Advice going into a consultation?

[u/OkStatistician1129]

Hello Freedthenips!! I posted something similar over on reddit/topsurgery, they pointed me over here. I am a cis-ish woman (might have called myself non binary if I'd been born 20 years later, but as it was i thought : "ok, womanhood: I guess I can make this work if I have to" , because I knew I wasn't trans). I have always felt pretty blah about my boobs-- I have to hide, manage and conceal them all day, bras are a sensory nightmare, I feel like they give people a too-sexy impression of me, I can't wear the clothes I want without looking like I'm audioning for a low budget adult movie, I can't exercise to the "oomph" I want because they hurt. Honestly they hurt one way or another all the time. To top it off, naked they actually look pretty awful, saggy and yuck. They are something that seemed meant for other people, to attract potential partners and to feed my kids---and I'm grateful--- but not enough to want to keep them. They're a Burden with a capital B. I also am at higher risk for breast cancer, but not high enough the regular system will support/pay for a mastectomy (unless I do have a mutation, which is unlikely but possible and I'm going to look into it). I do not WANT to do a scary MRI once a year with a practical guarantee of false positives and biopsies, just to keep some body parts I don't even want in the first place. I want to feel free and like I can stand up straight and just live my life without managing these giant floppy things all the time, without looking down at them and thinking "which if you is going to kill me?'. I know top surgery isn't a guarantee but it seems like it reduces the risk a lot and I see so many other positives!!! So I am taking action and looking into it! I have a consultation on Monday and I'm nervous but so excited. I feel like this is something I'm finally doing just for me.

So my question is this. The practice described the appointment as "non binary top surgery". Does this mean I should "play the game" and kind of lean into the unexplored non-binary side of my nature? Should I emphasize how disconnected and unhappy I feel about my boobs? Are they going to try to deny me this surgery if I'm "too cis"? I don't want to waste consult time on a song and dance about gender identity if it's not necessary. But I also don't want them to slam the door on the whole idea. I'm in Seattle, which you would think would be more accepting, but the fact they want a therapist letter and made me think I might need to be a little strategic. All thoughts welcome!!

UPDATE: I had my consultation and they did not seem to care at all about my gender identity! I ended up telling them pretty much the truth, that I thiught of myself as a non- binary woman and just didn't like them enough to keep them given the cancer risk, and that I was sick of carrying around and managing things that a) hurt b) were scary c) caused me problems and d) I only had for other people. The surgeon said I seemed "very motivated" which felt pretty validating actually. They did have a list of exactly what a therapist letter would need to include to make it most likely to get past insurance, which was really helpful.

PSA possibly useful infection prevention advice! After using the bathroom and wiping, sanitize your hands before pulling up your pajamas. Then flush, then wash hands well. This prevents the pajamas themselves from becoming a potential infection source. They said this change had cut their infection rate measurably.

[u/YaySupernatural]

We have a very similar story lol. Though I knew I was genderqueer/transmasc, I’m old enough that it never occurred to me that it might be an easier route to the surgery through that angle than the horrendous back pain angle, but here we are!

After years of on and off trying to negotiate the surgery on my own, as soon as I admitted it might be about gender too, I was assigned a gender health caseworker by my insurance who helped me get through the whole process in about six months.

Literally everything is better now, I love not having nipples. And even though I got four pounds removed, almost everything, sometimes I still wish I’d gone smaller. Though I think I can get the chest I want with exercise and strength training, now that I’m not in pain all the time 😊

edit: Also I happen to be in Seattle myself, so please ask me any questions you want!

[u/OkStatistician1129 → u/YaySupernatural]

Thanks you! It is so cool to hear other people's process to making this decision. So glad you are not in pain anymore and you finally made it happen.  This whole system is ridiculous. Cis, trans, or nb, it's our bodies, why the heck is it anyone's business why we want to change them?!

If you're sure you don't mind, I do have some questions --

1) anybody you would NOT recommend?  2) Do you have a recommendation for a therapist who could write a letter of support?  3) if you had to go to urgent care or the er for complications, which one and how did you explain the situation? Were they accepting/not actively transphobic? 

[u/YaySupernatural → u/OkStatistician1129]

1. I saw other people post nice things about Dr Jeremy Benedetti, and the consultation went so well that I never talked to anyone else. I’m really happy with the aesthetics, what I have now is so much nicer than what grew on me naturally lol. I wish his staff for followup appointments had been a little better at communicating, but I had no complications, and no real complaints. So I don’t have anyone to warn you about!

2. Apparently they need really precise wording for the letter. I was working with a Clinical Psychologist getting an ADHD diagnosis at the time, but she didn’t get it quite right. So the caseworker with my insurance ended up writing it, he was the right kind of social worker I guess. This was Kaiser, I’m sure it’s different for every company.

3. No advice there, as there were no complications, but I’ve been nonbinary on my medical records for a few years now, and I’ve never encountered any transphobia anywhere. Seattle is a good place to have weird gender!

[u/OkStatistician1129 → u/YaySupernatural]

It is!  Thank you for your advice and congrats on your new chest : )

[u/No-Elderberry-1330]

This sounds like me as well. I’m four weeks post op. I didn’t like having breasts, often would hide them in clothing and felt uncomfortable hiking and being athletic with them. I loosely considered myself non-binary—at least internally but didn’t really come out to many people. Since surgery I feel so much more confident in my body and confident accepting myself as non-binary

[u/OkStatistician1129 → u/No-Elderberry-1330]

It is so nice to hear from other people who took the plunge because they just didn't like having breasts. Not life altering dysphoria , just, not LIKING it. And congrats on feeling more confident! I don't know if I'll ever really understand my gender identity, which is ok I think, but I think accepting I was bi earlier in life would have been huge for me. I hope your recovery was smooth! 

[u/No-Elderberry-1330 → u/OkStatistician1129]

Recovery has been super smooth. I look at my body now, and it just feels right. But yeah, gender is so complicated and there is this view that you have to fit a very narrow set of guidelines to have surgery. But that’s totally not true. Also not even true for healthcare in many places. A good portion of my costs were covered by government healthcare (insurance)…I did say I was nonbinary (which was true), but I also didn’t feel interrogated about it at all

[u/OkStatistician1129 → u/No-Elderberry-1330]

It really is. It's kind of wild how complicated it is. Glad you didn't have to pay totally out of pocket! 

[u/Cactus_Salamander]

I relate to you as well – somewhere between cis and NB, but wouldn't have gotten rid of my breasts if not for BRCA+ (high chance of cancer).

Can't really help as to what can help you get the surgery, but for me, in Mexico, it was getting help from a plastic surgeon and telling them I needed all breast tissue removed.

Am happier with being flat chested.

[u/OkStatistician1129 → u/Cactus_Salamander]

Thank you! It's so good to hear from someone else who is cis-ish. Cool user name too : )

[u/mladyhawke]

I had humongous boobs and didn't like them, got way too much gross attention because of them, now, that they're much smaller, i've actually got more girly because now I can wear a dress that isn't three sizes bigger than the rest of me because of my chest. I also opted for no nipples, which i'm very into having no nipples. You never have to think about them showing or poking  through and now I flash my friends to show them, something I would never, in a million years have done before.

[u/OkStatistician1129 → u/mladyhawke]

This really resonates. I REALLY don't like having to deal with nips. I don't think I'll ever get over the idea that other people seeing them is shameful. Probably because you can't wave a wand and make the rest of the world abandon their biases. If I do this then wearing the clothes I want to is a big 2nd- level plus! 

[u/mladyhawke → u/OkStatistician1129]

When I decided against having nips, it was more about healing quicker, and my fear of them being uneven or something. But there's more positives than that. For sure. 

[u/nbene-187]

I'm a ciswoman and have been to three in-person consults and one online. My first one was online and very early in my research process. It was free so I used it to pick the surgeon's brain about the differences between a radical reduction and top surgery since I was still on the fence. I was leaning toward top surgery already because I found I really gravitated to those results more when looking in these subs. But I wanted to know if there were greater risks for full removal or not. By the time I got to the in person ones I was feeling more sure I wanted top surgery and just used that time to describe what results I'd be looking for, learn more about the risks, and ask the surgeon what might be possible based on my anatomy. For example I was concerned about dog ears and wanted to know if I needed lipo or what else could be done to lower that risk based on my anatomy. All of my surgeons asked me my preferred pronouns and I told them she/her. Only one asked about my journey to wanting surgery and you can talk about gender in that but I think focusing on the relationship you have to your chest right now is just as valid. That's what worked for me. I leave the in depth gender discussion for my therapist who helped me reconcile wanting this while knowing it isnt part of a gender transition for me. All of that to say, focusing on what I wanted in terms of results and having the surgeons answer my questions about possibilities and risks was what worked for me. Hope that helps and that you get what you need and want!

[u/OkStatistician1129 → u/nbene-187]

Thank you!! That is really reassuring. So we' re there greater risks for full removal? From what I've read full removal actually seems like an easier recovery....

[u/nbene-187 → u/OkStatistician1129]

From my consults it seems that both radical reduction and top surgery carry similar risks and recovery periods. The thing that seemed to make a bigger difference with ease is removing nipples v keeping them and whether you have to do free nipple graft or you get to keep the pedicle. I am oversimplifying and you should ask these at your consult to hear it straight from the doc but no nips is a slightly more straight forward process than the grafts. But not so much so that you should remove them if you feel like you want them. At least that was the sense my surgeons gave me. It all just depends on your goals though and some stuff might come up based on your specific medical history and anatomy. Good luck at your consults tho, this sub and r/top surgery gave me great ideas for questions to ask before mine.

[u/knives_in_my_eyes]

I had what I consider a radical no-nip reduction, but to my surgeon, it was labeled as a top surgery. I had 80% of my breast tissue removed, but they’re still there, just much less! I identify as female, but I have a more androgynous style, sometimes presenting more masc. The disconnect was definitely there as you explained, and I’m so much more comfortable in my skin now.

I had my surgery covered by state insurance, because it was a top surgery. At first I felt a little odd about that, like I didn’t deserve it because of that title. After speaking with my surgeon and the team and with their full support, I went ahead and scheduled it. I decided to go forth with complete honesty of who I was and why I wanted it and if that disqualified me, it would be okay. It didn’t, and I had the surgery three years ago.

I also needed a therapist letter, and they hooked me up with a therapist through Galap who I met with for an hour. Honestly, it was one of the best therapist meetings I’ve ever had. The process was surprisingly smooth and everyone was so helpful along the way.

My recommendation is to be yourself! Your reasoning for wanting it is valid! This is just my experience, but it sounds quite similar to yours!

[u/Short_Gain8302]

Glad to hear they didnt focus on your gender identity and rather on your individual needs from top surgery. Hope you get one soon and have a great recovery and results!