I Got Gender Affirming Top Surgery—Here's Everything That Happened

Nothing gets us more excited than talking about a not-so-little tweakment or a nip-tuck procedure. In the spirit of transparency, Marie Claire’s aesthetics column, Life in Plastic, delivers a first-hand peek into what goes on behind the doctor’s door.

Grayson is a 21-year-old creator and certified personal trainer who underwent gender affirming top surgery to remove his breast tissue with Dr. Keith Blechman, a board-certified plastic and reconstructive surgeon. This is his experience, edited and condensed for clarity.

I wasn't the type of person that, since a young age, always knew I was trans. It was something that I suppressed for a lot of my life. I remember when I was a kid, I would put books and dictionaries on my chest hoping that it wouldn't grow. So it was always something in the back of my mind. I'd say 16 to 17 is when I started turning the gears. It wasn't necessarily like I woke up and realized I was trans. I went through a lot of phases that other trans guys that I've talked to also experienced. At first, I identified as a lesbian. Then I identified as non-binary, gender nonconforming. And then I realized when I started building muscle, building what is more of a masculine look, that I would identify as a transgender man. I started using he/him pronouns, changed my name to Grayson, and then started T. Top surgery for me is what felt like the next step, and really aligned with what I always envisioned.

How I Found My Surgeon

My best friend, someone I've worked with—I post a lot on social media with—actually got top surgery with Dr. [Keith Blechman]. I have the same date as him, a year apart. So I saw him do top surgery with Dr. B, he has some of the most incredible results I've ever seen in my entire life. And a lot of the internet seems to think the same way as well. And I honestly was like, "Hey, I'll weigh out my options and all that stuff." But the second I got on with Dr. B and had that consultation, it just felt super aligned. I think word of mouth is huge in our community to make sure you can have a surgeon you trust and feel safe with.

"We treat patients with gender dysphoria or who are looking for top surgery, the same as we would anybody else that came into the office," says Dr. Blechman. "You [take] some basic medical history. Obviously there are certain questions that are specific to them that you're not going to ask other people. I generally don't ask people if they're taking testosterone, a woman coming in for something that has nothing to do with gender. And you do a physical exam just like anybody else. The only thing that differs as far as preoperatively is that for gender-affirming surgeries, the standard of care is to have a referral letter from a qualified mental health professional."

"It's become half the practice at this point. We've gotten calls from 46 states. I just spoke with somebody from Lexington, Kentucky. Because it's getting harder to find this kind of care outside in certain places, people are willing to travel. We have a level of expertise they're willing to travel for regardless, but there's just not as many options in other places. I'm like an accidental tourist in this area because I never even met a trans person when I was training. I was doing breast cancer reconstruction when I went into practice. So somebody came into my office randomly and asked me to do a mastectomy, and I was so puzzled because they didn't have breast cancer. It took me a second to figure out what was going on, and then I was like, 'Okay, this is within my wheelhouse.' So I did the operation, and then instead of tears and Kleenex, it was like, 'Hey, I finally look great.' And that was fun."

My Top Surgery Consultation

I started the process around April [last year]. I got on a Zoom with Dr. B because I was in California, and then I wanted to go in person for a consultation. Because I had a relatively small chest pre-top surgery, there were a few different options. I ideally wanted to get a double incision, but didn't know if it would work best. So the next time I was in New Jersey, a few months after that, I had an in-person consultation, and then everything went well.

We decided on a double incision. [Dr. Blechman talked me through the options, explained what it was going to look like, and then, based on my convenience (again, when I'd be back on the East Coast), we ended up scheduling for November 12th. I had this huge limiting belief that top surgery was going to be this massive waitlist and this long, dredged-out process because it is for so many others. So I remember when my buddy Ali called me and he's like, "Yeah, I just got on the phone with a top surgeon. I'm getting it in six weeks." It was unheard of for me at that point. That was actually another big reason I went with Dr. B. I was like, his results not only were phenomenal, but the turnaround time was so incredible as well. I work a lot with the community, so I hear a lot of people being on waitlists for years, consultations, pushback, surgeries, all that stuff.

"Generally speaking, when you talk about chest masculinization in general, there's really two main options," says Dr. Blechman. "Those options are going to be dependent upon whether, when you remove the breast tissue, if there's extra skin, meaning that if your breasts are small enough, if your skin is tight enough, you might be able to take the breast tissue out and the skin will just shrink wrap back to your chest. If that's the case, we do the periareolar approach—peri meaning the perimeter of the areola. We make it just a scar around the areola. We basically pry open the tissue, pull the breast tissue out, sew it back up, and it sticks back to your chest. If we think that if we did that, we'd be leaving someone with hanging skin pancakes or a ruffled appearance, then we want to cut that skin off.

"That's where the double incision comes into play. And the double incision gets its name because one incision goes under the breast and the other goes over, but it really should be called the quadruple incision because you do it on both sides. That allows us to take the tissue off with the extra skin, and then we sew it up, and that's what gives those two hockey stick-shaped scars at the base of the pec muscle, the bench press muscle."

My Surgery Preparation

I can attest to Dr. B's incredible team. It was very easy for me—one click of a button and I had an Amazon link of everything I needed, [and] I was able to order straight to my parents' house. When I got there, it was already there. The [surgical team] were in constant communication with me. I got a meditation or breath work [link] sent to me the night before. I was just hydrating like they told me to. Electrolytes. Stool softeners. Whatever they said I needed to do prior to the procedure, I was doing that, trying to just be as relaxed as I possibly could be.

The Day of My Top Surgery

I woke up at four in the morning. My mom and my girlfriend came with me and we got to the medical center where we were actually doing the surgery. It was a pretty seamless process, honestly. [There] wasn't a lot of waiting. They did the pre-op stuff, the anesthesiologist came in and talked to me. I had a bunch of nurses come in. Dr. B came in. And I was able to have family and friends be there for that part of the experience to an extent as well, which I thought was really, really cool.

I think Dr. B was the last person that I spoke with before I had a nurse take me up into the OR. I felt very comfortable throughout the whole process. I'm not typically the type of person to get super anxious about surgeries or anything along those lines, but I haven't had many. I was actually very surprised at how calm I was about the whole thing. And I really do think it was just because of how much communication I got with Dr. B and his team leading up to the surgery and just how comfortable I felt in the decision and the team that was going to be conducting the surgery. The surgery took a couple hours and then I woke up not in the operating room with family and friends.

Recovery From My Top Surgery

I've heard so many different experiences about top surgery because it obviously varies surgeon to surgeon. Some people are in excruciating pain for multiple weeks; some people have drains. I know Dr. B doesn't practice with drains, so right off the bat, I was grateful for that because I have heard that has been one of the worst experiences for people. That being said, my recovery was genuinely very, very easy. I wouldn't even say I experienced pain. I would say discomfort would be the absolute max. All I took was Advil post-op.

The biggest issue for me was just discomfort sleeping because I had to sleep on my back, and not being able to shower. So champagne problems when it comes to recovery. For 72 hours I was a little sleepy, a little out of it, but I work online, so I was back working, talking to my team, doing everything virtually and remote, pretty much a week and a half after. And from there, I never had any pain. Even when I started getting it to the gym, I never had any weird sensations. I even have feeling on my scars and my nipples. My buddy that's had top surgery for three years still can't feel his nipples. So I feel like I had an amazing experience overall with the recovery.

My Post-Op Visits

We did a four or five week post-op visit because I was still in the area, and we just communicated clear boundaries in terms of easing our way back into [training and working out], really just focusing on how you feel and not diving headfirst back into things. And at the 12-week mark, I looked exactly how I did before surgery. I was able to maintain the majority, if not all, of my muscle mass through diet advice that I myself knew and Dr. B talked about with me as well. So it was very easy for me to not feel anxious that I'd lose all that progress. And obviously muscle memory was a very real thing that came into play.

A snapshot of what we do is we aim to utilize fitness as a tool of gender-affirming care for individuals who maybe don't have access to T, top surgery, things along those lines. Fitness was a huge role in me feeling confident and affirmed in my identity when I was still in the closet, couldn't even think about T, top surgery, all that stuff. So it's always been a really big thing for our clients.

Final Thoughts on Top Surgery

It's funny, I don't remember what my life looked like before top surgery, and I've heard that a lot with friends as well. It feels very natural, and I never doubted the decision, but once it happened and once I took my binder off for the first time and was able to see that, it was an indescribable feeling.

I had a relatively small chest pre-op, so I was thinking there's [not] going to be much of a difference. Parts of me thought this might just be a box that I want to check to feel more aligned, but it definitely did not feel like that when it came down to seeing it for the first time. Also just being able to express myself in a way. I have always been the type of person, with my content and stuff, to preach confidence. Even when I was taping and binding, I'd take my shirt off in the gym and lift to show people that they can do that regardless of what step they're on in their transition. So to be able to see that from every single phase and now have, what seems like for me personally, at least right now, the final box in my medical transition checked, it feels like it's a memento to my younger self.

I was in this waiting game for years [where] I didn't want to come out. I didn't know who I was. I was like, Okay, maybe I'm a lesbian, maybe I'm this, maybe I'm not. I'm going to stop confusing everybody around me. So many limiting beliefs. And to be able to fully feel like myself and have everyone around me see that as well. I look in the mirror, I see me, and [for] people to look at me and see me in a way that I actually want them to perceive me is a feeling that is hard to put into words.

Meet the Expert

Keith M. Blechman, MD

Dr. Keith M. Blechman is a Board-Certified plastic and reconstructive surgeon, based in New York City, who specializes in breast reduction, breast lift, and transgender and non-binary top surgery, including chest masculinization and breast augmentation. He is known for his patient-centered approach, combining excellence, compassion, and advanced surgical techniques. With nearly a decade in private practice, he is a pioneer in innovating new strategies for postoperative pain control without narcotics, as well as a trailblazer in learning how to integrate telemedicine into surgical practice. 

Dr. Blechman trained at Brown University, New York University School of Medicine, NYU’s plastic surgery residency program, and completed a microsurgery fellowship at MD Anderson Cancer Center. He is active in national leadership roles within major plastic surgery organizations and is committed to advancing the field through innovation and advocacy.