Guest post by Awkward Turtles.
Note: this is part two of a multi-part series documenting my experience of getting top surgery (i.e. a mastectomy). This time around, I’ll be talking about identity exploration, why I chose to have surgery, what the operation entails, and my feelings going into it.
When I left you, at the end of my last segment, I was beginning to question my gender identity and to research and listen to as many trans/queer people’s experiences as I could, both in person and through books and the internet. As I learned more, my identity went through several shifts. Initially I was drawn to “butch” conceived of as a masculine third gender, especially given that some of the emotional aspects of the butch identity resonated with me at the time. I was also attracted to “genderqueer” both as an expression of a non-binary (neither male nor female) identification, and because it often seemed to have a political valence, an implied resistance to the coercive way in which gender is all too often reproduced. But apart from not being a broadly recognized term, “genderqueer” also felt somewhat less descriptive than I would prefer, covering a variety of gender conceptions from bigender to agender to somewhere-between-male-and-female, sometimes even coexisting with a male or female identity. I eventually concluded that my theoretical rejection of coercive gender assignments and oppositional sexism might better be described simply as a form of feminism.
Kate Bornstein’s work introduced me to the concept of “transgender” as an umbrella term for anyone who transgresses gender norms, but I still felt self-conscious identifying as trans or transgender without knowing whether I ever wanted to go on hormones and without even having chosen a male name. On top of that, I didn’t feel comfortable formally “coming out” as either genderqueer or trans without being sure I wouldn’t end up identifying as the other, partly because I didn’t want to create an impression either of myself or of trans/queer people in general as uncertain or insecure, and partly because coming out can be just plain exhausting.
While things weren’t completely clear on the identity front, I found baby steps to take in the mean time. Far and away the most crucial of these was ordering a chest binder. It is difficult to describe to someone who has never experienced dysphoria how extraordinary a feeling it is to finally feel able to identify with and be happy about an important aspect of your body in a way you never thought possible. Seeing my flat(tened) chest gave my self-image and self-esteem an almost immediate boost; I was able to walk taller and prouder now that my clothes finally fit the way I’d always wanted them to. Besides feeling much better in my own skin, binding had a profound effect on the way I was perceived by strangers. I began being called “sir” and other male terms right and left, and while I was still occasionally “ma’am”-ed, it happened with far less frequency.
I was surprised how much I found myself enjoying this turn of events, and began actively trying to pass. Plus, the more I was unquestioningly accepted as male, the more I began to be able to see myself, or at least imagine seeing myself, as such. I admire people who are not concerned about passing, and of course I completely support everyone’s right to self-identify as any gender regardless of whether they “pass”, but for me, in an uncertain place, it was a very positive feedback loop, and one of the first and easiest ways I had of having my identity recognized.
While binding helped, I quickly decided it was not a final solution. The compression was physically uncomfortable and became increasingly painful the longer and more often I wore the binder. It impeded my breathing and made any form of athletic activity, even walking up a steep hill, near-impossible. My back ached constantly. I decided I needed to pursue top surgery, i.e. a mastectomy. I felt more than ready, and had heard enough accounts of genderqueer and even female-identified people with chest dysphoria choosing top surgery that I felt comfortable taking the step regardless of how I would ultimately identify. Through a lot of negotiation and a series of incredibly lucky breaks with both the surgeon and my insurance company, I managed to get a surgery date of May 24 with Dr. Michael Brownstein, a veteran and very highly skilled surgeon, and authorization from my insurance company to boot.
For those who aren’t familiar with mastectomies, there are two main surgical approaches, each with several slight variations. The first only works for people with relatively small amounts of breast tissue (the equivalent of an A or at most a B cup) and is called the peri-areolar method. It involves the surgeon making an incision around the circumference of the areola, removing the breast and duct tissue through a combination of scalpel work and liposuction, trimming the skin to size, and bringing the skin together around the nipple like a drawstring bag. The second approach works for any chest size (good for my borderline C/D-cup frame) and is called the double incision method. Here, the surgeon makes two long horizontal incisions across the lower part of the breast tissue, removes the tissue with a scalpel, trims the skin to fit, and closes the incisions. Usually the nipples are cut away and then grafted on again, though sometimes the surgeon leaves them attached by a pedicle and operates around them in an attempt to preserve better sensation. Either approach (peri-areolar or double incision) takes one to four hours and is usually performed as an outpatient procedure, allowing the patient to leave the hospital after getting out of anesthesia.
The patient will have drains coming from the sides of the incision sites for about a week after surgery to prevent fluid buildup, and has to wear a compression vest for one to three weeks to minimize swelling. Most people spend the first few days after surgery pretty exhausted and groggy due to the pain meds. Through the rest of the first week they become much more cogent and able to get out of bed and walk around as the pain begins to subside, but mostly still try to take it really easy. After the first week you get your drains and sutures out and can shower and gradually start going back to your day-to-day life. However, it takes four to six weeks to fully regain mobility and come to a point where you can lift more than ten pounds and resume athletic activity.
On reflection, it’s kind of amazing to me how little fear or anxiety I am facing about the impending surgery. I feel a bit flustered with excitement now and then, but overall I’m feeling pretty calm. Of course, I’m not looking forward to wearing the medical binder and being unable to shower, exercise, or have my full range of motion for some time. But the only real fears I have are incidental to the surgery itself. Actually, the most present one over the past couple weeks has been of some horrible accident happening that would prevent me from getting the surgery; I don’t think I’ve ever been more cautious walking down stairs and crossing the street in my life! A more distant, but just as real, concern is what repercussions the surgery will have as far as my identity and transition. I’ve heard from so many people that although (or really, to the extent that) top surgery resolved their chest dysphoria, it also made them more aware of the discomfort they had with other aspects of their bodies (either because pre-surgery, one’s chest tends to literally block one’s visual field or because post-surgery, emotional energy that was previously directed to managing chest dysphoria becomes freed up and attaches to other things). I am especially concerned that I will feel increasingly dysphoric about my hip/thigh area.
Mercifully, I don’t have particularly wide hips, but the fat I do have collects in what is, for me, an uncomfortably feminine pattern. Given that I already exercise and eat well, the only healthy way to counteract this would be to start testosterone, which (among other effects) redistributes body fat so as to give one a more masculine figure. Now, starting testosterone has appealed to me for some time for this very reason, and others too: the possibility of a lower voice and the ability to put on more muscle are especially tempting. And over past several months of research and reflection, the physical effects of testosterone that once gave me pause, such as body hair growth and temporary increased acne, no longer seem like such a big deal. But I don’t feel that I could go on T without transitioning socially as well, and a complete social transition to male, despite the fact that it has attractions of its own, still feels like a pretty daunting prospect. But I remind myself that however I end up feeling after the surgery, and whatever I end up deciding to do, it will all be part of the process of self-discovery, and it will be for the best in the end. And given how I feel today, top surgery is not something I want to put off any longer. Only one way to go: onward!
Turtles is a young human living in Oakland, California. They enjoy yummy vegetarian food and weightlifting and queer dance parties and falling asleep in the sun. Their weaknesses include eating too many salty things and staying up late reading feminist blogs. They are attracted to many different kinds of people and are trans in the broad sense and are still figuring out the details.