In today’s increasingly anti-trans environment, finding affirming and inclusive information about gender-affirming care can be a challenge. As a nonbinary Nigerian, the prospect of undergoing top surgery initially seemed distant from my reality. However, finding, pictures, and stories of individuals who’ve undergone this procedure reinforced my belief in the possibility of one day experiencing gender euphoria. Since having top surgery, I’ve decided to compile a basic guide using my personal journey for those curious about top surgery or contemplating pursuing it.
What is Top Surgery?
The term ‘top surgery’ typically refers to gender-affirming surgeries aimed at aligning an individual’s chest appearance with their gender identity. As a nonbinary person, gender expression and decisions regarding gender-affirming care aren’t confined by a specific look or set of rules.
While some nonbinary individuals seek breast tissue removal or reduction to achieve a more masculine chest aligning with their gender identity or personal preferences, others may opt to augment their chest or maintain its existing appearance. Not all nonbinary individuals share the same desires, and for some, chest augmentation feels affirming in expressing their gender. In my case, I chose breast removal as it resonated aesthetically with my vision of how I wanted my body to appear. The important takeaway is that various options are available to help nonbinary individuals achieve their desired chest appearance.
Key Considerations
For nonbinary individuals considering top surgery, there are several essential steps in planning this journey. I have outlined a few things to consider as you go on your journey.
Emotional and Mental Preparation: For some people, undergoing top surgery marks a significant milestone in their transition. Thus, it is crucial to prepare oneself emotionally and mentally for the changes and adaptations that accompany this process. Understanding the associated risks is vital. Seeking guidance from experienced healthcare professionals and supportive networks can be incredibly valuable throughout this journey. Before my surgery, I sought insights from other black nonbinary individuals on social media to grasp their experiences and find reassurance. During my consultation, I asked my surgeon numerous questions, no matter how seemingly insignificant they appeared. Ultimately, it’s your body, and having comprehensive information before making this decision is your right.
Researching Surgeons and Clinics: Navigating the path towards top surgery can appear daunting due to several barriers, including stigma, lack of provider awareness, and systemic issues within the healthcare system. These hurdles create complexities in accessing gender-affirming care, imposing unnecessary restrictions and preventing individuals from obtaining necessary treatments. To overcome these challenges, it is crucial to familiarise yourself with the process and acquire the essential resources and paperwork required.
Extensive research into surgeons and clinics plays a pivotal role in this journey. Reviewing feedback, verifying qualifications, and examining before-and-after photos are key to ensuring a safe and comfortable experience. As a black individual, I specifically requested before-and-after images of other black individuals with similar builds and chest sizes to assess how the surgeon’s incisions healed on black skin. Additionally, I had to consider various factors, including the procedural process and costs. While residing in the United Kingdom, I encountered bureaucratic hurdles in qualifying for top surgery, as well as financial challenges with private clinics charging a minimum of £10,000 for the procedure. Through my research, I discovered equally qualified surgeons in other parts of Europe offering more affordable rates without requiring external approval, solely relying on the consent of the individual seeking top surgery. Among the surgeons I considered were Dr.Ivan Manero in Spain, Dr. Lubomir Lembas in Poland, Dr. Ergin Er, and Dr. Serkan Dinar both in Turkey.
Consultation Process: During the initial consultation with most surgeons, whether conducted online or in person, discussing your specific needs, understanding the surgical procedure, and assessing your suitability for the surgery are crucial steps. At this stage, the surgeon evaluates the appropriate surgical method based on your unique situation. Individuals with smaller breast sizes (A cup) and firm skin generally qualify for keyhole or periareolar methods, while those with larger chests often opt for a double incision mastectomy.
In this consultation, you can express your preferences regarding nipple preservation. Depending on various factors—such as your desire to retain nipple sensation or whether you prefer complete removal of breast tissue—the surgeon may offer options like a nipple-sparing procedure or nipple grafts. This initial discussion allows you to align your surgical goals with the available options and make informed decisions about your top surgery.
Travel Arrangements: Arranging your travel may encompass visa applications, booking flights, accommodations, and transportation. Planning your trip in advance is essential to ensure a seamless experience. Regardless of whether you choose a surgeon in your local area or country, arranging for someone to drive you home after your discharge is crucial.
Preparing for Surgery: Preparing for surgery involves adhering to pre-operative guidelines provided by your surgeon, which may include avoiding specific medications and making essential lifestyle adjustments. For instance, my surgeon advised me to cease herbal dietary supplements and blood-thinning medications like aspirin and ibuprofen. If you consume alcohol or nicotine, it’s necessary to refrain from these substances for a few months before and after the surgery. Unfortunately, some surgeons impose a BMI restriction for top surgeries, despite BMI’s limitations in measuring health accurately. Although top surgery has demonstrated safety for individuals at higher weights, some surgeons might refuse surgery unless the patient meets a particular BMI threshold. In my case, my surgeon’s BMI limit was 36, prompting me to lose weight to comply with this restriction before the surgery. Notably, not all surgeons employ BMI as a prerequisite for surgery, so it’s essential to discuss this concern and inquire about their policies.
Discuss any pre-existing health conditions, history of drug use, or eating disorders with your surgeon to understand their potential impact on your surgery and recovery process.
Contrary to common belief, undergoing testosterone therapy isn’t mandatory to undergo top surgery or achieve a successful outcome. As a nonbinary individual seeking top surgery without interest in other forms of medical transitioning, it’s entirely feasible. I personally did not use testosterone before my surgery and did not plan to start. Instead, I engaged in bodybuilding a year prior to my surgery to sculpt my chest muscles according to my preference, making it easier to define my pecs post-surgery.
Risk and Complications: Top surgery, like any surgical procedure, carries a risk of potential complications, although such occurrences are relatively uncommon. Some risks commonly associated with surgery include bleeding, infection, hematoma, seroma, delayed healing of incisions, and negative reactions to anaesthesia.
In cases involving nipple grafts, where the surgeon relocates and resizes the nipples, there may be potential post-healing side effects such as temporary numbness or irregularities in shape or pigment. In more severe instances, permanent loss of nipple sensation might occur, or the body might reject the graft completely. To better understand potential complications, it is essential to have a discussion with your surgeon regarding anticipated risks and their management in the event they occur.
Understanding Post-Operative Care: If you opt to undergo surgery abroad, you’ll likely need to remain in the country where your surgeon operates for a designated recovery period before returning home. Typically, this duration accounts for necessary post-operative check-ups to remove surgical drains or dressings, usually one or two appointments.
After these appointments, your surgeon will provide detailed guidelines for caring for your chest, nipples, and scars. Adhering to these post-operative instructions is crucial for a successful recovery, minimising the risk of complications such as graft rejection, hematoma, or seroma.
During the initial weeks following surgery, you may find it challenging to manage certain household tasks independently. Having a supportive network in place to assist with day-to-day activities is invaluable during this recovery phase.
Conclusion
Remember, there are no fixed rules to gender. If adjusting your chest size, regardless of your assumed gender at birth, brings you comfort, that choice ― be it augmentation, reduction, preserving some tissue, or even considering no nipples ― is the right one for you. Similarly, there’s no singular “correct” way to express nonbinary identity. The path that feels most genuine and aligns with your essence is the right choice.
Regarding top surgery, there isn’t a single “appropriate” reason. Whether you pursue this procedure to alleviate dysphoria, align your appearance with your gender identity, or for aesthetic reasons, it is a valid decision.
