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Explore what others have to say about TranssexualMale Breast Surgery (gynecomastia) using Recontouring Surgery and Liposuction (Suction Lipectomy) with answers by Dr. Michael Bermant, MD.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

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This is the page where you can review questions and stories from patients, view the opinions of lay persons, and see answers from Dr. Bermant and other physicians. Do you want to ask a question, post an answer, or make a comment? Information E-mailed to me will be considered for posting.

  • Why did you choose to have the surgery?
  • How did you choose your doctor?
  • How much did it cost?
  • Was the final cost the same as what you were told before the surgery?
  • How was the recovery?
  • Were there any complications? How were they resolved?
  • How do you feel about the results?
  • Did it have any effect on your life
    • emotionally
    • socially
    • sexually
    • professionally
  • How did others react to your surgery?
  • Did you learn any lessons?
  • What would you advise others?

Information posted in this section does not necessarily reflect the opinion of Dr. Bermant.

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Transgender Male Chest Contouring Travel from Washington State - 2 Months After Top Revision Gynecomastia Surgery


Dr. B asked me to write about my experiences with gynecomastia surgery. This account is more about some of my mental process rather than anything procedural having to do with the surgery itself.

It should be said that for much of my 20's I was actively "transgendered". By transgendered ("TG") I mean behavior usually associated with the desire to change one's physical sex and/or social gender, driven by an internal sense that that should happen, for whatever reason. It's usually spoken of as an expression of one's identity, but this is a deceptively simple interpretation which hides many complicated aspects of the phenomenon, especially for people, (such as in my case; I will extrapolate my experience to "other people" since I'm sure I'm not the only one) for whom such things are fluid, changing, or related to many other factors such as environment, stress, big-picture thinking, etc. I concede that for many TG people, the inner identity which for them drives the process is fully real. In my case the sense that identity was involved took a long time to manifest, and eventually fell away, displaced more formally by other factors. Part of the complication was the incessant insistence by the entire TG "community" (such as it is) that it is either a) identity or b) sexual gratification that drives the TG process. Read enough TG writings, opinions, blogs, and hang around the water cooler enough, and you'll learn that (apparently) option a) is desirable to have; option b) is for perverts, autogynephiles, fetishistic transvestites, etc. Therefore any attempts to explain whatcha got gets biased and shoehorned into the a) explanation, regardless of how hard you have to convolve your thinking to get there.

In my case TG thinking/feeling had been present for as long as I can remember, but it wasn't until my late teens/early 20's that it really "boiled over" and I felt I had to "do something" about it. To make a very long story short, I proceeded with the usual steps of shrink-therapy, wardrobe update, hormones, electrolysis, considering the name change, nearly transitioning at work, spending up to a week at a time in girl mode, actually passing much of the time, etc. This took roughly 4-8 years, depending on where you start and stop counting, with several false starts. Needless to say, it was a very challenging time for me, and I came awfully close to FFS and what would eventually have been SRS. I was consistently pulled by both the "identity" aspect which had been planted by the internet and others and fertilized and grown over the years of thinking about this, and the more basic maleness inherent in me from day one. This middle-ground to a large degree prevented me from having normal heterosexual relationships, and caused much anxiety when it came to interacting with women. I very much wanted a "normal" girlfriend (not an altertative type, etc.), but was unable to pull away from the TG habits I had spent years getting myself into. It's easy to get sucked into the TG vortex, especially in a sufficiently permissive environment such as the SF Bay area. Contrary to a therapists' strong suggestion, I found it impossible to think of myself in a lesbian relationship, which I suppose must have seemed like a reasonable perspective to take to make everything "fit".

Ultimately using identity to explain the TG in me did not work. Although I found other accounts (such as auotgynephilia [agp]) a bit more tailored to my experience, the controversy in the literature surrounding AGP obscured any real advancement which might have come from that exploration. I theorized that for whatever reason there was a mechanism in my head that linked an internal sense of anxiety to my sense of gender and body image, and eventually that morphed into a sense of self/identity over the years; the initial feelings of gender dysphoria were not at all originally due to an issue of identity, and retroactive explanations that the only way such a feeling can arise in the first place is because of identity is false. That would be a circular argument. Being in a non-ideal personal situation (job and career direction, stress, lack of friends, crappy apartment, etc) fueled the anxiety a bit more, which led to TG behavior, which led to further feelings of alienation from normal society, which started the cycle over again. It was a big positive feedback loop that made life pretty miserable for quite a few years. Although any particular step towards feminization helped reduce the immediate anxiety a bit more, and I eventually felt pretty good about the impending transition after taking serious mental steps to accept my fate as a TG/TS person, the big picture seemed farther and farther away. I wanted eventually to have a girlfriend or wife, be a dad, have kids, etc., in a very normal sense, and following the TG/TS path was NOT that direction. I knew this was a detour that had gone on long enough, and I knew I had to figure it out to keep happy.

I eventually resolved the agitation in my head by moving back home, near my parents, finding a job I like, and living in a physical environment where the people, the trees, the air, etc., suited my tastes. Also, concluding finally that my 100% heterosexual nature was NOT separable from identity (which is how many in the TG world would have it) helped seriously to dissolve the identity explanation of TG. Interestingly enough, a visit to an ayurvedic doctor, where he simply asked questions relating to my orientation, provided me with a compelling opposing view, which somehow seemed to snap me out of it. Basically if you get aroused with females and you feel like a guy in the presence of girls then you are a guy. Pretty basic stuff. Everything else is mental fluff that must be dealt with. I'd been "snapped" out of the gender feelings before for different reasons, but I had always come back, so I was skeptical. However this time I was in the proper environment and I was willing to give my theory a try anyway. He told me to get off the hormones (they are *not* "natural"), and come back later to deal with the anxiety/stress/depression, which they deal with all the time. I never needed to go back, but pretty soon after I was able to wean myself off the hormones, which took a few months, and which felt very "right" this time. I went on a very refreshing solo backpacking trip to Asia for a few months which helped clear my mind and returned home to look for a new job.

I finally found a better direction professionally, and surrounded myself with good friends and family and a good physical/social environment. This dramatic change in viewpoint took the fuel away from the TG flame and now, although the original neural mechanism is still there at some level, it has been "quiet" enough to re-develop a previously somewhat flaccid (pun intended) male identity and re-establish myself, both internally and externally, as a guy. I have been able largely to return to a much healthier-and-more-experienced version of the male mindset I had in high school, where the gender stuff was only a whisper, flirting with girls was easier, and there was no question about where I stood on the male-female continuum. I'm now in a great relationship with a girl who, ironically, was there as a friend-and-uncomfortable-lover during my most intense near-transition moments. It was through awkward interactions with her, and others, that led to the conclusion that transitioning would basically lead to a relationship-less life, and that was unacceptable. Friends maybe, lesbian lovers maybe, but a *real* relationship where all the bits fall into place? No. Since my return to sanity, this particular relationship has proceeded very nicely and "right" feeling, with guy and girl in their "proper" place, not viewed from any sort of moral position, but from a more fundamental bio-neuro-evolutionary position. The gynecomastia surgery helped with this too, but it was more icing on the cake than the significant component.

Nevertheless, the years of hormones left their mark on my body in the form of breast tissue, as well as some deformations of the underlying muscle due to a short time with breast implants. At first I greatly welcomed the breast growth as it had been a major goal of mine, infinitely more than the lower female bits. And clearly the implants were an explicit (and adventurous!) choice of mine. However, with the hormones, as I increased in cup size, my confidence as an official guy out in the real world decreased proportionately, triply (or more) so with the implants. I wasn't (yet, or ever) ready to transition full-time female, nor was I really happy as a dude with boobs, or as an "interesting individual" staying in between genders. After removing the implants, returning home, and re-establishing a new outlook on things, I started to consider having the gyecomastia surgery. I decided to wait a couple of years to make sure the TG thought patterns were well rested before taking such a drastic and male-minded step. Many times prior to this the TG thought/feelings had disappeared for some time, only to come back later.

A couple years passed with no return to the gender feelings (or rather, the feelings that did/do occasionally arise were below the threshold where I needed to "do something" about them). I looked online and eventually came to Dr. B's site. I was of course happy to see so many photos and explanations of the gynecomastia surgeries he has performed. After visiting a few "top doctor" folks in my area, I decided to have a cosultation with Dr B. I flew out to VA and observed a problem-solving approach that I hadn't observed in the other doctors. He spent about an hour measuring and testing the fat/breast tissue and underlying muscle, far more thoroughly than anyone else had. I determined either a) other doctors were erroneously not as concerned about the degree of breast tissue I had, or b) Dr. B. was overly concerned. I figured option b was the bettter/safer interpretation. He answered all of my questions and left no doubt in my mind that he is serious about his craft, and I'm extremely happy he took such an analytical, proactive, and planned approach to the surgery. To me it seemed the other doctors did "normal" gynecomastia surgery as part of their standard offerings, which also typically included the normal plastic surgery fair: breast implants, nose jobs, eyelid surgery, facelifts, laser veins, etc, but it seemed Dr. B's more limited (?) and specialized offerings allow a more focused and refined method, with gynecomastia as (apparently) his main specialty, but I'm not entirely sure. I had enough breast tissue that the "normal" gynecomastia surgery would be insufficient, and I wound up having to get the nipple re-positioned and skin removed as part of a male chest lift. At any rate, after I got home from the consultation and decided to have the surgery with Dr. B., I waited about 6 months before scheduling the surgery to lose ~10-15 lbs, as this would result in a better outcome. Eventually the surgery date came, and with my Mom's support, I finally went through with it.

My first "psychological" moment came 2 days after the surgery, when I was in the office and a female nurse or nurse assistant was standing there to assist the followup examination. I realized, standing there with my shirt off, that although my chest was covered in gauze and surgical tape, and that it was still very fresh from the surgery, that my sense of anxiety standing shirtless in front of a woman was gone! I was surprised to feel that it's preferrable to be bandaged and a bit bloody when standing in front of a girl than with "man-boobs". My next moment came a few days later in the men's room at the airport on the way back home. For the first time in a long time I realized that my little secret of trying to hide breasts under baggy clothes was no longer there. I was a "normal" guy again blending into the crowd and I actually felt I lost a little feeling of uniqueness I had developed over the years with regard to this thing. This was an interesting feeling of loss, since I had for so long developed, well, quite an attachment and affinity to the breasts, even though they were not good for me in the long run. I've heard others say that having gynecomastia doesn't seem to bother everyone *else*, only the guy involved. I think this is true. My friends and family haven't reacted *nearly* to the degree I have in my own head about how big a change this is for me.

Overall I'm extremely happy with how things turned out. I'm at about 8 weeks after the surgery and only a tiny not-fully-healed spot remains along the main incision, which is where the surgical tape caught some scab and I had a small infection on the surface of the skin. Also, Dr. B. reattached the muscle where the implants had separated them from the ribcage. This is taking a while to heal, but it gets better every day. The scar across the bottom of my pec muscles is clearly there but I expect that to diminish over time. The only major concern that I have is for the feeling in the nipples. Because Dr B. had to reposition the nipples higher than they were, there was some inevitable loss of sensation, even though he preserved the "stackup" (pedicle) of blood and nerve supporting the nipple/areola. I think I will regain some feeling as the nerves grow back over the next year or two, but for now the nipples/areolas and surrounding areas are completely numb. The big idea, however, is that I'm once again able to wear normal shirts without extra bagginess. I can wear sweaters again. I'm able to stand straight up with a proper posture and not worry about the profile. I have significantly increased confidence both at work and in social settings, etc. In other words, I had a certain expectation for the psychological benefits of the gynecomastia surgery, and those have been fully met. Eventually I shall be able to return to the gym after the scar fades away some more and start exercising again, but I'm not yet ready to expose these scars in the locker room. I can probably start exercising around the neighborhood, however, since the end of summer is still a month or two away.

If anyone is reading this who is or was in a similar TG state, I hope this text has been useful to you. I wish to thank Dr. B. and his excellent staff for providing a very much needed service, with great technical skill and patient care.

Dr. Bermant responds:

Thank you for taking the time and expressing the scope of dealing with these issues. We really appreciate your contributions and hope they helped in healing the emotional component. Please keep us informed about your progress and let us know if there are any questions or concerns.

 

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