Episode #41: Cole’s Journey As A Transgender Woman And Becoming Her Most Authentic Self
Dr. Barrett chats with Cole R. on her transitioning journey, from preparing for top surgery and her transgender breast augmentation experience to the risks involved with silicone injections.
Dr. Barrett (00:03):
On this episode of The Natural Plastic Surgeon.
I want the best of the best for myself.
Dr. Barrett (00:11):
We can tell.
And that’s why I came here. But there’s nuance exactly in your work, like the extended release. I did go to other consults for my breast aug. I was even turned away by the incision type. They wanted to go in through the armpit.
Dr. Barrett (00:25):
It’s like drinking the Kool-Aid. Right? It’s just, we’re taught that in residency that inframammary incision, which is a line right underneath the breast has a lower rate of capsule contracture. But if you look at the actual data, they’re not using Keller Funnel, they’re not using all the techniques that we can use now to prevent capsule contracture. Now with trans patients, one of the things you have to watch out for is bottoming out, meaning that the implant slides too far down on the chest. And that happens a lot of times because overactive pectoral muscle. So you don’t want to weaken that bottom part of the breast.
Dr. Barrett (00:53):
I have a special guest on today. It is a previous patient, just had surgery two weeks ago with your beautiful breast augmentation. Okay? And Cole’s here with us actually not even two weeks from your surgery, just underneath.
Just shy, yeah.
Dr. Barrett (01:08):
Yeah. And Cole is a self-identified trans woman, a bad bitch enthusiast with a loud mouth and a strong point of view.
Dr. Barrett (01:14):
Okay. Well, welcome to the show.
Dr. Barrett (01:17):
And how are you feeling today? And so recent from surgery and how are things going? Let’s just dive in to see how you’re doing today.
Yeah. I am feeling amazing. I have just had my appointment before this. We removed some of the stitching and-
Dr. Barrett (01:35):
How painful was that?
Not painful at all.
Dr. Barrett (01:37):
And I was forewarn that appointment might have been the more painful one of-
Dr. Barrett (01:45):
Who says that by the way?
Well, one of the clinicians mentioned that just removing that might be a little more painful than the last sutures or stitches. And no, everything just seems so shockingly painless. It’s wild to me that I’ve even had surgery just two weeks ago.
Dr. Barrett (02:00):
Dr. Barrett (02:02):
Yeah, well, I was there for your appointment, obviously we checked on everything. We actually did a little quick check in with social media. You did a little testimonial. Thank you. And I already, we did 300 CCS, I think moderate profile plus. They already look great at two weeks. So you’re doing everything right. They look absolutely beautiful. And I caught you on Instagram. Those who want to check out your Instagram profile, are you interested in sharing that?
Dr. Barrett (02:28):
Instagram handle @coleroc. So C-O-L-E-R-O-C.
Dr. Barrett (02:33):
Yeah. I’ve already been flaunting my new body on-
Dr. Barrett (02:38):
I saw that.
… on Instagram.
Dr. Barrett (02:39):
I saw that you tagged us and you looked beautiful. Tell us how that feels. Right? You had a sunburn on your postop today.
Dr. Barrett (02:48):
I could tell, you’re just loving your new body. And so tell us about that.
I sat out at the pool for most all of the afternoon, and it’s just been incredible to be able to actually during my recovery in those few days that I was in bed at first, I did a new shopping haul. Bought myself a whole bunch of new bikinis, and shirts, and tops.
Dr. Barrett (03:11):
Dr. Barrett (03:12):
Just because I’m so elated to be able to fill out clothing differently than I was able to before. I didn’t even know the significance and impact that my breast augmentation was truly going to have on me. I didn’t think it would be this impactful to my gender dysphoria. But having it as also given me a newfound confidence. So yesterday I was very eager while the sun was out to slap on one of the new bikinis and head out to the pool.
Dr. Barrett (03:44):
That’s incredible. Describe how that felt when you like trying on the bikini and looking in the mirror. What did you see? How did you feel? Describe that moment to us.
Yeah, that moment was euphoric, quite simply. It was a moment where you’re able to look, most people take for granted looking in the mirror and identifying with the person in the body that they see. And as a trans woman, that hasn’t been the case for me my entire life. I’ve had years of looking in the mirror and not being comfortable in the skin that I was in. So being able to then put a bikini on, and I tried on some of the other items as well, putting them on and being comfortable in those items. You’re looking at someone you’re actually, you’re satisfied with your reflection. And it’s something I just didn’t, like I said, I didn’t anticipate it being that impactful. I don’t know why. I had my gender confirmation previously and I had had such a high. I held that in such high regard that I think I failed to realize that this was going to honestly com be comparable, if not better.
Dr. Barrett (04:57):
So I want to break that down. So you’ve had a few operations at this point. It’s interesting, a lot of times I get a lot of my trans patients earlier on in their steps. The breast augmentation, trans breast augmentation portion, tends to not be as involved me as some of the other surgeries. So I typically get people that do this one first. And this one is your last step. Right?
Dr. Barrett (05:25):
Okay. Can you walk us through the surgeries that you’ve had and the parts of the transformation that you felt through each one of those steps? And then a little bit more about how this one might have been different?
Yeah. So very early on in my transition, for me I consider the beginning of the physical transition journey to start with hormone therapy. So of course I began my hormones, began those back in August of 2020. And, your body starts to change from the moment you start to take your hormones. For me, it was blocking testosterone and putting in estrogen. And I didn’t see as much advancement, or change, or modification in my body as I would have liked to in the breast area, breast tissue. But from there, I dabbled in some cosmetic filler procedures with my face. And I usually do routine [inaudible 00:06:24], but that’s all just kind of been always there. I’ve always been doing that, trying to do preventative care. And then it’s always been for me about doing my gender confirmation surgery or reassignment surgery, as well as a breast aug.
It takes a lot of work for any trans individual to line up the necessary paperwork and overcome those obstacles to receive approval and authorization. So it’s been time consuming. The greater part of last year was consumed by getting everything in place for my confirmation surgery. I had that only in December of we’re in 2022. So December of 2021 last year, I had my confirmation surgery. And that for me was what I knew was really going to change a lot because I was so dysphoric with that part of my body. And that procedure is, as you can imagine, as difficult, it’s as lengthy of a procedure and then a lengthy and difficult recovery, as you can imagine. A lot of reconstruction and some parts of your body, having to relearn that you may fail to realize even myself as a patient.
I felt I have now even equated it that originally I thought that was like 80% of my dysphoria. And if the other 20% I thought was equated to my breast in aligning that. But it actually turned out to be so much more in terms of the breast having a bigger impact on my gender dysphoria than I initially realized at least. But other than the confirmation surgery, it was then coming and seeing you. And from the process of seeing you, I think I first saw you on May 2nd, and now we’re only midway through June and look where we are. It’s just wild.
Dr. Barrett (08:18):
Right. It’s amazing how fast things can happen.
Yeah. And how fast the body can heal. Because really when thinking about it in a whole, I’ve had both procedures done relatively, within six months or so of each other.
Dr. Barrett (08:36):
Yeah. Yeah. You’ve bounced back so amazing, it’s been incredible. And it’s been an honor to be part of your journey in your transformation. It’s funny is me as a surgeon, I’ll never be able to fully comprehend what it’s like to not be really fully satisfied, with your body, especially when it comes to gender and having gender dysphoria. That’s just not something I’m probably ever have to go through. And so I always have it like a special place in my heart for women and men who feel gender dysphoria because it’s almost like the whole world’s kind of against. And it’s right and so it’s even like logistics, and paperwork, and everything else is just, it’s an uphill battle.
Dr. Barrett (09:20):
And so that’s, that’s partly why I don’t do the gender confirmation surgery for the genital surgery. I focus on top surgery and that’s my specialties, my passion. And I always have a little special place in my heart for doing those operations because I realize that my trans patients go through a heck of a lot to get to this point. Not to discount my cis patients they also have some body confidence issues. But I just think in general, it’s not at the same level as a whole as my transmissions. And that’s why I’ve specialized in this procedure. So I’m really glad that I’ve been able to kind of help make that happen for you. Because it’s like an extra level. Yes, there’s body confidence, but there’s a lot more to that too. There’s a whole identity there that’s I think is really positive.
There is. And I thank you immensely because having this bookmarked or this chapter closed, and by that I mean surgeries and you being able to help that. I like truly can now, as you pointed out, the logistical aspects, I can now focus my attention on things that normal people would be focusing on. And I can reorient myself and focus back to my career and so many different areas of my life. Romance, where I’m not just so consumed by aligning my body to my gender.
Dr. Barrett (10:45):
Exactly. Well, tell us about yourself. What do you do? What is your career?
Yeah, so I actually work for a company who makes menstrual products for menstruaters. A very progressive company as well. Okay. So we always say, “Menstruaters.” Trader because there’s many different genders that menstruate. I oversee regulatory affairs and quality assurance. So I do some nitty gritty behind the scenes work of interpreting legislation and guidance from the FDA and then applying that to our products, their labeling, and their compliance. Very technical by day, I say I am. But then that bad bitch enthusiast comes out in my spare time and free time.
Dr. Barrett (11:27):
That’s that’s incredible. So this whole journey for you started with the hormones in 2020.
Dr. Barrett (11:35):
I had a previous guest on here who talked about getting illegal injections, Silicone injections, people’s garages, people’s hotel rooms. Have you been exposed to any… this was a trans woman. Her name is Bitter Betty and we had a podcast episode. I forget which episode that is. Do we know guys?
Speaker 3 (11:57):
Dr. Barrett (11:58):
- We had episode 34 with Bitter Betty on the podcast and she’s a lot older. And she came from an underprivileged background and was tempted to get injections, and lip filler, and things like that on a illegal basis. Have you had any exposure to that or know anybody? Has that ever popped up in your research for what you were trying to do?
Yeah. So there’s so many different facets here. There’s honestly such little and scarce information made readily available to trans individuals, even Googling. You would think you can go and Google anything, we could learn how to change an engine in a car probably more easily than you can find some material for knowing the process and steps for getting over the table or appropriate care. So Reddit has been a place of going and reading. And I know as well for the trans community as a whole, older generations, they ha there was less. Right? We didn’t have the internet. So much was word of mouth.
I’ve had to just spend a lot of time digging on Reddit. Prior to seeking out my own procedures, I didn’t even know how to operate Reddit. I thought the user interface was terrible and I didn’t know what I was doing. And I familiarized myself because I realized that’s where the community goes to be able to talk to one another and find appropriate care. I have to say, I am very privileged and blessed in having been employed full time. And I have my workplace is extremely, extremely accepting and very, very helpful in that providing me benefits that allow me to get care that has been all by the books at least.
But I’ve had the propositions or proposals from others. Yeah. I’ve been even in a club in LA here where someone’s like, “Well, if you ever want some additional injections or if you ever want hormone injectables instead.” Because I do mine orally. They’re like, “We know where you can get some off market.”
Dr. Barrett (14:15):
So it’s definitely prevalent within the community. I’ve just thankfully been able to avoid it. I and also just too fearful. I don’t want to stick anything in my body that may go awry.
Dr. Barrett (14:27):
Yeah, you’ve got the perfect track record of really making smart decisions and that’s fantastic. And I, and I want people to know that there are resources out there. Red flags are, you want to go to somebody who’s qualified to do this that has a medical license. You don’t want to cut corners. Liquid silicone injections is really detrimental. We definitely want to stay away from that. It’s something you’re going to regret later. It’s your body, you only live once. And so I encourage people to really do your research on this and perhaps they can reach out to you on Instagram?
Dr. Barrett (15:05):
I don’t know if that’s possible, if they have any questions. I have had patients, even younger generation who have had liquid silicone injections into the buttocks and for the few that I have had recently they’re fine. But it’s a ticking time bomb. You get one infection there and it’s a disaster-
If may jump in.
Dr. Barrett (15:25):
What would happen? Because I’m naive even to understanding what would happen if I-
Dr. Barrett (15:31):
So the problem with liquid silicone is for two thirds of the, and don’t take this as a green light. The two thirds of the population, it ends up working out fine. One third of the population ends up dispersing in a kind of a grain, luminous manner end this more subject to being infected. So getting liquid silicone used to be actually, there’s still some doctors qualified individuals that do it for the nose, they do it for the lips. But it is like an antiquated art form. There’s only very few people. I think Dr. Colter is probably one of the only few people that I would ever recommend to actually do that. The rest of everybody else are not really qualified people. They don’t have enough experience with it or they over inject.
Dr. Barrett (16:11):
And if it gets contaminated, if it gets infected, when it goes in that residual infection can never be cleared by your body. So it causes a constant state of inflammation and infection in your body. And if you were to inject it sterilely and you have a lot of it let’s say in the buttock area for example, it can be fine for many, many years, but then all of a sudden, if you floss your teeth or you get a dental procedure and you create a transient bacteremia in your bloodstream. And for some reason it seeds a bacteria on that silicone and your body and its forms, a biofilm on that liquid silicone, that’s where you form big problems. So it’s just like a ticking time bomb that it may be fine, but the risk is way too high. 20 to 30% chance that you’re going to run into major problems. And it can be life threatening at that point or very at the very least very disfiguring.
Dr. Barrett (16:58):
Because the surgeries, you can’t just remove it becomes integrated into your tissues and sometimes it migrates. The buttocks I’ve seen patients when I was back in my residency training at the County Hospital where it migrated down their legs, and they had open wounds, and sores all down the backs of their legs, and they were on multiple antibiotics. It’s Not worth that risk. There’s other things you can do. We can do silicone implants for buttocks. Right? It costs more. But if you can’t afford that, just wait. Wait and prioritize and hit the gym, do the glute workouts. Try to optimize as best you can because it’s not worth your health, and your body, and your life to risk those things. In my opinion.
Yeah. And I got to say health insurance, at least for trans individuals, they’re trans gender dysphoria and treatment care have been evolving. And they’ve evolved so, so much in the last, even two years, I would say. Because even as I began to look into my procedures, they had changed the threshold, I believe from my carrier, from two years of waiting on hormones down to even one year.
Dr. Barrett (18:14):
So the thresholds are changing, the criteria’s changing and evolving to really make care more accessible and easier. So I would just encourage people to go see what the maybe appropriate route is first. And always try and get that done.
Dr. Barrett (18:35):
Yeah, absolutely. I we’ve actually had great success with dealing with insurance companies for these procedures. So for those of you who are worried about finances for this and things like that, check with your insurance, check to see what insurance options are out there that could potentially cover the procedures that you’re interested in.
Dr. Barrett (18:53):
I know there are many insurance companies that cover breast augmentation for trans patients. I always suggest at least six months of hormones, just because we want to develop some breast growth to cover the implant, to allow for a more stable operation result. But if they require a year, that’s up to insurance company. But generally we want to at least be on six months before we’re thinking about breast augmentation. But we have been working actually a lot with a lot of insurance companies because we are getting known here in our office as kind of a place that does these operations. A lot of surgeons they don’t know how to do these operations. It’s not like a cis breast augmentation. There’s a lot of other things you need to consider. And I talk about that in some of my videos for surgeries. I probably talked about ii, I think we filmed your surgery too.
Yeah. We filmed my surgery as well. And I want to also say that not only is it that you do it, but you do it well. I ultimately, I want the best of the best for myself.
Dr. Barrett (19:54):
We can tell.
And that’s why I came here. But there’s nuance exactly. In your work, like the extended release, I did go to other consults for my breast aug and I was even turned away by the incision type. They wanted to go in through the armpit even for putting my implant in. And that just seemed unnecessary to me. And you have an expertise in being able to go through and I’ll say I have the world’s smallest nipples so we still made that possible.
Dr. Barrett (20:25):
Yes, you do. They’re smaller than that Fiji bottle water cap. Yeah, there’s a lot of surgeons that like to use these other incisions and I say it’s like drinking the Kool-Aid. Right? It’s just, we’re taught that in residency that inframammary incision, which is a line right underneath the breast, has a lower rate capsule contracture. But if you look at the actual data, they’re not using Keller Funnel, they’re not using all the techniques that we can use now to prevent capsule contracture. So if you look at capsule contracture, that’s the scar tissue that can form around an implant. It’s the number one complication that happens in breast augmentation.
Dr. Barrett (20:56):
Now with trans patients, one of the things you have to watch out for is bottoming out, meaning that the implant slides too far down on the chest. And that happens a lot of times because overactive pectoral muscle. So if you go underneath the muscle, you get a greater push down of the pectorals muscle. And so you don’t want to weaken that bottom part of the breast. So it’s kind of like a double whammy if you’re doing a trans breasts augmentation. You don’t release the muscle enough and then you do an inframammary incision. Now, all of a sudden you have an implant that slides too far down on the chest. And you’ve seen this before.
Dr. Barrett (21:22):
Yeah. And then all of a, the nipple points up towards the sky. So you have to combat that. And then you have some surgeons that will just do everything above the muscle, and then you have an okay result, but then it tends to be very circular looking and it tends to be very fake.
Dr. Barrett (21:35):
There’s a lot of surgeons, the ones that I talk to that are in this town, I don’t like how they do them. There’s one who works at Kaiser and he always goes above the muscle because he doesn’t want to mess with the muscle. And I’m like, “You’re setting your patient up for a higher rate of capsule contracture, which we know. And then you’re setting them up for just a more fake appearing result that can kind of be giveaway.” It’s not natural. So-
And we as patients really look to you all to point those things out because we don’t know it otherwise. and so your willingness to be so forward and open with everything, even all the way through to your social media and the postings. Is like number one, what I think leads to feeling more comfortable in knowing that you’ve actually decided to look into different areas and know different things.
Dr. Barrett (22:27):
There’s not a whole lot of research. Here’s the problem is there’s no book on transgender breast. Maybe I should write one. Right? Yeah, maybe I should write a chapter. There’s no guide that we read that tells us how to do it. So I’ve had do my research and work through different techniques to see which ones work the best because we do a fair amount now. So yeah. And I think we found a happy medium. And yes the Perry [inaudible 00:22:53], which you have around the border of the areola is a very challenging incision. Most surgeons they can’t even deal with something that small. But it’s just like, if you take your time when you’re doing these operations, yes it’s harder. But ends up with a better result for the patient and that’s ultimately what matters. When you were doing your research, how did you come across me and the practice here?
Yeah. So I think I first found you through Instagram, honestly. Instagram’s got its algorithm, so I started to follow some other plastic surgeons I believe. And as a result, I think you were recommended to mine.
Dr. Barrett (23:33):
My Instagram is Dr. Daniel Barrett, by the way, for anybody who’s listening, wants to check it out. D-R, Daniel Barrett.
Yeah. And great content on there too.
Dr. Barrett (23:41):
Awesome. Thank you.
Fully support everything that’s on there. Once I had seen you on Instagram and started following, I went and validated it and checked it on Reddit. And so there’s a transgender surgeries sub I don’t even know what the jargon is for Reddit, but community on Reddit where your name was mentioned on the surgery Wiki.
Dr. Barrett (24:05):
Yeah. Oh, cool.
And so I knew that to me also validated that, okay you’re known in our community and that endorsed you for me a little bit. But I had ultimately found you on Instagram. And like I said, I was most blown away by seeing into the or room and you doing the on table sizing. Which again is something I brought up to some of the other surgeons during consults. And that was, that was like a, “No, that’s not what builds it out.”
Dr. Barrett (24:37):
They make you pick your size ahead of time. Right?
Dr. Barrett (24:38):
Which is just like going a new shoe store, buying a pair of shoes and you don’t even get to try them on.
Dr. Barrett (24:45):
It’s like, “Okay, this.”
And I’m out. I can’t tell you-
Dr. Barrett (24:49):
I know, exactly.
… While we’re in there. So you need to be make that judgment by sizing.
Right. Now we did that for you. We did 300 CCS. How do you feel about that?
Extremely happy, they’re the perfect size. They are so proportional to my body that I can already tell. And maybe it’s not everyone’s goal or aspiration, but that naturalness is something that I wanted. And that’s what we talked about in terms of goal. And I feel confidently that anyone would look at my breast or look at my frame and it’s believable that this chest size was always meant to be on my body.
Dr. Barrett (25:26):
Somebody who’s looking to get this procedure done or other surgeries in general, what kind of advice would you give them?
The advice I’d give is definitely to just take your time, do the research, and I say date around. I’ve mentioned a couple of times that I’ve done consults. Date around and get opinions and-
Dr. Barrett (25:48):
Oh, date around.
Dr. Barrett (25:50):
Dr. Barrett (25:50):
Yeah. Okay, cool.
So date around to different surgeons or providers. There’s a lot of different things that you want to take the time to think about that you may not think about up front. Even bedside manner, or chairside manner, and the entire team’s care. Being able to walk in as a patient, from the moment you walk in and feel from front desk all the way through to OR and out you want a good experience. Because that’s all going to color, just your mindset and your energy going into an operation.
Dr. Barrett (26:29):
Right. It’s like, if you go into a restaurant and the bathroom’s dirty. It’s like, what does that tell you about everything? Yeah. So I agree with that. People should always go to a consultation, get a sense for the vibes. If they’re not good, if the bedside manner’s bad, it’s going to be worse on the back end. Right?
Dr. Barrett (26:44):
So definitely don’t go with your first option. We get a lot of people that come, they’ll get a consult here and then they’ll go somewhere else. They’re like, “We have another consult. We’re going to go over there.” And they do that. They’re like, “Oh my God, we’re coming back here.” Because we have an amazing team and we bring on people that are really excited about our patient’s results. That’s what we actually try to incentivize everybody on. How happy are you after your results? How did everything go? It’s not about the dollar amount, it’s about the satisfaction rate and getting people on board that are really, truly motivated intrinsically about making people feel better about their bodies, even better about their bodies. We came up with a whole slogan that’s what we’re here to do, about themselves.
So, yeah and I already personally know some other friends who’ve already come to you. You’re someone I would now, word of mouth. The care that I’ve received is, I’m on here now to tell anyone that I endorse coming to you for this operation, for this procedure. And I would tell anyone of my friends or family also. Just because the care has been displayed and been there from all throughout.
Dr. Barrett (27:58):
Amazing. This sounds like a big infomercial for our practice.
I’m not getting paid to be here. I’ll tell everyone.
Dr. Barrett (28:04):
Well, thank you Cole. I can’t thank you enough. Is there anything else you want to share with the listeners out there that you think might be valuable or important?
Yeah, I do want to just give a little more to the trans community. And if anyone out there is listening, watching us, just take the time, don’t rush anything. I consider myself to have started my transition late. but I-
Dr. Barrett (28:31):
And how old are we now? Are we okay to share that?
Dr. Barrett (28:32):
Yeah. So physical journey wise, I began in 2020. So just a couple of years ago. But before that was a lot of time in therapy, and in talking with a therapist, and psychotherapist, and really learning to understand what it essentially was that crippling me. Which was how we identified gender dysphoria.
Dr. Barrett (28:57):
Did the therapist help with that?
Yeah. I’m a firm believer in gender is constructed, it’s a constructive society. And so I felt for me by identifying as a trans woman, I was giving into societally constructed genders and that they’re so binary. And that I also believe that gender just shouldn’t exist as a construct and it’s non-binary. So I felt like I was giving in a way but my therapist will never forget. I may also want to elect to have like laser hair removal and maybe someone else likes to have hair in that spot. I can still support you in your journey and believe that’s okay to do while making myself most happy and content in aligning myself. And so that’s really where through that work with a therapist, I got to a head space where I was able to accept myself and then truly move forward. So I would just encourage as well that if I had been younger, and eager, and started this transition earlier, I might have made rational decisions.
Dr. Barrett (30:09):
Yeah, you are well put together and you seem very mature. You’re definitely very mature about this whole process and that speaks volumes to all the decisions that you’ve made.
Yeah. Thank you.
Dr. Barrett (30:22):
I appreciate it.
Dr. Barrett (30:24):
Well, Cole, thank you so much for being on the show.
Dr. Barrett (30:26):
And we can’t thank you enough. We’re still healing, we still have a long ways to go. And you guys, if you are interested in seeing Cole’s follow ups, you check out our Instagram Dr. Daniel Barrett on Instagram. And also if you want to see Cole’s amazing bikini photos, check out her Instagram @coleroc, so C-O-L-E-R-O-C. Right?
Dr. Barrett (30:51):
At Instagram. And give her a follow in a shout out. And thank you, Cole.
Thank you for having me.
Dr. Barrett (30:57):