Talking is the best therapy, and talking is something I practice and enjoy quite a lot. My significant other and I have been talking about my recent feelings, so far drawing a few key conclusions. I’ve dubbed this emotional state post-surgical depression or post-operative depression. At first it seemed it could be similar to post-partum depression, but after some initial research it seems depression and anxiety are not uncommon after surgeries, especially after plastic surgery. We haven’t found any concrete resources yet. (But she is looking, she points out now, nudging me gently in the ribs. Sorry not the ribs, the arm, she wants to be accurate.)
Initial Research
As a general gist, we’ve found articles that relate to post-operative depression as caused or influenced by anesthesia. Being under general anesthesia is an interesting concept – you’re not quite asleep, not quite unconscious, yet your body undergoes one of the most radical changes imaginable. And you don’t feel a thing. Moreover, some articles state how surgery makes you reevaluate your mortality, it leaves you feeling powerless and vulernable (although I’d make the distinction of elective vs obligatory surgery). Still, that’s sort of how I felt afterwards – in pain, mildly drugged and semi-conscious, not self-sufficient, weak, and very very vulnerable.
Curiously enough the few articles we’ve found about this are related to plastic surgery post operative depression following a breast enhancement (and breast reduction). Women experience depression because their appreance is not what they thought it would be – it’s a horrible ugly mess of scars and swollenness and bruises and stitches and blood and pain. The same can be said for breast deduction / double mastectomy / top surgery.
Fun Facts
[Update: the girlfriend found some interesting facts]. Some quotes:
- Women are more prone to post-surgery nausea than men (and I’m more prone to post-or-pre-anything nausea)
- When we’re healthy, we tend to think of our bodies as somehow intact, both inviolable and homogeneous. Major surgery can shatter that image, and with it the concept of self-sustaining health. The feelings of mortality, of loss, and of vulnerability can be profound, and recognizing depression in surgery’s aftermath becomes very important. [This echoes my thoughts in a way. Before, my body was perfect - I never ever imagined that I'd be one with a deformity, an embarrasment, a prominent scar. For over twenty years I never went to sleep picturing myself with two hugely noticeable red lines across my mid torso, not until very very recently.]
- Post surgery depression can result from the after effects of anesthesia (which seems to bring out our sensitive side and our anxiety)
With a History of…
It’s no surprise that I experienced a surge of anxiety, as I have a history of anxiety and depression. This also fits into the puzzle, as I am already pre-disposed by personality to take in situations and have them turn into a cognitive mess. My significant other has forever called me her “little bundle of nerves.” Moreover, any kind of big stressor is likely to trigger this worrisome thought cycle again. The good thing about all this is that I know this side of myself, so I immediately recognized it as anxiety. I wouldn’t say I know how to fix it, except to hope and wait for things to get better (and ask my girlfriend to repeat to me a million times that things will get better).
More Ideas
I had realistic expectations coming in. Although I had come to terms with the idea of having scars, and had reconciled my current body with my potential future body in my mind, it’s not reality. And reality is just that, much more real. It hit me so hard I didn’t see it coming.
In addition, I would qualify this experience as a trauma, both physical and psychological: “an often serious and body-altering physical injury” and “an emotional or psychological injury, usually resulting from an extremely stressful or life-threatening situation.”
Again though, I’d like to emphasize the difference between voluntary and forced surgery, but only to recognize that neither is more or less stressful than the other, just a different kind of stress. In voluntary surgery, as was my case, you grapple with issues such as second guessing your decision, question the necessity of the operation, the validity of your right to do it, and only you are to blame for the final outcome, whether good or bad. Doubt, guilt, remorse, uncertainty of the future, holding onto the past – those are just some of the emotions flowing through me.
Catching Up
My body just underwent a very radical, and very quick, change. In comparison to other bodily changes, this one was lightning fast. Think about it – how long did it take me to grow to my current height? (yes, I was growing at some point) About a decade and three quarters, I’d estimate. What about my breasts, how long did those take to grow to their full potential? About 5 years probably. And I’ve only had them for 10. Then they were gone in the opening and closing of my eyes, literally. My reverse puberty happened overnight.
Consequently, my brain is racing to catch up. Due to the mind’s resilience, it will catch up. One day I will wake up, just like any other day, and feel the familiarity of my chest, and my scars, and all that remains there, as if nothing was ever different. And this day will not come suddenly, each day will build up on the last one, as I slowly familiarize myself with a new and strange part of my body.
Science Lesson Intermission
As an evolutionary psychologist, this sudden shock I experienced makes a lot of sense. The body always experiences slow and gradual changes, too small to notice in the present moment, and only with a retrospective mind does one realize the changes that have actually taken place over the long run. Thus our brain is used to processing bodily changes only at this crawlingly slow pace. Except in extreme cases, of course, such as accidents. Accidents are bad, therefore our brains should be shocked in the case of something that looks like an accident. They need to trigger the stress response, the fight or flight response. Increased alertness, which morphs to anxiety and nervousness, is the result. [Note, these are merely my deductions, not actual scientific research.]
Not Regret
I don’t regret it. I can’t regret it. When you do something wrong, you go through all the what-if’s. Scrolling down this list, we concluded it was impossible for me to have NOT made this decision.
If I had waited more, a few months, even two, five years, the itch would have still been there, top surgery would have remained on my mind. You can’t unknow something you already know, and this was one of those things. The minute I learned this was a very real possibility, I clasped on to this idea.
If I had researched more, I probably would not have come across counts of post surgical depression. I’m already actively researching this with almost no luck. In all the forums, list serves, conferences, blogs, etc, I never once read how people sometimes feel so crappy after their surgery. Or maybe I read it, glossed over it, made nothing of it, since nobody seemed to make a big deal out of it.
If I had been in therapy or counseling, I would have still wanted top surgery. Had the therapist tried to talk me out of it, I would’ve been resistant, doubly stubborn and doubly resolved. Had the therapist not tried to talk me out of it, I’d be, well… here.
If this was just “an idea I bought into,” like a cool fad or trend (as my mother has expressed), then why should I “buy into the opposite idea” or fad or trend (like my father has expressed)?
If this was for the worst, then what could have been for the better? Nothing has come to mind yet.
Time Heals
The old adage proves true, or will, hopefully. At least that’s what I’m betting on. With time, my body will heal, and my mind will heal. And the old adage about talking is also true. I only hope others would talk about this more, so it won’t hit you like a truck when it comes.
And now, I leave you with a quote from my most intelligent significant other:
Is it so bad that we have to rationalize everything? My honey is depressed, and what do we do? We go and look for medical journals that will tell us why.
And here’s today’s picture.
*Clean* purple underwear right after a nice "shower"
Resources
I have yet to read these in their entirety, but here are some resources I’ve seen, found, or am looking for:
- “Psychological Complications in 281 Plastic Surgery Practices” by Gregory Borah, et al. In Plastic & Reconstructive Surgery 104(5):1241-1246, October 1999.
- “The Effect of General Anesthesia on Postoperative Depression”, Scher C., Faw S, Anwar M. Abstract Presented at International Anesthesia Research Society, Anesthesia & Analgesia 88(2S) 27S. February 1999.
- Anesthesia and how to prepare for it
- An Understandable Complication
- http://www.breastlift4you.com/depression.htm
- http://www.med.umich.edu/depression/condition.htm
Thanks for sharing what you are going through, and your photos. A lot of interesting points. I wonder if the post surgical depression is something that people who have plastic surgery, especially when it’s related to medical gender transition, keep kind of quiet about out of fear that it will be used as “evidence” why transition (or other kind of plastic surgery) is “wrong”…?
I definitely questioned the validity of the surgery in relation to my gender, and I’d bet others do the same. You nailed it when you say they “keep kind of quiet about out of fear that it will be used as “evidence” why transition (or other kind of plastic surgery) is “wrong”…”
There’s an interesting post (which coincidentally occurred at the same time as this) in Matt Kailey’s blog about the film “Regretters” documenting two trans people who regretted transition. The commenters discuss (and mostly agree) that questioning transition is something that should be brought out into the open more, more for trans people’s own sake.
I saw that thread on Matt Kailey’s site, and thought about commenting but then didn’t. There were several issues at play there and I didn’t know how to condense it down into a reply, whatever it was I was going to say. But yeah…I think there should be more discussion about the different ways there are to be trans. Before I actually learned anything about trans people, I thought being trans was synonymous with wanting/having sexual reassignment surgery. (If it’s on television, it must be true!) I took a lot of comfort in realizing that I didn’t have to *do* anything to be a trans person, just that there were things I could do if I chose to. Medical transition is very new, but people like us have always existed. At first, I was quite frightened by the idea of getting top surgery, and it was good to know that it didn’t illegitimate my gender because I felt that way.
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What listserve?
I ran across your post while doing my own research about post-op depression. Like you I never found much online and was never told about post-op depression. I just went through major abdominal surgery and spent much time in the hospital due to many complications afterwards. I also had a long recovery time at home. I went through and am still sort of going through exactly what you’ve described in your post. I appreciate the total honesty and am glad ” I’m not alone” in this feeling. Thanks.
I would like to thank you for this incredibly intelligent and insightful article. I recently had a breast reduction and tummy tuck and awoke to a series of panick attacks that left me completely stressed and anxious and one bout of chlostraphobia. For five days I could not watch TV, could not sit still and was very very distressed. I am now (for the first time in my life) seeing a psychiatrist to see what underlying ‘problem’ caused this. I have only met her once, however I personally feel I have a problem with not being in total control and shock. The former, i.e. the need to be in control, could be related to early childhood experiences of not being controlled during bullying throughout the years. Who knows, but at least its kind of making sense and hopefully I will overcome the underlying ‘problem’. I too suffered from depression after the operation for about 2 to 3 weeks and forced myself to get out into society day by day. I feel much much better now, but it still bugs me that there is not enough information out there about post-operative anxiety and depression. My doctor hadn’t heard of anyone going through this which made me feel even worse! Thanks again for sharing.
Thank you for your sharing your stories.
I’m glad more and more people are finding this post and relating to it. That’s the reason I wrote this – to put out some desperately needed information. And I am (delightfully) surprised at the range of people finding it useful!
As a follow-up (in case you don’t want to read the rest of my posts):
My immediate depression and shock quickly waned – I’m guessing it was a momentary reaction to a huge change while being in a vulnerable state. What truly helped was the insight and research I did, but also _lots and lots of support_ around me. I needed constant reassurance that what I did was ok, and that everything would turn out ok. And indeed, especially with these kinds of surgeries, you need to give it time – at least a few *months* – before you can start to see the real results. If you’re curious, just browse through the pictures and you’ll see that barely around month 5 or 6 did the swelling finally settle.
My advice would be to prepare beforehand. But if you’re here chances are you’re caught in the moment – go see someone about it. It’s normal to feel this way, and you just need to tackle it head on.
Best wishes to all.
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I am about 5 weeks post top surgery, and very much struggling with intense feelings of anxiety and at times despair. I’m happy with my results, I do not regret my decision and I know given time they scars will fade and my life will be better for having had this surgery. Yet, I am currently having major issues dealing with my downward spiralling mental health.
I feel absolutely lost in feelings I don’t understand and I’m not sure where to go from here. I am finding my return to work incredibly difficult and when I’ve voiced my concerns to people it’s been dismissed as me being tired or just out of practice.
I feel like I need help, but I’m unsure as to where I should be seeking this help from. I guess my doctor is a good place to start.
I’m really glad I found your post here, and I’m glad to know I’m not alone in these feelings.
Congratulations on your surgery!
Indeed, anxiety and depression are common weeks or even months after surgery. However, transition can be a grueling process – physically and emotionally – and it’s possible surgery has stirred up more than you can handle. I know for me it jumpstarted everything – I’ve been writing this blog for a year and a half after the surgery, and most of these things had not even crossed my mind at the time.
Where to seek help? A therapist, a trans-friendly therapist who will validate your identity and help you navigate your conflicting feelings. They also teach you how to deal with the anxiety and depression, because for most of us it’s a chronic condition we just keep in check. Also, reach out to online communities and people, there are many of us who would be glad to listen. If you can find a local support group, go to that as well. Take care of yourself first and foremost, and know that you are not making this up, and you are not alone in this journey.
Ouch! I can see where the post-op period would cause a bit if depression, pain usually does, I think. Also, I would guess this type of surgery also dramatically signals a letting go of the past. Congrats on the courage to take this step and move forward.
I found this most helpful page while right now recovering from a hip arthroscopy a major”outpatient” deal. While it is outpatient, a lot of reconstruction work can be done (and was). So why is it that even though my surgeon said it was a success, I feel absolutely overwhelmed? I’m only one week out and constantly worry that I’ll mess something up and ruin my hip (not likely at all,really) or that it won’t work and I’ll be in constant pain,etc. While some oef these fears are normal, I also feel incredibly sad. Thank you so much for your insightful interpretations! They make so much sense and have been very helpful to me.
Lori
And, nope,mine has nothing to do with trans gender. I just found it to be a great resource here!
Thank you so much Lori for adding your voice to the conversation. Even a year and a half after writing this, this post is probably one of the most popular – people seem to find it and connect to everybody’s stories as their try to understand their own unexplainable experience.
Indeed, this is not a transgender issue at all, but just a little known sadness or depression period that commonly accompanies surgeries. The fact that some of us are dealing concurrently with gender (or with any sort of plastic surgery, which is equally taboo to talk about in public) often obfuscates the real issue.
Hip surgery actually sounds more scary to me! I hope you feel better soon, and that your recovery goes well.
Thank you! Hopefully I’m on my way. And you as well. I hope others in the same situation find thïs blog!
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Thank you for this article. I am in the same boat, different surgery. I had a mommy makeover. I miss my stretch marks and saggy uneven boobs. Hopefully like you said time will heal. Big fake boobs are awful. I would give anything to return and you can’t. I appreciate your hindsight and can relate it to my own. It’s crazy how so much time and energy you spend presurgery evaluation your “short comings. ” Elective surgery is not for the anxious. I have my husband say, “it will be okay.” I can relate.
It’ll take time for your mind to get used to your body, especially once everything heals and looks the way you thought it would look. Thanks for sharing and I wish you the best.
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“reevaluate your mortality” is a bit of a stretch, i think. I mean.. It’s not like a transsexual is going to come to the conclusion that it’s now ok to kill someone. Maybe it could be explained a bit better.
But i get it.. The problem is that it’s hard to really know. The human brain isn’t exactly the most cooperative when it comes to telling people how it works. But i’m glad for you, that you’ve gone through with it. And thank you for following me. (:
Stay safe!
It’s more about feeling extremely vulnerable, which makes you reevaluate how fragile life really is. Yeah, our brain is not the brightest sometimes.
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Thank you so much for this post! I just had breast reduction surgery and have been miserable. I thought I was going crazy but even just knowing that other people have go e through the same thing is helping. No one told me how awful I would feel afterward. Thank you for sharing and helping me feel better!
O, wow, so glad to have found your post. Had my 4th spinal neurosurgery. Suppose it was *elective* because we know from the prior 3, it won’t hold for long. But I did it again, anyway, because I want more time with my kids and the 1st grandchild is coming. Greedy me? Yes. Surgery was just 5 days ago & I am in a real slump. Thank you for writing so freely about how this can be a bear for whatever reason for some folks. I feel some comfort & am grateful. No one says much about *afterwards*. Thanks & best wishes. D-Girl