loading . . . top surgery journal: before surgery (part one of three) the purpose of this blog is to document some of the logistics, feelings, and social aspects of the journey before and after my breast augmentation. i hope that this thorough writeup will be useful to anyone who is considering getting a ba. i especially want to provide a text-formatted real human perspective, as opposed to a vlog, for those who prefer reading, as an article liked this one helped me tremendously in choosing to get an orchiectomy.
before
the process of getting a prior authorization from insurance was not fast, but it was fairly smooth. i had a therapist and my hormone provider both fax insurance letters that told them i needed this surgery, as well as an orchiectomy, facial feminization surgery, and even though i didn’t and still don’t want one, a vaginoplasty. just in case! my insurance told me they prefer the surgery letters to be all combined, which was honestly easier for me too. the gender department at blue cross was extraordinarily helpful, and someone there sent me an email weekly to let me know if they had approved the pa request yet.
while i was going through this process with insurance, i was also researching surgeons. i asked around, and unfortunately everyone’s recommendations were surgeons who did not take insurance, so i had to do my own research. i used the realself website, and others, and eventually found a few possibilities. i scheduled consults with about four different surgeons. my first consult was at one of the non-covered surgeons that someone had recommended to me, before i was familiar with the insurance process.
at this first consult, the surgeon measured my tits and wrote the measurements down. they put me in a size small sports bra and let me try out different sized implants, which they stuck inside the bra. i didn’t have anyone with me and didn’t ask the surgeon or his assistant if they could take pictures, despite wanting to. the process of trying on implants, without someone there to support me, and in front of a cis man and a cis woman, felt really uncomfortable. i did not feel like they viewed me as a real woman. because of that, i wasn’t comfortable enough to ask for everything i wanted (like trying on at least five different sizes, or pictures in them, etc). still, seeing myself in the mirror with the implants under the bra did feel good.
months later, i had my second consult (dr. miles bichanich). i still didn’t have anyone with me at this one, despite trying to get anyone i could to come with for support. it went similarly to the first, and i told the surgeon that if i had to pick a size in that moment, i would choose 400cc. i was very uncertain about the size, but that was what seemed like the best one i tried on. i told them that i wanted to schedule a surgery as soon as possible.
my third consult (dr. thomas suszynski) was devastating. throughout the entire process, i dealt with great amounts of confusion and uncertainty about whether or not i wanted the surgery, what cc i wanted, whether i should wait longer before getting it, and if i should just save my pennies for years until i could scrape together enough for an out of network surgeon that my friends had recommended. it was at this consult that i reached the absolute peak of confusion about all of these issues. the surgeon measured my tits, plugged it into a computer, and told me he would give me about 230cc implants. he did not show me what the implants would look like, and didn’t even have any size of implant for me to see (which was fine for me, since i’d already seen what they look like, but if this had been my first consult, it would have been incredibly frustrating). i had even been able to bring my aunt with this time, and was sorely disappointed that i wouldn’t get the chance to have her take a picture or two of me with the implants on. i asked outright why he was telling me what size implants i would get, instead of the other way around. he told me that most surgeons allow their patients to get implants that are simply too large for their anatomy, and that he has had to fix numerous cases of “uniboob” and implants that had fallen to the side of the chest. his nurse later told me that i could increase the size a few years after the initial surgery, if my anatomy seemed capable of it.
though i felt thoroughly confused and somewhat upset by this consult, i didn’t voice this to the surgeon’s nurse, and told her i wanted her to schedule a surgery. i figured i could cancel it if i decided to go with dr. bichanich. though dr. suszynski’s team had told me surgery would likely be in april, both him and dr. bichanich ended up scheduling within a week of each other in october of 2025.
i spoke with a large number of trans women who have had breast augmentations about my experience up to this point, and asked about their thoughts. they unanimously decried dr. suszynski, and told me to get whatever size i wanted with dr. bichanich. i decided the last thing i needed to do to be certain of the surgery was to have one last implant try-on. i scheduled a second mini-consult with dr. bichanich, and brought my partner and some clothes to try on over the implants + bra. i had my partner take photos, and tried on the 400cc implants again as well as a size above and a size below. i found the 400’s to suite me the best, and by this time had forgotten that i had liked them best at my previous consult with dr. bichanich. he reminded me, though, and said it was a good sign that i had picked them twice.
i canceled my surgery date with dr. suszynski, and his nurse asked for a reason. i told her that i was extremely disappointed in the fact that he picked a size for me, and disliked his fear-based process overall.
now that i was certain about the size and the surgeon, i became more excited for the surgery than confused. still, there were times when i felt tempted to cancel the surgery date and just wait longer until i was more certain. i had started intramuscular medical ketamine treatment for depression and ptsd. during my second session, i had a lot of unpleasant feelings that were similar to what i experienced as i was trying to decide if i wanted to transition. at the end of that session, i thought of my upcoming surgery, and had very unpleasant thoughts about it, like thinking that i was going to have clownishly large boobs, that i would hate them, that no one would ever take me seriously as a person again if i got this surgery.
this extreme doubt led me later that day to look at before and after photos for breast augmentations. i had obviously done this before, but this time, i knew more about what i was going to get, so i looked specifically for similar sized people and implants. i thought 400cc implants looked great on the cis women who were similar height and weight to me. the website that let me filter for height, weight, and cc did not have any trans women on it, so i looked at a different website and found trans women who had gotten 400cc implants. i noticed that i did not really like the results when trans women got implants that were under or above 400cc, but i loved all the ones who had gotten that size exactly. these two websites greatly helped my confidence that this surgery would make me happier with my body, and i became 100% excited and 100% impatient for the surgery.
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### _Related_ https://alicemvv.wordpress.com/2025/10/18/top-surgery-journal-before-surgery-part-one-of-three/
