Tam Alexander sat in the doctors office thinking purposefully about how life will change after the procedure just completed.
“I have been wanting to do this for as long as I can remember,” they said, after receiving gender-affirming top surgery one week prior.
Alexander’s pronouns are they/them as they are nonbinary and identify as neither male nor female.
Alexander was in for a post-surgery follow-up with Amie Hop, MD, at Corewell Health’s Spectrum Health Medical Group Comprehensive Breast Clinic.
Dr. Hop, who prides herself on providing a safe and affirming space for everyone who sets foot in her clinic, has helped hundreds of people with similar procedures. Alexander marked the 300th top surgery patient milestone.
Top surgery is a procedure that removes breast tissue and reshapes the chest to create a more masculine appearance.
A big change
“When I was very young, I was attracted to both boys and girls,” Alexander explained. “I liked pretty boys and boyish girls. I didn’t know there were words for these feelings back then.”
Alexander struggles with gender dysphoria.
In Alexander’s case, much of this stemmed from not feeling comfortable with the gender assigned at birth.
Alexander finds peace through these challenges by spending time with their emotional support animals.
“I help to take care of the feral cats in our area. I have even taken some to the vet to get them fixed, checked out,” they said.
But on this day, Alexander was the one being taken care of.
“I start exercises today too for my chest, shoulders and arms,” they said. “And I’ve been filling out my drainage log so you can see how that’s going.”
Alexander said their entire family has been accepting throughout the process, but some still have some questions.
“I didn’t want to be male or female,” they explained. “I wanted to be neither … or androgynous.”
They said they are not taking any testosterone and had a hysterectomy a few years ago.
Their dream realized
Dr. Hop entered the room, and a big smile came across Alexander’s face.
“Do the bolsters come off today?” Alexander said. “I have been feeling this crackling and itching. It almost feels like everything is coming back online.”
Dr. Hop said pathology came back normal and everything looked good, but the drainage was still working its way out.
“I was always trying to hide my breasts,” Alexander said. “I was teased as a kid for not wearing a bra and I knew as early as high school … I didn’t want to be a woman. But I was still attracted to male and female.”
They said labels are so complicated and they didn’t want to be defined by them anymore.
“I’m just me,” they said.
This is the second time the bandages came off, as Dr. Hop helped put on a double bind to wrap the chest tight.
Alexander’s breasts were a 52 DD and weighed 3 to 9 pounds each prior to surgery.
“I was carrying the equivalent of two five-pound bags of sugar on my chest,” Alexander said. “This feels great,” they said pointing at their chest.
“The arms and belly come next. As soon as I can, I’ll be working on them,” they said.
“We can try it out without a binder if you like,” Kimberly TexleyQuigg, WHNP, certified obstetrics and gynecology nurse practitioner, said. “Maybe just an Ace wrap or something similar.”
She explained the possibility of phantom pains to Alexander.
“It can feel like a little electrical shock,” she said.
She explained that next they will prepare a dressing over the nipples, which will need to come off within a week.
“Take a nice deep breath,” she said as she removed the drains and gauze to reveal Alexander’s new chest.
“I have been trying to get this surgery for years,” they said. “I finally came here and the process was seamless with no discrimination. I even thought about no nipples, but decided I liked it this way.”
They slowly stood up and looked at their chest for the first time.
“Oh my gosh,” they said. “It’s so amazing.”
They stood sideways and looked at their profile in the mirror.
“I have always carried my chest high,” they said. “Oh my God, this is so cool,” they said turning side to side in front of the mirror.
Ediana Hoxhallari, MD, a resident physician at Corewell Health, assisted the surgery with Dr. Hop and stopped in to see the new Alexander.
“How’s your back feeling, my friend?” she said. “I’ll bet it’s a lot better with so much less on your chest.”
Dr. Hoxhallari performed the procedure on one side, and Dr. Hop did the other.
“I have been doing these surgeries for three years now,” she said. “I’m hoping to do more top surgeries in my future career. I have done six so far.”
Recovery is different for each patient, but Alexander seems to be doing well according to the medical team.
“The nipples take a few weeks to attach,” Dr. Hoxhallari explained. “They will eventually scab over, the scabs will fall off, and they will heal naturally.”
She explained that the procedure makes the areola and nipple smaller in order to look more like a male nipple.
Dr. Hoxhallari said the mental health benefits of this procedure are a game changer.
“There are so many things that trans and nonbinary people have to go through that many of us will never know about,” she said. “If there is anything that can make them feel better or more at ease with who they are … we want to do it. This is as necessary as any other medical procedure we would do for any other condition.”
“Again … this is amazing,” Alexander said as they put their shirt back on with no binding or wrappings.
“Thank you for being on this journey with me,” they said. “I will always remember you.”