Having a top surgery in the midst of a pandemic

The Covid-19 pandemic has forced the temporary closure of all surgical centers for trans people. Here is the story of a person who had a mastectomy at GrS Montreal when the hospital reopened.

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Special collaboration: Alex Simon is an American-born and Montreal-based student interested in LGBTQ+ and trans realities. They themselves being non-binary, they proposed the idea to GrS Montreal of writing articles on their blog TransAvenue.

My journey to top surgery started out much like the journeys of many other transmasculine and non-binary people before me. One of the most exhilarating aspects of the entire process was yet one of the most simplistic: sending in my application to get the forms sent to my e-mail address. At the time, there were few people to whom I made mention of my future top surgery, so it felt a bit secretive. I had to juggle how I would share this life-changing information with my family and friends. Undergoing surgery is no small feat. However, I knew the moment I clicked “send” that I was going in the right direction.

The months following that e-mail confirmation, I went through the typical, somewhat bureaucratic steps towards getting referral letters and medical approval to get my surgery. The forms were signed by my family doctor, and I went through the therapy sessions to get a referral letter. Both of these steps were costly, but I figured in the scheme of things, at least the mastectomy itself would be covered by the government. I knew deep down that this procedure was what I needed, yet all of the questioning from the medical practitioners on my motives undoubtedly made me re-evaluate the relationship I had with my body and my gender identity. Having the main criteria of eligibility for top surgery consist of whether or not I was far enough away from femininity and close enough to masculinity made me acknowledge (in the first of many instances) how non-binary individuals can face challenges when accessing healthcare. During the final appointment for my referral letter, my psychologist had to pull out the DSM-V to verify that I filled enough of the criteria to get the letter, and I barely skimmed by. It was absolutely nerve-wracking. The fate of my gender affirmation procedure rested in the pages of a pathology manual and its interpretation.

Once the letters were acquired and the forms were sent late summer, it took about two months for my file to be processed and created at the clinic. I was then given a pre-operative consultation date at the beginning of 2020. I spent the following weeks imagining conversations with my surgeon and reading as much information as I could to prepare myself adequately. When I was not studying for my final exams, I was reading articles and watching videos from clinics and Youtubers alike. I also took the time to inform my family members and friends one by one about my future procedure. While most were accepting of the idea, most also needed more information to educate themselves. For many of them, I was the first person in their entourage to undergo gender affirmation surgery.

In January, I had my pre-operative consultation at the clinic. While rather short and straight to the point, I was relieved to be one step closer to my dream of a flat chest. The next step was for my procedure to be approved by the Quebec government. Although I had little reason for concern, I was worried that with my luck, I would somehow get turned down and would have to finance my surgery out of pocket. Luckily, that was not the case: I got my approval in February and at the beginning of March I received a surgery date for the summer. I danced outside of my workplace and cried tears of joy.

Then COVID-19 struck. I was able to meet my surgeon a day before the clinic was to close. The weeks to follow were full of uncertainty. I had numerous friends have their respective surgeries cancelled and postponed to some unknown later date. Each week was spent waiting for the press release to know how long the clinic would be closed and when surgeries could resume. Finally, in June, the clinic reopened and gradually restarted performing mastectomies.

I count myself lucky. My date was not postponed like many others. That provided me the stability I needed to get into a healthier mindset before surgery. That excessive reading and video-watching came in handy when making a list of items I needed, and I went shopping for everything from bandages to button-down shirts and slip-on shoes.

The days and hours leading up to my surgery, my nerves were overpowered by my excitement and enthusiasm. More than a year of navigating the system and more than three years since I started thinking of top surgery had gone by. Soon the chest I had known for over a decade would soon be replaced by two lines under my pecs. It was surreal and made me giddy.

The morning of surgery, I woke up at 4:30 for 6 a.m. admission. My happiness made me less concerned about what was to come. Even though I was to follow strict health protocols and have no visitors accompany me, I felt surprisingly calm despite my anxious nature. I gave a last hug to my mom at the front door and walked into the clinic with my head held high.

That morning went by so incredibly quickly. I went from the front desk to the care unit to admissions in a blink of an eye. Soon I found myself getting ready to lay down on the operating table. The last thing I remember before going under was peacefully smiling.

I woke up, or should I say I was able to somewhat open my eyes. Time stood still while I was recollecting what was going on and what happened. I was rolled into my bedroom and shifted over to the main bed. When the nurses were gone, I smiled in ecstasy. I was overcome by so many emotions simultaneously. My chest was wrapped Christmas-style in numerous layers of bandages, but I knew under all of that I was flat. Once I was able to think straight and keep my eyes open, I texted my mom and friends the very first picture of me post-op: with a grin of contentment. Soon a second person was wheeled into the room, and while we had a curtain separating us, we were able to speak of our shared sense of relief and satisfaction.

Before long, I was able to put my clothes on and slowly walk out of the care unit. Two days later, my Penrose drains were removed (much to my relief), followed by the removal of the gauze three days after that. It was the first time I got to see my chest post-op. I did not even wait for my mom to come home to remove the bandages, I was way too enthusiastic to wait a moment more. My jaw hurt from smiling so much. I had to pat my torso gently to remind myself that the image I saw in the mirror was me. I made it. I got my double incision mastectomy with no nipple grafts. After so many instances of questionable mental health in which top surgery was the only thing that got me up and moving each day, I finally did it. I survived my bad days and now I get the chance to thrive as my authentic self.

Alex Simon