On July 26, 2010, I had a bilateral peri-areolar mastectomy with purse-string with Dr. Medalie in Cleveland Ohio. I have moved all of my posts on the topic to this page.
I have just over 2 weeks before my top surgery (I can’t believe it’s so close).
To prepare for surgery, I’m going to start working on my body and mind. I’ve done a lot of research on this and here is my plan.
I’m going to try to eat a high-protein diet with high fiber and as little junk food as possible. This means absolutely no more coffee rolls from Dunkin Donuts. I’m going to drink more than 2 liters of water every day, and I’m cutting back on caffeine and sugary drinks like soda. I’m not drinking any alcohol. I’m going to avoid things with extra ginseng, garlic, gingko, kava, and valerian root. And I’m not going to take aspirin or ibuprofen, and am going to only take acetaminophen when I absolutely need to.
I’m going to take supplements with lots of Vitamin A, C, and E. It has been recommended that before surgery you also take Bromelain and Shark cartilage, but I don’t have that and am not spending the money on it.
I’m going to do 30 minutes of aerobic exercise every day, with weight-lifting when I can. I’m going to focus on my core, so my abs are strong to help compensate for the lack of use of my chest and arm muscles. I’m going to make sure I’m getting good and regular sleep, and staying as unstressed as possible.
I’m going to do relaxation and/or meditation exercises for 30 minutes daily, and afterwards envision myself after surgery, with a flat chest, recovering well and feeling good, comfortable, and happy.
I’m also going to remind myself of my intentions in surgery whenever I start to get worried about it. IE “This is going to change my life for the better - I’m going to look in the mirror and love my new chest,” etc.
PS - I don’t smoke, but if I did, I would obviously stop that immediately.
Homeopathy:
I’ll be continuing these for a week after surgery, too. There are others that are recommended, too, but I can’t afford all of them. It costs 6.99 for enough of each of these to last just over a week.
Oh also, someone asked why I was avoiding gingko, garlic, and ginseng. I’m just avoiding things with extra of those products because they can interact with the body’s natural recovering processes. Those three actually inhibit blood clotting and/or affect blood sugar.
Kava and Valerian can impact the effectiveness of anesthesia or sedatives, so I’m also going to avoid herbal teas that use those as key ingredients.
He seems great. He was very confident without seeming arrogant ortoo confident. He answered all of my questions, did not rush me off the phone, and spoke with me for a while about DI vs. peri.
I have decided that I want to go with peri. He seems very confident in his results, particularly with my body type. When we talked about breast tissue he said that with my type of chest, he would be able to remove the same amount of tissue that he would through DI. He pointed out that this is different from the type of mastectomy that a breast cancer patient would have where they remove 100% of the tissue. That would result in a concave chest and is not what is done even in double incision surgeries. This was a misconception I held.
He was honest about nipples not being necessarily smooth or perfectly round (especially in the first 3-6 months) but said that his purse-string technique allowed for good placement and since I was so thin, I did not have a lot of excess skin to worry about. Additionally, my nipples are on the small side, so they will not require much trimming down.
The procedure itself is only 2 hours wow! He said he has never had to admit anyone to the trauma center for this operation. And the only complications he has had were bleeding related (and still only 6 in the past year despite him performing this surgery multiple times a week) and required very minimal OR intervention.
He is going to meet with me and my parents before and after the surgery (“for as long as [I] need”) and he said my parents could stay with me all the way through surgery prep - i.e. until they take me in to go under. This all makes me feel feel much more at ease, because I know it will add to my comfort and help my nerves prior to surgery.
He went over the type of pain and anti-nausea meds I will take and walked me through the process from arriving at the surgery center to my follow-up appointment.
He also told me that I do not need to stop testosterone. Some surgeons require or suggest that their patients do this. He said that occasionally if someone is due to take it RIGHT before surgery he will ask that they wait, because it slightly increases the risk of blood clots (in the legs) during surgery. But I am actually due for a shot today so it’s almost as far before surgery as it could be. And he said he’s never had anyone have a clot during this surgery - it’s a short surgery and they have special boots that move and compress yr feet and legs to prevent this (I assume this in common in most ORs).
Additionally, I had some concern because my breast tissue is somewhat “lumpy.” I’ve never worried about it being malignant (though I sometimes call my big lump “my cancer” which may be a subconscious way of expressing my anxieties…), but I did ask him to go ahead and send my tissue to pathology which he was more than happy to do (we just have to pay the pathology fees which are $400 - small price to pay for peace of mind). He said that the lumpiness didn’t affect his end of the procedure at all.
YAY SO EXCITED> And I am feeling really good about my decision to go with Medalie.
I was actually confused about what peri areolar is. I thought it was the same as keyhole, as the terms are often used interchangeably, but they are actually two different kinds of surgery.
With peri, the incision is made around the areola and the nipple itself is detached from the skin entirely. Then the surgeon uses a scalpel to remove the breast tissue (in keyhole, only liposuction is used). This allows for the same amount of breast tissue to be removed as in a double incision. The thing that makes it ideal only for smaller breasts is the issue of excess skin. Dr. Medalie described the purse-string technique that helps to tighten the skin into a flat chest. If you have larger breasts, there will be too much skin to trim down and tighten.
Anyway, the reason I did not want to do peri was because I was concerned about the amount of breast tissue that would be left and about the placement of my nipples.
Speaking with Dr. Medalie and understanding the actual methods and results of peri made me feel comfortable that it would result in the chest that I want.
Hi everyone - as I write this, I am exactly 7 and a half hours away from top surgery. I am arrive at the surgery center tomorrow at 6:45am! I just finished the last glass of water I am allowed to have before surgery..
It’s funny because I’ve started thinking of the things I’m doing as this being the last time I’ll ever do them with boobs. It seems appropriate when I’m taking off my binder to think “This is the last time I will ever wear or get out of a binder,” but I’ve also been doing it all day with random stuff. For example: “This is the last glass of water I will drink while having boobs,” “This is the last train I will ride with boobs,” “The is the last time I will sleep with Seuky (my teddy bear) with boobs,” etc. It’s kind of awesome.
I am feeling very calm. I think I have allowed myself the time and space to think things through and really be at peace with everything. I have repeatedly envisioned the process of getting prepped for surgery and going under and envisioned myself waking up from a successful surgery and seeing my family. This has eased almost all of my pre-surgery jitters.
And on the front of “being sure this is what I really want” as my grandma put it (her intentions here were mostly good, by the way - I’m taking it out of context), I have never felt connected to my breasts. They have never been something I have wanted to flaunt or cared that much about, though I was proud to have breasts that were shaped the way Cosmo tells people boobs should be. And wanting to hide my breasts, and even talking about wanting to not have them, is what prompted me to really start examining my gender identity. I’ve been binding for just over a year and I have no doubt that if I never had surgery, I’d be binding for the rest of my life. I have learned to look my past my chest in the mirror - in fact, I think I’ve been doing this for years, but it will make it a lot easier to see “the man in the mirror” (haha) once I move forward with this. I have no doubts. Absolutely none. And trust me, I really let myself think about this honestly. I didn’t want anything secretly floating around.
I feel so positive about this part of my journey. And honestly everyone’s support has just made this feel so great. I feel like I’m about to run through that piece of ribbon at the finish line. That’s actually exactly how I feel. It’s not that I see this as the end of my journey; it is not the end of any of my journeys. But it is a goal and an important milestone and it’s also significant in practical ways, too (i.e. being read as male more often). And I think of all of the messages I’ve received, from friends, my girlfriend, strangers, family, tumblr followers, etc. as people cheering from the sidelines as I’m thrusting my chest forward into this ribbon with my hands in the air. Now I’ve got an image of that song Chariots of Fire playing (dun-dun dundun dunn dunn..). I may listen to that in the drive to the center. But really, I can feel all of yr positive energy, thoughts, and prayers.
Another thing that is really giving me strength and excitement and a feeling of triumph in all this is that I can use this experience to help others who are considering a similar path in their transition, or to anyone who likes a good story of working hard to become who you really are. Knowing that this will not only benefit me but hopefully others in the community gives me a kind of peace and courage that I can’t describe.
My parents are both here in Cleveland with me (my dad decided to drive since we couldn’t really afford a third plane ticket), and they will both be in the waiting room or near by, and my mother’s cousin’s husband who is so generously putting us up and taking care of us this week (and is an awesome pastor) is coming with us, which I think will really help my parents, though they tell me they are feeling pretty good about this :) I showed my mom how to update tumblr so she will hopefully be posting on here when I get out of surgery just to let everybody know I’m okay (though there’s not much of a risk that I won’t be :P )
Thanks for all the support everyone - I’m going to try to sleep now! Oh, also, I am going to try to make a video as early as I can so I’m all drugged up and stupid. :D
Much love! Aaaaahhh I’m so excited!!!
So I’m back home. I’m tired and the vicodin makes me feel stoned (duh), but I’m feeling surprisingly good. I’ve been feeling good since I woke up. The nurse said she had never seen someone come out of anesthesia so well, so that’s good to hear. It seems like my body and mind preparation was really good for me.
I’ll write more later - I just wanted to check in, because my parents couldn’t unlock my phone to do a mobile tumblr update as planned. You can’t see the drains in the photo but they are way less nasty than I thought they would be.
In the recovery room, they gave me crackers and ginger ale and water, and on the way home, I got a mango smoothie and I had some homemade bread with butter once I got back. I am living like a king haha. I’m sore, but I don’t expect anything to be intolerable with the vicodin. I’m having to get used to my limitations - It’s hard for me to lift the computer, and I couldn’t open my pills because I couldn’t apply the strength necessary to push down on the cap haha. But I can’t get over how great I feel. More on the surgical center and staff and process later. I’m going to nap.
But Dr. Medalie was very nice and I was comfortable the whole way through. :D Now let’s just hope for good healing and that the swelling goes down as fast as possible so I don’t have man boobies. :P
PS I took a video in the car that I will put up in a day or two.
Thank you everyone for yr thoughts, positive energy, good vibes, and prayers. It REALLY helped me - I went into all of this feeling good, and I think that’s why I was able to come out of it feeling so good, too.
Here is the story of my pari peri- (you can see the effects of the vicodin already haha - I promise I’m not that out of it) areolar bilateral chest surgery with Dr. Medalie.
I arrived at the outpatient surgery center at 6:45 in the morning. My parents both drove me over and waited in the waiting room.
I went back with the nurse to the changing rooms where she took my blood pressure, pulse, and temperature and gave me a gown to put on (two actually, so my butt wouldn’t be showing which was nice). Once into the gown, she messed up my pronouns a bunch. She’s not Medalie’s nurse, but a prep nurse for the MetroHealth outpatient surgery center. I think knowing that she had to ask me about menstruation and I was strikingly less masculine looking in that gown… it threw her. It didn’t really bother me, but I can see how it would bother someone else. She did have to ask a few times about pregnancy, but I get it - it’s actually a legal thing for them.
Then she took me out into the prep room, which was a big room with three or four surgical chairs separated by those hospital curtains. Dr. Medalie came out and looked at my breasts and did markings. He expressed concern, because the volume of my right breast was bigger than he thought from the pictures. We talked a minute about maybe doing incision for that one, or doing double incision, but I had pretty much already resigned myself to peri - the benefits and the more negative aspects. And he said he felt confident that he could do a good job with it, because it was still not too big and I have good skin elasticity, but he told me it would bunch and swell more and take longer for everything to settle down. I suspect I’ll have a bit of a man boob looking thing over there for a few months. And you know I may end up getting a revision in the future- none of this upsets me. My big thing was removing the boobs. I am comfortable enough with myself that I won’t be embarrassed by a slightly different chest should things come out a little funky for a while. And I won’t need to bind!
Dr. Medalie was reallly really nice and calm and in no rush, which was nice, because being in that big room had the potential to make me feel like I was on an assembly line of sorts haha. But he really put me at ease. After I spoke with him and signed his waiver, I met the anesthesiologist, Dr. Joy, who was a little more typical doctor - seemed in a hurry, and kind of full of himself. We went over my medical history and talked about what he would be doing. He was nice though, and when he double checked that I knew the consequences of being pregnant under anesthesia (since I had chosen not to take a pregnancy test), he apologized ahead of time and said he was required to ask it of all his patients. Then I met his assistant Joe who was dorky and funny and awesome.
Once they left I started envisioning that finish line thing I wrote about yesterday. My prep nurse put my IV in (ouch! but she was good so it could have been worse) and got my parents to come back to stay with me until I went into the operating room. I put on my surgery cap (read: giant shower cap) and was walked to my surgery room by Dr. Medalie’s nurse (who used correct pronouns and was very nice). By the way, at one point later someone in the room said “her” and Medalie immediately corrected them.
As we walked over, the nurse asked me if I was ready? And I said yes. And I was. I was very ready and felt ready.
Once in the room, Dr. Medalie’s nurse and Joe, the anesthesiologists assistant, went over what they were going to do, got me situated on the table, spoke to me very calmly and nicely - even made jokes. They put these boots on my feet and legs that essentially massaged my legs to prevent blood clotting - they were very comfortable. The room was a nice temperature. Joe helped me out of my top gown and untied my bottom one without exposing me until I was knocked out. I was on the table for maybe 3 minutes total before Joe said “here’s a cocktail” and put the stuff to knock me out in my IV. I didn’t even have time to get nervous! And everyone was so assuring and calm (even just in their tone of voice) that I was very comfortable.
I remember thinking, “Well I’m not feeling tired yet - I wonder how long this takes.” And I must have gone out right after that haha.
Oh, also, they apparently put something in my IV to help with nausea, since most people are sensitive to anesthesia.
Next thing I knew someone was gently saying “Sebastian,” and I was in the recovery room (another big room with multiple bed-chairs separated by curtains). I woke up and it just felt like waking up groggy - I wasn’t dizzy and my vision wasn’t terribly fuzzy. They offered me water and ginger ale (I had both) and cookies and crackers (I had Ritz). Nancy was my recovery nurse and was very nice. Although, I think I would have thought everyone was nice at that point. I was just so happy and also drugged :) Everything was great. I was required to stay in the recovery room for an hour, even though I was basically able to leave after 30 minutes. I didn’t mind. The nurse walked me to the restroom (me having to pee was apparently another good sign). I went a head and took one vicodin while I was there.
Nancy brought my mom back to see me and showed her and me how to empty the drains and record it. Apparently the nature of the surgery or wounds suggested to Medalie that I would likely be able to have my drains out earlier than normal, so I changed my follow-up appointment to Friday instead of Monday. The drains didn’t gross me out nearly as much as I thought they would (I have photos for anyone curious - just give me yr email in my ask box or in the comments - I won’t publish it) and my parents went through this twice with my mom in 2009 because she had bilateral mastectomy and reconstruction surgeries…. so they are total pros at all of this.
After that, Nancy walked me to the changing room, got the key for my locker where all of my clothing had been put. My mom helped me put my clothes on - I just put the sweatpants and jacket on rather than trying to get a shirt over my head.
I walked out and my dad was waiting for us with the car. The 30 minute car drive went very quickly - I was feeling SO GOOD.
We picked up my prescriptions from a local CVS, where I had to give them both my names (Sarah and Sebastian) because my insurance hasn’t been changed yet and my prescriptions were written for my legal name. The pharmacist didn’t seem phased at all!
We also got a mango smoothie from Whole Foods :)
I came back to the house where we are staying and had some homemade bread and butter, spoke with my family for a bit, and got on my phone or online (it’s a little fuzzy). My dad had already set up my bed with these special cushions my mom used to help her sleep on her back and slightly upright when she was in recovery. So I was able to get in bed and I fell asleep somewhat quickly and very comfortably.
I’ve been napping throughout the day, but haven’t been totally out of it, and have carried on normal conversations well (I’m told) and haven’t gotten sick to my stomach at all. I had a milkshake and risotto, and have been munching on club crackers whenever I take my vicodin. My dad also got me my favorite Dunkin Donuts iced coffee just how I like it :)
I’ve been taking one vicodin every 2 hours (They say 1-2 every 4 hours as needed), and hopefully will only need one every 4 hours tomorrow.
All and all everything is great. I can’t believe there aren’t boobs under this vest. I have to wear the vest until the drains are removed, by the way. I’ve been talking to friends and family and Maia. My parents are incredible caregivers. And my mom’s cousin and her husband (with whom we are staying) are really great and super accommodating. They also have the complete disney collection!
So I know I overshared here, but I wanted to include everything people might have questions about. Feel free to ask anything, though.
not much to update. getting tired of being “in recovery” already. I’m sleepy and my head feels weird sometimes and I am constantly taking pills and can’t move around much. I am a little out of it and I get mild headaches.. But it’s okay. And I’m grateful that I’m doing pretty well. I’m just getting a little stir-crazy. If I’m up for it, I’m gonna go somewhere with my parents tomorrow - maybe for ice cream.
I’ve started taking advil now, had to wait a bit because it thins yr blood I think. So I’m down to taking 600mg of advil every 6 or 7 hours, and 1 vicodin (5mg hydrocodone/ 500mg acetaminophen) every 6-8 hours. I am also taking 2 colaise a day (one in the morning, one in the evening), and magnesia for constipation (unfortunate side effect of the vicodin). I’m making sure I eat every time I put something in my body, and I haven’t gotten sick to my stomach.
Dad is emptying my drains twice a day, though he may only need to do it once today.
I still can’t believe I had this surgery I’ve been wanting for so long! I don’t think it will hit me until I go in for my appointment on Friday.
Today I had my follow-up appointment and the big “reveal” !!!
I AM SO HAPPY with the way everything turned out. My nipple placement and size is perfect and there is no excess tissue as far as I can tell! There is pleating and bunching around the nipple, because the skin is reattached using a “purse-string” method in the peri-areolar surgery, but that will go down over time. For now, it is just super important to keep my chest compressed, because the drains were removed. My body will absorb the fluid, but we have to “encourage” the absorption by not letting there be any room for swelling.
I’m hella drugged up right now because I took a full dose of vicodin :P but I can tell you that I’d be feeling really amazing anyway.
Pictures are after the jump (my nipples are purple-ish but otherwise it’s not very gruesome at all). Thanks again to everyone!
….
And just for comparison:
I’m wearing the compression vest for another 9 days, and applying bacitracin to my nipples and the incision/stitches around the areola twice a day.
I ended up getting sick last night for the first time. And though I hate to admit it, I think it was partially because I was kind of grossed out rubbing the ointment on my nipples and looking at my not-yet-healed chest. It was also because I was feeling so good yesterday that I ate crap and drank sugary stuff all day. But yeah I was doing my nipple-care and next thing you know I was about to pass out…
Anyway, I don’t think anything is going to change much until it starts healing. I’ll put new photos up in a couple weeks when all is healed, but for now I’d like to get back to the main focus of this blog, which is not following my chest, but talking about gender issues and identity and answering you guys’ trans-related questions.
Thanks again SO MUCH for all the messages of support and well-wishing.
I am 3 weeks post op and have had a major nipple complication. I had blood supply problems and my right areola and nipple have died. It is unclear whether or not new nipple tissue will grow. If not, I will need a revision to reconstruct or tattoo a nipple on. This is a risk of peri, but I had never heard of it happening, and it is pretty rare. Other than that, my chest i doing great. Here is a picture from today with the dead nipple pixelated out.
This is what I wrote about my experience dealing with Medalie’s office and the nipple:
Okay, so I am… 17 days post op at this point and I’ve had a pretty rare nipple complication. My right nipple has had blood supply problems and I am essentially going to lose that tissue. They aren’t sure why it has happened and Dr. Medalie’s nurse said she didn’t think she’d seen it with a peri patient. I’m not entirely surprised because I’ve never considered myself a super healthy person - my body is just a little more sickly than most. But this means that my right nipple will literally “sloff off” eventually, and the tissue will have to regenerate. We can’t be totally sure what it will look like when it is fully healed (which is going to take a long time I think), but it will most likely look like a normal areola/nipple with an extra scar ring around it. She said this can be easily fixed in revision if it is something I so desire.
I actually had a friend who freeze-dried his nipple on a dare and the same thing happened to him. And as far as I know his chest is pretty normal looking. It’s just too bad because it’s going to take a long time to heal and the idea of seeing my dead nipple in the shower one day makes me a little whoozy… The other one is looking great.
And honestly I am now more happy with my decisions to go to Dr. Medalie than ever. Their level of communication with me has been great and they have gone out of their way at every step to make me feel at ease, even as I’m looking down at a nasty looking nipple. Medalie himself is out of town, but his nurse practitioner has been in constant contact with me, via email and phone, even when she is not in the office (through their secretary Valeries) and said she’s already prepared a new file on this for Medalie and they’re going to go over it on Monday and let me know if there is anything else I should be doing.
To be facing the loss of a nipple 6 or more states away from my surgeon is something that I think would generally be giving me a lot of anxiety, so I’m feeling 100% confident in my decision to go with Medalie, whose office has kept me sane and calm through it all.
