My Surgery Consultation (caution: graphic surgical terminology ahead!)


April 21, 2018

When I first thought about how much I wanted to tell people about my transition process I was hesitant to reveal the details of both my top (breasts) and bottom (genital) surgeries. Like, do I really want to tell that much about myself? But, isn’t that the whole point of this blog? I mean, I wanted a place to log my transition, but I also wanted this to be a resource for other trans-individuals, friends, and families of trans-folk and everyone on this planet. When it comes to talking, or more to the point, asking someone about their top and/or bottom surgery, generally it’s not something one should do. It’s a social faux pas, a no-no. It would be like asking a married couple how they have sex. It’s personal.  But, I really want this blog to be open and honest.

With with all of the blogs and forums out on the internet, it has been difficult even for me to find out what I want and need to know about these surgeries. Interestingly enough, the people that I have surrounded myself with to aid in my transition don’t have all of the answers either. They do know their part of things. And I liken it to the crew on a submarine. No one person operates a submarine. There is a main officer, a helmsman, crew in the engine room, a navigator, and so on.

For my transition I have a therapist to help me with my emotional and mental state, and to make a formal diagnosis which is required for making the legal change as well as beginning the medical portion of the transition. I have an endocrinologist who assists in the prescribing hormones and in my case testosterone blockers for transition. An endocrinologist is also the type of medical specialist that a diabetic would see to help control insulin levels so I benefit two-fold from seeing an endocrinologist. I had/have a plastic surgeon who performed my facial feminization surgery. And now I am employing another plastic surgeon who is trained in the medical practice of changing the primary and secondary sexual characteristics for a transgender individual to the characteristics of the gender to which they identify.

Each of these individuals is an expert in their own right but not necessarily the bearer of the keys to all of the knowledge on every aspect of transitioning. I have had to scour the internet and talk to my medical team to piece information together. I admit I haven’t reached out to my local LGBT center but I guess in a way I don’t feel like I belong there. Not because they have given off that vibe but because I feel like I’m in a kind of floating limbo. Half in and half out of cis and trans. This is my own hang-up really and I suppose one that I should bring up in therapy next time.

Yesterday I had a consultation with a female surgeon in Madison, Wisconsin. I live in Milwaukee, about 75 miles east of Madison. I’m so fortunate to have a gender affirmation surgeon this close to me. Not only is she a practicing surgeon but also a teacher at the University Hospital. In fact, most of my medical team is associated with medical colleges, another aspect of my health care that I am fortunate to have, and one which I feel is very important in my overall health care.

The first thing that I’d like to say is that the nurse that I met with prior to seeing the doctor introduced herself and said, “My preferred pronouns are “she” and “her”, what is your name and preferred pronouns?” This is such a wonderful way to instill a sense of confidence in my choice to see this doctor at this facility. I think so many people feel that they don’t have a choice in their medical care.

Over the years, through a very long medical history of doctors, I have developed the view that I am more the customer than the patient. I am the one paying for the service of medical care. I also am very well informed about my body and my medical needs. I have “fired” doctors from general care physicians to specialists when I am certain that I know more about my specific needs and when I feel that they are contradicting me. I don’t want to give anyone the idea that I am a know-it-all but when I am prescribed a medication that I know would interacts poorly with either a medicine that I am currently taking or one that would negatively impact a surgery or health care path that I am currently working toward. Example; within the past few years I was prescribed a maintenance medication by a specialists that I had seen a total of three times and about 5 minutes each time. After that visit of being prescribed the drug in question I went home and researched the medication only to find out that once on it I would experience increased risk should I ever cease taking it. Additionally, it would complicate any future surgeries. I messaged the surgeon with my concerns only to have his assistant tell me to “just start taking the medication immediately.” I sought a second opinion at a completely different hospital where I was given a diagnosis contrary to the initial one and more in-line with what I felt was improper.  To be clear, I wasn’t just looking for a doctor to tell me what I wanted to hear. I was also doing my research on my own and taking a risk that what I was doing was the correct path. But remember that you are responsible for your health with everything from what you eat and drink to whom you seek for your health care. I see any one of my doctors about every 3-4 months. Granted, I have a chronic health condition, but I believe most insurance plans allow you to see your doctor annually.

OK. Here endeth the lesson. I don’t want to get too preachy!

I guess what I am trying to say is that the staff at the hospital was interested in making the patients feel welcome and cared for from the very greeting, and it didn’t go unnoticed.

I’m going to get technical and personal here.
If you’re squeamish or in any way prudish please stop reading now.

In my previous post “Time Flies…“, I talk about the options for “Top” and “Bottom” surgery.

For top surgery or breast augmentation I personally am going to have a round silicone insert placed under the breast muscles. Modern silicone breast implants are not your mother’s implants. The problems associate with the leaking silicone breast implants of the 1980s have long-since been fixed, and the inferred risks and negative side effects been refuted. Modern silicone implants are a cohesive gel which, even when ruptured will not “leak” into the surrounding tissue. They would also retain pretty much the same shape much like a run-flat tire, and just need to be removed and replaced with a new implant, Saline implants, if ruptured, would deflate and the saline would absorb into the body leaving a flat breast. Also, the exterior structure of both the silicon and saline implants are made of silicone, so either way there is a silicone portion to the implant.

There are two shapes to the implants, that I am aware of, round and tear-drop. My surgeon only uses the round implant. One potentially negative complication of the tear-drop is the possibility of it turning inside the body and creating an unflattering shape which would then need surgery to correct. The placement of the implant can be either on top of the muscle or underneath. I do not know if one is a more involved surgery than the other, but the doctor did say that placing the implant under the muscle produces a more natural and flattering look when finished. The incision would be under the breast as opposed to around the nipple, two options.

Onward and downward!

The four options for bottom surgery are Penile Inversion, Sigmoid Colon, Peritoneal, and Limited-Depth. I’m choosing the fourth, limited depth. Basically it is all of the surgeries involved in bottom surgery without the creation of the neo-vagina. The reason for this is for the simple fact that I am 48, I am married to a woman, and I have no intent to engage in an intimate relationship with a man. Also, by omitting the procedure of creating a neo-vagina, the surgery is less involved, less expensive, recovery time is greatly reduced and after-care is less intense. “Traditional” bottom surgery involves the following procedures:

  • Orchiectomy (removal of testicles)
  • Penectomy (removal of penis)
  • Clitoroplasty (creation of clitoris)
  • Labiaplasty (creation of labia)
  • Urethroplasty (reconstruction of female urethra)
    and finally
  • Vaginoplasty (creation of vagina)

I will have all of the above except for the final one, Vaginoplasty. The after care for vaginoplasty requires the use of dilators to prevent the neo-vagina for closing up like an ear piercing when the earring is left out for too long. The schedule for using these dilators is multiple times per day for the first few months and taper off to once a week for the rest of the person’s life. For clarification, intercourse is not accepted as dilation. Many trans-women have published articles describing the after-care of bottom surgery. This is just not for me. There are some trans-women, trans-women of all ages, that want a fully functioning vagina. Every person’s journey is different.

All through my research for bottom surgery I had been saying, “I want everything but the vaginoplasty. I just want a to look like a Barbie Doll!” , and that is exactly what the doctor said to me!

There are some pre-surgery things that I will need to have done, chiefly making certain that my insurance covers both top and bottom surgery, and obtaining proper mental health paperwork. These are actually the first steps and I’m already in the throes of doing so. I had said that wanted to have all of my transition surgeries completed by the time I turn 50 in late 2019. It looks like I may attain that goal much sooner! I think I may have to change the name of our bungalow to The Barbie Dream House!

– Tiff

All information above is gathered by myself and any errors are entirely by accident.


Author: Tiffany Thomas

I am a 48 year old trans-woman living in the Midwest with my wife and two cats. I was born the year we landed on the moon, grew up in the 70s and 80s, am a type 1 diabetic of 34+ years, and have a bachelors degree in fine arts. I work as an Art Director in manufacturing. I began transitioning in 2016. I enjoy traveling, seeing new things and meeting new people. And I believe that the greatest accomplishment one can have in life is to have a positive impact on another person. This blog is an account of my journey as it happens. I make every attempt at citing correct facts. Every person's journey is different and nothing that I post here should serve as a blanket fact about anyone person or group of people.

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