location: Transition > Chest Surgery > Surgery Experience
We left Burlington at about 9:30am on Tuesday August 26, 2003 for Montreal. We had no trouble getting through the border; I didn't even have to show them the letter GRS Montreal gave me describing why I was going to Montreal, who I was seeing, etc. We got the the Residence Care about 12:30, and we were just in time for lunch. Before we could even take our bags to our room, they ushered us to the table for lunch. Despite what I've heard others say, I actually found the food to be quite enjoyable. We passed the time that night working on a puzzle, reading, relaxing, and socializing with some of the other guests. We also went swimming in their indoor pool; for the first time in my adult life, and the night before surgery, I went swimming without a shirt on.
The next morning, Wednesday August 27, 3003, the nurse woke us up at 5am, and the taxi came to pick us up at 6am. We went to the hospital where I checked in and was given a room. I remember noticing the beds were the very old kind, where you have to hand-crack them to raise them. Also, the floor was carpet, which struck me as odd for a hospital. Dr. Menard came to see me and asked me if I had any questions, and then I took a nap before I went in for surgery at about 10am. The nurse and I walked with me down the hall, where we took an elevator downstairs. Just outside the operating rooms they had 2 beds, both empty. I was instructed to lie down on one and wait until someone came to get me. I waited for about 15 minutes, until someone wheeled me in, past one operating room, and into another where they had me transfer to the operating table. While a guy was starting my IV, I remember noticing classical music was playing from a small radio on top of a cabinet in the corner. He said I would start to feel a little sleepy, I remember looking at the huge round lights above the table, and that was it. It was the most pleasent IV experience I've had yet.
I think it was about 1:30pm when I woke up. I had the binder on and ice packs on my chest. They kept giving me morphine, so I don't remember anything too well. I do remember my stomach huring because I was so hungry. Everytime a nurse would come in, I would beg and beg for something to eat, but they all would say, "No, you can't eat anything until you can get up." Finally, one nurse gave in and gave me a pack of crackers, which I prompty ate. I think around 4:30pm, I got up to go to the bathroom for the first time. I was OK until I started looking at the drains, and then it was all over. I ended up vomitting all over the bathroom and the nurse, then passing out in his arms. They put me in a wheelchair and wheeled me back to my bed. The only good thing about that experience was that after, I wasn't hungry at all anymore. I ended up sleeping most of the remaining time, until I went to the bathroom again at about 1:00 am. That went much more smoothly. The nurse told me not to look at the ground because "as soon as you do, you're going to kiss it."
We went back to the residence care around 2:00pm Thursday afternoon. My partner-at-the-time gave me a sponge bath and washed my hair because I felt so disgusting. We spent the rest of Thursday and Friday just hanging around, reading harry potter, watching movies, etc. I wasn't in too much pain, but it was difficult to move my arms much more than past my elbow height, and I found myself hunching over due to the binder. We emptied the drains every couple of hours, and the right side was draining more than the left, but not more than a small Nyquil cup every 4-5 hours.
On Saturday, Dr. Menard came to the Residence Care to take my drains out, and I got my first look at my chest. He must have done the right side first, giving it time to swell before they put the binder on. The left side was completely flat and had some minor swelling near the top and the sides, but the right side was super swollen, like twice as big as what I started out with. It looked like I had a single mastectomy, it was kind of funny. The right side was draining twice as much fluid than the left, so he didn't seem surprised that it was a lot more swollen. He said it would go down in time and to just keep wearing the binder all the time for at least the next 3 weeks. It burned a lot when he took the left drain out, but it was quick. I didn't really feel the right drain coming out at all. I did have a blister on the left side of my back where the dressings and binder were rubbing, and that actually hurt a lot more than everything else.
I felt 10 times better after the drains were out, even though I still had to wear the binder. I took my first shower on Sunday, the day we left, and that made even more of a difference. Overall, I'm definitely happy with my experience in Montreal. It was kind of hard, because everything was in French, even the nurses talking to me at the hospital, so I felt in the dark more than I would have somewhere in America. It was much harder to get information. but they were gentle and took good care of me.
After returning to Burlington, the swelling on my right side did not go down. In fact, it continued to get worse. I went to the emergency room on Wednesday, September 2, 2003 to see if there was anything they could do for me. We waited forever, but when we were finally seen, the doctor said she wanted the head OR doc to look at it. He came in, looked at it, and said that it probably could be drained. However, he didn't want to do it because it was ultimately my surgeon's call. They sent us home, simply telling me to call Dr. Mendard the next day. When I called Dr. Menard, he was very nice and concerned about it, and he said to try to find someone locally who could drain it so I didn't have to travel. If I couldn't find anyone, then to call him back and he could do it for me the following Tuesday. After many phone calls, I ended up at the Breast Care Center at my local hospital's oncology unit two days later on Friday, Septermber 5, 2003.
The woman I saw was very impressed by my left side, and it was obvious to her that the right needed to be drained. 15 minutes and 3 large needles/syringes later, she had sucked out 100ml of old blood, which was black and thick, from my right side. Turns out I actually did have a hematoma, and if the blood had remained inside it would eventually have solidified...and my body, over the course of years, would have to re-absorb it. After draining it, the skin felts a lot looser and the whole thing felt much lighter. We put the binder on extra tight to try to prevent it from filling up again.
The following Monday, September 8, 2003, I went back to the Breast Care Center to see if she could drain it again. She drained another 90ml, but it wasn't as black or thick as the first time. She said it didn't look infected or anything, so that was good. A week later, on the 15th, I went back to the Breast Care Center in hopes of her wanting to aspirate it again. By that time, it had improved so much compared to just 10 or so days before that she didn't want to try to drain it again, as every needle prick risks infection. I continued to wear the binder 24/7 as tight as I could get it.
About a month later, on October 20, 2003, I returned one more time for just a checkup. She did an ultrasound of the right side of my chest to look for any more old blood, and she couldn't find any evidence of a fluid pocket or hematoma. She said the residual swelling is most likely postoperative swelling within the tissues that should go down in time. By February 2004, it was was still very swollen so I looked into physical therapy options that might help reduce the swelling. My student health insurance would pay 100%, up to $700 (per "injury"), in physical therapy if I went to the sports physical therapy center at school, so I began going there twice a week. Over the next month I had eight ultrasound treatments on the swollen areas, which seemed to help, but only minimally. However, since my insurance paid 100% for these visits, it was definitely worth my time.
After the physical therapy ended mid-March 2004, I just waited, and the swelling continued to go down, or at least change, very slowly over time. Currently, I am still battling this chronic swelling, though it is clearly going down...just very slowly. Recently, and mostly out of curiosity, I saw Dr. Donald Laub in Burlington, Vermont on February 15, 2005 to ask him if there was anything I or he could do to improve the situation. While he was extremely nice, he immediately assumed that I would have phalloplasty in the future (i.e. he does not understand variability within the trans community), and he insisted that my chest looked fine and natural and even he wouldn't "question [me] in the locker room." Nevertheless, he offered that he could certainly improve the "minor" difference in the two sides by removing some of the underlying fashia from the right side of my chest. However, since he is part of the hospital system, he would have to charge $3,000, which would include his fees and anesthsia. He urged me not to do it, claiming it would be a different story if he was in private practice and could alter this price and besides, I "might as well wait until [I] have bottom surgery and get it done at the same time."
Also mostly out of curiosity, I saw Dr. Menard again on March 31, 2005 to see what he had to say. I asked him about the right side and possible nipple revision to raise the left nipple/areola. Dr. Menard claimed I should wait at least another year to see what the swelling is going to do, and upon measuring, he found the height of my nipples are 0.5cm different, a "natural" difference in terms of male chests. A year from now, if I wanted, he could remove some of the underlying fashia via scapel (it's too thick for a liposuction needle) from the right side and raise my nipple/areola complex under local anesthesia for $600. He took some pictures and sent me on my way free of charge.
I am glad I saw both doctors, and essentially got the same response: my chest looks natural to them and neither think I need a revision, but are willing to do it. I think I see the swelling more than anyone else because I've lived with it since August 2003, watching it like a hawk waiting for it to look exactly like the left side. In terms of nipple revisions, I'm not sure. I would like to get them both raised, and the left one a little more so it is even with the right, but I don't want to lose the hair-growing skin there, as that might look even more awkward than them being a little low and uneven. In Summer 2006, I revisited my options for a revision. I had another revision appointment with Dr. Menard in June 2006 and was supposed to have the revision in late-August 2006. However, I had to cancel that date, because I got into school at the last minute. I ended up having two chest surgery revisions that coincided with my bottom surgery (see Revision section).
Before surgery, I had normal surface sensation on my chest and did not have much sensation in my nipples. At two and a half years after my surgery, I think I have gained the vast majority (if not all) of the sensation I will regain. I can sense pressure from touch and deep pain over my entire chest. Both nipple-areolar complexes have erectile function. My nipples, areola, and around the areola for about a 1 cm radius are completely devoid of surface sensation, but I do have minor superficial pain sensation so I know there are some (although not many) nerves there. Because of this, I do not have erotic sensation in my nipples, but I'm not worried about that because I didn't have it pre-surgery anyway. In fact, if my nipples are pinched or compressed, I have very sudden, sharp pain. I have since gotten one (left) nipple pierced, and was worried this type of pain would be stimulated during the piercing process, during healing, or even after it was healed. Thankfully, I have not experienced that, and the process of getting it pierced probably didn't hurt as much as it would have before surgery.