1 Week Post-Op: A Photo Gallery [Warning: includes graphic content]

It’s officially 7 days after my top surgery with Dr. Garramone. I underwent a bilateral mastectomy with free nipple grafts. I will have to look back on the surgery related spending and give you a full sectionalized total when I am back from my trip. That will give you a good idea of what it will cost for you if the decision lands on Dr. Garramone as well.

Here are the photos, fresh off the press, of my chest as of this morning.

Chest: Front

Chest: Side

Irritation from drainage tube: Left Side

Left Nipple: Minor irritation

Chest: Center; connected scars to prevent puckering

Right Nipple

Right Nipple: Close-up

Chest: Left angle

Right Side: Under my arm

Nipple Pasties!

My Top Surgery 5/5: Post-Op Appointment

I was able to get my wrappings removed a day early, as I went in with Zeke for his post-op appointment. I can finally state that I am DONE with my transition from female to male. Finished. Completed. Conquered. Or whatever successful term comes to mind.

Dr. Garramone unwrapped my chest, removed the stitched bandages on my nipples, pulled out the drainage tubes and bandaged me back up: minus the ace bandaging. My adhesive stuck pretty well this last week, and that was a bit painful to remove, probably due to a few of my chest hairs coming back already. He pointed out that he did have to connect my chest scars together, as there was just going to be too much extra skin that could pucker out and look very unnatural later in my healing process.

There is medical tape / bandaging over the horizontal scars which should remain on for about a week. They should start falling off by themselves and if they aren’t by next week I am instructed to remove them gently at that time. The sutures themselves will dissolve or be pushed out over the next several weeks of healing.

Then my drainage tubes needed to come out. He laid my chair back and had me breath in deeply and then exhale hard with my head pointed the opposite direction for each tube. The left one came out without any feeling, but the right one burned and itched quite a bit right away. It burned for several minutes, but feels much better now about an hour later. The instructions for care of these small holes is that I need to keep them covered with a band-aid and neosporin, changed daily. They should close up just fine in the next couple of days.

There were lovely yellow Xeroform Petrolatum dressings sewn on to each nipple and so he had to remove those stitches and bandages one at a time. My instructions for nipple care are pretty precise. I can’t let any shower head water hit them directly for several weeks while they heal. I have more Xeroform bandages, which I will cut a little square off of each day and apply with some neosporin to each nipple. I will then put a large band-aid over each nipple and make sure that it stays clean. The skin will start to peel off of my nipples in the next week and will likely even continue to do so for a couple of weeks. This is the dead skin flaking off with the growth of new cells underneath. Basically the nipples are going to look pretty gnarly for some time. After my Xeroform runs out, I should still neosporin and bandage my nipples daily. Hot.

Movement and exertion should be kept minimal for the next 6 weeks after the date of my surgery. I should not swim, exercise or fornicate until that time to prevent tearing or stretching of my scars. I should try not to extend my arms too far or lift much more than 5-10 lbs for 5 more weeks. So this puts me out of the running until August 26th, 2010. I’ll have to be good until then.

I’ll post the post-op appointment video, as soon as it’s up.

Update: It’s UP.

My Top Surgery 4/5: Post-op Care / Experience

Post op care is the most important aspect of this entire process. It is vital that your incisions are kept free from infection, that you take it easy and that you follow all the instructions provided by your doctor. They know what they are doing and take your money in exchange for that care and advice. Post-op care instructions likely don’t change much between doctors, but here are mine.

Those are some lengthy instructions, but in essence I have ace wrapped bandaging around my chest with adhesive gauze bandaging underneath. I haven’t seen my chest yet due to this packaging. I have a tube off to each side of my chest and they end in a 100 CC sized bulb that is compressed. I empty it of fluid a few times a day and it’s slowly become more and more pinkish / clear. There are some “chunkies” in the tube that haven’t affected drainage, but we have tried to slide fingers down the tubes without much success. They are pinned to the the ace bandaging and so hang pretty easily to either side. Here are some shots of that system:

Chest shots and Tube System Shots

It is pretty awkward while laying around / sleeping… but it’s not terrible. I have a hot beer belly, now.

Up close and personal.

The little lid releases the vacuum when it’s popped off.

Then you empty it out, dump it in the toilet and compress the bulb to re-plug the vacuum. And that’s about it.

Post-op Appointment.

My Top Surgery 3/5: Chopchop!

The day of surgery was both very relaxing and very stressful. My surgery was scheduled for 9.30am on July 15. I was to be there at 8am. I woke up early, having slept fitfully throughout the night, but wasn’t able to eat breakfast or drink any fluids before the procedure. It was a good thing it was so early because I am not the type of guy to enjoy missing a meal.

We showed up on time. I wore some classy blue gym shorts with a blue plaid button up shirt. I opted not to wear a binder shirt since I wouldn’t want to be hauling it around with me afterward. I just hunched forward a bit to hide the monsters for their last outing.

There was more paperwork at the surgery center, of course. I had to take a pee-test because if there is any possibility for pregnancy they have to verify. So I passed that one. Then I sat on the bed with an IV in my hand wearing nothing but a robe, my boxer briefs and socks for what felt like an eternity in the pre-op room.

I was very concerned about my tongue ring. It had to be removed for the surgery because tubes were going in my throat to keep everything working while I was under general anesthesia. The nurse was very nice about it and let me hang it from a little baggy on my IV rack, rather than tucked under my bed in my personal belongings bag. While waiting, I was so nervous that I sneakily put it back in my mouth until right before they took me in for my operation.

I spoke with the anesthesiologist who explained everything to me as well as Dr. Garramone who came in and drew all the necessary lines on my chest for surgery. He reiterated what he would be removing and where my nipples would be and what size. He asked how I was feeling and I told him that I was very ready for the events of the day.

Then another nurse for the anesthesiologist came in to give me a Margarita! By that I mean a cousin to the Valium family. Just before that, I made sure that I went to the bathroom and that my tongue ring was secure on his little hook. They injected it through my IV and I can honestly tell you I don’t remember much as soon as they started wheeling me to the OR. I don’t even remember getting in to the OR so that was some pretty powerful stuff.

Then I woke up. I was a bit confused so I just laid there quietly for a minute and took everything in. I had throbbing pain, the room looked different and I was under a few layers of very warm blankets. I figured that I was done with surgery very quickly. The nurse came over and was surprised, I think, that I was just calmly laying there. She told me I had done really well, hadn’t woken or had any problems during surgery with anesthesia and got me some ginger ale and crackers upon request.

Amilya came in shortly thereafter and helped me get clothed and sitting in a chair rather than on the bed. I was very very cold, as I remember, but we kept that heated blanket nearby. After consuming my crackers [non-salted saltines] and a couple cups of ginger ale [with a bendy straw!] I was able get up and out to the car. That car ride was scary because of my seat belt, but didn’t hurt too much. I’m all wrapped in gauze and I’ve got a couple of tubes hanging out, but otherwise, I’m doing well. I sleep a lot, but probably mostly due to the pain pills, antibiotic and benadryl I am occasionally taking to avoid scratching at all the itchy. I’ll have a full photo gallery up soon with some before and after photos, video, etc.

Post-Care.

My Top Surgery 2/5: pre-op appointment [with Dr. Garramone]

Arriving in Florida was a fun adventure. It’s far more humid than I have ever experienced and it is really REALLY hot. I’m really glad for air conditioning. We had a long overnight series of flights and then proceeded to nearly get lost in deciphering the bus system to get around town. We did make it to our pre-op appointment in a timely manner, luckily.

Dr. Garramone’s office is small and personal. I appreciated that it was not in some sort of central hub with excessive traffic all around and was very at ease for the duration. Zeke and I filled out a long series of paperwork with our medical history, the appropriate permission forms, etc. The type of surgery was a bi-lateral mastectomy with free nipple grafts.

After paper work was filled out, read and signed, it was time to see Dr. Garramone himself. Zeke and I opted to have our appointments in separate rooms seeing as we needed to be topless. Dr. Garramone came in and had me stand up straight while he did some measurements. All dimensions of my chest were measured and then he showed me a bit of what he would be doing.

He made sort of a chop gesture 2/3 of the way up my chest and said to imagine all of this gone. Then he pointed out the higher location for where my nipples would be attached and made his fingers into about the size of a nickel as demonstration. His assistant took pictures of my chest for his own medical records and we then talked about the post-op instructions, surgery schedule and healing in general. All in all, he was personable and related well with me. I felt comfortable at his office and was reassured that even if my chest doesn’t look the best, the work he does is going to be worth it.

With my chest in particular, my breasts were really close together and so he asked what I would prefer: separate scars or a connected line with a point in the middle. The reason for this is that with my breasts so close together, leaving the scars separated could cause that remaining skin to pucker out. I told him if they needed to be connected that I was fine with that. I’m sure he needed to connect them, but I haven’t seen under my bandaging just yet.

I’m hoping it looks good, obviously, but expect it not to for quite some time. My biggest relief, I related to him, was that I would no longer need to worry about a binder shirt and uncomfortably large chest mass.

Chopchop.

My Top Surgery 1/5: Pre-Op Requirements [with Dr. Garramone]

Dr. Garramone is a well-known plastic surgeon and having seen a lot of his work, I opted to go with him. It was cost effective even with travel. Surgery fees were $5700, travel adds up to about $1000 and food / misc spending is somewhere between $150 so far. All in all…a pretty good run.

The Aesthetic Plastic Surgery Institute is the office Dr. Garramone works out of and after my appointment was set, his Office Manager sent me the required prescriptions and instructions. Here are some details from the Pre-Op packet:

• Required paperwork included a letter from a Gender Therapist or your Primary Care Physician, Copy of ID and Birth Certificate, Medical Clearance [lab work on your blood and a physical] and photographs of your chest.
• All surgery fees are to be paid in full 2 weeks prior to surgery. I had a slight delay on my bank loan and was able to pay half at the 2 week mark and the other half as soon as my loan money cleared in my account.
• Do not smoke at least 2 weeks prior to surgery, this can interfere with healing.
• If you take prescribed aspirin or blood thinners contact the physician who ordered them to work out when to stop and resume around your surgery.
• Do not take any ibuprofen, herbal products, aspirin, vitamin E or diet pills for at least two weeks prior to surgery. These can interfere with bleeding or anesthesia.
• Prescriptions given to you before surgery need to be filled by the date of your surgery.
• You are not permitted to drive home from the hospital so ensure you have a responsible adult to take you home.
• Have a responsible adult scheduled to stay with you for 24 hours after surgery.
• Lab work and physical need to be completed within a month of your surgery. Results need to be sent in to the office by the time of your pre-op appointment.
• Report ANY colds, fevers or infections within two weeks of surgery.

There was also a rather lengthy list of medications, herbal supplements, etc that needed to be discontinued 14-21 days prior to surgery. The only pain reliever you should take in that time period is Tylenol. All medications you take need to be cleared by Dr. Garramone. I was cleared to remain on Testosterone [I've now been on it for 2 years so it's worse on my body to stop]. If you want a copy of the pre-op packet, I will gladly send it to you.

Up next…my Pre-Op Appointment.

Day after Surgery

I thought I had posted a quick entry the night before my surgery, but I guess that I was mistaken. There were a few Internet connectivity issues, so that likely explains it.

Anyway, my surgery is done! I underwent surgery with Dr. Garramone and I’m still here in Florida until my post-op appointment in the middle of next week.
I will go over the entire process as I remember it so you can all take note of how it went down. This will probably stretch a few posts.

[1] Pre-op Requirements.

[2] Pre-op Appointment.

[3] Surgery Day.

[4] Post-op Care / Experience.

[5] Post-op Appointment: [To Follow]

Also, I am updating my YouTube channel with any number of little videos during my recovery, so feel free to check in there.

How to get “Top” Surgery

T-Minus 10 days and counting…Unfortunately, I will not be making a montage of my surgery as I don’t have inspirational music beyond Hyper Crush telling me to keep up. My close friends plan on creating one with pictures and the like, so I will likely post a link to it when they have it created. Be warned, I suggest.

I wanted to briefly cover the steps it took to get to this point so that anyone who reads this blog for the educational value can know what to do or where to point transmen looking to accomplish such a procedure.

First: See a therapist!

• There are many practitioners of medicine and the law that require a letter from a therapist for you to get surgery of any kind [related to being Transgender] and seeing a therapist over the course of your transition is most helpful. I have continued to see the therapist I initially met with. I have used letters through her office for starting hormone therapy, changing the gender indicator on my driver’s license and now for my chest surgery.

Second: Know the procedures!

• There are a number of different “top” surgeries out there, dependent upon you, your chest size and your surgeon. I would recommend reading up on them here. It will be good to know what you will likely get, what works well in terms of recovery and scarring and what surgeons are better at which procedures as you make further decisions.

Third: Select your surgeon.

• You will be seeing a plastic surgeon in almost any top surgery and there a number of them that provide Transgender surgical options. I myself e-mailed several offices in the Salt Lake City area, looking to get prices and see who might be supportive. Many were supportive and after a consultation with one, I was able to find out what procedure would work best for me, talk with him to learn his experience and get a quote for how much the surgery and fees would cost. It was more expensive in SLC than I liked and the surgeon I met with had limited experience. I am someone that ensures that my body and wallet are in good places, so I opted to see Dr. Garramone, one of the top FTM chest surgeons I have researched, based in Florida.

Fourth: Fund your surgery.

• This is an important step after you know where you want to have surgery. With Dr. Garramone, there is a flat $5700 charge for the chest surgery. Travel, accommodation and food will all be extra, but even with those charges I am paying less than what I would have paid in Salt Lake City [around $7500 just for surgery]. I would recommend saving up as much as you can, wherever you can, but as that isn’t always a viable option there are a few great ways to get it funded with credit. Visit Garramone’s site linked above to find recommended medical loan companies. I was able to combine loans from my bank and through a service called Prosper to fund my own surgery.

Fifth: Prepare your body.

• Having surgery is stressful, and it can also be dangerous. Whomever you opt for surgery, each surgeon will be able to provide [upon request if not up front] detailed instructions on care for yourself before and after surgery. The better you are physically before you go in to surgery, the quicker you will recover and the easier the entire process will be. I opted to stop most if not all of my drinking and smoking prior to my surgery [which wasn't a lot anyway]. I restricted other substances that I either usually avoid or use sparingly such as high fructose corn syrup, caffeine, and excessive sodium. Trying to get appropriate rest and exercise is also important to make sure that your body is ready for surgery along with your mind.

Sixth: List everything!

• I like to be prepared. If you are traveling for surgery, make a list of everything you will need to bring a week or more in advance. Make sure you go over this list as you think about the day to day itinerary of your trip. In my case, I am remembering to purchase a few cheap button up shirts and to bring clothing that is easy to slip in and out of. I will be on medication and likely bed-ridden for a few days post-operation and don’t want to be needlessly uncomfortable or make dressing myself an added hassle. I am also listing out the locations of the places I will be traveling so that I can have that list for handy reference. Other lists could be important like making sure things at home are getting taken care of. The more prepared you are, the easier things will go down.

Seventh: Talk about it.

• I won’t lie to you, this surgery scares me shitless. There, said it. Don’t be afraid to talk with friends, family or therapist about how the upcoming surgery is making you feel. I have no doubts that this is what I want to do, but I’ll be in an alien climate and may have a hard time recovering due to the stress of a new environment alone. I want to make sure that I am able to heal so I can come right back to work, but do worry that it will take a harder toll on me than I anticipate. I have not spoken about this as much as I need to, and so I think that it’s important advice to open up to your friends. If they ask you how you are feeling about your surgery give them the truth. Talking about it can help you prepare for possible outcomes that you might not have considered.

If you need help with any aspect of preparing for surgery, you are more than welcome to send me a message. I have a history of obsessively tracking down and verifying information when it comes to things such as this and I would be glad to help however I’m able.

I’ll try to update more often through this and next week to give some good coverage of how the process is accomplished.