#I mean it's less complicated with mastectomy

[answersfromzestual]

Can I have top surgery and be overweight? The Truth.

I am here to clear things about being overweight and top surgery (aka double mastectomy).

Can I have chest surgery if I am overweight? Blanket answer, yes you can.

HOWEVER, let's talk about some things first.

As soon as we peek under my blanket statement, most doctors will not want to touch you if you are too far outside their BMI index. Sounds like a preference, right? I mean, true, but they are a business and, like any other business, can refuse service for any reason. Especially when your life is in their hands.

The BMI index is followed to a degree by most plastic surgerons. This index is not to body shame you in this case. It is strictly for medical reasons. There are many medical reasons to refuse the surgery.

As you lay flat on your back, your own weight presses on your lungs and heart. This can actually cause damage your heart and lungs and also restrict your breathing even further.

Anesthesia issues are a lot deeper than most people realize. It is not just a harmless gas to keep you asleep. Anesthesia is poisonous to us, and it does more harm to your body the longer you are under its direct effect. Also, the more you weigh, the more they have to use. The best anesthesiologists in the world probably would have a hard time with this, especially depending on how long you can potentially be under. The more you weigh means more tissue they need to work with and extra time can mean complications not only while under the drug but can cause many complications after the procedure is done, and even when you wake up. Issues include headaches/migranes, intense nausea, vertigo like symptoms, having a hard time passing urine, lack of gross and fine motor functions, brain functions, paralysis, coma, and death.

Blood flow issues for people who are overweight are a real risk. The skin has stretched over time , and more skin, along with viable tissue, is thinner, with less of a blood supply being delivered to the skin and tissues itself.

Being overweight also means your skin is stretched and no longer has the same elasticity as if you were not overweight. This thin skin is easy to pull apart/tear.

Time in the operating room, more is not better. The longer you are being operated on, the more complications can occur during the procedure and during the healing process. (This is also a general risk)

Upping complications means more likely needing revisions. Plastic surgerons take this into consideration for your health. Insurance probably won't shell out for the same operation twice because of the views on transitioning lead to a lot of "this is just cosmetic."

Diabetes exponentially increases risk of infection and potential necrosis and gangrene (death of tissue).

You are a living canvas for the plastic surgeron(s), your results reflect highly on them. They want the best results for you, but they also have a reputation to upkeep.

If the surgeon gives a condition they consider reasonable and the patient does not produce results near their actual target BMI, which tends to be more liberal than the numbers that are thrown around, the surgeon can question the patients ability to be able to take care of themselves and adhere to the strict rules given for post operative care. A surgeon can also think "does this person want it bad enough if they can't do this request?". They may not say that out loud, but they may think it.

The heavier you are, the harder it is on your body to heal because the extra work your body needs to do to do daily tasks, let alone extra tasks yet also rest.

You do not realize how much and how often you use your chest muscles. Getting out of bed without being able to lift yourself up is really a thing. Using those muscles in some cases can cause rips and tears of stitches, tissues, and muscles.

Surgeons will give you realistic, cis-like results with your chest, this may mean you will not have a flat chest, they may perform more of a reduction than a double mastectomy. Surgeons will make your chest look proportional to your body, hence another surgery if you do lose weight.

Do they want you to have bad results? This is a physical correction to make a positive mental impact if you have bad results post-op. This may not really fulfill the function of procedures purpose to help you like your body.

Doctors want to know you want this surgery, so if they give you a time frame and you don't meet their goals, that's fair. You may have seen your day to day but the surgeron didn't and doesn't care. To them, you didn't meet their goals/ requirements. No surgeon wants to lose their job, role, or status.

Surgeons only want what's best for your health. It's not a shaming conspiracy, it's literally just biology.

Waiting sucks, we know. But what sucks more is that having bad results, you will have forever and potentially risking your life.

Source List:

Anesthesia 1

Anesthesia 2

Anesthesia 3

Anesthesia and Obesity

Surgery 1

Surgery 2

Post Op Risk

Minimal use of being overweight during a procedure personal experience.

P.s: I tried to use respectful and professional terms and wording. If anything is offensive, please let me know in my ask box, and I will fix it.

Stay Safe

Stay Golden Everyone ✌️ 💙 💜

[sapphos-darlings]

i think i might be both lesbian and ftm (definitely homosexual, female, dysphoric, have considered transition for years and think it genuinely may help - its just putting the pieces together that gives me hesitation). im single, have dated a few other trans men when i identified differently, but ive never tried to date in the lesbian community. im trying to figure out how it would, i guess, work if i did transition? my current plan of "meet women & transmascs looking to date women or transmascs, tell them im a transmasc lesbian immediately, hope they understand what i mean and also mutual attraction is there" seems honest but possibly unlikely to work. am i missing something, or is it just a hard path im considering? i know one of the mods previously lived as a trans man so i was hoping you might have some experience or advice to share

Your identity, while it will sound wildly conflicting by the book, is actually not at all out there or anywhere near as rare as you'd believe. People are rarely black and white or fit into neat boxes, and transmasculine people have a long history with homosexual women. There have been, and continue to be today, butch lesbians who are taking testosterone or who have had mastectomies, and who go by male pronouns. Gender dysphoria and breaking the rules of our gendered society, in both gay and lesbian communities, has always been so prevalent that this cross-gender expression is rightfully part of our recognised cultural heritage, and one of the most rooted stereotypes associated with us. Even with the rise of transgender people's own, clearly separate rights movement, there is much more overlap in reality than these easy to identify labels would let you believe.

You, as an individual, do not have to be "lesbian" or "ftm" or "female" or "male" or "man" or "woman" in any particular way. It's up to you to express yourself, not your categories; while people instinctively assume that a label will cover all that you are, this is never the case for a person. We are so much more than these aspects of our identity.

And yes, the opposite is still true: there are gay men who date transgender women, and gay women who date transgender men. I follow plenty of trans channels to date as it's both relevant to my life now and to my history before and remains an interest, and some of these channels are for partners of trans people. One of the most common topics brought up is how to match one's identity label to the seemingly out-of-bounds relationship that is happening now, and seeing so many of them, and the unique situations of the people behind them, you come to realise that a label is not a natural fit for people, it's just something we make up to find community.

Further... beyond just exclusively gay people, we bisexuals are also here, we are plentiful, and we are absolutely wonderful. Not all of us, of course, are open to dating gender diverse people - but many others are, and we're typically quite relaxed when it comes to label complications simply because they don't challenge how we're expected to be dating, which is often a source of distress for both exclusively heterosexual and exclusively homosexual people when confronted with a relationship that isn't quite what the handbook said it would be.

Lastly, yes, you are choosing the hard path. That's just how things are, universally, for transitioned and transitioning people, and for lesbians, and for anybody else who is not the norm in our society. There are fewer of us, we are less understood, and we have fewer people whose attraction will naturally match with us either because it isn't how they're wired or because they've never brushed up with the idea beyond a hypotethical concept. However, this doesn't mean you're doomed by any means. Just using myself as an example: I'm truly a mess when it comes to gender, both trans and not trans at the same time and which label applies to me more depends entirely on the subject and the alignment of the stars, and though it's taken its sweet time coming, I've now been in a relationship with a wonderful nonbinary/gender diverse partner for well over a year. While they may not always understand the fine details of how my identity works, that can't really be expected of anybody, even somebody using the same label as I hypotethically might. I don't understand how theirs does all of the time, either - I'd say more than they don't get mine, as my struggles are largely of the transsexual variety, more about the body than expression, and theirs are more of the gender variety, where their identity and inner perception of self reign superior to the matters of the meat. But we don't have to be fully up to date on any of that: what we have in common is much more relevant to our everyday life than the fine details of the things we don't, and at the end of the day, what we have is a gay relationship, which - while it comes with its own struggles and difficulties - still allows for an amazing variety of self-expression in gender and identity both, even within this simple overarching label and state of existing in the world.

Whatever you choose, you'll find people you match up with, and in the end, it's better to be happy with yourself than unhappy with somebody else.

[pluralismajestatis]

Falling in-between / Contradictory identities.

I'm frustrated. Let's start with that. I also have issues, which is the second problem here. The frustration comes from an intersection of two problems: not having easy expressions for what I am, and worrying that my contradictory experiences will be cherry-picked for use against me.

In particular, right now, this issue is regarding my gender and transition status. For the record - I transitioned from female to male medically when I was 20. This didn't pan out in various ways, my body did not like HRT and I was never allowed to have a mastectomy despite desperately needing one, and these factors together made it impossible for me to live as a man long-term, or to any degree of true success. As a result of medical problems arising from HRT, I quit taking testosterone at 26; essentially it was making me sick, but not giving me any results worth writing home about. I had to do very hard soul-searching after that to figure out how I wanted to live my life, but my identity remained the same. This was until I discovered that I had a serious dissociative disorder, which, at 29, threw me in for another identity loop. Through trauma/dissociation focused therapy, an identity that did align with my observed sex at birth surfaced, and took on the everyday role of... well, being "me."

This didn't undo the continuity of a coexisting male identity. In fact, within the parts identified, the vast majority are male-identified. If we assume six everyday parts, two of them are women, one falls inbetween on the male side of the spectrum, and two are men. In the overall system of parts, there are three female parts against at least ten male parts. Almost every subconscious part of what is myself is a male.

But in conversations with people, this is not something I'm going to be divulging. In fact, you can pull nails off of me before I'm volunteering all that information to someone off the street. So what you have is me flipflopping with terms in a manner that absolutely comes across as picking whatever suits me in the moment: in detrans discussions, I'm a detransitioned woman. In trans discussions, I'm a post-transition FtM. They're both true. I am both of these things. And yet, neither is true, because I am both, and they're exclusive to one another, or at least I perceive them as such. So in a discussion about trans issues, you can pull my detransition card against me. And again, you'll have to pull nails before I'm going to volunteer all of the previous information just to prove that I have the right to call myself FtM. In discussions about detransition, this happens much less; people understand that gender and transition are complex, not black and white matters where every story is a succesful one. I have much more leeway just saying "it didn't work out, I got sick, I'm now living as a woman" and people don't worry about it. But this excludes me from conversations that are pertinent to me, as a transitioned person of a gender identity that to date remains just as complex as it always was. Even in detransition contexts, I prefer "post-transition", and would love to call myself desisting rather than detransitioned, because desisting implies cessation of pursuing transition, whereas detransition implies taking a turn back, and I definitely did the former much more than I did the latter. I haven't gone back to anything. I stopped moving forwards because it was impossible. But desisting means ceasing to pursue transition before transitioning, so me calling myself detrans is also complicated and uncomfortable.

I can only imagine the way my language flipflops about this is confusing for my partner and my friends, and I can't imagine what it looks like to an outsider, aside from just looking like I'm lying out of my ass no matter what I say.

And it is tiring. I feel so silenced. And before you offer me the word "queer", I don't want it. I've been called queer and it is not a good, safe, cozy word for me. It is a word that rouses immense dread and distress. I am not able to adopt it, nor do I want to. It fit me ten years ago, after that, I've had it soured for me completely. It's not a choice I'm making. I can't reclaim something that feels like an open wound bleeding uncontrollably. I don't want to call myself any more names.

I just want a voice. I want to feel like I belong and I want to feel comfortable and confident about my place. But wherever I look, I'm not good enough. Further; I hate knowing that when I tag this post as detrans, I'm tagging it into a fetish tag. That's all people like me are to you, it seems. A hypotethical humiliation fetish.

[voiceoffenrisulfr]

Becoming Spider-Man - Chapter Ten

Peter Parker Makes a Decision

𝐏𝐀𝐈𝐑𝐈𝐍𝐆𝐒 -> Peter Parker & Tony Stark (IronDad)

𝐒𝐔𝐌𝐌𝐀𝐑𝐘 -> In which Peter has to make choices, and Tony is ready to help.

𝐖𝐎𝐑𝐃𝐂𝐎𝐔𝐍𝐓 -> 1275

𝐖𝐀𝐑𝐍𝐈𝐍𝐆𝐒 -> (T) None.

𝐀/𝐍 -> Check it out below, or on AO3 here! Cute divider by @/sweetmelodygraphics!

<- Previous Chapter (9/16) Next Chapter (11/16) ->

The day after Tony’s surprisingly spectacular response to my period, small bins appeared in every bathroom in the entire building, without a word or expectation of gratitude.

I had assumed that would be the end of it, imagining that Tony was no keener to discuss the matter than I was.

Boy, was I mistaken.

It was almost two weeks later when I arrived home – for that was, undeniably, what the Compound had become to me – to find Tony sat in the kitchen on our floor. I merely blinked owlishly, hesitating by the refrigerator as I sought out juice. “Mr. St-… Tony? Is everything ok?”

He looked up, a screen glinting briefly in his glasses before he swiped it away. “Huh? Yeah, yeah… Why don’t you have a seat, kid?”

I swallowed around pulp and emotion, sliding onto a stool opposite him, heart hammering in my chest as my mind raced to figure out what I had done wrong. Does he not want me anymore?

“Don’t look so terrified,” he admonished lightly, chuckling. “It’s nothing so dire.”

“Okay…” I replied falteringly, words sticking in my throat, balling trembling hands in my lap.

“I think we should discuss your current goals, if you have any, for medically transitioning, and how I can help to facilitate them, both practically and emotionally.” I watched as tiny, backwards words ran along the bottom of his glasses, and bit my lip to suppress a smile.

“Mr. Stark… Did you study for this?”

He met my gaze through the tinted glass, scowling. “It’s not something I’ve got much experience with. I didn’t want to offend you.”

My playful grin softened, touched. “Tony…”

He waved away my praise before it had chance to be heard, shuffling in his seat. “That’s not what we’re talking about.  We’re talking about you.”

I scratched at the back of my neck uncomfortably. “I guess… I mean…”

“You don’t have to share your thoughts with me, if you’d rather keep them to yourself. I respect your privacy,” Tony clarified, and my unease faded a little.

“I appreciate that. I think I’m just… Not used to being able to talk about these things, y’know? May never would have…” I trailed off, sighing, before shaking my head to clear it. “I’d like to start testosterone, and have top surgery – a mastectomy,” I added, and he nodded. Of course he knew that. He’s done his research, I noted, honoured by his attention to detail. “Probably a hysterectomy, at some point - but I don’t feel so much urgency about that. Once… Everything…. Stops, it won’t really bother me all that much.”

Tony nodded again, eyes flicking to more words at the side of his private screen. “Have you given any thought to bottom surgery? I know it wouldn’t be for a while, but I’m interested to know where you stand.”

I hummed, distantly amazed that I didn’t feel more uncomfortable discussing this. “I’m not sure. I want to wait and see, I guess. Testosterone and top surgery – they might make me more or less inclined towards bottom surgery. I don’t want to make a firm decision just yet.”

Another nod, this time accompanied by a proud smile. “That’s a good way to think about it, Peter.” I grinned under the praise, feeling my shoulders straighten unconsciously. “But the other things – the hormones and the mastectomy, at least – you’re sure about?”

“Positive,” I replied firmly, meeting his gaze unwaveringly. “I’ve had a long time to think about it, Mr. Stark. When I first realised who I was, I wanted to do it ‘right’ – get everything I could. But… Over time, I realised that ‘right’ is just what’s right for me. There’s no wrong way to transition – no minimum amount that makes any one guy more or less valid than another. And that’s complicated, sometimes; trying to separate what I actually want from the expectation held by some of what I should want can be hard, and that’s why I want to take my time. But I’ve never been more sure of anything as I am that I want to start T and have top surgery.” I hesitated momentarily, glancing down at my hands in my lap. “There’s a lot of things I hate about myself, Mr- Tony. I’ve learned to love myself quite a lot since coming out, and being able to be myself, but there’s still a lot I hate. Testosterone, top surgery – they’ll help with that. I just want to be who I am, and to stop feeling so… So… Disgusting, all the time. It never stops, never gets quieter. I can’t wait for the day it ends.”

Tears blurred my vision, and I picked at the skin around my thumb as I sniffed, fighting to rein in my emotions. There was a moment of silence before I was pulled into Tony’s arms, him having rounded the counter between us without my knowledge. I buried my face in his shirt, hiccupping back a sob, and he squeezed me tightly, comfortingly.

My face was dry by the time I drew back, offering him a weak, reassuring smile. “I’m sorry. It’s just… Hard, sometimes.”

Tony’s gaze was gentle as it rested on me, ignoring the words at the bottom of his glasses. “I can’t imagine how difficult it must be for you, and I’m sorry it feels that way.” He took a step back, pulling a pen from his pocket. “How about we make a plan on how we can make it easier?”

By the time the sun began to set on the window-like screens, Tony and I had scrawled all over a loose sheet of paper, with words being crossed out, replaced, moved and edited. His laptop history would never be the same, and he would definitely get some oddly specific advertisements for a while – but at last, we had a rudimentary idea of how to proceed. Identifying a clinic was part of the struggle; there were many that looked good, but on further investigation had a pretty spotty record in their treatment of trans youth. It was easy to despair, but Tony kept me motivated, assuring me that we could find somewhere ideal if we kept looking. And so we did – eventually stumbling across a clinic just outside New York that seemed perfect.

Tony made a few calls while I poured over the website, eyes growing wider as I read more and more testimonies praising the institute, glowing recommendations and profound gratitudes. With an introductory appointment booked in two weeks’ time – “Being Tony Stark’s son has to come with a few privileges,” he’d assured me with a grin – a lot of the hard work was over.

“Are you nervous?” Tony asked as we reclined on the sofa, a glass of whiskey in his hand, and a glass of juice in mine.

I hummed, wriggling my fingers indeterminately. “Yes… And no. It’s a big step, and it’s one I’ve wanted to take for a real long time. It’s a little scary, but… In a good way?” I offered uncertainly, making him chuckle.

“You’re an Avenger, kid. This clinic? You’ve faced way scarier. You’ll be fine – and I’ll be there as much or as little as you’d like,” he added, glancing at me. I smiled broadly, feeling warmed by his concern.

“I know, Mr. St- Tony,” I corrected quickly, still unable to shake the habit, even now. “I really appreciate it.”

We lapsed into companionable silence, half-watching a randomly chosen movie playing out on the screen – but my own mind was elsewhere, exhilarated and terrified in equal measure.

It's finally happening. This is it… This is where everything starts to change.

[iamthestrangerinmoscow]

transition update

My last one was on Halloween, I think, and since then not that much have changed tbh, but I’ll describe it anymore.

So I have come to the point in the “diagnostic process” of F64.0 where all the alternative explanations for me identifying as a man have been ruled out and the only one that remains is that I am, in fact, a man. I’ve done karyotype testing (it’s 46 XX), EEG (normal), brain MRI (normal) and the sexologist/psychiatrist ruled out schizophrenia, personality disorders and body dysmorphic disorder.

(Btw the “diagnostic process” phrasing used to annoy the hell out of me, but now I think about it like about the scientific process. Statistically speaking it is much more likely for a person to be cis, or to be cis and have one of the problems/disorders I was tested for. However, that hypothesis has been disproved, and now we are as close to proving that I am indeed a trans man as we can be. So that makes sense.)

That doesn’t mean the process is over and I can do whatever I want. There’s still the observational period of at least six months so he can’t write me an endo referral until around late February. Also I need some tests for the endocrinologists before I can start hormones (ultrasounds, blood tests, etc). But assuming I will have all those results by the time of my first visit and they’re all good, there’s probably no reason why the endo can’t write me a prescription right then.

So assuming everything’s fine and I won’t have to wait for anything more than I need to, I might be on T in March. But I don’t wanna persuade myself of that cause shit might happen and disappointment is the worst feeling ever. Also it would actually be more convenient for me to start T in May cause then the most profound changes will happen during the summer holidays and it won’t be as awkward. But anyway.

In terms of identity, I am finally, thankfully, not questioning. At all. I am now 100% sure that I’m a trans man. Maybe not a totally binary man, but definitely a man. I really relate to how Chase Ross ids (part man, part squiggle). Like I can add a lot of adjectives at the front (queer, genderqueer, bisexual, gender non-conforming) but the operative word is still man. So that’s nice, I guess. I was so tired of questioning tbh.

In terms of my family… eh. We had one meeting with the specialist where they talked about all their concerns and stuff, and they’re all things I’ve addressed multiple times, but they only believed the guy with a medical degree. And I get it, I really do, but I am a bit pissed that they will take the words of an educated stranger over their own kid. And despite what the specialist has said they are absolutely not willing to call me a different name and pronouns. My mum said “maybe when you’ll start growing a beard” which is… ugh. Frustrating.

I am thinking about how I’m gonna come out to my grandparents and god, it’s even more complicated. My mum is saying I should present it as a medical condition, which might be easier to understand, but idk, that might do more harm than good in a sense that they could demand a different treatment for me rather than HRT. So I’m thinking I will do it once the changes are impossible to hide.

All of this is in the future, but I am, weirdly, feeling better. I’m looking forward to male puberty and all that stuff but I’m also feeling more confident in my identity and more able to deal with all the bad stuff. I might be angry at my family but I can also understand them. I might be frustrated with the wait but I also get why it is necessary. And I’m trying to live in the now and appreciate good things in life. So changes might still be far away, but I believe that I can make it.

[female-malice]

I'm actually glad you're saying things about personally finding top surgery unattractive. I think women should know this going in: you might convince yourself it's beautiful and it's an expression of your true self, but it DOES affect your ability to sexually interact with your partner. Not everyone in the whole world views these things the same way. In fact, I think we owe it to these women who are considering top surgery to tell them that it's not some magical flat-chest potion. It's a surgery that leaves wounds and scars and it's done out of severe distress and an inability to cope. I've known same sex attracted trans men who think transitioning will make their love life easier. A lot of people will be put off by your self harm, especially if you defend your decision and immediately berate someone for being put off. Not everyone is going to feel that way, but it's literally another risk of transitioning that isn't talked about. It will affect your sex life and the integrity of your body. Not everyone is going to feel the same way about your transition as you do. And you can't just bully people into getting over it, the guilt tripping of "you're so squeamish! You're so mean! You're so weak!" can only get you so far. I am sorry that you have made these decisions. But it's also not lesbians' job to act like those decisions don't have consequences or cause potential distress in sexual partners. I think there's space to both respect women who have transitioned and the complicated relationships they have with their bodies and also be truthful about these things. I know it's painful to read, but I feel like we're all on here to do some hard work.

You get it!

I do have empathy for detrans women. That's why I'm honest with them. I don't feel one way or another about someone who started then stopped HRT. That's really a non-issue. That doesn't get in the way of intimacy and connection. But "sexual reassignment" surgeries are designed to get in the way of intimacy and connection.

So I'm not gonna lie or avoid the topic. I don't want detrans women to think that it's their looks or personality getting in the way when it's not. I don't want them to feel self conscious about a deep voice when it's not that either. It's just the mastectomy. It's a choice that was already made. And there's nothing that can really be done about that.

I just need women to understand that removing breasts will NOT make it easier to find women. I know they market "top surgery" as a cure-all. But breast removal will NOT cure loneliness.

I also need everyone to try and un-normalize "top surgery" for five minutes. Just for five minutes, forget the whole sociopolitical framework around it. Forget the way it's marketed with euphemisms. Pretend you're yourself from 10 years ago and you've time traveled to the present day. And just look around at your life and the lives of the women around you. What do you feel?

How does it feel when half the women at the lesbian/bi event have cosmetic mastectomies? What does that make you feel inside? And when you come home from the event and go about your life, what feeling lingers? Do you become less social? Reluctant to meet new people? Reluctant to participate in lesbian/bi events? Are you less open about your sexuality around coworkers and casual acquaintances? Are you optimistic about lesbian future?

The "top surgery" phenomenon is widely traumatizing and not just for the women who get the procedure.

[workmaninprogress]

2016 // 2021

As my two year post top surgery anniversary rapidly approaches, I wanted to give some insight into a somewhat “less traditional” gender affirming surgery path.

There have been several questions and comments on my posts asking why I had a reduction. I don’t know that I ever fully, publicly explained it, or if I did it was years and hundreds of followers ago.

The real simple answer is: insurance coverage.

In 2016, I was still a dependent on my mother’s insurance which, thankfully, covered breast reductions in full. Money played a huge factor because I knew I would end up paying for top surgery out of pocket.

The more complicated answer is related to how my family (at that point) viewed my desires to transition. They were not on board with my interests in seeking gender affirming care. Again, at that time; they did not support or understand my need for the medical intervention that would allow for me to become my fullest self. (They have since grown to understand and become accepting, but that’s not the topic of this post)

A reduction made the most sense at that time for me. It was like stepping into a puddle rather than jumping off the highest diving board. It felt that way for both my parents and I. The reduction gave me a chance to really evaluate whether or not the full mastectomy was my end goal.

Top surgery continued to be my goal so obviously I went forth and had a second surgery to remove the remainder of the breast tissue. But! In the mean time (3ish years between surgeries), the reduction provided RELIEF from the weight (literal and metaphorical) that my chest carried. The reduction reduced my chest size AND reduced my dysphoria because it allowed for a binder to lay flatter against my body.

A reduction was a good option FOR me.

As with all things, experiences differ from person to person. What worked for me, might not work for you. Though I do feel like this puddle-stepping route is becoming more common, at the time I had not seen anyone else do it.

Much like my single scar visibility, I wanted to represent/advocate for something that isn’t often talked about in our community.

[transgenderteensurvivalguide]

is there a weight limit for top surgery, and by gaining weight after getting top surgery could the affects be ruined? i've heard people losing weight before getting bottom surgery so i wasn't sure if it's the same for top surgery. i'm also deathly terrified that if i get top surgery, i'll gain weight after and ruin the flatness of my chest. what's the truth in all this?

Lee says:

As long as you don’t have any serious health complications because of your weight, you can get top surgery-- but it isn’t always easy. 

The medical field is kind of known for “fatphobia” and that can affect you when you’re looking for a top surgeon. It’s true that there can be some increased risks for overweight people going under anesthesia, but there are some top surgeons who have pretty strict weight limits and use that as an excuse to turn down a patient even when it is possible for them to get surgery safely.

One surgeon’s website says “Dr. Mosser does not have a body mass index (BMI) requirement for surgery, and has performed top surgery on patients with BMIs as high as 65″. 

On the other hand, the USCF team says  “you must have a BMI less than 35 before scheduling your consultation. The reasons for this are twofold – to reduce the risk of general anesthesia and to give a better appearing final result. Those with a BMI between 32 and 35 may experience higher surgical risks and less satisfying cosmetic outcomes.”

So you can see that different surgeons have different requirements; some don’t have weight limits, and others do. 

You may have to “surgeon shop” a bit to find a surgeon who is competent, capable and has no weight/BMI limits for their patients, but it’s possible to find someone and fully achievable! I have two fat trans guy friends who got top surgery, and they’re totally happy with their results.

Fat folk are probably going to have to get double incision top surgery, since their chest would be too large for a keyhole or periareolar, but they can get just as flat as anyone else with double incision.

It’s more likely you’ll get “dog ears” at the end of your scars towards your armpits, but that can be dealt with by getting a revision which is often free. Make sure you ask your top surgeon what their policy on revisions are, and what fees you’d have to pay if you needed one.

There are some fat folks who choose to leave in a little more fat in their chest because they feel like the extra fullness fits their body type because some fat men have “moobs” but that’s a personal aesthetic choice and not required or something, and it’s possible to get a flat chest with top surgery if you tell the surgeon to make you flat. I do think the majority of folks choose to go fully flat, but there’s nothing wrong with choosing otherwise.

I gained about ~15 lbs in the three-ish years since I had top surgery (I went from around 120 lbs pre-op to 135 lbs) and it hasn’t affected my chest at all, or made it any less flat but I don’t weigh a lot even now.

If you gain a lot of weight after top surgery your chest may get a little larger, but it won’t regrow to whatever your pre-surgery size was because the breast tissue has been removed. It’s the same with cis men; if they gain a lot of weight, they may also get “moobs”.

Because a typical trans double mastectomy leaves about 10% of the tissue in for contour, and a few fat folks opt for even more (although this isn’t common), it’s still possible for post-top surgery folks to get cancer in that tissue. That means top surgery may decrease the risk of breast cancer, but it won’t prevent breast cancer.

Top surgery (via double mastectomy) is pretty customizable in the amount of fat you choose to keep, so you can choose if you want a very flat chest, a more contoured chest, a breast reduction or “moob-like” chest because they’re doing large incisions which means they have lots of room to work with when it comes to excising the fat and using liposuction.

You can see an example of a larger fellow who got a flat chest here, and another example here. It’s definitely possible for fat folks to get flat chests after top surgery if that’s what they want from the procedure!

Trans Bucket has a ton of pics of this, but right now folks say the website seems to be acting up so your mileage may vary with getting an account.

The Facebook groups Top Surgery Support (removal/reduction) and Non-Binary Top Surgery both have a ton of pictures uploaded as well, but you can’t see any “before” pictures there because of Facebook’s NSFW ban. They’re still worth checking out though for the personal experiences, community, support, and post-op pics.

If your surgeon tells you at the consult that they are requiring you to lose weight before you get a surgery date, at least you’ll have an idea of how much weight you have to lose which can help direct your goal and keep you motivated, or you can decide to go with a different surgeon who doesn’t have BMI requirements.

There are a lot of folks who find it really hard to lose weight even if you’re eating healthy and exercising and all that because the body really doesn’t want to lose weight, so waiting until you’ve lost a significant amount of weight might not be an ideal timeframe for getting surgery because you might find it really difficult to lose weight which means you’ll keep pushing back the process of getting surgery until an undetermined date in the future, and not having surgery or an idea of when you’ll be getting surgery can be bad for your mental health if you have a lot of dysphoria.

So you may also want to consider getting a second opinion with another surgeon instead of putting all your eggs in one basket, so schedule two consults with two different surgeons if you can, instead of seeing one surgeon, then deciding to schedule a consult with another one which will increase the wait time.

And of course, if you don’t get completely flat after top surgery and you end up with dog ears or something, you can always get a revision.

Similarly, if you do end up gaining a lot of weight and getting “moobs” then you could also get a little revision and have a bit of liposuction or excision done. This may or may not be covered by insurance if it’s “cosmetic,” but revisions are typically cheaper than the initial top surgery.

So you definitely can get a flat chest after top surgery even if you weigh a lot pre-op and have a big chest- I’ve seen it myself a ton of times!

Plus, even if you did have moobs, your chest would still be “male” looking because your nipples would have been resized to be smaller during surgery so your areolas would be more like a man’s, and your chest would match your overall body type so you’d be similar to a typical cis men with that body size instead of a typical cis woman with that body size.

While is possible that gaining a large amount of weight post-op will make your chest less flat, it’s also true that right now your chest isn’t flat either. So you’d still be better off after top surgery then than you are right now, even if you regained a little weight. So it’s a pretty significant step in the right direction.

Again, it’s really unlikely that you’d get gain enough weight to get moobs that are larger than the breasts that you have currently, so getting surgery moves you closer to a “flat-er” chest, and it’s always possible to make it a fully-flat chest by getting a revision if it becomes necessary. 

So yeah, there are some surgeons who have BMI limits, and there is a chance you could regain some fat in your chest if you gain a significant amount of weight after surgery, but most people who need top surgery find that it’s worth fighting for anyway.

[thessalian]

Thess vs Progress

Bits and snips from the office - some kind of grumble-inducing, and one very, very good.

Scruffman’s taking his unused annual leave in bits and chunks, which gives my two fellow typists license to behave like the office is their own personal conversation nook. Doesn’t leave a lot of work getting done, except by me. I imagine I probably come across as unapproachable or unfriendly because I don’t join in these conversations often and I certainly don’t start them, but mostly it’s because I’m there to do a job and I can’t do it if I’m standing in the middle of the office gabbing.

Also, both other typists apparently have a thing against doing any dictation that reads as being longer than three minutes. As in, they will always, always, without fail leave the longer, more complicated bits of dictation in hopes that I will break down and do them, even if I’m typing things for the other site because the others “haven’t been trained on that site yet”. (Fuck that; I wasn’t trained on that site either but I figured it out. It’s not exactly rocket science.) I mean, do they really think I won’t notice the time stamp discrepancies as they pick and choose the quick and easy typing and leave the long-winded mastectomy, hemicolectomy, and prostate stuff to me? It’s fucking annoying. I’ve had a word with Temp about it once but she seems to have waved it off.

On the subject of the Temp... Well, Scruffman being out, he transferred the phones to the staffer I will call Sunshine (she is a sweetheart). But of course, Sunshine needed to have lunch too, so Temp offered to grab the phones while Sunshine was out. But that was apparently a huge mistake because when she got a call asking for a report, it came out that she didn’t know how to search the system for a report. Because apparently “no one trained me how to do that yet”. She has been here for months. Anyway, I said I’d take the call but then I would show her how to do a search for a report. She agreed ... at least until I got off the phone, at which point she tried, “Maybe this isn’t the best time...” I fucking insisted. I said, “It’ll take two minutes”. And that’s exactly how long it did take because it’s one of the most idiot-proof functions on our system. It’s literally “click a button that says ‘Search Entries’, add in at least some search information, click ‘Search’ and watch all the reports for that patient come up; then just weed out the one you want and make sure it’s authorised before you send it”. I know Temp just wants to stay on her typing groove, with only the shortest and easiest bits of typing to make her feel extra-specially productive, but fuck that; she needs to know this shit. It shouldn’t all land on me.

Now for the good news, though - one that will probably make Temp laziness less of an issue on at least some levels. Got an email from Grand High Poobah Manager saying, “So the IT people need to set stuff up on what will be your laptop so I need your login details”.

You know what that means?

That means that working from home is going to become an imminent reality!

Now, as I’m given to understand it, I’ll still have to come into the office sometimes. Probably towards the end of the week because that’s when we have the fewest people in the office. But it will mean even less travel and possibly even being able to go back to a five-day week! I cannot work an eight-hour day anymore, even if the commute is taken out of the equation entirely. But I can probably do a five-day week if I’m not having to cross basically all of London for those five days. We’ll see how I cope with four days a week with some of them work-from-home before I make any decisions on that score, though. That’s already been discussed with Mid-Manager (the one between Scruffman and Grand High Poobah Manager on the chain of command, as it were; the one I have meetings with to discuss my various accommodations) so it should be workable to make the change if I’m able to do so.

I’m just really glad that something concrete is happening here. I mean, given I was told “the end of last year”, it’s probably understandable that I was despairing a bit. But I think email from Grand High Poobah Manager talking about ‘my laptop’ is the best indicator I could hope for that things are actually moving. PROGRESS! HUZZAH!

I still wish I didn’t have to go into the office at all, but I’ll take what I can get; I do understand that they need someone to help deal with phones etc sometimes. Besides, I’m basically their tech expert; the place’d fall apart without me around to ask how to switch on the spellcheck function on Google Chrome or how to make a headset microphone work for their online meetings...

[thecoleopterawithana]

When you were young and your heart was an open book

Don’t Let Me Down | Paul’s Upbringing

John, because of his upbringing and his unstable family life, had to be hard, witty, always ready for the cover-up, ready for the riposte, ready with the sharp little witticism. Whereas with my rather comfortable upbringing, a lot of family, lot of people, very northern, ‘Cup of tea, love?’, my surface grew to be easy-going. Put people at their ease. Chat to people, be nice, it’s nice to be nice.

— Paul McCartney, in Barry Miles’ Many Years From Now (1997).

Paul grew up in the warm embrace of a loving family. There was hardship, certainly: they were definitely working-class, and the war had been unkind to the cotton exchange business, so it fell on mother Mary to be the main bread-winner of the family, as a domiciliary housewife. Her nursing job also made it so they were always on the move, from one new outskirt council estate to the next, “always on the edge of the world” that was the rebuilding of a war-torn Liverpool. But despite this surrounding instability, the core of the family itself was a safe harbour of reliably loving parents.

I got my compassion for people from my mother. She was a midwife. I think that would probably be the most important quality. Again, respect and caring for others.

— Paul McCartney, interview w/ Jonathan Wingate for Record Collector: Paul McCartney gets back to work (July 2007).  

[My mum] was very kind, very loving. There was a lot of sitting on laps and cuddling. She was very cuddly. I think I was very close to her. My brother thinks he was a little closer, being littler. I would just be trying to be a bit more butch, being the older one. She liked to joke and had a good sense of humour and she was very warm. There was more warmth than I now realise there was in most families. [...] They aspired to a better life. That idea that we had to get out of here, we had to do better than this. This was okay for everyone else in the street but we could do better than this. She was always moving to what she saw as a better place to bring her kids up.

— Paul McCartney, in Barry Miles’ Many Years From Now (1997).

Not only had this notion of rising out of their current situation been instilled in Paul and his brother Michael from an early age by his mother – by encouraging them to speak “the Queen’s English” and insist on their education, for example – his father, Jim McCartney, also did his best to pass down his values of “Toleration and Moderation”, a good education and a special emphasis on an honest and responsible work ethic.

I think I got my respect and tolerance for people from my dad, which is a pretty cool quality to inherit. He was very big on tolerance, my dad. It was a word he used to use all the time. I think I grew up with that attitude. You know, you’d say, ‘Bloody hell, I hate that guy.’ and then you’d stop and go, ‘Alright, wait a minute, maybe he’s got a point,’ and you’d try and consider it from his or her point of view. I think that was a great lesson.

— Paul McCartney, interview w/ Jonathan Wingate for Record Collector: Paul McCartney gets back to work (July 2007).

He had us out aged about nine. I was virtually a door-to-door salesman by the time I was twelve. [...] I was certainly not shy with people, I think because of all these activities my dad encouraged us into. I think it's probably very good for your confidence with people. It was all right. That was my upbringing.

[...]

My parents aspired for us, very much indeed. That is one of the great things you can find in ordinary people. My mum wanted me to be a doctor. 'My son the doctor' - and her being a nurse, too. No problem there. And my dad, who left school at fourteen, would have loved me to be a great scientist, a great university graduate. I always feel grateful for that. I mean, God, I certainly fulfilled their aspirations, talk about overachieving! That was all bred into me, that.

We had George Newnes Encyclopedias. I can still remember the smell of them. If you didn't know what a word meant or how it was spelled, my dad would say 'Look it up.' I think that's a great attitude to take with kids. It steers you in the right direction. It was part of a game where he was improving us without having had an awful lot of experience of improvement himself. But I always liked that, and I knew I would outstrip him. By going to grammar school I knew I'd fairly soon have Latin phrases or know about Shakespeare which he wouldn't know about.

— Paul McCartney, in Barry Miles’ Many Years From Now (1997).

Just from these passages alone, we can spot the origins of Paul’s tolerant and caring nature, social skills, self-reliance, and tireless drive for self-improvement (with its nuances of social climbing and fierce competitiveness).

All in all, it was a good solid childhood: exploring the woods outside of his house – “Mother Nature’s Son” through and through – playing and running from Speke teds with his friend George Harrison, going to school and working the occasional odd job, helping his family and making them proud.

And then, Paul McCartney’s secure existence was shattered.

My head was in a whirl, only then I realized, I lost my little girl

On the 31st of October 1956, Mary McCartney abruptly dies from complications following her mastectomy. She’d been admitted at a far too advanced state of breast cancer after she’d kept working – while in pain – for several weeks, choosing not to divulge this symptom or the fact that she had a lump in her breast to her colleagues.

The whole family is caught unawares, but the boys especially are mostly kept in the dark.

I remember one horrible day me and my brother going to the hospital. They must have known she was dying. It turned out to be our last visit and it was terrible because there was blood on the sheets somewhere and seeing that, and your mother, it was like "Holy cow!' And of course she was very brave, and would cry after we'd gone, though I think she cried on that visit. But we didn't really know what was happening. We were shielded from it all by our aunties and by our dad and everything.

— Paul McCartney, in Barry Miles’ Many Years From Now (1997).

The boys are sent away to stay with relatives, noticing that something was wrong but unaware of what was going on, unable to actually say goodbye.

Two days later, it’s too late.

Paul is 14.

As Jim comes to break the news, and his brother Michael breaks down in tears, Paul has an unexpected response.

Mum was a working nurse. There wasn’t a lot of money around – and she was half the family pay packet. My reaction was: ‘How are we going to get by without her money?’ When I think back on it, I think, ‘Oh God, what? Did I really say that?’ It was a terrible logical thought which was preceded by the normal feelings of grief. It was very tough to take.

— Paul McCartney, in Ray Coleman’s McCartney: Yesterday & Today (1996).

It would not be the last time that Paul McCartney’s initial shock response to grief is considered “flippant” or “callous” by the people around him; a fact that has haunted him throughout his life.

I’m very funny when people die. I don’t handle it at all well, because I’m so brought down that I try to bring myself up. So I don’t show grief very well. It actually leads some people to think I don’t care, and I do. I’m not good at it like some people. [...] But I’ve always been kind of inward about those things. So I just deal with it myself.

— Paul McCartney, in Ray Coleman’s McCartney: Yesterday & Today (1996).

By virtue of nature or nurture, Paul exhibits from early on an extreme difficulty or unwillingness to deal with his less pleasant emotions.

His response to the alarm that is pain is to deny that it is ringing altogether.

And this manifested not only in inadequate optimism for some situations, it most often took the shape of what appeared to be too hard and cold pragmatism. Some people, unfortunately, saw his defence-mechanism of turning completely rational in the face of crisis and mistook it for him not caring; when, in fact, he cared so much that his only solution was to try and shut it off.  

He carried with him a great burden of guilt and regret; not concerning his reaction to his mother’s death but also due to other misdemeanours and minor hurts he’d caused her when she was alive.

There's one moment that I've regretted all my life which is a strange little awkwardness for me. There was one time when she said 'ask' and she pronounced it posh. And I made fun of her and it slightly embarrassed her. Years later I've never forgiven myself. It's a terrible little thing. I wish I could go back and say, ‘I was only kidding, Mum.' I’m sure she knew. I'm sure she didn't take it too seriously.

— Paul McCartney, in Barry Miles’ Many Years From Now (1997).

In retrospect, he even theorized that the lyrics to his acclaimed ‘Yesterday’ were related to his mother’s sudden departure.

With ‘Yesterday’, singing it now, I think without realising it I was singing about my mum who died five or six years previously, or whatever the timing was. Because I think now, “Why she had to go, I don’t know, she wouldn’t say, I said something wrong…”

— Paul McCartney, interview w/ Pat Gilbert for MOJO: Don’t look back in anger (November 2013).

So in the aftermath of life completely pulling the rug from under his feet, Paul was not only struggling to deal with his own emotions, trying to bury them far from sight as best as he could, he was being consumed by terrible guilt for doing exactly that.

More than that, he was under the care of his uncle and aunt for several more days, trying to rally his brother so that they wouldn’t appear ‘softies’ in their cousins' eyes, while friends and family tried to hold together a shattered Jim McCartney, “whose first thought was to join his wife”.

Seeing his father break down like that had a huge impact on Paul.

My mother's death broke my dad up. That was the worst thing for me, hearing my dad cry. I'd never heard him cry before. It was a terrible blow to the family. You grow up real quick, because you never expect to hear your parents crying. You expect to see women crying, or kids in the playground, or even yourself crying – and you can explain all that. But when it's your dad, then you know something's really wrong and it shakes your faith in everything. But I was determined not to let it affect me. I carried on. I learnt to put a shell around me at that age.

— Paul McCartney, in The Anthology (1995).

This is very important.

Not only had the only reality he’d ever known been destroyed by his mother’s sudden death, his own father – who was supposed to be this strong, unshakable pillar in his life – couldn’t be relied on to hold it together.

Paul had been let down. He was on his own.

Fear steems from a feeling of powerlessness. You feel painfully vulnerable to whatever life might throw at you, at constant risk of being hurt again, and the only solution is to be on the lookout. Be prepared.

Paul was caught unawares because the people he’d counted on to always be there suddenly weren’t. And with his compassionate and reasonable nature, he probably didn't even blame them at all. But the facts were that Paul had been left hanging, not once but twice, when he needed them the most. So he kind of lost his faith in everything.

Life is chaotic and unpredictable; and people, through no fault of their own, are just as inconstant.

And so, in order not to risk being let down again, Paul took matters into his own hands. He tried to escape the pain and dread of being powerless by seizing control of whatever he could. And that was mostly himself.

And so begins Paul McCartney’s saga of isolating independence and other control-issues.

As Paul said above, he’s “always been kind of inward” about grief and other “negative” emotions. He’d rather be alone at this stage because he doesn’t want to expose his vulnerabilities. Not to others and much less to himself. So he needs a distraction. Something to devote himself to that’ll take his mind off the pain.

The saving grace, as usual, was music.

— Paul McCartney, The Q Interview (2007).

His brother Michael, probably the closest observer we could have of this period, recounts how Paul was like in the aftermath.

Paul was far more affected by Mum’s death than any of us imagined. His very character seemed to change and for a while he behaved like a hermit. He wasn’t very nice to live with at this period, I remember. He became completely wrapped up in himself and didn’t seem to care about anything or anybody outside himself.

He seemed interested only in his guitar, and his music. He would play that guitar in his bedroom, in the lavatory, even when he was taking a bath. It was never out of his hands except when he was at school or when he had to do his homework. Even in school, he and George Harrison used to seize the opportunity every break to sit and strum.

When we left our auntie’s house and returned home, it was agreed that Dad, Paul and I would take it in turns to do the housework.

“We’re a family on our own now,” Dad said. “We’ll all have to help.”

But time after time when I came home from school, I would find that Paul hadn’t done his bit. I would go looking for him and sometimes I would find him, up in his bedroom, perhaps, sitting in the dark, just strumming away on his guitar. Nothing, it seemed, mattered to him any more. He seldom went out anywhere – even with girls. He didn’t bother much with any of his friends except his schoolmate George Harrison and John Lennon, who was at the art school next door. Work and work alone – his school books and his guitar – appeared to be the only thing that could help him to forget.

— Mike McCartney, Woman: Portrait of Paul (21 August 1965).

So Paul takes to complete dedication to work and music to help him ignore his pain. And he’d rather go through this process of burying it on his own. We see him isolate himself from his family and friends, according to Mike socializing mostly with George, also in the context of playing music. John is also mentioned; this could be a smudging of the timeline in Mike’s recollections, as Paul would only meet John the following year. That or Paul’s mourning lasted until the autumn of 1957, when John was enrolled in art college.

We also have a clue about how guarded Paul was with his “negative” emotions – how resilient he always wanted to be – that no one imagined he would be so affected by his mother’s death as he was.

This will also be a repeating theme through Paul’s life: his wish to always be strong, positive and reliable will make others and himself overestimate his imperviousness to trauma. People will then feel free to burden him with their own pain or unload their frustrations on him, without feeling that there would be consequences; because Paul is so tough as to be unaffected by all that. This proved, time and again, not to be true.

His true strength arises, in my opinion, not in the fact that he is unshakable but in his determination to quietly pick himself up again and again.

Losing my mum when I was fourteen was a major tragic event in my life. But, when I think about myself, I am, overall, pretty optimistic, pretty enthusiastic, pretty much into getting on. One of the reasons being, she would want that. I know for certain she would want that. I know Linda would want that. I know John would want that, and George would want that. My dad would want that. They were very, very positive people. And the idea that their deaths would plunge me into some sort of morose depression would bother them. I know that for a fact. So that helps me to not go there.

— Paul McCartney, interviewed by John Colapinto for the New Yorker: When I’m sixty-four (4 June 2007).

But as a 14-year-old Northern lad, his tactic of picking himself up didn’t involve dressing the wounds, which would continue to bleed silently in the recesses of his mind.

I certainly didn’t grieve enough for my mother. There was no such thing as a psychiatrist when I lost her. You kidding? I was a 14-year-old Liverpool boy. I wouldn’t have had access to one and I do now.

— Paul McCartney, interviewed by Nigel Farndale for The Telegraph: Love me do (17 May 2002).

But soon, Paul would find an even greater outlet for his love of music, almost magical in its specialness:

Someone to perform with.

[muppetsilas]

Top Surgery FTW

So getting any surgery is scary and you’re bound to have a lot of questions. In the case of top surgery, there is really a lot to consider.

A few things to know: 1. You should check your insurance’s (or in the case of Medicaid and Medicare, your state’s) policies on coverage. Pennsylvania, for example, covers top surgery fully for Medicaid recipients. There is also a helpful and important organization for transgender healthcare called WPATH (World Professional Association for Transgender Health) You can visit their website here: http://www.wpath.org/

2. Major surgery for cosmetic reasons, especially something this drastic, should never be decided on a whim or without doing loads of research and consulting a psychologist or counselor. Even if your surgeon doesn’t require the year long visits, it is HIGHLY recommended you see a therapist for at least a few months to just talk through things. They are not going to judge you or convince you to get it or not get it. They are not going to be able to stop you from getting it either. Therapists are allies and even if it isn’t about you transitioning, talking about something this big is crucial to processing. It’s major surgery, after all! Anyone having any kind of surgery would benefit from speaking to a counselor about it.

3. Your body may not look the way you think it will after surgery. So do a lot of research and consider every possible option. Also, really think long and hard about why you want to do this and what it will mean for your life moving forward. You do not have to change your body to match society’s standards of gender roles. You certainly don’t have to medically alter your body because most trans men or non-binary persons you know have.

Ok, here are the questions I used...

-Are you board-certified? As a Plastic Surgeon or General Surgeon? (See Surgeon Credentials)

-Are you a member of WPATH?

-Do you have specific training in gender-affirming surgeries?

-How long have you been working with transgender/gender-nonconfirming patients?

-Do you work exclusively with transgender/gender-nonconfirming patients?

-How did you get involved with trans healthcare?

-Have you attended any transgender conferences?

-How many Top Surgeries have you performed?

-How many Top Surgeries do you do per week/month/year?

-Will you be doing the surgery yourself or will less experienced surgical residents take part?

-Will you provide a letter for getting my gender marker changed on ID/Legal documents?

-What kinds of gender-affirming practices has your office adopted? Will I be referred to by my preferred name and pronouns?

-What types of Top Surgery procedures do you offer? (remember there are many kinds of incisions and procedures)

-Is there a Top Surgery procedure that you prefer?

-What Top Surgery procedure do you think would best suit my needs and goals?

-What are my options for scar shape and placement?

-Where will the nipple/areola complex be positioned?

-How big will the areola be? How big will the nipple be?

-With Peri-Areolar/Keyhole, can you do a nipple reduction during the initial surgery?

-Will you perform Double Incision without nipple grafts? (No-Nipple Result)

-Do you use Drains? Why/why not?

-Will my surgery include male chest contouring/liposuction? Is there an extra "cosmetic fee" for this?

-What techniques do you use to reduce the chances of Dog-Ears?

-How long will the surgery take?

-What type of facility will my surgery be performed at? (Ex. Ambulatory/Day surgery clinic, local hospital, academic medical center)

-Do any of the nursing staff at the facility have specific training for working with transgender/gender-nonconforming patients?

-Can I see a portfolio of before/after photos for your patients? (If the answer is no, consider finding another surgeon)

-How much long-term follow-up do you do of patients, in terms of determining patient-satisfaction?

-How much nipple sensation should I expect?

-What is the chance of developing a hematoma?

-What is the chance of developing a seroma?

-With Double Incision, what is the risk of losing a nipple graft or getting an infection?

-What other complications am I at risk for?

-What symptoms should I be on the lookout for?

-Who do I contact if I think I have a complication?

-If a complication happens, what is the protocol for managing it?

-There is a family history of breast cancer. What do I need to know about this with regards to Top Surgery? Do I need to get a mastectomy beforehand? Will my insurance cover that?

-Do any of my medical conditions increase complication risks?

-Can I take THC or CBD in the weeks/days before surgery?

-When do I need to quit smoking before surgery? (usually 6 weeks)

-Do I need to stop taking Testosterone before surgery?

-Do I need to stop taking any other of my medications before surgery?

-Will I need to have any blood work done or do any other lab tests prior to surgery day?

-Will you be providing detailed, written pre-op and post-op instructions?

-Is there a pre-op appointment prior to surgery day?

-What type of anaesthesia will be used?

-Will I meet with the anesthesiologist before surgery?

-Will anyone be providing updates to my caregiver during my surgery?

-Will I be able to go home the same day as my surgery?

-If being released the same day: How long will I need to stay at the surgery center after I wake up?

-If coming from out of town: How long will I need to stay in town after surgery?

-If coming from out of town: Do you have arrangements with any hotels for reduced-cost stays for patients?

-When will my post-op appointments be?

-What medications will I be prescribed after surgery?

-I can't take opioids. What are other options for pain management?

-Can I take THC or CBD during recovery?

-Will I need to wear a binder after surgery? If so, for how long?

-When will I be back to normal daily activities?

-How soon after surgery can I be on a plane?

-When can I go back to work with a (desk job/physical job)?

-When can I go swimming/use a hot tub?

-What do you recommend for scar treatment?

-What percentage of your patients have required a revision?

-Do you provide free or reduced-cost revisions if they're necessary?

-Are revisions done typically with local anaesthesia or general anaesthesia?

-What letters do you require?

-Do you have a BMI requirement?

-What is the total cost? Does it differ by procedure?

-Does this include the surgeon's fee, facility fee and anesthesiologist fee?

-Does the cost include a post-op binder or any medical supplies?

-Does the cost include post-op appointments?

-Is there a down payment required to secure a surgery date?

-Does the cost need to be paid in full before my surgery date?

-Do you offer a payment plan?

-Do you accept medical financing via CareCredit, etc.?

-How much should I budget for post-operative medications?

-What types of insurance do you accept? (Medicare, Medicaid, private insurance)

-How much success does your office have getting pre-authorization for Top Surgery insurance coverage?

-If you don't take insurance, is your office able to assist with filing for an insurance reimbursement?

Those are just the ones I needed, but take a long list of questions to your visit. If your surgeon makes you feel like they don’t have time to answer them (my first one did), don’t use them. I know this is all intimidating, and so many people feel like they have to please the surgeon, especially if there are limited surgeons in your area (like in the South), but PLEASE think of this in the reality that YOU are interviewing THEM and they need to earn your business. Even if insurance is paying, they are still getting the money for it and you deserve their time and attention. This is a long and scary process that can get very intense, you need to feel comfortable and open with them and really trust that they will be there for you after the big day.

Website of Surgeons Currently Accepting Medicare (may not be completely updated, so do your own research also): https://www.topsurgery.net/surgeons/medicare.htm

[kpopfanfictrash]

Angel (V)

Author: kpopfanfictrash

Pairing: You / Jackson

Rating: PG-13 (angst, depictions of chemotherapy / surgery)

Word Count: 4,479

Summary:  You’re a medical intern, always a perfectionist and used to being the best at everything you do. Jackson Wang is the male nurse beloved by everyone and constantly on your nerves. When you two are brought together, it could be the best or the worst thing that’s ever happened. (HAPPY BIRTHDAY, @baebae-goodnight !) 

“Jackson,” you demand, waiting for him to look at you. “What’s wrong?”

Jackson looks your way. His eyes find yours, for only a second. “My dad just called,” he manages.

“Oh?” Unsure why, your heart starts to pound. “What about?”

“My mom.” Jackson can barely get out the words. His mouth tightens around them, and he swallows. “They found a lump in her breast. They’re doing a biopsy but Y/N,” he half-breaks, needing to look away. “They think she’s re-lapsed.”

You don’t know what to do.

The wind pulls at your hair, blowing it in different directions as you stare, struggling to come up with words. In medical school there are several classes you take, all designed to enhance empathy. Designed to teach bedside manner, the importance of communicating with your patient. It’s something you’ve been taught over and over, and you don’t know why it’s difficult now.

The idea, itself is odd. Logically, a patient should want a doctor who knows what they’re doing. The patient should want a doctor with the right statistics, the right answers, right schooling and right credentials. They should want the one who, ultimately, can cure them. In reality, patients want a doctor who makes them feel better.

To feel better doesn’t necessarily mean ‘to not be ill.’ Oftentimes it’s emotional, a quintessential calmness that comes from a person’s words or gestures. It comes from the idea that they care, because people who care try harder. All this, is a roundabout way of saying there are many phrases you use, to comfort patients.

You can tell them they’re strong. Tell them you’re here, that you’re sincere in your efforts. You can tell them their options, explain what they can do and what to expect. None of these seem relevant now, looking at Jackson. Jackson’s expression is crumpled, a man at a loss, and you know there are no words you can say to fill this void.

When he looks your way, he’s silent. Silent, but then he reaches out a hand. You accept it quietly, letting yourself be pulled into him. You’re exhausted. Tired from your shift and the events of the night but you find yourself feeling strong, in his arms. Not by choice, but because you must. You know what will happen now, what Jackson will go through – and in the coming months, he’ll need you to be the strong one.

Jackson doesn’t cry, though his body relaxes into yours. He softens, as though he’s letting go. It’s all too often, that he’s the solid one. All too often he’s the happy one, the bright one, the smiling and laughing nurse who makes others feel better. That’s the kind of person he’ll need to continue to be, for his mom, but with you – your arms tighten.

“I just,” Jackson inhales, breaking off, “didn’t expect him to say that, when I answered. I talked to her last night and she seemed fine. Maybe a little tired,” Jackson buries his face deeper, “a little off. She lost weight, was kind of nauseous – ah,” his arms tighten. “I should have known, I should have seen it.”

“No,” you exhale, shaking your head before pulling away. Jackson’s eyes are rimmed with red. “You’re her son, not her doctor.”

Jackson doesn’t respond at first. “I know.”

“When… will you know?” you ask, and he shakes his head – he’s not sure, when the biopsy results will come back.

“Probably sometime today,” he mumbles, pushing a hand through his hair. “It depends on what tests they run.”

You nod, because you understand. Looking at him, you stifle your yawn – you don’t mean to, truly you don’t. It’s just that today has been so long, you’re so tired. Jackson notices this, catching your hands with his own.

“Hey,” he bends. “Go home. Get sleep. I need to get to my shift, we can talk tonight – okay? When do you come in next?”

“Not until tomorrow morning,” you say, yawning again. “Go, go – we can talk tonight.”

“Okay,” Jackson straightens, glancing over your shoulder. “I’ll get through today, and then I’ll call you when I’m done.”

“Okay,” you agree, lifting on tip-toes to kiss his cheek. “If you need anything, tell me and I’ll come.”

“Anything?” Jackson manages to smile. “Anything?”

“Barring certain violent crimes, yes.” When he groans at this, you poke his arm. “You want a slushie? Done. You need your laundry separated? I’m your girl. You need a recipe, some surgical technique researched, someone to drive your grandma to the airport? Hello, I’m here.”

Jackson laughs, though it disappears faster than it normally does. “I appreciate that,” he says, squeezing your hand. Then he turns around, hiking his messenger bag higher. “I’ll see you tonight.”

You watch him walk away. Jackson disappears through the doors to the hospital and you can’t help but shiver at the sight. It’s an odd part of being a doctor, the normalization of the place. For most of the world, a hospital is somewhere you visit and might not leave. It’s a place to be healed, but also one to die – and for some reason, this fact seems glaringly obvious right now.

Turning away, you walk across the parking lot. Shoving both hands in your pockets while crossing to your car, tugging on the handle until it opens. On the inside, you sit for a long moment. Hands gripped around the steering wheel before tossing your bag into the passenger seat. You lower your head to the leather wheel, taking a few deep breaths in and out.

It’s a lot – first Mr. Ronstein, now Jackson’s mother. Anger pushes at you from inside out, twisting your skin and bones with the pain. It’s not fair – it’s not fair that Mr. Ronstein is gone, that Jackson’s mother will have to go through this all over again. It’s not fair that Jackson is overworked, that he’s over-tired and still must deal with this. Then there’s you – it’s hard not to think about yourself, in all of this.

Perhaps that’s selfish but then, humans are selfish creatures. You only understand the world as it relates to you, through your own eyes and right now, you’re barely hanging on. You can barely deal with your own perfectionism and neuroticism – and to have to support another person on top of that? It’s a lot.

Just thinking this, makes you want to cry. You squeeze your eyes shut, convincing yourself not to. Whatever you do, crying won’t help. Taking another breath, you slowly lift your head. Monitoring your breathing, you wait until your vision clears, and then place your car in reverse. The drive home is long, silent since you forgot to turn on the radio. It’s only ten minutes to your apartment, but it may as well be ten hours.

When you pull into the parking space, you almost don’t recognize it. Staring dazedly at the curb before shaking your head and opening the door.

Your bed welcomes you, face-first. You barely make it there in time, tossing your keys on the counter and kicking your shoes in your closet. Half-stripping your body to fall, mostly clothed into bed. You sleep instantly, barely remembering your head hitting the pillow – it’s only your cell phone which wakes you, insistent and shrill.

Hand fumbling, you grasp for the device – lifting it to answer, “Hello?”

“It’s cancer,” Jackson breaks, barely able to speak. “It’s – she’s.”

You sit up. “I’m on my way.”

The new few weeks pass in a blur.

Jackson’s mom is put into chemotherapy. Normally for a re-lapse, the approach would immediately be a mastectomy. Jackson and his father are both insistent though – the less invasive, the better. Which means chemo first, hoping to shrink it enough to perform a lumpectomy. The doctor still prefers the latter – quietly, you agree – but Jackson is livid at the thought.

“Is he crazy,” he hisses, while you push him hastily out of the room. His mom and dad are still talking with the doctor – reviewing the side effects, talking about potential outcomes. They don’t need Jackson going off the wall, making this harder. “Really,” Jackson turns, halting when he sees how close to the wall he is. He exhales, slowly extending his fingertips, “is he actually crazy.”

You say nothing, as you wait for him to explain. Sometimes, it’s better to let someone talk themselves out of the pain.

“She’ll go through so much with a mastectomy,” Jackson groans, meeting your gaze. “She’ll lose a part of herself. It’s invasive, it’s a long recovery – my mom likes to do things. She likes hanging out with her friends, likes going on random road trips. She likes singing along to the radio, she…” he breaks off, shaking his head.

You reach out for him, taking his hand as Jackson stops talking. “I know,” you nod, searching his face, “she has options, though. Chemo is just as invasive, some say more so than the surgery.”

Jackson groans, before burying his face in his hands. “If they shrink the tumor though, it will be a less complicated surgery.” He quiets, then lowers his hands to look at you. “I know what the right answer is. I know what she should do – so why is it so hard, when it’s my mom?”

There’s no answer, besides the obvious. “Because you love her,” you say simply. “It’s pain she’ll feel, pain you’ll feel as well. It’s hard to make the right decision, when you’re hurting yourself.”

Jackson nods, then looks out the window. “I’ll step back.  Whatever she decides,” he says hollowly. His eyelids flutter. “Thank you.”

“For what?” you ask.

“For making me say this out here,” Jackson takes a step, wrapping his arms around you. His head finds the top of your head, “instead of in that room.”

“You’re welcome,” you mumble against his sweater – fingers connecting behind his back.

Jackson holds you that way, gathering strength before he’s ready to go in.

The second week of his mom’s chemo, it’s a difficult week at work. You mix up some paperwork, nearly miss the distribution of a patient’s pills and things only go down from there. You’re beaten, bruised and thoroughly convinced you can’t do this anymore. The only thing getting you through it all – the knowledge of why you’re doing this – becomes suddenly unclear.

You want to help. Want to be of use, but how can you, if you’re crap? If you’re not good enough to save people, if you mess up more than you succeed – how is that helping anyone? It seems unfair, to lay any of this on Jackson – so you don’t.

Instead you keep silent, pushing your worries deep inside yourself. Normally, you think Jackson would notice. Normally, he’d sense the distance and try to draw you out. This time though, he can’t. Right now his attention, his entire being is devoted to his mom.

You can’t begrudge him that – it’s who Jackson is. He gives his whole self, every bit of him – it’s what you love about him. Because through all this, that’s one thing you’ve realized. You love Jackson, you’ve fallen love though you haven’t told him. That’s a lot to reciprocate, and you don’t want to be a burden.

It’s during her final week of chemo, that Jackson rushes into the break room. He appears frazzled, hair askew and scrubs half-on. You see him enter and rise, hastily crossing the room. “Jackson,” you breath, scanning his face. “What’s wrong? Are you okay?”

He nods, grabbing your arm. “It’s my mom.”

Dread pools in your stomach. Those words are never followed by anything good – and Jackson takes a step closer, pushing you backwards into the on-call room. He shuts the door and you turn to face him, worried. “Yes?”

“One of the nurses is sick,” Jackson grimaces. “The flu, I think. I need to cover their shift, but my mom is about to go into chemo.” He pauses, shudders. “I don’t want her to be alone. I was wondering if maybe – if possibly –”

“Jackson,” you touch his arm. “Of course I’ll sit with your mom. I’m in between shifts, its fine.”

Jackson’s face drops in relief. “Oh, thank you,” he exhales, grabbing your face for a kiss. “Thank you, thank you, thank you – I owe you,’ he declares, throwing open the door – wagging a finger in your direction. “Sexual or not, I owe you big.”

You laugh, crossing your arms as the door falls shut behind him. Once you’re alone, you take a deep breath. You can do this – you can go to his mom’s chemotherapy, you can sit beside her. It’s not that you’re scared, exactly – you’ve met Jackson’s mom many times before. You’ve been in the same room, sat in on other treatments – but never like this. Never alone, never without Jackson. You’re always the one supporting Jackson, who in turn supports his mom.

To get ride of that barrier is intimidating. As you change out of your scrubs to pull on street clothes, you wonder what you should say. Wonder if you should think up talking points – then look in the mirror, smoothing your sweater lower. It would be weird, if you wore scrubs. Dressing like that enforces distance, makes it clear that you’re the doctor and they’re the patient. That’s not what today is about. Today is about friendship, not professionalism.

The oncology wing is all the way on the other side of the hospital, which means you’re almost late traveling to Jackson’s mom’s appointment. You arrive just as Mrs. Wang is being walked in, the on-call nurse checking her name, medicine and dosage before she settles in. This is one of the last appointments, before a decision on surgery is reached. Everything has gone remarkably well – Mrs. Wang’s tumor has shrunk, it’s in a more manageable location and overall, things are looking good.

When Mrs. Wang looks up and sees you, she smiles. “Y/N,” she sighs, lowering herself onto the bed. Bed is a loose term, it’s really more of a recliner. “Thank you for coming, but you needn’t stay.” She half-laughs at this. “Jackson worries too much – I’ll be fine, alone.”

Before now, you were frozen. Before now, you were unsure what to do with your words or speech or hands. Now you move, walking to the side of her bed and pulling out a chair. “ I know,” you declare, sitting. “I want to be here.”

She raises an eyebrow, but nods. “I see.”

The moment is interrupted by the nurse, returning to start the infusion. She begins the drip of medicine into Sophia’s IV before leaving, checking her vitals and exiting the room. Today the place is fairly quiet, just one or two people throughout – neither of them with visitors. You nod when the nurse leaves, already monitoring Mrs. Wang yourself. You check that everything looks textbook; that she’s safe, healthy.

“I have doctors, dear,” Mrs. Wang interrupts, though she smiles. “You don’t have to do that. Between you and Jackson,” she laughs – then winces, “I don’t know when I can ever have normal conversation.”

You offer a hesitant smile. “I’m sorry, Mrs. Wang,” you confess, shaking your head. “When I don’t know what to do with myself, sometimes I fall into the pattern that I know.”

“Don’t we all,” she murmurs, closing her eyes. “And please, call me Sophia.”

“Really?” you sound dubious. “That seems awfully informal.”

Sophia laughs. “You’re dating my son,” she counters. “It doesn’t get much more informal than that.”

Smiling to yourself, you fold your hands in your lap. “True.”

Opening one eyes, Sophia looks at you. “He cares deeply for you.”

“I,” you exhale, organizing your thoughts. “I care deeply for him, as well.”

She smiles. “You’ve been good to him. You are good for him, I don’t know if you know that.”

It’s hard, to control your blush. “Jackson is a wonderful person,” you respond, shaking your head. “I’m sure that, in no small part, is due to you.”

Sophia laughs, a happy sound. “Yes, he is – Jackson is sensitive, though. Most don’t think so, since he’s so bright and cheerful – but Jackson feels the world, deeply. He likes to be liked, likes to be seen – you seem to temper that, somehow.”

“Oh,” you frown. “I don’t like to think I’ve changed him.”

“Sometimes change is good. I don’t think he’s changed in a bad way,” she confesses. “Jackson just doesn’t try so hard, around you. He seems more like himself, more confident – though people always are, when they’re loved. You do love him,” she asks, curious, “don’t you? I’m not sure you’ve said it to each other yet, but from the way that you look at him…” she trails off.

Your cheeks must be tomato-red. “I – I do,” you confess, though when Sophia starts to smile, you hasten, “I haven’t told him. Haven’t wanted to well, put that on him.” Saying this out loud, you wince. It sounds so lame, so inadequate.

Sophia doesn’t seem offended, just thoughtful. “You think your love would be a burden?”

When she says it like this – so simply – it’s hard to think of an answer. You stare, for a moment. “I suppose,” you manage, “when you put it that way.”

Adjusting herself on the bed, Sophia smiles, “Life is short, Y/N. You don’t always get a second chance, so take the first one.”

She’s right. She is, and for a brief second you say nothing back. For a moment you’re silent, considering the reasons. The reasons why you continually block yourself from happiness, why you think it’s only appropriate to feel one emotion at a time. Even in tragedy, there can be light. That’s the beautiful part of humanity, it’s your favorite part of working in a hospital. It’s because of things like this, like Mr. Ronstein – so brave, when faced with fear. Because of small miracles, like that one car accident. The one where, against all odds, everyone pulled through. It’s because of the brightness – light, where there should only be dark.

Your love for Jackson is along those same lines. Just because he’s in pain, just because he’s busy doesn’t mean there isn’t room for you. It doesn’t mean you can’t be loved, in return. Looking back up at Sophia, you exhale. “You’re right,” you admit, ducking your head. “Thank you.”

It surprises you, when Sophia reaches for your hand. Her grip is strong, smile bright – much like her son. “Of course,” she nods, before closing her eyes.

The steady beep of the machine goes on.

It’s weeks later, her surgery is determined to be a mastectomy. Despite the chemo, despite how her tumor has shrunk – Sophia’s doctor still recommends the entire breast be removed. You know clinically speaking, this is the right call to make. It’s what was suggested, right from the start, especially given that this is a re-lapse.

Sophia agrees with the doctor, much to your surprise. You wonder if, she did the chemo more for her family than for her – if she knew they wanted the less invasive procedure, and humored him. It’s not what you would have done but then, not everyone is you. A mastectomy will give Sophia the greatest chance of survival, the greatest chance of defeating the disease – though it’s more painful, both emotionally and physically.

Sophia declares she wants it, though – and Jackson and her husband fall in line. Jackson was angry at first; though he softens, once he realizes it’s what she truly wants. He and his dad still fret, though. They insist on being there all throughout pre-op, assuring Sophia that they’ll be there as soon as she wakes up.

You’re there as well, mostly for Jackson – but also for Sophia, whom you’ve grown close to, as of late. Standing in the room with them, Jackson’s hand continually seeks yours. His arm half-slides around you, touching for reassurance, for the comfort you offer freely.

You still haven’t said, ‘I love you,’ but honestly, there just hasn’t been time. You’ve both been busy, working alternating shifts of night and day. Even when you’re not at the hospital, one of you is asleep or with Sophia. Any other free time is spent collapsed in front of a TV. It’s not the bad kind of silence, far from it – it’s just that life is hard, and you’re utterly exhausted.

The two of you talk, in the presence of Sophia. You talk a lot – sometimes too loud, sometimes over-bright, so when you return home, it’s nice to be quiet. Nice, to gather strength from the silence and presence of another. Jackson doesn’t say much to you, but you know when he’s worried. Know when he’s stressed, like he is now, with the weight of this surgery hanging over him. You don’t want to add to these worries, despite your talk with Sophia.

The surgery day dawns, bright and sunny – something which seems like it should be a good omen. It seems like it should, which is why you can’t shake the feeling that something will go wrong. Maybe it’s just pessimism, but pessimism on the whole is hard to shake. This surgery has a high success rate, Sophia is in otherwise good health – there’s no reason for anything to go wrong. Still, you think of Mr. Ronstein – think of all those one in one hundred cases that go wrong.

A mastectomy is typically around 2-3 hours long. Sophia’s should be of similar length, and when she’s wheeled out of pre-pp, the three of you go to wait in the lobby. The couches are hard, uncomfortable surfaces made for hard, uncomfortable decision and you settle onto one hesitantly. Today is a day both you and Jackson took off work. You made sure this happened, switched with three different people to ensure you have the entire day. Jackson needs you.

He lies with his head in your lap, saying nothing while you push fingertips through his hair. His gaze is tense, eyes fixed on the door before you. His father tries to read, but the pages shake in his hands. He says this helps, though, having something to do with his mind.

Two hours pass, then three. Jackson grows anxious, staring at the clock between glancing at the doors – you fight the urge to tell him a watching pot never boils. He knows this, so do you – but it does nothing to alleviate the worry.

“Why hasn’t she come out yet,” Jackson exhales, sitting up. He looks around, searching – then stands, rising stiffly from the couch.

“Jackson,” you sigh – before standing as well. It is odd, for things to take this long. You don’t want to admit it – you imagine, Jackson also does not – but it’s rare, for good news to follow a wait of this length.

Jackson reaches the receptionist first. He tries to smile, placing both palms flat upon the counter. “Hi,” he looks down at the woman. “I’m Jackson Wang; my mother, Sophia Wan, is a patient of –”

“Dr. Zimmerman,” the woman nods, glancing up. “I know. How can I help?”

“Well,” Jackson starts – then turns, as a pink-scrubbed nurse pushes open the doors to the lobby.

She looks tired, dark circles beneath her eyes while searching the room. When she sees Jackson, she exhales – walking briskly in your direction, still saying nothing. You recognize her, though you can’t recall her name. Sarah, maybe – the two of you have rarely had reason to interact, in the time that you’ve been here.

She comes to a stop, several feet away. “Hi,” she says, glancing around. “I’m Sandra. Jackson Wang, right? I need to speak with your father, as well.”

Jackson’s father joins and you blink, not having seen him move. Based on her words, it seems Sandra doesn’t know Jackson personally, just of him. Her gaze is tight, though sympathetic upon Jackson’s face.

“What’s wrong?” Mr. Wang’s hand finds Jackson’s. “What seems to be the matter?”

“The surgery is taking longer than expected,” Sandra confirms. “Sophia reacted poorly to the anesthesia, they had to try several different things to get it under control.”

“I,” Jackson inhales, eyes wide. “What do you mean, she reacted poorly? Is she okay? Is she having trouble breathing – did the surgery continue?”

“Jackson,” his father warns, nodding at Sandra to continue. “Go on.”

“The surgery is ongoing,” Sandra informs. “It will likely be another hour – the surgeon just wanted me to tell you why. I’m sorry,” she adds. “I wish I could be of more help, but that’s all they told me. I really have to go now,” she winces, looking at the clock. “I just stopped by in between patients.”

When Jackson nods, she turns – pushing open the doors and disappearing once more.

Jackson stares, hands shaking at his sides. You wind your fingers in his, pulling him gently to the couch while Mr. Wang follows. He sits on a chair jerkily, lowering his body before resting his face in his palms. Jackson remains still, staring at the spot where the nurse disappeared. Softly, you wrap your arms around his waist – mostly, because you can’t think of anything else to do.

“It was too easy,” Jackson chokes, the words soft. “Things were going too well.”

He looks defeated, broken – so you pull back to look at him. “No,” you declare, meeting his gaze. “You can’t think like that. Your mom can, and will pull through this. She’s strong, Jackson. You’re strong – even if you stop believing, I won’t. I’ve believe enough for you, me – this whole hospital.”

Jackson licks his lips, eyes red. Then lowers his head, burying his face in your neck. “Thank you,” he exhales, and you wait like that.

It’s another hour, before the second nurse enters. Another hour, before any new news – the second nurse walks out differently though, hope in her eyes.  She smiles, explaining that Sophia is fine – everything is fine. She underwent a complete mastectomy, unfortunately – her nipple was removed, in the process. You were hoping this could be avoided, but it appears this was not possible. The situation with her anesthesia was remedied, Sophia remained under the entire surgery. She’s waking up now, though she’s still groggy. You’ll be able to visit, soon.

Mr. Wang cries, upon hearing this. Jackson doesn’t break down – not yet – but he turns, wrapping his arms around his father. He holds him, as the older man cries into his shoulder. The sight is unexpected – before, you found them to be dissimilar. Not in a bad way, just that they were different. You though of Jackson’s father as stoic, silent – in direct opposition to his bubbly son. Now though, you see how similar they are.

Both are brave, both force themselves to seem strong – they hold on, until that moment when they no longer can. Until that moment when they no longer can, and the world comes crashing down around them. It’s only the way that they wear their masks, that’s different.

Jackson’s father goes to visit first – he exits alone and once gone, Jackson looks at you. “I don’t know what to say,” he admits, voice hoarse. He reaches for you subconsciously, pulling you closer. “You’ve given me so much,” he murmurs, speaking into your hair, “so much, I don’t know how to thank you.”

“You don’t,” you exhale, wrapping your arms tighter. “You don’t.”

[Master List]

[ukftm]

[cw top surgery, complications, cancer mention] I know double masectomies for breast cancer differ from top surgery, but my grandma had a double masectomy a year or so ago and suffered from lymphoedema as a post-complication, meaning that her left arm is going to be swollen for the rest of her life and she has to wear a compression sleeve. obviously she's also a lot older than most folks having top surgery, but my parents are concerned about this happening to me with top - how likely is it?

Lymphoedema after mastectomy happens due to either the removal of the lymph nodes or by treating them with radiation therapy.  If the lymph nodes are removed or blocked then this can cause the lymphatic system to become overwhelmed and lymph (a clear fluid) to collect, leading to swelling.

As the objective with top surgery is to provide an aesthetically pleasing and masculine chest rather than removing all tissue which may be affected by cancer then there is less need to remove the lymph nodes.  Lymph nodes are generally not removed during top surgery, which greatly reduces the risk of developing lymphoedema.

This is might be something that you’d like to discuss in more detail with your surgeon when you have your consultation as they’ll be able to provide more specific information about the surgery that they perform, whether they will affect the lymph nodes, and generally be able to discuss post-op complications and their frequency.

~ Alex

[sophygurl]

Today is hard. 

I mean yea, it’s Father’s Day and I just had my annual lunch with my dad (actually we had 2 this year), so stuff about my complex difficult relationship with him and all the issues I still need to deal with once I get my butt back to therapy is kinda knocking me out.

And I’m also really worried about my one roomie who is having mega-emotional issues which he is self medicating with instead of finding a new psych. to treat him/adjust meds/whatever he needs. 

But it’s also one week away from when I’m going to spend a week and a day with my best friend. Which is hard for reasons I’ve only vague-posted about before. She’s recently given me permission to talk about it publicly though (only in spaces where some folks she hasn’t told yet aren’t around and tumblr counts).

I’m gonna put this under a read more in case stuff about cancer is triggery for anyone reading.

So here goes. In January, my bestest friend in the whole wide world was diagnosed with breast cancer. She had retinal cancer as a baby and her mom died of cancer, so we always knew there was a high chance of her getting it again, but of course knowing that and having it happen are two very different things.

My bestest is one of the closest people in the world to me (right up there with my mom and my ex - the same roomie I mentioned being worried about above). We’ve been besties since high school and been through a whole slew of shit together. She’s been there for me during so many of my own crises in ways that no one else was or could have been. She is the kindest, most generous, most loving and overall most amazing person I know. 

Thankfully, all of her doctors agree that this cancer is curable. I try not to focus on the fact that shit happens and there could be unforeseen complications or she could get another form again later yaddayadda - it’s hard enough dealing with the current reality without letting that other stuff seep in. 

My bestest doesn’t have a ton of local support. Her sister lives a couple hours away and has come in for a lot of appointments (bestest just completed 20 weeks of chemo!!) and to help with certain things, but her sister has 3 kids and a job and can only do so much. 

I, also, live a couple hours away and can’t drive and travel is fucking hard on me so while I managed to sneak a half hour visit in with her on Mother’s Day when my mom was driving us to another town in the area to visit my bro and his family - I’ve been otherwise kind of desperate to see and be there for my friend.

I’ve been talking with her on the phone a lot (I am not a phone person but she is and also my gods have I been needing that connection with her also), and doing lots of looking stuff up online and being a conduit of info to mutual friends and finding resources and whatever else I can think of to do really.

But this coming Friday she is having a double mastectomy and her sister can only stay for a couple of nights. When I started reading up on the surgery and what the recovery would be like and stuff a couple months back, I kind of panicked about who could take care of my bestest. And there were no good answers. So I volunteered. And I’m doing it. But it’s gonna be really hard. I’m pretty disabled myself. But I’m determined to do this because she needs it. 

I have to take a bus there, but fortunately things worked out for me to get a ride home at the end of the trip. I’m so worried about my friend, and I’m anxious about how I’m going to manage, and as I mentioned above I’m having complex issues around my dad, and worried about my roomie, and the people I normally go to with this kinda stuff are: 1) my bestest who I’m not gonna lay any of this on for obvious reasons, and 2) my ex/roomie who is not exactly positioned to be a support to me rn and who I am at any moment either really worried about or really angry at or both, and 3) my mom - who let’s just say has her own shit to deal with rn too and who is turning 70 this summer and is starting to show her age and who I’m also worried about and feeling like I should really be relying on less because I’ve leaned on her my whole life and it’s probably about time for those roles to be reversed yk?

So anyway. I’m having a rough day. And at least I can finally talk about the one big reason things have been hard since January. If you read this - thank you, and yes a “like” will let me you know read and care. 

[hellosaltysaladcollectionstuff]

“KATHY, BY WHICH I mean I, was getting married,” Olivia Laing writes. “Kathy, by which I mean I, had just got off a plane from New York.”

Known for her nonfiction, Olivia Laing has explored whether loneliness was inherent in creativity, the connection between writers and alcoholism, and walked the length of the River Ouse in which Virginia Woolf drowned herself in 1941. Crudo is her first work of fiction, written over seven weeks “in real time,” keeping pace with the fast-changing nature of the modern news cycle as events unfolded online.

Who is the protagonist? From the beginning, Laing is cagey. We’re in the head of a writer who may or may not be Kathy Acker. Though the punk troubadour of postmodernism died in 1997 from complications relating to breast cancer, Laing imagines Acker aged 40 in 2017. She’s living between America and the United Kingdom, on the precipice of getting married for the first time to a man 29 years her senior. She’s obsessed with Twitter and rattled by commitment.

There certainly is a lot of Acker in there. There are references to Great Expectations, Blood and Guts in High School, her Upper East Side upbringing, her “years in a strip joint in Times Square […] releasing her flat little fried-egg tits into the eyes of the world,” her breast cancer-induced double mastectomy. Centering the novel on Acker at all may seem like an odd choice if you’re unfamiliar with her own practice of pinching the lives of figures like Toulouse Lautrec, Don Quixote, and Pier Paolo Pasolini. Yet there’s a healthy dose of Laing, too. After all, she is the “poster girl for female solitude.” She also wore Isabel Marant to be married the poet Ian Patterson, whose first marriage was to the “famous writer” Jenny Diski. Like her fictional Kathy, Laing also “insisted on Maria Callas because she didn’t operate via understatement” for her wedding ceremony. Kathy and her husband “talked about Crete,” for their honeymoon, and a glance at Laing’s Instagram will reveal her own honeymoon’s rocky beaches and turquoise Grecian seas. On the day of her wedding, Kathy arranges “a china platter that had once belonged to Doris Lessing,” an allusion to Diski, who was taken in by Lessing when she was 15 years old. Blending these two individuals, Laing floats between third and first person, seemingly unable to settle on a pronoun that suits her purposes.

Inspired, or perhaps horrified, by the current events of summer 2017, Laing began writing as an escape from another project. This escape quickly took form, walking the line between fiction and reality. This line is becoming ever blurrier. Crudo stands alongside Sheila Heti’s Motherhood, Rachel Cusk’s Kudos, and Karl Ove Knausgaard’s The End, the final installment of My Struggle. And those are just a few standout examples of autofiction published this year. Even the term autofiction feels somewhat murky — just as subjective as the form it’s trying to clarify. Coined by French novelist Serge Doubrovsky in Fils, published in 1977, autofiction has a loose definition as “fiction, of events and facts strictly real,” while he argues that the main distinction between autofiction and autobiography is that “autobiography is a privilege reserved for the important people of this world, at the end of their lives, in a refined style.”

But potential lawsuits aside, where do we draw the line between what can safely be classified as fiction and what qualifies as autofiction? Technically there is no magic formula balancing fact and fiction until we reach an artistic equilibrium. Though false claims of veracity have had powerful consequences, as a quick Google search on James Frey or Clifford Irving might tell you, does a bit of truth in fiction really matter? At the opening of Calvin Trillin’s Floater, he gives readers a “Claimer” in place of a disclaimer, revealing that “the character of Andy Wolferman is based on John Gregory Dunne, though it tends to flatter. The other characters are fictional.” Sweetbitter novelist Stephanie Danler has been often asked whether there was a real Jake — her agent is still looking for him. Perhaps with Crudo, this distinction is more cut and dry. Kathy Acker remains within our cultural consciousness with her cult classic Blood and Guts in High School reissued as well as Chris Kraus’s After Kathy Acker: A Biography hitting shelves in 2017.

While it might be hyperbole to suggest that current events and modern life act as the catalyst — especially considering the long history of authors cribbing from their own lives — it is interesting that there’s less artifice in masking the aspects they’ve borrowed. There seems to be a direct correlation with social media’s practice of posting curated snippets, arguably blending our lives into a fictive narrative, and the rise of autofiction. We’re already primed. Even our news is fake now. With Crudo, Laing appropriates Twitter’s trademark intonation, writing in a flippant and conversational voice, concise to the point of discarding nonessential punctuation. The novel feels cathartic, written in the breathless rush of a Twitter thread. Even Laing’s choice to juxtapose images of Kathy’s upscale Tuscan holiday in Val d’Orcia alongside the mounting horror of the news cycle portrays the experience of scrolling.

Trump is never far behind. His asinine antics are reported through direct quotes from his Twitter feed. One stunning example of his hubris forms the epigraph and tells the reader exactly what kind of novel Crudo will be: “The cheap 12 inch sq. marble tiles behind speaker at UN always bothered me. I will replace with beautiful large marble slabs if they ask me.” As we read, Grenfell Tower burns; Trump fires Comey, “trashtalk[s] the FailingNewYorkTimes,” and provokes North Korea; Neo-Nazis with their “disgusting putrid horror-faces, Halloween mask America” march through Charlottesville, and people suggest that Holocaust “was a narrative that got fixed.” A start-up called Bodega aims to replace mom-and-pop shops with their glorified vending machines. “Twitter’s ABLAZE gurl,” a friend texts Kathy.

Yet current events are contrasted against quotidian life, which for Kathy means her impending nuptials — and her mounting anxiety over her relationship. As her wedding date approaches, she marks the days and hours like some kind of countdown to detonation. She is uncertain if she can commit to a single person or even a single place. She contemplates the practicality of rotating among three or four residences, as “she was happiest on her travels, like a clockwork toy, maybe happiest unpacking or booking a train ticket.”

Kathy also considers her “abnormal talent for withholding, as if she’d finally become one of the many men she’d chased across Berlin, London, San Diego.” One such man replies to her casual email as if she’d been hounding him relentlessly. “Disappearing now,” he wrote, ending their conversation. “I’m IN ANOTHER COUNTRY,” she shouts at her husband, appalled by his power play. “I HAVE ALREADY DISAPPEARED. Why does he always try and OUT-DISAPPEAR ME.” With the exception of her husband, her relationships are unequal, emotional “withholding” becomes the refrain. Whether it is acted out by ex-boyfriends, elusive sleep on a muggy night, or Kathy’s own behavior, withholding leaves her wholly unprepared for the compromise and tenderness of marriage. It becomes clear that Kathy “liked liars and evasive people, she liked seeing what they’d say, she liked being continually shocked surprised disappointed by the way they were never where she thought they’d be.” Even her affinity for living alone is a hurdle to overcome, but her love for her husband cracks her open like the crabs they smash to bits with an Ikea hammer over dinner, sifting through the shells for the meat. Waiting to board a flight, she realizes that she’d never really loved anyone, never mastered the art of opening herself up before. Travel can act as an escape hatch, but love can’t be tethered to a specific geographic pinpoint. No, “she was in [the world] now, she was boarding, there was nowhere to hide.”

¤

Lauren Sarazen is currently pursuing a master’s in literature at Université Sorbonne Nouvelle. She has contributed articles for publications such as Broadly, LensCulture, and Paste Magazine.

The post Crudo, She Tweeted: Olivia Laing’s “Crudo” appeared first on Los Angeles Review of Books.

from Los Angeles Review of Books https://ift.tt/2qZ7Cqz

[kristenfights]

It’s hard to believe today is 7 weeks post DMX with DTI Reconstruction. I thought by 4 weeks I’d be back to my normal self - I can laugh at that thought now because I was completely WRONG. I’m still not even half way there - though I am very thankful for my progress. I owe it to my plastic surgeon for scaring me into eating all of the protein and lowering the carbs so my reactive hypoglycemia would stay in check meaning less complicated healing. I’ve had a few bumps in the road - the cording I’m currently experiencing, the blood blister (THANK YOU BODY for not being necrosis - Since I was too neurotic to quit vaping nicotine a month before my surgery and quit 6 hours before 🤭) that I had to treat with Santyl but overall I’m very happy with how my foobs have turned out. I’m still confined to my 2014 (judge me, buying food is more important than buying bras) sports bras - it actually hurts not wearing a bra. I’ve walked 2 miles the past 4 days as well as cleaned. I haven’t touched nicotine or medical marijuana in 7 weeks 😭 Before surgery, I thought I was healthy - that was a lie. I couldn’t go an hour without eating without my blood sugar plummeting, I vaped my face off, I worked out for 2.5 hours a day every single day, I lived off of carbs (the vicious cycle of low blood sugar over and over) - absolutely none of that was healthy. I may be underweight, I may still have bad ED thought days, but I appreciate and love my body for all that it does rather than how it looks. I lost all of my muscle and stamina, so what? I’ll get it back when I’m able to hit the gym without pain. I’m in a good place mentally, a better place than I’ve been since I can remember and I’m happy. #mastectomy #breastcancer #breastcancersurvivor #recovery #edwarrior #edrecovery #ednos #anxiety #depression #mentalhealth #mmj #adultswitheds #bopo #bodypositivity #selflove #scars #stretchmarks #looseskin #fitness #fitnessjourney #positivevibes https://www.instagram.com/p/Bnb6-JWFVS0/?utm_source=ig_tumblr_share&igshid=1t0aec8hzp51n