#mastectomies

Florida could be banning all mastectomies, even at the cost of a woman’s life. If you’re biologically female living in Florida, you should get out before breast cancer treatment becomes illegal.

+ from a different anon:

I really, really want to get top surgery but have been unable to schedule even a consultation due to being paralyzed with anxiety. Do you have any idea what I should expect, going into a first appointment? Will I need to take my shirt off? Should I be prepared to be touched? Drawn on? Photographed? Really any information would be greatly appreciated.

It depends on 1) where you are 2) what your medical history is like 3) your surgeon and 4) what kind of consultation it is.

If what you’re having is a pre-screening appointment with a GP, which are uncommon but becoming more common, you will likely just talk to the GP about your expectations for surgery and your medical history. They will ask you questions about any history of dysphoria related to your chest—e.g. “how did you feel when you went through puberty and your breasts started developing?”. They will ask you questions about your mental health, particularly if you’ve ever been suicidal, because surgery can be a psychological and physical stressor and they want to make sure you have an appropriate care plan in place. They will likely measure your height and weight, ask you to list what medications you’re on, and review your medical records to see if you have a condition or risk factor that would require extra consultation or special monitoring. (For example: I was considered a sleep apnea risk, and while I wasn’t asked to do a sleep study I did have to schedule an additional consult with an anaesthesiologist to talk about my family medical history.)

If what you’re having is a first consult directly with your surgeon, they should ask you the same kinds of questions, particularly about what you hope for out of surgery. They’ll also:

Talk to you about methods that they use, healing time, what you can expect out of nipple grafts if you’re getting those, and where they perform surgery (e.g. private clinic vs hospital).

Ask you to take your shirt off so that they can physically examine your breasts; this is because they approach their techniques differently depending on how full vs hanging your breasts are, their spacing, “sideboob”, etc.

This involves touching, which can be weird to experience but should be done professionally; they may ask you to stand with your arms hanging loose or turn from side to side, and use a measuring tape to go under your breasts, over your nipples both horizontally and vertically, and above your breasts.

They may also lift your breasts to measure from your nipple to the mammary fold, where your breast meets your chest.

They usually don’t draw on you for a first consult, though they do immediately prior to surgery as reference marks. They use a Sharpie for this, which really threw me at the time.

They may take photographs of your chest at the initial consult. I’m not sure how common this actually is, versus taking photographs in the pre-operative room, but either way they will take photos at some point before surgery. These are for the surgeon’s reference, and usually they take photos from the front, both sides, and at angles both before and after your surgery (immediately and ~6 months post-op) so that they can see how their techniques heal over time.

Your surgeon shouldn’t be brusque about this at any point. It’s completely normal to be nervous or anxious, and even if you’re the most chill person on Earth it’s still a little weird to have someone picking up one of your breasts to put a measuring tape against it. They’re aware of how weird this is for you as the patient, and should generally tell you what they’re doing before they do it. Don’t be afraid to ask questions—not only should they be able to answer your questions, but actively participating in your care can help you feel less anxious and more in control of the situation. Honestly, one of the weirdest parts of the whole consultation process is how not big of a deal it is to the surgeon—they do this a lot, and for them it’s their work, while for us it’s a huge event.

It depends on the surgeon, but usually they’ll take this into account when deciding how much fat tissue to take out of your chest! Even the “default” level of flattening doesn’t remove 100% of the subcutaneous fat deposits (*see below), but they should listen to your preferences in this area and talk to you about what it’s likely to look like if they shape your chest in different ways. I’m sorry that sounds kind of vague and circuitous; since techniques and results vary a lot, it’s hard to give a definitive “It Will Look Like This” kind of answer.

As for if your chest will lose weight if you do post-surgery, the answer is... kind of? I’m gonna assume for the purposes of this answer that you’re asking if your chest will change shape with weight loss via losing subcutaneous fat, and that can definitely happen, but it tends to be proportionate to your body, and more like losing fat deposits in your arms. I’m having trouble articulating this—here’s a diagram [NSFW, drawn] of the inside of a breast for reference. When you have top surgery, in the vast majority of cases the surgeon removes the mammary glands entirely, and if you have free nipple grafts they’re no longer connected to milk ducts. What’s left is a layer of subcutaneous fat over your chest muscle. If you’re also on testosterone, your body doesn’t have a reason to build up and maintain fat deposits over your chest, hence the comparison to an arm. Your chest will change shape fairly noticeably if you build upper body muscle.

It’s also worth mentioning that for the first, like, six months to a year your chest is still healing and changing shape—it’s going to look a lot flatter at that point than it will eventually turn out. This goes double if you have a lot of fat over your abdomen; that kind of messed me up during initial recovery actually because it was such a big body shape change. It has settled a lot more since then, making it easier to see where my surgeon left fat in to create a specific chest shape. (I’ve also lost a lot of weight by accident due to a flare of gastro illness, so I’m speaking from experience on the proportionality thing!)

TL;DR: Talk to your surgeon about this; they should take it into account, and work with you on the chest shape that you want within the limits of their technique. Building pec muscle can help if you’re comfortable with that; losing some fat deposits won’t make it look disproportionate, but the initial change in appearance can make you feel like it is, and you’ve got to give your chest time to settle into its long-term shape.

- Mod Wolf

It’s hard to give targeted advice without knowing what bothers you, but it would probably help you to go very slow with your post-op care. You’re probably not going to see your actual incisions for a while, but how long depends on when your surgeon tells you that you can take your compression vest or bandage off to shower (usually that’s 48 hours to a week). Once you can shower, you’re not supposed to let the incisions soak in water or scrub at them with soap—you minimize touching them, honestly, until any steri-strips (kind of like a tape that helps hold the edges together) come off on their own. That’s what’s kinda gross more so than the incisions, IMO; they catch dried blood, which can make your incisions look a lot more gross than they are. When your surgeon gives the okay, you can gently wash these with bare hands and soap in the shower, as long as you don’t soak them in water; this helps remove a lot of the gross stuff.

You might also have trouble with the drains if blood bothers you. The liquid that they drain isn’t like... it’s not like blood coming out during a blood draw. It’s red or pink in the first couple days after surgery, and slowly lightens until it’s almost clear, kind of yellowish. Sometimes your tubes will get clogged with thicker fluid, and you need to manually push it through the tubes by gently stretching them, which the friend helping me post-op referred to as “juicing”. It’s gross; having someone else help you goes a long way, because that way you don’t have to actually look at the tubes. If you’re doing it on your own, you can go very slowly, and talk yourself through each step of it—”now I am opening the top of the drain, now I am squeezing it into a cup”. You can also do it while watching a movie, or listening to a podcast, or doing anything else that occupies part of your brain so that you aren’t fully focused on the sensory experience in front of you.

Psychologically—it’s weird, I don’t want to downplay that. But I don’t think that you should entirely avoid interacting with your chest and pretending that it doesn’t exist post-op, even if you have someone else helping you. This is an opinion, not a hard rule, but I think that it will help your brain to integrate your new chest into your everyday experience if you treat caring for it as something that you can walk through at your own pace with as much distraction (and bribery. get yourself some mini donuts) as you need to.

You’ve gotta sleep on your back for at least the first few weeks, likely longer. It’s not a hard and fast rule because as far as I know it’s not technically a requirement, it’s just something that you’re forced to do because sleeping on your incisions hurts a lot, even just rolling onto your side. I woke myself up from a dead sleep doing that several times. (It’s also probably not great for your incisions.)

The same goes for sleeping sitting up (which your surgeon might actually tell you to do for the first couple weeks)—it’s a lot harder for you to sit up + lie down when you’re healing, and you’re supposed to minimize how much you use your arms for things like reaching or holding your body weight.

It’s totally a pain in the ass and it’s something that nobody can really give you a solid end date on. Lots of “oh, you’ll know”, which sucks but is unfortunately true. I think I could sleep lying down after a couple weeks if I was careful, but still had to be on my back until like two months out. Get a lot of pillows. Those giant U-shaped ones that are marketed for pregnant women are the best thing in the world because you can coil them up at your back to sit up and use them to keep you from rolling onto your side while sleeping. I also know a couple people who got wedge pillows, which help with how uncomfortable sleeping sitting up can be.

Similarly, if you have a loft bed, you’re gonna want to put your bed closer to the ground before surgery, since you can’t use your arms to pull yourself up.

Usually a month is the default—it varies by surgeon, but ranges anywhere from three to eight weeks. I was told to avoid reaching over my head (e.g. top shelf) for a month post-op. It sucks but there’s no way around it, really; a grabber arm can help, as can a tall sympathetic friend.

I could have sworn I did write a post about this, BC-specific too (same hat!), but I can’t for the life of me find it via search, which means that you probably wouldn’t have been able to either. I think it depends on whether your doctor is your family doctor/GP or if they’re already seeing you for hormones. The latter doctor has probably done a lot of referrals for surgery, and the former may not be as familiar. Bear with me here, because you have a couple different options and it’s early in the morning. c:

I’m going to go under the assumption that you’re familiar with Trans Care BC’s guide, but are getting stuck on the first part, which requires asking about a readiness assessment. They also have a specific page on readiness assessments (second tab, if the link doesn’t open properly); the important part here is “qualified”, because medical professionals in BC do some extra training to be able to assess people for trans-related surgeries. If you’re on hormones, and still seeing the doctor who originally prescribed them to you, then they are almost certainly qualified to do this. Let’s call that Scenario A. If you’re not on hormones, or if you are and no longer seeing the original doctor, but you have a GP, let’s call that Scenario B. If you don’t have a GP, or talking to yours isn’t an option, let’s call that Scenario C.

Scenario A (trans-competent doctor): At your next appointment, you can say something like “what’s the process like to get assessed for top surgery?”. You can say this even if you already know—it’s just meant to let your doctor know you’re interested and want to gather information. The doctor will probably tell you about the readiness assessment, and say whether or not they are able to do it. Sometimes, if you’re on hormones, the assessment of your health that they did for that will count, and they can jump straight to writing the referral letter for you.

Scenario B (doctor, but not necessarily trans-competent): I think that the least anxiety-inducing way of handling this would be to ask them at your next appointment if they “have any experience doing readiness assessments for transgender surgeries”. They may say yes, in which case you’re golden. They may say no, in which case you can say “okay, thanks, do you know of anywhere I could get referred to have one done?”. They might refer you to another clinic, or to a psychologist; they might also say that there’s no referral required and that you can contact another clinic/practitioner directly. Which leads me to…

Scenario C (no GP): You can contact Trans Care BC directly and ask them to help you look up assessors near you. They even have an email form on that page, so you don’t have to call them on the phone. It doesn’t have to be elaborate, and you don’t have to justify yourself to them; you can say something as simple as “Hi, my name is [X] and I live in [region/city]. I’m trying to find a doctor that I can talk to about top surgery, and who can assess me for it. I [have/don’t have] MSP coverage [or any secondary insurance]. Thank you for your time!”. You have my full permission to copy/paste that message and fill in the blanks if it’s helpful for you; the folks working there have been very nice whenever I’ve talked to them. You’ll also be asked, either on the email form or over the phone, how old you are + your nearest city + what health coverage region you fall under.

If you’re under Coastal Health/live in Greater Vancouver/can easily access Davie or Broadway in Vancouver, you can also call Trans Speciality Care directly; they refer to Three Bridges downtown and Raven Song off Broadway. I’ve been to both (for HRT/assessments and injection training respectively) and they’re very nice. [EDIT FEB 21: I’ve since been told they no longer run trans services through Raven Song.]

If saying something out loud, to a doctor’s face, is too stressful, I think C might be a good option for you—I personally find email contact a lot easier than the phone, and Trans Care BC exists in large part to help people coordinate healthcare services. They also handle all surgery referrals in the province anyways; that’s where doctors send your referral letters once they’re done, and then they go into a queue, and then you get a phone call from Trans Care BC once your name comes up giving you surgeon options and possible dates. (You don’t have to decide on the spot.)

You could also write your question down on paper and physically hand it to a doctor! If that sounds awkward, you could preface it with “I want to ask you something, but I’m anxious to say it out loud. I wrote it down; can I just hand the paper to you?”. Chances are they’ll say yes. You can also read the question off of paper, like a script.

And, finally: This is less tailored advice than it is a weird fact of… anxiety in general, but especially this situation. It seems a lot more terrifying in your head than it ends up being. For you, this is a major step in your life; for the doctors, it’s something they do all the time, and the mismatch can feel pretty weird if you’re internally going “oh my god, I can’t blow this” and then you speak to someone who has the same casual air as if they’re seeing you for a chest cold.

It’s not a bad thing, and this isn’t to knock doctors at all—I mention it because a doctor who advertises themself as trans-friendly here, and who operates in the network of trans health services, that doctor is not seeing you as weird or a medical anomaly based on your trans identity. They’re seeing you as part of their patient demographic, and likely know that you’re anxious about this. You’re not doing anything wrong and won’t be yelled out of the office because you’re shy.

That may have been me! I asked my surgeon about this ~a week ago at a checkup, and she said that she would give it a minimum six months post-op but a year if the design would go over the scars, to give them time to fully heal.