revision · surgery · thoughts · top surgery

top surgery revision timeline

10 February 2017, 3:05PM

Today is the day.

I see Dr. Tim Hewitt today at 4:30PM for a consultation on nipple revision. A second opinion as I was not satisfied with my original surgeon’s suggestions. The original surgeon kept cutting me off and refused to hear what I wanted to suggest.

To say I am nervous/anxious/scared is a huge understatement. I am also resolved to be assertive and make it absolutely clear what I want done. I am open to other suggestions as long as they aren’t the same suggestions Dr. Ed Van Beem made, in which I’ll have to deal with the remaining colour.

I find I am intimidated by male surgeons, I fold up and feel like I cannot voice my needs/wants/opinion openly. I need to push through this because my dysphoria over my nipples is crippling me to the point that it’s affecting how I see my entire chest. I feel like my original surgeon gave me pecs because pecs is easier to do on a larger bodied person than a flat chest. He left fat under my pecs and on either side of my pecs (near the underarm) that makes it look malformed. It just does not look natural but I hope losing weight will resolve this but I will bring this up to Dr. Tim Hewitt and see what he thinks.

I heard about a fellow trans guy who recently had top surgery and he agreed with the surgeon to opt out of the nipple grafts altogether. He went into surgery and woke up to find nipple grafts on himself. I was horrified for him, it turns out his surgical notes got mixed up with someone else’s but he is pleased with how the surgeon is handling everything.

4:26PM

I am in the waiting room.

So tense, nervous and emotional. Now feeling numb and detached.

I don’t think I am asking for the impossible. Just remove the grafts, let the scars heal up, do nipple reconstruction and I’ll get the areolae tattooed to my specifications and colour needs.

If he tells me he can’t do that, I will be crushed.

6:04PM

He is disappointed in what my original surgeon has done to my chest. He said my surgeon made the incision across the breast instead of underneath on the pec line.

There is excess skin on both sides of each pec. He said I have far more pressing matters than the nipples. He believes my chest can be improved immensely.

He said my nipples are in the wrong place, they are too high up and too far in. He is trying to discourage me from nipple reconstruction because grafted nipples look better than reconstructed nipples but in the end, he said it’s up to me.

I will end up with more scars due to having to remove the excess skin and if I decide to remove the nipple grafts.

I am so angry at my original surgeon. I feel like I’ve been given a botch job. I’m not the first person either. He’s done the same incision on other patients who have seen Tim.

Because as much as I like my A-cups, I am severely unhappy with how my chest looks overall.

Adriana, the practise manager, will be getting a quote done and emailed to me on Monday. This is because my health fund had closed for the day by the time I was given to her by Hewitt.

12 February 2017

I wasn’t entirely comfortable with my original surgeon during consultation, especially when he said he was going to give me pecs. I did speak up that I didn’t want to look like a body builder, that I wanted a flat chest, he said he’d give me a “flat chest”, which was in his mind, pecs.

I can only assume he did pecs because doing pecs on my body type is much easier, less work (he didn’t bother to remove the excess skin) than trying to give me a flat chest.

He was my last resort and one of the “best” at the time. Turns out, as I now found out, he is more specialised in doing surgery on guys who have small breasts. I am so fucking angry that this information isn’t widespread enough and that only in the last few months, Hewitt has been gaining popularity due to tailoring his techniques to suit the individual’s body instead of half-assing like my original surgeon did.

To give an idea, someone from the group posted this;

“Little pre op surgery rant/post to think things through:

I’ve had a consult with Hewitt, and Van Beem. Hewitt suggested a double mastectomy, one surgery, any extra consults or touch ups are covered etc. He said any other procedures might look puckered or heal funny.

Van Beem suggested cutting a large chunk of the lower breast and suck a lot of fluid/have a bilateral scar across nipples and have to pay for multiple surgeries and operations over years.

I know how you heal is extremely diverse from person to person and somewhat unpredictable but Hewitt seems faster, cheaper, and seems to have a clearer picture of how my chest will look.”

But Tim Hewitt? I am absolutely comfortable with him. 100%. I may end up with more scars but it’s ok, scars fade to white. I’d rather have a bit more scars and a chest I’m happier with than a chest with minimal scarring and unsatisfactory appearance. This chest has got to be fixed, nipples included. I know Hewitt is against it but I cannot stand these nipples anymore.

I have so many emotions running through me. Mostly envy, anger and grief.

I’m envious of people in America who have surgeons who do top surgery in one surgery and get it right in one go.

I’m angry that my original surgeon did this to me when he specialises in lean guys with smaller chests, he should have referred me to someone who is more experienced.

I’m grieving because I probably won’t ever have a cis-male chest. I’ll just have constant reminders that I’m trans and nature and an incompetent surgeon fucked me over. No joke, suicide was on my mind, I was in that dark of a place. No, don’t worry, I won’t do anything.

I knew things were bad about my chest shape and that something about the nipple placement looked off to me, I just didn’t realise how much the extent of it all was.

I’m glad Hewitt sees all the issues with my chest and then some. It makes me scoff in disbelief and even more angry that my original surgeon looked at my chest, stood back in January and was pleased with his work.

Boy, I got a lot to talk about with my therapist next month.

24 February 2017

I have another appointment with Dr. Tim Hewitt on 14th March. It is a pre-op appointment and free of charge since I’m going to go ahead with surgery with him, regardless of what happens at the appointment.

I am absolutely certain I want nipple graft removal, nipple reconstruction and my chest to be fixed up. If possible, I’d like it to be done all in one surgery. I have a feeling it will be like having a 2nd top surgery all over again which kills me in a way but maybe this time, I will finally be happy with how things look this time around.

I’m especially excited about the idea of having new nipples and have them tattooed the colour I see them to be in my head (round pink circles). I will also be relieved with the excess skin removed as I noticed I sometimes can’t relax my arms down my sides because the excess fat pushing out from my armpit area. It’s uncomfortable. I had been dealing with that since surgery but didn’t think anything of it, now I know it’s not normal.

I will write down all the questions I have, at a later time.

I know what I want, it’s whether Dr. Hewitt is willing to do it is the question. I hope he will. I absolutely will not keep nipple grafts because they make unhappy, I will tell him I don’t mind if reconstructed nipples don’t look better than grafted nipples because I’m not after what’s better, I’m after what suits my needs and I know nipple recon will suit my needs far more than the grafted nipples ever will.

1 March 2017

Questions I Will Ask:

Will having this procedure (liposuction, removal of excess skin and nipple grafts, fixing overall chest shape) be like top surgery all over again? (e.g. keep arms down by sides for 6-8 weeks, don’t raise arms above head?)

Re: Nipple reconstruction. Can you do nipple reconstruction at the same time to save me from going under general twice?

Re: Nipple reconstruction. After a year of healing, can I get both of the new nipples pierced or will they reject?

Re: Cosmetic Nipple Tattooing. Will I be able to pick the colour and size of the cosmetic tattooed nipple? E.g. can I have the areolae fade into the surrounding skin?

Re: Cosmetic Nipple Tattooing. Can you do 3-D nipples? Can you show me results? (I don’t mind if they are female results)

Re: Cosmetic Nipple Tattooing. How much will this cost? Is it covered by Medicare/private health fund?

How much will the entire procedure cost?

Will the discomfort under my armpits when I relax my arms against them will go away after this surgery? (I assume this is due to the excess skin)

Answers I Will Give:

If he tries to discourage me against nipple reconstruction, I will just explain to him that the placements of my nipples and their current appearance, I am deeply unhappy with. Plus, my self-image of myself, I see myself having pink nipples. I can’t fight or change my self-image of myself. All I can do is change my body to fit that self-image as close as possible.

14 March 2017, 1:34AM

I found a study that proposed a new technique, the boomerang flap to solve the issue of CV flap nipple reconstruction losing projection.

The boomerang flap is so funny because I’m Australian and the boomerang is iconic :) maybe this is a sign, that its meant to be…!

Basically, the CV flap uses two wings to make the nipple. Boomerang uses only one and uses scar tissue to build up the nipple pillar. (In female patients, they use the masectomy scar to do nipple recon, since Dr. Hewitt said he’d place my new nipples on my top surgery scars, this is perfect!) The nipple shape is an upside down trapezoid to avoid loss of projection… the study even showed an example of the technique done and what it looked like 14 months post-op, I was thoroughly impressed! I wonder if the surgeon would be willing to use this technique, I hope so because this solves all the previous issues Dr. Hewitt told me CV flap nipple reconstruction would present to me.

I aim to print out the study tomorrow if it isn’t too many pages long. The study was published in September 2016 so it is fairly recent. If I can help the surgeon expand his technique and improve the results for his future patients, I would be very proud! I have a strong feeling he may agree to do this and that he might be impressed by my research. I just have to present it the right way and articulate myself well enough.

Here is the study: www.ncbi.nlm.nih.gov/pmc/articles/PMC5040852/#!po=76.6667

Ya… I’m determined. I want nipple reconstruction badly.

An alternative is getting nipple tattoos. On one hand, I like this idea but I prefer the former method as I will be getting the areolae tattooed over the top anyway.

I saw results of a nipple reconstruction on one breast, the other breast had the original nipple. I preferred the look of the nipple reconstruction. It looked convincingly real. I’ve also heard someone else say they couldn’t tell the difference from nipple reconstruction to a real nipple…

Ya… I sound a little nipple obsessed. Its all I’ve been thinking about the past month.

I hope tomorrow brings good news… and cooperation from Dr. Hewitt. I don’t think I’m being unreasonable. Whether he agrees or not with doing the Boomerang flap will be a deciding factor in which way I go. If he agrees, I’ll go ahead with Boomerang flap. If he doesn’t agree, I will just get nipple tattoos and get nipple prothetics (www.gendercat.com sells nipple prothetics for FTMs)

3:58PM

Okay…. nipple graft removal is not feasible so both my options (e.g. boomerang flap or nipple tattoos) aren’t possible.

Goodbye, pink nipples. This fucking sucks. I’m emotionally devastated. He said he can remove the grafts and construct nipples from scratch but they will never look as good, plus I will be left with scars from nipple graft removal which won’t look good.

He actually told me my left nipple graft didn’t take entirely, thats why it is pink in the middle and turns white sometimes.

Holy fuck, my original surgeon NEVER told me this. He said my nipple grafts took extremely well. What a fucking liar. Dr. Hewitt says the pink part is all scar tissue inside.

He proposed this to me:

He will make an incision under the chest, where the scar line is supposed to be, fix the excess skin/tissue, stretch the chest down, this will put the nipples in the correct placement, then he will fix the asymmetrical nipples by cutting them to look round then he will do a modified CV flap but have the incision within the areolae to minimize scarring.

He will go to his secretary, Adriana tomorrow morning and she will call me or send me an email discussing the quote.

I feel numb. Logically I know this is the realistic path I can take even though it is not entirly ideal. Fuck… I’m so depressed but maybe the brown nipples will look much better when they are fixed to look round, tattooed over and pierced to my liking.

15 March 2017

Slowly accepting the reality that I won’t have the ideal nipples I’d like.

I’ve been talking to Joey from gendercat.com, he does nipple prothetics for FTMs and MTFs. He is going to mold a nipple around a nipple piercing as a fun side project. If this works out, I will be happy and gladly pay money for pink nipple prothetics with nipple piercings in them.

At least I will have something…!

I also hear nipple piercings (on actual body, not prothetics) will make things more sensitive. I semi-have some sensation in my nipples??? I never had any sensation pre-op.

17 March 2017

I booked the revision surgery today and paid a 10% deposit!!! :)

27th June is marked on the calendar. I go to his office on 28th of March to get measured for a surgical vest and pictures taken. Hoping to drop weight in the next 10 days (89kg would be preferable… maybe 84kg, the weight when I had the hysto?? If I work hard, I could do it!)

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One thought on “top surgery revision timeline

  1. Thanks for writing such a detailed account! Takes courage to go through the process again, and sounds like a great idea to go to a new surgeon this time around.

    I also am not happy with my original surgeon or her post-op process. And I get what you’re saying with feeling intimidated by male surgeons – part of the reason I picked her in the first place. Definitely going to go with someone else for a revision, and this time I don’t care whether they are male or female!

    Like

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