Top Surgery Regret, Part 2: Healing

Forgiving yourself, ways to distract and nurture yourself, how time (sort-of) heals all wounds, the pros and cons of reconstruction surgery

This is the second part of 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 this essay. Thank you so much to Carol and Jamie!

The previous essay was about being surprised with grief and pain after top surgery. This essay is about the internal process of healing, some advice about ways to deal with regret and pain, and some thoughts on reconstruction.

Forgive Yourself

“I should have known better
Nothing can be changed
The past is still the past
The bridge to nowhere”

-Sufjan Stevens, Should Have Known Better

After the detransition, I spent a lot of time in what I call “The Self-Hating Sadsack Zone.”

It was not a nice place. My internal monologue was somewhat like:

“I’m so stupid! I’m so stupid. I’m so stupid. Why did I go through with it? I’m so stupid. My life is ruined. I should have known. I should have listened. I hate myself so effing much much. My life is ruined. My life is ruined. I’m so stupid.”

I know: Depressing AND repetitive. What’s not to love?

I did not stay in the Zone forever, however. For the one thing, it was just too pathetic. And on the other hand - it was a waste of my energy. Just as hormones and surgery was not helping my gender dysphoria, self-flagellation and wallowing was not curing my regret.

The first part of that was going to be forgiving myself. I started by trying to honor myself for what I was trying to do with transition. It was an attempt - an extreme attempt - to improve my life. Yes, it was ill-advised, and yes, maybe I should have known better. But I can’t deny that in the distorted frame of mind I was in, I thought I was making a good choice for myself. I even suspected that the operation was a necessary part of a life-affirming, even life-saving transition. Was I wrong? YES. But I had been supported in my belief by several nurses, two doctors, and my therapist. I had a cadre of credentialed medical professionals telling me that this was the sort of thing that WAS likely to help me. And, of course, I was frightened by slogans like “better to have a happy son than a dead daughter,” which made me think I might be likely to commit suicide if I didn’t transition.

 I had to forgive myself for doing what I thought was right for me.

Looking back at my choices, I know I transitioned because I wanted to live. I wanted to thrive. I had realized it was terribly wrong for me, but I still wanted to live, and ideally flourish. To do that, I was going to have to scrape myself off the floor and get on with my life. 

The liberating truth is, you’re the only one who can save your life. And even if you’re longing to turn back time and undo the past, you have to start in the only place you can - where you’re at right now.

How To Start Feeling Better

tenderqueerthings #52, Mar Pascual. 2016.

“Fear and pain and despair do not disappear. They only become slowly less and less important.” - Audre Lorde

It’s hard to imagine life as a woman without breasts, especially after you had them removed to try to live as a man. I’ve struggled with feeling like I’m scarred, mutilated, and deformed. It really sucks. But you can heal from them to a large extent, and learn to live with them.

Zoom out for a minute. Something helpful for me is considering all the other kinds of bad things that can happen. Life is cruel. And yet, people survive all kinds of stuff. They survive horrible injuries, they survive the deaths of people they love, they survive war and trauma and senseless cruelty.  If you’ve lived a sheltered life, if this is the first really hard thing you’ve been through, you may not know your own strength yet. 

I asked my friend Jamie if she had any advice for post-mastectomy detransitioned women. She said: “ I think it’s really important to let yourself feel the bad feelings. Mourn what you’ve lost for as long as it takes, and it isn’t a linear process. At the same time though I’ve found positivity and humor can help. Looking on the bright side. The risks of breast cancer are significantly reduced! Many non detrans women go through mastectomies and reconstruction as well for cancer and prophylactic prevention. Obviously the reasons aren’t the same, but losing natural breasts is not an isolated, very rare, detrans only experience and that comforted me!”

If you look at writing by breast cancer mastectomy survivors, you can also find women expressing deep grief at the loss of their breasts. Of course, the context is very different, since mastectomy for breast cancer is a life-saving procedure and top surgery is part of a gender transition. I luckily haven’t gone through the horror of cancer and chemo. But nonetheless, I took some solace from reading the voices of these women.  There was great wisdom, strength, and resiliency there that I could learn from and try to emulate.

I know this probably isn’t how you hoped things would go, and I am truly sorry. It’s a bad situation to be in, and the scars are there to stay. But the grief slowly gets better. In my experience, you have really bad grief for a while, and then it lets up a bit.  And then it gets worse again, and then slowly, gets better. After a while, you’re not as sad anymore. It gets easier and easier, little by little.

You’re stronger than you think. Maybe you haven’t had the opportunity to learn this about yourself yet. But now you can. You can survive this and grow and heal.

Which  brings me to the second part of my strategy for healing: distract yourself. Oh yes, distract yourself - but distract yourself the right way. Don’t numb the pain with alcohol and weed, or anything that harms your body.  Think hobbies, exercise, art, work, cooking, being with friends - constructive and generative things. 

For example: Try distracting yourself with something physical. Many, many detransitioned women speak highly of exercising. (Wait until you are physically healed from surgery before you do this, of course.) 

I know what you may think.

“Exercising? I just realized I regret my transition, I am missing my BODY PARTS, and you want me to exercise? What will that do for me?”

Well. Yes. Exercise is good. Your body has been through a lot, so don’t overdo it, but you can benefit a lot from something as simple as a daily walk. Healing and strengthening yourself with exercise will make you feel better. Exercise can also blast away dysphoria. It’s not a complete solution, but rather one way you can begin to get back to being comfortable with your body. 

I thought one detrans woman put it beautifully in an interview I did with her: “Starting an exercise routine has been great for me. It sounds silly, but one of my almost-daily routines is a hot yoga class in front of a mirror. Spending an hour a day looking at myself as I sweat and struggle with something has been grounding. It has helped me accept how I look, and seeing myself slowly get stronger is a great reminder of how change happens over time.”

Taking care of yourself physically is very important. On the same topic, you should make sure you are feeding yourself regularly and well. Like exercise, this won’t make you entirely feel better in and of itself. But not taking care of yourself will certainly make you feel much worse. 

Surround yourself with beauty. Try nature. In Stone Butch Blues by Leslie Feinberg, the protagonist beautifully described the peace and release spending time away from society’s judgements: “Nature held me close and seemed to find no fault with me.” 

Or try a hobby. The point is, you sometimes just need to distract yourself with something positive. 

The problem is that once you’ve gone under the scalpel, there’s no quick physical fix. The body heals at its own rate. And the regret and pain isn’t easily healed. In my opinion, they never fully heal, you just learn to live with them more gracefully. But I’ve seen some convincing evidence that ruminating over bad experiences can make your sorrow last longer. So while it’s inevitable to spend some time in deep grief, contemplating what you have lost, one must also move forward. 

My friend Carol has poured her feelings out into art. “Art has helped me explore my emotions and feelings around my mastectomy. When I was early on in detransition I started to paint. I’m no artist, I just did whatever I wanted, even if it was just a mix of colors and shapes. Nothing very planned. As I painted it would seem easier to think about my emotional pain, I could express it in some way. I eventually did do a painting that was more planned around my mastectomy. As I painted it, I cried, I felt the loss, the pain and I put it into the painting. When I was done, I felt a sense of relief. As if I had unloaded some of the weight of the mastectomy.”

I also used crafts  to get through my post-operative, post-detransition freakout. I’m a knitter, so I bought a huge quantity of yarn and the pattern for a gigantic blanket. I told myself “once this is knitted, I’ll feel better.” It took me 6 months to finish the blanket. When it was done, I did feel a lot better. I was still very sad, but I was able to see the difference that those 6 months had made. That gave the hope that six months from now, things would be a little better again. And in another six months, things were better. And so on.

When Will I Feel Better? 

Christina’s World by Andrew Wyeth

“We don’t so much solve our problems as we outgrow them. We add capacities and experiences that eventually make us bigger than the problems.”

— C.G. Jung

How long does it take to get over it? I’m not sure. I went from deep despair to pretty-bad unhappiness after 6 months. I was feeling still pretty battered and depressed but a little more normal after a year. After two years, I started to feel lively and mischievous and happy again. I still struggle and have bad days, and I still miss my breasts. But I no longer feel like my life is ruined. I think humans are astonishingly resilient, and everyone has strength within them to survive very hard things. 

This is a place where therapy could be helpful. There are so many different kinds of therapy, I don’t know what to recommend. When you’re dealing with a really hard regret, it’s nice to have a professional there to help give you coping techniques. When I was first reckoning with regret, my sadness was so extreme that I could barely function. I felt like I was telling my friends and boyfriend the same things over and over again. 

Don’t go to a super-ideological gender therapist if you’re going to get therapy to deal with surgery regret. They might be confused and threatened by your experiences. It’s really aggravating having a therapist use your time to suggest you are on a “gender journey” or suggest your conceptualization of your experiences is inappropriate, so look for someone who isn’t too invested in that narrative.

Going online to connect with other detransitioners can be really nice as well.  It can be an isolating experience trying to talk about top surgery regret with people who haven’t been through it, or people who don’t understand. 

There’s a small but growing body of resources out there for detransitioners. There are groups on Facebook and lots of people on Twitter. 

The main thing you need to know is that just as your body heals from trauma, as your scars fade and your broken nerve endings reconnect, you can heal too.

Carol says:

“When I have physical pain, I find that rubbing my chest and scars with some body oil is very helpful. I tend to get itching that feels like it’s inside my chest tissue. Its nerve issues, the best thing for nerve issues is massage. It also has the added benefit of getting you in touch with your body and performing self-care. Sometimes my wife will massage my chest for me. If you have a partner it can be very nice to have them take care of you in this way. It makes you feel loved and cared for. It can also be healing if your partner was with you through the mastectomy. It can be healing for both of you to make peace with your body as it is and to see the beauty in it, both tending to your wounds and helping you to heal.

Everything gets easier with time, if you are doing the work to heal. For me personally it’s not so much that I feel the loss of my breasts but more the reasons why I had them cut away. I miss them because they were a part of me, they were mine. But I could not and didn’t feel that way until I detransitioned and made peace with my sex and body. It was only then that I really felt the loss of my breasts.”

A Few Thoughts On Reversal Surgeries

It’s tempting to rush to reconstruction after top surgery if you are missing your breasts. Isn’t it strange how keenly you can miss a body part? 

I would recommend not rushing into a reconstruction, or any other elective surgery, right after a detransition. There really is no rush. Your body has already been through a lot. It’s best not to jump into another surgery when your emotions are running high. Please take all the time you need to truly assess your options. Jamie said “I think first off it’s really important to mourn the loss for a while. It took me months to fully appreciate the devastation I felt when I realized I shouldn’t have had the mastectomy. I think on the topic of recon, at least in my case, I wanted it to come from a place of level-headedness, not urgency like before where I felt like I would die if I didn’t get top surgery.”

At first, I badly wanted to “go back” - the harsh truth is, you can’t really go back. There are options for reconstruction, but they won’t create what you had before. So I think it’s important to consider and understand your options carefully, so you go in with clear eyes and aren’t disappointed. 

As far as I know, the two main options for reconstruction are breast implant and DIEP flap. DIEP flap involves constructing new breasts out of other parts of your body, like your stomach. It is higher impact and involves more scarring, but the breasts will be made out of your own flesh. There are a lot of potential complications to this method.

Implants are more commonly used, but the breasts don’t have feeling. There are a lot of other factors to consider, and you can find information on various medical websites.

I have taken a lot of time to read information from women who have had both kinds of reconstruction. A lot of women who had these surgeries for breast cancer talk about their experiences online, on Youtube or forums. Most of the testimonials I found are from women who survived breast cancer, although there are growing numbers of detrans women getting reconstruction. 

Most of the post-op women I know have forgone reconstruction for various reasons - whether financial, avoiding further elective surgery, being okay with the aesthetic look of their flat chests, or other reasons. However, I’ve read testimonials from a few detrans women who are happy with their reconstruction choices. 

I have personally avoided reconstruction so far. The experience of my first surgery was horrible, and I am not sure what having silicone implants under my skin would feel like. If I do get reconstruction, I’ll try to write about it so others can learn from my experience. 

Unfortunately, as of 2021, it’s usually hard to get reconstruction covered by insurance. Many state’s Medicaid policies explicitly don’t cover “sex change reversal” surgeries. Some policies do, though - you should call your insurance provider and ask. Getting reconstruction covered by insurance can be tricky. Jamie pursued reconstruction after her insurance denied her. “I’d tell people to keep pushing their insurance companies, especially if their top surgery was covered. Push and push and push. They offered you a treatment that didn’t help and in fact harmed you, the least they can do is pay for reconstruction.”

The third and final part of this essay series will be about post-surgery social experiences, including friendship and dating. If you like this please consider subscribing to my Substack, and please follow Jamie and Carol on Twitter! They are both lovely people.