The Verdict

I'm keeping my nipples. Well, actually, they are being cut off, resized and then grafted on to my new, flat chest. But I'm keeping them.

I am SO glad that my surgeon wanted me to come in for a face to face consultation. She now has a clear understanding of what I want from chest surgery and I have a clear understanding about technique and other specifics. This was a half hour well spent for both of us.

She had initially been considering doing what is called a pedicle procedure where the nipple/areola is kept attached to breast tissue on a pedicle of tissue, and then that is brought back together with the breast. This is common for women who undergo breast reduction, but in their cases they are keeping and want to be keeping breast tissue. What my surgeon is going to do is remove all breast tissue (YAY!) and graft the resized nipple/areola onto my chest. She totally understands that I am going for total flatness, and she completely respects this desire. She is confident that the grafted tissue will survive and that I will have a great looking chest post-op.

One of the biggest reasons I was considering not keeping my nipples was because I feared not being flat enough. So if I can keep my nipples and be totally flat, I'm into that. I think I am indifferent about my nipples, but when push comes to shove, I prefer having a natural looking chest, which to me means having nipples. My surgeon likened it to people who have hernia surgery. Often times it would be easier for the surgeon to take away the bellybutton, but they make every attempt to keep it and even to create a fake one so as to achieve a natural look. She said that people sometimes don't realize how attached they are to their bellybuttons, nipples and other parts until they are gone. I'm not saying that it is unnatural not to have nipples. I just prefer that my chest look natural, and all my life since puberty and growing breasts, I have visualized a flat chest with small nipples -- a man's chest if you will -- in my mind. If my nipples don't survive -- oh well! I just won't have nipples. But like I've said before, I only have one shot to do this, and this is how I'm choosing to do it. My surgeon said she is not looking at me on the gender spectrum, she is looking at me as a human being who will have a natural looking chest.

The grafted tissue will be stitched back on and will be pretty gross for a few weeks as the stitches heal and the tissue returns to a normal color. So there will be a lot of care involved in the healing of not just the large incisions but also of the nipple/areola area. I told my surgeon that if making larger incisions will mean better results that I am fine with that, and she said that is good information to know. Having scars does not scare me at all, and I'd rather have slightly bigger scars if it means better results. She also said that a lot of skin will be removed, and excess skin is usually what causes excess fluid to build up, so I will hopefully be able to get my drains out after about a week. She thinks that she can contour my chest so that it maintains a nice shape when I lose weight, which I fully plan on doing once I am healed and am able to start exercising.

I feel really great about my appointment. I brought a list of questions with me, and all questions were answered. She even answered some questions that I hadn't had a chance to ask yet! I feel confident that I am making the right decision and that the chest that I have post-op will be the one I have been dreaming of since the 4th grade when I first started growing breasts.

One funny thing about my appointment is that the whole time I stood and sat topless, and my surgeon rarely was making eye contact with me. She was talking to my breasts. It was so hilarious. I could literally see her artist's mind working and making notes. She probably knows exactly what my chest will look like already. She tried to make eye contact with me, but my breasts -- her future work -- were too powerful I guess :)

I thanked her before I left for using the informed consent approach to this surgery. Trans related surgeries and hormone treatments are usually governed by the Harry Benjamin Standards of Care, which basically means an individual needs a gatekeeper -- usually a therapist -- to acquire hormones and surgeries. The therapist has to write a letter saying they believe the person has Gender Identity Disorder and that surgery and/or hormones are necessary. My surgeon only required that I understand what I am doing and that I have thought it through thoroughly. I have a therapist, and believe me, she and I have discussed this through and through. But why should I as a well informed, healthy adult have to have someone else give me permission to do something to my own body?! I am thrilled that my surgeon and I have the relationship that we have around this and that she respects my decision to augment my breasts. True, I am totally removing them, but why would someone have to have a therapist's letter to remove their breasts and not have to have one to make their breasts a DDDD?!

That will be my nightmare the night before surgery -- that I wake up from surgery having had implants put in rather than having had my breasts removed. That is a truly frightening thought!

While I was at the hospital today I went ahead and paid the out of pocket charges for the chest surgery. That sure made it feel real! Money well spent is all I can say :) I am preregistered for my surgeries and have paid the out of pocket fees, so all I have to do is show up Tuesday morning, check in, probably have to sign this and that and then get some of those happy drugs that will make me forget all of my fears and anxieties, and before I know it I'll be post-op. I can't wait!