Top surgery, like so much of trans healthcare, is a subject about which much information in desired, but little is available from trusted sources. Every surgeon has their own particular instructions on how to prepare and heal, and most of them do not have good websites. I personally don’t know how anyone transitioned before the advent of YouTube (I guess talking to other people in real life?), but random people in the internet may or may not be good sources of knowledge about a complex medical procedure.
To help solve this problem, I want to offer some basic information about how Chinese Medicine thinks about surgery in general, and top surgery in particular, and then outline some basic steps that you or a loved one can take to have the best possible experience.
First of all, what do we really mean by the term top surgery? This is really an umbrella term for a few different procedures that reconstruct a person’s chest to have a flat appearance, if that person has grown breast tissue that they do not want. Most people who undergo such procedures are trans-masculine and non-binary people. Broadly speaking, there are two categories of surgeries: the kind that use long incisions to remove tissue and re-size nipples, and those that use only a small incision near the nipples. The first kind is used for most people who have a B cup or larger, which the second is reserved for those who have a small amount of tissue to remove. While the procedures involving only liposuction and a small incision are less invasive that those where more tissue is cut away, they both require recovery time and can be hard on the body.
A key thing to know about surgery is that the body does not really differentiate between a surgical procedure and a stab wound.
A surgical cut is much cleaner than the average wound, and is closed with staples or sutures to increase the speed and comfort of the body’s repair cycle, but it stills goes through all of the regular stages of the healing process.
In Chinese Medicine, all wound healing has three basic stages:
- First stage wounds and injuries are characterized by heat, severe pain, and swelling. This stage can last anywhere from a few hours to several days, depending on the severity of the wound. In this stage, we want to help the body clear away the damaged tissue, which we consider a form of toxicity, and dispel the heat of the inflammation. We use cooling, fluid moving and blood moving herbs, either internally or topically, to help this stage resolve as quickly as possible.
- The second stage begins when the heat in the injury subsides. There is still Qi and blood stagnation in this stage, as the body continues to mobilize resources into the area, and this congestion can cause stiffness and pain. This stage is where the incisions begin to consolidate into the beginning of scars, and we want to keep Qi and blood moving so that all incisions heal quickly and with minimal pain.
- Third stage healing is the cleanup phase, where all incisions have fully closed and scarred, but there can be lingering pain and stiffness, and sometimes numbing or other odd sensations. A fresh wound is vulnerable to the environment, particularly to dampness and cold, because the skin is open and Qi and blood are not not circulating normally in the area. If dampness or cold become lodged in the tissue, chronic pain and stiffness can result. Is this stage we focus more on using herbs that warm tissue and expel cold and dampness, as well as moving Qi and blood.
The body does an excellent job of rebuilding itself after being damaged, and our goal with natural medicine is to help modulate the body’s actions and make them as efficient as possible. The third stage of healing need not become chronic, so long as the first two stages are managed well. However, if there are complications then chronic symptoms can arise.
A variety of issues can arise as a result of even uncomplicated surgeries.
First, scarring. Sometimes people’s scars are larger or most noticeable than they would like. This can occur from moving the arms too much during the first few weeks after surgery, and sometimes can just happen even if utmost care is being taken. Life happens. Keloids can also occur, and may be more likely to form in those with darker skin. A keloid is a hard growth of scar tissue that is raised, hard, and smooth. It is not dangerous or malignant, but it can be more noticeable than non-keloid scar tissue. Most scaring is considered an issue of blood stasis in Chinese Medicine.
Second, restricted movement. If scars do not heal well, movements involving raising the arms or turning to the side can become more difficult because of the pulling effect. Qi and blood stagnation in the channels that were cut into is usually also involved.
Third, numbness/loss of sensation: some surgical methods involve cutting the nerve stalk that connects the nipples to the rest of the nerve structure of the chest. This causes of loss of sensation, and can also lead to numbers or tingling in other parts of the chest in some cases. This is often due to dampness or wind that has sneaked into the area, and become a third-stage problem. And fourth, pain. Pain from surgical wounds can persist beyond full healing. This is generally, but not always, seen along with some numbness or loss of sensation.
Acupuncture and Chinese herbs can treat all of these issues, even years later. A combination of herbs, acupuncture, gentle movement and appropriate dietary adjustments can continue the healing process in gentle, but effective ways. However, the goal of this article is to help you reduce the chances of any of those things from happening in the first place! With that goal in mind, here are some steps that you can take to prepare your body for surgery and recover well.
Before surgery
- Take good care of yourself in general. Eat nourishing foods, get plenty of sleep, and exercise in ways that feel good to you. The better you feel before surgery, the better you will feel afterwards.
- Take some herbs. Much of the difficulty in healing from surgery comes from the blood loss inherent in the process. Taking herbs that help build blood prior to the procedure gives the body the most resources possible to do the job.
- Treat any underlying health concerns. If you have digestive problems, breathing issues, chronic pain, or anything else that is really bothering you, surgery is going to add stress. Most people get a date far in advance, so plan ahead and access as much care as you can beforehand.
- Supplement strategically. Vitamin C, Zinc and Selenium are all involved in the process of synthesizing collagen, which is the main building block of new tissue in our bodies. They are cheap individual supplements to buy, and you can take them in the weeks leading up to the procedure, and then start again a few days after.
After surgery
- Take some herbs, again. Faster and less painful healing is a huge win. We like to prescribe Wangbuliuxing Tang (Vaccaria Seed formula) 2 weeks before and 2 weeks after surgery. This is an
Wangbuliuxing the active herb in the formula for treating wounds by metal herbal formula traditionally used to treat cuts from knives. It speeds things up by moving blood and fluid, and treats pain quite well.
- Get some acupuncture. Acupuncture treats pain, reduces swelling, decreases scarring, and helps people recover emotionally from the difficult experience of a medical procedure.
- Follow the instructions of your surgeon. When they say not to lift heavy things, please listen. Ditto for raising your arms. Try to set up your living area so that everything is at waist height, and ask for help if you can’t reach something. Your future self will thank you.
Lastly, I want to say a bit about the emotional experience of top surgery.
As I said earlier in this article, our bodies don’t really know the difference between an on-purpose surgery and a stabbing. This is also pretty true of our minds/psyche/spirit. Mentally, we may be excited about one and fearful of the other, but a sharp metal object is piercing our skin either way. This is important to understand, not only to frame the steps of healing, but also to put into context the feelings that can arise after going under the knife. People are generally quite happy to be in a body that feels more aligned with their felt sense of themselves, but there can also be powerful feelings of helplessness, fear and even anger that arise after waking up covered in bandages and in pain.
Bearing this in mind, it helps to do everything that you can to create a cozy and loving environment for yourself or your loved one to settle into once they leave the surgery center or hospital. Comforting foods, movies, careful snuggles and pet friends can all help people return from the experience more quickly and fully. Give yourself space to feel whatever you feel, and know that the scary stuff will pass.
Much thanks to Hamilton Rotte, who provided the bulk of the information about the three stages of injury healing. More information about his work can be found by clicking this link.