Feelings About Top Surgery Plans

So Fergus and I are planning on having a second kid sometime in the next year or so, after I’ve started and gotten a chunk of the way through HRT-aided transition. Binding is workable now (though I sometimes do it to an unhealthy degree), but my understanding from reading stuff from transmen who got pregnant after social transitioning was that binding was difficult or impossible while pregnant or breastfeeding because of tenderness, size, engorgement, etc. I am pretty sure I can handle the pregnancy bit, even with the potential for awkward conversations, but not binding for pregnancy plus 6-12 months of breastfeeding sounds… very very unappealing.

I know that some form of top surgery as soon as I can manage with insurance requirements should help (I have almost a year of real life experience already, based on when I started going masculine part time, and regardless of binding or not, my chest gives me back problems). I keep going back and forth about degree, though. The plan that fits in better with balancing my overall goals is seeing about a reduction that leaves the parts needed for breastfeeding intact (glands, leave nipples as they are, etc), with a full top surgery later on. The plus sides to that idea include: better health for kidlet #2, potentially easier time getting insurance to pay for reduction as a non-trans issue over full top surgery as a trans issue, and smaller chest than my current size during pregnancy. The cons list is longer: two top surgeries instead of one (surgery has inherent risks, insurance might have issues with covering a second top surgery), living with breasts for longer, dealing with social consequences of breastfeeding while ftm, unable to be flat during time between reduction and removal. There’s also the risk with that plan of not even being able to breastfeed the baby, which would take away a good chunk of the reason to do the plan that way.

One of the parts I keep getting stuck on is: what if the baby needs to eat while out and about? That was no problem when I was an awkward trying-to-be-a-woman person; I just did it and covered or left the room as the situation dictated. But the thought of every feeding being a chance for stares and potential need to come out as a very uncommon category makes me really uncomfortable. I’m fine with the idea of breastfeeding itself, and in private, I imagine that it wouldn’t be a problem (I might be wrong, because when I breastfed kidlet #1, I was still assuming I was a cis woman). But I keep picturing myself as a passing man in a public space breastfeeding a baby… it’s bizarre and uncomfortable and dysphoria-inducing. Perhaps breastfeeding would be a private thing, and formula or pumped milk would be the solution for being out and about?

Some un-paragraphed thoughts about breastfeeding and top surgery that I’ve been having tonight:

  • Breastfeeding is certainly better for a baby’s health.
  • Or is it? Some sources suggest that the benefits that breastfeeding research have discovered are partially confounded by socioeconomic status.
  • Having full top surgery means committing to a year of formula, which would get expensive.
  • How bad does back pain or involuntary slouching have to be to get insurance to cover a reduction? Can trans-related coverage be used for a reduction (ie, can a reduction count as top surgery assuming that the insurance covers trans top surgery).
  • Doing top surgery before pregnancy instead of reduction means changing the plan yet again on Fergus. What if I change the plan right out of pregnancy?
  • How much of a reduction is possible while still maintaining ability to breastfeed? Is going down from DDD to A/B possible for that?

Thankfully I have an appointment with my gender therapist to talk about my transness generally and future top surgery more specifically (my understanding from the intake appointment was that they expected that I was going to them for a referral letter). That’ll be a good time and context to talk through this particular issue of reduction/top surgery and timing, at least on the emotional bit.



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