The Other Recovery

Handling post-surgical depression

My tits don’t hurt anymore.

Not really, not like they had for weeks after my breast augmentation. Fierce, sharp pain, hot and ruthless, whenever I moved my arms the wrong way or stood up the wrong way or tried to pick up something too heavy or put on a pullover top or—

Well… “or an awful lot,” when you get down to it. “Or most of the things I’d needed to do,” if I’m being really honest. Jumping to 900ccs of implant in your first operation demands a toll, as the implant pocket heals and your pectoral muscles slowly stretch. Now I’m just weak as a kitten, unable to even open a dryer door.

I know it’ll get better, eventually. It’s still spooky as hell right now.

But then, of course, there’s the damned elastic band. Three inches wide and wrapped around my whole chest, pressing ever-downward on my painful, new breasts. As soft as something like this can be and still work, which means it chafes my armpits every goddamned day.

I’m nestled in B—’s lap, her legs wrapped around me like a husband pillow, supporting my arms as we cuddle, together, on our grey sectional after dinner. It’s one of my favorite comforts right now, the few hours each day I feel safest.

The reminder alarm goes off on my phone. I scowl at it, then silence the damn thing.

“Time for the massages?” B— asks. She’s not really asking, any more than the “massages” are really massages. Twice a day, we do this dance. I sigh and nod, and she hooks her arms under mine to pull me into a more upright position. One of her hands takes up residence on the upper slope of my left breast, and one on the lower curve.

And she squeezes, firmly, in the way she’s learned, on the top of my breast, just enough for it to hurt a little. Then her hand relaxes, and the other squeezes, just as firmly. Back and forth, top and bottom, again and again and again and—

Seven and a half minutes go by. She switches to my other breast and starts over. Another seven and a half minutes.

It’s only exausting now. When we’d had to start, a week after my operation, it had been intensely painful.

I could never do this for long enough. The sheer exhaustion of the pain, over and over, sapped my willpower every time, so now B— does it for me. We both hate it. But we both know this is the best thing we can do to keep me from developing capsular contracture and make the girls sit properly even on my chest.

I close my eyes and fight to endure endure as anime girls coo over camping food on in front of me.

I want to cry.

My hair transplants fell out months ago, just like they were supposed to, and while they’ve started to come back in by fits and spurts, just like they’re supposed to, they’re crooked and scraggly and hopeless-looking right now. I know they’ll be better, eventually. They’re not now.

I want to scream.

My face is saggy and gross and it’s been four months since my facial feminization surgery. I know damn well that this time is a dysphoria trap, because all the swelling is gone, but my soft tissue hasn’t tightened up to the new contours of my face yet. I know it will, eventually. It’s not now.

I want to give up so, so badly.

This is my third surgical recovery this year. Not even this year. Three operations in ten months, with two more coming in the next seven.

I’m so very tired. Tired beyond words, beyond description.

I let the pit of grey hopelessness of it all yawn open in front of me as my wife squeezes pain and healing into my body for me, and I fall, fall, fall—

The pit

I love my wife more than words will ever, ever be able to communicate, for more reasons than I will ever, ever be able to list. She saved me from myself, again and again and again.

I would never have made it through the eighteen months of surgical hell I scheduled myself into without her love and care and support. Never.

I want to repeat that, because it’s important.

I had five surgeries in eighteen months. It was a terrible fucking idea, but it let me get the surgeries done that I needed done while my sabbatical ran. I didn’t trust Human Resources at my work to understand that I needed a month off after each of my breast augmentations, because I couldn’t carry the things I’d need to teach while I was on lift restrictions, or for the month or two I’d need after my FFS, let alone my other operations—operations I didn’t even want to talk to them about.

But for my sabbatical? For my sabbatical, all I had to do was read and think. That I could do while in surgical recovery. And I know exactly what an enormous privilege it was to have the chance to do any of this. If I’d tried to do it all in the regular school year, I definitely would’ve fallen to pieces and probably would’ve lost my job.

You see, there’s a part about surgery that we don’t really talk about. We should. We definitely should. But we almost never do.

Because many, many of us fall, as I did, into the grey, hopeless pit of post-surgical depression in our recoveries. As much as 25% of us.

One in four.

It’s the single most common post-surgical complication trans folks go through by a huge margin, and it usually brings a whole grim spread of extra complications as we fall into that pit, unable to care for our healing bodies the way we really ought to.

It’s not like it doesn’t make sense why—either why we have it so often, or why we don’t talk about it. These surgeries are benedictions, blessings we fight like hell to get. They often cost us huge sums of money, massive insurance fights, multi-year wait lists, sometimes even our relationships and our jobs, all to heal a hurt that we cannot live with. These are the Herculean labors our lives are burdened with, and which we must overcome to rise anew, whole and proud, or not at all.

How can we speak aloud our despair, after having achieved the unachievable?

How can it be worth it, and yet leaving us want to scream and cry, hopeless and inconsolable, both at once?

And so, many of us are swallowed by the pit. We emerge, later, healed and whole after all, but carrying the memories of that time and that suffering with us, forever changed by the harrowing we survived.

What’s going on

Post-surgical depression is a really common complication that people, cis or trans, have to wade through after surgery. How common and how intense it is depends on how big the surgery was, mostly, but also how we’re doing, both physically and emotionally, when we’re wheeled into the operating room. It’s why cancer patients usually get pretty grim after they’ve been through a few surgeries, even if their recovery is going really well.

Surgery takes a toll on the bodymind. I don’t blame you if you haven’t heard that term before, but it’s important in understanding disability and recovering from big stuff like surgery—because, and this is another thing you probably haven’t really thought through, when you are in surgical recovery, you are a member of the disabled community.

We all will be disabled eventually. Sometimes we recover. Sometimes we don’t. That’s the nature of disability. Unless you fall off a cliff first, you’re going to become disabled eventually.

Now, the body and the mind are inescapably tied together because our thoughts, our feelings, our wants, and our needs? They’re not just some sort of wispy piece of ephemera, drifting in the astral plane while we sift and sort through whatever it is that we want out of life. No, our feelings are massive, complicated chemical reactions that take place in every single living cell of our bodies. Every single thought, every single feeling—it is a physical thing inside you. This isn’t a new idea. We’ve known it for the better part of a century now.

Seriously: the microbes in your intestines have a huge effect on how you think. Everything in your body is connected. We are not machines with easy modules that you can slot in and take out, self-contained for your convenience, as much as some of us wish we were.

Because that relationship between body and mind is so fundamental to every single part of your existence, when you’re disabled—when your body works in a way that’s different from its expected baseline—it inevitably feeds back into your brain. That’s not a bad thing, either! It’s part of how your body is meant to work. Feeling down and low-energy after surgery? Yeah, that’s because one of the best things you can do is rest and receive care from other people. Your mind is responding to the evolutionary instinct to rest when you’re hurt, so your injury can heal properly.

So, your sense of self sits at the heart of this feedback loop of bodymind, a complicated series of chemical reactions that shape what and how you think in ways that are eons old, all to increase your chances at long-term survival.

And that means that that post-surgical depression we so often fall into after receiving the gender-affirming surgeries that so often save our very lives?

That’s normal.

You’re not broken for feeling sad. Quite the opposite.

That depression, as awful as it feels, is something we evolved to feel to help us live, even though the depression itself tends to slow healing down.

Getting ready for the pit

Let’s get practical.

One of the best thing you can do as you’re getting ready for gender-affirming surgery is to plan on having a bout of post-surgical depression. Expect from the beginning that, for some period of time, you’re going to be in an emotionally tough spot while you recover.

Okay. What’s that mean, nuts and bolts?

Get in a good place before the operation

The single best thing you can do to reduce the chances and severity of post-surgical depression is to be in a great place before you get wheeled into the operating room. Since we’re talking about bodymind here, that means giving yourself a boost both physically and emotionally beforehand.

If you can? Ramp up whatever exercise you do, whatever that looks like for you. Exercise is great at completing stress response cycles and flushing cortisol from the tissues of your body, so they don’t get flushed out when you’re resting in the aftermath of surgery. Go run, lift heavy stuff, bike, swim, do pole—whatever makes your body feel more alive, and do as much as you safely can in the weeks leading up to your operation.

And at the same time, go and do things that bring you joy—go dancing with friends, see some theater, enjoy a concert, eat great food, whatever makes your heart sing. If that means being around abunch of people, wear a great mask (kn95 for preference) for a few weeks beforehand to reduce the chances you’ll catch cold. Even if you do, know that being sick doesn’t often delay an operation—just nasty resperatory stuff like COVID and the flu.

Banking those good feelings and good vibes will help carry you through recovery.

Get a care train ready—and not just for food!

One of the very best things you can do after a surgery is be social. People are social creatures, and to be alone is to be in danger, especially when you’re physically hurt. A lot of post-surgical care trains focus on bringing someone food, and that’s great, but just as important as that physical sustenence is the emotional sustenence that you’re going to get from being around the people you love.

One of the biggest predictors for post-surgical depression, aside from how you’re doing when you get wheeled in, is how well-supported you are by friends and family in recovery. Have a sleepover and watch bad movies together! Play board games! Heck, hang out on Discord playing video games if that’s your thing.

And the other part of this? Have comfort stuff ready for you when you get home. Sure, that means food and friends, but also little things that you love, and which bring you joy—treats like snacks or a few stuffy dolls or your favorite comfort media.

Buddy up if you can

At a few of the very best places you can go for gender-affirming surgery, like FacialTeam, where I got my FFS, the surgeon’s office will make an effort to cohort their patients together, so people roll into and out of the operating theater together, and go through that initial recovery phase right alongside someone who’s going through the exact same thing. The Suporn Clinic, for example, is all-but-legendary for how it houses patients recovering from bottom surgery in a common hotel and encourages all of these trans women recovering at the same time to meet each other, talk, hang out, break bread, and all the little things that tell a bodymind that it’s safe, and with people who understand.

But no matter what surgery you’re doing, whether it’s going to one of these titans or just the local surgeon who knows how to do what you need, you’re not the only person out there getting exactly your surgery on exactly your surgical date, or one a couple of days before or after. A lot of places will have support communities, usually Discord servers because we’re trans and stereotypes, if enough people get that procedure with that surgeon.

Join them. Find someone who’ll be Going Through It on pretty much your same timeline.

Not being alone in your recovery is an incredible boost.

Get up and move around

When you’re hurting and tired, your instinct is going to be to stay in bed and rest. And yes, absolutely, you’re going to need to do plenty of that.

But for God’s sake, take a walk as often as it’s safe to.

Healing is a major situational stressor, which means your body is going to be accumulating stress chemicals in the tissues of your body. You need to complete those stress response cycles, and one of the very best ways to do that, like I said a minute ago, is to exercise, whatever that means for your body.

Better yet, some light exercise—again, this can be as little as regular short walks around the block—is one of the best things you can do to reduce the chances that you’ll have the scariest types of post-surgical complications, like blood clots. Remember: one of the things they make you do in the hospital within 24 hours of getting a total knee replacement—that means opening up your knee, sawing out your knee, and putting in a titanium replacement—is to get up and walk, at least a couple of times a day.

Respect your physical limits. Don’t push yourself.

But also, don’t bedrot.

Eat, ya dummy!

For fuck’s sake, even though dieting doesn’t work, really throw your diet to the wind in the first couple of months after surgery. There are a lot of really good reasons to do so, but the biggest one is right down in your metabolism.

After surgery, or any major injury, your body goes into healing mode. That means that the effects of insulin are, temporarily, reduced by a lot, to encourage your fat cells and muscles to start releasing a whole lot of stored-up nutrients into your bloodstream. Your body needs all of these nutrients to help your body heal from the surgery you just went through—after all, it needs to grow a lot of new cells in a short period of time, to heal that injury.

And if you’re on the skinny side in particular, you’re just plain not going to have enough nutrients stored up to do this very well, and not in the right proportions. In layman’s terms? If you don’t eat a lot more than you usually do, you’re gonna end up hangry all the time, even if you don’t feel especially hungry. That’s your blood glucose levels being lower than your body needs at that particular time.

The overall effect of this? Your body will need to consume two to three times more calories than normal to heal. If you’re in for a really big surgery, like bottom surgery? Deep-tissue healing doesn’t even start until you’re three months into your recovery. You need to keep feeding your body what it needs to do that healing, especially lean proteins.

So, yeah, order a pizza. And stay hydrated. Your body is working hard.

And in many ways, that’s really the tagline to remember here. Whether you fall into The Pit or not after your operation, please remember that your body—that includes your brain—is doing a looooot of work when you’re in surgical recovery. Of course you feel tired, of course you feel down, you’re managing a whole-ass lot, both physically and mentally.

Give yourself space to be messy.

And don’t be down on yourself for feeling, well, down.