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The Realities of Top Surgery & How Transitioning Changed My Life

Xander Perez, 26, offers an update on his experience and recovery from top surgery and how it has taught him how much he can handle.

July 27 came sooner than I ever expected. It was top surgery day. I woke up feeling pumped, much earlier than I needed to. I wasn’t tired. I was ready.

We blasted music the whole car ride to the hospital. My wife, Rose, was crying. I was crying. There’s been a lot of crying since I began my transition journey, but in a good way!

Check in at Jefferson Washington Township Hospital was at 5:30 a.m., in the new Silvestri Tower, which looked and felt like a beautiful five-star hotel. It was so exciting. I was almost in disbelief. Was this really happening? Did I deserve it?

The reality of it all didn’t hit me until I was in pre-op. There was a constant buzz of activity around me as I got ready. Gown on. IVs placed. Vitals taken. Belongings put aside. Then my anesthesiologist came in. This was my first surgery and my excitement briefly turned into fear.

Dr. Susanna Nazarian, my breast surgeon, came in next and swept away my doubts. She closed the curtain, looked me in the eyes, and asked how I felt. We sat and spoke privately until I felt ready again. It was some of the most genuine support I’ve ever received.

Xander with Dr. Nazarian in the hospital room pre-surgery

Xander with breast surgeon Dr. Susanna Nazarian after his surgery.

I don’t remember leaving that room. I just remember waking up; it was done.

In the Room Alone

Xander in his hospital room post-surgery

Xander recovering post-surgery.

It’s scary – for the lack of a better word – to recover in a hospital bed alone. I know many people have gone through this during the pandemic. You might be able to call or text loved ones, but it’s not the same as having them there with you. It was difficult to wake up alone – a changed person – when I wanted to share that moment as soon as I could.

I knew my wife wouldn’t be there when I woke up from my surgery. She needed to watch our baby daughter, who couldn’t come into the hospital due to COVID-19 visitor restrictions. What I didn’t foresee was the panic attack that gripped me. It was nobody’s fault. All of my providers had come to check up on me. There was no lack of compassion. I was just anxious.

I didn’t even realize how much it was building. One moment, I was talking to my overnight nurse, Connie Leming, then suddenly, my throat felt like it was closing.

Connie recognized what was happening, held on to me, and helped me take deep breaths. After it passed, she helped me get up and move around – shake off some of the nerves – and get cleaned. I felt so much better. I can’t thank her enough for the time she spent with me – truly wanting me to be OK.

When I reflect on this, I think I was meant to go through this part of my journey on my own. It was my body, my decision, and my bravery. Even though I missed my wife and our baby deeply, I learned a lot about myself – about what I could handle. I made peace with my thoughts and realized that this was something I deserved. It was bittersweet, but in that time alone, I realized one of the most important lessons of my life.

Going Home to My Wife

The moment I was able to see my wife again, after what felt like one of the longest days of my life, was well worth the wait. She came to surprise me before discharge.

Cue the crying, again! We were speechless. It was the best feeling in the world to have my wife share that with me.

The Risks & Realities of Top Surgery

On my first morning home, my wife and I immediately noticed something wrong. There was significant swelling under my right breast, and my pain was getting worse. We called Dr. Nazarian, who instructed us to go back to the hospital as soon as possible.

Xander taking a selfie of his chest bandages post-surgery

Selfie of Xander while recovering post-surgery.

I had a type of hematoma; I was told it wasn’t a typical hematoma. It was likely caused by trauma to the area. My cat jumped on my chest overnight, but I didn’t think anything of it at the time. A hematoma usually involves a buildup of blood that needs to be flushed – mine was less blood, more swollen tissue. It still had to be surgically treated, but it wasn’t too intensive and didn’t take that long.

Hematomas are a rare side effect of surgery, but, generally, are more common after a double mastectomy (or top surgery), Dr. Nazarian told me. Usually, they’re not serious and easily fixed. Fortunately, this was true with my case as well.

However, a couple weeks after my hematoma was flushed, an infection developed near the drain site. When I first spiked a fever, I was hesitant to call, but I knew it was a warning sign and that surgical infections can and do happen. Infections are no joke. They put you at risk for sepsis, so, I had to stay in the hospital for several days. At home, I stuck to a course of antibiotics. The infection cleared, and the swelling continued to go down.

I’ve followed up with Dr. Nazarian and Dr. Eric Chang, plastic surgeon multiple times since. Overall, they are both confident and happy with how I am healing.

One of the most challenging parts of recovery, though, was more emotional. It didn’t dawn on me that I wouldn’t be able to pick up my daughter for a while (five days – and, yes, I counted them down). I’ve never had to sacrifice that before.

Each day, I feel a little better. I’m slowly re-building my energy and range of motion; although, my right side is a little stiffer still. I don’t like to sit, so resting has certainly been a challenge!

The Journey Continues

I’ve cried so much; I don’t think I have any tears left to give. I’m still adjusting to how “real” this is. I’m still surprised when I wake up in the morning and look in the mirror. I can wear some of my favorite shirts that didn’t fit me well before.

I carry myself with more confidence. I haven’t been able to find the right words – put all the pieces of this puzzle together – to give justice to how amazing I feel.

Xander at a follow up appointment post-top surgery.

Xander at a recent follow-up appointment post-surgery.

One of my first social gatherings since surgery was my daughter’s first birthday party. That’s when I felt a significant difference in how I perceived and presented myself. Some people know about my transition; others don’t. But I didn’t have to think about it. I didn’t get asked how I identify because I’m “passing” as a guy.

I have faced hurdles with recovery. With any surgery, there are inherent risks you have to understand. If you suspect any problems, it’s important to address them right away. Through all the “ups and downs,” I’ve had a dynamic care team at my side. I’m so appreciative of everyone who has helped me get to this point.

I know this isn’t the end of my journey. There’s so much to look forward to. I still have a lot to process, and I’ve been doing a lot of self-reflecting. Right now, I’m focused on healing and taking each day one step at a time.

What led up to Xander’s top surgery? Read about the start of his medical transition here.

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