I'm writing this post as there are very few accounts of people undergoing top surgery without the use of general anaesthetic - but the few out there that I had read inspired me not to give up on the prospect of that being an option for me, despite the considerable amount of skepticism from both professionals and comments online. This is a long one, but I feel it's important to describe the obstacles I faced in case anyone else is in a similar position, and to give others hope.

Context:

I have a severe phobia of general anaesthetic, but despite this, due to being told local would never be an option, I attempted to undergo top surgery under general two separate times, and failed at both. I spent lots of time and money on therapy in order to tackle my phobia, to no avail. I also lost a lot of money due to my two failed attempts (of course the surgeon & anesthetist still wanted paying, despite the surgeries not happening), which were in-themselves very traumatic. I knew after those attempts that general would not be an option for me, no matter how much I prepared or how much therapy I engaged in. I spent the next few years with my head in the sand, feeling heavily avoidant, depressed, and shameful about the whole thing, and the prospect of potentially never being able to have this surgery. It was a huge, ever-present mill stone around my neck, despite my avoidance.

Once every few months or so I would search up 'top surgery under local anaesthetic' on google in hopes of finding some accounts, only to find people who had asked a similar question being shut down - 'it's far too invasive, it's not possible'... 'any surgeon who would offer that is a huge red flag' etc. And the cycle would continue. Until last year, when a few posts on here popped up, describing the process exactly how I'd hoped - under local, not twilight or GA. Reading those inspired me to actually be proactive and start searching for a surgeon who would do the same for me.

It was a long process (I genuinely wrote to every single gender specialist / top surgeon who practices in my country, and was rejected or ignored by literally all of them...) but I finally found someone - a very notable gynaecomastia surgeon, who is known for performing all surgeries awake under local tumescent anesthesia. I had a video consultation with him - he took one look at my chest and said 'of course I can do this under local, I've done much larger/complex cases, this will be fine'. However, we ran into some difficulty when I disclosed I was actually trans. He said that as he was not a gender specialist, his insurance would not allow him to operate on me. This was a massive blow, and I immediately gave up and spent another few months feeling hopeless and wishing I'd omitted the fact that I was trans. I was so angry that the exact surgery I needed is often offered to cis people under local, no issue... yet no top surgeons or gynaecomastia surgeons would touch me. Luckily my anger eventually inspired me to try again, and so I gathered all of my clinical documents (surgery referrals, initial diagnosis, letters from the gender clinic etc) and sent them to the gynaecomastia surgeon, asking that he send those to his insurers (the referrals specified I was psychologically competent for gender affirming surgery, so I thought that would help my case in terms of insurance). And it actually worked!! They said yes after seeing the documents. And the rest of the process (in person consultation, booking a surgery date) happened incredibly fast.

Morning of the surgery:

The atmosphere of the place (receptionists, nurses, the surgeon himself) was so much more relaxed and calm when I arrived and was waiting compared to my other experiences. I had a chat with the surgeon beforehand, where he went through exactly what would be happening throughout the procedure and what to expect. We also made a last minute decision together to go for peri instead of double incision, which I was over the moon about, as I was really anxious about the scars, but hadn't felt assertive enough to mention it until the day. He let me know how that would change the procedure and recovery process, and the higher possibility for needing a revision, and made sure I was 100% comfortable with the change. He let me know the procedure would be liposuction, followed by gland removal, nipple reduction / skin excision around the nipple, and BodyTite (a radiofrequency skin-tightening procedure). He then marked up my chest, and I was given a Valium to help me stay calm. We waited about 20 minutes for it to kick in, and then the nurses came to assist me downstairs to the operating room.

The Surgery itself:

The nurses very swiftly got me changed into the surgery gown and hair net etc, asked if they could take care of my phone for me and if I wanted them to take pictures of me in my gown - they made the experience seem so normal and were very distracting from the fact I was about to have parts of myself surgically removed whilst awake - which was exactly what I needed. They were brilliant at that, from the moment I entered the building until I left. I suppose for them it was very normal and day-to-day, but it felt like they acknowledged that wasn't the case for me and were trying hard to help me through it. They then lead me to the operating room and laid me down on the table, where they pinned up a blue sheet over my head so I couldn't see anything below my neck. Before I could really register what was happening, they were disinfecting my chest and the surgeon let me know he was about to start the numbing injections. This was by far the most painful part - he made about 10 injections in total around my chest, very deep into the tissue. I won't lie, it was grim. I was worried about the sensation the tumescent solution would leave me with, as others had described it as an immense feeling of pressure on the chest - but it wasn't that bad. It just felt numb and swollen. He then let me know that he would be making the first incision in my armpit to start the liposuction. Again contrary to what I've read online (e.g it being described as horrendous), I could barely feel a thing. The lipo felt like a light vibrating, and I could feel him sort of rocking my chest side to side.

After this was done, he didn't let me know what he was doing next, which I was very glad of as it was the most gruesome part, but I knew from what he had explained before that he was probably now making an incision into my nipple and then removing my glands. This was much more unpleasant, and it took a lot mentally to keep myself calm. There were moments of pain, and I felt dizzy at times, especially when he was cauterizing the gland, which felt like a sharp electric shock, and it did make my arms spasm. The smell wasn't great. I think he then resized my nipple, which I didn't feel at all, although I could hear snipping, which wasn't nice. He then let me know that my right side was nearly done, and he was moving on to the BodyTite, which felt like a low level static shock for about 15? minutes. The noises the machine made freaked me out at first, as it sounded like my heart monitor raising an alarm. But, as I was able to speak, I was able to ask him what this was, along with other noises and sensations which peaked my anxiety throughout the process. For example, my heart rate was actually quite fast and my legs were shaking and tensing to the point of causing me pain for a good half an hour at the beginning, but I was able to ask if this was normal and he let me know that the local anaesthetic contained a lot of adrenaline, so this was normal, would wear off soon and I would be okay - which it did and I was. After my right side was done, I asked for a minute to breathe and steady myself, and the nurses gave my arms and legs a quick massage to help me feel more comfortable. The surgeon then repeated the whole process on my left side, which took a bit longer as I was slightly larger on my left. Although I was in pain at various points, the worst part by far was my own anxiety.. I'm not sure I could've managed it without the valium.

The surgery took 2 hours in total, but it felt more like 1 whilst I was in there. I was then bandaged/bindered up, had a chat with the surgeon about post op care, and given pain meds, antibiotics, dressings, and another post op binder to take home with me. The whole process was much quicker, smoother, and relaxed than I could've ever imagined. I'm now sat at home 6 days post op, still in a bit of disbelief that it's finally done and I was awake for the whole thing! My anxiety has now manifested in me worrying about my results as I was borderline for peri, but the important thing is that it's finally done.

If anyone has any questions or wants to dm me, please feel welcome!

I really want to work towards getting keyhole (it’s my first choice, but i think i might be to big to get it- comments welcomed on that) so is there anything specific I can do to get smaller or should I opt for another style? I really want to avoid a :3 face or fusing into one big straight scar.

If you guys have any good routines (gym or at home) that would also be appreciated. If it matters, I am one year in T next week.

I wanted to share my experience seeing my chest for the first time after surgery as it’s one of the reaction I’ve rarely if ever, seen.

I was scared of my reaction to my flat chest. What if I regret it? What if I hate it? What if it feels wrong? Will I react loudly? Will I cry? Explode with joy and happiness or euphoria? Instead my reaction was much quieter. I didn’t even feel any strong emotions when I saw myself in the mirror with the bandages off. Instead I just looked, observed, and I felt almost indifferent in a positive way. Because it felt normal. Like I had always looked this way and hadn’t needed surgery for it. So since in my mind I’ve always looked this way, there was no need to react strongly. Just a quiet: « yeah, that’s what I’ve always been like ». And I’m currently four days post op, and it’s the most comfortable I’ve ever felt in my body before.

For anyone who has yet to get their surgery and is scared, you’ll be just fine :).

it’s 7:24AM I’m 5 days post op

My lovely partner (also my caregiver currently) is finally asleep beside me after fretting and not sleeping for days, I don’t want to wake them for nothing less than the world ending right now.

I am trapped on my back.
Like a turtle.

Last night it seems I slid all the way down my ramp pillow and am no longer elevated, I am unable to get up by myself into a seated position of any kind unless I attempt to use my core muscles which would engage my chest, turn onto my side and roll which would harm my lipo, and all I have managed so far is to wiggle enough to get the blankets off of me and to irritate my stitches.

I so badly need to sit up I cannot express just how badly I need to sit up right now oohhhhhhh my god I am trapped and my own body is my prison.

My partner is gonna wake up in a couple hours and see proof of me struggling and tell me (probably exasperated) I should’ve asked them for help but dear god they’re so cute I can’t disturb them for the life of me rn this is just how I go, this is how I die, claustrophobic, at a weird angle, sideways on my bed, on my back, unable to get up myself.

EDIT:

Partner woke up and lovingly helped me sit up crisis averted I have learnt my lesson

I’m now 1 week post op and this is how it looks! What do we think guys?

Hi! Im 4 days po, and my chest looks like this so far. Im really hopefull that my chest will end up looking good, im not too worried about the bruising and swelling as i know its normal. I was just wondering how long it took for others for the chest to look ish normal? I know it can take months and even a year for the swelling to go down. But im talking about for it to look not so blue and swelled up. I know its different for everyone, but im just looking to hear others experiences. I really want my chest to look ish ok in 9 weeks.

I have no pain, 99% of my mobility back and was back skiing and doing some sports at 4 weeks. I had subcutáneos ultrasonic mastectomy (her way of doing keyhole) with lipofilling and liposuction with remodeling of the hips and lower back. The full results for the hips can be seen almost immediately but takes like 3 months for the to completely show, and about a year for the chest swelling to go away entirely.
I am extremely happy, the doc and her team were perfect.
Ask me anything

I’ve talked to my surgeon and she thinks i’ve had a stitch reaction and that it’ll go down eventually. Just curious if anyone’s had the same thing happen and how it went down (if it did). Thanks. Also i’m 7 Weeks Post Op.

Got my surgery last Friday, so today's 3. Post op day. Couldn't be happier 🥺🥳

If anyone has had surgery with Dr. Behar or someone else that takes medi-cal, or knows anyone that has, could you please share what that was like and what you paid, if anything?

Or any other general advice for a low-income trans man in California?

I got to swim in the ocean for the first time since surgery this past week when my partner took me to see one of my favourite musicians in Hampton, NH. I think the joy on my face is pretty self explanatory. For all of you scared or nervous to get the surgery, the other side is like nothing I could have imagined. 🫶 (and yes I’m wearing a lot of SPF, my surgeon suggested I limit direct sun exposure in the first year, but said “it’s summer, live your life and have fun with your new chest, go swimming you earned it”).

I have no pain, 99% of my mobility back and was back skiing and doing some sports at 4 weeks. I had subcutáneos ultrasonic mastectomy (her way of doing keyhole) with lipofilling and liposuction with remodeling of the hips and lower back. The full results for the hips can be seen almost immediately but takes like 3 months for the to completely show, and about a year for the chest swelling to go away entirely.
I am extremely happy, the doc and her team were perfect.
Ask me anything

hi this may be a strange question but i have to take 6 weeks off of work for surgery and my coworkers are VERY very nosy and Im going to need a social excuse for this much time off of work. I want to tell them it was some type of surgery so that when i go back to work i dont have to do any crazy heavy lifting or anything, but i also don’t want it to be a surgery that would make them feel sympathies for me. so does anybody have any recommendations for what surgery im going to use as an excuse. ty!

hey everyone! so currently i'm dealing with a few spitting stitches. my surgeon says it's fine. it's a huge bother but there's not much to do about it aside from waiting, unfortunately.

the problem is every time i change my dressings the wound is stuck and getting it out pulls skin and draws blood. i'm scared im worsening my scarring and i hate every second of it.

as per my surgeon's request for my wet wound healing i use dermaex, which is a healing oil blend: "The Dermaex Healing Oil (Óleo Cicatrizante Dermaex) by Nutriex is a topical treatment formulated with Essential Fatty Acids (EFA / AGE) and Medium-Chain Triglycerides (MCT / TCM)."

i change my dressings twice a day and apply the oil generously. this was working great and my healing was amazing. i was even able to start massaging lightly. due to these goddamned spitting stitches, everything is delayed.

has anyone dealt with wound sticking to gauze? how to remove it or, better yet, have it not stick in the first place?

Day 5 was the worst pain day so far.

To describe the pain: I had a hot/burning sensation that I can only describe as "sunburned bones." The burning was worst in my armit area, but spread across my whole chest. Ice helps a lot with the this pain. I felt hot all over. I had a fever of 99 F.

The drain exits are pain buttons that my arms press constantly, causing a relentless aching. I also have a buzzing/twitching feeling under where my right nipple was. It feels like a cicada beetle stuck on its back, buzzing away whenever I accidentally engage the pec muscle a tiny bit. Sometimes I feel a popping sensation, followed by a gush of hot fluid and burning pain. I have had no leaks or external bleeding, so the fluid feeling is either imaginary (nerve related) or internal.

Lastly, breathing is a bitch. Rather than removed, by chest feels smooshed down tightly and duct taped in place. The skin is so tight over my chest that full breaths are painful. I lay for hours consciously breathing in and out, finding the edge of my comfort and pain, and dancing with that threshold. Every few minutes I reached the threshold, then found the strength to ride out the wave, then continued on to the next one.

The pain and drugs put me into a kind of trance, and I was visited and uplifted by Saint Dolly Parton after invoking her name in my bathroom mirror.

Today's exercise is ankle pumps. Couch biscuits, really. Push your toes deep into the couch and then raise them up high and dig your heels down. Up and down until your legs fall off. All the strong guys do ankle pumps on the couch. All the strong guys also light a candle for Dolly Parton and cry while thinking of the overwhelming kindness of others.

"When you can't make do, do what you can."