Top Surgery Regret

Part One: The Post-Surgery Bad Feelings, Expectations Vs. Reality, and Grief

This is a three part essay series about detransition/regret after top surgery, or double mastectomy.

This essay was influenced and inspired by Carey Callahan’s great essay about detransition. If you’re a detransitioner or know someone who is, give that a read. It’s a great balm. I wrote this in collaboration with Carol and Jamie, who contributed their post-op detransition experiences and wisdom. You’ll be hearing quotes from them in the next two essays. Thank you so much to Carol and Jamie!

This, the first section, is about being my experience of being surprised with grief and pain after top surgery.

What it’s like to regret your mastectomy

“You arrive at the place
It is not what you want
But it is what you chased”

-The Spine Song, by Cake Bake Betty

I’ve made a lot of mistakes in my life. But none have impacted me so indelibly, or caused as profound regret, as my 2017 decision to transition FTM: female-to-male. As I write this, the mastectomy scars are twinging on my chest. 4 years later, I’ve grown older, wiser, and way more cautious.  But the scars remain. 

When I realized that being a trans man wasn’t what I wanted anymore, I fell into despair. My body was permanently changed. The surgery was the hardest thing to deal with. The scars hurt. I missed the feeling of having an intact, unscarred body. I was convinced my life had been ruined. 

As a detransitioner, regret can be crushing. But somehow, eventually, even after the most catastrophic of mistakes, life goes on. It’s still your only life, and you still have to figure out how to survive. It took me a while, and I learned I could survive.

Above all, I just want to say: you can come back from this. People have lived through a lot more. I am not a guide, I have no special wisdom, but I come to you humbled, scarred, and holding out my hand. You can get through this, and build a life. 

Top Surgery, Expectations Vs. Reality

by Jenny Holzer

If you’ve never had a body part removed, or at least a major surgery, it’s hard to understand what it feels like to have “top surgery.” I used to romanticize it. The removal of the breasts leaves a smooth, flat chest with two sexy, mysterious slashes. The scars themselves were like a testament to suffering and transformation. I wanted it really bad. And more than the physical results, I wanted what it represented. It was freedom from binding, it was the first step to truly, powerfully reshaping my body with my own will. It was freedom from the physical sensations of having breasts. I fixated on it as the quasi-religious ceremony of my becoming. 

It was what I thought I wanted. As the date got closer, ragged jolts of fear started to come through me. But I persisted, and bolstered my belief by reading happy stories of post-op trans people.

During our brief pre-op consultation, my surgeon said that this was an easy surgery. Quick recovery, back to normal in no time, really. She glanced over my body and told me that I would look great. I was imagining a transformative and spiritual experience when I went in for surgery. I’d hyped myself up to believe that this was going to be a beautiful turning point to becoming the real me. Of course I knew in an intellectual way, it was going to be tough to have surgery. Nonetheless, I expected powerful relief from my dysphoria. 

I had no idea how bad it was going to be. But once I got the surgery, I found out for myself.

After my mastectomy, I felt sewn up, aching, ghastly. My sutures oozed blood, my abdomen was swollen and grotesque. My chest didn’t feel at all natural. A disturbing, never-abating sensation of numbness and occasional pain had replaced what I now realized was the natural feeling of my intact body. And almost immediately after the surgery, the dread of regret started to sink in. Whatever I thought I was getting into, I had failed to contend with the fleshy reality. 

Lesson learned, younger me. Don’t let the pushy, glitzy Instagram “before and after” photos fool you-  a mastectomy is ALWAYS a big deal. 

I felt like I might be crazy having this kind of reaction to the surgery. I had binged on smiling, triumphant pictures of post-op trans men. The gore and the pain and sadness were not what I had expected. I posted on the ftm reddit about feeling a strange sense of grief at the surgery, and asked if anyone felt the same. Many other members of the forum came out of the woodwork to agree. Even if they were happy with the end results, they still felt loss and pain.

Not only that, but my feelings of gender dysphoria increased. My obsession migrated to my hips, my voice, and my very mannerisms. The top half of my body looked okay, but what was I going to do about my hips? The way I moved? I was more obsessed than ever before with monitoring myself. I told myself I was being liberated, but really it felt like I was stacking the bricks to my own prison walls.

I had this nagging feeling - that nothing would ever be enough, that I could just keep cutting and cutting my body but I’d still be the same increasingly-wounded me underneath it all. That feeling grew and grew. When it got loud enough, I began to realize I would have to detransition. I stopped T, and then my hormone-dampened sadness came flooding back. 

Loss and Grief

ouch (Ryder-Waite tarot deck)

I was taken aback by the deep, serious loss I felt. I tried to connect to other people who were struggling with the same feelings, and searched for more information about mastectomies. In The Cancer Journals, Audre Lorde said that losing a breast (from a mastectomy for cancer) was as viscerally painful as losing her own mother. Another friend described the post-op feeling as being like she had been placed on a strange planet and she could never go home. I think if you haven’t experienced it, it’s hard to convey the feeling.

There was also the psychological fallout of having body parts missing. I felt a harrowing feeling that something was wrong with my body, something was missing. Alarm-signals went off in my brain constantly. In a bleak way, it was fascinating - I had discovered a whole new range of bad feelings I had never felt before. I fantasized feverishly about turning back the clock. Life as I knew it seemed to be over.

It was also really upsetting to cope with the difference between what I hoped the surgery would do for me, and what it actually was. It’s easy to think top surgery will fix your life in some magical way. It’s supposed to help you pass as a man or be androgynous. It’s a huge step on your transition journey. To have those expectations fall through for whatever reason and end up regretting is really hard. 

When I realized my mastectomy had been a mistake, I felt betrayed, disoriented, and confused. My fantasies of what transition would do for me, the road map I had structured my future on, dissolved into meaninglessness. How did I get in this situation? Why did I think this awful, awful surgery would help me? Why didn’t I run screaming away from the surgeon’s table? 

And on top of all of that, if you end up reverting to a female gender identity, there’s the entire collapse of your understanding of yourself to deal with. While detransitioning is different from transitioning, they share the feature of reckoning with the nature of your life and identity. What’s your new name?  Who are you after all this? What does it mean to be yourself, now? To a large extent, you have to find your own way out of the wilderness. 

So: this was hard. Especially the first year, especially the first six months. It got worse after I realized I needed to detransition and make peace with my body, because that also involved accepting that my natural body would never be restored.

If you had top surgery and you’re taking the loss of your breasts really hard, I’m sorry. You’re not alone. You are entitled to healing and relief. You can find it. I’ll talk about that more in the next essay.

The next essay will be about physical and emotional healing, forgiveness, and reconstruction surgery.

Edit: I deleted a line joking that I would be playing Tennis 2 weeks after top surgery. It was a joke, but I’m worried it didn’t come across correctly and don’t want to misrepresent my surgeon. My surgeon did say about 2 weeks would be recovery time for most activity post-surgery.