Archive for November, 2014

Stitches out!

Yes yes! Got my stitches out yesterday. It wasn’t a bad experience considering I am still numb in that particular area. It was just scary because in the past 10 days, I haven’t seen anything bloody in relation to my chest. While removing, it began to bleed. Not a lot but enough for him to keep on asking for Q-tips to wipe off the area. Stitches on the torso area are usually removed in 10-14 days and mine came out on the 9th day. A day may not seem a big deal but in aesthetics, it may be difference between perfection and failure. Or maybe that’s just me and my OCD.

My surgeon also gave me a choice of not removing the stitches, which I did not agree to because 1) I was already there and 2) I don’t want to go to work knowing I was still literally stitched up.

I might have to agree with him that it may have been a bit too early and that DOES matter because the tension would be between the whole surface area of the chest versus that incision around the areola. When it bled, somehow we both knew. Thus, he used 6-7 steristrips per areola as reinforcement for the removed sutures. This is what they looked like when I got home from the hospital..

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And with the sutures removed, I can now OFFICIALLY take a normal bath, letting the water run down my now-flat chest 🙂

I will also talk in detail about a medication that was recommended to me which I consider a miracle now. Why? This is a comparison between the picture above and after I slept overnight with the medication applied..

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Gaps are almost closed, wound is almost dried up. And that’s in less than 12 hours. I will discuss the medication in a separate post.

And this is a healing comparison of Day 6 and Day 9. IDK if you see it but there a whole lot of “spot the difference” stuff going on, except for the obvious steristrips.

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9 Days Post Op

I have an appointment today to get the sutures out. I think the wound is ready LOL From there, it’s straight on till I can go back to my usual physical activities…hopefully.

I am regaining sensation on my areola. Whenever I clean and put ointment, I can definitely feel something. Every now and then, a brief swoosh of soreness will happen. Happens in a split second or in three pulses. I read somewhere that these are the nerves trying to re-establish their network.

I started taking a bath last Tuesday but still trying to keep my nipples dry. What a relief! But I think one of the drain holes got infected or scarred more. My left drain hole is flat and undetectable now. The right one, however, bulked up sort of like a keloid. I think it may have been because I move my right arm too much.

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I am still binding with the Ace bandage. But it’s a very itchy experience every time. I did buy a compression vest yesterday so I should be receiving it on Monday. The Ace bandage is very dysphoric for me, especially since it is detectable under clothing. And if I have to do this everyday for at least 4 weeks, then I might as well forget having had the surgery.

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My nipples are looking dry and nice already. Sorry about the crusties, that’s from the ointment. And the reddish parts, pulling off the tape irritates everything LOL.

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And standing up, this is what it looks like 9 days post op. Can’t be happier 🙂

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Reality Check # 1

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Sure your chest is flat. By now, your range of motion has improved loads and the bruises are now yellowish-red rather than purple-red.

But for the next 4 to 6 weeks, you still have to bind your chest, ideally 24/7 except when bathing. WHY?

The removal of the breast tissue, glands and fat creates a cavity in your chest. This cavity attracts fluid, blood and all other biological liquids. If these liquids are given the chance to penetrate the cavity, that will cause swelling, seroma and even hematoma. Plus your capillaries and nerve were most likely severed during the surgery and are looking into reconnecting.

The binder compresses your chest to close off the cavity. It allows the skin adhere to the chest wall properly. This also allows the nerve endings and capillaries to rebuild and help you regain sensation. Binding prevents seroma or fluid buildup. It also prevents hematoma or blood buildup.

Binding will your bestfriend. Be a man and suck it up. It’s the last time anyway 🙂

Almost 1 week post op..

I decided to this post because there are things that have surprised me especially with recovery that I wasn’t expecting to happen. Plus I’m bored. LOL I will be posting de-saturated pictures to lessen their graphic nature.

So again, I am 6 days post op. I got the drains out last Monday (4 days post op) and will be getting the sutures out on Saturday (9 days post op). Generally, I am feeling much much better since getting the drains out. They limit everything you do, from sitting upright to just plain moving around. Big pain, literally and figuratively. I remember going to the hospital last Monday in a taxi because I really won’t be able to handle the roughness of jeepneys. I went home that night riding a jeepney and walking about 2 blocks. All because I felt so much better without the drains.

I am still wearing my compression garment almost 24 hours a day. I take it off every now and then to let my skin breathe and for the blood to circulate. It is still tingly numb in some areas especially within the proximity of the nipple. And let me share something funny. I was changing my shirt yesterday when a cold draft went through the window. I got goosebumps all over and when I looked in the mirror, my nipples were standing up. It was so funny because I couldn’t feel them but when I touched them, they were raised and hard. Haha!

I also want to tell you about the general feeling of walking around at this stage in recovery. I recall reading something about this but cannott recall where. Amputees, when they first get a limb cut off, experience something called phantom feeling. They feel like the limb is still there even when it is not. I actually experience the same thing with my chest. Whenever I walk around without the binder, I feel like gravity is acting on my chest even though it’s not really pulling anything down. It’s such a weird and scary feeling that I sometimes put a hand there to support it.

I still have some localized swelling and brusing especially where the drains were and where the liposuction happened. These were the drain holes (steri stips fell off this morning)..

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Bruising has definitely gone down. The incisions look clean enough and I am.not worried about scarring at all. Sorry for the adhesive residue LOL i still do not have my full range of motion but I am not sure if it’s the fear of opening these drain incisions that’s preventing me or because it really isn’t time to stretch that far yet. But I do the mobility exercises everyday.

These are pictures of my nipples. You can obviously tell the signature purse-string closure technique of the peri-areolar approach. And you can definitely tell these are my original nipples and areola. I feel a bit in my nipples but definitely not 100% yet. Areola is still numb.

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And the last set is the bruising on my sides where most of the liposuction happened. As a result of having been on T for a little over 3 years and going to the gym, my ches fat just distributed itself on the lower region of my chest. It all just sat there, waiting for redemption. LOL

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I’m trying to think of all the things I can put in this blog to help Filipino transgender men with their future surgery plans. I am planning to interview my surgeon and other surgeons so people would have an idea on who would be their best choice.

Preparing for Surgery

I think it is high time for me to recall what I have done to prepare for the day. This is going to be a random list. Just gonna go with what I remember.

6 MONTHS TO 1 YEAR BEFORE SURGERY
– Plan a date. I found it easier to stick with everything else with this small time frame.
– Check your options. Do not concentrate on just a couple of surgeons. Inquire, ask, email, call, Google. Exhaust your resources.
– Establish a gym routine at least a year prior and stick with it till the day comes. I have been working our consistentl for 8 months and stuck with it till 24 hours before surgery.
– Plan your finances. Unless you have salary of XXX,XXX.00 every month, it’s pretty easy to mess up your finances. Budget everything. You will have all the time and money to spend on shit after surgery. What do you really want: those Js or freedom?

3 TO 5 MONTHS PRIOR
– Make sure you are still on track. It’s very easy to deviate. Been there, done that. Stop, sit down and re-evaluate how you are progressing.
– Think of how you will stash the money. Open an account, keep a piggy bank, whatever floats your boat. I personally just stashed my money inside our closet because I am more motivated seeing my savings grow.
– High time to fix your nutrition. Trust me on this. A healthy body promotes better recovery and results.
– Schedule an appointment with your preferred surgeons. Ask what they can do for you and how they intend to go about the procedure. Don’t be stingy with them. Haggling with doctors is very delicate because you will be asleep while they are holding the knife. Top surgery at this point has a range of 100,000 php to as much as 250,000 php. Consider that before you compromise.

1 TO 2 MONTHS PRIOR
– Stop any vices you may have especially smoking. I need not say why as there are a lot of pieces already about smoking and post-operative healing. Just Google.
– Finalize your preferred date so you can set other affairs in order.
– If you work in a contact center, advise your manager or TL about your plans. Bear in mind that if you want to file a Leave of Absence, it takes at least 2 to 4 weeks of advaned notice plus documentation.

LESS THAN 4 WEEKS PRIOR
– Start to mentally prepare yourself. Coping varies depending on the person so you need to have ample time to discover yourself.
– Make your workouts a bit upper body focused and start on some cardio if you are still trying to lose fat.
– Finalize what procedure and surgeon you would go to.
– Ask your surgeon if they have any pre-operative reminders like if you need to stop taking anything etc. I was asked to stop taking fish oil as this may contribute to thinning of the blood.
– Ask your surgeon about the clearance tests you would need to do and when they want to get the results. Some want them a month prior. Mine wanted 2 weeks prior.

2 WEEKS PRIOR
– Start taking 1000mg Vitamin C. It helps with healing afterwards.
– Again, STOP SMOKING.
– Submit lab results if you have them already.
– Workouts can be a bit more chest focused.
– Stop taking NSAIDs, aspirin, Vitamin E, herbal supplements, bodybuilding supps (except whey) etc that may interfere with your surgery. Ask your surgeon about this!!

1 WEEK PRIOR
– Everything will happen fast from here so do not panic.
– Ask your doctor for any pre or post op drugs you need. You need to buy these in advanced. Do not wait till the day before or the day itself, not even the day after.
– Relax. Relax. Relax.
– Finalize your time off work. Submit any medical certificates or documentation pertaining to what you need.
– Try to stop binding if you can. It may help in regenerating your skin and its elasticity. Plus it will help your surgeon draw better since your chest will drop in its most natural way. Binding tends to hold the chest in a certain way, sort of like muscle memory.

12 TO 24 HOURS PRIOR
– Have a button down shirt and garterized shorts/basketball shorts/sweatpants. The shirt will be the easiest and prolly only thing you can wear for 1-2 days. The shorts will be easy to put on as well. The last thing you want is fumble with buttons.
– Have a water bottle with a straw filled with Gatorade or any ionic drink. This is for you to drink once you can while in recovery. Anesthesia dehydrates you a lot.
– Pack some crackers (Saltine or Skyflakes) that you can eat once in recovery.
– If your surgery is in the morning, you will have a full fast by 12mn. Do NOT eat or drink anything.
– Make sure to check all paperwork you need to bring to the hospital.
– Do NOT be late. It’s bad manners to be late in a hospital setting.

Woops, this turned out to be longer than expected. But that’s roughly the timeline I followed 🙂

The Revelation!!

Remember I kept on saying Tuesday? Well it got moved a day early. I texted my surgeon over the weekend to note that there is almost zero drainage going on and what used to be a painless recovery is now having a bit of throbbing. The suction is creating pressure on the area and it is starting to throb, sometimes a shooting pain will just materialize.

One very important thing to note was I was really nervous while waiting in the reception for the surgeon. I was definitely more nervous than I was during surgery. I got so light headed that I ended up buying some chocolate (as if I encountered dementors…okay that was a Potter joke LOL) and some ionic drink. It took me about 20 mins to go back to the waiting area. Something about the unknown scares me. At this point, my expectation was my chest would look like a scene from The Walking Dead: bruised, bloody, swollen and there might even be necrosis or dead flesh.

So there I was sitting on the infamous post op reclining chair. He and his nurse started to undo the dressings on the drain site (which I have replaced twice since surgery) and once that was off, they loosened and removed the bandage. Everything was done in front of a mirror and I tried so hard not to look….but of course, can’t resist. So far, so good! No swelling, no bruising except for where the drains were sticking out. There was still some gauze over the majority of the chest so still can’t let go of my fear. They lifted the gauze and this is what I see..

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My TWD expectations were obviously not met and that alone was very promising.

He then proceeded with cleaning the drain sites. And let me say this: GETTING DRAINS OUT IS THE MOST UNCOMFORTABLE, IF NOT PAINFUL, PART OF THE WHOLE EXPERIENCE. PERIOD. People describe it as a quick process, like getting a parasite pulled out or a strand of (very very very thick) hair  exiting your body. It felt more like a piece of rope being pulled out. And because it has been there for 4 days, it felt like my body was already trying to make the rope a part of it, like it was partly fused already. When the doctor pulled it out, I was scared that the drain would have pieces of flesh attached to it already because honestly, that was how it felt. And I remember saying my right side was problematic but it was actually my left. Can’t describe how it felt but I clenched my eyes shut in the middle of the pulling process. NEVER AGAIN.

On the bright side, once the drains were out, I immediately felt 90% better! He put steri strips on the incisions made for the drains and covered it with antibiotic ointment. The doctor then started cleaning the nipples and it felt so weird because — well — I can’t feel it. I know there was pressure but you know how nipples are amazingly an erotic spot and at this point, it’s nothing more than a dull spot. Again, it is to be expected even if I did not get nipple grafts. I got to keep my original nipple-areola complex.

Once cleaned, the doctor needed to put some waterproof dressing and ointment. It was also at this point that he gave me the go signal to shower that’s why he opted to put the dressings. But but but, he made me take a selfie first before covering everything up again. So this picture is the first official one post op..

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I noticed that he did raise the nipple-areola area and he said that he did so it would align with my pectoral muscles once developed. Initially, I also planned to get a nipple reduction but it seemed like they shrunk already. My surgeon said it was to be expected since the nipple was cut off from the mass, milk ducts etc. My areola did not get any resizing and most of small bruising on my sides were caused by the liposuction. Overall, I am really happy with the turnout. Happy is actually an understatement here.

I am to wear the binder for at least 2 more weeks for at least 24 hours. He said I can take it off every now and then to relieve pressure (and perhaps he knew I needed to satisfy my selfie needs LOL). He also reminded me to do some mobility exercises to restore full range of motion on my shoulders. I can fully raise my right arm and around 75% on my left. I will be going back on Saturday morning to get the areola stitches removed.

I can now sleep on my back and my wife can hug me a bit or snuggle. She was scared of knocking the drains previously. I can now wear shirts again and I did earlier…without the binder so I can relish the moment of my chest touching the fabric. And although I can’t feel it yet, I know my nipples stood out for joy when I put on that shirt 🙂

The Best Type Of Surgery for You

Most, if not all, FTMs always dream of a perfect chest. Nothing beats running shirtless, feeling the wind whip on your skin. In that moment, you forget boundaries and feel like you can conquer the world.

When we snap back to reality, we realize that it is easy to say you want the “twins” out..but determining how is an entirely different prospect.

I’ve mentioned once or twice that the procedure I had is called peri-areolar mastectomy where the incision is done around the areola. The good things about this procedure would be keeping the nipple sensation, less to no visible scarring since the areola area is dark (and I produce dark scars) and much less overall trauma to the skin. The possible negatives would include no control over final nipple position, possible revisions and the sunken chest look where too much tissue is removed.

Please note that this is different from the keyhole type of surgery where in the incision is just below the nipple-areola complex

Luckily, due to the combination of the gym, healthy diet and T, I was able to downsize my chest a great deal thus qualifying for the procedure. I was a candidate for keyhole, however, I did not want to risk having extra loose skin due to binding previously. Since the peri-areolar method has a purse-string closure, it would “pull” the surrounding skin towards the center thus producing a tighter result. This is something that I discussed extensively with my surgeon to prevent future revisions.

So how would you know of qualify for the peri-areolar method? Based on the method by Dr. Scott Mosser, he bases his decision on the inframammary angle (the angle formed by the junction point below your breast). You can read all about it here but in a nutshell, if the angle falls between 90° to greater than135°, your are good with keyhole or peri-areolar. If the angle is less than 90°, then your best option is the double incision method where 2 incisions are made below the twins.

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