I had chest surgery on the eleventh of December, 1998. My experience is somewhat different than other FTMs or transmen. I waited almost 8 years to have surgery and the last nine months were an agonizing process of self-analysis. For me the decision of whether or not to have surgery was far more difficult than the decision as to whether or not to start hormones.
While I didn't journal the entire process, I did journal through and including the month following surgery. I have thirty two pages worth of entries, some of which are repetitious. I have by no means included my entire journal, just some excerpts here and there. The excerpts appear in italics and are unedited. The following are my experiences and mine alone. Everyone will have different issues and a different approach and that's a very good thing. By all means, don't let the expression of my fears limit you or taint your process. You are the one who must live with the choices you make.
Because I know how we all can be in the patience department, to those of you who would rather see a picture rather than read words, just follow the link.
I am providing this information in the hope that those who come after me have an easier time of it. I am also giving a great deal of attention to my pet peeves about the process. Please feel free to share this information with anyone and everyone. If you have your own webpage, I would much prefer that you link my webpage rather than reprint the information. To those of you who want to print it out and pass these words along, feel free to do so. My only request is that these materials not be reprinted in any newsletter or publication without my prior express written permission.
In the Beginning
I started hormones in March of 1991. In the beginning that's all that mattered to me. Surgery was a long way off for a variety of reasons, the foremost being money, but that's not the only reason. I had my hands full at the time. I was in a relationship that suffered a great deal of stress due to "transition" and ultimately terminated within the first three or four months after I started takint testosterone.
I was self-employed and didn't know how my clients would take to the idea. I was afraid that I didn't "pass" and so continued to wear skirts and heels to Court. This proved to be self-delusion on my part. It later dawned on me that at least one Judge thought that I was an MTF, but that's a story unto itself. I was afraid that my parents would reject me. My body was changing on what felt like a daily basis, although in reality it is a continuing process. I was just learning to navigate the period of gender ambiguity, deal with friends and my community. Dating proved a challenge. My self-esteem was on it's way out of the toilet and hung by a tenuous thread. Yet binding was enough.
As time progressed, I some of these fears proved unfounded. Others were right on the mark. I became comfortable with who I was. My beliefs and focus began to shift. I found my sense of humor and stopped taking rejection as personally as I did before. With this increasing comfort level, and a rather heavy work load, I began to care less and less about surgery. Lack of money continued to provide a convenient excuse for the avoidance of the surgery issue altogether. I continued to take in information regarding surgeons, but the thought of returning to therapy for the sole purpose of satisfying someone else's need for documentation wasn't an undertaking that I was willing to pursue. Since I had friends with a pool, I didn't feel terribly deprived about swimming although the beach was definitely out. As my beard grew in, binding became less important and less necessary with the exception of specific circumstances. Also with the passage of time, I became more and more invested in nipple sensation, but we'll come to that in a minute.
Ch-Ch-Changes
I'm not a fan of change. I approach it grudgingly. Okay, okay, kicking and screaming is more like it. I drag my feet and recite the mantra "change is goooood, change is your friend" in a voice dripping with honey. It doesn't work, but at least it makes me feel like I'm doing something. After the fact, I have always managed to bashfully concede that change was a good thing, but that doesn't make the next one any easier to embrace.
The move from Northern California to Southern California was simple in comparison to other changes that I have made in my life. There were substantial benefits, like the peace and quiet of our little country paradise. There are no nosy neighbors. I can hear myself think and all around me there is the natural beauty of the high desert replete with hawks, coyotes, rabbits, lizards, the occasional snake or two, and yes even horny toads.
However, the move also meant that I became oppressively overheated when to binding to travel to and from work. Miserable in fact. [Travelling to work for me means a three hour commute one way. No I'm not insane. I make the round trip once per week].
Ocean related activities are more feasible in this warmer climate, but remained on the restricted list as I had not had chest surgery. The greatest emotional discomfort came when entering mens sexually charged spaces. I couldn't take my shirt off and I felt like I was expending far too much energy taking precautions against having my chest touched.
My partner who had wanted chest surgery long before ever starting hormones did a great deal of research to locate a surgeon who would be responsive to his needs then began scrimping and saving to pay for it. The fact that he went first allowed me to view the process close up. I started waging my own internal war about whether or not I would proceed. Friends began asking when I would have chest surgery and I became immediately defensive. From their perspective they were being supportive. From mine a lot of loose assumptions were being made. Each question seemed to contain a tacit assumption that I would have surgery and I certainly had not reached any conclusions. Instead of letting these things fester, I immediately communicated my feelings and managed to clear these misunderstandings up to my satisfaction without feelings being hurt on either side. With each question that came up, I had to reflect on whether my adamant refusal to have surgery was due my perception of outside pressure or something else. Whatever it was, the issue became foremost in my mind.
Three months after my partner's surgery, and during a period of extreme self-reflection, I made an appointment with the same plastic surgeon, Mary Lee Peters, M.D. of Seattle, Washington. I was immediately impressed by Dr. Peters' rapid assessment of the situation -- she clued into the fact that my nipples are a source or erotic pleasure AND that I certainly wasn't ready for surgery. She also made this assessment herself. In other words, I wouldn't be required to go to a therapist for the sake of jumping through hoops prior to surgery. That's not to say that I wasn't asked any questions about transition, my support system, etc. Dr. Peters asked very pointed questions. She also provided surgical options and made it clear that I should not rush to judgment about what to do. She encouraged me to spend all the time that I needed to decide what was right for me, didn't insinuate that she had the answers, and said that if I did decide to have surgery that she hoped that I selected her as the surgeon. Imagine that. Not only did she not assume that I would have surgery, but the decision was all up to me -- a far cry from other surgical approaches for transfolk. I walked away from the appointment empowered, but with a lot of soul searching to do. The risks were clear, there were no guarantees regarding outcome or sensation.
After three 1/2 months of grappling with the prospect of surgery, I took the plunge and set a date far enough in the future that I could supplement what I had managed to save over the course of the prior year and still cancel if I changed my mind.
I began to closely scrutinize posts on the internet from people who had recently undergone surgery. I also questioned anyone who would stand still about their surgical experiences. I began to sense that there was a conspiracy of silence about the pain and limitations surrounding surgery. If not a deliberate conspiracy at least selective memory at play. No one that I spoke to had a bad thing to say about surgery. Everyone was thrilled and relieved. I took every word in with a grain of salt because it was abundantly clear that I was different. Sure, I wasn't thrilled with my breasts, but my nipples, that was another story.
Journal entry 8/16/98
Made the appointment with Mary Lee Peters, M.D., for the [chest] surgery and I'm nervous already. Not that I wasn't nervous before. I have a different relationship with my breasts than other transmen. Its indifference and/or inconvenience [for me] rather than `hatred'. I love my nipples and would rather not have breasts . . . the thing is that they are tied into nipple function . . . It'd be easier of the breasts were gone. But am I trading form over function?
Journal entry 9/7/98
[T]here is a secrecy about the process leading up to surgery and after. Perhaps its that others see their tits as useless flesh to be avoided at all costs, while in my case I have no qualms about my nipples. Actually, in retrospect, I think that my nipples became a focus of my sexuality as I began to explore my masculine/masculine sexualities.
Fears coalesced during the waiting period. I was terrified that I wouldn't make it through the surgery. Having never undergone surgery that was a biggie. As a practical matter I should have updated my will and durable power of attorney, but I didn't. They were in place and would suffice in a worst case scenario. I debated writing letters in the event that something didn't go according to plan. As the surgery date approached I had a million and one things to do before leaving town the thought of writing a bunch of letters was daunting.
What finally cinched this fear is that I survived the reenactment of Mr. Toad's wild ride by an SF cabbie. Never before had I been convinced of imminent death while a passenger in a moving vehicle. Horns blared as we careened through intersections narrowly missing other vehicles and pedestrians as well. I was convinced that this was as sure a sign as any that I would live through surgery. Okay, so it wasn't only the cab ride. I was also able to put this fear to rest by virtue of the fact that of the hundreds of people who had had chest surgery, I had yet to run across a single story or instance where someone had died.
I was afraid that I'd lose nipple sensation or worse that a graft would become necrotic (death of body tissue) and I'd be short a nipple or two. Fortunately, I knew a large number of guys who had been to Dr. Peters and none of them lost a nipple. While that's no guarantee, it did make me feel better. My partner reported nipple sensation starting to return several months after surgery. I embraced the possibility of sensitivity and reconciled myself to the fact that I was running a risk. One of the most sensitive sexual organs is the brain -- arousal is largely controlled by the mind. Touch and visualization would help with the process of resensitization. It would be different than before surgery, but not necessarily worse. I could help my body relearn what would work, just as I did after the use of testosterone changed my genital configuration and masturbatory technique. It would be a matter of patience and practice.
Being very independent, I didn't welcome the vulnerability that would occur after surgery when I would depend on others for simple things such as getting out of bed. My partner had cleared his schedule and would be there with me during the recovery period. He had cared for other folks after their surgeries. The bottom line was that I trust and trusted him with my life. I knew that he wouldn't do anything that would increase the feelings of helplessness. I also knew that if I wanted to minimize scarring that I'd have to refrain from using my hands as much as possible. I practiced a number of things without my hands, such as getting up from a seated position, getting out of bed, reaching for things without letting my elbows move away from my body. I started to pay attention to my body mechanics and also began to eat more. I put on 10 pounds from stress between the time of my consultation in May and my surgery in December of 1998.
To be continued . . . . [follow this link to read the conclusion]
© Copyright Jan/Feb 1999 Michael M. Hernandez All Rights Reserved