Transfem Body Contouring - Night Before Surgery!

It's 9:30pm the night before my surgery. This is the first surgery I've ever had, and it feels like a big one. It includes liposuction of my abdomen and flanks (belly and waist), an abdominoplasty (tummy tuck), and fat transfer to my buttocks and hips/outer thighs. I like to call this "middle surgery". :)

I scheduled with Dr. Mangubat in Tukwila (Seattle). I chose him because he has a LOT of experience with trans people, and has been the go-to doctor for many years for top surgeries. He does other trans-affirming procedures, but there is little information online and Dr. Mangubat isn't big on before/after pictures. So I'm nervous because I'm not exactly sure what to expect, but I do trust him and he has glowing reviews for all procedures. He also seems to be very knowledgeable, is board certified for cosmetic surgery, and is very involved in teaching and mentoring, including the other most well-known trans surgeon in the area right now, Dr Sajan. He also talked about body surgery as sculpting and he is big into a program called "sculpting for surgeons" that I really liked, as a natural-looking result is very important to me.

The large amount of fat in my belly has always been a huge source of dysphoria for me, since I was maybe 12 or 13. I don't think a lot of people think of middle body fat as gendered, but it is VERY gendered, as people with majority estrogen grow fat in their hips, outer thighs, buttocks, as well as breasts, while testosterone-dominant people grow fat in their abdomen (belly and waist) mostly, and back. Some of this changes when starting HRT in adulthood, but not the majority of fat that's already there. I also have a good amount of extra skin in my belly, since I have gained and lost a lot of fat over and over through my life as I've worked through eating issues - that's what the tummy tuck is for.

My goal is to reduce my body/gender dysphoria, be comfortable or even happy with my body, and help me pass as a cis woman when I need to. I am nonbinary, but reliably passing would help a LOT in many stressful and traumatic situations, especially those outside of my little progressive big city gayborhood bubble. I also would love some gender euphoria, even.

Right now my chest (underbust) and waist are pretty much the same circumference - 38 inches. I'm hoping to reduce the size of my waist and belly a LOT, which I think is very doable with lip and especially the tummy tuck. I hope that it can be shaped in a fem way.

The fat transfer to my buttocks and hips/thighs are the area I'm most worried about. I'm not sure exactly what to expect there for results. This procedure is mostly done to cis women (where a very similar procedure is called a BBL). But, they are pretty much always starting in a place with more fat in these areas already, unless they're very thin (my BMI is 27).

I do want a rounded and more feminine butt and hips, including outer thighs which I also don't think people see as gendered, but they are. I also do NOT want them to be very large by cis woman standards, like a lot of cis women are looking for. I would be very, very happy with typical cis woman proportions there. My hips already have a 41" circumference, larger than my chest, which I don't really understand because my hip and buttocks are pretty flat. We'll see. According to internet, a typical/healthy fem waist/hip ratio is 0.7, so that means if I go up to say 44", my waist would be 30" ideally. I don't know if those are realistic results right now since I didn't talk numbers like this during my consults.

I have also seen transfem body contouring before/after pictures where the results seem minimal. I hope that I can see clear results, but not too dramatic.

Some other hopes -- my tummy tuck scar is low and straight, there are no major complications with the surgery, and my recovery isn't too bad. I've been having bad dreams about major complications (lost limbs etc) and other horrible things happening. Also feeling dread about dying. Yikes.

I have 12 days off my work-at-home job. I bought a BBL mattress from bootybeanbag.com, which is great quality, but jeez the hole in the middle of the air mattress is very uncomfortable even before the surgery. I also have a lovely cat who I'm afraid will puncture it. We'll see how it works post-surgery. The purpose of the hole is that since I am going to have my tummy tuck/lipo healing on my front, and fat transfer to my sides and butt, I won't be able to sleep on a regular mattress on any side. With the hole, that area of my body won't be touching anything.

I don't have anyone to watch over me after the first day. I'm single, I don't have close/accepting family, and I've lost a lot of my friends over the past 1-2 years. I am building a trans community and a few of them have been great at offering help and support. I'm very prepared with ready-to-eat protein-packed food -- protein bars, shakes, trail mix, as well as dried & fresh fruits including pineapple and papaya (both good for healing). I got a lot of other stuff. I'm probably gonna be in this mattress for a while.

These pictures I took 3 days pre-op. You can see the very masc torso I have, especially the belly and lack of hips/butt. I'll plan to follow up soon, but after pictures probably won't be for a while as I heal.

Wish me luck!

Wow, it's done!! I got to Dr Mangubat's office at 7:45 and got vitals taken, photos taken, and marked up by Dr Mangubat. He either REALLY knows what he's doing or is very confident or both. :) He walked through his markings and I could tell he was using his sculpting skills. One example is that I've never heard any other surgeon doing transfem body contouring or BBL's for cis women talk about fat transfer to the outer thighs, which after looking at cis women's body shapes are a very gendered area of fat.
I didn't have anything really to say because he covered everything in the markup. Which was very impressive since I came in with a boatload of questions & asks on what to do in the surgery.
Quick aside, the anesthesiologist was very friendly and charismatic too and seemed very competent! We met before the surgery and I then I don't remember anything after him putting the IV in my arm.
I woke up at about 3pm, a whole 7-8 hours later. No pain, nothing besides stiffness and I was VERY high off the anesthesia. I could walk easily but slowly.
I left pretty quickly after that, with just a couple notes including that I'll be leaking a lot and that my genital area would swell, maybe to the size of a grapefruit. My caretaker and I laughed at that exaggeration. (foreshadowing: IT WAS NOT AN EXAGGERATION! wow!)
I don't remember going home really, got into my BBL mattress pretty quick after a bunch of water (hadn't had water in ~20 hrs except a tiny bit after surgery). Still feeling fine except being goofy and high.
Then it started to hit hard an hour or two later. Massive swelling, massive leaking, some pain but not very much thanks to oxys.
I left in a diaper (like depends) and a few hours after getting home they are SOAKED. I recommend getting TONS of pads to put on wherever you are staying. I had 25 I bought plus a few the office gave me, but I just bought 50 more online to arrive in 2 days.
I got one bottle of pineapple juice and now I am craving wildly. I recommend stocking up! I've never had this craving for pineapple juice, but my body must really want bromelain: All I've had is water, pineapple juice, and protein shakes. Stock up on those, too.
I need to go to the bathroom SO MUCH, I guess because I'm trying to drink so many fluids. But some other surgery fluid is going out too, I can tell from the smell. Get a """female""" urinal like a shewee!! Even if you pee standing up (I don't), you'll likely be unable to aim, since you'll be so swollen. And sitting isn't great for results & pain. I'm soooooo glad I got one.
I attached pictures of my preop markings from Dr Mangubat and my dressing postop. You can see the scrotal sack swelling -- it is 100% scrotum, even tho it's a picture that doesn't look like it. This wasn't the extent of the swelling, it maybe doubled in size from this photo.
Sorry for misspellings & nonsense in this post, I'm still a bit under the influence.
I have a postop appt tomorrow! I'll keep trying to updare.

Quick update, day after surgery -

Last night was rough. I slept about 2 hours and the swelling around the genitals was intense and very uncomfortable throughout the night. It's slightly better today but still bad. The area is completely black with bruising. I had my day-after followup appointment and they said this is completely normal, and could last a week or more. Yikes. Wearing tight underwear helps, but use a thong so it doesn't compress your buttocks.

I can walk around and bend okay, but I am getting exhausted very quickly, and start sweating a lot after 1 minute of standing. So today's a bed day after the appointment.

I'm not hungry but trying to eat as many protein drinks/bars and homemade kale chips (prepped in advance) that I can to help heal.

I had my drain looked at and massaged in my back, and took off my garments for the first time to have a look at my body! It's very swollen all over, but it looks good. Of course with the swelling, my front is not as flat a I hope it will be, but my new hips and buttocks look good overall. There are a couple funny areas like the top of my buttocks looks like a shelf (flat horizontally) and where my hips meet my pelvis it's a bit bumpy, but I'm of course not passing judgment until the swelling's mostly gone. I'm so excited and am happy with the belly gone at the very least. I'm really looking forward to trying on clothes when the swelling's gone.

My next followup is in 3 days, where they say I'll have my drain removed, and I can finally take a shower. I'll probably try some clothes then even though I'll still be swollen.

<3