The Nitty Gritty on the Itty-Bitty No-Titty Committee

Just a quick note: my girlfriend is going to cringe because the word "titty" is in the tittle, er, title.  I have tried to help her understand that to southerners, titty's just part of the talk and that there were even these padded flip-flops that were around back in the 90's called "Tiddies."  Yeah, they may not necessarily be invoking anything to do with titties, but still, it sounds the same.

So any way, I thought I'd share a bit about the surgery most commonly referred to as "top surgery" so folks could understand that if someone decides to do this, he really cannot live in his body as-is any more.  It's no stunt for attention or because someone has only weird superficial body issues.  It's called an "elective" surgery because one could choose to simply live with a binder on forever and still pass as male.  Yeah, ladies, how much do you enjoy wearing the breath-stealing Spanx on occasion?  I know men who can't even think about wearing briefs because of the level of crammage they would feel.  So who on earth wants to wear a crushing, uncomfortable, and non-breathing hot undergarment all his life rather than fix his body?  I am done with the binder; I'd like to some day go swimming like a normal guy, enjoy the sunshine with my shirt off, and not have to spend 90+ degree days roaming about with this stinky, hot undergarment on.  Think mega-corset for a man's chest...  Yeah, no.

This surgery is beyond "tattoo permanent."  Tattoos can be altered and mostly removed, though both can be a pain in the ass.  They are "permanent" but not really.  They can definitely indicate someone's willingness to dive into something that has lasting consequences without thinking long-term, but not the way a chest reconstruction surgery does.  A surgeon is going to become a sculptor and a human body is the marble.  Going back is really not an option, so for someone to do this means he really needs his body to get in line with his mind and spirit as a man.

I chose the man who is arguably considered the very best surgeon for this particular procedure, Dr. Charles Garramone  He is located in Sunrise, Florida, which is a spit away from Ft. Lauderdale.  He basically has this surgery down to a science; everything is efficient and he knows it like no other.  Leading up to the surgery with him, I had to have a phone consult with him so he could decide if I was mentally and physically fit enough for the surgery.  Once he decides he will take someone on as a patient, there are numerous other steps to take.  I had to set an appointment (which was difficult to do because he is BOOKED - a cancellation saved me), arrange travel, and set up the payments because you have to pay in advance.  I also had to make sure I got the mammogram inside a 30-day window prior to the surgery and have a final physical assessment, including an EKG and blood work, done by my doctor around the same time frame.  Just taking care of pre-op stuff is quite a bit of coordination and management.

The day before surgery, I met with him so he could do measurements and examine my body.  He and his whole staff are extremely kind to transgender patients.  The day of the surgery, I went to a day surgery center not far from his office.  The staff there has worked with Dr. Garramone for a good while, and they have their end of the drill down pat as well.  Everyone there was incredibly nice and attentive to all of us guys (there were three of us there getting work done back-to-back-to-back).  The pre-op stuff is pretty standard: put on the hot gown, speak to the doctor so he can mark your body, speak to the anesthesiologist, meet the OR nurse, and get the IV needle set up.  He was behind that day, so I was dozing on and off while waiting.  The nurse who set me up was really cool and we chatted a bit while she prepped me.  I was just ready to get the show on the road!

They let my lovely lady come back and hang out with me until I was taken back.  They injected some happy meds into my IV to sedate me before going back, and the last thing I remember saying to my lady was, "They're gonna leave you by the roadside; you have to be this tall to ride this ride."  I was not even conscious upon entering the room!  I love it!

The next thing I know, I was awakened briefly and I think my lady mentioned my nausea, because I think they said something about giving me meds for that.  Later I awoke again, and I felt pretty good actually.  I had to do the whole wobble to the bathroom, prove I can pee thing, then we were out the door.  The only thing that bothered me immediately was the scratchy throat from the breathing tube and the gross-tasting stuff I coughed up (anesthesia takes like metal).  Otherwise, I was in good shape as a whole.

Now for what most people really want to know: what does the surgeon do exactly?  Basically, he cuts off the breast part as a whole.  All the breast tissue is removed this way.  He cuts the areola and nipple down to an appropriate size (a nickel and a pencil eraser, respectively) so it can be reattached, or grafted, to the chest in an anatomically correct spot on the pectoral muscle.  The incisions go the entire width of the pectoral muscles.  He sews up everything in a way that will minimize scarring, then they wrap you up so tightly for a week.  Right now, my chest feels like it's in a vise.  This keeps the incisions from being torn open and helps keep the drains in.

Tubes are inserted a little ways under the armpits, kind of to the side of the pecs, so that the fluids in the chest can drain.  My lady has the lovely job of emptying the drains every few hours.  This is not for the faint of heart, believe me.  Having to endure the crazy tight wrapping, itchy tape, and looking at the tasty tubes and drains is the chore now.  When I go in Monday, he will be taking off all the wrapping and gauze, and removing the drains.  The tape over the main incisions stays on another week then I can start applying Scarguard to try to help the scarring remain minimal.  Amazingly, though, Dr. Garramone's work looks pretty damn good from the outset.  He truly is an impressive plastic surgeon.

This is the Cliff's Notes version of this odyssey just to keep everyone up to speed.  I've been lucky to have very little real pain, just a lot of itchiness because of the tape being so tight.  My woman has proven what a gem she is by scratching some of the irritated areas, applying Benadryl spray, emptying the drains (and recording how much on the log - you have to do that!), monitoring when I need which pill, making sure I have food and drink, and helping bathe me and wash my hair yesterday (thank God, because I was feeling disgusting).  Baby wipes and crackers have been my key companions throughout, and comfortable sleep is only managed for about four hours at a time following a Vicodin each time.  I have to be very careful getting into the bed and how I lay because of the drains and all.

Soooooo....  just understand that people who undergo this procedure are for real.  This is not something I'd ever really want to do for fun.  It's not I was like, "Hey, what can I do that is really cool and different!  I know!  I'll get my breasticles hacked off!  I really need these fatty chest tumors gone, so let's scrape up $6K of my own money for surgery, pay another $1,500 for car and hotel, and show everyone how unique I really am...."  Um, no.  It's nothing any trans guy wishes he had to do, but we are certainly grateful it's a viable option now.  I'm not someone who believes in unnecessary body alteration, trust me.  I don't get all these famous people and their lip plumping, eye lifting, nose destroying, and so forth.  I do not enjoy going under the knife and all the risks it involves.  But I do need to be able to live the rest of my life as my whole self, and there was no other alternative as I saw it.

Additionally, to anyone who has ever HAD to have a mastectomy or any type of alteration in the chest area for any reason, props to you.  This is no cake walk.  My only hope is that I heal really well, can get on track with my fitness, and try to make the most of the body I now have.  I can't exercise for another 5 weeks at least, so I am going to hit it hard when I can.  And remember, knowing your body, mind, and soul all match your gender is a blessing.  Be happy with that, and don't be too hard on your perceived physical imperfections.  If you're healthy and happy and can live your life the way you want, run with it.  Don't waste time beating yourself up over the little things.  Most improvements can be easily made: better diet, more exercise, a good hair colorist, etc.  :)  Spend more time being grateful for health and less worrying about a new wrinkle or some gray hairs.  Trust me, I don't worry at all about those things.  If there is any belief that this surgery is a vanity thing, just come see all my grays and you'll know I'm not about the vain stuff.  It's just a comfort thing, and now I'm feeling comfortable in my own skin.  Well, I will when I don't have to itch any more.  :)

Thanks again to everyone who has chosen to come along on my journey.  I appreciate the fact that you have chosen to gain more empathy for trans people through knowing me and actively taking in the information I share.  That's always the goal: to bridge gaps, eliminate misunderstandings, and shine a light in the dark.  Be well, friends.  More to come...