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Dana Rodriguez for Vox

The best $6,250 I ever spent: top surgery

I didn’t know it was the best money I’d ever spent until I’d spent it.

There’s something truly wonderful about referring to a procedure as specific as a bilateral mastectomy with a term as blandly ominous as top surgery.

Is it serious, doc? Yeah, son. I’m afraid there’s nothing to do but schedule you for top surgery.

What parts of me will be affected, doc? The top.

What are you gonna do to the top of me? Surgery. We’re going in and we’re gonna have to Surger your Top.

“Just get rid of the whole thing, doctor,” I imagined myself saying generously, swinging my legs from the examination table. “Take the whole top off. I want my neighbors to have a clear view to the sea. Give it away to the deserving poor, who may have no top to speak of. I’ll get by just fine with a bottom and a middle. No top for me — I’ll get by.”

If you’re in the market for top surgery, odds are good that you’ve spent a fair amount of time and money and fabric fussing about with what Liz Lemon once referred to as “the top front quadrant.” Recently, I took a guess at how much I spent on bras (and later binders) every year — probably somewhere between $100 and $150, depending on how fancy or flush I felt, and allowing for the occasional outlier — and figured that, garment-wise, top surgery will have paid for itself in about 42 years. All told, $6,252 out of pocket; my insurance at the time didn’t cover the procedure, or indeed much of anything. *Slaps top of roof* This baby does not exactly pay for itself!

Last year, I publicly admitted to having a body for the first time, an act so embarrassing I have still not fully recovered. The dominant story of my life as a woman had been, “I’ve never given a moment’s thought to my body, although I’m sure it’s quite nice; never been there myself, but I hear it’s lovely this time of year.” The idea of caring $6,250 worth about the shape of my chest alone, not to mention the rest of it, seemed designed to elicit uncomfortable follow-up questions. But the work of adopting a pose of nonchalance eventually felt more exhausting than anything else.

I had a particular cycle of fears that kept popping into my head: Other people wanted or needed to transition because they were legitimately trans in a way that I was not (what legitimately trans meant or why it couldn’t apply to me, I couldn’t have told you); I, on the other hand, simply couldn’t stop thinking about transitioning, which was not the same thing. Merely thinking about transitioning was somehow distinct from wanting to transition, as long as I was the one doing the thinking, which meant that I was not trans, which meant that I ought not to transition, which meant that I had no choice but to continue thinking about transition. “If only I were trans, then I could transition” — you can see how this could get old after a while, like a Stephen Sondheim song.

In the season seven episode of The Simpsons “Marge Be Not Proud,” Bart wants the video game Bonestorm more than anything else in the world but despairs of ever coming up with the amount of money it costs to get it. The ad instructs kids to tell their parents, “Buy me Bonestorm or go to hell,” which doesn’t work on his mother: “Games like that cost up to and including $70!”

I’m more of a Martin Prince kind of guy, but I’ve never felt more like Bart than I did in the months between scheduling a consultation for top surgery and figuring out how I was going to pay for it. Bart wants Bonestorm so badly that he publicly embarrasses himself, decides he no longer belongs in his own family, and winds up thumping his head against the kitchen table of his best friend’s mom, a woman who’s never really liked him but right now holds his only hope of salvation: “Tell me I’m good,” he mumbles into the table.

I don’t think she ever does; it’s been a while since I saw that episode and I’m sensitive enough about all the ways reentering puberty in my 30s makes me feel adolescent that I’m not precisely eager to rewatch a TV show from my childhood in order to empathize with a 10-year-old boy. But it’s about wanting something so badly you feel exposed and humiliated at every turn, and worrying about disappointing your family in general and your mother in particular, which carries a certain sort of transmasculine resonance (your transmasculine resonance may vary, transmasculine resonance not guaranteed).

I had friends who thought their surgery was going to be covered by their insurance company right up until the day itself, and friends whose claims were denied after the fact; I knew people whose fundraisers never made a big enough splash to even cover the cost of their pre- and post-op prescriptions; someone whose surgeon said at the last minute, just as they were going under, “I know we talked about [Technique X] but I’m going to go with [Technique Y] because I’m more comfortable with it, pleasant dreams”; people who have had to schedule revisions because they had been forced to choose a surgeon they could afford rather than a surgeon who had experience with top surgery. You don’t always know what it costs until you spend the money.

I paid for mine with a cashier’s check. It was the most money I’d ever spent in a single day. If living without top surgery for 31 years had a monetary value, I’d assign it something south of $6,000. (Not the living part. Living’s great. Full marks.)

One might worry a bit that it’s shortsighted to write about one’s transition for the general public, that it invites unwanted scrutiny, unhelpful comments like, “Hi, I’m some guy you don’t know and I think you shouldn’t have gotten top surgery,” that eventually forces one to turn one’s own physical history into a sort of sales pitch. (“Top surgery is not only good, it’s the greatest thing that ever happened to anyone in the history of top parts, and it’s actually heroic of me to post shirtless pictures on Instagram.”) I have no interest in trying to sell anyone on any top surgery, mine or someone else’s — it’s already expensive enough.

At least part of what I was paying for was relief from the recurrent thought that any minute, maybe now, I was going to look down and see the chest ideal snugly installed between the ribcage and the collarbone without a seam or a stitch in sight, through either surgical breakthrough or divine intervention. As soon as one gets/achieves/undergoes/receives top surgery, this future becomes impossible.

Or: It’s made more obvious how impossible that future always was! As soon as I got/achieved/underwent/received top surgery, I was released from the hope that I was mere seconds away from the perfect top surgery, scarless and painless and replete with instant running hot-and-cold sensation, and there was a great deal of freedom and relief in that. I was more connected to the imperfections of the body than I had been before, and was better for it.

After Bart has failed to convince his best friend Milhouse to let him play Bonestorm with him, Milhouse reveals that he’s grown weary of the game and now only cares about a little cup with a ball attached to it by a string: “I’m really into this cup and ball now. Whoa! Wow! [Laughs delightedly.] Man, you never know which way this crazy ball’s going to go!”

Transition isn’t a consumer good you purchase, but if you want top surgery, someone still has to pay the surgeon. Top surgery was a working theory about my chest until it was a reality; before, we knew in part and prophesied in part, but when that which is perfect is come, then that which is in part shall be done away. (You never know which way this crazy ball’s going to go.) When I woke up in the recovery room, all I could think was, Of course. Oh, thank goodness. Oh, of course. Of course, of course, of course. But I didn’t know it was the best money I’d ever spent until I’d spent it.

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