Top Surgery Sensation Worries

And just after bidding you all adieu, I’m back to share some of my thoughts and apprehensions about why I want top surgery, despite having a small chest, and why I am now having second thoughts, due to worries about sensation.

First of all, I don’t “hate” my chest and it isn’t a major bother to me. As I’ve mentioned before, it’s extremely small. In my teenage years, when I was trying to be a girl, try as I might, I could never fill up a AA cup. And since I’ve been on T, they’ve hardened, shrunk, and become proportionately insignificant as my chest muscles have broadened and grown more defined. They almost look like fatty pecs. But not really. Especially since I’m pretty skinny and not the type who would have fatty pecs. But they’re not a bother. It’s very easy and not uncomfortable for me to bind. But, on the other hand, it isn’t comfortable either, especially during the summer, when I’d much rather feel the breeze under my shirt.

Despite my small chest, I rarely allow myself to be seen unbound. I know some guys with small chests just wear a loose shirt and don’t mind that others may notice a not-entirely-flat male chest. But I really really would not want that to happen. I make an exception to swim, wearing only a tank top with nothing underneath. I feel self-conscious, especially when it’s wet, but if it’s only my friends around, I can shrug it off and enjoy the beach. As soon as I get to the privacy of my home, however, I take off my binder and enjoy lounging without it. It feels so comfortable to have nothing between your body and a t-shirt. This is when I think that I would love to feel this sensation all the time – just walk straight out of the apartment feeling it – but at the same time have the flat chest that matches how I want to be seen. That would be really really great.

Because, after all, I would prefer to have a flat chest and never bind again. This seems obvious to me. And since I’m a good candidate for the periareolar procedure, I have a good chance of regaining sensation and having almost invisible scarring. So, I planned to get top surgery once I could save enough for it – which would definitely take more than a year. Knowing that I had time plenty of time to do my research, process, and come to terms with the idea allowed me to confidently assume I would have top surgery without worrying too much about the details.

None of the gay men I’ve had sex with have minded my chest (they knew I was trans, of course, so other gay men who would not have agreed to sex with a trans men may well have minded). In fact, all of them have wanted to play with my nipples, which was great by me, as that feels good. While having sex, I don’t feel like a breasted person with them, just one with very sensitive nipples. But as soon as it’s over, I feel self conscious again and hasten to cover my chest.

I love my torso after being on T for 2.5 years. When I look at it in the mirror (practicing a certain overlooking), I see a svelte male torso. When I cover my extra chest tissue with my hands, or pull it down a bit, though, I think I can see the true, beautiful shape of my chest. I admire it, and think of how I would love to be able to show it to the world instead of hiding it in embarrassment and discomfort. I’d love to just go out during the summer wearing a form-fitting A-shirt, or a low-V neck shirt, or a loose, airy tank top with large arm holes. I can’t wear any of these things now, because they would expose my binder, which I keep carefully hidden.

I avoid locker rooms, saunas, and public pools. I also don’t get acupuncture, and it can be nerve-wracking to try to get a massage without having my chest be noticed. But I would love to join a gym, get acupuncture, and go to a sauna in the winter. I have nightmares sometimes that I have to change in front of someone, and I’m trying to figure out how to do it without showing them my chest.

None of this is unbearable. But I’ve made it insignificant by thinking of it as temporary. Once I have top surgery, I would think, I will do everything without worrying, and I will enjoy the comfort of never binding again.

I can easily imagine continuing this for a while, for a year, for years even. But if I think about binding, worrying about situations in which others might notice my chest, and avoiding certain healthy and pleasurable activities for my entire life, I think “no way.” That would be, if not intolerable, then at least a total drag.

So I’ve assumed I would get top surgery. Then, someone told me that my new health insurance might cover top surgery if I saw a therapist for three months. I was pleased, but it took a while to find a free therapist and book my first appointment. I went just recently, which meant that it would be impractical, with my travel plans, to get top surgery by the time the three month surgery period elapsed. So I hoped to do it in January of next year.

During my first appointment, my therapist suggested that I speak to my insurance directly to find out the requirements regarding therapy as a qualification for top surgery. When I finally gathered the required information and spoke to a representative, I was astonished to hear that there was no three-month period required, all I needed was letters from a therapist and a doctor, and there should be no problem with insurance coverage. At this point, I was thrilled! What a windfall!! How lucky was I to have one of the very few health insurance plans that would cover top surgery! And they were barely making me jump through any hoops at all! This meant that I could gather the necessary letters and potentially have surgery as soon as May! For a full two weeks, I was flying high indeed.

But, as the potential surgery date draws near and plans become more concrete, I’ve started reading everything I can find about the procedure and healing process as well as looking at pictures of results. And there are a few things I’m beginning to feel ambivalent about.

With peri, I have a good chance of getting most of the sensation back in my chest post-surgery, if not erotic sensation in the nipples. I would definitely miss having erotic sensation in the nipples, but overall, I think it would be worth it for the other lifestyle changes it would make possible. This is something I’ve known I would likely have to give up. I’m starting to think about the fact that there’s going to be a period of time during which my chest is entirely numb. I imagine this would be weird as hell, and kind of alienating for someone who was not alienated from his chest in the first place. From talking to other trans guys, I’ve learned that, as sensation comes back, there may be tingling, nerve pain, burning, or hyper-sensitivity in certain areas. This might happen on and off for years. So it seems that what I imagined as the “comfort” of not binding is actually going to feel more like a mixture of numbness and shooting, burning, tingling sensations for quite a while, perhaps years. This is not what I had imagined. And even if, at the end of several years, I am fortunate enough to have “full” sensation, rather than patches of it along with patches of numbness, I’ve heard from a couple of guys who had my procedure, that there’s actually often a distinction between being able to fell pressure – like a hard touch or pushing – and being able to feel surface sensation – like the brush of a hand or a light touch. So the soft T-shirt brushing against my chest in the breeze is actually something I may never feel. Oh, and my surgical results could be less than aesthetically pleasing.

And of course, there are the worst-case scenarios – that I would have patchy sensation in my chest, no sensation in my nipples, or lose my nipple stalks. I would be very disappointed if any of these things happened.

However, I’m feeling lucky. I’m healthy, have good skin, a nicely shaped torso, not large nipples, and little extra tissue. Chances are good that none of the worst case scenarios would happen to me (though I probably really need to spend some time coming to term with how I would feel if they did happen). Nevertheless, if I couldn’t feel light touch or a breeze on my skin, which seems like a more likely outcome, I would also be disappointed. As I would in the interim period of maybe years while normal sensation gradually returned. I want surgery to help me feel more whole, not more fragmented. I want to enjoy the feelings of an unbound flat male chest even more than I want to enjoy its appearance.

But appearance is what’s stressed by both surgeons and most trans men in internet information and discussions about surgical results. It’s true that many and perhaps even most people who get top surgery want to be rid of their breasts so badly, that they’d rather have a totally numb chest than breasts. But I’m sure that this doesn’t describe everybody. And I’m sure that for most people, regaining sensation and, therefore, a felt sense of the wholeness and the new contours of their chest, is a significant part of the healing process. So why do so few people who post about top surgery mention sensation. Even most trans bloggers report in detail about surgery and the post-op recovery process while failing to mention the degree of the return of sensation, especially in terms of year and 2-year updates. In addition, there is a total lack of substantive statistics on sensation post-op. No statistics on what percentage lose their nipples after surgery, on what percentage loses erotic sensation, on what percentage loses all sensation, on what percentage has chronic nerve pain. One is left to hope that it is minimal and that one on the majority lucky side.

I wish there was a more open dialogue about this online and that surgeons recognized this as a legitimate and important issue for clients. I’m going to post a set of questions folks can answer on sensation post-top surgery in a moment.

What I immediately need to do, though, is revise my post-surgery vision and decide if it still is something worth doing.

To break it down, here is why I want top surgery, in order of importance:

1. The comfort of not having to bind.

2. The beautiful chest that I imagine would be mine! Being able to show it off shirtless or in summery tanks.

3. Having access to certain activities, treatments, and locations I currently avoid.

If the “comfort” of not binding is, in reality, a mix of tingling and numbness, do my reasons for getting surgery still outweigh this?

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