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Everything You Need To Know About Preparing For And Recovering From Top Surgery

Everything you’ve ever wanted to know in one place.

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For many trans or gender-nonconforming people, top surgery is a significant milestone on the road to living life as one's authentic self. But, like any other major surgery, it can be overwhelming knowing where to start and what to expect.

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And if you're younger, this may be the first time you've had to advocate for yourself in a hospital setting or deal with navigating health insurance — that's a lot to deal with. We asked BuzzFeeders who have already gone through the process to give you their best advice on preparing for and recovering from top surgery.

BuzzFeed LGBT also spoke with experts Dr. Rachel Bluebond-Langner, associate professor of plastic surgery at NYU Langone Health, and Gaines Blasdel, a medical case manager with the Callen-Lorde Community Health Center, to help you keep all the facts straight about this big step.

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1. First things first, you need to find a doctor. You shouldn't feel guilty for shopping around — find a practice and surgeon with experience performing gender-affirming surgeries.

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"Different surgeons have different training and think different things are the best way to go for valid reasons," says Blasdel. "So, you might get different answers from different surgeons. I advise everyone to go to multiple consultations — getting a second opinion will make you feel more secure in your decision."

It will also help to find a practice where staff are sensitive to gender markers on ID cards as well as to preferred names and pronouns, says Bluebond-Langner. "I do think it's important to go to a board-certified surgeon, someone with experience in gender-affirming surgery — understanding that chest masculinization is not just a mastectomy."

You can read about the various types of top-surgery procedures here. You and your doctor will have to discuss which is the best fit for your particular case.

2. Know that you will (most likely) need a letter of support from a therapist or mental health provider.

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Once you find a surgeon, your provider will send a request to your insurance company to confirm that payment will, in fact, be covered. This is when they'll use letters of support from a mental health provider, explains Blasdel.

For practices which follow the World Professional Association for Transgender Health's standards of care for chest-masculinization surgery, it will be required that you have at least one letter of support. If you're on hormones, explains Bluebond-Langner, it can help to also have a letter from your hormone subscriber — though hormones are not a prerequisite for surgery.

Having a letter of support ensures that you, as the patient, are fully capable of making informed decisions for treatment. This entire process, confirming coverage, can take anywhere from one to several months. And if you get denied at first, don't get frustrated — just appeal.

"If they deny you coverage for any reason, you should request that in writing," says Blasdel. "You will use this to appeal. I always tell people to expect to be denied and you have to call their bluff. People will get denied even if, eventually, they will be able to receive coverage."

3. Figure out exactly how much your insurance will cover, down to the dollar, so you can plan accordingly.

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"Talk to your doctor about how much your insurance will actually cover. My insurance boasts that it covers top surgery when in reality, it covers about 15% at most, and that you have to fight them for. It may be worth it to change insurance companies entirely if top surgery is something that you want." —Anonymous

"Ask questions. Write things down. Figure out the cost of everything (the actual surgery, travel, post op care, etc) and be prepared for unexpected expenses." —Micah, 21, Trans

"Because it can be so different place-to-place, I encourage people to connect with local LGBT projects and centers. Ask if they know any surgeons or can point you in the right direction. A lot of places will provide free legal resources but you won't find them unless you ask," Blasdel says.

If your insurance has a web portal, you can use it to figure out exactly what is required for coverage through your certificate of coverage. Also keep in mind there may be costs associated with co-pays or deductibles — payments you will be responsible for before your coverage plan kicks in.

Note: This post focuses on the process for someone who's hoping to get the procedure covered by insurance. Insurance coverage will vary by plan and by state. Figure out if your state mandates insurance by checking out this map.

4. Take even the smallest steps to save up for the costs.

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"I saved money for a really long time and didn't think I'd actually need it all. But I did. You can purchase groceries and supplies before the surgery, but I found that even though we used all those things, my caretakers also needed to eat and sometimes they needed a meal that was already ready- they get tired too!" —Paige, 26, Trans

"Take baby steps. I started off by practically taking half of my paycheck to put towards the surgery. Bull. You can't live like that. It might take longer than it seems to save up, and during that time it might seem like you'll never get there, but trust me, take your time. It gives you plenty of room to prepare as well." —Adrian, 19, Trans

"Remember you'll also need to get time off work. People should plan to take at least two weeks off, or if you have a really physical job it could be two months or more," says Blasdel. "It all depends on how you feel which will be affected by your age and health conditions."

"[The procedure] can range from $4,500 in Mexico to $15,000 elsewhere in the US. Average, you're looking at $8,000 to $10,000 — though it does depend on circumstances," explains Blasdel.

5. Any health problems you may have, including high blood pressure or diabetes, should be under control well before your surgery date. Basically, try to be in tip-top shape!

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"I started working out a month before my surgery. It helped: relieving my anxiety, building muscle to prepare for surgery." —Renato Borges, 21, Transgender

"Drink lots of water the week before and up until surgery day. I mean lots. So much water. More water than you've ever had. It was the easiest thing that I could do for myself to make sure that my body was hydrated and happy." —Paige, 26, Nonbinary

Weight is another factor a doctor may look at before performing surgery — as it's sometimes related to other markers of health and heart health in general, and could be a factor in optimal wound healing, according to Bluebond-Langner.

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6. And if you smoke? Now is the perfect time to quit.

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Many surgeons will outright refuse to operate on patients who smoke, as it can affect your recovery. Also, it's just not great for you.

"We ask our patients to stop four weeks prior to surgery and to refrain from smoking for at least eight weeks post-surgery as smoke or nicotine products can impair wound healing," says Bluebond-Langner.

7. Keep a journal to track the journey, or take photos to document the entire process and see how far you've come!

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"Keep a journal and take as many photos as you can of your before and after. Looking back on your journey can help motivate you later when you are feeling fearful about something else in life." —Anonymous

8. Feeling nervous? That's OK. Talk to a friend (IRL or in an online community) or a therapist, if possible, about what's going on.

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"It is always good to see a therapist if you are having any emotions about the whole situation, just remember that while it is exciting while leading up to top surgery, it is okay to be anxious and nervous. This does not mean that you are making a mistake, it is just a natural reaction to having major surgery. Do not suppress these feelings just because you feel like people will invalidate your desire to get top surgery as being stressed and nervous will make the surgery just that much harder on your body." —Ryen, 19, Trans

"Also remember to talk to those around you about how you feel. It's normal to be scared, even if you're very excited. There is no shame in asking help or sharing emotional moments. This is a big deal for you, and you deserve to feel that way." —Lucas, 21, Trans

9. If you can, reach out and learn from people who have already been through this.

"I read other peoples' blogs about their top-surgery experiences! It soothed any worries and reaffirmed my decision to get top-surgery." —Logan, 27, Trans

"I spoke to a therapist for a while, but I found connecting with other transguys/people who have had this type of surgery was really helpful as well. They could help with specific fears/questions/etc in the lead up to the day." —Isaac, 22, Trans

10. Make a detailed list of things to bring with you to the hospital, as well as things you'll need when you get back home.

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"I found it helpful for my peace of mind to make a to-do list of things to pack/bring to the hospital. Especially with items you wouldn't think of at first, such as a pillow to put between your chest and the belt of the car when you go home, or an extended phone cable because the sockets are quite far away from the bed usually." —Luca, 22, Trans

"Don't try to do too much after surgery! Get wipes because you can't shower. Easy to digest foods are great! Laxatives because you will be bloated and swollen." —Liam, 29, Trans

You'll most likely need an escort home from the hospital, says Blasdel, as many doctors won't let you go home by yourself after anesthesia. Plan ahead to have someone you trust with you.

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11. Plan out easy-to-fix meals ahead of time, because during the first days of recovery you'll pretty much be stuck in bed.

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"Buy some nutrient shakes and ready meals for the first week or so, especially if you're going to be on your own. Have lots of pillows to prop yourself up - I slept on the couch for a while." —Dan, 26, Nonbinary

12. Speaking of your bed, make it the comfiest it has ever been.

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"I'm a side-sleeper and if you have a double mastectomy, you can't lay on your side for at least a month and a half. I resorted to some sleep aids and lots of pillows to help my back. I also got one of those backrest pillows and it saved my life. I could comfortably sit on the couch or in bed without much stress on my chest." —Jack, 27, Nonbinary

13. Make sure you have at least one person you can count on during the recovery process to help you change your drains, reach things on high shelves, and yes, go to the bathroom.

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"Know that you will be very tired and asking for help with everything. You'll need help changing clothes, bathing, cooking, even getting a glass of water if the cups are stored above chest height. Advice: take it easy, put your pride on the shelf, ask for and accept all the help you can get." —Micah, 21, Trans

"YOU WILL NEED HELP. This surgery will knock you on your butt. Just getting up to use the bathroom was a challenge, I couldn't imagine having to make my own food and do other things on top of that. Having someone to help for at least the first three days is a must. Also, be careful with eating after you get home from surgery. I waited a good five hours and then thought it was safe enough to eat a bowl of light soup. A half hour later I threw up said soup." —Anonymous

"Having someone to help you change drains will make it much much easier. As they strip them toward the bottom, hold the end that's stitched to your side steady so it doesn't tug with one hand. With the other, follow along and hold the tube closed after they strip it down, so that suction doesn't pull stuff back up when they let go to move farther down." —James, 27, Trans

Post-surgical drains can be one of the most annoying parts of recovery — but they're there for a reason. "Drains collect the excess fluid that your body produces in response to trauma," explains Bluebond-Langner. "We instruct patients to pour the fluid in the drain bulb into a measuring cup and write down the amount." When the level is low enough, the drains are no longer needed.

14. Embrace your inner type A and follow your surgeon's specific instructions carefully.

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"Write out exactly how often you need to take any medicines/supplements you are prescribed and clearly keep track of when you've taken them. I put all my meds in a row sorted by the frequency that I needed to take them and placed a post it note in front of each bottle with instructions and made a tick each time I took the medicine." —Logan, 27, Trans

Specific care regimens for bandages and the timing of when you'll be able to shower will be surgeon-specific, as every surgeon has their own best practices, says Bluebond-Langner. When in doubt, listen to your doctor.

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15. Take your recovery (deep breath) one day at a time.

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"Make sure you're at a place where you know your limits and understand that recovery is going to drastically reduce those limits. I don't care how proud you are of your arms or abs or whatever, you're going to have to rest after surgery. Make sure you can commit to a full recovery and not push yourself too far." —Dan, 26, Nonbinary

"I'm about 6 months post-op and I still have very visible scars and can feel some painful pulling at my incisions if I lay down on my stomach or stretch too far." —Jack, 27, Nonbinary

"An important thing to remember is that every day it gets a little better," says Bluebond-Langner. "The pain gets a little bit less, you'll feel a little more confident each day."

16. Prepare and manage your expectations before you take off the bandages for the very first time.

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"It will suck to heal for so long, but it's what you, have always wanted so it is worth it. And never have high expectations for removing your scars completely — they will show, despite how much Cocoa butter you use." —Anonymous

"When my dressings first came off a week post-op I was really worried that something had gone wrong because it looked really gross and I had these scabs on my nipples that made them look all burnt like someone had left them on the barbecue too long. But I just had to trust my surgeon when everything was fine, and my chest looked much better after a week after the residue from the dressings and the bruising had gone away, and the nipple scabs fell off eventually leaving nice, normal looking nipples underneath." —Anonymous

"When I first saw myself after surgery, I expected to feel relief immediately but I actually compared myself to Frankenstein's monster for weeks. It was hard to see my body so beat up after surgery but what helped was confiding in people I trusted and keeping my mind focused on other things." —James, 19, Trans

When you are first able to remove the bandages and see your chest for the first time will depend on which type of surgery technique your surgeon used (double incision with a nipple graft or periareolar incision). Usually, you'll see your doctor again the next morning to check for a hematoma or other complications, says Bluebond-Langner. "From there, you'll be seen periodically to take down nipple dressings or have drains removed."

Be sure to ask your surgeon about scar massage and products to help your scars heal in the best manner possible, adds Bluebond-Langner. "There are a lot of products out there on the market. Silicon sheeting is a very old, tried-and-true way to protect your scars, and you want to keep them out of the sun."

17. And don't compare your progress to anyone else's — because every situation is different.

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"My recovery process was surprisingly difficult. I only ever saw other guys who flew through recovery without complication but that simply wasn't the case for me. I went through three different complications, each extending my recovery period by weeks. I had to go back to my surgeon and flush out a seroma, close holes that opened due to being allergic to the dissolvable stitches and go on medication for 20 days due to an infection. It was really hard for a long time but it's definitely made me a stronger person. It's made the end result more worth it!" —James, 19, Trans

18. Some people might experience a feeling of loss or depression after surgery, but it's not necessarily a feeling of regret.

Charlotte Gomez/BuzzFeed News

"There was a moment when the realization that I just did this major event that I cannot get out of really hit home. I wasn't regretful, but it was more along the lines that I just did this massively permanent thing to my body. Something that may be extremely hard to reverse, if it could be reverse. You can't help but realize that weight of that consequence, even if it's a consequence you want so badly to happen.

"My mood dropped- my mood dropped pretty badly. But talking to friends, and reading books for pleasure reading and learning more about the career I'm pursuing, watching the scars heal, once I really was able to touch my chest without pain. I felt regret, and loss. But it was more for me as a end of a chapter, and a start of a new one, one that makes me not regret one inch about making the decision.
" —Adrian, 22, Trans

"A low mood post-surgery can occur, and it's usually due to the anesthesia and narcotics," explains Bluebond-Langner. "It's important to continue to derive support from your loved ones and therapist but also making sure you're keeping on your circadian rhythm. Go out and walk during the day and get back on your regular schedule, that will help with mood elevation."

19. Remember that having surgery is not necessarily a "quick fix" for feelings of dysphoria.

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"My therapist helped me work through issues of disappointment and feelings of missing out on having a biologically male body. Surgery doesn't erase dysphoria. But it does help with the process of accepting that this is who you are." —Anonymous

"My nipples are also oddly shaped and won't ever look like a cis male's nipples. I'm still coming to terms with them." —Jack, 27, Nonbinary

"While I love my chest and have never regretted top surgery, there is a lot of cognitive dissonances that can happen when you first see your chest. Your brain is not used to your body looking that way, even if it is what you've always wanted, so it was very strange and almost alien to see my chest at first. There was a definite adjustment period that I went through, remember that your body and mind have to adjust and that your chest will be changing and healing for months." —Ryen, 19, Trans

20. And, of course, remember to celebrate!

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"I had a party after surgery. Friends planned a surprise 'its a boy' shower for me." —Anonymous

"After my revision, my friend baked me a fifteen-layer cake that said 'Welcome nips!' on it :) We lit the candles and sang happy birthday to my nips. it was so wonderful." —Paige, 26, Trans

"I got the date of my top-surgery tattooed on my rib cage to remind me every day of how strong I am." —Anonymous

"We took my husband to the Polar Bear Plunge on January 1st after he was 100% healed. It was the first time he took his shirt off in public! He stood proud with his best friend, chest puffed out, flashing his arm muscles while he posed for some photos before running into ice cold water. Best. Day. Ever." —Samantha, 31, Straight

Need more reading? Here are some links to get you started.

The Philadelphia Center for Transgender Surgery: Great resource with some before-and-after photos of real surgery patients.

USCF Transgender Care — A good resource for understanding the different surgical techniques, complete with a downloadable patient checklist!

World Professional Association for Transgender Health Standards of Care: Standards of care for trans patients based on the best available science and expert professional consensus.

The Mazzoni Center, Callen-Lorde Community Health Center, and other LGBT centers in your own area.

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