Sydney Dolan

Several years back, I wrote about my thoughts on gender, and where I felt my gender was. To this day, it remains one of the most viewed posts on my website. When I wrote that post, I was still coming to terms with the idea that I could take a formal medical step towards gender affirmation, how my life would change, and what it could mean for how people would treat me.

Privately for many months, I extensively researched top surgery; a gender affirming surgery to remove one’s breasts. I poured over other’s surgical results, learning about the different techniques for top surgery and the doctors that the community thought delivered the best results. Through my research, I came to learn that it would be possible to get top surgery that would leave no visible scars, known as peri-areolar surgery. And in a stroke of luck, I found that one of the preeminent doctors doing this class of top surgery actually practiced in Boston.

After months of deliberation, I finally made a top surgery consultation appointment in February 2023. It felt like a big step to finally go speak with a doctor about this, I had shared this desire of mine with no one, it was too vulnerable and precious to face the callous real-world reactions from others. As I entered the clinic, I saw a can of yellow redbull on the doctor’s desk, felt a shared kinship over our preferred energy drinks, and already began to get the subtle sway of confidence that the rest of my flat chested life was so close. The consultation was very professional and quick. Confidently and promptly the doctor told me that the class of surgery that I wanted would not be possible due to the size of my chest. I was devastated. As I soullessly stumbled out of the clinic, the secretary asked me if I wanted to schedule the surgery. I mumbled I would call them later to be polite, but that was a lie. The thought that I couldn’t get that surgery was painful. I had finally gotten to this point where I recognized that top surgery was something that I wanted, but I had only imagined myself with a normal chest, just like my brother, or my friends, or really any man I had seen ever. But that possibility was crushed.

When I had imagined my body with top surgery, what I was imagining was a cisgender man’s body. I wanted to enter manhood quietly, as if this was the way my body always was, with no one to know my past transgressions. Looking back on my feelings at this time, I was devastated over the idea of being visibly trans, of being different, of having a different body than most people. I know it seems crazy to be so zeroed in on this notion of a normal body while fundamentally pursuing a significant plastic surgery alteration but that was how I felt.

When people talk about gender affirming surgery, a lot of the narrative is around returning to one’s “true” body, or crafting a body that you always would have had if medicine was better. But at its core gender affirming surgery, or at the very least FTM top surgery, is a classification of plastic surgery. And the goal of plastic surgery is to look better, to become more desirable, to right the wrongs that nature handed you. And at the time, I felt like if I couldn’t have peri-areolar surgery, then I was doing a disservice to the world, because I had nice boobs. My boobs had never caused me back pain, they were symmetric, and they were reasonably sized. My boobs were the type of chest that I saw people request breast augmentations to replicate, and here I was, wanting to throwing that all away. I felt a lot of guilt over whether I had the right to alter my body from something that most people would love, to something people found repulsive. I wondered if it was worth it to pursue a such a selfish change that could make me so undesirable. I wondered if I had become vain to focus so much on aesthetics in the first place. I wondered if I really needed to change things at all, or if this desire was just a hyper-fixation in the larger dilapidated shack that was my body image.

And so I did nothing for months. I mourned the chest I’d never have. Summer came, and as I dealt with the oppressive sticky sweat from my binder, I found myself still wishing for a flatter chest. In my day to day life, people only read me as a woman, and that label grew to be more uncomfortable. Although my desire to have top surgery increased, graduate school kept me busy, and I felt too overwhelmed with work to really pursue the daunting task of finding a doctor, getting insurance approvals and taking time away from work for surgery.

When I met with my primary care doctor in October, I brought up to her that I was thinking about top surgery, but felt overwhelmed by the paperwork side of things and thus unable to really pursue the matter further. She assuaged my concerns, saying that she’d handle everything. In just a week, she knocked out all the necessary paperwork and I went for a top surgery consultation with a different doctor in November. When he once again confirmed that I would need double incision top surgery, I no longer felt devastated. I had finally gotten to a place where my desire to have top surgery outweighed my concerns about desirability. At the end of the consultation, I scheduled the surgery.

The time between consultation and surgery felt like eons. Telling close friends I was going to get surgery felt both relieving and intimidating. I felt like I couldn’t go back on my word now that I had articulated these thoughts out loud. I both liked the subtle social pressure to see things through and also feared that I was making the wrong decision but too proud to change.

On February 22, 2024, I went to Beth Israel Deaconess Hospital in Boston Massachusetts and got a bilateral double mastectomy with chest reconstruction . My medical sheet says they removed over 500 grams of breast tissue. When I woke up from anesthesia in the operating room, I looked down, and I felt an incredible sense of relief. I texted all my friends that I survived. I joked with my partner about being topless in the middle of the recovery area. The attending nurse in the surgery area was very nice, but only used she/her pronouns on me the whole time. I found it hilarious. To finally be at this pivotal moment where I went through with this huge step in my self-actualization and seeing through the daunting fears of surgery and still be referred to as a woman. In the process of thinking about top surgery, I had mentally built it up to be this monumental change that would permanently alter and impact everyone around me. But as the nurse, with a clear sightline to my new nipples, continued to refer to me as ma’am, I felt a huge sense of relief that my body really didn’t matter to others in any tangible way at all. I hadn’t committed this grave sin of depriving the world of my pre-surgery chest. The state of my body wasn’t a tax to exist in the world.

In many ways, my life has changed a lot since top surgery and it has also not changed at all. Now my gender confuses a good chunk of people. Unlike before, there is now the possibility that strangers will read me as a man or as nonbinary. Bathrooms have gotten more complicated, and I appear to scare most women when they see me upon entry. The people that knew me before surgery changed nothing. I get gendered the way I always was before. But I feel so different about myself and my body. Granted, I expected to feel better, otherwise I wouldn’t have gotten the surgery in the first place. But I never realized how much better I could feel through a change like this. I actually like the way my body looks in a mirror. It wasn’t that I was ever acutely miserable from the way my chest was before, but I also never realize the ways I was never really happy.

I still feel rather uncertain about what I would call my gender. But regardless of that, top surgery has been a gift to me, and I feel so grateful. It’s been 2 years from the first post and I can still say I am probably in that state of gender confusion and ambiguity. But getting top surgery was such a great choice that it feels like these labels don’t really matter at the moment anymore. I am me. I am my body, and for the first time in a very long time I actually like the body I have.