Bilateral Mastectomy with Dr. Peter Raphael

Bilateral mastectomy pictures of Corbin’s chest. Bilateral mastectomy surgery by Dr. Peter Raphael, a Texas surgeon who specializes in female to male chest surgery

May 6, 2005 : Bilateral Mastectomy Consultation with Dr. Peter Raphael

Jesse and I traveled up to Plano, TX for a consultation with Dr. Peter Raphael.  The 4-1/2 hour drive wasn’t bad at all from Houston to Plano–just outside of Dallas.  We were impressed with the facilities and the respectfulness of the staff.  Prior to the drive up there, Jesse and I had already decided to have Dr. Raphael perform the operation.  He has received superior reviews from our friends and the results of his work have almost all been excellent.  It is always different to visit the office of a Plastic Surgeon because they use the environment to comfort you.  Whatever the case, the price is a flat $6,000 which includes anesthesia, aftercare, and any revision procedures.  I am going to try to push to have the surgery at the end of July or beginning of August so that I may return to school without the stress of dealing with breasts.

October 16, 2005 : Formalizing the Plans

We are planning to schedule my chest surgery for the very beginning of January with Dr. Peter Raphael. We also debated over Dr. Brownstein, but with travel costs and whatnot it was nearly a three grand difference, and we don’t seem to think that difference is worth the results. Raphael’s quote was $6,000 and Brownsteins $7,500. Add $680 for round trip flights for Jesse and I (not including mom and transportation). Whereas Raphael is a four hour drive away, cheap hotels ($150 for a weekly place) and his surgery is so much cheaper. I’ve also seen the work of Dr. Raphael on many of my friends (who apparently haven’t posted on transbucket.com) and I have been more than pleased.
We definitely could do Dr. Brownstein, but that would mean waiting until summer so that we can save the added 3,000 and not miss school. Honestly, at this point I am eager to have a flat chest. I hate having to wear binders and I especially hate not being able to wear skin-tight t-shirts. Before starting testosterone I figured that I would have chest surgery, but that my breasts wouldn’t drive me too crazy. Well, I have news. At about three months I was ready for them to be gone—and not gone in a little while, but gone right then. Since then it has become much worse—I think about it every time I put a shirt on, I think about it when I go to the men’s room, when I’m talking to friends, when meeting new people, etc. It has become a serious self-confidence killer and I am determined to fix the problem as soon as possible.

October 29, 2005 : Scheduled Bilateral Mastectomy with Dr. Peter Raphael

We scheduled my chest surgery for January 5, 2006 with Dr. Raphael.  The pre-op appointment will be noon on January 4th, 2006.

January 4, 2006 : Pre-op appointment

The pre-op appointment was the main information session for the surgery. They went over basic procedures, medicine needs, and important guidelines for me to follow before and after the surgery. They also took before pictures. My mom was able to meet and speak with Dr. Raphael and he showed her a rough diagram on my chest of how he gets everything to fit together. At the end of this appointment I was given several prescriptions. They are as follows:
Medrol pack : to limit swelling
Antibiotic Keflax : to guard against infection
Valium : for anxiety and muscle relaxation
Percocet : for pain
Phenergan : for nausea (did not need)
They also had me pick up some basic supplies for post-op recovery that we had not thought to pack, and some stool softener (since the mixture of not moving, pain medication, and hard foods often causes constipation). These are as follows:

Dr. Peter Raphael has been exceptionally wonderful. All of the office assistants are perky and respectful. They have all referred to me with male pronouns, and have shown no intolerance for my situation. I was and still am completely satisfied with Dr. Raphael and I will definitely return to see him for any other procedures that I choose to have.
The evening before the surgery, the anesthetist called me to go over my medical history. When I first scheduled my appointment, he requested that I stop taking testosterone three weeks before surgery. This would help to lower my red blood cell count and protect against complications. He said that 72 hours after surgery, I could begin taking my injections regularly.
The anesthetist also said I could take a Valium the night before if needed, but I was unusually calm and slept very well without any meds in me.

January 5, 2006 : The Day of the Operation

We went in for the operation prep at 9:30 . The first thing they had me do was give them a urine sample for a standard procedure pregnancy test, and then they had me change into a gown with one of those wonderful puffy blue hairnets. The anesthetist placed a small catheter in my wrist and began an IV for fluids. Dr. Raphael came in to mark up my chest and say goodbye before the surgery. During this time my mom and I filled out some paperwork for the Dr. as well as legal paperwork that placed my mom as my primary decision-maker if I was unable to make them for myself.
After all that was cleared up, the anesthetist brought over a syringe of medication that would calm me down—I referred to this as my margarita. As he was putting it in the IV I asked him how quickly it would hit me. He said one circulation cycle. It hit immediately. It was like four margaritas! I was automatically completely relaxed, but I only remember a minute or two after he gave it to me. Apparently I became very talkative and wouldn’t quit talking about chocolate chip cookies. My mom and Jesse said they wheeled me out about a minute after they gave me the relaxation stuff, but I honestly don’t remember.
Later on –a day after the surgery–I remembered some funky playing music in the operating room—I remember thinking that it would be calming music, but all I could think of at the time that it was damn funky—kind of like a Jimmy Buffett song but not. Get it?
They performed the surgery.
I woke up on the operation table, or in some room—which one I’m not really sure. There were four or five people over me and they were getting me to scoot from one gurney to another. They then wheeled my through a hallway and into the recovery room. At this point my vision was very blurry and I must have been in and out of consciousness because I would have sworn the whole process of waking up took ten minutes–it was actually an hour and a half. I remember laying my head back to rest for a second, but I really must have been falling asleep. At one point, the recovery nurse asked me to rate my pain from 0-10 with 10 being the greatest. I believe I told her three and I later came to find out that three was about an average answer. Through this whole ordeal my pain level hasn’t hit above a four—except for my neck but that is unrelated to the surgery. Considering that the part of the surgery I was most worried about was the anesthesia, it went very well. I didn’t get nervous at all when waking up and overall the whole experience was rather pleasant. I have no complaints about it.
Jesse and my mom came in to see me shortly after I was awake. I was still very tired and I wanted to go to sleep, but all-in-all I was comfortable. The nurse explained that every three hours I would need to walk for about ten or fifteen minutes and that I would also have to do basic breathing and coughing exercises. We went straight back to the hotel room and I soon fell asleep propped up on a bunch of pillows. The evening of the surgery I was having very little pain and I was hungry from not being able to eat the night before. The nurses asked that I start out with only soft foods and liquids the first day, but the first evening we ordered Chinese food with vegetables and chicken. I have not been nauseas at any point.
I tried to watch a CSI episode last night, but the surgery was exhausting and I couldn’t focus on it for very long. I would sleep for a couple hours and wake for an hour. The rest was well worth it. I think that it has made all the difference in helping me to recover.
The drains that come out from under my arms are not much of an inconvenience at all. They seem to just be there, although they make it hard to wear a shirt. Hence, I have been laying around with my shirt open or completely off. For those going into surgery, I recommend pick up button down shirts that are a size or two too large.

January 6, 2006 : 2 Days Post-Op

Today I am feeling much better than yesterday; I seem to have a lot more energy and I don’t need as much help moving around. Jesse has been wonderful helping with all the chores. She helps me pull my pants up and down in the bathroom because it stresses my chest too much. She is keeping all the medication in check, cooking, and helping to drain the drains every once in a while.
Yesterday (day 1) we needed to drain the drains more often because there were many blood clots that kept blocking the tubes.
As of today, the drains seem to be doing much better. My right side drains a lot less and it is now draining a pink lemonade looking fluid rather than dark blood. The left side, which was always the larger breast, is consistently draining dark blood. It is probably draining about 25% more than the other side. I can also feel sharp pressure just above the nipple whenever we tug the fluid out of the drain. The left side is also a bit more sore, although I am overall not very sore.
With the constant level of Percocet and Valium in me, pain has not been a big issue. I can get uncomfortable, but it has not become intolerable. As for right now while I am typing, the bandages and drains are just there—they aren’t in the way or noticeable much at all.
At 10:00 this morning, we went to do my post-op visit with the nurse. She removed the ace bandage from my chest and cut away the gauze, revealing two strips of tape covering my Frankenstein-like scars and clean white gauze over the nipples. She the demonstrated how to cut the Kotex pads, place Neosporin on them, and place them around where the tubes come out. She then put on two new Ace bandages, but they were much looser than directly after surgery.
We brought our DVD player and CSI videos to keep us busy. I also brought a box of books to read and we packed some board games.  Unfortunately the Medrol (steroids) affected my ability to retain much of an attention span reducing my activities tremendously.  My efforts to play Trivial Pursuit were in vain.

It is very exhilarating to see a flat chest—I can’t wait to put a shirt on with no gauze or bandages on. The scars looked fairly even and the nipples, which I haven’t seen without gauze on, are above the scars, which was a concern of mine before the surgery.

Thanks to all my friends who have supported me in this journey—It makes all the difference in the world.

January 7, 2006 – 3 Days Post-Op

I’m feeling very perky today. Jesse and I went for a walk around the general area of the hotel and checked out some of the shopping centers. We plan to walk to Target tomorrow and pick up some supplies. I brought my car but I won’t be able to drive for several more days and Jesse does not drive so we are limited to walking for a while. Overall, we’ve been laying around watching CSI and reading. The hotel that we are staying at has been wonderful (Sun Suites—and cheap!!). The place is clean and has a full kitchen. We went ahead and got a double bed room so that Jesse can lounge around on the bed without having lazy ol’ me in the way.
As for the surgery stuff, we removed the Ace bandage today and cleaned around the drain sites. We have to pull the fluid and clots out of the drains about three times a day. Well, the first days we did it more often because my body was spitting out all that post-surgery gross stuff. Now it has slowed down and is no longer so bloody and gross. The drain on my left side is the bitchy one. That breast was larger in the first place and I think that the drain ends somewhere around under my new nipple. When we drain it there is a sort of pinching feeling under the skin that I am not particularly fond of. The other drain hasn’t been uncomfortable at all. They just kind of lay on my stomach and collect gross looking fluid. It will be nice to have them out. The nurse said they may come out when there is less than 25cc in 24 hours. For those who are truly interested in bodily wastes, here is where I’m at :

They said it is normal to have more coming out mid-week because patients tend to start moving more. I can definitely attest to that. I have been taking walks and wandering in circles around the hotel room. Moving seems to make me feel better. I have been following all of the instructions given out by the nurses and hence, I have had no complications or problems.
I placed my first photos up on www.transbucket.com). They are listed under Dr. Raphael and should be the first to come up.

January 8, 2006 – 4 Days Post-Op

Today we had a nipple crisis. Well, it wasn’t much of a crisis at all. Late, late last night I noticed that there was some dark red blood encircling the thick gauze around my right nipple. I figured it was normal and decided to call the nurse first thing the next morning (unfortunately on a Sunday). I called the nurse and she said that as long as the blood was a dark maroon (old blood) that it shouldn’t be much of a concern. Well, about four hours later there was more blood and it was quite a bit red. Obviously I was bleeding. I called the nurse again and she said that most likely there was some leaking out of the nipple. She instructed me to place ice packs around the area—not on the nipple—and do that for fifteen minutes on, thirty minutes off. She said to do this for two hours only. I then took a nap and when I woke up there were spots of blood on the sheets. On closer examination, there was a square inch of blood that had soaked through gauze and two ace bandages. When we looked under the bandages Jesse and I saw that there was definitely new blood that had not yet dried. Worrying that I was being a nuisance at this point, I called the nurse once again and explained the situation. She told Jesse and I to meet her at the Dr’s office ASAP.
In the office I asked her if this was anything to worry about and she replied that it shouldn’t be a big problem. In her words—it’s better to have the blood coming out rather than building up behind the nipple graft. BTW–all of the nurses for Dr. Raphael have been awesome. All in all she removed the dressings and Jesse and I were able to see my right nipple for the first time. Yes, it was a bit purplish-brown but the nurse said it looked completely healthy. I have to say—I was very pleased with its appearance and I am completely intrigued to see more final results soon.
My energy level today has skyrocketed. I have been very perky for the last couple days, but as of today I stand up more straight, I’m able to move around more comfortably, and I am not feeling so limited in my ability to move around—granted, I have restricted my activities for the sake of healing quickly.
Jesse and I are still taking regular walks every several hours. I haven’t felt like the Valium is as necessary as it was the first days after surgery. The Valium helped to calm me down and keep my pectoral muscles from twitching so much but lately this hasn’t seemed to be so much of a problem. Jesse and I have expanded the times between my painkiller regime as well. Instead of every four hours, I have been taking one every six. I must say, pain hasn’t been much of an issue.
The most uncomfortable part of this whole process has been clearing out the drain on the left side of my chest. The drains help to release fluid buildup from where my breasts were removed. Specifically, the drain on my left side sends a sort of pinching feeling near my nipple when cleared. I asked the nurse if that can be caused by a nerve near to the drain and she agreed that that is most likely the case. The other drain hasn’t been a problem at all to clear. I’m looking forward to having them removed. Today the drains pushed out 63cc of fluid as opposed to yesterdays 85 cc. In order to have the drains out they need to drain a total of 25 cc or less in a 24 hour period. Even though they aren’t awful, I’m looking forward to having them out soon. Hopefully they can come out before the 12th. If not, we may decide to hang around in Plano for a little longer. Driving my car home with these drains on my chest would be uncomfortable.

January 10, 2006 – 5 Days Post-Op

It appears my drains are ready to come out. They only collected 20 cc today. My appointment to have them removed is not until the twelfth and I am debating whether I should just hang around tomorrow with them in and go in for my scheduled appointment or call in and have them out tomorrow.
I cannot wait until my appointment on the 12th . They will remove the drains, take out my stitches, re-tape the scars, and I will be able to see my chest without all the gauze! After that I will still have to wear a compression bandage for a couple weeks but I’m not too worried about that. Yay!
I am very tired and the steroids are making me a bit impatient so I will write a more extensive post tomorrow. Goodnight my friends!

January 11, 2006 – 6 Days Post-Op

Jesse is packing our stuff up right now. We have our final post-op appointment with Dr. Raphael first thing tomorrow morning. He should remove the drains and I’ll get to see my nipples! Jesse and I are both very excited!
Other than that I have been having vivid dreams. My particular favorite was when I got to meet Bartleby the Scrivener (literature nerds will understand). I would go into detail, but “I prefer not to.”
I haven’t been taking the pain medication regularly because the pain hasn’t been that bad. I have also been avoiding taking the Valium as well. I have no problem with medications, but the mixture of all of these makes it hard for me to read. The Percocet is nice, but it only seems to help a little bit. Years ago I was in a car accident and I took pain medication regularly for quite a while—perhaps my body still hasn’t lost its tolerance yet.

January 12, 2006 : 1 Week Post-Op Appointment and Drain Removal

I was extremely eager to have my drains removed because the drain on my left side was continually hitting a nerve that made my arm sore. Two days before the post-op appointment I was draining less than 25cc, which meant that the drains could be removed. Jesse and I decided that it wouldn’t be too big of a deal to wait instead of going in early. Big mistake.
When my chest drained less than 25cc the drain on my left side became very irritated and sore (possibly from lack of lubrication inside my chest). Nonetheless we toughed it out and went in for my final post-op appointment.
To get straight to the point: having the drains removed was no big deal at all. The nurse told me to take a deep breath and exhale. When I exhaled she pulled the drain out very quickly.
On my right side I barely felt it at all (it almost felt as if someone dragged their finger lightly across my chest) and my very irritated left side was a bit more noticeable but not painful at all. Immediately after she took the drains out I remarked “I can move!” I gained an entire range of motion and I was extremely more comfortable.
After this, Jesse and I made the four hour trek back home. I drove the entire distance without much of a problem at all. Closing the car door and making turns was a bit difficult but the ride went very smoothly.

 

January 16, 2006 : Day 11 Post-Op

After I returned home from the surgery the nurses instructed me to change the dressings over my nipples and drain sites twice a day. Unfortunately, the adhesive tape that they gave me was virtually super-glue tape and I began to form numerous blisters from pulling it off regularly. I became so uncomfortable that I decided to start using other forms of tape instead. Since I have still been wearing the Ace bandage, I chose to begin using paper tape. The paper tape is very gentle on my skin and the Ace bandage keeps it from coming off. The wounds are now beginning to heal and I am feeling much more up to the task (so to speak).

January 19, 2006 : 2 Weeks Post-Op

My chest seems to be healing well. The scabs are beginning to fall off of my nipples revealing a very pink color. The right nipple has a little piece that did not attach to my chest, however I feel that it will heal itself over time.
Overall I am much more comfortable when sleeping. I just a bit sore on my sides which may be attributed to pressure from my arms pushing on the Ace bandage. Other than that, my chest looks awesome and much of the dark bruising has started to fade to a light yellow.
I removed the dressings from over my drain sites and covered them with the same tape that is over my incisions. I am also now wearing one Ace bandage instead of two. The second was for extra pressure to reduce swelling just after surgery. Without the second bandage on, I am extremely more comfortable. I have found that my shirts fit me very differently; T-shirts that used to be tight on my chest are now very loose.
The only down side to this week has been a fairly bad allergy to the surgical tape.  As mentioned in my Day 11 entry, blisters formed on my chest causing me to begin using paper tape.  However, since the tape on my incisions hadn’t yet been a problem I assumed my reaction to the tape was from the harshness of pulling it on and off.  I kept the surgical Durabond tape over the incisions.  Last night I noticed a redness around the tape but assumed it was possibly from the Ace bandage.  I awoke several hours later and my entire chest was red with hives.  I could tell it was the tape because the area around the tape was the most swollen and red area on me.
I immediately removed the tape and put hydro-cortisone cream on the area.  I called the Dr. first thing in the morning and asked the nurse what to do.  She said to keep the tape off, apply %1 hydro-cortisone cream, and put paper tape over the incisions once all the blisters have healed.  I added a picture of the allergic reaction after much of it had healed.

January 21, 2006 : 16 days Post-Op

Apparently I am also allergic to the paper tape.  Darn 

February 5, 2006 : 1 Month Post-Op

One week ago I left the house with no binder on.  I cannot begin to explain what a wonderful feeling it was to feel my shirt against my bare chest.  I feel so much more able to face the world now.  Having the chest surgery made me feel less like a male-imposter and more like a man.  I have to say, I kept freaking out thinking that I wasn’t wearing a bra–for the feelings are very similar.  I don’t worry about walking in front of a window accidentally without my shirt on either.
For a while I was struggling with allergic reactions to tape.  The doctor recommends keeping tape over the incisions for 3 months post-op in order to keep the scars small and to loosen up the tissue.  Unfortunately I am allergic to every type of tape I’ve tried and after the millionth try I decided that having allergic reactions was not worth the money or effort.  I was also concerned with what the inflammation from the reaction could have done to the healing process.  Since I’m not wearing the tape, I have been massaging the scars daily in order to smooth them out.  This seems to be working well.
Near my sternum on my left side there is a ridge along the scar that is noticeable if I stretch in a T-shirt.  Massaging this area has been particularly helpful and it is no longer as tough as it once was.
At about three weeks post-op the dissoluble stitches fell off my nipples.  Unfortunately my right nipple is fairly flat and I may consider going in for a small revision to fix it when I return to the Dr (I’m planning on having some cosmetic surgery).  I’m sure the revision will be a minor procedure.  On the other hand, Jesse and I refer to my left nipple as my “perpetually hard nipple.”  –Quite funny actually–
I stand behind my decision to use Dr. Raphael 100% and I will return to him in a heartbeat.

January 5, 2007 : 1 Year Post-Op

The last year has been fantastic.  I finally have the chest that I’ve dreamt of having my entire life.  I no longer have to deal with the breasts that were once mine.  Even a year after surgery, I am still amazed with my new chest.  I find myself running my hand against it and I love the look of it in tight white t-shirts.  I back my decision to have chest surgery 100%.

4 Months post-op: May 2007

The scars are turning an angry red. I’ve started treating them with Mederma to cut down on the redness. Once the Mederma treatment is complete, I’ll switch to using cocoa butter with vitamin E. The scars are also very thick, and they feel tough/hard to the touch.
Dr. Raphael said that they will smooth out with time. In addition, he said that it is helpful to massage them to break down the scar tissue.

March 2010 : Post-revision

Dr. Peter Raphael offers free revisions following his bilateral mastectomy. He trimmed a small amount of excess fat of the sides of the scars, underneath my arms. The revision eliminated the “dog tags” and I am very pleased with the results.

I’ve regained all of my sensitivity, even on the nipples. However, there is still some residual nerve sensitivity, particularly on the nipples and just below them. It is uncomfortable to pinch that area between my fingers because it causes a sharp/tingling feeling that is very unpleasant. However, that doesn’t bother me.
Dr. Raphael was very intrigues when he performed my revision. He said it was unusual for patients to have the high sensitivity in and around the nipples that I regained. He said it was normal to redevelop sensitivity, but apparently he felt that mine was unusually above average. This is just my personal speculation, but I often wonder if the higher sensitivity can be attributed to my chest workouts. It’s certainly true that chest presses will bring a lot of red blood cells to the pectoral muscles. Perhaps the increase in red blood cells accelerated the nerve regeneration, but it could be unrelated.