One and Done

By Noah Grey Rosenzweig 

As we drive to Maryland, I think of the scalpel. How sharp it must be, to cut through all seven layers of skin, of fat, of muscle. The exacting slice of nerve endings, deadening all feeling with a decisive swipe. The cold, viscous roll of my stomach is unending—I turn to stare out the window and imagine myself outside, standing still and on even ground, though the car is going so fast I barely feel the road speeding below us.

Water. Water, water, water, I think as my friend and boyfriend chat from the front and back seats. How can any person go twelve hours without water? My thoughts swing wildly from the silver gleam of the operating room to the sandpaper feel of my mouth, the scratchy cotton dryness in my throat. I want to relax, I want to tell my panic that in a few hours, maybe only two, I can have as much water as I want. Everything is fine.

But this is too real. We are hurtling towards the irrevocable, the permanent, the unchangeable scythe of the surgeon’s blade.

My friend, boyfriend, and I pull into the parking lot of the small, squat brick building. The pillows piled in my lap are sweaty with my handprints, my beanie pulled low over my eyebrows to hide my freshly buzzed head. The surgery center is one story of dark red brick, with four or five different entrances—it’s got the look of every middle-of-nowhere strip mall. The lot is nearly empty. It’s 7:15 a.m., and we’re early, but only just. I press my hand to the soft curve of my chest under the binder, heart sprinting to meet my palm. My boyfriend gets out of the back seat, pulling his phone out of his back pocket as he straightens up, tapping “record” with a slim finger. His voice is steady when he asks me, the phone held between us, “What are we doing today?” I look up at the camera and tilt my head, squinting against the sun and the fear.

“Getting top surgery,” I say. When I watch that video now, nearly three years later, I’m glad that I didn’t know what was ahead of me, that I would say these words not once but twice.

***

Seven weeks earlier, I stood in the kitchen, binder wrapped snugly around my rib cage, telling my boyfriend how impossible it would be to get the thing I most wanted. We were only seven months into COVID-19, still thinking the world might change back on a dime. But something had shifted irrevocably for me, as it had for millions of others while we stayed home in lockdown.

I realized that my body was truly mine and every choice I made could be mine, alone. The dread of putting on and taking off and putting on a binder just to exist comfortably in my own apartment could not go on. Previously, I worried that I was only trans when other people were looking—perhaps it was some outside pressure that made me desire to be seen as masculine. But six months inside, with only my dog and boyfriend for company, proved what my body had already known. This decision was always coming, and the pandemic produced the perfect opportunity for me to make the choice freely. And then I picked up the phone and made the call.

I drove an hour each way for a fifteen-minute consultation. The office was clean and bright, staffed entirely by women, and my surgeon is a trans woman, so I felt a gentle kinship: she must know the fear I was feeling, asking for something that felt taboo to want. She was kind and soft-spoken and answered the questions I had typed up, printed out, and carefully folded into a small, jagged square that I now unfolded with shaky hands. Had anything gone wrong in previous procedures? Could she replicate the results I’d printed out? Did she think I could do it? I wanted to ask her if she thought it was the right choice. I wanted to ask everyone I knew if they thought it was the right choice. I agonized over whether or not to get top surgery each week in therapy. I begged my therapist to tell me what she thought I should do. I wanted, nearly more than I wanted anything else, for someone to make the hard decision for me.

The weeks between the consultation and surgery date were filled with a kind of giddy despair. I swung wildly through my emotions, one day wanting to cancel it altogether, another wondering why I had not taken the earlier date I’d been offered. I returned to my old and terrible habit with fervor: checking and rechecking the Instagram accounts of other transmasc people with large followings, watching them post about every minute of their top surgeries—their perfect results. I was insatiable. I watched every video, read every caption repeatedly until I had memorized them. This experience, put so brightly on display by these creators, was unknowable to me no matter how many posts I pored over. And these creators, these transfluencers, all had a number of things in common: they were thin, muscled, and white. This particular subset of the trans community takes up an enormous amount of space online—they go to The Surgeon in Miami or Davie, Florida, and come out with results so perfect they hurt to look at. Each one so similar to the next, the assembly line of perfect bodies and perfect top surgery results.

There is no room on Instagram for error. If your results are not perfect, don’t post them. That white, eurocentric, androgynous beauty that we see as the pinnacle of transness is held up over and over. And selfishly, I thought, perhaps I could look like that too. I’m white, but not thin. Always a bit too short and stocky—too masc for the girls, not masc enough for the boys, the strange limbo of queerness and gender refusal. In my mind, I superimposed my body over those white trans boys, trimming the fat around my hips, my chest, my legs, stretching myself to be taller, trying to will it all into existence. It was the thinness, over everything, that I craved. If I just worked out more, if I ate fewer meals, if I counted my macros, would I, too, be the perfect candidate for top surgery?

And I wanted those perfect results. It would be a lie to say I would have been happy with anything. I wouldn’t have. I wanted perfection. I drew the shape of the scars I wanted in the corners of my notebook like a schoolgirl with a crush. I wanted. Desperately.

***

Miraculously, I survived the blur of anxiety, nausea, and desperate dehydration of the car ride to Maryland, and we pulled into the lot. The surgery center was so small that I walked, side-by-side with the anesthesiologist, back to the operating room. Halfway to the OR, I felt a sudden, animalistic fear. I turned to the anesthesiologist, Melissa, who was smiling warmly at me. I wanted to tell her, I want my mom, can you please call her, I need her to tell me I am okay, but instead, I said “I’m scared.” It was all I could manage. She nodded, face crinkling into a motherly smile.

“Don’t be scared,” she said as tears welled in the back of my throat. “Today is a big day. And it’s going to be good.”

We stepped into the OR, and she gestured for me to hop up on the table. They had given me Xanax, but to this day I’m not sure that it even touched my emotions. How can anything protect you from the fear of the unknown? An hour and a half later, my boyfriend wheeled me out to a friend’s car. My boyfriend and I would spend the night in a hotel nearby and come back to the center the next morning for a post-op checkup. We would return a week later to get the drains pulled out—one for each new scar, held in place by a single stitch under each of my arms.

The next morning, I was back in the surgery center for a post-op checkup. They explained, weeks in advance, that exactly a day after surgery the nurses would pull everything apart again to make sure it all looked right. The main concern was that I might develop a hematoma, a swelling collection of blood under the skin that isn’t necessarily life-threatening but would certainly ruin the aesthetic of my results and would maybe turn out to be detrimental to my health, after all. I gingerly laid myself back on the exam table where the nurse, with practiced and brisk motions, unzipped the vest I wore and found the edges of my bandages. She did not tell me it was going to hurt, but I braced myself anyway, stiffening as much as my body would allow.

The sharp tear of the adhesive pulling away from my skin was a burning, hot and fast. And then, for a brief and dizzying moment, I realized I could not feel my chest at all. Perhaps below my neck, where I did not dare to look, there was nothing left. Just an empty body cavity, one large wound, swollen and stinging from the pain. I kept my eyes fixed on the ceiling, away from this gruff nurse and the war zone that was possibly my chest and possibly a gaping hole. A tear slid out of my left eye, hitting the table with a quiet pop. I breathed in, shallow and fast, afraid to take too deep a breath and somehow cause myself to bleed out.

The nurse nodded to herself, and told me everything looked good so far, would I like to see? It wasn’t really a question. She had been in this room, shepherding hundreds of people before me into an upright position so that they could look in the mirror and “see themselves for the first time.” It’s the “big reveal,” the moment that garners tens of thousands of views on Instagram, TikTok, and Twitter. That small, muscled, perfectly shaped transmasc person walks up to the mirror, arms held in an awkward lift away from their sides, their shoulders stiff with soreness and fresh pain, to see themselves in the mirror. And then they grin and then they cry, because it is perfect, their masculine body, so lithe and lean and strong, those brand new incision lines perfectly placed, their re-sized nipples two bullseyes in their chest marking them as masc, marking them as good.

She levered me up from the table, and I slid myself off and into a standing position, shuffling towards the mirror to see my chest for the first time. The same moment that I caught my reflection in the mirror, gravity failed. The floor dropped out underneath me, becoming nothing but black space. I swayed but remained standing. The body I was looking at was puffed up in a postmortem way, mottled with bruising. A single, thin line of blood dripped down my left side, a place where the adhesive had ripped away a barely formed scab. Whatever sense was left in the body that I was barely tethered to allowed me to nod along as the nurse stood behind me, smiling expectantly, awaiting praise for her good deed. I turned away as soon as it felt appropriate, wanting to be wrapped up quickly, looking away from my bruised, bloody body.

I cried on the ride home and for the rest of the day. I was inconsolable. Had I made a mistake? No one else felt this way, from what I had seen. None of the hundreds of posts on Instagram prepared me for this. I felt betrayed—by my surgeon, by the people on Instagram I didn’t even know, and by my own body.

I had lost a part of myself. Even if it wasn’t a part I very much liked, it had still been mine. I’d known my chest intimately. I’d always had it, that untouched, soft skin, and now I’d torn myself apart. The new chest was raw and cruel, the incisions twisting over themselves in the tight, woven shape created by the stitches. The regret curling inside me felt taboo, more wrong than my decision to get surgery. If I regretted my choice, then I was no better than the TERFs, than the LGB Alliance, saying that people who got top surgery were making huge mistakes and would go on to hate their decisions. If I felt anguish, if I posted shame, if my trans friends heard that I had these feelings, I was proving the people who believed I shouldn’t have had surgery at all right.

That week of waiting for my drains to be taken out, the inability to shower adding a layer of grease that no bout with depression ever had, passed slowly. We filled it with TV and quiet, contented relief. I believed that the hardest part was already over. There was a final post-op visit, another moment spent laying on my back as the nurse unzipped my vest. She leaned over me, chatting about things I could not hear over the rush of blood and terror at the thought of seeing my uncovered chest. With practiced, rough movements, she snipped the stitches holding my drains in place and unceremoniously yanked each one out, the tube slithering along the inside of my new chest before popping out with a bright, sharp sting. Again I was levered up, but this time I covered my chest up myself. I knew what there was to see, and I didn’t want to look.

***

Months passed, the days and weeks tripping by, and my scars healed into two pink lines. My fondness for them grew slowly, as they flattened and turned shiny, the fresh skin a sweet pink. But it never came naturally—I felt like I was being forced into an imperfect relationship. When I spoke to the surgeon, I asked her to place the scars along my pec line, hoping to have them fall in a natural shape as I healed and built up muscle. But they did not, and with their clear imperfections settled permanently on my chest, I returned again to my old vice. I pulled up page after page of post-op posts on Instagram, reading, and re-reading, trying to find between the lines the same feelings of despair, of loss, of possible frustration with their end results. I wanted companionship, and the endless posts of good results no longer provided the sort of comfort they once had. Still, I scrolled, knowing there was nowhere else to find trans company, imperfect as it was.

That familiar twist of dread wound its way through me when I saw myself shirtless in the mirror. Shouldn’t you be gone? I wanted to ask.

But dysphoria is cruel that way, never quite leaving but shifting, taking new shape, finding a new place to settle. My surgeon had, I felt, forgotten what I asked of her moments before I laid down on the operating table. And my scars were half an inch too high, leaving remnants of tissue from my former chest sitting below. I could see my old chest through my new one—the clean break, the new start I wanted had come up short.

Top surgery, like any cosmetic surgery, is an imprecise science, made far more varied in its results due to the fact that top surgeries are in large part performed on trans people. There is no standard method for the surgery, for the aftercare, for the scar care, for any of it. All of the advice, knowledge, and support comes from a huge network of other trans people, posting questions, pictures, videos, links to products that worked and didn’t, surgeons who accept or reject insurance, and more. We are failed, continually and effectively, by medical systems that do not care about us or our bodies. And yet. There is continued hope and joy in many of these posts—the relief of being freed from our former bodies, the celebratory nature of each comment under the post-op posts of drowsy, smiling faces, thickened from amnesia. Even with this network, I felt anger at my new chest, that in its healing, it had not morphed into the exact results I’d expected.

Once more, the itch to turn to Instagram found its way under my skin. This time, along with the multitudes of posts about the joy, the freedom, the absolute certainty of perfection of top surgery, I looked harder for the stories about imperfection. Revision, scar revision, top surgery scar revision, top surgery revision, scars for top surgery revision, I typed into the search bar, over and over again, looking at the same handful of results. The longer I looked, in the depths of my punishing addiction, at perfect result after perfect result, I realized that I still wanted something—I wanted to post my chest on social media with abandon, with the confidence of that word, “perfection,” buoying me against it all. I wanted to believe that the perfection I had spent hours scrolling over was still available to me, even as I knew that the results of my first top surgery rendered the perfection I had brought myself to tears over unreachable.

A year and a half after the first phone call, I again found myself leaning against the kitchen counter, phone pressed to my ear, calling a new surgeon’s office to schedule a consultation. His office was high-end, the way D.C. offices are—the countertops marble, the mini fridge stocked with mini waters. I had hoped he might offer a solution to the extra tissue beneath my scars, that stubborn reminder of what had been there before, but wasn’t sure it was possible. Moments into our meeting, he looked up at me.

“I can get the extra tissue out with a full scar revision. That way, your scars will lie flat to your chest, and they will also be lower. Right now, they’re a bit too high.”

How can two and a half years disappear? I learn, with a sentence.

We stood up, shook hands, and less than fifteen minutes after the surgeon walked into the exam room, I was stepping out into the warm, damp D.C. air, my undergraduate school close by, my new apartment just up the street—all these places where I had decided my life could be more than what it had been for so long. I unlocked my bike, pulling the handlebars closer to me before tilting them just off to the side, swinging my leg over the frame and pushing off, the end of summer filling my nose as I biked to work.

The second car ride was a quick fifteen minute drive across D.C. I was allowed to have water until 8 a.m. that morning, and I downed cold glass after glass, trying to hydrate myself and the person who drove out to Maryland two years ago.

The surgery center was much bigger, with a long driveway leading up to an all-glass, modern-looking entrance, and a small trickle of patients coming in and out for their various procedures. The waiting room had just two other people in it. My boyfriend and I sat side-by-side, waiting for the 12:15 p.m. slot I had been instructed to appear for. I pulled out my Kindle and read a novel, not thinking about water or my impending surgery. The slight swell of nerves was easily quelled this time around—I was only moving towards things I already knew. I’d survived the imperfect result, and I was getting a second chance. I was as untouchable as I could be going into surgery. Nearly an hour and a half passed before a nurse stuck her head in the waiting room and called out for me. I put my Kindle to sleep, and placed it in the tote bag we’d brought with us, leaned over to kiss my boyfriend, and handed him my phone. I wouldn’t be needing it, or Instagram, or the thousands of perfect top surgery results while in the operating room.

“I’ll see you soon,” I said.

The nurse in the back walked me through what to expect after surgery. We went through a long list of to-dos, of steps, and expectations, and she paused at one point, marveling at my good humor and apparent lack of nerves. For the last time, a nurse, kind and thoughtful, explained the procedure and the post-op instructions to me. I pulled a hair net over my long hair, and relaxed back in the bed as she and I chatted and laughed. I did not feel a sudden flash of panic—I could carry myself through this, this time. I continued to wait for the desperation and fear to seal my lips into silence. For the urge to run. But the surgeon walked in, drew his marker along the lines of my chest, and told me he would see me soon. I nodded.

There are no second chances. I couldn’t find more than one other person who had a scar revision, though the Facebook group I belong to has over 15,000 members. So many of us believe that it is, essentially, one and done. And then you live with it. But I had decided something different for myself. I decided there was more. Three years prior, I decided there was more than the endless pain of bruised, bent ribs, of blistered skin from taping my chest, of the overwhelming desire to go on a run and feel the smooth, flat expanse of my chest moving along with me. I would make perfection out of all the imperfect cards I had been given, and in that, I would find the kind of happiness that brings us to tears.

Now the anesthesia came quickly, sour in my nose and mouth. I closed my eyes and trusted.

About the Author

Noah Grey Rosenzweig grew up in New Jersey (home of the best bagels) before moving to Washington, DC, with his beloved sidekick, Pilot Jones. He is the editorial fellow for Roxane Gay Books and a literary agent in Triangle House Literary. His pronouns are he/they.