Would it have made better sense for me to make a log of all this while it was actually happening? Sure. I do keep a daily journal/diary so there is actually a fairly decent record of the day to day experience, which I will draw on here, but it's not designed to be a cohesive narrative about the surgery itself since it's where I write about everything and anything that's going on that day.
Anyway, there may be stuff in here they didn't tell you about top surgery, or it may be stuff you already knew, or a mix. This is just my own personal experience. First off, it's important to note that I have led an absolutely charmed life and have never had any kind of actual surgery. I've had a mole removed with local anesthesia, and I have been put under twice, once for my wisdom teeth and once for an endoscopy. That last one sucked. I did not handle the anesthesia well as I had a headache for two days straight after. I told them this in advance. Anyway, I still have my appendix and tonsils and all that, I've never been cut open before. I've never been in the hospital (as a patient) apart from the week I was born, so I really wasn't sure what to expect.
Preparation: I knew I had a decent amount of body hair. Literally the first thing the surgeon said, on seeing me shirtless, was "You're gonna want to shave that, or else the nurses will." and boy did that last part sound like a threat. So I shaved my chest. It took an HOUR to shave my chest. Holy crap you don't realize just how hairy you are until you have to try to get rid of it. It's long and it's a carpet but the hairs themselves are fine and straight and just defied the razor sometimes. And then when I finally finished- I even went up into my armpits just a little (for reference it was absolutely good that I did that), I looked in the mirror and I did not like what I saw. I felt like a shaved bear. I felt naked. I didn't think I was that attached to it but I just looked Wrong without it. I also had to wash with chlorhexadine soap both the night before and morning of surgery, that was such a familiar smell, we used that stuff for everything when I worked at the vet hospital.
At the hospital: It felt really weird to go in there essentially in pajamas and slippers, but I guess that is exactly what you should do? I did wear a button-down shirt, which was recommended. Again, felt naked because my wife had to hold onto my wallet and stuff. I did not wait around in the waiting room for very long before they took me back and put me in a bed, but I think I was probably back there for an hour or more. The nurses were nice, everybody was nice. We'd had some mild concerns because it was a Catholic hospital. I was anxious anyway, but everyone was so pleasant and honestly they made it the best experience it could've been. The nurses and anesthesiologist were all black women, which is not important except-
Immediately post-op: I was dreaming and there were people nearby talking, and then I realized I was actually hearing the nurses talking and remembered I was in the hospital. They must've knocked me out still in that waiting room full of beds because I have no memory of being wheeled out of there to the surgical theatre. I had a really hard time opening my eyes, and when I did there were a handful of nurses and they were every last one of them white women. What the hell happened? Somehow despite the fuzzy-brainedness of anesthesia plus my own possibly autistic bad social graces, I managed to just restrain myself from saying out loud 'it sure got white in here!' Only just. They let me sip some water because my mouth was super dry, and they had given me a scopalamine patch behind one ear before they put me under which may have helped, because I felt fine apart from super sleepy. My bed was in a very cramped, labyrinthine room of beds and equipment that looked very behind-the-scenes to me, so I was actually pretty surprised when they brought B right on back there. She helped me to get dressed and the nurse basically had her doing the more sensitive stuff like my underwear and pants. Very tactful. They also let me touch my chest, but I was already done up in the compression vest. Still, almost cried when I felt how flat it was. They sat me up for the getting dressed and B said afterward I seemed fine until that moment, at which point I turned paperwhite. I was immediately nauseous. Did not puke, but it was an effort not to. They got me into a wheelchair and wheeled me out, B by my side all the way to the car and my god that wheelchair ride was the most nauseating experience ever, they had me holding a barf bag. Still did not puke. Car ride was also sickening but honestly not quite as bad as the wheelchair/elevator combo? I don't love elevators at the best of times, though. My father-in-law drove us, and he and B both helped me from the car into the house and all the way to the bedroom and sat me down, and just like that, I was fine. Once I sat down on the bed, nausea was gone. No headache. Still slightly loopy feeling, but otherwise perfectly okay. I was desperately thirsty, though. I was thirsty nonstop for about 48 hours. I sucked down gatorade like it was the best thing ever. I did not take a nap. Within maybe half an hour of getting home, I'd gotten up and walked the length of the house to the couch without assistance, and we watched TV while I drank gatorade like it was air and periodically went to pee because I was drinking gatorade continuously. I ate some dinner. I was coherent and totally fine.
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| Drains & Vest |
Post-op week 1: I sat on the couch and alternately watched movies and stuff, but also dozed off sitting up every couple of hours. I slept in the bed alone, and slept only 2-3 hours at a stretch, then got up and walked the house, then slept another couple hours. I was still thirsty more than usual but after the first 48 hours it wasn't like a desperate thing. By the end of the week the compression vest was starting to get uncomfortable, and I had some pain up towards my armpits. Emptying the drains twice daily was gross, I don't know how I would've done it myself (or at least it would've been awkward) but B did it for me like a champ. By the end of the week there wasn't much in them, which was as it should be. After one week we went back and they took the vest off and the drains out- I'd heard it was painless, and I figured that was an exaggeration, but while I was taking a bracing breath the doctor and nurse each took one side and by the time I'd finished breathing in he was like 'yeah they're already out now' and I went 'what??' because I literally did not feel a damn thing. My nipples looked like purple blobs. There was still sharpie and iodine stains all over my chest. My body looked like a horror show but it was flat. Also after I removed the scopalamine patch I apparently neglected to wash the area behind my ear thoroughly. The next day I proceeded to touch that area, and then later my eye, causing my pupil on that side to dilate hugely and become unresponsive to light. Cannot recommend. Made watching TV and my vision in general feel weird. Wore off overnight. I had been warned, so I figured out real quick what had happened, but it was still an experience I would like not to repeat.
Post-op following weeks: We were allowed to take the vest off briefly and B helped me take a sponge bath literally that same day, and we tried but it was clear a lot of the stains were going to take more than one washing to get off. I realized I had more sensation than expected, and the incisions went way further up towards my armpits than I anticipated. Also that's where the drains had been coming from so it made sense that was a sensitive area. Working at a vet I'm kind of used to looking at incisions, and once I got cleaned up a little I could tell mine actually did look pretty good. Unfortunately I continued to have pain in my armpits over the next few weeks. I was keeping my arms down all the time, and not using deodorant because that's not something you want in your incisions as they're healing. The discomfort actually got worse until I lifted my arms enough to get a good look in the mirror and realized I had a yeast infection. Cool. Fun times. If you have assigned female parts, as I do, and have ever been on strong antibiotics (I had those post-op so probably a contributing factor), you may be familiar with yeast infections in a very sensitive area. I was okay there, but I've never had it in my armpits before. Had to call the surgeon and get a prescription, and yeah that sucked. I wish I had realized that's what was happening sooner. So that's my warning to others. Overall my pain levels were worse around the armpits and that yeast infection than they ever were for the incisions themselves. I did take the opiods. After the first few days I only used them at night, and took extra strength tylenol during the day. The vest got annoying and uncomfortable, like wearing a binder 24/7 basically, so I looked forward to baths/showers when I could take it off briefly. We got rebandaging down to an art, but again something I do not know how I would've managed without my wife's help. She did so damn much for me. Gradually I got better range of motion back in my arms, and my nipple grafts turned from purple to reddish-purple, the left one turned into something like a sad pepperoni, then pinker, then slowly into just a nipple. The right one... did not. I was worried about it early on because it seemed to be lagging behind the left in progress. It stayed dark, then turned ugly and darker with pus. The surgeon declared it a layer of necrotic tissue over healthy tissue. Eventually the dark parts came off to show pink underneath.
When I finally got the compression vest off it was such a damn relief. It was itchy and obnoxious by then.
Nearly 6 months post-op: Not quite there yet. My six months visit is next month so I guess I'm closer to five right now? My right nipple graft did not, technically, fail. It did take damage. Up until a few weeks ago it was still flat, if pink, and it is only just now trying to show some distinction between the aereola and actual nipple and gaining some dimension. There is a weird little lump of aereolar tissue that escaped damage but honestly makes it look more weird by comparison rather than less. It may look normal in a year? Or it may not. The left side is raised and a normal color and just generally looks as normal as could be. The incisions are definitely still visible, but they're not raised anymore and I feel like they're subtle enough that with time they may become hard to see. I'm still using silicon scar stuff on the incisions and the right nipple, and damn that stuff is expensive, $80 a pop. I've looked for over the counter stuff but the gels do not have the same ingredients and the scar tape doesn't work as well, it gets uncomfortable fast. I had to work hard with hot compresses and a massager/roller to get rid of some lingering swelling, but I'm past that now and I honestly absolutely love how I look with a shirt on. Actually shirt off is okay, too! It's a work in progress, scar-wise, but overall I'm happy looking in the mirror. I did worry with my chest flatter my belly would be more visible. It is. I'm remarkably okay with that, although I should try to lose a little weight. I'd like more muscle on my arms. I have basically a dad bod. Some days I want to improve that. Some days I just don't care that much. I'm okay with it, and that says a lot about just how dysphoric my chest was making me.
I expected to one day look in the mirror and be surprised to see my chest flat. That's never happened. What has happened was looking in the mirror and having a slow dawning surprise that I did not see something unexpected in the mirror, like breasts. It's a reverse surprise. I'd love for the right nipple graft to eventually get with the program, but if I were to never get any further than where I'm at now, I'd still be happy and I don't regret it at all. And I will still continue to heal, from here. I'm 45 years old and stuff takes a little longer than it used to. Maybe I'll get back to doing bench presses and see some improvement, there. Maybe I won't, and that'll still be okay.
As a note, I will say I've glossed over the truly hardest thing in all this. In the month leading up to my surgery, we discovered that my cat was terminally ill. For a while there we were just desperately hoping she'd hold on for a few weeks past my surgery, since we knew she'd be thrilled to have me home 24/7. She did, and she was. She sat in my lap and hung around me a lot while I recovered, although she was never exactly a lap cat. Still, she wanted to be where I was. She actually hung on until just a few weeks before Christmas. We were debating what to do over euthanasia to make it as painless as possible (she was terrified of the vet), and waiting for those final signs like not wanting to eat- she was taking medication, but I just put it in her food and she ate it, I vowed I would not force pills down her throat. Ultimately she was begging for our pizza and eating great even that night, although she seemed a little disoriented at bedtime, climbing half into her bed, looking bewildered, wandering around a little. I got up to pee in the night, and she didn't show up in the bathroom doorway. Yes she was still even doing that normally. I had a feeling, after how she'd acted a few hours before, and went looking for her. She passed in her sleep, laying on the dining room carpet in the same spot she'd been frequently napping. I'm so grateful to have had her by my side through the hardest parts of my recovery. I'm so glad she seems to have gone out painlessly at home.
I still miss her every day.
Maxie Magpie trying to sit on both of us at once
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