I Have Boobs Again. Sort of.

How I decided to reverse my top surgery, eight years later (Part 1)

painting is “Saint Agatha” by Francisco de Zurbarán, 1633

I got my mastectomy, a.k.a. “Top Surgery,” like 8 years ago or something. Wow, time flies! And, yesterday, I got breast reconstruction surgery. I have boobs¹ again!

(For new readers, the tldr on that is: I thought I was trans, Female-To-Male, and I took hormones and had my boobs cut off when I was 22-23. In fact, it was just a post-college mental health crisis and a Big Fat Mistake.)

I wanted to undo the damage as much as possible. I thought about reconstruction immediately. But after the disaster of the first surgery, I was extra-super-cautious about getting another one. So I put off deciding about reconstruction, keeping it a “maybe,” for a while. A long while.

However, all these years later, I never really moved on. I was still radically conflicted about getting surgery... until recently. But why did I take so long to decide? Shouldn’t it have been a no-brainer to “get my boobs back”?

The Case for Staying Flat

I could have just not gotten any more surgery, and remain flat-chested. This option has a lot to recommend it, such as:

• easy (no maintenance surgeries, no revisions, no recovery period with lifting restrictions)

• safe (there are many known side effects that could occur from breast reconstruction)

• totally free (duh)

And let me be clear about that “side effects” thing, because it sounds so breezy, doesn’t it — oh, sure, it’s an effect, but just a “side” effect, not a “main course” or “entree”… At least, that’s how I felt going into surgery as an idiot in my 20s. But any surgery, any opening up the skin and rummaging around in the body, is serious business. Sure, thanks to modern medicine, it’s pretty safe. But if there’s even a small risk of a very bad consequence, I knew I needed to consider that It Could Happen To Me. When I was trying to decide if I should transition, I took a lot of comfort in the “only 1% of people detransition” stat, and, well… turns out that was a bad strategy. Could I live with breast implant illness? Could I live with one of the implants developing a scar tissue capsule that contracts and moves it somewhere weird on my body?

And then there’s another piece, which is the idea that it might ultimately be productive, spiritually nourishing, to accept my body as it is, modified, and just continue to do the work of living with it. To realize that living with mistakes with dignity is better than grasping after things that are, truly, long gone. In the eight years since I have had the surgery, the regret and pain has lessened a lot. Who is to say I couldn’t learn to live with it and find peace in my flat chest? Isn’t that the mature option?

But I Don’t Want Hard-Won Acceptance of My Mistakes! I Want Boobs!

It’s so hard to live with a regretted trans mastectomy. I hated the weird, artificially prepubescent look of it. I still had a disturbing, persistent feeling of missing parts of my body. It’s like a “check oil” light blinking on your dashboard, but for missing the body parts that were removed — the nerves are dead but my nervous system is still looking for them. It’s a hard feeling to transmit in writing. It vexed me after the surgery, sometimes mildly, sometimes a lot, but never ended.

And I’m in my 30s. I have (hopefully) a long life remaining in front of me. I like fashion, and it never really stopped hurting when I tried on a dress and saw the empty sockets for breasts gaping out over the empty space and scars on my chest. Moreover, there’s the constant visual reminder of my folly. It was a temporary madness, but a permanent disfiguration.

And at least among women who had mastectomies for cancer reasons, it’s pretty widely known that having your breasts removed can cause emotional pain, a feeling of de-feminization, sensations of unattractiveness. For this reason, breast reconstruction is generally covered by insurance as “medically necessary” since the psychological benefits are strong.

People don’t like this word, but I think it’s fair to say it about myself: I feel mutilated. I do. Torn apart. There’s a heavy, heavy Adrienne Rich poem describing a woman who had a mastectomy, her “scarred, deleted torso.” She is unable to sunbathe topless with the other women because it’s just too painful for her to see her wounds laid bare. It’s a poem about cancer, I feel sheepish quoting it - I know my situation doesn’t remotely compare - but there’s so little writing on the emotional texture of having a mastectomy, and I couldn’t help but relate to certain lines. And one particular part of that poem just returns to me every spring when everyone comes out in their beautiful spring dresses and my mastectomy scars ache dully in the sun under my T-shirt:

“You hadn’t thought everyone

would look so perfect

unmutilated”

- A Woman Dead in Her Forties, Adrienne Rich

It’s kind of a mind bender to think about reversing a surgery that I got for aesthetic reasons (although, you know, it’s complicated). Where did the gender dysphoria go? It was a symptom of a bigger problem. It was a passing thing, or if I feel strains of it from time to time, it is very mild. I think I separated out my former distress into its real sources, no longer scapegoating the body and therefore desiring to micromanage people’s perceptions of its sex.

But the changes remain. I’m no longer pretending to be a man. But I am, actually, permanently, a woman with no breasts. That remained true.

Realistic Expectations

One of my biggest concerns was managing expectations. There are some things that, having given them up, are permanently off the table. The old dead nerves in my chest will not re-knit and come alive again, for example. My nipples, having been cut off and grafted back on, will still be weird stiff FrankenNipples with stitch marks on the sides. And, obviously, the implants will not produce milk so I can feed and soothe my children with breastmilk from my own body.

In these ways, and others, I cannot ever “have my breasts back.”

This is all pretty obvious. But it was useful to tally it up because I was trying to be very realistic about what this surgery could and couldn’t do. I was scared that if I didn’t think very hard about what I was actually signing up for, I might go in with secret hopes that I haven’t admitted fully to myself - and then be crushed when they didn’t come true. Of course I want my old body back. But I can’t have it, any more than I can rewind to being a baby-faced 22 year old. So what could I actually do?

The Options

There are two basic options for breast reconstruction, broadly: there is implant-based reconstruction, and flap reconstruction -the flap being a piece of tissue from elsewhere in your body: thigh, stomach, buttock. If you want to learn about these options in exquisitely helpful detail, The American Society of Plastic Surgeons has a thorough and detailed list available on their page Breast Reconstruction: Know Your Post-Mastectomy Options.

The silicon implant reconstruction is an easier procedure - you can do whatever size, too. However, it requires ongoing maintenance, it’s an artificial implant in your body, and possible side effects include encapsulation (scar tissue grows around the breast and seizes it up), infection, implant bursting (ee gads!), and breast implant illness.

The other version is flap-based, where they slice some bits off you and refashion them into breasts. This has the benefit of having the breasts be “real” in a sense, but it’s also a much, much harder procedure than implants. More scars, more chances for flesh to become necrotic. And there’s the little matter of “donor flesh.”

I sent my picture to a DIEP-flap reconstruction surgeon and he told me that I was too thin to get much of a breast going. Maybe an A-cup, he said, if he took flesh from my bottom. When I looked at his website at the skinny patients, the ones who had parts of their buttocks turned into breasts, the idea became less appealing to me. Surgery scars are pretty painful, and the idea of having them on my, erm, sitting flesh, did not appeal. Plus, I’m not so hard up for breasts that I’m ready to maim my poor bottom. It didn’t do anything wrong.

For implants, there’s only so much you can fit without tissue-expanders. These sit beneath the skin and stretch it so you can accommodate more of an implant. My original cup size was something like 30D, which is a little bigger than I can really get without expanders. But doing the tissue-expanders and then taking them out and putting in implants is two surgeries, and that’s very difficult for me on account of two adorable little logistical complications called MY CHILDREN.

That Fearful Asymmetry: Nipple Issues

During a masculinizing FTM mastectomy, the nipples sometimes get moved around. I know mine were - the surgeon cut them down smaller and put them kind of off-center and down, more where a man’s would be. They were also a little crooked, I think, but that probably wasn’t on purpose. My surgeon said he couldn’t reposition those during the first surgery, they might be wonky, but maybe a follow-up could be done. I don’t want the nipples to appear weird and off-center. But I also don’t want to get more surgeries - again, I am responsible for children! I guess my real question was - how bad is it going to be? Were my implants and FrankenNipples going to look totally cockeyed and insane?

Recovery Period Difficulties

My surgeon told me there would be a strict ban on lifting heavy things (over 10 pounds) for five-weeks post-surgery. This presented a real problem for a stay-at-home-mom such as myself. I have a toddler and a baby, they are both strapping lads well over 10 pounds, and they both require lifting many times a day: onto the changing table, into the crib, into the stroller, out of the playground, etc. When it comes to surgery, if I do go ahead and lift things, the consequences could be quite severe: blood vessels rupturing, causing blood to collect with no escape, possibly necessitating emergency surgery to remove the implant. Not good.

So I would need 5 weeks off of lifting them. I have no family nearby, and my husband works in an office for long hours. As it turned out, my parents were down to come fly in and help me out for the full 5 weeks. We sublet an apartment for them. But it was a lot to ask of them, and otherwise, we would have had to pay for a nanny.

This is one reason I started to wish I actually hadn’t waited as long. Waiting a long time to be sure I’m ready is all well and good, but once little kids are in the picture, it becomes much more complex. On the other hand, I didn’t have a well-paid job with insurance until like 5 seconds before I got pregnant, so, whatever. But just something to consider for prospective mothers who may be in my shoes.

So Anyway, I Did It

I found a very good plastic surgeon who had heard about detransitioners and wanted to help. He helped me submit paperwork to get my insurance to cover the procedure, and it went through! But it only was pre-authorized through July of 2026. And I have good insurance through my husband’s job, but it’s an uncertain economy and I’ve been laid off a time or two and know that you can’t take that for granted. And my mom could come stay and help out. If my mom moved to Spain or my husband became a monk or I got pregnant again or the pre-auth expired and couldn’t be renewed (insurance is mysterious), it wouldn’t be anymore. It wouldn’t be easy, but it would be doable.

I know there can be side effects. But ultimately, I decided I was willing to take the risk. And I hoped that I could find some peace and no longer have that constant blinking “Hey Where Did My Boobs Go” wounded animal sensation in my body, no longer wince when I saw myself in the mirror. Was I taking the immature way out? You could say that. But I decided to be a little bit selfish, to inconvenience my family quite substantially, and to give myself the gift of saying “this could help. It’s worth a try.”

I had a strong fear that I would be punished for trying again. There was so much shame from last time - I had been so stupid, so naive. And here I was, going for another surgery? Didn’t I learn my lesson last time? I was worried. But there were so many post-mastectomy women - most from cancer, but some detransitioners - who seemed to genuinely find the reconstruction satisfying. And it wasn’t politicized in the same way that transition was 10 years ago. And I had really, really tried to be realistic about it.

A trip to the hospital always gives me bad dreams. The same thing happened before the breast reconstruction surgery. I couldn’t sleep, and when I finally did, I dreamed an invader came into my home and tied up my children, and I ran out and slashed him with a knife, over and over and over again, wincing with horror at what I was doing. And then my husband came out and said “What have you done?” and the vanquished home invader had turned into a little child. (Any Jungians in the audience want to take a swing at that one?)

There’s a feeling of finality. A feeling of dread. You walk up to the crucifix-shaped operating table. You lie down and give yourself over to the artificial darkness. What happens next is totally out of your control. It’s horror.

And then I woke up!

It’s too soon to tell you what I think of the results. I’m still healing, so I don’t really know what they are. I can’t even take the sports bra off my aching chest. (In the post-op debrief, the surgeon casually fired off that he decided to move one of my nipples after all, which was nice of him). I am in good spirits and am cautiously optimistic that I made a good choice, a thoughtful choice, a choice I will not regret. But it’s impossible to say until I’ve healed and lived with it.

I can’t guarantee anything about what comes next, except this: I will follow up about how I’m doing, once I figure out exactly how that is, and I will do my very best to be honest and helpful to other detrans women who might be considering this surgery.

Until then, I’ll be drinking smoothies and gingerly patting my children on the head. I’ll leave you with another lovely little fragment from Adrienne Rich.

I came to explore the wreck.
The words are purposes.
The words are maps.
I came to see the damage that was done
and the treasures that prevail.

-Adrienne Rich, Diving into the Wreck

1. well, sort of