#ghostsurgeryseries

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FTM Top Surgery Q&A - Installment #1

Operation Day Process and Experience

I posted a few weeks back that I'm doing a Q&A / Series combo for FTM top surgery as a large, disabled guy with ADHD and low income. If you want to know more about it, check out the announcement here or visit the installment masterlist here. The list will be updated when each installment is posted and I'm accepting questions to incorporate into each installment until May of 2023 when the series should have its final installments written.

For the first installment, I'm going to cover the operation day process and experience so that people who aren't sure how it all works, or those who have never had surgery before, can know what to expect.

This installment will be all about body preparation, surgery time, what happens at the hospital beforehand, and the direct aftermath of the operation. If you're interested in how to prepare your home for surgery, or want to know more about the results and recovery, you'll be interested in the pre-op environment preparation and progress installments, respectively. The preparation and the 1-week progress installments should be posted within the week and will be linked in the installment masterlist.

I'm going to write this as I experienced it, but different doctors may operate differently in their surgical procedure, so don't expect your experience to be an exact replica of mine.

So, without further ado

Pre-Op Preparation

There are only a few things, outside of environment preparation, that I had to do before surgery.

Earlier in the week I had to get a pre-op COVID test and I also had to pick up my antibiotics, pain meds, and anti-nausea meds, which were prescribed ahead of time.

The day before, I was given a time in the afternoon to call and get my surgery time for the next day. This is because they sometimes have to move surgeries around so they don't know until the day before. Luckily, they called me instead, so that was a help to my nerves.

After midnight, I had to fast, which would have been easier if I'd slept, but I had food prep to do, so I ended up just staying up all night. Let me tell you: worse than the exhaustion was cleaning and slicing 2 massive containers of strawberries without being able to eat a single one. Would not recommend lmao.

And, finally, the morning of the operation, I had to wash the surgical site with a soap they'd given me at one of my pre-op appointments. I can only assume it's some special antibacterial or something. I was told, after showering, not to use any kind of lotion or deodorant or anything like that.

They said I could use the soap and shower the night before if I wanted to but, considering you aren't allowed to shower for a week after surgery, I recommend doing it right before.

Then it was just a matter of putting on some loose clothes and heading to the hospital. Make sure to wear or bring a button-up shirt with you. I ended up having a bit more arm movement than I've heard others do, but I wouldn't count on your experience being the same. It's possible that this is related to my stretchy EDS skin making it possible to reach further before it starts to tug at the surgery site. Either way, it was a relief to know I didn't have to worry about it and made getting dressed with help a lot easier.

Arrival and Immediate Pre-Op Preparation

After I got to the hospital and checked in, I had all of my information confirmed and was given a hospital bracelet. After much waiting around in different places, I was finally taken back to the pre-op area where there are different alcove rooms with curtains for doors.

I think pretty universally, they're gonna make you give a urine sample. They do this for pregnancy testing, and I'm pretty sure whether you've had sex recently or not is completely unimportant to them. So, if you kinda have to pee but aren't on the verge of pissing yourself, just hold it. It will make this go faster.

After I'd given my sample, I was taken to one of the little pre-op rooms and instructed to undress. The nurse generally leaves the room for this so you'll have some privacy. I was given a couple of clear bags to put my clothes and shoes in and a gown to put on, and was told to get onto the bed after I had done that.

There was also a weird foil blanket to pull up. These foil blankets have holes that can be plugged into and are filled with warm air while you're being operated on to keep you warm and improve circulation. They're much less nefarious than they look.

After that, I had a nurse come in and confirm all of my information again. If you take a bunch of meds, make sure you know them by heart or bring a list of them with their dosages. If the nurse is missing one on your chart, you'll want to be able to give them what they're missing. Med lists are really important, especially before general anesthesia, because certain meds have interactions with anesthesia or other things they put in your IV.

Tell them about vitamins and supplements too. I can't stress this enough: anything you are putting into your body can potentially interact harmfully with stuff they're using and can literally kill you. As long as they know what you're taking, they can be sure that none of it will and it will be no problem. This includes illegal drugs. They don't care that they're illegal, they just don't want to kill you because you didn't want to mention you're doing coke or are an alcoholic. They have things they can give you to prevent withdrawal as well, because that's not good for you either.

After a long time of this checking my info and asking me questions about when the last time I ate was, another nurse did an EKG (I think that's the right acronym - I always mix up the different acronyms for looking inside of you in one way or another. Anyway, they put some sticky things on your chest and such and print out a scan, then remove them)

The IV was next and wasn't Super. I'm pretty used to getting jabbed for various things, including IVs, but the direction she put my IV in had it pulling a bit upward on my skin which was uncomfortable, but oh well. It wasn't the end of the world.

If you've never had an IV before, my best advice is, don't look, take deep, slow breaths, and remember that the pain is only temporary and that you just have to get through a couple of seconds of it before things are back to normal. Keep your arm and hand relaxed. The more tense your muscles are, the more it will hurt. If you faint from needles, tell them this. They'll use a smaller needle that will be slightly less painful, and, perhaps more importantly, much easier on a psychological level.

Once all of that was done, the anesthesiologist came in and asked me some questions, then had me sign off on a consent form.

The last thing in that room was my doctor coming in to mark my chest and ask me some questions about preferences. She made a line down my sternum and some curved lines under and on top of the breasts to show where the incisions would be made. Then, because I opted for a free nipple graft (that's free like separated, not free like no cost), she made markings where each one would end up. This is where your input is important. You can give direction on size and location. If you don't like where your doctor is marking you, say something, for the love of god. This is your body. If you've ever needed to assert yourself, now would be the time.

Once she was all done marking things with her bio-safe marker, she had me get back into bed and that was that.

The Painful Stuff

I bet you were nervous about that heading, but nah. All the painful stuff is gonna happen in another dimension. You will be Gone.

After the pre-op prep, they wheeled me to the operating room. When they say they're putting something in your IV for anxiety, it means you're gonna get stupid. I thought he meant something and what he meant was Something.

They had me say my name and date of birth to the other people in the OR and then had me state why I'm there - this part, I'm not sure if for security reasons or for their own amusement, because not ten seconds after he put the Something in my IV, my response was, "I'm getting my tiddies cut off!" Then immediately leaned over to the nurse and said, "Does that stuff for anxiety make you say stupid shit?" and she laughed with all the glee in the world and said, "Uh huh. This is my favorite part."

They lifted the bed and wheeled it right alongside the operating table (which is also just a narrow bed) and had me scoot over onto it, and honestly, from there I have literally no memory. I think they asked me about my boyfriend or something and then I was under.

Post-Op Aftermath

If you've never been under general anesthesia before, it is like taking a time machine into the future. Idk if it's just because I don't sleep like a normal person, so this is extremely fun and bizarre to me, but it's super fun because you will have little to no recollection of falling asleep and then you will suddenly be waking up with nothing in between.

When I woke up, I was only a bit sore because they'd put pain meds in my IV ofc. I felt a bit like if I moved too much I would hurt myself, but staying still wasn't really painful. There was just kind of an ache.

Straight up the most painful part of the operation for the first few days is the sore throat from having a breathing tube. Make sure you keep tea on hand and I recommend some cough drops if you can get them.

In previous experiences with general anesthesia, I woke up very quickly and was fully awake when I did. This time, I was very slow to come out of it, maybe because this procedure lasted longer than the others I've had. Also possibly because I literally didn't sleep the night before.

A nurse told me while I could barely keep my eyes open that I needed to eat some crackers so she could give me my pain pill. I told her I needed a few minutes because I was so half asleep that I could barely keep my head up, let alone eat something.

I was hoping the pain pill would be chewable, but no luck. My throat hurt really bad and I was afraid I would choke on it, but after eating some saltines and drinking a bunch of water, I managed alright.

From there, I had some time to lie there and wake up more. Natural first reaction: immediately feeling my chest and being overwhelmed with relief. I pulled the binder out a bit to look under it. It was mostly gauze and stuff blocking the view, but I could see enough.

After I'd had a bit of time to wake up and eat some more crackers, she let me know she was calling my ride home and helped me get dressed. Then she gave me a note where she wrote down what time I could take my next pain pill and antibiotic after I got home. After that, they brought a wheelchair and walked me out to the car where it was waiting at the pickup drive-through.

I was a little bit unstable on my feet trying to walk up the stairs when we got home, but holding the handrail was enough to keep me balanced. I was a bit dizzy and nauseated from standing upright while going to the bathroom and getting my shoes off and whatnot so I took one of the anti-nausea pills. That was the only one I needed during the whole recovery, so I guess I have those on hand in case I need them some other time.

From there, I just laid down and went the hell to sleep lmao

My 1-week post-op recovery and progress installation should be out in the next few days, so check the installation masterlist if you want to read about the first week of recovery and see post-op pictures.

Also don't forget to send in some questions to spice up the series!

[ghostonly]

FTM Top Surgery Q&A Announcement

- For Larger Lads, Disabled Lads, Lads with Ehlers Danlos, and Lads with ADHD -

Hiya! I'm going to be having double-incision top surgery on the 27th of April and, being that most top surgery Q&As and information online seems to cater mostly to smaller and more abled mascs, I feel like I'm in a uniquely important position to be able to share information for those of us who don't get our questions answered as easily.

Things About Me That Will Impact My Surgery and Recovery:

I'm a large guy (about 260lb) with a big chest - For Now >:)

I'm disabled, which, relevant to healing and recovery, means:

I have very limited energy and am fatigued very easily

I have undiagnosed EDS or an adjacent disorder which means my skin acts weird, heals weird, and is really sensitive and weak

It also means my joints don't stay in place the way they should, which leads to constant pain (in one area or another), inflammation, and partial dislocations many times per day

I have POTS, which, in simple terms, means changing position in certain ways has a massive impact on my heart rate

I have a lot of muscle soreness all the time for unknown reasons (might be Fibromyalgia, but I'm not sure and not diagnosed with anything yet)

I have IBS and a number of food intolerances which means antibiotics will impact my already touchy diet

I've got moderate persistent asthma which can be triggered by what position I'm lying in

I have ADHD, which will impact my recovery due to executive function issues, difficulty with falling asleep, etc.

I have roommates, but will be attempting to handle the bulk of my recovery by myself, as I'm not super close with any of them

I'm poor, so how I approach recovery will be very money-conscious (I'm not going to be ordering food every day, unfortunately 😔)

Q&A Series Installments

Because I'm in a position to be able to provide much needed insight into the experience of having top surgery for those with similar disabilities or weight, I plan to put together an extensive Q&A series.

The series will include these general timeline installments:

Operation day process and experience

1, 2, 4, and 6 Week post-op recovery progress and results (with photos)

3, 6, 9, and 12 month recovery progress and results (with photos)

As well as these more specific installments, which I'll post when convenient in the first couple of months after surgery:

Advice for handling recovery with ADHD/executive dysfunction

Pre-op environment preparation for disabled people - post-op wisdom and hindsight included

Post-op comfort and positioning advice for people with joint and/or pain issues

Incision and scar care for people with sensitive skin and/or EDS

Final Q&A

All of the installments will include relevant submitted questions and answers.

Any questions that were sent after the installment they would have fit into, or those that are more miscellaneous, will be posted and answered in the Final Q&A installment

If you could benefit from this Q&A, whether you share my disabilities or not, please send me questions!

Askers do not need to be disabled or fit into all of the categories I listed myself in. Even if you're skinny and abled, if you have questions about top surgery and recovery and this is the opportunity you needed to ask them, please do!

All questions asked will be saved until the installment relevant to them, then quoted and tagged. Anons are welcome.

Q&A Question Rules & Guidelines

Asking people to send me questions would turn into a nightmare without some boundaries, so here are some general rules and guidelines for sending in questions:

Do not ask for nude Before pictures. In fact, this one is so much of an obvious No that, if you do, you will be blocked. I will post a before with a shirt on in my progress installments.

Do not ask basic questions that can be answered with a 2-minute search. (e.g. "What is double-incision?" If your question is more specific or experience-based, I'll treat it in good faith (e.g. "How do I know if double-incision is right for me?" or, "How do you find a doctor who does double-incision?") Both of these could probably be answered with a search but aren't as simple and allow me to actually give my input rather than state a definition.

Keep sexual questions respectful and appropriate. I'm not completely against questions about sex if it is related to how top surgery affects things, but they need to be respectful and it should be clear you're not trolling in some way. Sexual questions will only be accepted off anon, but you can request to remain anonymous and I won't put your name in the post.

Refrain from asking anything related to law or medical practices. I don't have a list of resources to offer and I know there are others out there who do. I don't want to send anyone in the direction of outdated or unreliable information. If you want to know about my own experiences with insurance, qualifying, and getting my appointment, DM me or send me an ask off anon so that I can reply privately and see who's asking. I won't give specifics about my location and doctors in an open post.

I look forward to writing all of this up and, the more asks I get, the more robust the series will be! So send in your questions.

I'll tag each installment as #ghostsurgeryseries, so you can follow that tag if you don't want to miss any, or follow me. This blog is only original posts or reblogs where I add a substantial response, so it's low output and mostly unrelated to fandom (I have a couple ofmd posts but otherwise it's mostly about disability, adhd, and miscellaneous stuff)

Thanks for reading!

[ghostonly]

FTM Top Surgery Q&A - Installment #2

1-Week Post-Op Recovery and Progress

Welcome to installment #2! If you're new here, I'm currently working on a Q&A / Series combo where I outline my experience with FTM top surgery as a large, disabled guy with ADHD and low income. I'll also answer any questions sent in to me. Currently, I haven't received any questions. If you have any now or when you're done reading this post, feel free to send them to me. I'll be taking questions all the way until May of 2023, when the series should be wrapping up.

If you want to know more about the series, check out the announcement here or visit the installment masterlist here.

For this second installment, I'll be covering the first week post-op, what it was like, what changed, and so on. There will be progress pictures included.

Content Warning: There are photos under the cut showing incision sites from as early as a couple of days after surgery. If you're squeamish or triggered by blood, scars, wounds, bruises, or just a generally beat-up looking part of the body, I recommend skipping to a later installment.

If anyone is interested in reading my notes without looking at pictures, please let me know and I'll copy the commentary to a new post with the images excluded.

This installment should be the longest of the bunch, since it introduces so much starter information. If the length is overwhelming, fear not; the others won't be as big.

So to start, here's me after I got home! Very tired and sore

Sore Throat

The worst part of the first few days home after surgery was the sore throat from the breathing tube. The best remedy for this was drinking tea constantly. I kept a bit of a side-bar on my bed with a folded up blanket where I had my med basket and set up a hard surface to keep drinks on and this spot was occupied by a glass of hot tea about 90% of each day and night.

I know a lot of people prefer cold on a sore throat over hot but, looking it up, I found a couple places saying warm fluids are more helpful in the long run. I found this to be true. Ice cream felt amazing in the moment because the cold numbed the area, but the hot tea relaxed my throat and made the soreness go away longer.

Pain Levels

I was on oxycodone-acetaminophine for the rest of the pain and it worked pretty well. Everyone I told about this (3 others who had had top) was like, "Oh, they gave you the good stuff," and then went on to say that they hadn't used the pain meds as long as they were allowed to, which I did not understand.

My pain levels after surgery seemed to be a lot higher than those of my friends who had had top done. The original prescription of pain meds was enough to last about 3-4 days and they gave me a second prescription as well. All in all, I was on those meds for about a week and I was in misery when I had to go off of them the following Wednesday. If this ends up being your experience, ask your doctor if there's a pain medication halfway between opioid and over-the-counter that they can prescribe. Mine prescribed me a synthetic opioid called tramadol. I was too late to pick it up for it to be there when I needed it, which is why I wish I'd known to ask for this ahead of time.

My pain levels were manageable, but not pleasant, even on the pain meds. Aside from my throat, the worst pain was actually the drain exits, followed by the nipple bolsters, then the incisions. I'll get to these in more detail in a moment.

The Compression Binder

After surgery, you get wrapped up in a compression binder. I think there are other types of post-op binders, but mine is plain white with one vertical end lined in about 2 inches of velcro (so it's strong and won't come undone)

Most doctors insist you wear this for a month post-op, ~24-hours a day, but some say 2 weeks or 6 weeks. It depends on what doctor you go to. Mine wants me to wear mine 6 weeks. By the end of week 2, I was about 90% sure I was not going to do this, but now that my drains are out, I think I probably will. More on that in the 3-4 week installment.

The Drains

While there are some cutting edge top surgeons who will operate without using drains, they're still the default.

Post-op drains are basically rubber bulbs with a thin, squishy, rubber tub that runs in through the skin and into the surgery site to collect fluids. This is because your body is pissed that it's been fucked with in this particular manner and sends all kinds of water and shit to collect there, presumably in an effort to heal it faster (which it doesn't).

The content of the drains has to be measured daily, which is a pain in the ass but, ultimately, not a big deal. They give you a little sample cup with measuring marks on the sides.

To measure the fluid output, you just pop the top off the bulb (the container at the end of the drains) and pour it into the sample cup. After checking the amount on the side, you dump it into the toilet. Then you repeat with the other bulb and write down the output on a piece of paper.

My doctor said that when I got to less than 10cc of output from each in a 24 hour period, I could get the drains out.

First Follow-Up - 24 Hours

Brutal as it is to make someone leave the house just under 24 hours after surgery, the first follow-up was the next day.

This follow-up, as annoying as it was to leave for, was exciting because it meant getting to take the binder off for the first time. They had me come in and lie down on a long exam chair (think something like a dentist's chair) and undid the binder.

There was a bunch of gauze packed in it from right after surgery, which I was told I could remove. They also told me that, if I wanted to, I could put on a shirt under the binder to help pad things and create a barrier between my skin and the binder (which is kind of rough and unpleasant).

With the gauze removed, here's what it looked like (taken the next day)

About the Pain Sites

I'll call each area affected by the surgery a pain site and cover what each is and what sucks about it in order of most to least suckiness.

Drains

So, the first pain site is caused by the drains. Generally, the only painful part of them is the exit hole. The drain tube is really soft and flexible, so it's not much of a bother where it's sitting inside. In fact, you generally won't feel it at all unless you squeeze out the drain tubes and create a suction, which can kind of sting. The drains run along the bottom of each pec, near where the stitches/scar are. They run all the way back, under the arm, and exit through a separate hole there. You can see in the image above where it's hanging from the exit hole.

The drain exit gave me a bitch of a time. First off, try your best not to accidentally pull on it like I did. I was conscious of this the whole time I had them in but, a few days after surgery, I lifted my arm, not realizing it was under the tube, and pulled on it a bit. The reason this sucked is because, at the exit hole, there is a stitch tightly looped through the skin and around the drain tube to keep it from coming out. You can imagine how good that felt :)

For the first week, the drains got progressively more and more irritated because your body isn't really a fan of having a hole in it that's not allowed to heal.

The most important part of keeping the drains from being a (pretty literal) thorn in your side is to ensure they're kept pointed back so that they're not pulling on the exit in a different direction than they're running. I used bandaids and then medical tape to tape them down. That way, if the tube tried moving downward, it would pull on the tape and not the exit hole.

Nipple Bolsters

The next pain site is the nipple bolters. These are the thick bits of padding that are stitched onto the nipples to protect them. They're both kind of hard and have stitches running through them to the perimeter of the nipples.

These aren't too bad. The really irritating part of them was that, because they stick out further than everything else, they're the first thing to pull when the binder moves. So, if you twist your core, the binder will want to stay in place and your nipples want to move with the body, creating some drag. This will tug at the stitches and hurt, limiting your core movement.

The other annoying thing is that, again, because they stick out further than everything else, the pressure from the binder pushes them in pretty hard. I was worried this would leave my nipples indented or something but it doesn't.

Incisions

Finally, there are the incisions. These are actually the least troublesome part of healing for the first week. They're pretty numb.

These are stitched with dissolving stitches on the inside and taped shut on the outside. In the picture above, it's hard to see, but there's a clear tape about 2 inches wide going from one end of each incision to the other. This tape is very very strong. It's like a solid piece of adhesive with mesh running through it. There's no apparent backing to it so it's sticky and obnoxious and stays there for a couple weeks.

Near the end of the first week, I started to regain some feeling in the scar area, mostly in twinges. If I moved too far or used my chest muscles too much, I'd get these tight pains. Otherwise, they weren't really notable. I was much more focused on the drain exit pains, since the exits really ached.

Range of Motion

So I was told by most people that you can't lift your arms past your chest for like a month after surgery, and this wasn't the case for me.

I'm not sure if this is because my skin functions and stretches differently because of the probable EDS, or if it's something else. I was able to lift my right, upper arm to about 120 degrees. Adding in the fact that I've got a whole forearm attached to that, I had a lot more reach than I thought I would. The key is just stretching very slowly so that if you hit a limit you notice right away. My left arm was slightly more limited for some reason - possibly because the incision seems to go back farther on that side.

Within a couple days of surgery, I was even able to put regular shirts on and off. The key to this was that the shirts I was putting on were either stretchy or a bit oversized, so they made up for what my range of motion lacked.

Movement

Another thing I wasn't sure what to expect on was how much I'd be able to move. It turned out, I could move quite a bit. It was the little movements that you can't really avoid that caused discomfort or twinges of pain. Getting out of bed and going to the bathroom and whatnot was no big deal as long as I didn't like, yeet myself out of bed.

Keeping a hand pressed to my chest for stability was helpful as well. The biggest thing is just making slow motions. Large motions that jostle things around is what leads to pain.

Binder Management

I had a bit of a hard time with the binder as someone with a belly and with asthma, so here's what I took from that.

Tightness and Position

For the first week, I don't think I had the binder tight enough. This was fine, generally, because the nipple bolsters prevented the chafing from causing any actual damage (even if it was uncomfortable).

I thought I had it tight enough because it felt snug, but I later realized that making it even tighter prevented some of the binder movement and chafing that was causing me trouble with my drain exits and bolsters. Part of the reason I didn't put it tighter was because of the size and position of it. I experimented with this a lot and have got some great advice for you.

The experimenting I did with the binder mostly had to do with folding it in different ways. The trouble with wearing something that goes down your torso when you have a belly is that your belly is pushing upwards on it. So, any time I sat up, it was pushing upwards on my chest and trying to move things that I didn't want moved.

The kind of binder I was given is made up of 4 panels that are sewn together. You can see what I mean in the first picture. These panels are sewn together with a lot of thread, but the thread is kind of weak, so it can easily be bent at those areas.

Folding one of the panels up made my shape less of an issue. However, there was still enough of the binder overlapping my stomach to cause discomfort when sitting. So, next I folded it in half. Trying to fold it in half upward was kind of difficult and would have ended up with the open side of the fold toward my face, which seemed irritating. Instead, I figured out how to fold it in half downward, before putting it on, overlapping the sides to secure it, then pulling up the top layer of the non-velcro side before securing the velcro.

I'm not going to try explaining that better because, in the end, it doesn't matter. The better method was, after okaying it with my doctor, cutting the entire thing in half the long way. Now I have, basically, two binders that are both only wide enough to cover my chest instead of chest and stomach. I also cut about 6 inches off the non-velcro end because it was a bit too long to secure tight enough with ease.

With a more narrow binder that covers just my chest, and a bit shorter so that I can easily secure it much tighter, I now have less chafing and less interference from other body parts.

The important thing when gauging tightness is to make sure you can easily fit a hand under it. If you can pull it out a bit, that's also good, as it means more expansion for your lungs and also the ability to adjust it while you're wearing it.

Asthma

So, my asthma is triggered by all kinds of stuff, including pressure on my chest and lying on my back. So, wearing a binder and lying on my back 24/7 after surgery was really great! :)

I was coughing almost nonstop for the first few days, both from asthma and from the sore throat. If you have asthma or have had asthma in the past, and don't have an inhaler, get one before you have surgery. If anything is going to bring it back up again, this is probably it.

If you don't think you have asthma, I would like to inform you that asthma is not the way it's portrayed dramatically in TV. Your throat doesn't just close off like you're going into anaphylaxis.

These are symptoms of regular asthma:

Wheezing or crackling sounds when breathing (most common after physical exertion or breathing outside in the cold) These will not be noticeable if you're breathing more shallowly, which you will naturally do if you start to have asthma. To check for wheezing, take a deep breath and exhale forcefully.

Difficulty taking a deep breath without coughing

Pain in your chest when you try taking a deep breath

Difficulty breathing in cold air

Continued cough that you can't think of another cause for

Phlegm (this is made by your lungs to try and catch whatever triggered the asthma)

Stuffed up nose in combination with cough (I don't know if this is for everyone, but when I have asthma, one of the first signs to me is that my nose is hard to breathe through. I'll exhale hard to see if I'm wheezy and find I've been having asthma without realizing it.)

If you experience these things, talk to your PCP before surgery. Getting an inhaler is usually covered by insurance, including medicaid, and will be your best friend if you start having asthma attacks after surgery.

Specifically because of the amount of asthma I had the first few days after surgery, I think it might have been better that I didn't have the binder on tighter than I did. As time passed, the pressure from the binder and the lying on my back caused less asthma. I think part of the reason it was triggering it before was some kind of subconscious panic response from my lungs because the position and sensation were unfamiliar and my lungs thought something was terribly wrong. After the asthma stopped being so persistent from the pressure and position, tightening the binder a bit didn't pose a problem.

My biggest advice is this: make sure you breathe deliberately every once in a while. Every ten minutes or so, take a nice slow, deep breath. If the pressure from the binder is inhibiting your breathing, this will help keep your oxygen levels up. After the first couple days of trying to remind yourself to do this, you'll just start to remember naturally to pay some amount of attention to whether you're breathing enough.

Shirt Under Binder

After the first follow-up, I was told I'm allowed to take my binder off for repositioning or cloth-baths. The first thing I did when I got home was take it off, use alcohol prep pads to try getting rid of some of the sticky shit surrounding the incision tape (not the tape itself), and put on a tank top under the binder.

Putting on a shirt under the binder is like, so necessary imo. The binder I got is kind of a scratchy material, so having it directly on my skin was crap. Plus, I wanted another layer between the binder and my chest and nipple bolsters after the gauze bandaging was no longer there so that there was something for the binder to slide against without directly rubbing against the surgical site.

I chose to use some shirts that weren't my most favorite, in case they got blood or adhesive on them that wouldn't come out. I don't think there was any blood on them, but they did get sticky with adhesive. I don't think any of that stayed on after going through the wash though.

When the fabric gets sticky after a day or so of being shoved up against the sticky incision tape, it loses that additional movement it was adding. So instead of moving slightly when the binder rubs against it, the friction would cause the fabric to pull at the skin where it was stuck. That was my signal for changing my shirt.

Food and Drink

If you don't have a personal assistant who's going to cook for you and bring you things, you need to prep for what you'll eat ahead of time.

Accessible Foods

The biggest piece of advice I can give is to plan ahead with accessible foods. Have a variety of snacks, both sweet and salty, wet and dry, so that when you need something to eat and don't have the energy to put different things together, you have something appealing on hand. Keep them within reach of your bed.

If you have a shelf or table, put it beside your bed where it won't make getting up difficult. If you've got a large bed you're not sharing, consider making some kind of spot on a wall-adjacent side to set things. I did this by folding up a big blanket so it's about 1x4 feet and a few inches thick and laid it against the wall next to me. This gave me somewhere to set my meds basket, a couple snack containers, and a hard surface for setting drinks. (Just be careful if you intend to set open drinks here. Spilling something in bed after surgery is like, one of those things that would straight up give me a breakdown lmao)

Prepare foods ahead of time. I picked all the meat off of some rotisserie chickens as well as cleaned and sliced a ton of strawberries. The chicken I ate in tortillas with some shredded cheese and tomatoes. That was one of my favorite meals in the first week because it could be prepped in about ten minutes, sitting at the desk, and it didn't make any mess to eat in bed.

Other considerations are frozen meals, ice cream, fruit drinks with some amount of natural sugar to keep your blood sugar up when you don't feel like eating, and things you can eat on crackers, like tuna. Tuna Creations pouches are great for this.

Fluids

As far as fluids go, I recommend keeping a water bottle with you and just chugging that shit as often as you can. If you don't have a personal servant fetching you things, 100% keep some kind of big water vessels with you for refilling.

I like tropicana bottles because they have a wide opening so don't Glug when you pour from them. They're almost 2 liters. If you're going to get some juice to drink beforehand and harvest the bottles from as makeshift pitchers, I recommend going with orange juice. For some reason the taste doesn't get into the plastic as much as something like the strawberry peach juice. Just wash it with hot water after you're done and keep the bottle aside for later. Remember to keep the lid off if you plan to have it sitting in wait so it can dry and doesn't grow bacteria.

Keeping some large bottles of water nearby means not having to get up as much and, if you live with stairs, not having to go downstairs as much. Frankly, if you're disabled, highly recommend just keeping these around regardless of if you're recovering from surgery or not. I have a mini fridge, so I also have the added perk of keeping them cold.

Next up, hot tea. 100% if you enjoy any kind of tea at all, keep it around. I had a box of sleepytime tea (which I just drink because it's a good blend) and I used the entire thing in like 5 days. Tea for the first few days is a life saver because of the sore throat. Personally, I have an electric kettle that I keep in my room, so making tea is really easy. If you've got an electric kettle in your kitchen, move it to your nesting area and bring a bunch of hotcups or mugs with you.

If you don't have a microwave or kettle near where you'll be nesting after surgery, I recommend changing that, but I know not everyone has the money to throw down on new appliances.

If you live alone and have a free-standing microwave in your kitchen, it might be worth moving closer temporarily if you have things near your nest to heat up, like canned soup. This is especially true if you have a mini fridge near your nest. This is more likely to be helpful if you live on a different floor from the kitchen and have a mini fridge. If you're on the same floor and don't have a mini fridge (thus, keeping all of your cold food in the kitchen anyway), it's more likely to just make more work.

Fighting Constipation

Anesthesia causes constipation. Pretty sure opioid pain meds also cause constipation, but could be wrong. Either way, after surgery, your body will not want to shit.

If you don't enjoy putting chalk stool softener in your drinks, I highly recommend having some fruit prepared and some coffee on hand.

I know it's not a universal thing, but I'm one of those people who coffee makes shit. If you are too, keep some on hand and start drinking it in the days following surgery. Be sure to drink lots of other water to offset the diuretic effect of coffee.

As far as fruit, everyone works differently but, for me, a bunch of apples worked pretty well. I know it's probably not like, the most healthy choice, but I found out a week or two before surgery that eating a bunch of apples in one sitting would definitely get the desired outcome, somehow with no stomachache, which is a rarity for someone with my digestive issues. I thought they would give me a stomachache because apple juice does, but empire apples and caramel dip did nothing but move everything along. I'm talkin' 4 apples in one sitting.

It sounds like a lot but if you slice them all up and eat them as a meal, it's not as much as it sounds. For anyone smaller than me, I'd recommend more like 3, since 4 was pretty filling for me. Stool softening powder can kiss my ass, basically.

Healing Progress

Finally, now that I've gone through all of the details, here are a couple photos of the healing progress about 6 days after surgery, one from each side:

The tape is more visible in these two because it's got some remnants of kleenex stuck to it that I used to try preventing my shirt from sticking to it (yum, I know).

And a selfie of me where I am very happy to be flat (but still tired asf)

Conclusion

I think that's about all I can think of for week 1. Let me know if you have any questions!

Here's another link to the installment list if you want to see what else there is but don't want to scroll back up. Follow me or the #ghostsurgeryseries tag to keep up-to-date on the next installments! the 2-week progress installment should be done soonish~

[ghostonly]

FTM Top Surgery Q&A - Installment #4

4-Week Post-Op Recovery and Progress

Welcome to installment #4! If you're new here, I'm currently working on a Q&A / Series combo where I outline my experience with FTM top surgery as a large, disabled guy with ADHD and low income. I'll also answer any questions sent in to me. Currently, I haven't received any questions. If you have any now or when you're done reading this post, feel free to send them to me. I'll be taking questions all the way until May of 2023, when the series should be wrapping up.

If you want to know more about the series, check out the announcement here or visit the installment masterlist here.

If you haven't read the previous installments, I recommend you do, as I'll be introducing terminology there that will be used in this installment.

In this installment, I'll be covering the healing and recovery progress of weeks 3 and 4. This will include the removal of stitches, incision tape, and drains as well as scar care and so on.

Under the cut, there are photos showing the surgical site before it's completely healed. If you're sensitive to scars, injury, blood, or other things that go along with surgery, please continue with caution or let me know you'd like a copy of my commentary without the images.

Various Removals

On day 1 of week 3, I had my 2-week follow-up. This was a very exciting appointment, because it meant getting the rest of the shit attached to me removed!

Tbh, while I was excited to have that over with, I was pretty scared of it hurting and, honestly, with good reason. I'm not going to sugar coat this.

Stitch Removal

The first thing to be removed were the non-dissolvable stitches. There were two on the inside ends of my incisions (I think to hold the ends of the drains tubes in place) and a bunch around the outside of my nipples.

The stitches being removed hurt pretty bad. Someone tugging at plastic stitching that's wound under your skin does not feel great. This is the first time I've had stitches at an age where I remember them, so I didn't know what to expect. I think my expectations were pretty accurate though. The pains were sharp and uh... spicy, you could say.

Incision Tape Removal

So, the stitches coming out didn't feel great. However, the incision tape removal was the worst. Straight up, this was the most painful part of the entire surgery process.

The skin under where I used to have breasts is extremely fragile. Firstly because I probably have EDS, so my skin is wimpy and fragile anyway. Secondly because that fragility in combination with having had large boobs that sweat and chafe meant that that crease of skin was constantly getting damaged from being too dry or too moist combined with friction. It's like raw, underdeveloped skin covered in crepe paper, to paint a vivid picture.

The adhesive on the incision tape is extremely sticky and extremely strong. It's basically glue. I was already tensed up from having the pain of the stitch removal, and then they had to take the tape off.

We can assume each incision is roughly 10 inches long. With no pain meds, no numbing, no anesthetic, I had to sit there for a solid 30 seconds straight while a nurse on either side of me pulled the tape off. I don't know if I've ever sworn that many times for that long of a time in my life.

I would not feel remiss comparing it to torture. They took off at least the top layer of skin (not to the point that it was raw underneath, but it generally hurts to have any amount of skin removed from a layer beneath it if its not totally dead, you feel me?), and in many speck-sized spots, it came off to the raw level. And I just had to sit there and let them.

My chest felt raw and sore for hours after. If you get a prescription for something strong like oxycodone-acetaminophine, save one. Take it a couple of hours before you're scheduled to get your incision tape off. I doubt it will prevent it from hurting like a bitch, but it might do a little something.

-9999/10, would not recommend

Drain Removal

Directly after the tape, it was time for them to remove the drains. You can imagine how I felt about that, having just gone through a straight minute or so of various tortures.

"It's not going to hurt."

Okay, like I haven't heard that before.

It didn't hurt.

I didn't even feel it to be honest. She told me to take a deep breath on the count of 3 and then they both pulled one of the drains out. If there was any sensation at all, I didn't notice it - probably because I was still focused on the burning across the surface of my chest. And the relief was immediate. Like, if we ignore the terrible tape pain, the drains coming out immediately had me feeling better.

Movement and Pain Changes in Week 3

Week 3 was amazing. Started out shitty with the tape removal, but getting all the extra crap off of me made everything so much more comfortable.

Week 3 is when I started to get back to a feeling of Normal in terms of movement and pain. I still occasionally got twinges in my nipples from reaching too far, but I got back to an almost normal range of motion, was able to start sleeping on my sides without the drains causing pain, and resume most of the activity I was doing before surgery (please note this is only because I am not a very active person. Please don't go to the gym or something at week 3 lol)

Chest Upkeep

After everything came off, a new bit of upkeep was added to my routine: bacitracin. On top of using Vaseline gauze on my nipples, I then had to start applying bacitracin (an antibacterial ointment) to my incision 3-5 times a day. It sounds like a lot and like it would be hard to remember but, I actually didn't have a hard time remembering. I didn't count how many times per day I did it, but it was easy to remember to do it repeatedly. Every time the bacitracin dried out/fully absorbed (into either my skin or the bra I was wearing) my chest felt a bit more stiff and uncomfortable. Applying more moistened everything again and made it feel better.

They didn't tell me to, but I found it was also helpful to apply some of the ointment on top of the nipple gauze. Because the gauze is just one layer of meshy material, the ointment goes right through it pretty much, so you can moisturize your nipples and also protect them from bacteria without having to remove the gauze. (There's not necessarily a reason not to remove the Vaseline gauze. I just didn't want to mess with it more than necessary.)

The addition of the ointment on the gauze also helped to kind of re-adhere it to my chest since every few hours is enough time for the edges to dry out and start to come up a bit with any movement that leads to bra/chest friction.

Binder Usage

Because the pain went down so dramatically with the drains gone, the idea of wearing the binder for 6 weeks, as the doctor wanted, became a much more tolerable idea. The pressure and stability is nice most of the time.

However, as much as I wanted to avoid unnecessary swelling that could occur if I don't wear the binder as long as instructed, at the beginning of week 4, I stopped wearing it.

The reason why is because of the construction of the binder. So, you know how it's made up of long, narrow panels that are heavily stitched together? Well, the stitching between the panels began to loosen from use, leaving a gap of a few millimeters between the two panels on one of my half-binders. When pulled across my chest, the panels not being directly next to each other led to higher tension at the center where the panels were separated which, in turn, led to painful imprints right across my nipples and incisions. Not only did this hurt a lot, it seemed like it could cause problems with healing.

So, week 4 being the week where I began to actually feel pretty close to normal, I just said fuck it and stopped wearing it.

Chest Protection Without the Binder

I didn't want to just go from all to nothing. My chest still felt a bit uh... operated on. That is to say, accidental chafing, scratching, or interference with foreign objects scared me still.

So, while I stopped wearing the binder, I did keep wearing my flat-fronted sports bras, which was also good for keeping the gooey bacitracin ointment from getting on my blankets and clothes.

Movement and Pain Changes in Week 4

With the binder out of the picture, everything became even nicer. My range of motion was almost entirely back to normal. Lifting my arms fully up was still a bit too much tension on the ends of my incisions, but they can almost get there.

The twinges in my nipples had stopped by this point. However, the feeling was slowly returning to the incision/scar area. This felt a bit bruise like and didn't feel super nice to touch a bunch, but wasn't much of a bother.

Everyday Changes

Without the binder on, I could wear t-shirts without it being noticeable that there was anything under them anymore, which was super nice!

I went to the grocery store for the first time after surgery and it was unbelievable being able to walk around and focus on things other than my chest, which has been my biggest source of dysphoria.

Scar Healing Progress

Week 3 - 5/11, 5/14, 5/17

Week 4 - 5/20, 5/22, 5/24

Questions for the Future

There are a few things I'm wondering about that I won't be able to find out until some more time has passed.

Do wrinkles near the scar go away?

I assume most of the small wrinkles will smooth out a bit over time. However, I am a little bit concerned about this one (perspective from my POV, looking down):

The wrinkle in the middle of this picture is pretty raised because there was a wider piece of skin above the stitches than below. I wonder if my body will figure out how to shrink that down or if it will look like this forever. I guess we'll see!

Will my nipples become cold sensitive again?

I've been wondering, also, if my nipples will become sensitive to cold again and harden/raise from that, or if they'll remain in this kind of in-between state where they're not flat but they're not hard either. At the moment, they're a bit raised but also totally squishy lol. It's a bit weird, but not a bad thing I suppose

Will this shape be grounds for a revision?

And, finally, something I will probably get an answer to at my 6-week follow-up: is the pointed shape at the back end of my left incision grounds for a revision?

You can see this very clearly in the front-facing picture in the last set. Perhaps not enough fat was taken out there and the skin wasn't cut and pulled tight enough before stitching, so it sticks out weirdly. I'm not really a fan. If it was just an appearance thing, it would be bothersome enough, but I can also feel it and bump into it when moving my left arm. I'm kind of hoping I can get that fixed, as much as I don't relish another operation any time soon.

Here's what it looks like from my POV with my arm down:

Well, that's it for weeks 3 and 4!

I'll leave u with another flat and happy selfie from after my shower the other day

As always, thanks for reading and here's a link back to the masterlist.

[ghostonly]

FTM Top Surgery Q&A - Installment #3

2-Week Post-Op Recovery and Progress

Welcome to installment #3! If you're new here, I'm currently working on a Q&A / Series combo where I outline my experience with FTM top surgery as a large, disabled guy with ADHD and low income. I'll also answer any questions sent in to me. Currently, I haven't received any questions. If you have any now or when you're done reading this post, feel free to send them to me. I'll be taking questions all the way until May of 2023, when the series should be wrapping up.

If you want to know more about the series, check out the announcement here or visit the installment masterlist here.

If you haven't read the previous 2 installments, I recommend you do, as I'll be introducing terminology there that will be used in this installment.

In this installment, I'll be covering the healing and recovery progress of week 2, including the removal of the nipple bolsters as well as the regained ability to shower.

Under the cut, there are photos showing the surgical site before it's completely healed. If you're sensitive to scars, injury, blood, or other things that go along with surgery, please continue with caution or let me know you'd like a copy of my commentary without the images.

I wrote this entire post and then the page crashed, so this might be a bit shorter because retyping everything you just wrote is one of the worst things humanly imaginable.

Nipple Bolster Removal

The first big thing in post-op events is getting the nipple bolsters removed after 1 week. So, the first day of week 2, that's exactly what happened.

The nurse said that no one has ever told her it hurt, and I'm so excited to tell you that I was the first person to tell her that.

The nipple bolsters are secured with stitches along the perimeter of the nipple that are sewn up through the bolster. In order to cut those stitches, they have to tug on them a bit to expose them enough for clipping.

There was one side of one nipple in particular that hurt really bad during removal. I don't know if that particular stitch was just a bitch or if maybe there was some scabbing that got displaced from the tugging, but it was a sharp, searing pain. It didn't last that long and I didn't have the issue with the other nipple. I wouldn't worry about it if I were you. It seems like kind of an outlying occurrence.

Nipple Appearance

Hands down, the scariest part of recovery is dealing with the nipple grafts. When nipples get free-grafted, the whole graft isn't actually expected to survive. What happens is, the entire top layer of the graft dies and the base layer has to produce new nipple skin.

This doesn't affect the long-term appearance as far as I'm aware but, during the healing process, it means you have to deal with the entire top layer of your nipple skin sloughing off and it's very freaky.

Generally, when a part of your body is completely numb, as your nipples will be, the way you gauge if that part is okay is by looking at it. Well, looking at your nipples will not be any consolation. They will look fucked up lmao. After the bolsters are removed, they look saggy, smushed, and grey. This is normal and they won't look like this forever.

Here are some pictures I took after I got home and showered that day:

Showering

After the nipple bolsters were removed, I was allowed to start showering again. If looking at your fucked up, half-healed nipples is scary, trying to shower around them is terrifying lol.

Securing the Drains

Originally, my drains were secured in place with a strip of velcro that could be fed through some hanging loops on the bulbs and then stuck to my compression binder. However, when you're showering, you need them to be secured to something else.

I used an old purse strap I had lying around that I use for random shit, but you could use a string, rope, piece of yarn, or a number of other things. Just find yourself something long and cord-like, tie the ends to the bulb hanging loops, and then hang them from your neck. Then, use a twist-tie or another piece of string or something to tie the sides together at chest level so that they won't rub or bump your nipples or incision.

Nipple Guarding

I was told that it was okay if water ran over my nipples from where it hits my shoulders, when I'm facing away from the shower spray, but to not let the water hit my nipples directly, as it can cause shearing.

There are two ways to shower with these restrictions: you can manually guard your nipples every time you need to get fully under the water or, as I figured out in week 3, you can wear your binder into the shower.

Because I cut my binder in half the long way, I effectively have 2 compression binders, which makes this no big deal. I wouldn't recommend doing this with a wholass shirt under the binder, but with the barrier I mention in the section below, this is easy and comfortable. Wearing the binder into the shower allowed me to wash everything else and save my chest for last, which meant I didn't have to constantly guard my nipples while washing.

If you don't have the kind of compression binder that you can or want to cut in half, you can also just protect your nipples manually. This generally means a lot of washing outside of the water, then leaning that body part into the water to rinse.

For parts that require more submersion, like rinsing soap from your face or shampoo from your hair, you can use your hands to block direct spray. I cupped my hands and pressed them firmly into my chest above each nipple, keeping the bottom unpressed so that any water that slipped past my fingers could escape instead of collecting against the nipples.

Doing this can make your shower take more than twice as long as usual, so I really do recommend wearing the binder in. If you have two halves, you can then just toss the wet half into the laundry and put the other one on.

Nipple Graft Care

Vaseline Gauze

After getting the bolsters removed, I was given a pretty simple care regimen: replace a square of vaseline-coated gauze over each nipple at least once a day and then tape a gauze bandage over it.

The vaseline gauze comes in a package in either sheet or strip form and you have to cut it into squares. The fold creases make this pretty easy, but it's kind of gooey and obnoxious.

When removing the gauze, the dead top layer of nipple skin will want to come away. Personally, I'm of the opinion that it should stay there as long as possible, since it's protecting the new skin underneath from exposure. So, any time a notable amount started to come up, I changed which direction I was removing the gauze from to avoid removal of the dead skin. Sounds gross, but this dead skin is basically acting as a scab, it's just soft because of the copious amounts of vaseline being put on it.

Eventually, it will all end up coming off, but I wanted to slow the process to minimize the likelihood of pain or damage to the fresh new layer of skin beneath.

Protective Barrier

On top of the vaseline gauze, I was told to put a slightly thicker gauze bandage and secure it with medical tape. Unfortunately, I'm probably allergic to adhesive, so medical tape and I don't get along.

I did this for all of week 2, but in week 3, I figured out a better solution.

If you have any flat-fronted sports bras, don't throw them out, burn them, or whatever you plan to do with them until you're done with surgery recovery.

All of the bras I had were these simple, t-shirt material sports bras with a multi-layer, flat panel for the front. These have made my recovery so much more comfortable.

At first I was wearing t-shirts under my compression binder, but this led to problems because t-shirts aren't usually form-fitting, so they wrinkled beneath the compression binder and wrinkles being pressed hard into my skin, especially against healing scars, is pretty painful after a while. A form-fitting piece of fabric that only covers my chest was more comfortable as well as a godsend in the sudden heat of summer.

Here's a picture of that from week 3:

The fabric of these is soft enough that I can just skip the gauze barrier. I put on the vaseline gauze, put one of these fabric sports bras on, then secure the binder over that. It's great. Even better in week 3 when you start doing scar care involving ointment. If I had been using t-shirts when I started on the ointment, it would have gotten everywhere. Sports bras help contain everything. And, if you have a bunch, like I do, you can switch them out when they get kinda sticky with ointment. More on this in the next progress installment.

Pain Levels Changing

The Drains

So, week 2 was actually the most painful week for me because of the drains. Generally, they're supposed to come out after about a week, however, mine didn't come out til the first day of week 3 (so, after 2 weeks). This was because of the office not being open on the weekend and then my 2-week follow-up was only a few days later, so I just waited.

Generally, your body doesn't like it when there's a hole in it with something in said hole so that it can't heal. The drain exit holes tried scabbing around the perimeter which increased itchiness, inflammation, and made pressure, movement, and so on significantly worse. By the latter half of week 2, I was moving around and changing position and adjusting the drain tubes really often to try and minimize discomfort.

I don't expect most people would have quite as hard of a time with this for two reasons: Most people get these things out before the 2-week mark and also I'm extremely sensitive to skin-level pain and discomfort.

Movement

Movement pains in week 2 became more frequent, but less intense. This is because the overall achiness of everything went down and, therefore, I was moving around and pushing limitations more often, leading to more pangs of pain from my body saying, "would you fucking stop reaching for shit."

One of the pains that was most common in week 2 were these twinging, zapping, pinching feelings coming from, I think, the nerves to my nipples trying to reestablish themselves.

When you start to get these, they can be kind of freaky, but I'm like 95% sure they don't really mean anything. As in, just because they happen when you reach doesn't mean you shouldn't reach. Listen to your gut. They will happen regardless of if you reach or not anyway, reaching just causes them because it means moving the insides of your chest and your nerves are trying to figure out what that means for them now.

More Healing Progress

Here are a couple more pictures I took a few days after the last set:

The bright pink that you can see on the nipple in the left picture is some of the fresh skin showing through from beneath. As you heal, the dead skin will grow darker and the contrast will be more obvious.

That's it for this week! I'll be back again soon with another progress update covering weeks 3 and 4.

Here's another link to the installment masterlist in case you don't want to scroll back up. I still haven't gotten any questions, so don't hesitate to send some in if there's any part of the process you'd like more information on!