aaages ago, i had a diary of my top surgery experience on my site, but after several overhauls of my site’s design, i ended up taking the page down, intending to redo it at some point, but i never got around to it. now that i have a functioning blog i figured i might as well revive the page in blog post format!
this post will contain pictures of my chest immediately after surgery, so there will be some blood, scabs, and general crustiness on display. nothing super gory (top surgery isn’t that dramatic), but if medical things gross you out, you might want to skip this.
this’ll be the somewhat abridged version compared to the original page, since the original was even longer and wordier than this, but i don’t have it anymore so i’ve since forgotten what i wrote but i remember the experience so here we go! i apologize in advance for the weird colors and crappy quality of the photos in this post; i took most of them in my old apartment bathroom.
i had surgery on november 5, 2020, so it’s very fitting that i’m writing this right after my 3rd anniversary. my surgery was done by Dr. Mangubat at La Belle Vie Cosmetic, in Tukwila, WA. my husband actually had surgery with Mangubat like a month or so before me and had a very good experience, but he wasn’t my initial choice of surgeon because i was initially seeking out surgeons that marketed themselves as fat-friendly. after i had a terrible consultation experience with the only surgeon in the area that specifically said he was good with large bodies, i went to Mangubat, and i’m so glad i did. that first surgeon i saw (Dr. Sajan in Seattle, if you’re wondering) told me i was too fat for him to operate on me— not because of any health concerns, but because i was, according to him, so heavy that i would break his operating table i guess he operates on a fuckin plastic folding picnic table, lmao. so…so much for fat-friendly.
i was super nervous going into my consult with Dr. Mangubat after that, but he was much more respectful of me as a fat person, and assured me that my weight wasn’t a problem for him as long as i passed the pre-surgical health checkup. which i did so we set the surgery date, and the waiting began. because my husband had just recently had his surgery, i knew what to expect as far as the recovery, and i’m thankful to have had that privilege. partly why i’m writing this whole post is because i think it’s super important that trans people share our experiences with stuff like this, because it all seems very scary if you don’t know anything about it! even i was scared, despite knowing exactly how the process was going to go, because i have pretty severe anxiety about health-related stuff. i was convinced i was going to die on the operating table and just kind of dealt with the fear, because i would rather have died in the OR than keep living without top surgery, tbh.
day of surgery
but luckily… i did not die i went in for surgery at around 6 AM, and i think i was done in about 4 hours, although i don’t remember the exact time because i was absolutely zooted afterward my surgery went perfectly, according to Dr. Mangubat. the only “complication” was that i had a roll of fat that was inaccessible while i was laying on the table, so they weren’t able to remove it. this isn’t a big issue, i’ll discuss it more later in this post.
also, before surgery day, i had a pre-appointment where i was given some instructions and had any lingering questions answered. i was also given an antibacterial soap to wash myself with on the morning of surgery.
on the morning of surgery, because this was peak COVID time, i was only allowed to bring my husband in until they took me into the OR, so he sat in the exam room with me while i was prepped. they put compression socks on me and gave me a blanket and a little warm beanie to wear, so i kind of looked like a large baby. i took some meds, i think it was an anti-nausea pill and a pill to keep my blood pressure down during the procedure. i also deliberately made an effort to do a last-minute poop because i was worried i would fart on the surgeon then the time came to take me away, my husband had to leave the clinic, and i remember being so wrapped up in my own thoughts in the moment that i almost forgot to give him a goodbye kiss, which is really funny in retrospect because i was like 80% sure i was about to die and i was just gonna casually dip on him, haha.here’s a picture i took right before surgery!
the staff that took care of me and led me into the OR were all super nice. we chitchatted about my job while they strapped me in and shot me up with anesthesia, and then a few seconds later i was out.
my husband and a few friends hung around at the mall near the clinic while i was in the OR, and came to collect me when i was done. i don’t remember any of the ride home, or getting into the house. i “officially” woke up several hours later, i think it was around 7 or 8 PM that night, and i felt pretty good, all things considered! i was worried the anesthesia would make me nauseous, because that happened to my husband, but i wasn’t nauseous at all, just super thirsty and groggy. i also had kind of a mini-panic attack because my pulse was faster than usual, and like i said…health anxiety…so i thought i was dying i informed Dr. Mangubat of this when he did his follow-up call that night, and he reassured me that my body was just reacting to the surgery. he was right; i felt fine after a few hours, lol.
the first week after surgery was a lot of sleeping on the couch in the living room feeling bored and vaguely uncomfortable. i wasn’t really in a lot of pain at any point during my recovery; i didn’t use the prescribed painkillers much because i didn’t like how they made me feel, but i didn’t seem to need them that often. i just took one every few hours and that was good.when i came out of surgery, i was fitted with this wrap-around velcro binder that you wear to minimize swelling and hold everything in place while it heals. underneath the binder was a big absorbent pad, basically a flat diaper, to soak up the fluid from the drains.
the drains that Dr. Mangubat uses are called penrose drains, and they’re basically just a big hollow cannelloni noodle that sticks out of you and lets the fluid drain freely. some surgeons use drains with bulbs at the end that you have to manually empty, and i’m glad i didn’t have to deal with that instead of bulbs, i just had to change the pad out for a fresh one every few hours, which was always a nice break from the snugness of the binder. i was allowed to have the binder off for about an hour at a time, so i would take it off to change the pad and then run it through a washer-dryer cycle to have it nice and clean when i put it back on.
the drains! you can also still see the lines Dr. Mangubat drew on my chest before surgery, as well as some bruising around my armpits.
the drains sitting under my skin was a weird feeling. it didn’t hurt, i was just very aware of their presence in there. the drains are the first thing to go, though, after just a few days. i went back to the clinic and Dr. Mangubat removed them, which i didn’t feel at all, and he told me everything looked like it was healing well so far. i remember he actually told me i had the best results he’d seen on a patient of my body type. yippee!
the main sources of discomfort during this initial healing period were the nipple bolsters—more on that in a minute—and the fact that i couldn’t bathe until the drains came out. my husband and i devised a system of sponge-bathing while he was recovering from his surgery, though: we had a plastic folding chair that just fit in our bathtub, so we set it up in there and i would wash his body from the waist down, so at least the lower half of his body would feel fresh. that’s the most important part of the body to keep clean, anyway so, he returned the favor by helping me bathe in the same way. but unfortunately you can’t wash or deodorize your armpits, so if you’re having this surgery, prepare to be stinky for a while.
now, the bolsters! these little fuckers were so irritating!
you can actually see the redness peeking out from behind the bolsters in this image. the bruising on the upper part of my chest had progressed a little more by this point, too.
the bolsters are just little pieces of material stitched onto your chest to hold the nipple grafts in place. while the actual surgical incision itself used dissolving stitches, the bolster stitches do not dissolve. and my skin did NOT like that! i think the problem was that i insisted on doing things for myself while i was recovering, so i was moving around more than i probably should have been, and this caused friction between my skin and the suture material. it stung and was itchy and generally just really annoying. but you should never touch the healing nipple graft area, so i just had to deal with it until it was time for the bolsters to be removed
also, when the drains had been removed i was cleared to shower, but i still had the bolsters in, so they gave me these really funny little stick-on nipple shields to prevent the bolsters from soaking up water. i thought these were hilarious. i think it helps a lot to have fun with the recovery process, wherever you can.
as a quick aside, i felt like i should mention the weird smell that my incision had, because if you’re thinking about getting this procedure done but you’ve never had a surgery or any kind of large, healing wound before, you might not be aware of this: there are bacteria that like to party in healing surgical incisions that can sometimes make it smell like ammonia, and this is totally normal! they’re good bacteria, and smelling them is a good sign that your body is doing what it needs to do. i’ve heard that some people’s bacteria smell sweet or like almonds, but mine definitely smelled like the pool room at a La Quinta. lucky me
anyway. if i remember correctly, i got the bolsters off on november 12th? getting them off was unpleasant, because of the irritation i mentioned earlier. i remember laying back in the chair, wincing as Dr. Mangubat picked all the sutures out of my skin, and he said something like, “hmm, there’s some blood, that’s not normal…” and i was like WHAT DO YOU MEAN IT’S NOT NORMAL but it was just because i had formed little blisters around the stitches. bro had me thinking my nipples were gonna fall off!!
once the bolsters were removed, my healing nips were covered with gauze, and i was instructed to change the gauze once a day, or whenever it started to come loose. a layer of aquaphor was also to be applied directly to the nipple to keep the scabs moist and encourage them to slough off.
by this time, the piece of protective tape that was placed over my incision was also gone. so the bolster removal appointment felt like the first time i really saw my new chest, even though i had seen it while taking the binder off before. it’s something else entirely to see it clean, with no dressings, looking more like a real part of your body rather than a big healing wound. this was when the reality started setting in that i did it, i was finally free! it’s worth noting here that the puckering of skin and shelf-like protrusion of the incision in the picture below is just an effect of the swelling, and this completely flattened out over the next several months. in my time following online trans communities i’ve seen a lot of people worrying about that when they get their own surgeries, but it’s totally fine unless the swelling is abnormally large or painful. healing is an ugly process and sometimes you just gotta trust your body to do its thang.
my chest immediately after the bolster removal. still pretty bruised near the armpits!
when nipple grafts are healing, they form a scab on top, which falls off over time to reveal the fresh healed nipple underneath. so they look really gross for a while while that’s happening! mine looked yuckier than my husband’s did, because my chest is so pale, so the redness around the scab was VERY RED.
the pictures below are probably the grossest ones i took during the entire healing period.
this is the left graft
and this is the right
you can probably tell from the pictures that my right graft is shaped a little weird— i think that this was caused by how much movement i was doing while recovering. i’m right-side dominant, so i think what happened was there was more friction and tugging on that graft as a result. this didn’t affect the health of the graft, just the aesthetics. sit your ass down when you’re healing, people!
from this point forward, recovery was pretty straightforward. i took care of my nips until the scabs came off, and from then on it was just a matter of taking it easy and not doing any heavy lifting until my incision was all closed up.
my chest without nipple scabs. they look very raw and pink here, because it takes a few months for the pigment to come back.
i did have one little scare when i had a scab along the incision line pop open before it was “ready”, and some pinkish, watery fluid started leaking out, but i called the surgeon’s office and they told me to just keep the area clean and it would be fine. i did as they said and didn’t have any more issues, thankfully!
over the next few months, and then years, my scar got flatter and lighter, and now, 3 years later, you can barely even see it anymore, but this is partly because i’m very hairy i didn’t do any scar care routine at any point. some people use scar gel or tape to reduce the appearance of their scars, but i wasn’t concerned with that, and i actually would be kind of sad if my scar ever fully disappeared. i wear it as a badge of honor.
my chest as it looks now!
even after 3 years, and after having written and re-written this account of my experience multiple times, i still have a hard time believing that this all happened. especially now, it seems like such a distant memory that i was laid up on the couch oozing blood and wrapped in bandages. i had a huge pre-op chest—i was an H cup—and i remember thinking i would never be able to have this surgery. now i can barely remember what it was like to have boobs!
on being fat
before i end this post, i think i should go over some things that were unique to me as a fat person having top surgery:
- the first, and most obvious, thing is the experience i had with that first surgeon that turned me down. actually, he didn’t turn me down— he still pressured me to schedule an appointment with him as soon as possible, because i would have to pay another consultation fee if i waited more than 90 days to schedule (for comparison….Mangubat doesn’t have a consultation fee, lol.) i cannot stress enough how dehumanizing and humiliating that experience was. i remember the office staff literally whispering my shirt size…because part of the consultation “experience” was a free t-shirt with his logo on it, you see…to me like it was a dirty word. i don’t have anything conclusive to say about this, really, just that it was horrible, depressing, and if you come across a surgeon who speaks to you like this, run far away. don’t trust someone who hates your body with cutting it open.
- if you’re someone with a belly but also a large chest, try to prepare yourself mentally to see yourself without your boobs there. every trans person struggles with their body image, but fat trans people often struggle with “size dysphoria” on top of that. even if you’re comfortable in your body, it can be a shock seeing how far your belly protrudes without a full chest to balance it out! seeking out before and after photos of people built like you can be a huge help; try looking on surgeons’ websites, or FTM reddit or facebook communities as a source for others willing to share their photos with you.
- this is just a weird little thing i wasn’t expecting to happen: because i have PCOS, i have a thing called acanthosis nigricans, which is just a skin condition that causes darkened, velvety skin on certain areas of my body. it happens in places on my body where my skin rubs together, like my armpits, and was also very noticeable in the space between the underside of my breasts and the top of my stomach. i had a “titty stain” on my stomach at first that i thought was permanent, but it actually ended up going away over time!
- about the dog ears that i mentioned earlier in this post. dog ears are little flaps of excess tissue that can sometimes be left over after top surgery. in my case, i had a pronounced roll of fat and breast tissue under my arms that wrapped around to my back, and since you’re laying on your back while the surgery is being performed, Dr. Mangubat wasn’t able to access that spot to remove the roll entirely. if you look at the last picture in this post, you can see the extra tissue sticking out on the sides. for me, this isn’t something i’m really concerned with, because you can only see the dog ears when my arms are in that specific position. the rest of the time they just kinda smush down and blend in with the rest of my fat. but, since the only way to fix dog ears is by going in for another surgical revision, i figured it was worth mentioning that this is likely to be the case for anyone with my body type.
- the last thing i want to mention is the shape of my incision. i had a double incision(that’s me) procedure, but you’ll notice that it’s actually one long incision that goes all the way across. this is something that surgeons might do if your breasts meet very closely in the center of your chest, which is often how they sit on a fat person’s body. this doesn’t really affect anything beside aesthetics. i actually enjoy having a more unique scar shape
hoo wee this post ended up being super long. but i think all of this info is stuff worth sharing! like i said, it’s so important that we keep the tradition of sharing knowledge alive in our community. it’s funny how trans people are now more visible than ever, but that’s made it harder to find information about our unique medical procedures through the noise. so i hope you found this post informative, or at least interesting to read. and if you’re thinking about top surgery, i hope you feel a little less nervous after reading. don’t be afraid to shoot me an email or a discord message if you have questions you wanna ask, either. anyway, that’s all for this epic of a post. good luck out there, my titty-shedding friends