TOP SURGERY TIMELINE & DESCRIPTION -- PRIVATE: DR LORIMER & ANDY/ANDREW MELLINGTON

(Kindly given permission to copy from TMSA Facebook post )

I thought I would write up my process/timeline so far in the hope that it helps others. It will contain all the info that I searched for whilst researching all in one place. I am an information wh0re because it helps me to feel more in control over something that I have very little real control over, so this will be very detailed for all the other anxious babes out there!

TL;DR VERSION:

• I am 34, non-binary, not on testosterone (with no current plans to start) & had not engaged with any gender services before this, on NHS or private

• 12th June 2022: First contacted Dr Lorimer @ GenderCare

• 12th July: Psych Eval with Dr Lorimer (£300)

• End of July: Given consultation date with Mr Mellington

• 7th Nov: Consultation (£200)

• 17th Nov: Given quote & surgery date

• Quote: £7430

• Initial surgery date: 11th January 2023

• Postponed/final surgery date: 9th March 2023

• TOTAL TIME: 9 months.

DETAILED VERSION:

• 12th June 2022: Emailed Dr Lorimer with the completed triage questionnaire from his website to enquire about a psych eval for top surgery referral.

• 14th June: Got a reply offering an appt.

• 5th July: Paid £300 for psych eval

• 12th July: Psych Eval over zoom with Dr Lorimer. Cannot recommend him enough, so sweet, empathetic, funny & kind & understanding of how bullshit the whole system is. He said I wouldn't need a second evaluation (this is decided on a case by case basis & I have no idea why he felt I only needed one) unless my chosen surgeon required one. I mentioned that Mr Mellington was my current preferred surgeon.

• 19th July: Draft of Dr Lorimer's report sent for my approval to check the content/names/addresses/pronouns etc.

• The report came in the post shortly afterwards & I assumed I would have to contact Mr Mellington/Nuffield myself but next thing I knew, a letter came from them giving me a consultation date which I was really surprised by! I'm assuming that Dr Lorimer's office must have forwarded my psych eval report/referral to them directly but I had no idea that was happening. The consultation appt letter was dated 27th July so they must have done it super quick!

• Initial consultation was for 14th November but on 5th October Claudie emailed me saying they had to reschedule it for the 7th Nov instead, I was obvs v happy to have it sooner!

CONSULTATION

• 7th November: Consultation! Had to fill in a basic info form at reception & they took a zero swipe from my debit card (it doesn't charge you anything, I imagine it's so they have a card on file?). Had to wait about half an hour past my appt time to be seen. The person I'm dating came with me & Mr Mellington allowed them to come into the consultation with me. He started off by asking about me, my lifestyle & hobbies, and my gender journey as it all feeds into advising the best options etc. It also made me feel like he was interested & really cared about me as a person & what I wanted.

I explained that I was mostly concerned with aesthetics & wanted as natural-looking a masc chest as possible. He talked me through the different scar options, how they work & showed me pictures of the ones he'd done & looked at the reference pictures I had brought with me. I had a v short examination behind a curtain with a female nurse chaperone; he asked me to stand with my hands on my hips and tense the whole time so he could get a sense of all the muscles. He also looks at the symmetry of your ribs & skin condition/elasticity. He was very brief & light/gentle & clinical with his touches & touched me a lot less than I expected tbh. Then I redressed & we continued the discussion.

He explained that scars that curved up at a slight right angle under the armpit would probs get me closest to the results I want because that would help hide the scar round the sides in the shadow of the pec/armpit, but that because one of my boobs is bigger than the other, there may be more puckering initially on that side but that should go away over the healing process. He drew out little diagrams to help me understand.

NIPPLES

He also explained in a lot of detail exactly how the nipples are created because I enquired about why some people have that "perfect" masc nipple with the little blob in the middle but most don’t and are flat -- he explained it's determined by the nipple you have & because AFAB nipples are inherently different from AMAB ones, if you have tiny nipples you're more likely to achieve the little blob but otherwise it can be more difficult to get that. This really helped me to understand & better accept that I am unlikely to have the "perfect" nipples I have in my head (which is a fallacy anyway because if watching Love Island has taught me anything it's that AMAB nipples are just as varied as AFAB ones!).

I had a list of questions on my phone & Mr Mellington made sure I had asked everything I wanted but tbh he answered most of them without me having to ask. He took lots of notes the whole time & could not have been lovelier & really made me feel truly listened to & my wishes respected. It was honestly so affirming! He explained that once I received my quote in the post then I would be able to book in my date but that it was unlikely to be this side of Christmas which I was expecting anyway!

QUOTE/ COSTS

• 16th November: I knew from others that it could be up to two weeks wait to get my quote but I rang up just to see & Claudie happened to be processing the quotes from that clinic right then. She said they'd be sent out the next day.

• 17th November: I got my quote by email around midday, not by post, which I wasn't expecting! The £7430 quote includes: pre-assessment with nurses, the surgeon, anaesthetist & one night hospital stay, post-op follow-up care. My quote is slightly less & slightly more than recent quotes I've seen in this group, no idea what accounts for the variation in price! I replied to the email in order to book my date but was too impatient so rang Claudie a bit before 5pm & she booked me in over the phone. I was first offered the 29th December but didn't want to be possibly staying in Brighton over New Years or deprive my carers of their NYE! Next date was 11th of January, arriving at 7am, which I took. She said all the info will be sent out by post next week by the bookings team.

• I also asked if any possible revisions were included in the quote & she said that essentially, yes, but the process is a bit more involved/complicated than it used to be as they have to square it with the finance department.

• I also asked if I had to pay a deposit, she said no. I then asked about payment plans/arrangements & if I could pay in two halves & she said I would have to discuss that with their payment plan provider Chrysalis Finance.

• I applied for a payment plan but was rejected by Chrysalis and they wouldn’t tell me why I was rejected as apparently they’re not allowed to divulge their approval criteria. I imagine it’s because my previous annual income was not enough which was so annoying because I knew for a fact I had a job that would pay me enough to pay the loan off very quickly. This was a HUGE spanner in the works because I was unable at the time to pay for it all in advance.

• I therefore had to postpone my surgery which was devastating at the time obviously but I’m glad it panned out the way it did because the new date worked much better in terms of being able to finish the work I had on, take a month off, and have my best friend take care of me.

• Once I knew when I would have the money, I booked a new date which was 9th March. Claudie was very sympathetic and accommodating the entire time. At the time waiting two more months felt like eternity but it went by so fast.

• FUNDING

I crowdfunded over £7K which I was living off for five months as I had absolutely no income in that time (I'm a freelance screenwriter with no fixed/regular income, contracts take forever to negotiate, invoices constantly paid late etc etc, nightmare basically) so I replaced that money/paid for surgery with the fee for a writing job. I paid for both the consultation and the surgery a week before my surgery.

• PRE-OP

I had my pre-op appointment with the nurse Kirsty two weeks before my surgery and she couldn’t have been more lovely and reassuring and helpful. She took a very detailed medical history, explained everything that would happen on the day of my surgery, the day of discharge and the two-week follow up, gave me a lot of informational print outs about general anaesthetic, avoiding blood clots

TOP SURGERY

March 2023

I got an airBnB in Brighton from Wednesday 8th to Sunday 12th and had my tiddy get riddy surgery on Thursday 9th March.

You arrive at 7am and have to have already showered with the sponge you get at the pre-op appointment, and have stopped drinking two hours previously and not eaten for 6 hours. Friends/family were not allowed on the ward so I said goodbye to my bestie and was taken upstairs and shown to my room. I changed into a gown and then you get a lot of visits. The nurse explained everything to me, someone comes to take your food order (the menu is surprisingly extensive!), Andy Mellington came to do all his measurements and mark my chest with a pen, the anaesthetist came to introduce himself and explain how the anaesthesia will work. Everyone was so friendly and kind and reassuring!

I was first on the schedule for the day so I didn’t have to wait long and I really expected the nerves to kick in once I was actually at the hospital but they never did, even when they walked me down to the room outside the operating theatre and I lay down on the bed and they were injecting the anaesthesia.

I woke up in the recovery room and just remember being super cheerful and friendly and thanking all the nurses and then next thing I know I’m waking up again back in my room. Again, the rest of the day is just lots of visits. Funny story: a doctor came by and asked me if I had peed yet and I was like “Nope!” And the nurse said “You absolutely have!” and then I suddenly remembered I had peed myself in the recovery room and simultaneously realised I was no longer wearing underwear lmaaaooo! So yeah, bring extra underwear!

The first time you need the toilet/want to get out of bed the nurse helps you stand up to make sure you don’t feel faint. Then for the rest of the day/night the nurses check on you every couple of hours and take your blood pressure and see if you need any pain relief etc.

I got a sandwich in the afternoon which I ate very slowly and managed to keep down but I threw up a few times throughout the rest of the day/evening due to the anaesthetic and couldn’t keep my dinner down for long. But they gave me anti-sickness medicine and in the morning I was fine and ate a full English breakfast with no problems. Mr Mellington came by first thing in the morning and opened up the binder/soft padding (called a gamjee) to show me my chest (incisions and nipples all covered in tape/dressings of course) which I wasn’t expecting to see until my two-week follow up so that was an amazing surprise and he took some pictures for me.

Other than the throwing up, I really had no issues. I was walking about the ward in the evening which they encouraged to help circulation/avoid blood clots, and I’ve been incredibly lucky for my entire recovery. I had no real pain, no substantial swelling, no bleeding, slept fine on my back (which I was worried about because I was an exclusively side/foetal position sleeper) and was very mobile and able to do nearly everything by myself except reach up very high for things and push/lift very heavy things.

 I had 2x paracetamol & 1x codeine on the Thursday, 2x paracetamol & ibuprofen the next morning, then 1x codeine Friday & Saturday before bed, but that was just in case pain came in the night, not because I was in actual pain. After that I didn’t take any painkillers.

I was a bit bloated and didn't poop for five days but it wasn't painful or anything. Even the binder didn’t bother me that much! It freaked me out a bit as I was really prepared for the worst. Obvs I know that everyone is different and heals differently but it felt bizarre to feel so fine.

• TWO WEEK FOLLOW-UP

Went down to Brighton to have my follow-up with Kirsty who removed my dressings and I got to see my new chest and nipples fully for the first time! She removes all the adhesive from the dressings and then gives you new ones and some micropore tape and nipple dressings to take home with you. You have to wear nipple dressings for a further two weeks (4 weeks total) and micropore tape for a further 4 weeks (six weeks total). After six weeks all scabs should be gone and incisions fully closed up and then you can start scar care — massaging and silicone scar tape etc.

Currently at 7.5 weeks and I just started going back to the gym and exercising and am at about 90% full range of motion above my head, but obviously everyone is different so listen to your body!

-Laurie

(they/them)