgeons can be cold sometimes. Mine was, he was straight to the point. "This is what I can do and how I do it." He always emphasized nipple lost sensation, which was something that was important to me, was a high possibility, and that he couldn't make promises that I would get it back. I think he was preparing me for the worst, just in case it did happen.

The coldness didn't bother me, and I was more concerned about his ability to not fuck up my body. Some people can be the nicest people in the world and be bad at their jobs lol.

I was still clothed at this point, just going through my list of questions I had prepared & writing down answers. I searched up "consultation questions" on r/TopSurgery, and found several posts to help me curate my own list. I was explaining my goals, and that I was in nipple preserving DI. He said that he'd have to look at my chest to see if it was possible.

The surgeon left the room for my to undress and put on a robe. When I was done, he came back with an assistant to look at my chest, take measurements (like the size of my nipple and positioning of it), and take pictures. The pictures are for insurance purposes. When he saw my chest, I heard the gentle surprise in his voice when he said I'd be eligible for nipple preserving DI. This was an ego boost for me because I know I did my research LOL. He did say my nipple would be a bit larger than the average cis man's, but that did not bother me.

He agreed to the method, and told me once I could bring back the letter, he could schedule me for 2 to 3 months out. It took me a week or so to get that letter back, and another few days for review. I was scheduled for next year in Feburary.

I was only at my job for about 8 months at the time, so I was not eligible for FMLA leave. I did let them know VERY early on that I would need to take a leave late in the year or early next year. My job is very trans friendly so they were understanding & they treat all leaves as FMLA leaves. They just sent me some paperwork for me and my doctors to fill out. In the mean time, I was saving up for rent, bills, food, and supplies. Due to my surgery taking place in next year, I was able to used newly offered sick time to have income flowing in.

I was recovering alone, so I also rearranged my room so that everything was right next to me. I also meal prepped, but I did end up ordering delivery a lot lol. I didn't have to get up for water, snacks, medicine, or garbage. RECOVERING ALONE IS REALLY HARD, MENTALLY AND PHYSICALLY, AND I DON'T RECOMMEND IT LOL. But it is doable.

Some non-food supplies I ordered: normal painkillers (Tylenol & Advil), laxatives (sometimes stronger pain medications can make you constipated),

They sent me a packet in the mail for what to expect during top surgery. I also needed to schedule a "surgery pre-op" with my PCP at least 30 days before surgery. I scheduled it about a week and a half before surgery. Here they did an EKG and a physical. My doctor said there was no reason I shouldn't have the surgery.

Sometime between then and surgery, a nurse called me to let me know when I should arrive at the hospital. She told me I have to have someone drop me off and pick me up, which I was able to arrange.

Surgery day! My memory of this day is a bit muddy due to anesthesia. I arrive and wait in the waiting room. A nurse calls me out to go to the prep room. She asks me, "In your own words, what procedure are you getting done today?" "Nipple preserving double mastectomy." The nurses find this very cute because I'm using the correct medical wording. She gives me a robe to get into and a bag to put my stuff in. She also brings me out warmed up blankets. She takes vitals and injects an IV. Between these 30 to 45 mins, a few people (nurses, surgeon assistants, anesthesiologist) come in and out to ask me the procedure questions & some more questions. Finally, my surgeon comes in to take one last look at my chest. He takes a marker and makes a few markings on my chest to see where he's making the incisions. I kind of wish I took a picture.

Then I go to sleep, and wake up with a bandage around my chest & drains. I think this is when they put an anti nausea patch behind my ear. I feel like I went back to sleep again, and then woke up to my friend being in the room. They took me out to his truck in a wheelchair, and I felt SUPER fragile on my ride back home.

I got home, laid in bed for a while, and threw up due to the anesthesia. I was fine afterwards. The worst part of recovery were the drains and changing my bandage to milk them. Most people do not experience pain while milking their drains, but I did :( It was not a fun experience at all, and I went to Urgent Care because I was so worried about it. But they told me it was normal, just rare.

You're supposed to milk them twice a day & measure how much fluid comes out. When the fluid amount is low enough, you can get them removed. It's also important to smell the fluid, just to check for infection. If it smells bad, you need to call your surgeon/go to an ER immediately.

Fortunately, I was able to get them out at my first post-op, scheduled about 8 or 9 days after surgery. My physician said I was healing SUPER well, and that the scars were very thin and nice. The sensation of the drains being removed is very weird lol. One of them hurt juuust a little, but it was fine.

You feel like a completely different person after the drains are gone… Like you finally feel free LOL. I still couldn't lift more than 15 lbs, and was advised not to lift my arms up. Along with that, I needed to keep the binder that was provided to me by my surgeon on for another month to compress any swelling that may appear. It was still super nice to be much more mobile.

I went back to work about a month and a week after. I could've gone back earlier, but tbh I didn't care much to lmfao. But yeah, I had an uneventful recovery. Nothing went wrong. I'm still happy with where I'm at now, 8 months post op. I have bottom surgery in December!