Surgery: Stage 2 revisions and breast augmentation

I had a full depth Gender Confirmation Surgery (GCS) 16 months ago, done as a single-stage procedure, but unfortunately the clitoral hood and labia minora shrank away, leaving some very sensitive spots very exposed.  There’s a reason I don’t wear pants very often!  Ow...

I now have a surgery scheduled for February 26 with Dr. Salim of the San Francisco Gender Clinic, at Kaiser San Francisco for a revision and breast augmentation (BA).

On the GCS revision, the plan is to fuse the very top of the labia majora to construct a clitoral hood, produce a pair of folds within the labia majora so as to reconstruct the labia minora, and at the posterior end the fourchette or labial frenulum, a fold of tissue joining the labia, will be lowered to be level with the introitus or vaginal entry.  (This will make dilation much easier.)

I’ll be off dilation for 3-4 days after surgery, and may have to restart using a narrower dilator at first.  Not a big deal.

I will be using that donut pillow again for a while, though.

For the BA, I’ll be getting 300cc implants.  These will be circular smooth-surface lightly cohesive with medium profile.  (Other profiles may be flat to extended or conical).  With my particular anatomy and pectoral muscle form, I will probably have the most natural appearance and improved aureole placement with an over-muscle implant, with incision in the new breast fold.  I should wind up with something like a 36C.

I’ll be on restricted activity for a month, and won’t be able to lift my arms above shoulder height for a while.  I’ll have to shuffle the kitchen around quite a bit!

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And here I am, three days post-op! 

There’s a little discomfort at the labiaplasty site, nothing terrible.  I did use a minimal half tablet of the Norco equivalent I was prescribed to get to sleep last night.  The breast augmentation (BA) mostly just itches around the sides of the medical bra.  The Velcro front fastening on the bra kept coming loose until I put a safety pin through it, before I even left the hospital.  Having a BA?  Bring safety pins!

This morning marked the date I was to remove the bra and shower.  Oh, what a relief that is!  Of course, the unveiling produced it’s own reaction.  For just 300cc on a side, well, damn!    The incisions are quite small, surprising me.  It looks like they will wind up right on the fold, almost invisible.  I’ll start the silicone scar treatment as soon as I am cleared for this by the doctor.

I reapplied A&D ointment (allergic to bacitracin) on the labiaplasty sutures, and put on a fresh pad again.  Bleeding has almost stopped, just a tiny amount of oozing there.  I’ve been cleaning and swapping in fresh pads twice a day.

The Foley catheter is, well, a catheter, with all its own maintenance.  I have a night bag, a leg bag for daytime, and I have to drain them periodically as well as the sanitizing after swapping bags.  I’ve been more active yesterday afternoon and today, and of course that means the catheter tip and lumen (drain opening just behind the tip) have likely been brushing against the bladder lining.  A couple of clots have shown up in the bag, right after a twinge that tells me bladder pressure dropped suddenly.  They likely used a single-lumen catheter and the tiny opening was plugged by a clot.   I have to keep an eye on this, as a plugged indwelling catheter can cause significant problems.  (I can remove it, worst case, and suspect I can now pee on my own as swelling has started to subside.)

After the shower, I had to re-don a sports bra to maintain pressure and placement.  But first...

I have a fun Tommy Bahama resortware dress, rather open on top, that was a bit problematic to wear out in public.  I’d glue on a NuBra, and apply bronzer to try and fake cleavage out of my 34A-B bust.  Now, however, I can just wear it to good effect!

My Recent Surgery

Me, a few days after surgery

What Happened?

I am in recovery from a medically necessary set of surgical procedures intended to allow me to move onto the next chapter of my life, improve my safety, and make accepting me easier for others.

This does not come from a place of influence or vanity, but is to allow me to push into the next chapter of my life.

What Was Done?

I have undergone a series of medically necessary surgical procedures intended to remove inconsistencies between my gender and my facial appearance.  A series of surgeries were done to alter the appearance of my brow, eyes, nose, mouth, and jawline. 

There are differences in the shape of the skull between men and women.  Our brains contain a network that tries to guess the gender of persons we see from facial appearance as well as other cues.  In my case the facial appearance has been adjusted to read as my female gender.

How long will recovery be?

I should be back at full strength within a few months.  The facial swelling should largely subside by the end of the year, and all the tissues should have their final appearance in about a year.

Does it hurt?

Yes.  There’s a lot of tenderness, bruising, and swelling in the soft tissue of the face.

“You didn’t have to…”

Please, do not speak to me from your position of privilege about what I should or should not have done, or what I need to do in the future.  My experience of the world and what I have to do for my safety and survival is very different from yours.

I do not expect you to understand, only accept.

Before and one month after comparison 

Details!

The official punch list of surgeries to be performed on me doesn’t really match what was being done, so I’ll translate a bit.

Brow reduction and eye socket:

This was the Osterhout Type 3 forehead procedure, more or less.  An incision above my hairline and extending  to just above and behind the ears was made.  The forehead is drawn down, and the bone over the frontal sinus, or brow ridge, was removed and reshaped.  Additional bone on the orbit of eyes was removed.  When the forehead was reattached the eyebrow position was raised upward slightly, particularly on the right side to correct a droop.  

Blepharoplasty:

There are fine incisions on the eyelids used to raise the eyelid, producing a more open appearance, and to correct that droop on the right side.

Septorhinoplasty:

A septorhinoplasty was performed to improve the appearance of the nose as well as my breathing.  The nose appears to have a nice slope with a well-formed tip, or ‘break’, and is slightly upturned.

Lip Lift:

This looks like the traditional subnasal upper lift lip, placed with the rhinoplasty to produce a shorter upper lip, additional ‘plumping’, and a slight upturn to the tip of the nose.

Mandibular reduction:

A set of incisions are placed inside the mouth, on the gums, from which the surgeon is able to reduce the angle of the mandible, rounding the rear of the jawline, as well as reshape the ‘mental’ region forming the bone under my chin.