FFor many transgender and non-binary people, top surgery — the process of removing breast tissue to achieve a flatter or masculinized breast — is not an elective procedure. It is essential that they feel at home in their bodies.
Top surgery is a form of gender-affirming health care that can be used to treat dysphoria, the feeling of deep discomfort someone feels when their identity or appearance does not match the gender they were assigned at birth. It is also a complicated, intense, and invasive process that requires navigating a maze of insurance paperwork and can take years to heal. This means that the road to achieving your ‘dream chest’ can be a long, complex and fluid journey.
The number of gender confirmation surgeries rose sharply in the US between 2016 and 2019. Since then, more and more trans and non-binary people have publicly documented how their bodies — and their relationship to their bodies — have changed, even as anti-trans legislation has increased across the country.
“Everyone’s skin is different, and healing can look so different,” says Dulcinea Pitagora, psychotherapist and founder of the LGBTQ+-positive practice Manhattan Alternative.
Pitagora has worked with a number of clients who are afraid of their scars showing because they are “afraid that they will be ostracized, or that someone will hurt them because they are transgender.” That fear is exacerbated by the fact that Donald Trump, who has threatened to roll back LGBTQ+ rights, has won a second term. “We are seeing an increase in mental health symptoms caused by even hearing about (anti-trans) legislation in other states,” Pitagora said. “It creates more risks for clients, and it can impact whether a provider is willing to provide gender-affirming care.”
Despite the baggage that can come with a person’s scars, they can also become symbols of pride and resilience. The Guardian spoke to three trans and non-binary people in the US about their main operations.
Lazarus Letcher (she/them), 32, New Mexico
I had top surgery in January 2017, on Obama’s last day as president. I felt the need to get it done before Trump took over. It wasn’t common for non-binary people to get it, and I was probably the darkest person my surgeon had operated on. I couldn’t find many results online from people of color who had had top surgery.
I had to have a revision because I still had quite a bit of breast tissue under one of my nipples. It was done while I was awake, which was horrible. They put a towel over my face and I felt the surgeon cutting and pulling on my nipple. I ultimately fired him because he said sexually inappropriate things during that session. Fortunately, there are now great, competent top surgeons in my city who are showing other ways to support our community – like hiring trans people – besides just taking our money.
About two years after the surgery and a year after the revision, I got a huge chest tattoo of a moth. It felt like recovery because I didn’t want my scars to remain associated with the surgeon who harmed me and my community. This had been such a battleground all my life – first with breasts and my gender, and then with a horrible surgical experience. I still feel euphoria every time I pull a T-shirt over my head. It never gets old.
There’s something about losing your image that gives me pause. I’ve been part of a few trans photo series, and there always comes a point where they say, “take your shirt off,” and part of it almost feels like it’s the World’s Fair. There is a fetishization of transmasculine people.
If I ever get clocked for being transgender, it won’t be because of my scars, it will be because of my nipples. I was surprised that the melanin never returned to my nipples. That’s quite common among black guys because they have much pinker nipples after surgery. I used to be self-conscious about that, but now, whatever. My breasts are gone, that’s all I care about.
As a black trans person, I grew up “passing,” which means passing as white. As I met others in the trans community, I realized that there is a whole different conversation going on about passing, safety, and stealth (when a trans person chooses not to come out as trans). But I like that my custom nipples can radiate to those who know I’m trans.
Jenevieve Ting (she/them), 31, New York, New York
It was a years-long process of thinking about top surgery before I had it done in February. I kept thinking about life without my chest, like, “What will it feel like to ride in a car with the windows down and not have a shirt on? How will it feel to swim in the ocean without worrying about my chest?
On the car ride back from surgery, I cried. In the days leading up to the procedure, I developed a deeper, intense appreciation for my chest and felt sad about having to undergo this highly invasive procedure. I wish I didn’t live in a world that has these very binaristic standards about what kinds of bodies are male. It wasn’t regret, but I felt this all-encompassing sadness.
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At first I thought, “Does my chest match my dream pictures on my reference board?” Over time, I’ve experienced my scars less as a finish line, or a point where the journey ends, and more as a new texture of my transness.
I was afraid to apply oil every night and properly massage my scars. But my grip on it has loosened, and I’ve taken comfort in knowing that as I change, my scars will change. There are times when I’ve been shirtless in public and it’s felt like a commonality because it’s a way for queer people to identify me and vice versa.
I don’t think your chest will ever look the way you dreamed it would look. There are people on trans forums who find that after having top surgery they realize that their dysphoria has traveled to other parts of their body. As strange as it sounds, I never want to be completely satisfied with my appearance because my transness is an evolutionary project. I have found a lot of hope and curiosity in the fact that my body does not perfectly fit or conform to standards. I wonder, “How else can I decorate myself?”
Ezra Michel (he/him), 29, Los Angeles, California
When I was about 16, I didn’t come out as trans, but as a lesbian. I came across a YouTube video of a trans man talking about the scars from his major surgery. I was mesmerized watching this man who was born in a body like mine and who could now legally post a video of himself shirtless. Not the video play I trans. I was already so uncomfortable with my chest, and seeing that person take charge of their life and body—despite all the controversy and pain that top surgery could bring—gave me hope.
My best surgery in 2017 was a failure. I wanted that moment when I took off my bandages and looked in the mirror and had the big reveal – I’d seen that so many times online. Instead it was like a nightmare. My nipples were under my pectoral muscle on my ribcage. They were long and thin, with scars shooting up. I had never seen anything like it.
I ended up going to another surgeon for a revision. When he said, “We can fix this,” I felt like I could breathe for the first time in six months. It’s not that I missed my breasts; I haven’t regretted it at all. It just wasn’t how I wanted to look. I had to petition Medi-Cal to get the revision covered – which I eventually got after five appeals – because I had to argue that it met the criteria for dysphoria and that it wasn’t just a cosmetic procedure.
About two years after the second surgery, I thought it would be cool to tattoo my scars. As they started to fade, I realized I never wanted to pass as cis. Since I was 16, all the chests I admired were those of trans men who had had top surgery. None of my friends supported the tattoo idea. But after I did it, I started getting comments online: “This is such a powerful move.” There were other comments like “you’re a little too invested in your privilege,” meaning that if I had the privilege of fading scars and feeling safe, I would never want to give that up. I have compassion and empathy for that point of view, but I can’t imagine projecting that onto anyone else.
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Michelle Hyun Kim is a Brooklyn-based writer and editor whose articles on music and culture have been published by New York Magazine, GQ, W Magazine, Rolling Stone and other publications