Top surgery. A gender-confirming surgery that some transmasculine and non-binary people choose to get. There are many reasons people choose to get it and none of those reasons are any of your damn business if you are a random person on the street or even someone close who doesn’t know the context. But now that that is out of the way, I want to talk about this and my own personal challenges in considering it.
When I first put on a comfortable binder that minimized my chest, I did not want to take it off. It was the first time I had ever felt what I now know is gender euphoria. But the next logical question was what to do about top surgery. Did this mean that I wanted top surgery? What would it mean to me to permanently remove the lumps of fat on my chest? I can safely say that I don’t know what exactly I want to do, and that is okay. What I want to stress in this article is that not all trans people are the same or have the same journey. Not all of us know exactly what we want to do and when and how. To a certain degree, there is no real way to be 100% sure about these choices, but whether or not you make them does not make you more or less trans and to make a mistake does not mean that your experience is wrong.
People who are AFAB (Assigned Female At Birth) may go through the expected puberty and develop breasts. I say “may” because not all kids assigned female are female, they may be trans and elect to not go through their assigned puberty or they may be intersex and not develop in an expected way. For me, that experience was pretty terrible. I remember viscerally feeling myself separating from my body and all the expectations being laid on it. Everything about my body started to feel foreign and distant and I stopped caring what happened to it. My own chest quickly grew large and I wasn’t aware of anything I could do about it. I didn’t know what being trans was and I didn’t know that it was okay to exist that way. So, I thought that everyone in female-assigned bodies also felt the same. I know now that this is what is called gender dysphoria. This sounds big and clinical and is an official diagnosis, but I really disagree with the idea that it is a mental disorder—and that can be saved for another article. When it comes to chest dysphoria, that hit me like a truck but in slow motion. When I recently allowed myself to explore and accept all of this, I thought about what it would mean to get rid of the first thing that really started to ramp up my dysphoria.
The two most common forms of top surgery—known outside of the trans community as a “double mastectomy”—are a keyhole incision and the double incision. There are also other options like a periareolar surgery or an inverted-T surgery. I do not have the luxury of a small chest, so I would have to have a lot of tissue removed. The double incision also requires nipple grafts that have to be fully taken off your body and then put back on. It takes six to eight weeks to recover from that surgery, and with many of the surgeries listed it is not guaranteed that feeling will come back in any of the areas of your chest. This is terrifying and irreversible, but also necessary and life-saving for so many people. Because it is impossible to know anything with 100% certainty, it is difficult for me to consider a major surgery such as this.
Trans and non-binary people choose a diverse number of ways to be themselves. Some trans people not only get gender reconstructive surgery for their chest and genitalia but also on their face or the rest of their body. Some trans people cannot or do not get any surgery at all for personal and/or medical reasons. Some are like me, somewhere in the middle, considering reconstruction yet feeling terrified. There is so much pressure to get it “right” because you knew since you were two years old that you were this way. But not all stories go that way. Not all trans people will get surgeries or change every aspect of their physical appearance. At the end of the day, we are still trans. Even when we are unsure or scared, even when we cannot or will not transition and even when we are perfectly fine with some parts of ourselves and not others. I’m trans and I have no idea what I want for my future in gender reconstructive surgery, if anything, and that is perfectly fine.