D-Day
Ok, I’m proud of this joke, those of you who have spent any appreciable time with me know that I love a good pun.
April the 24th was D-Day but it remains to be seen whether I actually get a D cup.
Whilst the NHS covers some gender affirming surgery, it doesn’t cover breast augmentation and for trans feminine people this can be really necessary as in a lot of cases as HRT can only do so much to counteract the effect of testosterone. Honestly, I did have an appreciable amount of breast growth on HRT compared to some of my trans siblings but given my frame, it wasn’t enough to satisfy me with my shape and it felt like I was restricted with the clothes I could wear because my width and depth were somewhat out of sync. Testosterone has made me broader than I would like and there’s no known effects where oestrogen reverses this. Like it or not, boobs are an immediate signal of your gender so I’m hoping implants will alleviate some of the mis-gendering that happens to me periodically and makes me feel a little more comfortable in my body.
Preparation
After a lot of emotional wrangling, a lot of reading, substantial saving (I have to fund the procedure myself) and several consults with different surgeons, I booked an appointment with a local hospital.
One of the consults was particularly problematic which I’d like to use this to highlight the way that trans people are treated by some people in the medical establishment. This surgeon came recommended by lots of people and I know that he has treated trans women in the past so I wasn’t expecting any issues
I attended an video conference call with this particular surgeon and his assistant after work one evening. We talked about my hopes and aims and he asked to take a look at my breasts. I duly removed my top and he seemed satisfied that there was enough to work with. Whilst getting dressed again, I asked if he could fit me in soon, he turned to his assistant and said
“We should be able to fit him in soon shouldn’t we?”
I corrected him and said “You mean her”. He ignored my correction and the rest of the consultation passed quickly whilst my brain was spiralling as to whether I misheard him or not. I emailed the assistant after the call to check that I hadn’t misheard him (as I’m typically do because of problems with my hearing) and she acknowledged that he did in fact misgender me before continuing with the following in her email:
“I apologise for not addressing the surgeon’s error last night, and I want to make it clear that, as a compassionate and caring surgeon, he would not have intended any harm. I trust that this clarification helps resolve the matter, and I look forward to our discussion today”
My response to the assistant was thus
I'm sure that the surgeon didn't intend any harm but unfortunately he HAS caused harm with this. A surgeon working in gender affirming surgeries with trans women should NEVER misgender them. I understand that he is caring and supportive but now my brain is thinking "what is about me which caused him to think of me as he/him" . The fact that he didn't even listen to me when I corrected him, compounded his error. I see that you are a caring and supportive individual from our brief interaction but honestly this has hurt me, even though I accept this was entirely unintentional on his part.
I would recommend that he goes through some trans training before continuing to interact with my community. He very much needs to understand what these kinds of slip-ups do to women in my circumstances, being trans is hard enough on a daily basis without being misgendered by the surgeons who we want to pay to help alleviate this pain. You talk about the fact that he "wouldn't have intended any harm" which leads me to the conclusion that this has not been flagged to him directly? Is this correct?
Clearly this was not actually raised with him after my complaint and the assistant refused to do so when I pushed for it to be tackled correctly and I quickly received a curt, formulaic and largely boilerplate response from the hospital.
Thank you for taking the time to share your feedback with us. We highly value input from our patients and appreciate your openness and honesty in expressing your views. Rest assured; I will convey your feedback to the clinical team for their consideration.
While we have our in-house training procedures, we acknowledge and appreciate your offer to share your insights further. Your perspective is valuable as we continually strive to enhance our services.
We genuinely regret that we were unable to meet your needs for your surgical journey with us. We understand the importance of finding the right fit for your individual needs, and we respect your decision. We wish you all the best in finding a suitable surgeon who aligns with your preferences and requirements.
Your feedback contributes to our ongoing commitment to providing the best possible care for our patients.
My needs are are honestly simple, a competent surgeon who doesn’t misgender me when I’m trying to give him several thousands worth of cash to perform a routine operation on me. I totally understand misgendering happens on occasion with my community and I’d expect that it be handled in a mature way with an acknowledgement and apology rather than ignored hoping that the problem would just go away.
Further consults with other surgeons were thankfully less problematic (read this as not triggering dysphoria in me) and I nervously booked my surgery with another local surgeon who had good reviews from many women, he was affectionately known as the “Boob King" which gave me high hopes. He was retiring at the end of April so I booked an appointment and put down the deposit. As is normal with all significant dates in human’s lives, the time moved steadily and tediously towards the day of my surgery.
Surgery
I stopped my hormones before the surgery, as requested by the surgeon. Given that my testosterone is fully blocked, this means that I had no sex hormones in me at all which gave me menopausal symptoms for several weeks once the existing reserve was out of my system. For those of you who are interested, there are several forms of oestrogen, some forms are applied daily, some, like the ones I take are injected every 10 days which reduces the hassle of it all. It is a complex molecule of oestrogen and an enthanate ester which means that it takes time for the body to break it apart into the components and be able to utilise the “girl juice” that my mind craves. To be clear, “girl juice” is just oestrogen but I was in the mood for a fun visualisation, forgive me.
Being menopausal was hugely uncomfortable and I experienced the brain fog experienced by cis women my age as they hurtle through peri menopause into menopause and it’s not something I ever want to experience again. Since starting HRT I’ve noticed that the world has been more colourful and beautiful and this feeling stopped when I stopped my HRT. This aspect was hugely discombobulating and I felt wrong and out of place in my body despite the excitement of the upcoming surgery.
One other thing that I needed to do, other than stop my HRT was to remove my numerous piercings. I had as many of my piercings replaced with plastic retainers as was humanely possible. I currently have 15 piercings because, I have a slight addiction to body modification (see also tattoos…) and also needed to have my BIAB (builder in a bottle) nails removed. Going back to natural nails for a few weeks was weird and dysphoric and looking at myself in the mirror felt kinda weird because I was so used to seeing my nose piercings in my reflection. I understand the need to do this, surgeons use diathermy to operate and it can arc towards metal piercings causing unintended burns.
My friend Lizzie kindly offered to accompany me to the hospital, helped me get home and stayed with me for several days to make sure that I was recovering well. Surgery itself passed quickly and easily. I met the anaesthetist and the surgeon who took a magic marker to my chest and did some doodles indicating where he would cut and what size of implants he would put in. I was a little disappointed that he didn’t even try to colour in any of my tattoos, clearly he was a busy man.
The hospital staff were really supportive and lovely and I had a really good experience. I was chatting to the nurse about roller skating as the anaesthetic kicked in and I drifted off into a dreamless sleep. The general anaesthetic was disorientating when I came around as I didn’t really realise it had all been done. The surgeon came in to see me after I woke up and said he was hugely happy with how surgery went and thought I’d be pleased with the results. After a cheese sandwich, a kitkat and a wee, I was free to go home, once the nurses had helped shoe-horn me into my bra.
Recovery
So far the recovery has been better than I was expecting. I’m not too much in pain but I feel like I have balloons underneath my skin. Sleep is hugely frustrating as I need to sleep on my back at a 45 degree angle on a cushion to reduce swelling and wear a surgical bra constantly for 6 weeks. Various movements such as sitting up in bed are uncomfortable, I guess because my muscles have been shifted around a little.
Psychologically it’s more challenging as I’m finding it really difficult to not fall into my normal life patterns of exercise and roller skating, I’m not a patient patient and find it hard to say no to myself. I have been trying hard to relax and heal but find myself doing laundry and emptying the dishwasher only a few days after surgery which I probably should have refrained from or at least gotten my dutiful daughter to assist with.
For those of you who want the technical details, I had 550cc spherical and textured implants surgically implanted behind the muscle. Largely, 550cc is equivalent to 550g in each implant but it doesn’t feel like a lot with regards to how I move. The benefit of this placement is that the pectoral muscle hides the shape of implant and has the benefit of acting like a natural bra reducing the effect of gravity as the years progress. The negative side is that healing takes a little longer because more of your tissue was moved about to accommodate the implants. I currently have the peaky and high boobs of a teenager and the body of a middle aged trans woman who doesn’t do quite enough exercise. This does amuse me whenever I see myself in the mirror.
Having the bandage removed made a huge difference to my daily happiness as it was hugely uncomfortable to wear an adhesive bandage for a week. The bandages were thankfully removed last week and I can finally, take careful baths as long as I’m careful. I’m quite paranoid about ripping a stitch and it’s a constant background fear in my mind as I want to heal and go clothes shopping and get back on with life again.
With regards to the bandage removal, one of my friends suggested that it would be like a Hollywood film when the protagonist has their bandages removed and they slowly turn to face the mirror with much cinematic fanfare. It wasn’t hugely different to this, though John Williams and his orchestra were strangely absent and the only sound I heard was the kindly nurse congratulating me on how good they looked for my frame. I was hugely relieved to be able to finally itch where the bandage was (obviously avoiding my incisions).
I have since resumed my HRT and I’ve noticed a difference in how I’ve been feeling, the brain fog has disappeared and the world has much more of a rosy glow to it as my brain gets snuggled by the oestrogen flowing around my system (again, poetic license.. forgive me).
Because of the placement of the implants, my upper strength is a little diminished and I’m having to find new ways to get out of the bath as I can feel a little pain if I use the muscles wrong. This will improve over time and it’s expected that I’ll be back to normal within 6 or so weeks. The incisions are really still itchy and I have to be really careful how I move. Sitting in one place for long periods of time is uncomfortable and I feel largely exhausted from several weeks of broken sleep because for some reason, I cannot sleep past 2am without waking up.
The actual shape of the boobs takes some time to settle, your body takes several months to acclimatise to the implants and they’ll drop a little and soften and then I can start to work out what size I’ll end up with and what kind of clothes will suit me. I am very excited for the new possibilities of clothes that I can wear. There’s a lot of stuff that I avoid waring because I feel that my shape is wrong for it and I feel super self conscious about wearing things like dresses. I also would like to start swimming again, if I can resolve that emotion in my head. Swimming as a trans woman is difficult for varying reasons, not least because swim suits don’t really flatter the shape. However, I can see already that my shape is more feminine than it was and that the curves are more pronounced so maybe this is something I’ll be able to do when I’m healed.
Incidentally, the subtitle refers to the fact that I’ve recently had my 48th birthday and I count this surgery as a present to myself. Anyway, as always, thanks for your love and support. Please, be a vocal and active ally for the trans community, we need you more than ever at the moment.
Kat
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