Wednesday, March 15, 2006

and round I go, in a spin

My head has been spinning this week with plans for chest surgery and T. Group last night was good because it allowed me to have my head fill up with something else for a little while, to get my mind off of making this big decision. I really feel like I'm going a little bit crazy, trying to do tons of research, and figure out what's right for me, and I'm feeling the pressure of time coming down on me. I want very badly to have this surgery done this summer, and what with 3+ month scheduling buffers for both the surgeons I'm considering, I feel like I need to make my decision soon (the next week or so) in order to have the proper time frame come together.

I've been spilling to everyone who will listen, and people have been kindly obliging me- my friends because they like me, my family because they love me, my coworkers because they have to spend 7 hours a day with me, and my therapist because it's her job- and now I'm going to take advantage of one last captive audience/space and try to write everything down here. Maybe if I get it all out in words, it'll get clearer, right?

Basically, I'm trying to decide between going to Dr. Brownstein in San Francisco for a double incision mastectomy with nipple grafts, or Dr. Fischer in Maryland for a periareaolar procedure.

There are, clearly, pros and cons for each procedure, and while the natural optimist in me (echoed by my well-meaning, encouraging friends) has been saying that it's going to turn out well no matter what, I'm terrified of making the 'wrong' decision. I'm not sure what I even mean by the wrong decision- I suppose that I'm concerned I'll choose one procedure and then be less than pleased with my results and wish I'd gone with the other one.

I feel like Dr. B is more of a sure thing. I have a better idea of what to expect with him, because of the numerous pictures I've seen, and also because of how standard the procedure is- it's not like the peri technique, where so much depends on your individual chest size, and skin elasticity, etc. So a more definite probability of a good result...but then the risk of a bad result is scarier, because a bad result would basically be if my nipple grafts didn't take and my nipples fell off. Which sounds funny, admitedly, but is not a pleasant prospect.

My mother, in wonderful parental fashion, pointed out that the peri option seems less invasive, and "minimally invasive is good!" Which is true- it'd be nice not to have two large incisions made in my chest.

On the other hand, scarring (which is a major factor in most guys' decisions about peri vs. double incision) is not much of an issue for me. I've seen how the scars tend to fade and almost disappear with time. I'm also pretty confident that I'm going to (someday) have enough chest hair to render them further invisible...I come from a pretty hairy family. Last but probably not least, there's also the fact that those double scars are in some ways a transman badage- a visible reminder of my trans identity and experience- and so I would welcome them in some small way.

When I try to make a decision, one against the other, I've been playing a little game where I pretend that I can know for certain that I would get a Really Good Result from either procedure, and if I could be guaranteed that, which would I choose?

I think I'd have to go with peri, because of the nipple factor. I'd very much like to retain as much nipple sensation/function as possible. My nipples are the one thing that I actually like about my chest right now, and I'm going to have them forever, and it'd be a very good thing if they continued to be fully functional.

That's one of the pieces of information I'm continuing to try to gather, because I think it actually is the tipping point for me- what kind of nipple sensation will I get to keep? I'm waiting to hear back from Dr. Fischer's office on their official statement, though I imagine as a sensible doctor she won't promise me anything. I just asked for her to tell me what's been most common in her patients' experience, though, so hopefully she can give me a good idea.

Another piece of information I'm waiting to hear back from is her opinion about starting T before surgery or not. I've heard that for peri surgery, it's best not to be on T, because skin with more estrogen in it is more elastic, and thus shrinks/heals better. On the other hand, being on T also causes one's breasts to get smaller, which could theoretically possibly reduce me from borderline (B ish) to pretty good (A ish/smallish B). But there's no guarantee of that. It has been making me a little crazy trying to think about whether I'll need to hold off on T, because I'm scheduled to have my first shot in less than two weeks (!!) and the prospect of postponing it is not the most welcome. On the other hand, all this focus on my surgery hasn't really given me time to freak out about impending first day of T, so maybe I'll write more about that soon.

Anyway, the other part of the game is imagining what would be a Less Than Stellar Result for each procedure- what that would be like, and how I would deal with it. As I mentioned, the bad result for double incision seems much scarier (nipples falling off) and more permanent than for peri. Dr. Fischer mentioned possible excess skin leading to puckering around the incision and/or loose skin on my chest as being the primary possible downside. That would possibly need a revision, or could possibly be ameliorated somewhat through working out and subsequent pectoral development.

While a revision would be somewhat costly ($1850 is the quoted price) it wouldn't be the end of the world. Though I definitely would rather have this over and done with in one shot, which seems more likely with Dr. Brownstein, as his revisions generally are necessary for dogears, which seem like they occur more frequently in guys who are larger than I am.

So there's also some minimal price/convenience factors to think about. Dr. Fischer is about $800 cheaper than Dr. B, and it would be easier for me to get to Maryland than San Francisco, though harder for my mom + sister to come take care of me. There's also the possibility that I could return to NY sooner and recover more in my own home, with people (family/friends) around to take care of me- Dr. Fischer mentioned something about being able to have the drains removed by a doctor at home, so I wouldn't need to stay in a hotel the whole time.

But really, price and convenience are not what I'm focusing on to make this decision. I'm trying to think about how I'm going to end up with the chest that makes me happiest- flat, masculine, functional, and mine.

Right now, I'm leaning towards Dr. Fischer. The nipples are a pivotal factor, and when I try to imagine what a non optimal result would look like, it doesn't look too bad. My therapist asked me why I couldn't be sure/optimistic that Dr. Fischer's technique would give me a good result that way that I seem to be sure of Dr. B. And after all, before I knew that I was eligible for the peri, I was thrilled and excited about the prospect of double incision. I guess I'm not sure because of the fact of being 'borderline' in size, and all the vagueness that carries with it. And I'm scared to let myself be too optimistic, because it's easy to look at before/after pictures on the internet and think "Hey, I'm about the same size as that guy, and his chest looks really good, so therefore mine will too, right?"

I wish I had some guarantee of making the 'right' decision. I think I'd be happier with Dr. Fischer, but I'm more worried about it not coming out well, whereas, I'd probably be pretty happy with Dr. B, but the chances of really good things (like nipple sensation) are low to nonexistant, while the chances of really bad things (like nipples falling off) are low but really scary. It's the old connundrum of cost-benefit analysis- go with the 'safer' more foreseeable choice, or the slightly more uncertain choice with a chance to make me quite a bit happier?

Man, where's my Magic 8 Ball when I need it?

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