My body ate my boobs

Thoughts on Surgery and Nutrition

You don’t really know what is going to happen to you going into a major surgery.  You can be as informed as possible, having consulted widely, spoken to people who had a similar operation, and yet, nothing is like experiencing it yourself.

As a body-conscious, diet-obsessed, food writer and nutritionist, how to feed the healing body was top of mind.  As a snatch-waisted, vain, trans girl, I was also concerned about post-op weight gain, bloating, etc.

Weird things have been going on with my body as I heal from my “sex change operation”.  It was the big one, taking my male bits and turning them into girl bits, but there are others, a series of operations, I just had the big one first.  What I learn now, and how I heal, will shape how I deal with the next one—my face, my beautiful face…I just don’t want to be called ‘sir’ anymore.  And I worry about the nasty political climate…and although I fear that I will never pass and have written about the self-imposed but socially “required” need to pass, if I don’t make some changes to my face, I will forever be just too darn masc for my requirements.

One thing might alter that course, and that is modelling.  There seems to be a market for ballerina giraffes.  It is a small one, but one I intend to explore.

In the meantime, my boobs are shrinking.  It’s like my body is devouring all available fat stores, and possibly muscle and other things, in its search for the nutrients it needs to heal.  My boobs are almost completely gone.  My precious boobs.  And I’m thinking, why can’t you focus on the belly fat or the excess on my upper thighs instead of taking away my babies.

I presented my dilemma to my doctor, served up with a mixture of genuine distress and a slice of humour.

“Doctor, my boobs are vanishing.  Is this normal?”

“Don’t worry, they’ll grow back,” she said.  Non-issue.

The root cause is twofold…I cut my hormones, particularly oestrogen, down in the run up to and in the days following surgery.  Oestrogen increases the risk for blood clots, and though I have an extremely low risk for this naturally, and the patch method I use to take the bulk of my oestrogen is the safest, I do also take pills, and these are high risk, so I stopped those.  I also couldn’t take progesterone whilst in hospital.  I no longer need to take a testosterone blocker, as my balls were cut off, and so there is no longer a risk that I will make the stuff on my own.  The irony?  Some trans women get prescribed testosterone post-op (mood, libido, bone health).  It all depends on my adrenal glands and their ability to produce the low level of testosterone that my now formally female body needs.  I start back with my “normal” dose of oestrogen today.

Second is diet.  I am eating like a horse.  I had an appetite of any army coming out of surgery.  That surprised me.  But no matter how much I eat, my boobs got smaller.  And I apologize if this is graphic, but I am pooping with a volume I have never experienced before.  This business is flowing through my body at speed.

I think of my body as a giant sorting machine, and it is taking this volume of food, driven by a diet which is intended to reduce inflammation, increase collagen production, and promote healing, and then is passing the rest through as just bulk energy.  

Food cravings

When my consciousness emerged from the cloud of anaesthesia, and I awoke in my sun-bathed hospital room, I was surrounded by the loving presence of one of my dearest friends (and one whose friendship was profoundly deepened by this shared experience of utter dependence on her, inability to take care of myself, her tough and commanding love) and a bevy of nurses who were so kind and sweet to me.  I also had an intense food craving.  Well, two. 

Pineapple was the first.  It was so clear to me.  My body wanted pineapple.  I wasn’t thinking about why at the time, just that I wanted it.  And thankfully, the hospital had plenty of it, and was able to supply it to me not just at ever meal, but right then, when I first craved it.  In addition to its delicious, thirst-slaking qualities, pineapple is rich in fibre, and many other beautiful and healthful nutrients, but most importantly, is the number one dietary source of bromelain, a potent anti-inflammatory.  If there is one thing that is critical to recovery from this kind of operation, but in fact most surgeries, it is anti-inflammatories.

I was pleased to see that bromelain supplements figured amongst the cocktail of goodies that my doctor has me consuming.  But as with all things, it is far better to get the nutrients the body needs from food, and not from supplements.  I am munching on both.  My craving for pineapple has remained constant, and is so intense that I keep dried pineapple on my bedside table to munch on even when I wake up in the middle of the night.

Of course, eating dried fruit is really intensely antithetical to being diet conscious, but right now I don’t care, and won’t stand on the scale until I move out of the anti-inflammatory stage and into a long term healing stage.  I think it will take about 12 weeks, but my body will know when.

If you are interested in finding out more about what is so great about pineapple for a post-surgery diet, you can read about it here.  

https://www.healthline.com/nutrition/benefits-of-pineapple#TOC_TITLE_HDR_8

My second craving which kicked in about an hour after my pineapple craving was beginning to be satisfied was for blackberries.  Lucky for me there is an organic supermarket directly across the street from my hospital.  My friend brought me a large punnet of these delicious fruits, and I ate the entire thing in one go—and it wasn’t one of those little punnets either, it was a big one.  I also did a number on a small punnet of raspberries and made a dent in the blueberries, but mostly that was because I had run out of blackberries.

What is it about blackberries?  Many things, but again, blackberries are anti-inflammatory.  Perhaps, more importantly, my body was carving their mix of vitamin C and other collagen stimulating properties.  Blackberries help heal and regrow tissue.  They help you form connective tissue, grow blood vessels and help your body absorb iron—all critically important after a major operation.

https://www.healthline.com/health/benefits-of-blackberries

My craving for blackberries is less intense than the one for pineapple, but no less persistent.  It seems that my body is telling me about dosing.  I eat a few of them every day.

The last craving that came to me in the afternoon post op was bone broth.  I tried ordering chicken broth from the hospital but that came back as something made from a powder—high in salt and low in nutrition, exactly not what I needed.  Thank goodness for uber eats, which one hour later had me with two piping hot quarts of bone broth, one chicken and one beef.  I slurped them down, both of them, felt incredibly full, and then fell asleep…and stayed in this odd space that is unique to recovery between sleep and wakefulness as we do sleep, but are also continuously awakened by nurses who come to check our vitals.  That night I peed two litres.

All of these cravings have stayed with me as I heal and have become pillars of my diet.  There are three other foods which also hit me with power: eggs, sardines, and peanut butter.  Although I have to admit, I can’t think of a day in life where I don’t crave peanut butter, so although this has clear post-op benefits, I am not sure of the sanctity of the craving.  By peanut butter, I mean, ground organic roasted unsalted and untreated peanuts, with nothing added.  I eat about three tablespoons of it today, usually on an apple or a pear, or sometimes on a protein-rich bread I have.

Eggs are a nutrient dense food rich in protein.  They contain choline, which is essential to build cellular membranes, and is something we struggle to get enough of in our diets.  They also contain selenium, another hard-to-find mineral.

Selenium is a critical component in the bodies own defense against inflammation.  Critically, selenium is a potent anti-oxidant, which are critical components in the healing process both at the cellular level and also with the whole body.

Finally, eggs are superlative source of protein, containing all essential amino acids.  They are a perfect food, highly sating, highly versatile.

https://www.healthline.com/nutrition/proven-health-benefits-of-eggs#TOC_TITLE_HDR_8

What I eat

My diet is central to the healing process.  It occurs to me that what I am eating is apt for most people recovering from surgery, or from childbirth.  Indeed, the parallels to pre-and post-partum ideal diets are rife. And just as one must follow guidelines and principles, it also makes sense to really listen to your body and let it tell you what it needs.

Surgery means a course of antibiotics.  It takes about a year to rebuild the gut microbiome after.  That’s a long time, and a lot of damage.  You can mitigate the damage by taking probiotics before, during, and after your course of antibiotics—just not taking the probiotics within the span of 2 hours to either side of taking antibiotics.  This is such a wise course of action, that even my doctor was onboard and recommended it.

Eating foods that are strong in pre-biotics (those foods that your healthy gut microbes really enjoy eating) and pro-biotics is also a good idea.

So, what am I actually eating?  I get up at 5:00 am most always.  Even now.  I make myself a cup of brew that I developed which is a blend of dark, unsweetened chocolate, chicory, toasted barley, 8 different types of mushrooms (chaga, turkey tail, lion’s mane, maitake, shiitake reishi, cordyceps and king trumpet) and a bevy of spices including turmeric, black pepper, cloves, cardamom, cayenne, and cinnamon.  It is delicious.  I mix into this a small quantity of omega 3-6-9 oils from various sources like sesame and borage.  I also mix into the blend collagen powder, vitamin c powder, bone powder, and MCT oil powder.  It sounds wild, but it is so energising and health-giving, I can fly all day on one cup.

I also prepare a super-food muesli which is roughly 30% oats; 30% other grains including barley, spelt, rye, wheat; and 30% nuts, seeds, and dried fruits including hemp (as meal), flax (as meal), goji berries, mixed raw unsalted nuts (almonds, peanuts, pecans, walnuts, hazelnuts/filberts, cashews, and brazil nuts), pepitas, dried cranberries, dried sour cherries, dried mulberries, dates, sultanas…you get the picture.  I soak these overnight before eating in kefir, garnish with fresh or frozen berries (blackberries, raspberries, pomegranate seeds, and blueberries), and before eating, dust with bee pollen, add milk of choice, skyr or 0% fat Greek yoghurt, and a touch of my own honey from the farm.

My kids like to tease me about my “bird food”, and yet they devour portions that are 8 times the size of what I can manage as a single meal that would last me the entire day.  This meal alone meats all requirements for fibre, minerals and vitamins, 35 plants per week, and the three macro-nutrients.  It is enough to live a healthy life on.

What else do we need.  Green vegetables and leafy greens.  That is what I eat around 5 pm.  During the day I focus almost exclusively on getting as much protein into my body as possible without other things.  Sardines and mackerel are a firm favourite, as are the boiled eggs referred to above.

Sound good or weird?  Well, it is based on what we need to recover from surgery: protein rich, mineral and vitamin rich.  Carbs are also critical, but complex carbohydrates are the only ones.  This is a delicate balance at the beginning of post-op recovery, as gas is a real concern and beans, a great source of complex carbs, should be off-limits until your gut has recovered enough to avoid excess gas.  Vegetables, again, need to provide this, and the best are: broccoli, brussel sprouts, carrots, parnsips, turnips, beets, sweet potato, yam, Brussels sprouts, pumpkin and squash, spinach, bell peppers (strictly speaking a fruit), corn and zucchini.

What is worst for you?  

Red meat, fried food of any kind, any foods that have traces of antibiotics in them—animal products, alcohol and caffeine.  And if you love that cup of Joe, this extends to decaf as well…you should avoid any coffee-related products for two weeks prior to surgery and for a month after.  Why?  One of the main reasons is that coffee interferes with the uptake of vitamins and minerals needed to make new tissue and bone…and that is what your body needs most.  So if you can hold off for longer, even better.

How to Eat

We are told that we should eat three meals a day and to try and limit snacks between meals.  Or that we should keep our snacks healthy.  Not bad advice for steady state, but not right for post-op.  My personal trainer (and me) just spent a considerable amount of effort re-educating me to eat this way—that it helps manage energy levels and ultimately makes it easier to control weight.

Also, intermittent fasting has many advocates, including this gal.  While it is true that whether you fast or not, your total caloric intake will still be the determinant of whether you gain or lose weight, and that you are more likely to over-eat when you finally get to your window of allowed eating, it misses a key benefit of fasting.  Our cells are constantly dying and being renewed.  The fasting process helps with this, which becomes more important as we age, as this process is one of the best ways to fight aging.

But neither three meals a day nor intermittent fasting has any place in the lexicon of a recovering post-op soul.

No, what we need to be doing is to eat little and often.  This helps you continue to tune your body to what it needs (it is easier to “listen” when you are not stuffed to the gills).  It also aids with bowel movements, which become easier to handle, and believe me, constipation is one of the key issues to contend with post op—you do not want to become constipated…and the meds you are given are almost always constipating, so making sure diet and liquid consumption are working to prevent this are super important.

What not to Eat

I stopped drinking all alcohol in January, a little over three months before my surgery date.  Alcohol interferes with the healing process, and it also takes a while to ween the body off of wishing for it.  I won’t start drinking again until all of my inflammation is gone.

What else about alcohol.  You might also consider that alcohol is harmful to the gut micro-biome, and gut health is a particular obsession of mine.  

https://www.eatingwell.com/alcohol-and-inflammation-8415778

I shouldn’t have to say it, but anything with added sugar.  Sugar is inflammatory.  Exactly what you don’t want when your body needs to be doing the opposite.  I shouldn’t need to say another word about it.  Just don’t eat it.  Ever.  I promise I will walk the talk and start publishing recipes for cakes that have no added sugar (and are not availing themselves of chemical alternatives).  I promise to be good Mommy!

Salt is another one.  It increases the chances of post-operative swelling.  This can slow down recovery and does exactly what you don’t want your body to be doing—retaining fluids.  It contributes to constipation.  But the killer is that salt interferes with cellular healing….and really, you should cut back on salt intake well before surgery as well, to prepare your body.

And finally, any kind of packaged or processed food at all is not your friend.  Put it off, hide it in the cupboard, or throw it out until you have completely recovered.

We say YMMV for all things in the process I am living through, ‘your mileage may vary’.  But when it comes to healing, there is a lot you can do to take control.  Taking control is an act of self-love…and self-love is why you had the surgery in the first place, isn’t it?