I’ve had an interesting experience with my top-surgery through every step, and as a help to both other trans* people, and their friends/family, I want to recount as much as I can remember.
The week before surgery was a breeze, as literally my own plans consisted of getting clothes tailored, and eating food. For me, getting a tailored suit was very important to me, since I’m very small, and having clothes that fit relieve a lot of dysphoria for me. At one point when I was stressing about money I said something like, “Eh, I guess I don’t really need a suit,” to my girlfriend, and she very nearly slapped me. Even if other people don’t understand, getting clothes made was a really important step in my journey not only as a trans* person, but as an adult.
That was the easy part though. Then came the herd of drama-llamas.
The day before the surgery was a nightmare. I thought that I could send the money entirely from my online American checking account, but sadly that wasn’t the case. So the race was on to find an alternative. I tried to transfer funds to my German account, but the estimated time of arrival was the Monday after surgery. I thought about what friends I could call, but all my friends are broke/devoured by student debt, so I eventually broke down and called my mom to ask if I could use her credit card. We got the info, we thought everything was fine, and went to the consultation the next day.
At the consultation, the surgeon discusses my options, and he says double-incision would be best, and I said GREAT because that’s what I wanted anyway, and please don’t try to hide the scars (because apparently he’s very good and could put the scars on the side of my body if I wanted). Emma and I ask all of our questions, and the doctor answered them all very well and happily, although it was clear that he was more interested in cutting my body, as surgeons tend to be. We sat down with Jessie (our main contact at the clinic), and he started to detail more of the process to us, and then asked for the money before we went over to the hospital to get my lab tests done. I handed him my mom’s credit card information, and he immediately said, “I’m sorry, we can only use physical cards.”
SO, the race was on again. The clinic needed the money by 16:00 to clear me for surgery, and it was about 11:30. We needed to find a very quick solution.
For the next several hours the day before surgery, Emma and I were in close contact with my sister, who very generously gave her time considering she had a grant proposal due the next day. We tried Western Union, but they don’t send to Thailand from America, and apparently neither does ALMOST ANY ONLINE TRANSFER SITE. It was actually something from a nightmare. Eventually we decided to send the cash and pick it up. There were no pick up points close, so Jessie had to call the banks and find a solution, which he did. We ended up being able to pick it up from a different location through the same bank that was closer. Although the money wasn’t there, they said that I could go do my lab tests, pay for half of it with my credit card, and have Emma wait at the bank for the money.
After the tests were done, the money still wasn’t there, but the bank was closing. They said we could get the money and bring it to the hospital in the morning. Emma and I found another bank that was close by that was open later, and waited there. It happened to be inside of a Japanese themed mall, which was amazing because I’ve soaked in enough Japanese culture through doing karate, kendo, watching anime, playing video games, eating food, and reading Murakami novels, that I was a happy clam. We got some gyudon, some mochi, and a coffee, and waited. In the mean time, as Plan K, I contacted my mother again to ask if it was possible to go directly to a bank and wire money straight to the clinic. Eventually we got ahold of her, and grandma turned out to be a superstar and wired the money within the next two hours. We had a restless night without having a formal receipt to show them, but woke up to the e-mail from the bank with the receipt we needed.
The night before surgery I also had to stop eating at midnight, so at about 23:45 I scarfed a boiled egg that was accidentally frozen and a tiny banana. The next morning we woke up early (6:00) to leave at 7:30.
Once we got to the hospital, they took me and the other guy upstairs, took our temperature, blood pressure, gave us name tags, had us sign forms, and sent us to our individual rooms, where Emma and I still had about 4 hours of time to kill before my surgery. Pretty quickly they put me in a robe and put an IV in me, intermittently checking my temperature and blood pressure. They were very efficient, and very thorough, but because of the IV I couldn’t move much. We ended up watching ‘The Wind Rises’ by Miyazaki, which was beautiful visually, but also quite sexist and poorly written. Then around 15:00 they came in and efficiently took me away to the anaesthetist, and we had a small, important conversation:
Him: Hello, H_____, how are you today, may I call you that?
Me: Uh…good! Thanks! Actually, could you call me Holden?
Him: Holden? Holden. Ok, so Holden! do you have any questions?
Me: Will you use anti-nausea in the drip?
Him: Yep, that’s standard procedure for us.
Me: Good, then I have no more questions.
Him: Great. This will burn quite a bit, but don’t be scared. I’m going to put an oxygen mask on you right now, and then you’ll be out.
It was hard to breathe in the oxygen through the mask, and I found I was trying to take in deeper breaths than normal. Then I felt the burning sensation in my arm, and I thought I was going to die. It hurt so much, and I ended up heaving my chest and breath into the limited space of the oxygen mask, trying to get enough air, and then I was out.
While I was asleep, I was out, I had a dream. You can call it a morphine dream, you can call it a pain dream, but in the dream I was standing in a small room, it was mostly white, but not all white. There was a button on the wall that was loose, and I had a stack of papers in my hand or something, and tried to adjust it by smacking it against the wall. At that moment the entire room seemed to have an undercurrent of electricity, and I was vibrating with pain. I fell to the floor and curled into the fetal position. Eventually I woke up in the recovery room.
It was hard to move anything, or to even focus my eyes, but eventually I did, and they saw that I was awake and moved me back into my private room where Emma was. All in all the surgery took 3 hours with an hour of recovery. They set me up in bed, gave me food and drugs, and I passed out. Honestly, I don’t remember much.
During the night I woke up with horrible pain in my left arm. Nobody told me this would happen, but the pain wasn’t in my chest at all, it was in the arm with the IV. It was burning, and I could barely move it half an inch with horrible, shooting pain. My right arm was fine, but the left was practically immobilized. I pressed the red button for the nurse, and she gave me pain medication, and removed the IV. I still couldn’t move my arm, so Emma helped me mobilize it a bit, and I went back to sleep. The next day it still hurt, but I was able to move it gently.
While chatting with Emma, I found out that she had stumbled across something interesting in the night while she was looking for her iPad charger. As she squeezed various plastic bags, she felt something squishy that felt very much like a breast. Because it was. My breasts were in plastic bags in my hospital room. Luckily, Emma and I have a dark sense of humour, and we thought it was hilaaaaarious, and decided to take pictures to remember it for the rest of our lives. It should be noted that I was high out of my mind on painkillers.
The next morning, I was brought more food (more than I could possibly eat), and eventually was visited by the doctor. He looked very pleased, and said that the surgery went very well, no complications. He said to keep the binding on for a week, and that we would have a final consultation the next Saturday before I flew out. They sent me home pretty quickly, and I spent the rest of the day either sleeping or eating.
The week after surgery had major ups and downs.
The first night I slept OK, and was trying to eat more than I felt like because I knew it would help my recovery. Second night I was a crying, insomniatic mess, unable to breathe because my binder was too tight, and also unable to breathe because I was crying. I had also taken mellatonin pills, which are a natural sort of sleeping pill that signals your brain that the sun has gone down so it’s time to sleep. This might have also made the night worse, because I was in too much pain to sleep, but EXTRA tired. A very bad, yet retrospectively hilarious combination. We eventually called the clinic and asked if it was possible to release the binder a bit so I could sleep, and they said that was OK. Even half an inch made a huge difference for my sleep schedule.
Something I wasn’t prepared for was for my stomach to feel queasy. I think this was a combination of foreign food, too tight of a binder, and antibiotics. I didn’t know this beforehand, but apparently antibiotics can really mess with your stomach, which it apparently did. I had trouble the rest of the week eating without my stomach getting upset or having diarrhea. At first I was eating foods as complex as I always had, but eventually was mostly eating rice, eggs, and vegetables, almost without any spices. We went out for coffee most days (mostly for my own mood), which probably didn’t help in retrospect, but I think ultimately did lift my spirits.
During the days we would watch TV, movies, read books, and occasionally go for walks. Walks didn’t happen the first few days, since it’s honestly hard to move at all. I needed Emma to help sit me up from a lying down position. I needed her help to open doors, shower, do my hair, prepare food, tie my shoes, put on socks, put on pants, etc. Almost anything you think you can comfortable do for yourself, she probably had to do it for me. Luckily I could go to the bathroom by myself.
In the middle of the recovery week, there was an explosion in central Bangkok, near the Siam Skyway station, which was where we had gone to the mall to shop for clothes. We were safe at home during the commotion, but I got frantic texts and Facebook messages from friends asking if I was alive, because there were 20 people dead from a possible terrorist attack. This effectively killed any possible tourism that we wanted to embark on in our last week. We ended up taking taxis everywhere and staying indoors and away from the danger areas. we were a bit sad to miss the temples and night markets, but reminded ourselves frequently that we were there on a mission, and it wasn’t–despite the evidence in our wallets–shopping.
During all of this, most of my thoughts were centered around my theoretically masculine chest. I hadn’t actually seen it yet, and couldn’t until the day before we left.
Exactly a week after the surgery on the next Saturday, we were picked up by the transport to head back to the clinic for my final check-up. The nurses took my binding off for the first time, and very carefully took off the medical tape and gauze that covered the stitch-work. I was terrified, if I’m being honest. It felt like my chest was going to fall out, and I was afraid to move my head in case it disrupted my chest.
Let me give a little run-down of exactly what happens during the procedure for those who might not know. Basically, the surgeon makes two incisions (one under each breast), and takes the breast tissue out from those points. He also cuts any saggy skin so that it is completely flat and has a masculine shape. He then stitches up the incisions. The nipples are then cut out, resized to those of a masculine chest, and reattached with stitches. After a week of recovery you can take some of the nipple stitches out, and leave the rest to dissolve. A week after that you can take the rest of the stitches out from the main incisions. The entire time you have to bind (with either a medical binder or your own compression vest), and change the dressing underneath. You can shower, but you cannot put any water pressure on the stitches, and in general should only sponge bath the front. My surgeon actually warned, “Be careful, or you could accidentally wipe off your nipple in the shower, so don’t do that.” And then laughed. Yes I’ve already had nightmares about it.
This is the main difference between a top-surgery and a mastectomy. A normal mastectomy (such as when taking out malignant breast cancer tissue), has no male aesthetic reconstruction. Oftentimes the nipples are not replaced, and the placement of the incisions aren’t as important for aesthetics reasons. The main objective there is to get the cancerous tissue out.
After several minutes, the surgeon came in, said that everything look like it was healing well, and that he was going to take the stitching from the nipples out. This felt incredibly weird, because I didn’t actually have much sensation in my chest (besides pain), and it felt similar to when you have local anaesthetic at the dentist. I could feel that SOMETHING was happening, but I couldn’t really tell WHAT. They then cleaned the area around the stitching, and Emma took some pictures for posterity.
It was a bit of a shock to be without the binder. At first it didn’t feel real. It wasn’t my chest, but it was a chest that I liked more than the one before I went under anaesthetic. I’m still gently fascinated, weeks after the surgery. I think I’ll feel like this for awhile.
The next journey was getting on a plane and coming back to Berlin. This required getting disability assistance at the airport, which I’m very, very grateful for. It would have been just impossible without it. Not only could I not carry ANY of our luggage, but even walking was very tiresome for me. So they brought a wheelchair, and very slowly and elegantly rolled me through the Bangkok airport straight to my gate, where I finished ‘The New York Trilogy’ by Paul Auster and started ‘Spring Snow’ by Yukio Mishima. The actual plane ride wasn’t as bad as it could have been. I slept about 5 hours. Taking off and gaining altitude felt a little strange on my chest, but didn’t hurt too much.
Back in Berlin, I’m now staying at my girlfriend’s apartment to recover for the first week. It’s easier for her to take care of me here since I live on the other side of town, and plus her roommate’s a nurse and can change my dressing and take out my bottom stitches this weekend. It’ll be nice to go back to my apartment, but for now I’m really enjoying being in her space, and that me lounging around her space is actually MORE convenient for her, rather than a burden. There’s a nice satisfaction in that that helps me relax.
That said, there are a lot of limitations to my recovery:
- I can barely open doors by myself
- Sometimes I need help sitting up
- I can’t shower by myself
- I can’t cook or clean
- I can’t turn off the fairy lights on the headboard
- I can’t carry the water pitcher
- I can’t make coffee
- I can’t put a shirt on by myself
- I get tired quickly, no matter how little energy is required
My birthday was on August 26th, and I had a beautiful dapper tea party that Emma helped host with me. Lots of my friends came, and we ate a lot of cake and drank a lot of tea and coffee. Despite the very relaxed and low-key nature of the event, at the end of the evening, I couldn’t move off my back.
There’s the story up to now. Lots of surprises, a few dramas, but ultimately everything has worked out, and I’m recovering healthfully at the moment. If you’re interested in more regular updates to my recovery, check out my YouTube channel. 🙂