Help Dr. Liz share Great Sex with the world. Get insider perks. All in one place.
give now (opens in new tab)

What should I keep in mind when considering top surgery?

Aug 19, 2023

Dr. Liz Powell: I want to talk about the top surgery question because I have so many thoughts that I’ve gone through myself on top surgery.

So the question that we have is, what should I keep in mind when considering top surgery?

So, let’s talk about top surgery.

Rae McDaniel: So I said earlier that I got top surgery over the pandemic so I can share a little bit about my story there.

As a nonbinary person, I have never had really, really intense body dysphoria so I didn’t have intense body dysphoria about my chest really ever.

But I also didn’t have any good feelings about it.

It was very neutral to me and sexually, it really didn’t do anything for me.

And I got to a point where I had been considering top surgery for years kind of in the back of my head, not seriously, just kind of thinking about it.

And I realized that I had made some assumptions.

I had assumed that I needed to hate my body or have very intense gender dysphoria in order to get top surgery.

And I assumed that I needed to, how do I put it?

That I needed to have this urgency to it in order to get it.

Dr. Liz Powell: It has to be life or death, otherwise it’s not real.

Rae McDaniel: Exactly.

And I just didn’t feel those things.

But I did come to the point over the pandemic where I was like, “You know what? The only reason that I have not gotten top surgery is that I have always had my body as is. It does nothing for me. I am wearing really tight sports bras or binders pretty much all the time. Let’s do the thing.”

And once I made the decision, it happened really fast like unusually fast.

So that was kind of a thing.

But in terms of what to think about, number one, think about why it is that you want it and consider that you don’t have to be in a place where you were desperate or hating yourself or hating your body.

It can just be something that you think will bring you closer to how you want to show up in the world, and that is OK.

Another thing I will say there that I talk about a lot in Gender Magic is I have a good bit of – a good chunk of things about medical regret in there because I’m fascinated by that topic.

And one of …

Dr. Liz Powell: It’s such a popular topic among transphobes and like we – at least the folks I know in the trans community have so very little of it.

Rae McDaniel: Yeah, it is interesting to me.

It’s talked about so, so much but I’m like, “I’ve been a therapist for 10 years, I’ve never had anybody that regretted it.”


Not any aspect of their transition.

Well, I can get into that another time.

What I’m saying about top surgery and things to consider is the research shows that when you make a decision from a cold place as in opposition to a hot place, then you are less likely to regret the decision no matter what the outcome.

What that means and what cold means is really grounded.

So not in an escalated place, not a desperate place, not with this really like soul-sucking urgency but from a place where you are making a decision that is grounded and whatever fact-finding you need to find and feels good in your gut versus going in emotionally hot or impulsive in making a big decision.

And the piece here I really want to highlight for folks is that this is true.

You were less likely to experience regret no matter what the outcome.

That’s huge.

Dr. Liz Powell: Yeah.

So such an important thing and I think something that I would add on to this point is that when you are thinking about it and evaluating it, just be aware of who you are talking to about it because sometimes folks say some shit that is deeply unhelpful.

I was living with someone and I was talking to them about like whether I wanted to get top surgery or not and they, I think in a moment of their own impulsivity said to me, “But you should just be really, really sure because you have such great breasts and so you should just be really sure before you do anything.”

And I was like …

Rae McDaniel: No.

Dr. Liz Powell: Why?

And this is someone who is like very sex-positive, very leftist, someone who is supposed to be one of the good ones.

And it was just such a weird moment for me.

I’m like sitting there with someone who is basically saying like, “Well, but like don’t make a silly, impulsive decision and just chop your tits off because people like them.”


And here is the thing.

I think that if this sort of thing is something that you have never had to consider, you may not understand the impact of that kind of statement.

This person may have regretted it as soon as it came out of their mouth.

I don’t know.

They never addressed it to me after that at all.

But the place that I was in already of confusion of whether this was something I even wanted was definitely not helped by like, “Your tits are hot so be super sure about that,” because I know they are hot.

They are fabulous.

And your opinion of my tits is not important here.

Rae McDaniel: Yup.

That is super real.

I think one thing I did and I’m always in favor of your trusted people, talking to them, your therapist, sure.


It’s helpful to have people who know you, who love you, who see you to talk through some of these things.

And for me personally, I did a lot of it on my own.

And it was over a period of several years where I sat with it and sat with myself and kind of felt into my gut if this was something that I wanted or not.

And so by the time that I started telling people like it was booked.

And a lot of people were surprised.

They felt like it was impulsive, but it wasn’t at all.

It was many years in the making, a lot of considering, but it was just considering that I did when I got still and quiet with myself and asked myself, “What do you want? How do you want to show up in the world?”

You can never be a hundred percent certain but I was certain enough that I was willing to take that risk.

Dr. Liz Powell: Yeah.

And I think for me, at that time that that comment was said, I had been thinking about it, talking about in therapy for over a year already.

And so this idea that it was going to be some impulsive decision was like, “You know what? I’ve been thinking about this for ages already.”

And I like late last year I think, maybe early this year kind of came to the place of like, I think I actually don’t want top surgery because unlike you, I get a lot of pleasure from my tits and I don’t want them all the time but there are times I want to show these babies off.

I just wish they were detachable.

I wish I could just pop them off and just put them on for special occasions.

That’s what I want.

Rae McDaniel: You’re not the first person that I’ve heard say that, and the desire for boobs in a jar that you can just take on and off.

If somebody can invent that …

Dr. Liz Powell: I just want hot, supple body parts of all kinds.

I want a clip-on dick that’s actually innervated in my own tissue so I can feel it. I want to be able – I just want all of it. It’s not possible yet.

Rae McDaniel: Yet.

Dr. Liz Powell: Yeah.

So we have a question in the question.

Do you have anything else you want to say about top surgery stuff?

Rae McDaniel: Just a couple things.

So first of all, do it for you.

I think some people go into top surgery thinking, “Well, I’m going to do this and then people will see me for who I am or I’m going to do this and then I will never be misgendered again and all my gender dysphoria will go away.”

And that’s just not the case.

And yes, it feels awesome to be seen for who we are.

I’m in full support of that.

And you don’t need to change anything about your body to be seen for who you are.

I can guarantee you that.

It’s just about finding the right people who see you for who you are.

Dr. Liz Powell: I was going to say my answer there is like seen for who you are but not by everybody.

Some people are going to see you for who they want to see you as no matter what you do.

The top surgery would not change that.

Rae McDaniel: Exactly.

Dr. Liz Powell: And I think that you need to find the people who are going to accept you.

Something that a lot of trans and nonbinary clients that I work with experience is it’s almost like they die in some in senses and start over.

That the people who were their close friends, their community, their family before they start exploring their gender and transitioning, large proportions of them cannot go with them on that journey.

Rae McDaniel: Yeah.

Dr. Liz Powell: Cannot follow them on that journey.

And that is sad and also I think that’s OK.

Not everybody is in your life forever.

Rae McDaniel: No.

And that is OK and it sucks and it’s really hard and any time you grow, any type of self-growth whether it’s gender or something else, there are going to be people who don’t grow with you that you have to let go.

And that’s absolutely true.

So kind of bringing it back around to top surgery, make sure that you are doing it for you because you want to show up in the world in a particular way because it would feel good to be in your skin in that way.

That is a really strong why.

A couple of other things I would just say just super quick is make sure you have your support system and recovery plan unlocked super practically.

You’re going to need help for a little bit.

Make sure you have your meals planned or a meal train or like lots of Grab Hub credits or whatever.

And make sure that you have everything that you need to make that recovery period as stressless as possible.

Dr. Liz Powell: Yeah.

And you can – like I’m sure on Reddit there are a ton of threads about things I wish I had for my top surgery recovery.

Find all of those.

Treat it like getting ready for Burning Man.

You don’t have to reinvent the wheel.

There is a list somewhere somebody has already created.

Just find that list.

Rae McDaniel: Exactly.

And buy straws.

You will want straws.

Dr. Liz Powell: I already have straws.

Who doesn’t have straws?

Straws are the best.

Come on.

I got the metal straws that have the silicon tips that you put on which is the best of both worlds because the metal feels nice and cold but the silicon feels much better in your mouth because metal in the mouth is just terrible.

You can see it right here, my little metal and they’re like rainbow metals.

They’re in my same color palette with the rest of my life, right?

Rae McDaniel: I love this.


Well, I need to up my straw game clearly.

Sign up now for special content and exciting news delivered to your inbox.



Help Dr. Liz share Great Sex with the world. Get insider perks. All in one place.
big thanks to my sponsors!

Get the Book

Your practical, no BS guide to non-monogamy.
Buy it now
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram