The first time that the word “cleavage” ever appears in print to reference a woman’s breasts is as a euphemism. A 1946 Time article about movie censorship notes that the word is “[an industry] trade term for the shadowed depression dividing an actress’ bosom into two distinct sections.”
It is a word with an unusual history, used in an unusual way: for something to be divided, or “split into parts,” implies it must have originated from a single source, must have been split. This places breasts into a word whose literary history has, until then, only encompassed objects that accorded with this logic: geological phenomena and mineralogy (1816), cell division (1876), religious dissidence (1867).
To view my budding chest as cleavage in the context of this history makes a lot of sense to me. I have always associated the emergence of my breasts with a kind of displacement of my body from myself: the swelling, the aching, the pressing in, the insistence of the growing despite it all.
There is a name for all of this; a diagnosis even. I could spend hours on it, detailing how it wove into my life the way a drug dissolves into the bloodstream, distributes, integrates itself throughout the body. I could recount the customary stories of disgust and shame, the muddled airport scans and bathroom glares and fervent prayers for breast cancer. I could describe the horror of finding my nipples distended with oil and milk1, the scars butterflied across my chest from binding, the stench of an open wound that comes from peeling away a piece of tape. These anecdotes are, ultimately, disinteresting.
What is important to know is this: at one time, there was a flat chest, and then there was cleavage. That is all.
Here is a story my mother likes to tell when I am being stubborn.
When I was a baby, I cried and screamed whenever she tried to brush my teeth. One day, she had had enough, and she stopped doing so, and so my teeth went unbrushed for nearly a year. The moral of the anecdote is clear: I cannot control you, but what you choose to do against me will destroy you.
My mother at 30: her stomach permanently sagged from carrying the punishing weight of my body, her breasts torn from the force of my mouth, her body one long ache from raising two children in a foreign country without her husband and clinging onto her job to stay in that foreign country. A child writhing in her arms, grim cavities staining the child’s mouth like black stars. My mother’s face, still flush with the grace of youth, already somehow calcified.
I have only ever seen my mother cry twice. Once was when she was missing her own mother. The other was in fourth grade, when I lied to her. She made me bend on my knees, lift my hands face up. She hit them with a wooden stick so hard that blood rose to the surface of my hands and lined my palms like oil.
There are certain things of which my mother always reminds me. One—that she will always love me. Two—that I will always be her daughter. She sings both of these in the reedy half-whine that comes to her only when she is close to sleep. It is meant to be comforting.
Mom. Mom. This is what I say.
I have something to tell you. There are things about me, things that I want, that might not make me your daughter anymore.
Or rather, that is what I might have said if I could have gone back. In this story, I don’t say anything.
Mother, who forced me to sleep in her bed once every month because she craved the comfort of my little body. Who would rest easy next to me while I stared at the shadows on the ceiling. Who pulled at my toes until they gave that little pop that we both so loved. Who read Our Daily Bread in bed with me until I couldn’t fit on her lap anymore. Who tucked devotionals into my suitcase before I left for college. Who made me promise to find a congregation when I left, but not the kind with gay people. Who asked me if I liked women. Who asked if I had anything to tell her. To whom I always, always, said no.
Mom, forgive me. Forgive me for what I didn’t say. Forgive me for what I am about to tell you. I was only trying to protect you.
Mom. Mom. Mom, listen to me. Mom, don’t you remember? When I woke up in the middle of the night, I would go back to my room and spend the rest of the night there. But you never said anything about that, either.
One of my mother’s favorite Bible verses is Psalm 139, a song of David in a chapter full of lyric and prophecy. She likes to say it in the car when she looks at me that sidelong way as we wind our way home in the dark, reaching her hand out to tousle my hair. She has recited it so many times that I know it by heart:
“For you created my inmost being; you knit me together in my mother’s womb.
I praise you because I am fearfully and wonderfully made; Your works are wonderful, I know that full well.
My frame was not hidden from you when I was made in the secret place, when I was woven together in the depths of the earth
Your eyes saw my unformed body; all the days ordained for me were written in your book before one of them came to be.”
This is a psalm with a tumultuous political history. Pro-lifers have used it as justification against abortion; LGBT activists to naturalize same-sex attraction. In recent arguments against transgenderism, conservative Christian media has leveraged the verse to assert that one’s sex is determined in the womb, and any attempt to subvert that “den[ies] the goodness, or even the ultimate reality, of the natural world.”
I do not think that my mother knows any of this, at least not consciously. What she loves about the text is its gorgeous language, its sense of ecstatic wonderment of humanity, its assertion that she and I are both carefully constructed. Knit, to be exact—knit.
In their seminal exegetic text, Commentaries, theologians Franz Delitzsch and Carl Friedrich Keil take care to emphasize that the Hebrew word for knit used in the original verse, קָנהָ, specifies “not: to cover, protect, but: to plait, interweave, viz., with bones, sinews, and veins.” Christian website Answers in Genesis notes how “an obvious example of this woven or web-like organization can be seen in the dermis of the skin… [where] connective tissue fibers made of the protein collagen are woven in a highly complex manner.”
The Christians make a clever synthetic move in their analysis, literalizing the metaphor of God’s knitting by noting how the sinew and gristle of the body’s components are literally patterned like a weave. In reality, tissues are not constructed from strings of cells cleverly plaited together like a blanket. This does not matter. What does is that what these sources emphasize are knit is not the mind, but the body. The body contains the evidence of the weave; the body is what is wonderfully made. And thus, the body, the one that has formed beyond my control, is the source of truth.
Here is the crux of our relationship, distilled into a single verse: my mother’s denial that what she terms my gender confusion is fixed in reality. It is disbelief of my suffering, of queerness as a legitimate mode of being. My mother does not hate me, she has told me that many times. But she also does not believe me.
Like my mother, I too love the word knit, but for its quiet domesticity, how it places the task of creation into the feminine sphere. I know this is not how bodies are made, but I love the intimacy of it anyway, the image of God building up this body fiber by fiber from a single long strand, two needles in his hands.
We now know that every human originates from a single cell, and the mechanism of their growth into a person is cell division. That is, we can only become realized through splittage, through rupture.
There is another word for this.
When I accidentally reveal to my mother that I have been considering a “breast reduction,” she says, God gave them to you.
One of the things your dad insisted I had to do was breastfeed. He said it was very important to breastfeed you and your brother. I believe it had good results. Your breasts are for your children and your husband. Don’t be selfish.2
Later, I will write this in the pages of my notebook, again and again, so much that the imprint of the pen is tattooed onto the pages behind it:
“Don’t be selfish. Don’t be selfish. Don’t be selfish.”
Okay, I finally say. But, you won’t try to stop me if I do it?
No. A pause. You know that I can’t stop you. You know that.
Okay. Okay. Okay. Three times; like a chorus, like an incantation, like the strings of songs I must sing to myself over and over and over again to soothe myself to sleep. And then—Thank you.
As Emmanuel Carrère likes to say: “It’s not much, but it’s not nothing either.”
After graduation, I schedule my top surgery under my own health insurance, a double mastectomy meant to remove the entirety of my breasts. I do not tell her. I tell myself that this is motivated by fear of her disappointment, her confusion and incredulity and disbelief. Only later do I allow myself to admit that I do not tell my mother because I do not want her to come.
The insurance approval letter that arrives in the mail calls the procedure a “simple mastectomy,” and I laugh at the name.
In the 13th century, French-Italian surgical pioneer LanFranco da Milano described in his surgical tome Chirurgia Magna a process to determine what kind of corrective surgery to perform on hermaphrodites. It is an algorithm in the strictest sense of the word, gender stripped to procedure. The algorithm works by first ascertaining a “true” gender and then acting upon it surgically, and it goes something like this:3
if there is added flesh:
if it becomes erect upon touching a woman:
In no way touch that with the iron nor think to treat it with anything.
The fleshy piece is removed swiftly with cutting instruments, and those parts left behind with light cauterization.
if there is a pit resembling the vulva of women:
if there does not exist an opening through which they pass urine:
Touch that place with a hot iron little by little, and then apply butter and expect the occurrence of the cautery scab. If you followed your plan, you grow back the skin.
Abandon the cure.
Seven centuries later, John Money, a psychologist at Johns Hopkins University, will recommend similar surgeries for intersex children. He theorizes that in the presence of ambiguous genitalia, surgical correction in the direction of an assigned gender and “life experience,” or socialization as that gender, will lead to a clear male or female identity. Money assigns a sex to intersex people, and enforces it with the blade in a manner even his sympathetic biographers consider “doctrinaire.” Unlike LanFranco, however, he does this not to elucidate some true, natural sex of the person, but to assert the hypothesis that whichever sex is assigned is, ultimately, arbitrary.
Money’s experiments on intersex children pique his interest in gender identity, earning him the sensationalist title of “The Man who Invented Gender.” He becomes an instrumental figure in establishing the first sexual reassignment surgery clinic in the United States at Johns Hopkins in 1966.
It is a hard-won success for transgender people seeking surgery, perhaps, but also a cautious success, formulated as a “rigorously experimental” program that will operate in strict secrecy. Nevertheless, the program receives well over a thousand applications.
Thirteen years later, Johns Hopkins closes the clinic. Despite positive mental and surgical outcomes across virtually all participants, the newly appointed, Harvard-educated psychiatric chair, Paul McHugh, denounces transgender people as suffering from a psychological disorder, to be addressed “using a purely psychological approach.” The experiment is over.
Twenty years after McHugh closes the Gender Identity Clinic, a classics student from Rutgers is admitted to the Johns Hopkins School of Medicine. She studies there for over a decade, becomes a plastic surgeon, chooses to specialize in gender-affirming surgery despite her institution’s official stance. To become a “sex-change surgeon” is a difficult path for any doctor to take in the early 2000s, the kind of decision her peers will view as scandalous. They do not teach these surgeries at the medical school, and so to learn how to perform them, she travels to Canada, Mexico, Thailand.
And she does learn. She goes further than LanFranco and his scalpel ever did. She learns how to burnish a jutting brow bone down to smoothness, to peel breast tissue away from muscle, to fashion a penis from the skin that wraps around a wrist, to construct a self-lubricating vagina using robots. Many surgeons have built entire practices on just one of these operations. She learns all of them. She goes back to Baltimore, practices, develops a reputation. Her mentors predict that she will become a “superstar,” an “uber-plastic surgeon,” and they are not wrong.
Fifteen years after the classics student enters medical school, I enroll at Johns Hopkins to study biomedical engineering. I want to become a tissue engineer, the kind who coaxes cells to differentiate outside of the womb, grows organs in a petri dish. I am told that to do this, I must learn how to properly perform research, and so I do—I inject small pearls of cancer under living animal skin, dissect sciatic nerves from freshly-beheaded frogs, learn the most efficient way to kill a lab mouse using only my hands. I learn what most scientists already know: embedded into the scientific process is hard, often violent labor.
Johns Hopkins is the oldest research institution in the US, and also has the highest research endowment—$2.5 billion, nearly double the next place on the list. The university is a bastion of old-guard scientific and medical education, its founding statement ground in producing research, its motto “veritas vos liberabit.” The truth shall set you free. This system, the largest employer in the state of Maryland, will not perform a single gender affirming surgery during the entire time I am there, and it will use science to justify that decision.
Ironically, there also exists a certain camp of transgender people who think that justification for their gender identity can be wholly circumscribed by science. They call themselves transmedicalists,4 and most of them believe that being transgender is a simple question of brain chemistry. They cite research studies about exposure to testosterone in the womb, papers about physiological differences between male and female brains. Even their name reaches toward the authority of science (as opposed to the older, more derisive nickname “truscum” given by their detractors).
The holy grail of transmedicalism is to reduce the process of determining one’s “true” gender to a single brain scan. Controversial transmasculine YouTuber, Kalvin Garrah, perhaps transmedicalism’s most ardent and certainly its most visible proponent, notes in his video, “No, You Can’t Identify as Autismgender,” that “trans people wish there [were] a brain scan we could sit the [trans]trenders5 in and make them take it.” Ostensibly, to disprove that they were ever transgender in the first place.
If this could be done, science could finally be used to validate the existence of real transgender people. If this were true, we would see that perhaps LanFranco was ahead of his time—the truth could be found in the weave and weft of the body after all. I understand this, sympathize with it, find it seductive myself.
But here is the thing about desire: it resists the scientific method. It is a slippery thing, to categorize and label this kind of want, to pin a name to it, much less a number. The p-values used in brain research have found differences between male / female brains statistically insignificant. The scant research on transsexual brain chemistry was performed on less than 100 people. Anyone with even a cursory knowledge of statistics knows that nothing produced by a sample size this small on a question like this could ever result in anything scientifically meaningful.
The existence of gradients, the massive scope of human variation distilled in a relative modicum of genetic material, the inadequacy of even the most rigorous models to reflect the biological reality of the body: this, if nothing else, is what I have learned from my scientific training.6
Sometimes, all you can do is listen to a person, have faith that what they are telling you is real and enough. In this way, I have found that being transgender is a lot like religion.
May 15, 2014: “Top surgery without t”
June 22, 2015: “can breasts grow back after top surgery”
January 14, 2016: “nonbinary top surgery”
March 14, 2017: “periareolar top surgery”
July 20, 2018: “NYC surgeon”
July 20, 2018: “Top surgery alone”
I have always been obsessed with the idea of a personal archive that gathers the crumbs strewn along the path of a life. The archive is a second memory of sorts that aids in the process of reconstructing the path. It also serves as proof that the path was indeed traversed.
A bad habit I had during my time at college was to research top surgery. I scrolled through innumerable pictures of scarred chests and reattached nipples during bouts of self-loathing and desire greater than any lust I had ever known. My Google search history became an archive from which I could reconstruct a crude map that tracked this, insisted over and over again that the desire existed, and thus it was real, and thus what I am was real and abiding by force of repetition. This comes dangerously close to sounding like justification that I am not a transtrender, and sometimes I think it is. The compulsion to be believed has always, always, remained.
In 2018, I came across pictures of chests reconstructed by the classics student from Rutgers. The images were impressive, but it was when I read that she had trained at Johns Hopkins that I knew I could trust her, that she would be my surgeon. To have waited that long, to have shared in the same violent legacy, to have partaken in it on both sides of the table—it felt something like prophecy.
In the hundreds of times that I have imagined the day of surgery, I see myself wheeled in a gurney into the operating room, lifted by anonymous hands onto a table. But I walk myself into the operating room. They call my name and I walk up to them and they lead me through the hallway, open the double doors. The short walk feels like a journey through an execution reimagined for the 21st century: splinter of metal on metal, frantic machine-whine, glitter of a hundred refracted scalpels, electric drag of light, and, there it is, there it is, there it is at the center: a solitary table, fashioned in the shape of a cross.
I walk up to it, climb onto the operating table; lift my legs and hoist my body up. At that moment, suspended on my hands and knees in the middle of the table as if prostrating myself in prayer, my fear overwhelms me. But I swallow, and use my arms to drag the rest of myself on.
Only when I am secured onto the operating table, each limb individually strapped in, only when the propofol has been injected into my hand, only then do they take my glasses off, quickly and carefully. The procedure, all in all, takes two surgeries: the mastectomy, and then an emergency surgery. Another rush of tubes and painful splay of arms and enormous amounts of blood they told me I lost. This second time, I am lifted onto the table.
Still, there are little graces. Every time that I wake from my drug-induced sleep—groggy, fumbling, unsure—the glasses are already on my face.
During one of my follow-up appointments, my surgeon takes a look at the scabs that line my areolas, dry into the crevices of my incisions the way that water flows into low places. She grabs a pair of tweezers and scissors, and the vigor with which she pulls at the stitches and the scabs surprises me. A dusting of scabby skin falls onto my pants like crumbs.
I’m bleeding, I note.
She smiles. I’m sorry, that was me. One more intent snip at an errant stitch. The good part about bleeding, though, is that it means it’s alive.
What does it mean when you have to cut into something to make sure it’s still there?
How can you believe that something is dead without hurting it? How can you believe something is alive without hurting it? How can you believe something is, without hurting it?
John 19:34 suggests that this isn’t possible. The soldiers shoved a spear into Jesus’s side when he was on the cross to make sure he was dead, in the kind of inexorable logic with the force of prophecy7 behind it. There is a spiritual explanation8 for what comes out, but also a physiological one. When blood sits in a dead body long enough, it separates into cellular material and plasma. Blood and water poured from his breast like curdled milk, first in matted clumps, then cleanly.
But even this is grace compared to what they did to the men on the crucifixes preceding him: they broke their legs. This was not to determine death, but to assure it.
There is a kind of violence in eradicating disbelief. There is also violence in disbelief itself. We see this one verse later, after Jesus has risen from the dead. In John 20:25, his disciple Thomas says, Unless I see the nail marks in his hands and put my finger where the nails were, and put my hand into his side, I will not believe.
Jesus admonishes how Thomas requires evidence, inviting him to touch his wounds but also saying, Blessed are those who have not seen and yet have believed. This scene becomes known as “The Incredulity of St. Thomas,” and Thomas’s doubt becomes an object of fixation in the Western imagination, inspiring mosaics, bas reliefs, the requisite Caravaggio, etc.
I’m not trying to call myself Jesus. I am, after all, not a man.
Maybe if I tell the story this way, my mother will understand.
- I am naked, freshly scarred and keeled over in pain outside my mother’s door. The only recourse I have to cover myself: to knock on the door and reveal what I have done to her.
- My notebooks lie in a pile on my desk, detailing the existence of this surgery and all my thoughts preceding it. I tell my mother not to read them. I come back into the room to find her thumb tucked unrepentant in between a notebook, a small pile beside her already consumed. I scream myself hoarse, throat destroyed by the end of it all.
I trade in a perfectly fine body for swaths of numbness; for a militaristic regimen of Tylenol, stool softeners, and oxycodone; for adhesives and salves and gauze. For weeping drain holes under my armpits, recalcitrant scabs spitting stitches for weeks, medicated nipples rubbing bactroban circles into my shirts. This is not a surprise. Or rather, this should not be a surprise. It is, after all, an old adage that surgery is controlled trauma.
But still. I’ve never done something quite so scary, something that feels so bad and so good, that frightens me with how good it feels. I am ashamed of how much I love the violence sewn into my new seams, how much I want it all: each scab and mottled scar, each heartbeat visible through my chest, every instance of dread and fear, mapped, labelled, and catalogued until I can track entire geographies of the emotion.
I think of what will happen between us when my mother sees what I have done. My friend tells me the difference is obvious, which both delights and dismays me.
I know she cannot hurt me, cannot touch me or my hands or my chest, not anymore. Our mutual acceptance of the other’s presence is the last tie that remains between us.
Here is another kind of rupture, impossible to even begin imagining. How does a person prepare to become estranged from their mother?
There is one more thing: I do not want to make her cry.
I know that when she finds out she will cry.
At another follow-up appointment at my surgeon’s office, I count four pairs of boys and their mothers in the waiting room. The boy closest to me is carefully slouched, a mop of brown hair playing at his eyes. His voice is either pre-testosterone—consciously, painstakingly lowered—or one that is very early on the hormone. Either way, it is husky, sweet, a little unsure. His mother calls him Dylan.
Perhaps in another life, the one in which I have a white mother, I would have come here with her. We would ride to the appointment together; she would share in the excitement. My mother would fill out the forms. My mother would refuse to give me the forms because she had to fill them out, so stop pestering me, sweetie. Perhaps we could use the word “our” to refer to these things.
What would it have been like to have my mother watch as a surgeon touched my breasts? What would it have been like to watch my child being drawn on by this immaculately educated, aggressively competent woman in her early 40s? What would it be like to know that the body my son wanted to build himself required an act of “violent remedy”?9 What would it be like to be responsible for making that act happen for my child?
They are in this together, these boys and their blond mothers, co-conspirators on a journey towards gender realization. These mothers—they soothe their sons when they are nervous. They carry their sons’ sweaters for them. They hold their sons’ hands when they go in for their consultations. They call their sons their sons.
In the waiting room, I hear a strange sound—two muffled peals of laughter, like little bells dressed in fur. One high, the other straining not to be, and forgetting in its pleasure. Here, in the office of a surgeon who performs gender affirming surgery, I have found it: the shadow world in which a child and his mother’s joy are the same.
How can this be? I wonder as I step into the examination room alone. How can this be?
During the visit, my surgeon tells me to put my shoulders back, stand up straight. She gently holds my shoulders, pressing them outward with her thumbs the way you smooth the pages of a rare book, or wipe a tear from the face of a child.
I want to weep from the grace of this small gesture, and also because I know that from this moment on, there will be no one else to do this for me.
a. To part or divide by a cutting blow; to hew asunder; to split.
b. To stick fast or adhere.
The word “cleaver” originated in 1483, to indicate “a person who cleaves.” In 1580, it evolved to refer to the tool doing the cleaving. In this linguistic shift, the responsibility for a cut thing moved from the person to the tool, the agent no longer foregrounded in the process of rupture. The rupture, the rupture—always the rupture.
Can a cleaver also be one who knits back together? If cleavage is evidence of something forcibly parted, then perhaps it can also be proof that something has been stitched together again. Perhaps the one who cuts may also be the one who mends.
This is a paltry way of trying to reconfigure the violence that has made its way between me and my mother. The violence of her disbelief, and also the one of my omission. I know that. Or, I am trying to know that.
But my breasts are long gone, and still I find that I trace my scars with my fingers every day because the nerves where they once were have been severed, and I cannot feel my chest anymore. And without the cribbed sight of my hands, forever reaching at my sides, there is no other way to know that it is no longer there. No other way to remember that it has in fact been done, and will always remain so.
- To be exact, not milk in the sense of lactation. See “galactorrhea.” ^
- I find it interesting how nowhere in her argument for keeping breasts is there any of the joy of having them I am told most women have, any of the language of it being a thing that makes me a woman, and thus something I should keep. Rather, she seems to recognize (and maybe agree?) that they are strictly a burden for the pleasure and profit of others. A thing that is necessary to bear. ^
- Italicized portions collaged from “Erecting Sex: Hermaphrodites and the Medieval Science of Surgery,” Leah DeVun ^
- Transmedicalists are a subset of transgender people who self-define themselves as trans people who believe that “gender dysphoria is a prerequisite for being called transexual (sic), and that this is a medical issue” (definition from r/transmedical). ^
- Pejorative term for self-identified transgender people that transmedicalists do not consider to be transgender due to lack of dysphoria or outward presentation consistent with their sex assigned at birth. The name comes from the idea that such people identify as transgender because it is a “trend.” ^
- I remember a particular powerpoint slide from a biological systems modeling class at Hopkins that said in huge letters, “All models are wrong; some models are useful.” ^
- The act of ascertaining death via this particular less-invasive method is prophesied in Exodus 12:46, Numbers 9:12, Psalm 34:20, Zechariah 12:10. ^
- “This double flow consecrates at the same time the Baptism of Water and the Baptism of blood of the martyr.” ^
- The Latin etymological root of “surgery,” chirurgia (the same Chirurgia from LanFranco’s text) also means “violent remedy.” Another interesting thing about chirurgia: it comes from two Greek words, “kheir” (hand) and “ergon” (work, labor). Surgery is, at its (literal) root, manual labor. ^