Hi everyone, currently recovering from the touch-up chest surgery and I happened to see a lot of info online in English that was different than what my Swedish doctors/surgeons said, so I thought I'd talk about it here a bit. This is all from what I remember, so don't trust it completely.
As background info, transgender surgery in Sweden is free because it's counted as "necessary surgery" (same as heart transplants and stuff), and comes in two parts, an initial and a touch-up. It's done by a normal plastic surgeon, that is to say, they also handle burn victims and normal breast surgeries and stuff. You only have to pay for your meal costs at the hospital, which is $10-$20 a day, and the normal entrance fee you have to pay whenever getting any kind of appointment, which is like $20 USD or something). You don't have to be a citizen to get top surgery and hormone therapy but you DO have to be one to get bottom surgery. You can't just travel to Sweden and magically get it either, you have to go through the Swedish screening process (meaning: mental testing and hormone therapy) before you're allowed to get it.
The first surgery is the "major" one, they remove almost as much breast tissue as they should and stretch out the nipples and whatnot. If they remove too much tissue on accident then your chest will look concave, which is part of why they do it in two surgeries like this. You go "asleep" during the first surgery, so you don't remember anything. I got that surgery where they just cut around the areola, not the one where they cut underneath the entire breast. The last time I ever wore a bra I was something like 32DD but testosterone moves your fat around so your breasts shrink a bit, so I don't know what I was specifically right before the surgery, but probably a C.
You stay in the hospital for a certain amount of time afterwards (time depends on how fast you seem to be healing, if you feel dizzy etc), and these initial bandages stay on for 3 weeks. They give you pain medicine - I got something or other and morphine pills, the morphine made me throw up (only in pill form, I had no side effects from whateer they gave me during the actual surgery) but I was fine with not using them. You actually shouldn't skip taking the painkillers they prescribe even if you think you don't need that much because the pills ALSO help beat down any possible fevers. The amount of pills last about 2 weeks and by the end I got a bit of withdrawal from not having them.
You can't get the bandages wet, so I did stuff like showered with a plastic bag for a shirt (got someone to tape the top/bottom of the bag a bit so that it fit close to my body). If you want to know more about the before-surgery preparations, how it was at the hospital, how the hospital room was, etc, just ask and I can tell you.
After those three weeks the bandages come off at a clinic, they clean off the dried blood and take out the stitches that seem loose - if you had any swelling that you didn't notice until now, (as in blood coagulation) they drain it at this time. I asked them about it and the stitches are made out of "some kind of nylon I guess", in any case they don't dissolve and you're supposed to take them out yourself when you see that they've come loose. They asked me if I had a binder, I said no, they said "normally in these cases we tell the person to just wear a sports bra but obviously that won't work for you" and then the nurse went to get me a "binder" herself. It was literally just a cut-off piece of a giant tube of stretchy medical fabric. That is to say, it was a self-made tube-top. I was to double this up so things would be a little tighter and warmer, and then I was to hand-wash it every night.
They said "it's very important to keep medical wounds warm because the cold slows the healing and actually will feel painful. Having a slight pressure also helps it heal better, and the binder helps with both."
I had to put what I guess is called a compress and some gauze on. It's like a piece of webbing that has special wet stuff on it specifically so that it doesn't stick to your wound, and then there's something more like normal gauze that you put on top of that. I taped it in place with medical tape, also called "porous tape" or "paper tape". This is special tape that activates its glue thanks to BODY HEAT, so after putting it on you press your hand overtop the tape and hold it there for 1-2 minutes so that the warmth of your hand together with your chest underneath makes it stick better. I was to shower about once every 3 days at most, I think it was.
Some months later comes the touch-up surgery. Your nipples or areola or whatever have been surgically stretched out big at this point, and so what they do is change them to be a smaller size while also correcting any obvious lumps of breast tissue where they took too little in one spot. This surgery is with "local anesthesia" which means they only numb around the specific parts of the body that are being operated on, so you're actually awake and can talk and feel them doing stuff throughout the entire surgery.
It's a strange feeling. You can feel the pressure and heat of their hands, but you don't feel any pain (except for if you need more anesthesia). So you can feel when they're tugging at the sewing thread for example, but it doesn't hurt. You're released from the hospital immediately afterwards. In my case, both times the right breast healed more slowly than the left and during this touch-up surgery, the right needed a LOT more anesthesia compared to the left. I wonder if it's because I'm right-handed.
The original operation bandages for the touch-up surgery come off after just one week, and after that you have to put that "paper tape" directly onto just the incisions (the incision area only, not the entire nipple and whatnot). This is because tape tricks the body into thinking that there's already a layer of skin there, so the scars that form aren't as bad. You change the tape as LITTLE AS POSSIBLE, because when you change it often you're just irritating the wound/scar area more and more and possibly ripping off new skin that's actually healing and so on. You can shower as normal with the tape on. You don't put any compress or anything else on top. You'll get an appointment at the clinic/hospital for them to check up on how you're doing 3 months after the touch-up surgery, I haven't gotten that far yet.
Costs (all are estimates, I can possibly dig up receipts if someone is REALLY curious):
— Food bills from the hospital + entrance fee: $100
— Two rolls of medical tape (for 1st and 2nd surgery combined): $10
— Box of gauze square thingies (for 1st only): $7. Possibly used two boxes.
— Boxes of sticky webbing stuff (1st only): $10 each I think. Had 5 boxes or so, don't remember.
— Before-surgery body-cleaning soap stuff (2nd surgery only; 1st was free in the hospital): no idea but less than $20.
— Binder: free (nurse gave it to me)
— Roll of porous tape specifically for touch-up surgery: free (nurse gave it to me)
— Hotel + Transportation: free because they just made the surgeon(s) travel to the hospital closest to me instead of making me travel to them, and my wife's parents drove me both times. Apparently when they want to save costs they make the surgeons travel to you, probably because you can bill the hospital with your travel costs...?
Now, the differences I've noticed between what these guys said and what I read online in English:
0. You don't pause or quit taking hormones before the surgeries. The nurses all say that missing or delaying an injection can be really bad for you. By the way, here you pick up the testosterone yourself at the pharmacy via prescription but it's illegal to inject yourself with it or get someone else to do it for you, you have to get a nurse to do it every time. This is because if you do it wrong you'll get heart attacks among other things.
1. Which type of chest surgery is done, and possibly whether or not you need drain tubes, depends entirely on the elasticity of your skin, NOT on your breast size or "body type". The surgeon said he didn't know if I'd need drain tubes or not beforehand but it turns out that I didn't. If you eat junk food and smoke, predictably your elasticity is a lot worse. If you want info on a super great diet then you can ask me.
If you're curious about how much smoking really affects the healing time - I knew a guy who didn't quit smoking for the first surgery, and he had to stay in the hospital for two weeks afterwards because he was healing so slowly. I've never smoked and I left the hospital after two days.
2. They automatically send the breast tissue they've removed to cancer and disease-checking services for you, and then later you get a letter saying if they found anything or not. Also before the surgery you can sign a paper allowing them to take photos during the surgery in order to share with student surgeons if you're okay with it.
3. They didn't specify how long to keep taping after the touch-up surgery but certainly longer than "one week" (as is what I saw online once).
4. I can't quite remember what it was, but basically a lot of the side-effects I had read about online in English, these doctors said "that only happens if you have a bad surgeon". Likewise they were completely unconcerned with the idea of infections, they seemed to think the chances of infection were extremely small (and no, I haven't gotten any).
I had something more I thought I'd add but now I forgot what it was... Feel free to ask me anything you're wondering about. I haven't gone through hormones/surgeries in the USA but I did grow up there so I can answer questions about that if anyone has any. I haven't actually looked at much to do with what American surgeons are saying but I might do that and report back if I find any other differences.
