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Being Ready for the Emotional Ups and Downs of Recovery

Learning about the emotional ups and downs during recovery will hopefully help you feel better equipped for the surgical recovery process. Overall, gender affirming surgery is a hugely positive experience in one’s life. In addition to having feelings of celebration about what is to come, it is important to also be aware of the possibility of experiencing temporary negative feelings after surgery that are called “postoperative depression.”  This melancholy is actually common after all types of surgery. It warrants some special discussion for gender affirming surgery as people often expect to feel happy after surgery. 

Postoperative depression does not affect everyone, but when it happens it can be confusing and upsetting. This is because people understandably think that emotions after gender confirming surgery should be universally good, but that is not always the case immediately after surgery. There are a variety of reasons that sadness or low mood can occur after surgery; some reasons are physiological, some are psychological, and some are due to changes in routine and lifestyle after surgery through the recovery period. 

Surgery can be considered a type of trauma to the body–after all, your physical being is undergoing a huge transformation! After such a big change, a period of postoperative depression makes sense. The body registers surgery as a type of ‘wounding’ from which it needs to recover. After surgery, our emotions can kick in and tell us, “it’s time to dramatically lower your energy output for a while so you can get better,” which we may perceive as feelings of sadness and low motivation.

Likewise, given that it typically takes a year to see the final results of surgery–a shorter period is expected for liposuction and fat grafting–some patients experience a very temporary frustration and even regret after surgery. It is common for patients to feel unsatisfied with their appearance during the initial phase of recovery when they experience the highest levels of pain and inflammation. A patient’s apperance can change drastically as inflammation has gone down, which is why these feels are considered a normal part of a temporary postoperative depression. 

If feelings of postoperative depression occur for you, it’s important to remember that these feelings are normal and tend to go away by the end of the second or third week of the recovery process. Shortly thereafter, those feelings will very likely begin to be replaced by happiness and confidence. It is also a good idea to have coping mechanisms in place–such as meetings with a therapist, friends you can speak with and/or written reminders or affirmations ready for you to read–so if you do experience postoperative depression you are equipped to manage it while it lasts.

Your support system

Undergoing any kind of surgery takes preparation, and it is important to have a strong support system in place. The person/people caring for you should be warm, encouraging, and not critical or afraid of your appearance or needs that come about during the healing process. You will need their full support during this time.

If you have a therapist…

Many people see a therapist on an ongoing basis. If you are currently seeing a therapist as part of your support system, then it is a very good idea to plan a session within 1-2 weeks of your surgery date, in case you experience symptoms of postoperative depression. Even though these feelings are temporary, it can be very helpful to talk about them. It is also important to let your therapist know you are having surgery before the day comes, so you can discuss coping mechanisms to put in place in case of potential postoperative depression, especially if you are already predisposed to depression.

Below are some timelines to further explain what you may experience after surgery:

Emotional Roller Coaster

Please note that the following timeline is a rough estimation of the emotional experiences you may have post-op. That said, every recovery process is unique. Depending on the amount of procedures you undergo, your general health (both physical and mental) going into surgery, the type of support you recieve and other factors, the symptoms and timelines listed below may vary:

• The Day of Surgery: Tired, ‘out of it’, sleeping a lot 
• 2–7 Days Post-Surgery: Exhaustion, anxiety, sadness, irritablility, perhaps doubting the decision to have surgery
• 8–14 Days Post-Surgery: Hyper-critical, impatient, scared, eager for the recovery period to end and to get back to your regular life
• 15–21 Days Post-Surgery: Noticing results, feeling more positive, more confident in your decision to have surgery
• 1 Month Post-Surgery: Boost in confidence, happy you went through with it, getting positive reactions from others
• Beyond: Outcomes keep improving as healing continues

The Healing Curve

This diagram can help you understand how healing progresses. 

Physical reactions: swelling

Many patients ask when the swelling will go away. This curve will help you understand that it is a gradual process. Swelling can last much longer than expected, but it will eventually go away.