awkward transypants.

I had so much to say about my surgery experience, I kept a journal containing all recounts of the physical and emotional chaos that was/is this process, as well more abstract and reflective stuff, and some (gasp) prose. Here's the story, Or if you're more inclined, read down to read about my processing of choosing a doctor, finances, retrospect, etc...

My Process for Choosing a Doctor

When searching for the right surgeon for me my primary concerns were aesthetic and functionality. I wanted my chest to not look concave, or sunken in. I'm a little bigger, and felt that that would look really out of place on me, so having every ounce of tissue sucked out wasn't my primary concern, as it often is for some guys. I also really didn't want to loose sensitivity in my nipples and chest overall. I had spoke to a fellow who has no feeling left in his entire chest region at all, only ghost sensation, so anything that touches his chest besides his shirt is uncomfortable for him, so this prospect freaked me out. The idea of having nipple grafts was so unexciting to me (that's where they cut off the nipple then sew it on in a different location). Yeah, it's likely that one would regain feeling to touch, but the nipple would be severed from the nerve, cutting all erotic sensation. :-(

After my consultation with Dr. Brownstein I started thinking about how general breast reductions were performed, thinking that they didn't do nipple grafts in those. So I started doing some more research, and came across this procedure called the pedicle procedure (which is a double incision procedure), wherein the nipples remain connected to the nerve supply, or "stalk," but get moved up into more masculinized positions. I found that Dr. Reardon and Dr. Weiss in New York CIty performed this procedure, as well as Dr. Steinwald in Lake Forest, IL. Dr. Reardon (a known surgeon for FTM surgeries, also well known as a screw up and jerk within the trans community) lost his license shortly before i began considering consulting with him. Pictures I'd seen of Dr. Weiss' work lent me to believe that he left a little too much fat in the chest, and he was also out of my price range, as he required an overnight hospital stay averaging the surgery at $11,000 not including travel expenses.

I had also thought about Dr. Fischer outside of Baltimore, as she is very reputable, primarily with keyhole, but double incision also. I sent an email to her office asking if she performed the pedicle procedure, amongst other questions. Yes, I know email isn't the best way to make initial contact with a would be surgeon, but getting a really lame automated response, one which was clearly only intended to be in response to inquiries of trans nature, irritated me, and her website did not disclose that she performed trans related surgeries, which annoyed me also. Also most of the images of chests I had seen on transster were on smaller guys, body size and tit size. So I thought that I would proceed with consulting with Dr. Steinwald, revisiting the idea of Fischer if necessary.

Dr. Steinwald's website included a section of images of FTM chest surgeries he had done, which I appreciated. Differently from Reardon and Weiss, Steinwald's technique results in an anchor shaped or "inverted T" incision/scar, as opposed to the usual 2 single long scars following the bottom of the pectoral muscles. This was done to be able to get more fat out of the chest, while still keeping the nipple connected to the nerve supply (Note - This explains why Weiss' work seemed to have excess fat left in the chest, as he only uses the single incision technique, and also makes sense when comparing FTM chest surgery to a standard breast reduction, which also uses the anchor shaped scar).

Keeping my nipples attached, having 5% breast tissue remain (ensuring that my chest wouldn't look sunken in), and having an anchor shaped scar all sounded great to me. Anchors are cool. The images on his website and on transster also showed that he could achieve good results with bigger bodies and bigger chests, and I liked the look of his placement of incisions and nipples, the contour, etc.

S and I drove to Lake Forest, IL, an hour North of Chicago, for a consultation. Dr. Steinwald made a very good first impression over all. His office was nice and on the campus of Lake Forest Hospital, he and his staff all used the correct pronouns with no prompting, he spent thorough time with me - explained the procedure, walked me though several pages included in the handouts I got to take home, talked about recovery, and answered my 3 pages of written questions. When I asked if he would require a letter from my therapist, he said based on meeting me, as I seemed to have a very real expectation of outcome, and solid understanding of the relatively irreversible nature of the process, etc. that I did not need one.

Also desirable to me was the fact that Dr. Steinwald performed his surgeries from a hospital, as opposed to a surgery center. I have genetic blood condition, and would put me at high risk of getting a blood clot under body trauma, so the idea of already being somewhere where if that should happen it could be treated immediately set me at ease a bit. Another desirebale factor was that Lake Forest was only an hour north of my hometown, meaning that I could recover in the comfort of my own place, with all my friends and loved ones around me for support and cut travel expenses dramatically. Also, of lesser importance to me, Dr. Steinwald was agreeable to writting a letter stating that I had undergone SRS surgery, therefore supporting application for a legal name change. All this, plus the fact that he was respectful and thorough.

So I sat on it for a bit. Then six months later went ahead and booked my surgery date with Dr. Steinwald.


The drawing Dr. Steinwald did to illustrate the proceedure	The drawing I did to try to clarify his drawing	L made a spreadsheet to record how much fluid was draining	The letter Dr. Steinwald wrote in approval of gender marker change

Finances related to my chest surgery.

Consultation with Dr. Brownstein - free
Consultation with Dr. Steinwald - $25, I printed a coupon off the website

Dr. Steinwald's surgery fee - $5000
Lake Forest Hospital fee - $1700
Anesthesiologist fee - $1050
Surgery Total - $7,750

2 ace bandages (compression), Neosporin, Band-Aids, gauze, tape- $30
Silicone Gel strips (for scars) - $50

Travel expense (driving from Chicago to Lake Forest 5 times) - Estimate $100

Loss of income from 3 weeks off work - $1440

Totals for all of the above - $9,325. damn.

Insurance does not cover an "elective" procedure, however this is perhaps bendable if you already have an "M" marker on your identification, in which case this surgery could be billed as Gynecomastia, or "man boobs."

And here i will say, what low income person in the world would give 5 grand to some already rich dude if they didn't feel that it was a necessity? This is not for kicks, not for a thrill, not for attention, not to self mutilate, not to "experiment," or go through "a phase." It's not because one enjoys hardship, or wants to fuck the system (though that may help), or destroy a family, or create a spectacle. Sometimes necessity just happens.

In preparation.

I intentionally scheduled my chest surgery at a time when many of my other obligations in life could be put on hold for a bit. I also scheduled for directly after I would be finishing a major project (i work off of contracted positions primarily) knowing that there would be a little gap before the next one began.

I quit smoking six months before my surgery.

Started a vitmain regime to promote healthy blood flow. This included cayanne, ginger, and butchers broom (not all at the same time) in addition to my normal multi and fish oil, but stopped taking vitamins 3 days before surgery, to prevent blood thinning.

Kept up my normal work out schedule, 3 times a week and lots of bicycling, but did not work out for the 3 days preceeding surgery to ensure I wouldn't have any sore muscles.

During the month leading up to surgery I centered my work outs around pectorals, shoulders and arms, knowing that I would loose a lot of muscle in those areas during the recovery procecss.

I stopped drinking alcohol one week before surgery. Lots of people stop a month in advance while some don't stop drinking at all. I guess I wanted my body to feel kind of "pure," or something, but damn i like beer.

In Retrospect: Things I'm glad I did before/after surgery

Had several pairs of pajama pants and a few button up short sleeve shirts

Trimmed my armpit hair!

Removed piercings before getting to the hospital

Had arranged to have someone with me 24-7 for the first 5 days after surgery

Got a Netflix subscription

Cleaned my apartment spotless

Got groceries, ran errands, etc. – stocked up on everything that required driving.

Got bendy straws! Cause it's hard to lift the glass to your mouth the first couple of days.

I'm glad I made sure to take one walk a day outside during the week after surgery.

Honored my feelings around processing emotion

Kept a journal

Set up a "recovery space" for myself before heading to the hospital. For me it was folding out the couch, getting extra pillows and blankets, getting the side table set with everything I would need, etc.

Got some vitamin water. It's good because you get fluids and calories at the same time. The anesthesia makes leaves you without an appetite for a couple of days, and sometimes eating is just too much work.

I'm glad I notified everyone involved in my life of my decision, and not just my family. It made me feel like I had the strength of 30 people behind me, and not just one. And having some buzz also kept me in pumped mood. This is the letter I sent my friends.

I'm glad I allowed my parents to be part of my process. This is the letter I sent my parents after a heated converation.

Helpful Links

Dr. Steinwald - Performed my surgery, website has pix.

Dr. Brownstein - I consulted with, website has pix and lots of info.

Dr. Fischer - I researched and considered consulting before deciding on Steinwald, website does not disclose.

Transster - A huge database of trans masculine surgeons, photos and reviews.

FTM surgery info and Surgery Support - These are yahoo groups that require membership.

FTM Transition - This is the most informative and indepth personal website about Ethan's trans experience.