My Top Surgery, Part 1: Decision Journey

Trigger warning: descriptions of chests and dysphoria.


Amigues hispanohablantes, la versión castellana está en proceso :)


I'm sitting down to write this seven months after getting top surgery — I've been planning to do this for a while but it's hard to condense a journey that took years. I'll be doing a few posts, not sure how many or when, on things that a) I think are important, b) I feel comfortable discussing and c) I didn't read about or see in the run up to the big day — and wish that I had.


Let's be crystal clear. The only thing that is necessary for you to get top surgery is that you want to get top surgery. Full stop. There is no room for discussion or debate. But there is room for complex and often difficult emotions over extended periods of time.


Before we get started: if you're wondering if your feelings about top surgery are valid, they are and these posts are for you. If you don't want to get top surgery and just want to understand the process of getting top surgery a little deeper, these posts are for you. If your surgery date is in a few days and you're a puddle of nerves looking for someone who's been through it, I see you and these posts are for you.


Today I want to talk about the long and emotional journey that preceded the decision to get top surgery, before I had a surgery date. I'll get into the emotional nitty gritty of that in another blog post, but what I want to share now is that these decisions may not be made in a day and that's okay.


So grab a cup of tea or something because as you know, I try not to edit myself too much on this blog and this could get pretty long.


The only thing that is necessary for you to get top surgery is that you want to get top surgery. Full stop. There is no room for discussion or debate. But there is room for complex and often difficult emotions over extended periods of time.

Wait, you can do that?


It's hard to know where to start. When I was ten and cried for days because I didn't want to wear a bra? My first experience of dysphoria as a young teenager, without knowing what it was? I lived with breasts for twenty years and can think of zero moments where they brought me joy or even peaceful indifference. Zero. I had a large chest, especially considering that my back is pretty small, which had always made me uncomfortable (and plagued by back/neck problems). I used to say that I wanted to be able to remove them at the end of the day and maybe not wear them on weekends.


Given that (and how happy top surgery has made me), it seems so obvious that I was going to get top surgery. But it took years to come to terms with that decision. And then even more time to take action.


Let's just start in 2018, when I came out as non-binary. There was a lot going on emotionally but a big thing was realising that the weird non-relationship I had with my chest was valid. I'm not sure how to describe how relieved I felt because the messaging had always been that I had a "perfect" and enviable hourglass body. Why on earth would I feel insecure about it? But it wasn't insecurity — it was complete and utter denial, laced with a painful unease I couldn't yet name. Knowing that there were other people with my experience felt like jumping into a pool of clear water after swimming in a swamp. Let's just go with that metaphor.



In 2018, the possibility of surgery was pretty far off — my partner asked me about it pretty soon after I came out and I think I kind of shrugged and said "Yeah...maybe. Probably?" The idea made me giddy. I was still coming to terms with my new pronouns, this new perspective on my history and a new way of inhabiting the world, even if I wasn't publicly out, quickly finding out who my real friends were and working through a lot of emotions — I had my first brush with dysphoria that I could properly name, for example.


Soon after, the questions began: should I get a breast reduction or top surgery? I looked into both surgeries, the procedures, the healing, the results I might want. I remember breaking down crying in front of my mother at her table saying that I couldn't stand having breasts anymore, and to her credit we immediately went to a surgeon's office down the road to ask about a reduction and wow, it was a pretty awful consultation but a pretty good bonding experience!


Note: I can write about my surgery consultations but I want to focus on the emotional side today. I can heartily recommend Ash Hardell's YouTube channel though, they were an amazing resource in general.


In March 2019 I was accepted to the Craig Newmark Graduate School of Journalism in New York. Amid many other preparations, I decided to get a slew of check-ups before leaving because wow, the U.S does not have a good reputation when it comes to healthcare (which is well-deserved even without mentioning the additional barriers for trans* people). One of those check-ups included getting a mammogram and an ultrasound of my breasts. I had images of surgery on my mind (both breast reduction and top surgery). I sat in the waiting room fervently hoping they would give me a medical reason for removing them, giving me the justification I wanted. I asked the ultrasound technician if there wasn't anything untoward. Twice.


Looking back, it's tempting to call that a lightbulb moment, but it wasn't, really. Moments like that are, if anything, sparks that fly out randomly and dimly illuminate a dark room you don't know the outline of, but understand intimately. And then you're in the dark again wondering if you really saw what you saw. I knew something was wrong, but I wasn't suddenly sure that top surgery was the way to go.


Note: That's the image that my brain conjured up soon after surgery and it's the only way I know to describe it, apologies if it's obscure or inaccessible somehow.


I sat in the waiting room fervently hoping they would give me a medical reason for removing them, giving me the justification I wanted.

In August 2019, I moved to New York and I thought "Well, that'll have to be put on pause." I focused on J-school and lived publicly as a non-binary person for the first time, which was equal parts amazing and exhausting. But getting surgery was always in the back of my mind.


If I'm honest, I don't quite remember the moment I discarded the notion of a breast reduction: I just remember saying that given my size, I didn't want to go through multiple healing processes and extensive scarring (I love my top surgery scars though and will write about that soon!). Dysphoria was becoming more and more frequent, both socially and physically. And each transphobic encounter was taking a larger toll. I also remember that I said to someone at an event that I wanted to get top surgery before I turned 30. So the decision was made, in a way, but there was still some way to go before I truly acknowledged my need and kicked into gear.


Turning points


Ah, 2020. There is so much to talk about there but basically I remember one aspect of lockdown was that I was relieved about not being perceived for a while: can't be misgendered or mistreated if you don't meet anyone. Yes this is sad — a lot of trans* people I know felt the same way because basically, society is not great.


In March, I got COVID-19 and got through it with the help of my local Mutual Aid in Ridgewood, Queens. In April, I bought my first binder and felt intense joy, but also physical pain and the lived-in knowledge that I really needed a flat chest. I spent three months completely alone in my small room. Spring semester continued remotely while I played music, read books and tried to make my space a peaceful nest while New York became the centre of the epidemic.


I saw photos of people at the beach and cried because I wanted to be in the sun but absolutely could not fathom putting on a bikini. I couldn't stand to think of another summer with breasts. I couldn't.


I worked on an audio documentary about postponed gender affirming surgeries called "The Covid Transition." I read studies on the barriers to healthcare trans* people face, naming things I was going through and witnessing struggles that weren't my own (huge thank you to Tat Walker for trusting me with that moment of his life).

In August, with my landlord pressuring me to leave, I moved to the apartment next door to a magical building with lovely humans I felt comfortable with. Comfortable enough to not wear a binder around, even if I hated the feeling of my breasts on my skin and avoided full-length mirrors. The binder was starting to hurt in shorter intervals. Bad posture, chronic neck pain and my size already made for a rocky start but as the months went on, my ribs hurt and I had some trouble breathing. The binder was the right size but the stress around having breasts was getting worse.


Mount Sinai's Transgender Clinic reopened and I thought I might as well go in and see what the process was like. Almost with a "What if?" mentality. Maybe I could get top surgery in New York while my partner was visiting! What a lovely notion. A couple of months after that, in November, I had my appointment. I tried to tune into a class on Zoom in the waiting room. I watched Ash Hardell's videos while waiting for the surgeon, which was comforting. However, I was not prepared for the actual consultation process, which obviously includes showing the surgeon your breasts (again, I can write a post about them).


I asked questions and tried to make the best of it but came away feeling extremely dysphoric and hopeless. There had been a bureaucratic error, so I had had my consultation before all the necessary tests and administrative things, so I wouldn't be able to have the surgery until those happened — plus, there were no dates until at least April the following year. My partner came to the clinic, we bought vegan muffins and went home. I was very sad for a few days: my experiment hadn't worked. I called Mount Sinai over and over trying to get the tests done but couldn't get through and/or wasn't given an appointment.


So again, I thought, "Well, so much for that." It was something that I would get in an ideal world but wouldn't have access to, really. Maybe in a few years. Or when I moved back to Buenos Aires, whenever that happened.


I'm not sure how much I want to go into the mental health breakdown I had in March 2021 after my partner left. I am forever grateful to my wonderful neighbours across the corridor whose door was literally always open. I will never know how to repay them for those nights on their couch and conversations filled with laughter when I felt so empty inside.


But one day I saw a woman in a mirror in my apartment. I jumped and all the tenuous healing went out the window. Who was that person? Was that...? That couldn't be me. That wasn't me. It couldn't be. A wall of glass descended on my brain, cutting it in two, shattering and pulling in all directions. My heart felt utterly broken and my lungs about to collapse although I wasn't wearing a binder. I had absolutely no idea who I was looking at. Coming to grips with who that reflection showed was too much. It was dysphoria again at its strongest, having a field day when I was at one of my lowest points.


That's when it hit me, more a dull thud than a benign lightbulb. I'd been reporting on the effects of barriers to healthcare on trans* people and here I was, a trans person, who hadn't been receiving the help they needed for years. I didn't want top surgery hypothetically. I needed it. And I needed it soon. I couldn't keep holding back from getting it and disrespecting my own decision through denial. The wait was over — it had to be.


I remember being pulled towards the oblivion of my bed but managing to get up and cross that corridor again.


I messaged my partner. I called my parents. I stopped applying for jobs. I moved back to Argentina three weeks later and immediately felt a sense of relief (which I wrote about last year). I was back with my partner and my family, slowly knitting the support network I needed. I told everyone that I came back for three T's: my partner's name, therapy and top surgery.


I didn't want top surgery hypothetically. I needed it. And I needed it soon. [...] The wait was over— it had to be.

In a way, I didn't actively make the decision so much as my mental health did. I felt numb as I started looking for surgeons again, almost like someone else was making those phone calls instead of me. I don't think I truly believed it was possible, like it wasn't something I actually deserved or would have access to. But I understood now that it was a necessity.


The third surgeon I met in Buenos Aires turned out to be a winner. I left that office with a surgery date, on cloud nine. But even as I walked home, new thoughts started swarming in and a horde of new emotions came along. The next post is going to be about that because the process of working through them in the run up to the surgery was intense and complex in its own way.


A recap of doubts


For the years between realising I'm non-binary in 2018 and my surgery in August 2021, there were a myriad of doubts, questions and internal monologues that played over and over in my head. One big question was breast reduction vs. top surgery — I've already gone into that, but wanted to recommend "The Weight of Them," an autobiographical comic by Noelle Stevenson, who got both.


Before 2018, surgery in my mind was basically a medical emergency situation. That I could decide on such a major modification (outside expected standards of beauty) was somewhat alien to me — learning to completely inhabit that fact that yes, it's my right, took time. A conversation with a friend a few years back, when they told me about their plans to get a vasectomy, was eye-opening in that regard. So was my first pride march surrounded by beautiful trans* folks with their top surgery scars covered in glitter — that's when I truly fell in love with top surgery.



Because of course I knew my body is my own but seeing people living that truth was different. The other thing that really helped was getting a piercing and a tattoo in 2020: I made decisions about modifying my body for the first time that made me incredibly happy and the notion of regret played absolutely no part in that. It may seem small but knowing that yes, I can trust myself with those decisions, was a substantial step to fully embrace my own agency.


The next step was to understand that getting surgery wasn't just my right — I could have it done and deserved to.


Another factor that affected the emotional process was public discourse. The "acceptable" narrative around trans* people getting surgery is that "we were born into the wrong body and knew at age two that we needed to transition." I came out at 27, older than most of the other non-binary people I saw in the streets, social media and meetups (huge shout out to people like Jeffrey Marsh for embodying the fact that non-binary is not "just a Gen-Z thing" and talking about it!). Although I know I never felt comfortable in my assigned gender, I simply didn't have the language to say "I am trans non-binary, I need hormone blockers/top surgery."


Even within trans* creators and spaces, there's an expected process: come out, start testosterone, get top surgery. I didn't want testosterone. I didn't immediately start trying to get top surgery when I came out. And I didn't know a lot of trans* people in person at first so I wondered if my desire to get top surgery was because the trans* creators and influencers I saw had had it.


So.

  • Wait, that's like, allowed? (Yes. Of course it is.)

  • Did I really want it or did I want to fit in with my community? (The mind is so good at sowing doubt literally anywhere. Listen to your intuition, you know it's there)

  • Did I have enough dysphoria to justify wanting top surgery? (You do not need to have dysphoria to be trans!).

  • Why didn't I just get used to a binder? (It was painful and not enough for me).

  • What if I want kids years from now and wish I could breastfeed? (Nope, nope, nope. I know for certain I don't want children and am even more sure I don't want to carry. But it took me a while to be comfortable voicing that total disconnection from that possibility.)

  • Had enough time passed between realising I could get top surgery to warrant it? (Don't make yourself wait if you need it)

  • Had I suffered enough to justify it? (You do not need to justify surgery, much less suffer!).


I know there were others but we'll stop there.


I can't really advise on how to arrive at your own peace with the decision to get top surgery. I just want to share that those questions ate me up, to varying degrees, for years before getting top surgery. If you have them, that's okay. Time helps and there is no shame in months or years going by without knowing what you want.


But too much time pushing down the intuition that a change has to happen can really damage your mental health. You are worthy of a body you are happy in, you deserve the happiness of a decision you can own. You are also allowed to doubt and cry and wonder and stress and not know and change your mind. Your transition is yours. The emotional side of your decisions will take time. That time is your right. You are not less trans* for not jumping out of the womb knowing you want top surgery.


If I can give you advice, it would be to seek out our community and, if it's available to you, therapy. Even watching trans* and non-binary creators is important: watching Ash Hardell and their spouse get the surgery I wanted without going on testosterone was incredibly validating, for example.


Your transition is yours. The emotional side of your decisions will take time. That time is your right. You are not less trans* for not jumping out of the womb knowing you want top surgery.

Finally, I want acknowledge that this blog post focused on the emotional side of reaching the decision because once I moved back to Argentina, the practical stumbling blocks were removed. I was no longer an immigrant on Medicaid with nobody to take care of them post-op. I decided to go private and I have health insurance in Buenos Aires (no shade to Medicaid though, just the U.S healthcare system in general).


It's also important to note that I have privilege both in New York and in Buenos Aires as a thin, white trans person. I would not be denied surgery due to BMI (inaccurate and racist) or mistreated because of my skin colour. Nor would taking time to recover damage my finances to a point where it wasn't feasible. My partner was able to drive me to and from surgery, take days off work to care of me and come with me to post-op appointments. I also have the privilege of being accepted by my birth family, who took turns coming home and helping out.


Access to top surgery and healthcare in general as a trans* person is incredibly unequal. To my trans* friends and readers going through the pain of a transphobic, racist, ableist, fatphobic and inaccessible healthcare system that consistently pathologizes us — I see you, embrace you and love you.

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