CHEST SURGERY REPORT
(This was written at the request of another FTM who was considering having the same operation and wanted my impression of the surgery, so bear in mind that it's slanted in that direction.)
After I decided late in 2000 that I was ready to have chest reconstruction surgery, I made an appointment for a consultation with Dr. Beverly Fischer. I had looked at various websites for surgeons, hopefully in my area of the country, plus asked for opinions from others who had gone to her. Everything I heard was definitely favorable. Since I could drive to her office just outside Baltimore and also had a friend who lived not too far from there, I hoped to save on travel and motel costs.
The office told me that it was possible to combine the consultation with the pre-op on the day before surgery, for someone who was coming from a distance, but I wanted to meet her first, get familiar with the area, etc. while visiting with my friend.
The consult was in late February 2002. Everyone on the staff seemed very aware of transexual issues. They all called me Kerwin or Mr. Schaefer and used masculine pronouns. The Doctor herself was quite pleasant. She examined my breasts and said I was one of the relatively rare candidates for the peri-areolar surgery.
She explained how it was done and answered any questions I had. Then one of the staff took me into another room and showed me a photo album of before and after pictures of some of her patients. I could make an appointment for the surgery right then or go home and think it over. The price is $5,900.00, with a deposit of 10% required when you actually book a date.
I said I had to go home and find out when I could take off from work first, but would call back in a couple of days. The earliest appointments they had at that time were in May, but I knew one of my co-workers would be off most of that month, so figured it would more likely end up in June.
When I had checked with my supervisor and called back, I made my date for June 5. I was told they would send me an information and instruction packet detailing what I would need to do to prepare. When it arrived, it contained a form to be filled out by my doctor for a physical exam, requests for various blood tests and an EKG, numerous consent and information forms for me to sign and return, prescriptions for pain-killers (Demerol and Percocet), an antibiotic, anti-nausea meds, and powerful sleeping pills, instructions to avoid aspirin and aspirin-containing products for 2 weeks before surgery, and a suggestion to quit smoking, if I smoked, which I do not.
I returned as many of the forms as I could along with my deposit. The remainder of the fee is required 3 weeks in advance of the surgery. I was also told I needed to get a letter from my regular doctor stating that I was indeed emotionally and psychologically prepared for this surgery. (I think they would have accepted an equivalent letter from a shrink, if you hadn't been working with a regular doctor.)
That was a long couple of months to wait, once I'd made my decision. If you can, I'd recommend setting up a shorter waiting period. Easier on the nerves.
At any rate, June finally arrived. Along with a close friend of mine (who unfortunately cannot drive), I went to Baltimore a couple of days ahead of time and stayed at my local friend's house, who lived about 30 miles from the doctor's office. Since she also is a non-driver, I had made a reservation to stay at the Day's Inn just a few miles from the doctor's office on the night after surgery, with the possibility of staying an extra night if necessary. I planned to leave my car in the doctor's lot and the friend who was to stay with me at the hotel that night was to wait in the office for me to get out of surgery.
On the day before, I had a pre-op appointment. They once again explained the surgery, went over all the instructions of what meds to take and when, how I shouldn't eat or drink anything after midnight, what I should expect the next morning and after the operation, checked over all the paperwork and got my signature on some forms, etc.
The next day, my companion and I drove through rush-hour traffic and arrived a bit too early. As I sat and waited for them to be ready for me, two men walked into the office, one quite short and wearing a neat little beard who was walking with his arms very stiffly held at his sides. When the receptionist asked how he was doing, he gave them a big smile and said, "I'm great!"
I immediately figured that he was one of us, which was later confirmed by the doctor. He had been the previous day's patient and, by a rare coincidence, had also been able to have the keyhole technique.
I had a meeting with the anesthesiologist, who asked lots of questions and explained what she'd be doing, how I'd get an IV, then drugs through the IV that would knock me out, then would have a tube stuck down my throat which would likely leave me with a sore throat for a couple of days. (It did.) She fitted me with a tight elastic vest and said I'd have to wear it constantly for about 3 weeks. She showed me the drains that would be put in and where they'd be positioned, how to empty them, etc.
The business end of these suckers (no pun intended) is about 5 inches long and looks rather like one of those flat hoses with lots of little holes that you use to water your lawn. That part goes under your skin, one on each side beneath your breasts. It is attached to a thin plastic tube about 2 feet long, which comes through a small incision under each arm. The tube ends in a bulb-like container that you can empty, then squeeze together and plug. The suction that creates slowly drains the fluids from the surgical area. It's bloody at first, then gets clear. The drains can be removed when there's less than 25 cc's of fluid in 24 hours.
Next she took a series of "before" photos. Finally, Dr. Fischer came in and drew marks on my chest with a felt tip pen, as guides for the surgery.
At last I reached the operating table, was made comfortable, and had the IV started. Last thing I remember I was answering a question about the hurricanes we have in NC, then I was out.
I came to about 3 hours later lying in a darkened room, trying to see the clock on the wall without the help of my glasses. I felt fine, except for the pressure of the bandages around my chest. No nausea or anything. I was able to stand up after about a half-hour.
My companion later told me that I had actually wakened up some time earlier, as I had been talking to her and explaining about the various monitors that were attached to me. During this time, which I cannot remember at all, the nurse explained to her about the drains and how to empty them, plus what I should and shouldn't do for the next few days. If nothing else, it was nice to know that I can still make sense even when operating on autopilot.
One of the staff drove my companion and me to the hotel and made sure I was in my room before she left. Both the anesthesiologist and Dr. Fischer phoned me later on to check on how I was doing. I had their numbers to call should anything be wrong.
I sat around the rest of the afternoon and evening reading a book and eating the snacks we had brought along with us, far hungrier than I had expected to be. Never did need any of the heavy-duty painkillers or sleeping pills, since Tylenol seemed to work just fine.
I felt as if I had been hit across the chest with a baseball bat: bruised and sore to the touch, but no sharp pain unless I moved wrong, like twisting too far or lifting my arms too high. (I think the pain was mostly from the drains, since it was right where they're placed.) I quickly found that I could tuck the drain bulbs into my pants pockets and hide the whole mess beneath a loose untucked shirt, so be sure to have a large shirt or two if you're planning to do this.
I can honestly say that I didn't feel particularly afraid or anxious at any time during all of this. I expected to hurt more and to feel weaker afterwards, so I was pleasantly surprised when I didn't. My experience is, of course, only applicable to this method of surgery. Perhaps it would have been more painful if I'd had the double incision technique.
After having used the baseball bat description to several women friends, I've gotten feedback that that sounded awful, which wasn't what I meant to convey. I didn't mean a bat across a woman's tender breasts, which would surely hurt far more than this. I just meant a bruised feeling, rather than a sliced or cut feeling.
If I had to rate my level of pain throughout this entire experience on a scale of 1 to 10, I'd give it only a 3.
By the following morning, I was looking forward to the hotel's continental breakfast and polished off a donut, danish, cup of juice, and 2 cups of coffee. I felt well able to drive, even though my car doesn't have automatic transmission, so we checked out and took a cab to the doctor's office to pick up my car.
I had a brief visit with Dr. Fischer, who peeked under the bandages and declared my nipples to be looking good, although all I could see was slightly bloody bandages and reddened flesh. She also seemed quite surprised to see me moving around so easily this soon, alerted me to any complications I should watch for, and said to give her a call when the drainage got down below 25 cc's so I could come in to get the drains removed, hopefully early the next week.
I drove to my friend's with no problems, and even went to a movie that night.
Over the next few days, I felt good enough to go to downtown Baltimore to tour a
sailing ship, visit the Science Center, and go to a Scottish Festival. If all went well, I was even planning to drive up to NYC to visit my son and his wife.
If I had had to, I could easily have gone back to work by now. But why waste time off, right?
I got the drains taken out on Monday. What a relief! It hurt a bit when the nurse pulled the one on the left side out, but not unbearably and only for a brief moment. That side was more swollen and tender anyway, so I actually expected it to hurt more. Didn't hurt at all for the one on the right.
Got my first real look at my chest when the bandages were removed. Right side is very nice, left more swollen, nipple looking more unhappy about the entire experience.
The doctor said both sides look healthy, just one better than the other. Now I only need to wear the elastic vest for two more weeks, with or without any padding underneath, as I wish. (I just wear an undershirt, plus large Band-Aids on the incisions where the drains came through under each arm.)
Dr. Fischer said she finds most of us to be excellent patients and likes working with us. She even mentioned that she wishes she had tons of money so she could give some of us reduced rates, since she's aware of the lack of insurance coverage.
Before I left, the staff gave me a notarized letter saying I had had irreversible sex-change surgery and should now be considered legally male. (The North Carolina Department of Motor Vehicles accepts this letter as sufficient proof to change your sex designation. I later had no trouble getting a new license. If they arrest me now, they'll have to call me "sir".)
Driving through NYC traffic with my clutch transmission was a pain, but I made it. Had a nice time with Freddy and Ada, and even met the in-laws for the first time. Still playing tourist, we went to the Bronx Zoo.
Had one last check up with the Doctor, on my way back through Baltimore to North Carolina and she said I look great. The remaining swelling and bruising should gradually go down. Many of the external stitches have already dissolved and the nipple on the left side, which was all black, squashed, and nasty looking, is beginning to recover.
I'm very pleased with the positioning and everything. Still supposed to wear the elastic vest for another week or two, but it's so damn hot and uncomfortable that I've been cheating a little and using an ace bandage some of the time.
The long drive home was tiring, but I made it.
I went back to work and did fine. However, I'm glad I took a full two weeks off. It would have worn me out a lot more last week, and I feel less likely to tear stitches or do damage now than I did earlier. (Depends a lot on your job, of course. Mine is mostly not physically taxing, but sometimes I have to move patients, haul them to their feet, push wheelchairs or stretchers, etc.)
So far, the positioning looks pretty good. Dr. Fischer put the nipples into pretty good alignment with my pectoral muscles. There's still some swelling, but it's going down.
Three days before
Three weeks after
UPDATE - September 2002
Now that my nipples have healed further, I've noticed they aren't quite as symmetrical in appearance as I'd have liked. Either one alone is fine, but they don't match with each other too well. Since revision surgery is covered in the basic agreement, I will most likely get back in touch with the doctor in a couple of months and see what she can suggest. I want to give my chest more time to heal before I go back. Can't say there's much erotic sensation on either side, but I've found that I don't need it. Sex is terrific regardless. Still a little soreness, but most of the numbness is gone.
Have gained a little more muscle since I started T and began exercising more, but I'm still built like the stereotyped 98-lb. weakling. So I can't say my chest looks terribly impressive, but at least it definitely doesn't look female anymore. I can't even imagine what it must be like for those of us who have truly large breasts. I hated my small ones enough as it was.
Since I was so flat chested anyway, it was a bit hard to decide to go ahead with the surgery. You know, is it going to make enough difference to be worth the money/pain/risk/etc?
As of now, I say the answer is a big Yes! I can look in the mirror and be proud of what I see, instead of jarred by it. If I had the choice, I'd definitely do it again.
September 2002 -- First time at the beach without a top. Can you tell I'm enjoying myself?
UPDATE – REVISION SURGERY WITH DR. FISCHER, APRIL 2003
Just got back from spending two weeks in Baltimore and NYC, having some revision surgery on my chest and then visiting my new grandson. I wasn't sure what, if anything, could be done to improve the appearance of my chest until I saw Dr. Fischer. The problem was two-fold: below the left nipple there was a puffy section of skin that looked unnatural, plus the nipples did not match, one having ended up far more prominent than the other. Dr. Fischer promptly let me know that the puffy place was actually a ridge of fat, which could easily be removed by liposuction. As for the nipples, the left one had not survived the original surgery very well and had pretty much been lost. The areola was there, although somewhat scarred over. She suggested that a nipple-sharing procedure be done. This would involve a piece of the right nipple being removed and then used to build a new nipple on the other side. Sounded like just the thing to me, so we agreed to proceed with the surgery on the following day, as planned.
Just as for the original surgery, I had nothing to eat or drink after midnight, had been taking antibiotics several days ahead of time, and took anti-nausea medication that morning. Since this surgery would not require such deep anesthesia as the original, nor did it involve a very great chance of excessive bleeding, I would be able to return to the home of the friend at whose home I was staying, rather than going to a nearby motel overnight, much to my great joy. My friend, who has cerebral palsy and poor vision in one eye, normally does not venture to drive on expressways, but she felt she would be up to it, as long as I was in good enough condition to navigate for her and keep an eye on traffic when we changed lanes. As it turned out, the surgery lasted about one and a half hours, I came to pretty quickly, without any grogginess or nausea, and felt so alert and pain-free that I probably could have driven myself home, had the need arisen. No drains were necessary, and there was no pain, beyond a bit of bruising. I never needed even so much as a Tylenol. However, I was required to wear the damnable elastic vest again, this time only for two weeks, thank goodness!
Three days after the surgery, I drove to NYC with no problem at all, unless you want to count the horrendous traffic endemic to the area. While visiting my son and his lovely wife, I was easily able to hold and cuddle my new grandson to my chest, feeding and carrying him around without any pain. And I'm happy to report that, yes, my son does change diapers and participate fully in the less savory aspects of baby care, while my daughter-in-law is a conscientious and loving mother. I've never been more proud of them both in my life, and look forward to the day they move down to North Carolina, as they plan to do in the near future. I wasn't sure myself exactly how I'd react to the baby, since I was such a terrible bust as a mother. Much to my surprise, I found myself enjoying it all this time around. Guess it suits me better to be a grandfather.
On my way back to NC, I again stopped in to see Dr. Fischer, who said I was healing well and looked good. They took some photos of the results, and provided me with copies of both "before" and "after" pics, which are posted HERE, if you wish to view them. After things have healed more completely, I'll post a picture of the final results.
Three months after surgery. Not perfect, but I'm satisfied.
In 2005, the most noticeable problem was that the left nipple/areola area was much paler in color than the right one. I went to a local tattoo place and had it colored to match better. He was also able to emphasize the appearance of the nipple. I'm even more satisfied now!
