Bilateral Mastectomy with Free Nipple Graft

Hi everyone. I got top surgery yesterday, and I want to document the experience. I thought OMD might like to come along.

Origin Story
I was a fat kid, which meant I got pre-breasts pretty early. I remember being embarrassed by them, then eventually forgetting to be embarrassed so thoroughly that I forgot I ever was embarrassed for several decades.

I eventually settled out as a pendulous 40EE, though it took me a long time to realize bras went above DD. Going to my first ‘real’ bra fitting with a bustiere at 37 was a goddamn revelation.

I had the occasional thought about getting a breast lift, because my breast developed as pendulous, with a lot of bulk near the downward pointing nipples. I’d never had a young n’ perky stage, and it seemed a little sad. Plus, like most women I have a love/hate relationship with wearing bras. I talked about it with my wife, and she said it was my body but that she liked me just fine, and I didn’t think I could get surgery through insurance. They were never very serious thoughts.

First Inkling
I don’t remember when I first learned about gender affirming top surgery. Probably in college. I don’t remember feeling any tug towards wanting the procedure, beyond thinking it would be nice to eject bras from my life. So I knew surgery was out there.

I watched a YouTube video in 2018-ish of a non-binary person getting top surgery, and I remember being interested that top surgery had expanded outward from the transgender community.

At some point I started thinking about a breast reduction, but my wife still thought I was fine and I still didn’t think insurance would pay for surgery because I have no history of pain or rashes.

Stronger Inkling
I went through a pretty big life change in the format of a very surprising divorce, and I spent a year thinking about what I really, truly want for myself, without any outside influence.

What I decided is that I’m very agnostic towards my own breasts. They go from just being there, to being actively annoying, with the flopping, and the bras.

Planning
I made the decision to do something about my tits in Jan 2022, then plunged down the research rabbit hole. Where I found a lot of information that traditional reduction probably couldn’t get me below a B cup. The procedure for reduction just isn’t the same, and there are many stories on the internet about surgerons making decisions about sizing while a patient is unconscious.

The Snag
I’m not transgender, and I categorize myself as more middle-age and no longer taking any shit, than actually dysphoric. Which was a problem, since most surgical practices and/or surgeons require a letter from a psychologist affirming dysphoria.

Eventually I found a list of surgeons who do surgery based on informed consent, instead of psychological gatekeeping. There are 17 in all of America, which is a whole ‘nother post.

Back on the Path
I booked a consultation with 2 gender affirming surgerons, and one local cosmetic surgeon just to make sure I covered all my bases. I got the best connection and feeling about the surgeon in North Carolina, and I booked surgery in late March, scheduled for Dec 2022.

The big gap between booking, and having the surgery was to avoid being down ‘n out during hurricane season. Which, jokes on me, but we’ll get to that.

Money
Consultation Fee $100
Deposit. $1,000

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Hi Friend, I feel like I’m just beebopping around the internet following you in a very delayed fashion, so I’m glad to be here in real time. Congratulations on coming through your surgery healthy and whole (I assume, since you’re typing here), and I hope your recovery is quick and easy. :heart:

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Hope your recovery goes well and is uneventful. Glad to hear that you had your surgery as scheduled and nothing happened to delay it. :heart:

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The Wait
Scheduling the surgery in Dec was initially very clever, when I was still stationed in DC. Right after Christmas is generally when the administrative part of hurricane season ends, with a nice gap in Jan before admin for the upcoming season ramps up.

Then I unexpectedly got set to a different billet in CT, teaching cadets. It’s awesome, and I’m loving the experience, but my carefully aligned surgery date no longer made a lot of sense. I only have a week between surgery, and the start of the new academic year.

But, I kept the original date because I couldn’t have surgery during my first term, and I didn’t want to wait even longer until the summer session. I’ve got shit to do!

So, 3 weeks of convalescent leave during a mildly inconvenient time it is.

The Journey
I made the decision to fly a friend out to DC, then have us both drive my jeep down to Charlotte. Seemed convenient, at the time.

Holy cow, what a retrospectively inefficient decision, when considering that I then moved another 6 hours north. I should have switched paths, and flown Friend, Dog, and myself to Charlotte and rented a car.

However, we eventually fought our way through the post-Christmas traffic, and arrived in Charlotte with a full day to spare before surgery.

Money
VBRO rental $1205
Plane tix $318

Running total
Surgery Fees: $1,100
Ancillary stuff: $1,523

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The Day Before
Friend and I took care of many errands. Drove hella far away to the pharmacy that takes my insurance, to get my prescriptions. Went to the grocery store. Poked around a few shops. Took Sir to a dog park, which he summarily rejected in favor of the field next to the dog park.

The Night Before
Friend and I settled in to watch some TV. I packed my Xbox for the trip, and it definitely was the right decision. The VBRO rents has a Roku, but I want all the thins.

Friend went to bed around 2200, but I stayed up to 0100, trying to make sure I’d sleep in the next morning.

The Surgery
I woke up around 0700, so Stay-Up-Late totally failed. I spent 2.5 hours whining about being thirsty.

Dropped Gabe off with a sitter at 1000, and arrived at the office around 1020.

Friend and I sat in the waiting room for about 10 minutes, and the staff showed Friend all the amenities (pop, snacks, wine!, and a big TV. The nurse came out, and took me back to an exam room to get vitals, and fill out consent paperwork. Once I was done signing, I took a Valium with the most amazing sip of water, really I could rhapsodize about that sip for a long time.

The nurse took pictures from a bunch of angles, then left me to change. I took a few of my own pre-surgery pics. My friend came back into the exam room for final visits, and I was feeling the Valium. Very calm, and smiley.

Friend was ushered back out, and the nurse said the surgeon would be in next.

Once she arrived, we reviewed some pics of my ideal outcome, and I chose nipple size. She drew a lot of lines on my chest, then left with my phone, so I didn’t get any pics. Sadness!

After the surgeon left, the nurse anethsitispt came in, and talked me through what she monitors. She put a canula in my hand. Not my favorite spot, but I wasn’t going to be awake for very long. We walked into the operating room, which I admit was a little intimidating. I got naked, and lay on the operating table. I got a heated blanket, and two nurses started putting a pneumatic compression device on my lower legs. The anethsitispt hooked my IV up to something, and that’s where my memory stops.

Money
$10,900 for surgery
$185 pillow set to help sleeping upright on back
$147 covid tests & supplements
$67 on travel cooler for prepped meals
$6 ice for cooler
$20 on laundromat (come home to all blankies washed)
$102 on gasoline
$56 on food while traveling
$81 on hotel
$204 on groceries

Running Total
$12,000 On surgery
$987 on plane tickets
$1,286 on lodging
$102 on gasoline
$56 on eating out
$204 on groceries

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The Aftermath

I don’t have very many memories of just after surgery, beyond a smear of being very tired, confused, and kinda miserable.

The surgeon I chose works out of a clinic, not a hospital, and they’ve maximized space by using the OR as the recovery room. The nurse anethsitispt warned me I’d wake up still on the operating table, and that I shouldn’t be upset by the location.

I have a memory of looking at a big clock display, which might have still been in the OR, but I have no idea.

Someone kept trying to get ginger ale into me, and I was not into the idea.

At some point I was decanted into a wheelchair, put back into my street clothes, and was taken to Friend. Then we all went to the car, where I was pretty much hoisted into the seat, then reclined as far as the seat would go.

No memory of the drive home. Slight memory of being assisted out of the car, and into the nest that Friend and I had setup that morning. I was very cold, and Friend put another blanket on me. Puppers came to keep me company.

I felt nauseous, and Friend helped me take some of the anti-nausea meds, which worked amazingly fast. Then I took a hydrocodone.

The worst pain was actually in my elbows, radiating into my forearms. I assume from having my arms spread out and strapped down during the surgery. Either not enough motion, or they were hyperextended.

Friend turned on some TV, and I napped for a couple hours. When I woke up, I was still feeling the anesthesia, but I was regaining function and memory. I had some toast, and a few apple slices. Puppers curled up next to me. I took another round of narcotics, and that was the first night.

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Glad you were able to get this done for yourself. I hope recovery continues smoothly.

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Post Op Day 1

Woke up at 0300, and the local anesthetic the surgical team had injected was wearing off. My chest felt okay, but the lower rib area was bruising very nicely from the liposuction, and starting to feel both numb and painful.

I hadn’t really inspected myself yet, and I was surprised to be feeling pain in that area. I hadn’t realized how far down the liposuction would go.

Woke up again around 0700, took all the drugs. Spent a lot of the day laying on the bed a lot, ate a pice of toast, and walked the length of the block twice.

I noticed that a patch on the tip of my tongue was numb. I emailed the surgeon’s office, asking if I could put ice of my liposuction bruises, and wtf was up with the tongue. The nurse said ice was fine, and that my tongue was normal, and would get better with time.

I felt surprisingly good, and fairly mobile, and I wanted to do something up and about. So Friend and I went to the pharmacy for ice packs, and I think we might have gone to the grocery store.

My surgeon used penrose drains, and the absorbent padding (aka: maternity pads) gets changed once a day. I got to take the compression binder off, and inspect myself. Long incisions, and sad nips. Pretty much what I expected.

I was prepared for a moment of shock, or even unhappiness at seeing my flesh all torn up, but it was fine.

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Day 2 Post Op

Spoiler alert: the timeline of the tongue “improving with time” is somewhere between 6 weeks and never.

I was feeling pretty human when I woke up, but decided to take another round of narcotics. I was afraid of what kind of pain I was really in.

Then I spent most of the morning trying to poop. Friends, I could not poop.

Not wearing a hat.

Not after petting a cat.

All the stimulant laxative got me was sound and fury, producing nothing. So I switched to naproxen for the noon dose.

Friend, Dog and I went for another little stroll in the morning. Then we drove to a little shopping area for a small excursion - coffee, and browsing a couple stores. I felt fairly perky, but my poor grafted nipples were burning.

When I changed the bandage, I noticed the nip bolsters were being smooshed downward, and the top stitches looked very tight. I emailed the surgeon’s office, asking if the bolsters were okay. Then I alternated trying (and failing) to poop with fretting about the death of my nipples.

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I hope you are doing better each day.

Thanks for the encouragement!

Day 3 Post Op

Suuuuucked. It sucked.

I finally managed to poop, which was awesome, but happened mostly between 0300 and 0345. There was a lot of swearing.

Once the day actually started, I was worried about the bolster stitches ripping out, and spent the whole day background fretting. I had emailed the surgeon’s office the afternoon before, but the staff didn’t answer emails on the weekends, and the only contact number was the surgeon herself, which was reserved for true emergencies.

It was also the worst day for pain, and tolerating the compression. Which was never actually rose to the point of being overwhelming, but the constancy of being so uncomfortable started to wear on me.

I was also just kind of unhappy with everything. The excitement had worn off, and so had the torpor of the anesthesia. So I was awake, but uncomfortable, and also miserably anxious while trying to talk down my own hypochondria.

It was also the first day of the new year. Friend and I loaded up Dog, and we all went to visit a local food hall to browse the shops and get a smoothie. And later in the afternoon we visited a park for zoomies, then sat outside at a coffee shop. I had an Americano, Friend had a cinnamon roll, and Dog shared the cinnamon roll since the Bougie place didn’t have any whipped cream.

I drugged myself with hydrocodone and Benadryl, and I ended the day by going the fuck to sleep.

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Day 4 & 5 Post Op

These days were so similar, they don’t really need a separate designation. Friend, Dog and I got a good routine going. Wake up for morning meds, have breakfast, have a moring excursion to a park or shop, then go back to the abode for lunch and TV watching. Stay reclined until Dog got restless, then have an afternoon excursion.

Naproxen in the morning, hydrocodone at night.

By the start of day 4, I’d burned through worrying about the state of my nipple bandages. The stitches weren’t pulling through the skin, and I’d padded the part rubbing against the binder with some gauze pads. It was good I found my own chill, because I’d forgotten that Monday was the observed New Year holiday, and that the surgeon’s office wouldn’t answer emails until Tuesday the 2nd.

Day 5 the nurse from the surgon’s office emailed me back, saying the bolsters were fine, and that sometimes the edges of the grafts get exposed. Nice to finally get a verification. Meanwhile the exposed flesh blorbs had turned from dead fish belly white (day 2), to mangled looking red (late day 5). Progress!

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