Almost a year Post Op…

January 31, 2011

It’s been about 11 months since my surgery. I am amazed at how much better it looks now. It’s better, but I am not “totally happy.” I think my nips got pretty messed up in the grafting process (it happens). And the seromas caused fluid to become more tissue like and become more permanent. I had them drained a few times, but clearly should have had the seromas drained more often. (No one told me at the time but it seems obvious to me now)

I am considering a revision. I thought Dr. Fischer and her staff were very nice, but part of me wishes I had just done double incision with Brownstein (my B cup size was too big for Brownstein to do a keyhole and so I chose Fischer because she agreed to do it). Hard to say though whether the Brownstein experience would have been satisfying either. Being closer to home made a big difference to me, and it would have been nearly impossible to get my seromas drained at all if I had not been close enough to do the 4 hour drive back to Maryland every couple weeks.

At some point I decided to just stop expecting my chest to start looking a lot better and move on with my life even if my chest is not perfect.

The revision with Fischer would be another $3450 which seems like a lot to me right now.

My chest is totally passable under  a t shirt, but if you look closely at my chest (through a T-shirt) you can see the puffiness under my pec muscle. If I loose weight and work out more I am sure this would improve.

Thanks to everyone in the FTM community for their comments and posts. I hope my images help others make good decisions.

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The trans attraction to sameness as a form of inspiration and aspiration

March 20, 2010

This note is in reply to Bleedingembryo’s YouTube Post:   Great News! Also, What Do You Wanna Know?

http://www.youtube.com/user/bleedingembryo#p/a/u/0/Bp8i8NQFtU0

Hi Kaleb-

So I gotta question for you…

I just had top surgery 5 weeks ago. I am aware that a component of my FTM transition is my own raised consciousness of the male anatomy. As I heal, and I look at my own chest, and compare it to other guys for muscle tone, nipple placement, contour, etc, I have actually becoming quite infatuated with the male chest (and the male form), I find myself staring at photos of topless Abercrombie & Fitch models, studying the nuances of a guys pecs, shoulders, biceps, and ab muscles, etc. I think this is mainly because I so want to look male and I am gathering visual information as queues to my own aspirational goals. But I also think that as part of my transition, I am becoming more interested in guys. Where as before, as part of the queer community I found that my “attraction orientation” was towards being with women, now I am shifting a bit, I am realizing a new kind of awareness of my own attraction for guys. It’s probably always been there, but in my own brave new world, it’s like all my systems are being re-calibrated and I am open to seeing and feeling with out constraints.

This fascination with “what defines what a boys looks like” is not totally new to me, from an early age (8-9 yrs old), I was passing as a boy with short hair, boys clothes, and putting a sock in my underwear so I could have that bulge. So being of boy energy as a youngster, I of course looked to the idealized male form by carefully observing other kids who I admired, movie stars, athetes, etc, for information on how to dress, stand, talk, gesture, who to date, how to treat a woman, etc.

Now that I have had my top surgery, it’s like I am returning to this great place of my youth, before I became so aware of how much my family and larger society couldn’t accept my true gender identity, and I am tapping into an energy and a joyful freedom that I learned to hide (for basic survival).

My question is, have you, or other transguys you know, had a similar experience? Do you think this attraction to sameness is something many transguys feel? Does this looking and appreciating the male form make us more open to feeling gay/liking bioguys & transguys? I have no problem with what kind of person I am attracted to on the gender spectrum, but I think the discussion of where we draw our attraction and appreciation and infatuation from is very interesting.

I also really appreciated your vlog (16 Days Post-Op & Other Fun Things) where you mentioned Brokeback Mountain and sexism. I wonder how the dynamics present in that film (and in the book by Annie Proulx) plays into this whole attraction phenomenon as well.

I’d love to know your thoughts.

Thanks.

~ jasper

Envision a world with out a gender binary (FTX)

March 19, 2010

I hope and wish that the world will soon evolve to a place where there is less and less need to define gender as a binary. No more commanding our children to subscribe to be either /or, this/that. Where a person as the freedom to choose their clothes with out pressure to conform to any specific gender.

Imagine a level of acceptance that transcends definition, and allows people to be appreciated for who they are, in context of a more fluid space of existence. Where gender neutral pronouns are accepted as familiar, normal, and with out prejudice. Where not knowing a person’s gender is not grounds for a reaction of insecurity, apology, or violence.

How long will it take until we will live in a world that allows for the wonderful and wide spectrum of gender expression? 5 years? 10 years? 30 years? If we keep working hard as activists, and educators, it can happen sooner.

Should I be taking the time and the rist to explain “it” to my brother’s kids, to my employers, to my parents and grandparents?

It would be nice if the general population appreciated that there was a gender continuum, but at the same time I don’t want to feel obligated to define myself at some location on said gender continuum.
Can’t we exist on all keys of the zylophone, and move around on it as we feel inclined? That is how music is made. That is how empathy is created. We try on different perspectives, it is part of how we evolve into more humane people. An enlightened, evolved human being understand others as they allow themselves to feel a wide range of emotion, a wide range of perception, see through the many colored lenses.  Looking at life from above, and below, from the dominant and the submissive, from the perspective of privilege and the the perspective of needing means we are truly multi-spirited, we are closer to becoming one with all that is.

So, here is my challenge to myself: I would like to always allow myself and others to be as fluid with their gender as they would like to be. To be free to move around with their gender day to day, week to week, year to year. To do this I imagine I/we all have to become more aware and conscious of the ways in which I/we judge people especially at first glace.

Imagine a gender ambiguous person such as myself, going into a bathroom with out stress of being condemned or attacked. Where security isn’t being called and a guard is not knocking on the stall. Where women noticing (me), are not clutching their children tightly and exiting quickly. Where there are no angry silent glares.  Or even when people don’t walk out to make sure they are reading the sign on the door correctly.

Where it’s all good…

Callen Lorde – An Excellent Health Center for Gender Queer People in NYC

March 19, 2010

I went to Callen-Lorde Community Health Center for the first time yesterday.  As an FTM I have found that most doctors struggle to understand my gender identity. Although I find most doctors well intended,  I have experienced several doctors displaying a high level of general ignorance to gender queer issues. Those doctors who are not downright hostile, seem more curious to examine me as an oddity than interested in really hearing me and helping me out.

So going to Callen-Lorde was amazing – in a good way!

I was NOT treated with the usual form with check box questions of: male or female. They totally acknowledge “gender queer” people and were very respectful about it. I found the whole experience quite pleasant actually despite being nervous about having to pay for it with out any insurance. (The fee was more than reasonable.)

This Health Center exists really to help underserved populations. For that reason if you have some form of decent health insurance they probably won’t take you. They are really there to serve those who have no health insurance.

My Doctor was Irina Linetskya, MD. She was excellent.  She was unusually kind and friendly to me, unlike most doctors who seem mildly angry at my existence. She was smart, respectful, and well informed. I highly recommend her and all the health care professionals I was lucky to meet at Callen-Lorde.

http://www.callen-lorde.org

Here is the info from their website:

Callen-Lorde Community Health Center is New York City’s only primary health care center dedicated to meeting the health needs of the lesbian, gay, bisexual and transgender communities and people living with HIV/AIDS,
regardless of any patient’s ability to pay.
We are welcoming to all, regardless of sexual orientation or insurance coverage.

4 weeks Post Op – Top Surgery FTM

March 19, 2010

Okay so now that my seroma has been drained (which was indeed painless) things are looking better. I feel like it’s taking forever to heal, but apparently it’s actually all looking good according to my surgeon, Dr. Fischer (Timonium, MD).

Scroll down for photos from Week 4 Post Op– Note photos are graphic in nature and not appropriate for viewing in public spaces. Might be gross and make you queasy… View at your own risk.

The soreness under my arms is getting better…. slowly. The swelling has gone down a LOT. Thank goodness. My chest is starting to look a bit more like a guys chest now, which is a HUGE relief. I was worried it was just going to look like a freaky flat chested girl, with saggy flat boob skin.

I started to work out a bit (mainly elliptical machine to get some cardio which is probably good for my circulation), but I couldn’t resists stretching my arms a little bit which I really should NOT have done! I stretched my arms too much and caused a little tear in the scab (it doesn’t hurt because it’s numb so I didn’t even notice until a couple hours later when showering), now I am concerned I created a little hole at the edge of the nipple, where the scab and the areola meet. It’s not good. I used a butterfly bandage to pull that seam together, hoping it will heal up and not open up into a major problem. Yikes.

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24 days post op

24 days post op - Free Nipple Grafts

24 days post op

24 days post op

24 days post op

24 days post op

Photos of Top Surgery at Two Weeks

March 19, 2010

The healing is coming along slowly but surely..

Scroll down for photos. Note the photos are pretty graphic, and may not be suitable for viewing in public spaces.

My biggest issue is the binder (compression vest) does not fit well. I am told I have to wear this for at least 3 weeks, and maybe up to 6 weeks. Ugh…

I am 6ft tall and the nurse intentionally fit me with a size SMALL, so that it would be nice and snug and compress my chest well post surgery, keeping my nipple grafts under pressure is important so they heal properly.

I don’t mind it being tight around my chest, but the arm holes are not big enough to accommodate my shoulders. It’s cutting into my skin under my arms. So my underarm area is quite sore and feeling bruised. This bruising could be partially from surgery, but the vest is really making it worse. Lymph nodes are super sensitive and inflamed (feel like they are popping out). I am told that is normal for several weeks, as the lymph nodes are doing their job and working to fight infection.

I cut the arm holes a bit to lessen the ache. I also bought a roll of “absorbent” cotton from the pharmacy, which I use as padding in that area. It’s really soft and helps a lot. I recommend using this in any sore areas you might have relating to the compression vest/binder.

I currently have a “seroma” on my right side, which is where serum (not blood but a clear fluid) that is building up under my right pec. Note the saggy area. I am going to have this aspirated tomorrow. When they aspirate it, the Dr sticks a fine needle  into the area with the fluid and draws out the fluid into a syringe to drain it. Apparently it doesn’t actually hurt much… which is probably because my chest is still pretty numb at this point.

The sensation in my chest is pretty absent all around my pectoral muscle area. The numbness extends in about a 7 inch radius around (and including) my areola and nipples.

Nipples look pretty scary with all that black scabbing, but that is normal. The scabbing will slowly dissipate and reveal fresh pink skin underneath… if all goes according to plan. I have been warned NOT TO PICK… so I am not picking it AT ALL… actually I have no desire to pick. I just put some antibiotic ointment on them and put non-stick gauze like pads on them and then the cotton padding, and the compression vest/binder.

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The Seroma - Yucky

FTM Top Surgery

February 22, 2010

This blog is about my experience with Dr. Beverly Fischer who is located in Baltimore, MD.

Scroll down for Photos – Note photos are graphic and are probably not appropriate for viewing in public or at work. …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

I had a really excellent experience with Dr. Fischer. I recommend her highly.

My top surgery, a peri-areolar (“key-hole”) double subcutaneous mastectomy, was originally booked for Wed Feb 10th, but due to a massive blizzard which dropped 48 inches of snow on Baltimore over 4 days, it was postponed eight days.

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Those extra eight days gave me more time to reflect on it the procedure in detail, and as a result I was definitely a bit more nervous before the surgery than I would have been the week before, but in other ways I was more prepared. I had done a substantial amount of work coming to peace with what I was doing to my body and why. All in all, I believe the extra time was for the best, I was able to let a couple more friends know what I was doing, and as a result they reached out via text messages and emails to check in on me, which was very sweet. (Thanks friends)

I didn’t tell my parents which is a topic I may touch on at another time. I did tell my brother but he hasn’t called to check in on me yet, not sure how “okay” he is with it, but I think he’s doing his best to be supportive.

The night before the surgery after my wife was asleep next to me, I sat and thought about a lot of things, I knew I had found my peace with the fact that I could die from some kind of unforeseen complication. I also knew the odds were very, VERY low of that happening, but I had to at least acknowledge that I was aware of that, and if I died, I would be at peace knowing I lived a good life. I did the best I could, and that I have loved and lived bravely. I was a little bit afraid of the major changes in my life that were about to happen, but I also knew it’d been many years that I have been preparing for this, and now the day had come. I was good to go. I had made my decision, and I was happy with it. I was also incredibly grateful for the support of my wife, who really made this surgery possible. She has been so incredibly supportive, understanding, and kind. I feel like one of the most fortunate people on earth to have the privilege of having this surgery which stems from the privilege of having the financial situation and emotional support, and trans community support around me to make it all possible. There is no way I could have been able to do this 20 years ago. So I owe a great debt of gratitude to all the trans people who have come before me and “paved the way” so to speak for an easier experience for those of us pursuing this surgery today. I hope that this blog can be informative and helpful to those pursuing this surgery in the future.

I had chose Dr. Beverly Fischer in Baltimore, MD for many reasons that I am going to explain. I knew that there could be a huge spectrum of outcomes based on what I had seen on various websites. I have also had 4 close friends go through top surgery (two friends chose Dr. Brownstein in SF, CA, one went with Dr. Brassard in Montreal, and another decided on Dr. Fischer in Balitmore, MD).  Many trans guys show their results in photos and videos on various websites like http://www.Transbucket.com, but not many show the before pictures, which has a lot to do with one’s outcome, so it’s been hard to know what results I might get given my B cup breasts. But I had confidence in Dr. Fischer. She consistently had the best aesthetic results of any doctor I had seen using the keyhole method which leaves the least amount of scaring. I was a full B cup, which was really borderline for the keyhole process but Dr. Fischer though I was young enough and my skin was elastic enough to handle it well.  When I met Dr. Fischer two months earlier (Dec 10th, 2009), I was pretty skeptical, and I was worried that I wouldn’t like her based on very superficial unfounded reasons… Her website is very female oriented. She does all kinds of cosmetic/plastic surgeries not just FTM stuff.

There are two nurses, Bettye and Shannon, at Dr. Fischer’s office who handle all the FTM patients. After about 15 minutes of waiting Shannon walked me to the exam room. I passed Dr. Fischer in the hall where she was talking to a patient,she was just saying good-bye and making some last remarks about a follow up appointment as the couple was leaving. I am 6ft tall, and Dr. Fischer seemed pretty tall too, close to my height, but she was wearing heeled.

The exam room was much more clinical than the waiting room. It was a typical doctor’s exam room with white cabinets, white walls, a sink, and an exam table with tissue paper on it. There were several photos of Dr. Fischer with various large dogs which was a nice touch, clearly she is an animal and nature lover. I don’t know why but that put me in a better mood.

When I actually met Dr. Fischer I was so pleasantly surprised. She was able to connect with me, look me in the eye, speak to me respectfully, and understand my goals and desires. She didn’t talk down to me at all, but she took care to explain the surgical procedures in detail and what was possible. I was left with the distinct impression that she was very smart, capable, and well trained.  I learned that she did her training at John Hopkins, and she regularly attended surgical conferences and perhaps more importantly she spoke and published on the subject of FTM surgery. I am sure this has a lot to do with her consistently great chest surgery outcomes. I really liked her disposition, and her friendliness didn’t feel fake. Her nursing staff were nicer in person (than on the phone) and clearly they had worked hard to get the pronouns right and had tried understand the FTM community more than most doctors I have met.

By the way, about two years before (Jan 2008), I  had a consult with Dr. Brownstein in San Francisco, CA. His offices were kind of strange, located in an loft apartment building in the Southern Potrero Hill area. He had no real exam room, just some divider screens to separate part of the room so he could use the space for exams. It felt rather odd to be disrobing in a space where I could still make eye contact with his nurses (over the 5ft screens) and he just sat there and didn’t leave the space and re-enter once I disrobed, as most doctors do when you have an exam. As soon as I took my shirt off, while he was still seated, he said, “Oh. Put your shirt back on.  You are not a candidate for keyhole.” and he went on to tell me I could only have the double incision procedure. At the time I really didn’t know of any other surgeons who did this surgery so I assumed he was my only option. Gradually I learned more about other surgeons around the world.  After analyzing as many of Brownstein’s results as I could find, both my friends, as well as on the web, I felt like he always put the nipples up rather high on the pectoral muscle, and that looked strange to me. I asked him about this, and he shrugged like he knew that but didn’t really care to discuss it.

At the time that I met with Dr. Brownstein, I was living in San Francisco, and he was local, and he had done what seemed like thousands of FTM chest surgeries so he had a lot of experience and knew what to expect, and hopefully how to get great results. The more I thought about this though, and reflected on my consult with him and all the information I had, I decided to keep looking at other options.

A friend of mine, Matt, who also lived in SF, told me that he went to a surgeon in Baltimore, MD, and was REALLY thrilled with his results. And that this doctor was able to get great results with the peri-areolar approach on people who Brownstein turned away saying they were way too large breasted for that procedure. So my ears perked up… I thought “Hmmmm… well, I should look into that.”

My life took a few big turns, I ended up moving to New York, and it took me a couple more years to really follow up on my intentions to have this surgery.

Now that I am living in NY, as opposed to SF, getting to Dr. Fischer wasn’t too far, I could just drive the 3 hours south and have that consultation and drive home all in one day.

So that is what I did. I came home from my consutation feeling really optimistic, I was positive that I would move forward with the surgery with Dr. Fischer. Nurse Shannon had given me a bunch of dates in January and February. My wife was supportive. So now it was just a matter of scheduling it around work and obligations and creating the right support system around me. (BTW the consult with Dr. Fischer was $100. The consult with Dr. Brownstein was free.)

My surgery was originally scheduled with Dr. Fischer for Feb 10th. But as it so happened there was a major blizzard that paralyzed the city under more than 3ft of snow, on the date of my scheduled surgery so we had to push out the date to Feb 18th.

Thursday Feb 18th 2010 Surgery Day!

My surgery was scheduled for 11AM, but I had to be at the office by 10AM. My wife and I had driven down the night before and stayed in a hotel so there was no risk of getting caught in traffic.

Dr. Fischer met with me in an exam room about an hour before the surgery. We talked about the options I had for nipple grafts or to leave the pedicle and glands behind it intact, and I chose to move forward with the grafts (which is not required when doing keyhole) because they could give me the best results in terms of a flat chest because she could take more skin around the areola (good for my larger breasts), the nipples would lay more flat as grafts, and because she would be able to take more breast tissue and glandular tissue from behind the graft which is even better for reducing breast cancer odds. All good. The down side to nipple grafts (which is where she totally removes the nipple and cuts it down to a thin layer of skin, and then reattaches it) is that you are highly likely to lose sensation permanently. Your nip may still contract when cold, but it may never have true erotic sensation again. I was okay with that.

Then Dr. Fischer marked up my chest with a green sharpie with all kinds of dotted vertical and horizontal reference lines. These were not cut lines, but rather guidelines to know where she was on the geography my chest even when the dressings were covering the majority of my chest. I think of them as lines of latitude.

Nurse Bettye fitted me with a binder for post-op use and she explained a lot of the necessary post-op care and do’s and don’ts. Bettye also photographed my chest for the “before” images. There was a photo album of before and after shots from both bilateral incision method as well as the keyhole (peri-areolar) method that one could look through. Frankly, there were much better results for Dr. Fischer’s surgery on http://www.Transbucket.com. Also in the photo album were a few thank you notes and testimonials from Dr. Fischer’s patients.

Robin the anesthetist came in to the exam room talk to me about the anesthesia. She was really cool, which was good because I was more nervous about the anesthesia than the surgery itself. I knew that I was prone to feeling nauseous that that is one of the known side effects of anesthesia. I also had heard horror stories of people waking up on the table, or dying from anesthesia. She had me take my anti nauseous pill (which is cherry flavored) by dissolving it on my tongue. (You get a Rx for this  and other prescriptions weeks earlier in the packet that Dr. Fischer sends you in the mail).  Robin said, she’d take good care of me and I asked her all kinds of questions. She said she be right next to me through the whole thing making sure I was fine. By the time I was done talking to her I felt like I trusted her and I would be fine.

Next they walked me across the hall to the operating room and had me lay down on the table. Robin put the IV in my arm, and she told me I should feel the calming effects of the IV meds right away, and I talked to her for a little while and then I was out.

When I woke up I was groggy, and could hardly open my eyes. My chest was sore, but not really bad, but it was that feeling of something major had happened to my chest, tight and numb are the best adjectives. I was packed up with lots of bandages and rapt up snug in the vest binder. My chest felt achy, but when I touched my chest it was not flat, it was big with all the gauze packing so it felt like I still had a woman’s chest, and I was like what? Why is my chest so big? I remember asking at that point, “Did it go okay?” And they said yes it went very well. As I felt around with my hands it just felt like a lot of bandages, it was a strange sensation. “I also remember saying, am I supposed to be more awake than this?” I was so groggy, I could hardly open my eyes. I learned later that I asked the same questions over and over, and they kept saying, yes, it all went fine.

I was told that I had more breast tissue on my left side so she had to take more time to get it all (2hrs 15 min as opposed to the usual 1 hour and a half). She said she went all the way up to my Clavicle (collar bone) and down to my Rectus (abdominal muscles) then out to my Lats, and in to the Sternum which ends up being a lot of area on my 6ft tall frame.

My wife, was so sweet, she was such a comfort and she answered all my questions over and over, she helped me get my clothes on, which I don’t even remember doing. Apparently she had some trouble with my boots. So I advise folks to wear shoes that are easy to slip on. Not boots.

Once I was home at the hotel and lying in bed, I took another anti- nausea pill and a pain pill. The pain pills, Lortab (aka Vicodin), they gave made me feel really sleepy at times, like I was nodding off even when I was walking or eating, and then at other times I felt fine and awake. Strange. I was told the pain pills and anesthesia make you constipated so I also took some Ducolax and drank tons of water to help get the anesthesia out of my system.

Dr. Fischer had prescribed sleeping pills but I didn’t take them, because I didn’t need them to sleep through the night. The pain pills were enough to keep me comfortable, and despite being propped up on about 4 pillows (45 degree angle is what we were advised), I slept fine. I was glad we brought our own soft feather pillows (with soft pillowcases) with us as they were nicer than the hotel’s.

We stayed at the Residence Inn by Marriot in Hunts Valley. Really close to Dr. Fischer’s surgery center (10 min drive), and having a little kitchen and extra TV room was such a nice luxurious convenience. I am so glad we chose that particular hotel as it was perfect for our needs. I requested a handicapped accessible room which was ideal because they had the hose shower thing so I could wash my lower half and not get my binder & bandages wet. The room was $139 a night. The place was brand new as of Jan 2010, so really clean. We stayed 3 nights but we could have cut it down to just 2 nights, but we decided to stay another day just to rest up since the next day was Saturday. They have free breakfast and a work out center with pool. The staff was nice. We ate at the nearby mall both nights, which had a California Pizza Kitchen and other chain restaurants. The day after the surgery we went to a movie at the mall and walked around a bit. The mall is not really an indoor space, so the majority of the walking was outside (FYI). It was cold out.

Friday Feb 19th

Friday was kind of a lost day. I slept a lot, watched tv, and only ate enough to take the pain meds and not get an upset stomach (soup and crackers), until dinner when we went to the mall I ate some salad and pizza again and went to a movie. I took my last pain pill Friday night at 6pm and then didn’t feel like I needed them after that.

Saturday Feb 20th

We got on the road by 10AM and drove back to NY. Uneventful. My wife had to make two trips to carry all the bags in from the car which made me feel bad, but she acted like it was nothing.  (thank you, love you)

Sunday Feb 21, 2010

I had my top surgery on Thursday, just 3 days ago. I am feeling good. I just sneaked a peek at my chest and I am really excited to have this new form. I have been looking at a lot of FTM chest’s online and I was starting to get a little freaked out that there were so many FTMs with really mangled looking chests. When I looked in the mirror just now, with my binder off and the bandages removed on one side, I realized that everything is going to be just fine. Even if I have a little bit of saggy skin for a little while, I can totally be at peace with that. Mainly I can’t wait to wear a T shirt. Work out, build some chest muscle and just feel like the person I am on the inside is showing through to the outside.  Yay!

I am also so relieved to have just reduced my breast cancer risk so profoundly.

Pre-Op chest: B Cup means I barely qualify for "Keyhole" procedure.

5 days post op

Close up of Free Nipple Graft, steri-strips still stuck on there (not allowed to remove for 2 weeks)

5 days post opp - Free Nipple Graft Close Up