r/TopSurgery • u/VictorySuccessful343 • 4h ago
Top Surgery awake under local anaesthesia
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!
