One terrifying day in 4th grade, my nipples started to bud. I even asked my dad to confirm that they were definitely not tumors. As someone who had lived as a happy tomboy from toddlerhood on, I felt betrayed by my body. I knew I was not a man, but I never thought I would grow up to be a woman. Everyone in my life told me that growing breasts defined femininity. No longer could I remain a tomboy — genderfluid, free to express myself — I was on my way to a forced womanhood.

I’ve done my best to make peace with my breasts. I tried to be excited about them, dress them up, and take care of them. I sought to embrace the changes that came with puberty and tried to become like the women I looked up to, but it required suppressing who I am in favor of pretending to be a woman. For me, top surgery is an important step in enabling me to inhabit my body more comfortably.

When I told my parents about my desire for top surgery, both had questions about why I would want to permanently modify my body. Mom had questions about gender dysphoria, the debate between cosmetic vs. medically necessary, and post-surgery functionality. Dad wanted to be sure I was not being pressured into surgery. But when I researched answers to these questions, I discovered two unhelpful types of resources: the Transgender 101 articles that started at square one, “What is trans?” and the academic articles that took a theory-based approach to these issues. All but one of the articles focused exclusively on transgender men, but I am non-binary.

I set off to write my own explanations to these essential questions.

Firstly, for some, top surgery is medically necessary. Federal courts, doctors, therapists, academics, LGBT centers and task forces, the Diagnostic Statistical Manual (DSM), and even insurance companies agree. Many studies also confirm that trans people are happier and healthier when given access to healthcare, which usually means trans-inclusive doctors or gaining access to hormones or to surgery.

Secondly, my desire for top surgery comes from me, not from the transgender community. Non-binary people can have breasts, and I know plenty who happily do. In fact, nobody in my life is pushing me to do anything to my body. My need exists when nobody else is around, with and without mirrors. The transgender community’s main message is there is no single way to be a woman, a man, or neither. There is, however, one dominant way to look cisgender — that is, when one’s gender aligns with their assigned sex. For evidence, pick up practically any published magazine. You will notice that cis people have demanding expectations for how women and men should look. Thin, busty, curvy, muscular — these are cis expectations.

Mainstream white feminism involves accepting a body as it is, but among the groups of people it excludes, mainstream feminism excludes people who struggle with gender dysphoria. Managing gender dysphoria is different from accepting flaws. To call top surgery cosmetic or elective demonstrates a misunderstanding of gender dysphoria, which I will now explain.

Gender dysphoria is not the same as body dysmorphia. Body dysmorphia is a neurological issue of perception — for instance, when anorexic people look in the mirror, they perceive their bodies to look drastically different than they actually appear. The National Health Service (NHS) defines body dysmorphic disorder (BDD) as ”an anxiety disorder that causes sufferers to spend a lot of time worrying about their appearance and to have a distorted view of how they look.” I highlight the last clause because it is crucial to understanding the difference between these two concepts. Those with body dysmorphia share a disconnection between reality and their internalized perception of what is real. Even if one learns to recognize the distortion and its effects, it remains a struggle to accurately view one’s own body. Flaws become exaggerated through this lens.

Surgery is not a treatment for body dysmorphia, because the issue is with perception, not reality. It can be dangerous for people with body dysmorphia to get access to surgery, because typically, surgery cannot satisfy dysmorphic thinking. No matter what changes occur to the body, the perception process remains the same. Accepting oneself becomes a great strategy for body dysmorphia, but this solution is ineffective for gender dysphoria.

I do not have body dysmorphia because I do not have a distorted view of how I look. Instead, I am acutely aware of how I do look. If I were cisgender, I would be happy with my breasts. They are beautiful. They just do not belong on my chest.

When I am aware of my breasts — when I jog, walk down stairs, or wash them, I have an intense, physical reaction. I taste copper, feel nauseous, and want to cry. My breasts feel like a costume, a costume I am forced to wear. I can never take it off. Binding is the only way to hide the costume and minimize the appearance of my breasts. It helps a lot. It lets me look in a mirror, go running, stand up straighter. But it is utterly unsustainable. Prolonged binding is akin to wearing a Victorian Era corset, and it has singlehandedly caused my chronic back pain.

This surgery does not close any doors for me. It opens many. I will be able to swim without anxiety about going out in public with visible breast tissue. I hope to enjoy sex with fewer triggers. I look forward to trying on clothes without dreading how shirts fit my chest. I will be a freer person.

Top surgery is exactly what I need, and I will never regret working to fulfill my needs and striving for wholeness.

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