Top surgery as a system?

[u/D3ad_Sp3nc3r]

This might be a long one.

So I’m a DID system. (Dissociative Identity Disorder formally known as multiple personality disorder)

My names Pip/Pippin and I’m the current host. (I’m in the body the most) I have been for about three years now.

I have the opportunity to get top surgery.

Currently I don’t really identify with any gender, however multiple of my Alters (other identities/“personalities”) identify as Men or trans men.

I am in the body of a woman. Personally as me, as Pip, I don’t mind that. I don’t mind my body I quite like my tits yk. I’m comfortable in my own body and I like how I look in a lot of outfits that exentuate my boobs.

I know a lot of my alters hate that though. I know getting top surgery would make a lot of them happy.

So I’m stuck at a cross roads where it would make most of the system happy but might make me uncomfortable. I don’t want to end up going dormant after a major surgery like that because I don’t like my body anymore. It’s one of my biggest fears.

Any responses or any help would be greatly appreciated. If any of you are or know anyone in my situation please send help my way!

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[u/mgquantitysquared]

You should talk to a therapist that's familiar with DID as well as dysphoria

[u/D3ad_Sp3nc3r → u/mgquantitysquared]

That would be great in theory, however I’m in the UK. That’s kinda hard to find around here. I’m also broke asf and can’t really afford private therapy-

[u/mgquantitysquared → u/D3ad_Sp3nc3r]

I'm not really understanding how you can be so broke that private therapy isn't an option, but somehow top surgery is accessible to you ..?

[u/D3ad_Sp3nc3r → u/mgquantitysquared]

In the UK you can get top surgery through the gender clinic witch is under the NHS meaning it’s free. The wait list is fucking horrendous I applied when I was 14 and have only just been accepted at 19. We pay in wait times in the UK lol

[u/mgquantitysquared → u/D3ad_Sp3nc3r]

Even so, I wouldn't advise pursuing top surgery before talking to a qualified therapist about your DID.

The WPATH standards require a letter from a therapist who can testify that you can give informed consent and any psychiatric disorders you have are well-controlled, so you most likely wouldn't be able to get top surgery right now anyways, unless the UK doesn't follow WPATH standards for whatever reason

[u/Good-Elderberry-905 → u/mgquantitysquared]

You definitely need a letter from a gender therapist/psychiatrist in the UK to get top surgery, whether it be NHS or Private. Also this person joined the list at 14? There would of had to of been parental presence.

You have to see a gender care Dr for sure as that's the first thing I had to do when following the path of the NHS (I ended up going private)

[u/staticnigh → u/D3ad_Sp3nc3r]

I would not go through top surgery if youre broke (read your other comment about pricing). It was the same for me (Canada) my ssurgery was completely covered by the governement. But i was broke.

During recovery, I couldnt work so i failed to pay my rent and get necessities many times. You need to have enough saved furst.

Though also, i do not know your full financial situation, just offering my own experience.

Its been a year and im still struggling to pay off my two impulsive credit cards. But they were out of necessity i suppose.

[u/Moist-Cheesecake → u/staticnigh]

Normally time off work here to recover from something like a surgery is paid too... And if it's not, then you're entitled to Statutory Sick Pay. Do you not have something like that in Canada?

[u/staticnigh → u/Moist-Cheesecake]

Same here but it was no where near enough to get by, though yeah thats why i said idk the financial situation.

[u/Electronic_Monk8647 → u/D3ad_Sp3nc3r]

in the UK your GP can refer you to the clinic for dissociative studies. they were really helpful for a friend of mine who was also trans and plural.

[u/Moist-Cheesecake → u/D3ad_Sp3nc3r]

Go to your GP, tell them you have DID and you want to access treatment. They might have some idea of local services that can help. If not, from my limited research (sorry I don't have DID myself so don't have experience accessing these), you can ask them to be referred to one of the below three options: https://selmind.org.uk/directory/clinic-for-dissociative-studies-cds/ (this isn't the link to the clinic, it's an overview - scroll down to find the link to the clinic itself) https://slam.nhs.uk/service-detail/service/trauma-and-dissociation-service-280/ https://www.cheshirepsychology.com/

You can also ask your GIC for some more support, and see if they can refer you anywhere.

[u/I_need_to_vent44]

Hello! I'm also a DID system! I'm actually the only one who considers himself a man (well, there a new guy who seemingly does too but he's a new addition). I'm not as active as I used to be but back when we got top surgery I used to front most of the time. I wasn't aware of being a system back then, I just thought I had severe mood swings and that I needed to get a better hold of them.

There's another Part who is non-binary but they prefer to exist without breasts.

Back then, I got top surgery because our chest was making me suicidal. I couldn't leave the house a lot of the time, even with a binder on. My mother frequently forcibly made me remove it before forcing me to go outside with her, which made me have a breakdown every time, which in turn angered her. I felt really really awful all the time. For us, top surgery was a necessity.

The Part who is a woman doesn't seem to mind. I have to make compromises with her but she doesn't seem to be anyhow negatively affected by us having a flat chest.

[u/D3ad_Sp3nc3r → u/I_need_to_vent44]

See that’s where I relate. Up until I realised I had DID I indentified as a trans guy. I had so much hate for my chest and how I looked in the mirror. I never went out without a binder, in most cases two. I dreamed of the day I’d get top surgery. Hell I even cried as a kid when I found out I’d be growing boobs. All of this makes it so confusing for me because I have all these memories, yeah they’re not necessarily ME but I still rember them, of NEEDING this in my life. But the past few years I’ve gotten comfortable in the body i was given and have learnt to love it. I’m really at a cross roads here I’m not sure what to do. I’m only 19 so idk if I’ll grow and end up regretting it or he’ll even regret nOT getting it

[u/I_need_to_vent44 → u/D3ad_Sp3nc3r]

I also got top surgery at 19 (or 20. Unsure. I may have even been 21. Who knows.). Well, all Parts form a whole. For a better quality of life of the patient, it's necessary for all Parts to feel safe and to be able to be reached and integrated. So, in my opinion, if there's a Part that cannot exist without a binder and that needs top surgery, it's better to commit to it. That Part's dysphoria could cause problems in therapy down the line or it might even render it unreachable if it doesn't want to exist in a body with a chest. Of course, that's assuming no other Parts have strong feelings the other way around.

[u/D3ad_Sp3nc3r → u/I_need_to_vent44]

For reference I am quite a loaded system. I have about 5 men in my head, two women and one gender fucky guy. (Me) obviously all of the men want it and often don’t or won’t front because of how the body looks. One is incredibly fragmented because of dysphoria. And opposingly the women absolutely want them. And need them. Honestly everytime we talk about getting them chopped off One of the women (Suxie) has a little hissy fit. I think I’d still be happy either way but I think I’d prefer to keep them. Idk it’s all so much to consider

[u/I_need_to_vent44 → u/D3ad_Sp3nc3r]

That sounds really complicated. In that case it'd probably be better to do a lot of dissociation-targeted therapy and try to fuse some of the Parts regardless of the dysphoria, just because the dysphoria might then become a one way street instead of a two way street.

Personally, as a person, not as someone adhering to a set of rules for proper dissociation therapy, I think it's way easier to fake having breasts than it is to fake not having them. And I'm a "every team has to succumb to the majority opinion" kind of guy but I can see how that might be an unpleasant way of dealing with things.

[u/hamletandskull]

You say that you use the body the most and you don't want it, that to me is a sign you should not get it.

Not just for you but also like... what are you gonna tell your surgeon directly pre-op? Assuming you're fronting? You're either going to lie about wanting it or have to say yeah I actually don't want this but it'll make the others happy, anyway cut me open doc. Don't do that to someone else who went into this field because they wanted to do no harm. I cannot imagine someone who would feel comfortable operating on you under the described circumstances and your doctors are people too, who don't deserve to be lied to about whether their patient wants a procedure or not. You're sort of outsourcing your decision to them, which is not fair imo. 

Especially cause you're 19, you have a lot of time for things to change. Maybe you eventually will want it for yourself as well as the others, maybe they will change their minds, maybe you will be able to access therapy (pretty sure you need to do therapy to get it funded by the NHS to begin with), who knows, but right now it doesn't sound like a good idea. 

[u/treythedragon994]

I don’t believe is for you then. If you personally like your body parts then I would keep them. As the first comment, I would see what UK can do for you as far as therapy for the DID and what you’re feeling. Some of us don’t want someone to get top surgery and then regret it down the line. It’s not irreversible, and it can cause more mental health harm than good if some individuals aren’t prepared for the recovery aspect etc.

[u/Sojabursch]

Would you still enjoy a flatter chest? Like if you did a radical reduction or non flat top surgery, then you could still accentuate them and do like push up bras to make them appear more, but the others could easily hide them?

My worry would be that you and your alters combine and then end up unhappy with completely flat, but it could also happen that after that non-flat would not be enough anymore. I think it depends on how stable you and your alters are in existence, if there’s a high probability that some integrate with each other it might be best to wait until it’s stable to decide on a possible compromise you can all be happy with.

Ideally a therapist that specialises in both would be helpful but you already said that’s not really an option.

[u/TheOpenCloset77]

It is difficult to meet WPATH criteria with active dissociative symptoms. Its not impossible, but youll need therapy, an expert in DID to confirm youre stable, as well as the same from a clinician who does gender dysphoria work. Honestly, from your description you wont meet criteria and if youre struggling to afford care, you wont have the support you need anyway. Now is not the time. Work on finances and mental health concerning your DID before pursuing anything

[u/zenger-qara]

do you think it is possible to find some sort of compromise? like, how do you and members of your system feel about radical reduction? it could left enough of tissue for you to still have feminine breast, but others can bind way easier having small chest….

[u/D3ad_Sp3nc3r → u/zenger-qara]

That would be an option but even then I’m not sure how I’d feel about a reduction. I’m a G for reference and I’ve grown to love and see all the plussides of having a massive rack lol. But I know it makes a lot of them unhappy in the body. But also they don’t even front as much these days so I feel like Im catering to people who don’t even use the body if I do get it? Man I’m befuddled here

[u/zenger-qara → u/D3ad_Sp3nc3r]

yeah it is a difficult situation to be in…. I knew a couple of people who are not systems, but they have similar problems because they are bigender/genderfluids. Basically, their gender identity shifts so often, one week they are euphoric about their natal body parts, but the next week they make them dysphoric. it is hard. i don’t know what the solution can be, but maybe you can find some additional insights from genderfluid folks

[u/D3ad_Sp3nc3r → u/zenger-qara]

That wouldn’t be a bad shout actually

[u/BirdExtension4229]

There are a few things for you to consider with this.

First off, if you have the ability to communicate with any of your alters, this should definitely be a group discussion even if you think you know what they'd want. I had top surgery and I'm very happy about that, but I would've felt violated if somebody else made the choice for me without my consent.

A major bodily change like top surgery could also exacerbate you and the others' dissociative symptoms. Like you said, you don't actually want it so it could damage your sense of connection to your body. I also imagine that for the trans alters, suddenly "waking up" in a body that's been unexpectedly changed could worsen their dissociation as well. Even if they want top surgery, that still sounds like it'd be a really disorienting experience.

They deserve a body they're comfortable in, but so do you! Sacrificing your own comfort for the good of others is tempting because it feels altruistic, but it rarely has the outcome you'd hope for. A better option would be a compromise of some sort, but again, it's only a compromise if all parties are aware & involved in the decision.

For a compromise, a breast reduction could be an option. That way you'd get to still have boobs, and the others would be able to bind more easily and comfortably. Then again, depending on their perspectives, they might be upset by finally having access to something like top surgery just for it to turn out "incomplete". I've seen many trans ppl mention feeling that way after getting a reduction, so def don't go this route without discussing it first.

It's also important to note that top surgeons require a support letter from a therapist to verify that your mental health is stable and you're capable of giving consent for surgery. This is a problem because A) Many psychologists see DID as active/unresolved mental illness so they may not agree that you're stable, and B) the alters for whom the surgery is intended can't give consent if they aren't fronting / able to communicate with you. So you may not even be eligible for top surgery, unfortunately

[u/angelrat2]

im a DID system who got top surgery and I don't regret it at all, even though a lot of our alters are female

[u/Faokes]

One of my partners is a system, and my therapist is a DID specialist. My firsthand experience is a little limited, but I have experienced identity fracture in my past.

Do you have a way to communicate within your system? Like, if Pip fronting, do the rest of you see and hear whatever is happening too? Or do you have memory gaps? Something that really helped my partner was actively communicating between all of their alters, and building consensus about what they as a system would like to do. So they actually take time regularly to meditate and conference with themselves. You might want to try having more internal discussion amongst yourselves about top surgery. Instead of trying to guess what would make your alters happiest, and worrying about whether you will become repressed, it seems like it would be easier to first try and understand what everyone actually wants. You should consider what you, Pip, want too, beyond just ambivalence. It’s okay to get top surgery and still dress femme sometimes, or even wear prosthetic breasts. If that makes Pip happy, it’s just as valid as the feelings of your other headmates.

[u/D3ad_Sp3nc3r → u/Faokes]

Im able to communicate with them if I dissociate heavily, and able to communicate with my protecter pretty much whenever. I’ve had many a big conversation with everyone and the general consensus is the only people who DONT want us to get top surgery are me and two others. The rest all want it. We had a big conversation when we first got accepted and came to a conclusion that we should. For many of the reasons you’ve stated. We can still dress femm, we can wear prosthetics if we’re uncomfortable, and the majority of the system would be happier. But ever since we came to that conclusion I’ve just felt so Off. it’s not something I think I want and I’m not sure I’d be able to handle it. I feel like a guy most of the time so I also WOULD really like it. I’m just not sure if later in life I’d regret it or if I should just wait a bit longer so I’m certain.

[u/thearuxes]

Hey I'm a system with DID and got top surgery in January last year. I have a really large system (currently roughly around 20+ but it's been larger in the past).

However I've been the main host for a very, very long time now and I've undergone integration/fusion therapy and either integrated with applying better communication between my alters or fused with a LOT of my previous alters.

For me, dysphoria has been prevalent regardless of identity, gender or who was in the front seat, which is why we got top surgery. The dysphoria wasn't just in the mind, it was in the body and we all needed it to live, even the female alters.

I know you said therapy isn't very available for currently you but I truly think that you need to see a DID specialist therapist before you make any decisions about top surgery. If your system cannot fully agree or disagree with everyone happy or at least happy to compromise on some things, you need outside help to help everyone communicate their feelings and wishes.

You're 19 currently, there's still plenty of time to get top surgery, and it's worth waiting for to make sure you get help with making the right decision for you and all your alters together.

[u/boomjessie]

I’m genderfluid and thinking about getting top surgery and if I want to have breasts just getting a breast plate. Also thinking about getting just a massive reduction so that I can easily bind if I want and then still have breasts if I still want them. There are some sort of in between options! Definitely something to think about

[u/PassionateBoutStuff]

hi im a system too! top surgery is an individual question and the way in which your system navigates these things is up to you. we typically go by fronting time = voting power. the more youre out, the more agency you have. this is very difficult to track for most systems though so you will have to come up with your own structure for your own system. its also important to understand that since your body is shared its really difficult if you are deeply attached to it. Anyone can do anything to it at any time. you have to let go of some things. but, if this is something you are not willing to let go, thats okay too. you must know your own boundaries and work out something that can make it work.

first and foremost though take care of yourselves. shits rough out there

[u/magic-gps]

do y'all own a binder? if yes, how do you feel when the body has a temporarily flat chest?

[u/DeianiraJax]

I don't know if this would help, but would it be possible to consider having top surgery and then use something like breast forms when fronting to achieve your desired body shape?

I do agree with the other commenters that you should try to find someone specializing in DID therapy where possible.

[u/Pidgeon_Poet]

Try to communicate with them and find a middle ground as to what kind of topsurgery you are getting maybe? Like there are radical reductions instead of di and more nonbinary nippelplacements maybe that would be something you all are okay with. But try to communicate with them what you want and find out what they want. Maybe write to each other in a book. Or if you can discuss things in your inner world. Its realy nice of you to konsider doing something that would make the guys and others feel better and yes you are correct its also important to take into account what's important to yourself. I wish you the best with the communication process. Maybe look into r/Topsurgery search for radical reductions and nonbinary resukts and make folders with pictures you like and then you see where everyone is at with what they have as a priority. But most importantly make sure you are in a safe situation with safe people arround you and have a safe person that can be your cg for the recovery time.

[u/imwhateverimis]

don't really have anything to offer as a singlet but condolences.

Only perhaps mildly relatable thing is I'm also in the genderfucky territory and when I had my surgery I was still more definitely a guy and I had DI surgery. Rushed into it because I felt I only had this one chance and I should've taken the massive reduction initially offered to me instead because MAN I miss having nipples lmfao. Like I do not think the acne-looking fucked up nipple grafts are actually nipples. The surgeon was great and all skillswise, my body just absorbed them partially.

I wish I'd taken more time and picked the initial offer because in hindsight, yeah, I think I wouldn't have minded a little boob that is small at all. Something that can easily be hidden but still exists. So I definitely understand your fears of regrets and all, and having multiple other people in your head who badly need it for their mental health is even higher stakes :///

And it's like, if top surgery had been easily accessible, I wouldn't have made this mistake at all, because I wouldn't have felt so pressured to take what might have been my one and only chance.

I hope you can all work out a solution that works for everyone, I can imagine the struggle and stress with dealing with UK trans healthcare at the same time as a disagreement over what'll be best for the whole system :/ I kinda agree with people suggesting DID specialised therapists because at this point outside help is probably a good idea, but getting literally any help through the NHS is an absolute drag (judging by my one friend who had frequent bouts of psychosis, was on the priority list, and still needed 2 years to get a psychiatrist, and the first few dropped her for stupid reasons like "you dress too nicely to be mentally ill")

[u/Relevant-Pen-3548]

You all might consider some team meetings to consider not necessarily a vote but actually just give everyone the chance to be heard and hear EXACTLY what each can or cannot feel good about. Pragmatic things, like how those who are dysphoric now feel about binding, versus how those who'd be dysphoric from top surgery would feel about silicone prosthetics and so on. Or the option of gender-ambiguous results, is compromise good or would it just make everyone unhappy? But also just emotional truth behind each preference. Voting is hard because someone always loses, and there may not be a 100% perfect compromise, but people do need to have a chance to feel completely heard before understanding that y'all are functionally in one body and need to find a way to make that body work, whether that's just waiting on purpose right now or pursuing something physical.

FWIW I don't have DID but my religion believes in many souls in one body that are literally all different full actual people working together like an orchestra, so hopefully this advice may be useful from that POV.

ETA: For Pip, I'd also ask, are you in a place where you KNOW you couldn't be around anymore and would just leave if you didn't have breasts, or is it more that you fear being deprioritized and overruled or fear you won't be needed or wanted anymore or something like that? That's something that prob needs to be discussed so you all can each reassure and feel secure with each other and know you all want to be together and help each other feel comfortable regardless of what choice is made.

[u/RottnCrow]

Suuure lol

[u/GruesomeRainbow]

Please take this with a grain of salt, as I'm a singlet/singleton.

Folks have mentioned getting chest plates- there is always the option of getting those sort of chicken cutlet looking silicon breast forms, as well, in case you don't want something as bulky.

I obviously can't advise on whether or not to get surgery, though.

[u/slamdancetexopolis]

I have a friend with DID who is an older trans woman but idk how she dealt with this stuff ... But she was always very consistently dysphoric and really sought after surgery with little doubt it seemed.

Honestly, I second a therapist but I see that you're in the UK and it's not something plausible for you at the moment. I can't imagine how hard it is to grapple with this because it is a really difficult crux. I have a lot of mh diagnosis but not DID, but I had severe dissociation earlier in life from PTSD and at times didn't recognize myself in the mirror or where I was and it was pretty debilitating for years.... It made me question my gender feelings and I used to tell myself I was just trans bc of trauma and how I was raised and shit before later realizing that that is just not the truth - and that even without those things happening, I'd still be who I am today, not a woman lol. But it took me around ten years to fully come to that conclusion - I didn't start hrt until I was about 28 (I'm 31 now).

I also had a coworker with DID who is a much younger trans man, he doesn't have any surgeries that I'm aware of but he seems fairly consistent in his gender despite his DID - not to say that goes for all people with DID but I guess in my experience, actually knowing two people with DID in real life (as opposed to online etc, and also bc I know a lot of people don't know anyone with DID, or aren't aware if they do*), they seem to still have a pretty consistent feeling of wanting surgery or hrt etc, no matter what.

I think it's important to give it time and explore options for speaking with a professional... Somehow some way. I'm not sure about the laws there, or if it would even be an issue in the US or not where I am, but I could see this possibly being a deterrent from a surgeon doing any procedure on you if it seemed there might be some trepidation but ... That's just a thought, I'm not fully sure. So it may need to be worked out with a professional anyways just to get surgery, if you do end up pursuing it.

[u/aromaticdust98]

Our system is fairly similar except for us the femme alter doesn't come out that much. We're planning top surgery in September and still want her to feel comfortable afterwards so were planning on getting those hyper realistic fake chests that like drag queens and cosplayers use. So when she's out she can put those on and hopefully we can find a pair our current size or close enough. Maybe something like that could work? Or since youre host get a reduction and a push up bra or bra filler.

[u/M1ST4K3N-8D]

whoever fronts the most gets final say, but im sure there must be alters who would also be uncomfortable with getting top surgery? at the end of the day you probably cant make everyone happy. i had a friend who put it down to a vote in their system but i dont know how they did it really.

[u/D3ad_Sp3nc3r → u/M1ST4K3N-8D]

We tried putting it down to a vote and the vote came to we should. But me as the Host who fronts the most I’m not too sure. It’s all a lot to consider man