Top surgery “show and tell” with my transgender son

By Katrin Grace
@katrinannegrace

My fifteen-year-old son hopes to undergo a double mastectomy next year. Though my husband and I have not agreed to it, we’re open to learning more about the procedure. We know how important it is for Max’s sense of well-being that his body match the person he is inside. To get a better sense of his options, my son and I are attending the Gender Odyssey International Conference for gender-nonconforming people.

Max yanks me by the arm and leads me into the “Chest Surgery Show and Tell” workshop. We find seats for the presentation. A plastic surgeon from San Francisco shows slides giving an overview of the “top surgeries” available—the Double Incision, Keyhole, Periareolar (donut), Inverted T, Fishmouth, Lollipop, and Buttonhole. You choose the surgery appropriate for the original size, shape, and elasticity of your breasts—so I learn.

Trans teens are always ahead of their parents in researching medical issues. Before they tell you what they want, they’ve spent months reading articles on the Internet. So, while I’m stunned by the discussion of incisions, liposuction, and how to drain excess blood and lymph during post-op care, Max chatters on, remarkably nonchalant. “See, Mom. It’s no big deal,” he says, though I know he has no concept of what it’s actually like to have an operation. 

Because his chest is nearly flat—a lucky thing in this case—Max already knows he’s a good candidate for Keyhole surgery. In this procedure, the doctor works though a very small incision along the bottom of the areola. The “keyhole” refers to the doctor’s view through a laparoscopic camera.

After the presentation, thirty or so volunteers who have undergone top surgery station themselves around the room. I draw a breath. Ready or not, they’re taking off their shirts. A group of bare-chested transgender men stand near a sign that says “Keyhole” and Max rushes over to them. I follow reluctantly, not sure I’m prepared for the close-up view.

Some of the younger trans men look like muscular superheroes in comic books. You’d never guess they started out as biological females. Onlookers ask them about their surgeons: which one did you choose, and why? How much did it cost? They talk about nipples, of big areolas made smaller. But my only question is: “Did any of you regret having the surgery?” Absolutely not, they say. One man worked two extra jobs to pay for it.

Max is most interested in their ages. Did any of them have the surgery as young as 16? The answer is no. It’s difficult for patients under 18 to receive insurance coverage for chest surgery. Sometimes an exception is made when multiple mental health professionals write letters on a patient’s behalf. Most psychologists now accept that being transgender is not a passing phase. As a result, they advocate that transgender youth be allowed to physically transition for their own psychological welfare. 

Max talks with a tan-bodied eighteen-year-old, a Pacific Islander, who wears an ivory fish-hook on a thick string. Just like the surfers we’ve seen in Hawaii. Two small horizontal bandages cover the area under his nipples; his surgery was just two weeks ago. His build is slight and yet his chest muscles appear strong and contoured.

 “That’s how I want to look,” Max tells me.

“Maybe he does a lot of push-ups,” I say.

“Yeah. It’s partly that. But T helps you develop larger chest muscles.”

“Oh.” Despite myself, I’m intrigued by the possibility of my son appearing even more masculine.

Max is referring to the fact that the man is on testosterone. Starting six months ago, Max began taking T as well. I agonized over that decision, even more than the others. Haircuts. Clothes. The legal name change from Margaret to Maxwell. The pituitary hormone blocker, which blocks Max’s estrogen, so he won’t have periods. Then the T. It was hard, at first, to hear his voice deepening. To see him grow hairier. I have to admit, if Max hadn’t been so utterly miserable at 13 and 14, overcoming clinical depression that often kept him home from school, I’m not sure I would have allowed him to transition. But with each new change, he gained peace of mind.

He’s passing as a boy now—as long as he binds his breasts.

Max and I circle the room. I cringe at the idea of my son having thick red scars laced across his chest. Not that Max is fazed by the possibility. “They’re like battle scars,” he says. 

Soon there’s the grand finale, when all the models stand at the front of the room in a chorus line. Young and old, slim and flabby, they introduce themselves and name their surgeons. Their chests in most cases look as natural as if they’d been born that way. The Pacific Islander wearing the ivory fishhook stands out as particularly handsome. “Don’t they look great?” Max says.

My mind wanders. I see Max as a boy on the beach, joyfully taking off his shirt just like the other boys. He’s relaxed, because no one would ever suspect he used to be a girl. In the ocean, he swims sleekly, breaking the surface of the water like a dolphin, without a splash. And I’m on the sand, watching him, taking pleasure in the warmth of the day. We’re just like any other mother and her son.

Katrin Grace, a writer and editor, is the mother of sixteen-year-old twins, one of whom is transgender. This essay is part of a book-in-progress.  

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