Top Surgery FAQ

Answering your questions

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I posted a question box on Instagram welcoming questions about my top surgery and quickly realized many of the answers required more thoughtfulness and length than an Instagram story. I figured having an FAQ post may be helpful for those looking for more info and can be something to return to if needed. If you have a question I don’t cover below, feel free to post it in the comments.

THE DECISIONS

When did you first consider it/how did you move from that to deciding it’s what you wanted?

It’s always been something in the back of my mind as a possibility because I have never liked my chest or felt a connection to it. But I would say I seriously started thinking about it last year when the attorney general in Missouri tried to pass an “emergency order” banning gender-affirming healthcare. At the time, I lived in Missouri and had a real internal reckoning about what I wanted for myself in terms of gender-affirming care. Due to the urgency at the time, I was considering if hormones were something I even wanted and, if I did want it if I was willing to make that change on what seemed like such a tight timeline. I felt scared at the idea of top surgery being a thing I could no longer dream about or even pursue. It was a scary time and made me realize a lot about my gender and what my queerness meant to me. However, my divorce was a big catalyst for making the final decision that it was something I wanted to pursue (which I plan to share more about soon).

What helped you make a decision about top surgery/if it was right for you?

I think of a meme I saw once that said, “How many times do you have to press your boobs down flat in the mirror before you just get top surgery?” The number of times I would get out of the shower, and the first thing I did was press my boobs down and imagine they weren’t there really made me think that I should really consider it. After months of journaling about it, literally writing in New Year’s resolutions that “this will be the year I get top surgery,” talking to my therapist about it, dating a trans person who really and fully saw and understood me and my queerness, finding more queer community, and then finally trying tape, I took the leap.

What helped you push to do it?

I’ll say trying tape for the first time was the final push for me. I was always so scared of tape because I just generally have really intense sensory issues, especially when it comes to any kind of compression. I even hated sports bras that had any level of compression. So when I finally tried tape a few times and had my clothes fit my chest in a way that felt so wonderfully euphoric, I knew it was what I wanted.

How did you know? Were you scared?

I was so scared! I’ll be honest, about two weeks before my surgery, I had a big panic attack about if I was making the wrong choice. I even debated going to Target to try on a push-up bra just because I hadn’t in probably over a decade. I was like, WHAT IF I ACTUALLY WANT TIG OL BIDDIES!!! I also had a real ass conversation with myself and my therapist if any part of my decision was rooted in any kind of fatphobia because my boobs had gotten bigger over the last few years as I’ve gained some weight. So yeah, I was scared. I had doubts. But on a long drive with my partner, I told them, “I’m nervous, but I just can’t pinpoint why,” and I talked through every angle and finally, I completely broke down when I talked about how I was scared I wouldn’t have support. My body told me where the fear was coming from. Ultimately, I was more scared about the possibility of going through this big change alone than I was about the change itself. Luckily, I ended up having amazing support, didn’t feel alone, and now feel so grateful for the decision I made for myself.

How did you start? Did you just ask your doctor?

I started by having a conversation with my therapist. She knew about my gender identity and experience, but I had never talked with her about wanting to get top surgery. We had a few sessions talking about my experience of gender, her writing a letter, and just anything that came up about the process. After that, I emailed the surgery center directly and they led me through the consultation process.

Did you have the reduction vs. flat dilemma?

I personally did not! For most of my life, I had been a part of the itty bitty titty committee, but around 26 or 27, I had a growth spurt of some kind and had always been so annoyed at that. I knew I wanted flat top surgery from the beginning.

Was it optional to have nipples removed? What was the decision process like for you?

It was optional! My surgeon actually thought up until the day that I wanted to have nipple grafts, but I made it very clear that was not what I wanted. My decision to remove my nipples was rooted in my desire to degender my chest. To me, not having nipples was a way to feel the most neutral in my body and gender, which is ultimately how I experience my gender as a trans nonbinary person. Sure, there are times I weave in and out of different kinds of presentations, but having a blank canvas of a chest feels most aligned with my gender experience. Plus, I have heard the healing process for nipple grafts is kind of a pain in the ass.

Will you take hormones to change other body features? Or was top surgery the main goal for you?

I will never say never because gender is such a fluid and ever-evolving exploration, but I don’t see myself taking hormones.

THE CONSULTATION + BEFORE SURGERY

Was it challenging to find a provider that would complete the surgery?

I’m lucky because I have many trans friends who have had top surgery in Texas, many of which went to the same surgeon. I didn’t do a bunch of research but had heard that Dr. Dulin at the American Institute for Plastic Surgery in Plano, TX, was really great, so I decided to also go to him.

How long was the wait from the first consult to the operation?

I have to admit I think I was REALLY lucky in my situation. I sent my first consultation email through an online form in early March but didn’t hear back for a couple of weeks so I decided to call. When I called, they gave me a direct email, and I sent my consultation photos on March 27th. I received a response on April 1st, and my consultation was finalized on April 10th. I asked for their soonest appointment, assuming it would be in September or October because I had a couple of friends who have appointments in June and July. However, I received a response saying they had an opening on May 9th and chose to book it. So overall, it was a couple of months between consultation and surgery, but I don’t think the timeline is usually this quick.

Did you have any concerns going in as someone with other existing health issues?

It was definitely a concern. I have an inflammatory disorder, so there was fear that the impending inflammation could cause me to go into a bigger flare, which has historically impacted my heart and causes severe joint pain. My heart issues were a conversation when it came to anesthesia as well, but ended up being fine. It’s hard with a chronic illness that has pretty unpredictable flares because anything could really set it off. I knew it was a risk, but so far, I haven’t had any complications at all. In some ways, having chronic pain made the worst of the pain still not as bad as I’ve ever experienced. I’d say, so far, the worst of it is the joint pain in my arms and shoulders due to my mobility restrictions for the first 6 weeks.

How, if at all, did it interact with your OCD?

It’s inevitable, really. I went through every “what if” possible. My emetophobia was at an all-time high on the day of surgery. COVID was on my mind. My chronic illness fears were abundant. I asked for far too much reassurance and ruminated a lot, but I did the best I could to practice all of the skills I have to manage my OCD and just communicated with my people as much as I could when things came up.

Did you need any notes from a therapist/doctor about your dysphoria before your surgery?

Because I paid out of pocket, I didn’t end up needing a letter from my therapist, but she did write me one just in case. My advice for this is just to know that we live in a fucked up system, and the pathologizing of existing outside of the gender binary feels gross. But it is what you bump up against when needing a letter about “gender dysphoria disorder.” This does not define your experience or understanding of your gender. The language can feel very binary and icky, but just know it’s all because of our fucked up, transphobic healthcare system and not because there’s anything “wrong.” My therapist was VERY upfront about how she did not feel it necessary to “diagnose" me or make me “prove” myself, but that it was necessary to use language from the DSM to write the letter for insurance to make the approval, had I gone that route.

Did your surgeon have a BMI requirement?

It was not something mentioned to me at all, so I can’t accurately confirm or deny it for my specific surgeon. However, on the day before my surgery, I had to sign paperwork stating that I was considered “overweight” according to BMI, and there could have been possible risks.

Did you pay out of pocket or did insurance cover it?

I paid out of pocket. I wish I could be more helpful with the insurance process or fundraising, but to be transparent, I received some money from splitting the house in my divorce and used part of that to fund my surgery. Had I not had those funds, I likely would have tried to go through insurance and/or saved money over time to afford the surgery.

CARETAKING

Did you have a lot of caretaker support? Is there anything you wish caretakers knew?

I hired a doula that was SO helpful in my recovery. If you are in the Austin area, I highly recommend Court Harris for care and companion support. They helped with laundry, dishes, companionship, company on walks, resource referrals, and even shower support. I also have a partner who also had top surgery to support me and a rich community of queer friends who really showed up. Here are some things I think I wish caretakers/people supporting me knew/some things I am glad I asked for:

• Allow for so much flexibility. It’s natural to prepare by planning hangs or drop-offs or check-ins, but know that energy and spoon levels are so unpredictable, so know that cancellations/rescheduling may happen.

• Folding and putting away laundry is such an underrated care task. It’s more helpful than you know.

• It’s okay if the only thing a caretaker can do is provide company. Sometimes going through recovery can feel really lovely, so just having company is nice.

• Allow for nonverbal hangs. Sometimes, just coworking or sharing space is helpful, and maintaining a conversation can feel exhausting during recovery.

• Consider creating an energy scale to help all parties understand energy levels and what level of support is needed/available.

Was there anything in particular your nurse did to make you feel extra at ease?

• My nurse let me ask as many questions as I wanted to and ask for reassurance often (this is a delicate balance for someone with OCD, of course). I also loved that my nurse walked me through EXACTLY what was going to happen on the day before, of, and after my procedure. I was never in the dark about what to expect, especially on the day in the pre-op room. My nurse was also pre-emptive in asking for what I needed instead of me having to ask for it such as nausea meds, pain meds, and any adjustment of my bed, which I really appreciated.

POST-OP RECOVERY + HEALING

What tools/things did you need?

I have a whole little post about this that I’ll share soon on my Instagram but my top recommendations are a maternity pillow, a pillow wedge/elevated sleeping pillow, extra blankets and pillows, icy hot, thin socks for under the armpits of your compression vest, a journal for daily recovery tracking, a grabber reacher tool, a bidet, and a hand shower. Honorable mentions are stool softeners, bromelain, zinc, and vitamin C supplements, easy-to-prep meals, easy-to-grab snacks, a water bottle you will actually drink out of, a long phone charger, and multiple cozy button-ups.

Did you have any unexpected needs?

I was not prepared for my… inability to wipe my own butt after going to the bathroom. 😅 Get a bidet or find someone who is willing to give that kind of intimate care. I will also say that as my recovery continues, I am realizing that I may need a post-op physical therapist. I am hoping to check out OutWellness here in Austin (a resource given to me by my doula!) to gain back some arm and shoulder mobility.

Side note: one of the best things I did for myself was schedule a haircut for about 3 weeks post-op. Washing and styling my hair the way I like has not been easy and it was really nice to have someone really rub my scalp and style my hair in a way that made me feel cute.

How did you sleep after?

Sleeping has always been rough for me, and I can tell you the first two weeks were rough. What I’ll say, though, is that getting to sleep was the hardest for me, but once I was asleep, I stayed asleep pretty well. Sleeping elevated was not an easy adjustment, but I got the hang of it after a few days! You will too!

How did you navigate sensory needs while healing?

Crying a lot! Ha! But for real, though, let yourself fucking cry it out. It sucks. I’m not going to pretend that it’s easy because it really is a lot. But know that it will get easier and less intense as your recovery progresses. My best advice is to cry, breathe it out, find distractions, and let yourself complain.

If you could talk to pre-surgery Sam now, what would you tell them?

Be prepared to be fucking gentle with yourself! Don’t push yourself! Know that healing is going to take WAY longer than you expected and the fact that you think you’ll feel fine after week one was so delusional! Lol! Also, know that you are going to feel so cared for, so understood, so loved, and so supported. All the fears you have make sense and are rooted in past traumas, but you are not the age of the parts trying to protect you. You can and will heal, in more ways than one.

How are you feeling now that you’re through the early stages of your recovery process?

Emotionally, it’s still a big rollercoaster. There are a lot of big feelings, realizations, and fears coming up about perception, getting dressed, and body changes. Despite these big feelings, I am so happy with my decision. I love my chest and feel more comfortable every day. Physically, the first two weeks were definitely the worst for me, and I’d say the second week was worse because I pushed myself far too hard the first week. I am now about three and a half weeks post-op and I am feeling pretty good! I am still pretty sore. I am experiencing some weird pain I can only describe as painful TV static in my chest and shoulder pain from the limited mobility. But overall, I really have turned a corner and am feeling so excited about being almost 2 weeks away from my restrictions being lifted and easing back into regular movement.

Favorite gender-affirming moment since surgery?

Honestly, putting on a tank top.

Joy Newell

wrote about witnessing this moment and it truly was very special. It’s been amazing to start to be able to wear clothes that feel affirming on my body, even if I still don’t have a full range of motion to wear all that I want yet. Baby steps toward it all.

I’m sure many things will be revealed as my recovery, healing, and exploration continue. I’m excited to share my findings. Until then, I hope this has been helpful and again, feel free to ask any questions in the comments.

🍉 RAFFLE FOR FAMILIES IN GAZA 🍉

I have put together a little bundle of goodies to raffle off to raise funds for Noha, her husband, and their seven children and Areej, her husband, and their three children. They are about 94% away from their fundraising goal, and it’s my hope that we can come together to help them get closer to reaching it.

This family has lost their house, has very young children, and has no access to food, clean water, or even bathrooms. Every single donation will help improve the living conditions for these families, and any not used for everyday living needs will be put towards possible evacuation needs, as the families feel this is in the best interest of their children’s lives.

RAFFLE RULES:

• One ticket is $5 (you can get multiple tickets) 

• Send to @samslupski on Venmo or samslupski@gmail.com on PayPal with your Instagram handle or email and a watermelon emoji in the “What’s this for?” section

• The raffle will close on June 10th

• A winner will be randomly chosen through a random name picker

• I will send you a DM or email for your address when a winner is picked (again, remember to put your handle or email in the Venmo or email)

• I will match the final donation total up to $200

• I will post the donation receipt as soon as it is sent

• If you’d rather donate directly, find the link here.

Thank you for entering! Please share and spread the word, and if you haven’t already, please follow Operation Olive Branch.

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