Brooke McNally
Episode 13

Too Late In Life To Transition?

Brooke McNally

This episode includes topics about

Episode Thirteen of the Plastic Surgeon Podcast welcomes Brooke McNally to tell her story of undergoing a male to female transition and MTF breast augmentation with Dr. Sajan. Brooke’s transition story is unique because she did not begin her transition until she was in her forties.

Brooke discusses the challenges of coming out as an adult including handling her transition in the workplace and within her well established relationships. She also discusses some of her experiences of being misgendered in public and how she overcame those obstacles. Eventually, Brooke decided to undergo MTF breast augmentation with Dr. Sajan as part of their male to female transition.

Living an active lifestyle, it was important to Brooke that her breast implants not get in the way. Having a friend that had undergone the same surgery with Dr. Sajan, Brooke scheduled a consultation. Due to her lifestyle and concerns, Brooke went with 440cc gummy bear breast implants to achieve a natural looking breast.

Subscribe to the Plastic Surgeon Podcast for more plastic surgery stories from real patients and providers. Follow Dr. Sajan and the Plastic Surgeon Podcast on social media @realdrseattle.

Learn more about Dr. Sajan’s plastic surgery at

Transcription pending. Check back soon!


Dr. Javad Sajan 00:00 

Ever wonder what motivates people to get plastic surgery? Did they regret it? What can we learn from the stories of plastic surgery patients? We here to explore those questions and get some answers today with my guest, Brooke McNally on the plastic surgeon podcast.

Dr. Javad Sajan 00:34

Welcome back and thanks to our listeners for the amazing feedback we have had so much fun so far, and look forward to more of your insights and suggestions. Please rate us and review us on Apple podcast. Will help get you more amazing content. On the plastic surgeon podcast. We listened to real plastic surgery, stories of triumph and pain from real patients and providers to further understand the motivations of why they would risk their life under the knife. I'm Dr. Javad Sajan. And today I have the amazing Brooke McNally as my guest, Brooke, we're here to talk to you about your journey, how we came to know each other, the procedure you underwent and how it helped to affect you. So Brooke is my amazing patient. She underwent gender affirming breast augmentation with gummy bear breast implants. The size she had was 445 CCS. We're going to talk about that today. So Brooke, tell us about your, we're going to talk about your upbringing, your transition. We're going to focus on our life has been since then. We'll talk about surgery and where we are today. How does that sound?

Brooke McNally 01:36

That's good.

Dr. Javad Sajan 01:37

So, Brooke, where are you from?

Brooke McNally 01:38

I live in Tacoma, Washington. That's where I grew up. It's what I, it's the place I call home. I was originally from the East coast, moved here with my family. My dad was in the military and was stationed at McCord air force base. And then we moved here and this is where I've stayed.

Dr. Javad Sajan 01:58

How you liked it here?

Brooke McNally 02:00

Uh I love it here. Throughout my life, early adult life. I did a lot of traveling in the Pacific Northwest for work. And during that time it gave me a good chance to go and like live in some other places. And then I would always just sort of like come back to home and Tacoma is definitely the place I call.

Dr. Javad Sajan 02:21

And how old were you when you moved?

Brooke McNally 02:23

I moved that, that period of my time. Oh, when we moved to Tacoma. Oh, I think I might've been four. I was very young.

Dr. Javad Sajan 02:34

So your adult life has all been here.

Brooke McNally 02:35


Dr. Javad Sajan 02:36

Tell us about what led you to consider that your gender identity wasn't congruent with your gender assigned at birth?

Brooke McNally 02:44

Yeah, so it's I transitioned very late in life compared to a lot of people.

Dr. Javad Sajan 02:51

How old were you?

Brooke McNally 02:52

I believe I was about 47 when I kind of made the conscious decision to commit to transitioning. I guess I kind of like now in hindsight, looking back, I sort of describe it as always having this feeling like like I didn't get the memo on, like I didn't get the, I say I didn't get the dude memo. Like I just didn't feel like I fit. There was just something and I didn't really have a way to put a finger on what that was. I, my kind of like social structure was kind of established with the people that I knew. I didn't have a lot of exposure to people kind of outside of just this very same life. And I wasn't even before I was in my forties, when I first actually knew a person who had gone through transition, like personally, and I remember thinking like, you can just do that, you know, and it was this very like, kind of like light bulb moment for me.

Brooke McNally 04:17

And it just started me on the path of being able to understand kind of who I was and why I had that very, like, other feeling about myself. And then I think once I like made the conscious decision and said, okay, I, this is something I am going to do. You know, I sort of just kind of made a plan and just started working on it. I kind of approached things like that.

Dr. Javad Sajan 04:50

So prior to transitioning or during your childhood, can you have a greater affinity for classically feminine toys, clothes, or anything like that?

Brooke McNally 04:59

Not really. No. It really wasn't. I just was kinda, I didn't, I should say I had like, kind of an independent streak to me. Like, the activities that I was interested in were independent activities. I was into skateboarding. I was into cycling and I was not a person who was into team sports or any of those types of things. But I you know, my father wasn't exactly the most accepting person. And so I just kind of my life just, it was, I don't know. I just, like I said, I just kind of like, felt different, but I didn't, I couldn't really put a like connect to connect it to any like preference toward other gender exploration as a child. So.

Dr. Javad Sajan 05:59

Did you have relationships with the opposite gender before you decided to transition?

Brooke McNally 06:03

I had, had some experiences with, but not like relationships with, so.

Dr. Javad Sajan 06:11

Sure. Did you have relationships with the same gender assigned at birth?

Brooke McNally 06:15

Yes, I, Oh yeah. My, like up until transitioning, I was very much living, kind of this perceived just straight guy. Like I was married twice. I, and both of those people that I was married to, both women. They're great people. They're still in my life today. You know, I just it was, that was kind of, there was no, there was nothing insincere about the relationships that I had with women. It was just that you know, I didn't really come to fully understand kind of like who I was and what I was attracted to. And I kind of call it like a gay. I got to a point in my life where I gave myself permission to be who I wanted to be both in how I presented myself and the people that I was attracted to. And that sort of thing. So

Dr. Javad Sajan 07:26

And those separations you had from those marriages, do you think your gender identity was related to that or not really?

Brooke McNally 07:33

Oh, no. I don't know. I mean, I guess you could go back and like, what, you know, I guess, you know, that whole hindsight being 2020 thing, like I don't, but it was, for me, it was the reasons for those relationships coming to an end and really have anything to do with gender identity. It was, we just, in those situations, both of them, we just had the kind of very adult like this just isn't working for us and those no significant drama or anything. They were both very amicable. And as I said before, they're great people and they're both very much in my life.

Dr. Javad Sajan 08:18

What's your occupation?

Brooke McNally 08:20

I am an executive at a construction company to commercial builder. We build schools, hotels sound transit, we a commercial builder.

Dr. Javad Sajan 08:33

And you've been doing that this whole time.

Brooke McNally 08:35

Yes, I've been in construction my whole life. I've been with this company actually today is the 15 year anniversary for being a tech company.

Dr. Javad Sajan 08:46

Wow. And how long, you got transition?

Brooke McNally 08:50

Um so I like I said before, I of made a commitment to start transitioning. I think it would have been, I don't know, early 2019. And I made a plan. I actually had like a written plan.

Brooke McNally 09:13

I was going to do this and it was very loose, you know, but I kind of had like put this timeline together and I, you know, I started by, you know, talking to the people that were really close to me in my life. And I you know, I just kind of started talking, like I kept it really close. And then I started to just kind of expand that circle of people that I was kind of making them aware of what was happening, you know, with me and people were starting to notice like a little bit of difference in me, just in kind of what I was doing and what I was into. And I actually ended up using Facebook as a really good tool for communicating what was happening in my transition. And the way I did that was I used friend lists so that I could filter the content that I was sharing with people.

Brooke McNally 10:15

And I created this list that I called out to, and then there's basically everybody else. And I made a point of going through and taught and sending a message to people telling them about what was happening with me and that I was going to be adding them to my out, to list and asking them to just kind of keep it to themselves for now, but that the content that they would see on my page would start to look different. And I just started working through my friends list and just adding people over with the goal to just eventually get everybody over to the out to list, you know? And then it was all kind of timed, not timed perfectly, but like ultimately it ended up being timed around. Like when I was able to transition at work was kind of like, the last thing was when we talked about it at work, when, and it was from that day forward, the first day that I came to work as Brooke that was it like, that was done.

Brooke McNally 11:21

You know, and then I kind of changed my name on my Facebook profile. I actually kept all of my, I didn't make a new page, like, cause these are all my, it's still my story. It's still my whole life. And it's still all my friends that I had before. And I just didn't feel like I wanted to just abandon that because I have what I, one of the things I learned through the whole process was that I have a ton of spectacular people in my life already. And you know, I think a lot of times people are scared of how their friends may react to the news of whatever that is, gender sexuality, all of these things. And I know it was terrifying for me, but I, one thing I learned was that you can't really deny people the opportunity to do the right thing.

Brooke McNally 12:18

Like don't make up your mind that they're gonna not accept you. You have to give them the chance to actually do the right thing. And then you find out that they just do, you know, and so really like my life, like I live in the same home. I shop in the same places. I have all the same friends. I have the same job. My life doesn't look any different. I look different, you know but my life is kind of the same. And I just integrated the way I look at it as I integrated me into my own life.

Dr. Javad Sajan 13:02

And when you decided to transition, I know you said you got there because there was someone you knew who did it, is that right?

Brooke McNally 13:09

I was, I became more exposed to people. Like I saw people who were, it was not one particular person, but just, I was exposed to people who were transitioning and more trans people.

Dr. Javad Sajan 13:24

What would you say really made you feel or get to the point that your gender identity wasn't congruent with your gender assigned at birth?

Brooke McNally 13:34

Ooh, I don't know if I have an answer for that. I don't know if there's any one thing like a I don't know, that's a tough one. I don't have good answer for it. Unfortunately.

Dr. Javad Sajan 13:51

What made you feel that you were, and if you are, please tell me that you were more inclined to be attracted to the same gender as you were assigned at birth.

Brooke McNally 14:05

Hmm. All right. Well, I don't know that I, I don't know that I got to pick that, you know, I just she's just are.

Dr. Javad Sajan 14:14

Then you felt like you were.

Brooke McNally 14:15

Yeah, I think you just are like, I don't know that you can do it to pick that

Dr. Javad Sajan 14:21

If you don't mind sharing with us your current preference, because just because someone transitions, we don't want to assume they have a specific liking.

Brooke McNally 14:28

Yeah. I date men. So I have a strong preference for men who identify as straight men too, so that not a lot of people quite understand that you're going to be a little confused when I say that

Dr. Javad Sajan 14:47

Did that interest exists pre-transition?

Brooke McNally 14:52

In men?

Dr. Javad Sajan 14:52


Brooke McNally 14:53

Uh yes, I've been attracted to men. Yes.

Dr. Javad Sajan 14:58

Pre transitioning. Did you have relationships with men?

Brooke McNally 15:00

Uh I had some experiences with men, but not, what I would consider like an, a relationship.

Dr. Javad Sajan 15:06

And did those experiences you think help you understand that transitioning was for you or did it really?

Brooke McNally 15:14

I saw them kind of separately. Okay. You know, and then I guess it's a little confusing, you know, because I came out to the people in my life as transgender and then also became visible about dating men at the same time. And in a way that kind of contributes to this like sort of unfortunate circumstance where people tend to conflate gender and sexuality, you know.

Dr. Javad Sajan 15:52

Tell us the difference.

Brooke McNally 15:53

So, you know, gender for me, like my gender is how I present myself and how I view myself. And sexuality is you know, it's about who you're attracted to. And even then it's even beyond just like who you want to have sex with. It's like who you want to wake up next to and who like, I don't know, I guess it's like, who makes your heart beat just a little bit faster? You know? Like who turns your head? Like, and that's like and so for me, that's like the sexuality piece, that the people that I'm attracted to. And, you know, when, so when I transitioned and then also started communicating to people that I was also interested in men, it actually just kind of supports this idea that, Oh, well, all women trans women or otherwise are into men and that's not necessarily the case. So it's just kind of like this unfortunate circumstance that I due to timing continue to perpetuate. I used to joke, like when I was like really stressed out about transitioning and as I was early in treasures, I was like, man, this would be so much easier if I was just telling everybody I was a gay

Dr. Javad Sajan 17:20

People know that they used to it. Tell us about your transition plan. Can you give us an overview of what it was?

Brooke McNally 17:29

My plan. So it was really I started thinking, okay, so if I am going to do this, if I'm going to transition to presenting as female all the time I had to understand and be very comfortable with doing that all the time. And it wasn't just about like going to a club and looking good once a week. It's all the other little things just in life. And that now looking back, it's kind of funny to me that I found them so terrifying, but at the time they were, but it's just little things like, you know, you're going to have to go in like, get your oil changed and you're going to have to go to the grocery store. You're going to have to do all of these things. Right. And you know, you're going to have to learn how to like, dress yourself for activities that aren't going to the club.

Brooke McNally 18:35

Like you gotta go to work and, you know, like then just kind of like dress appropriate for whatever it is that you're doing and learning what my style was going to look like. And so those, like my plan involved kind of like, okay, well, I would go out in, what do you know what I called girl mode? You know, X amount of times per month or per week or whatever, because I was on this mission to get comfortable. I wanted to be at a point where I didn't sit in my car for a minute nervously before I went into the grocery store. Like I wanted to, when I got to the point where I was ready to start living full time, that I was ready to just do that without thinking like it just became. And so it was basically just a series of practice.

Dr. Javad Sajan 19:38

Did people treat you differently when you've presented in quote girl mode.

Brooke McNally 19:41

Uh which people.

Dr. Javad Sajan 19:46

At the grocery store doing tasks changing oil?

Brooke McNally 19:49

No. No. And that's the thing is like, that's one of the things that you start to figure out is nobody cares or something, but I sure did, you know, I was like, Oh, this is terrifying, but I was like, nobody cares.

Dr. Javad Sajan 20:05

Did anyone treat you differently? Or not really

Brooke McNally 20:07

Sometimes, like, I I've had some weird kind of negative experiences with people who just, I don't know, they're just awful people. They're not, they're just looking for somebody to be mad at, you know? And it's not limited to just me. It's, they're just, they're probably just mad and don't have great lives anyway. So

Dr. Javad Sajan 20:30

Could you share one of those experiences?

Brooke McNally 20:33

The one that I told a lot of people have heard this story. So it was in 2019 Christmas Eve. I flew to Boston and back I flew on Christmas Eve, got off the plane, got back on the plane and then flew back Christmas morning. And it was basically just to get enough miles to get MVP gold status on Alaska airlines and so it's like Christmas Eve, it's a red eye flight and I'm at one of the places on the airport at the food court. And I am standing, there's a person that.

Dr. Javad Sajan 21:21

Is this Boston or Seattle.

Brooke McNally 21:22

This is in Seattle. There's a person at the counter, so I'm standing like the appropriate distance back in line. And I'm not really paying attention other than I can just see from my peripheral vision that that person has now left the counter. And I hear the person working there say you know, just kind of loudly, like I can help you sir. And I had started to take a step forward, and then I actually hesitated because I'm looking around going like, Oh, who's she talking to? And like, am I cutting some guy in line? And then there's a woman behind me in line.

Brooke McNally 22:05

And she saw what had happened and heard what had happened. And she was just kinda like kinda shrugged and was like, kind of like annoyed by it. And I'm like, Oh, this is not comfortable. So I go up there and then through the transaction, she like very intentionally misgenders me a couple more times calling me, sir. And I.

Dr. Javad Sajan 22:29

Did anyone use a pronoun or greeting at those? I fly all the time, didn't anyone use those.

Brooke McNally 22:33

Yeah, it was very intentional and it was very mean, and I and I just was like, I'm not going to make a big deal about this. I just want out of this circumstance out of this situation as quickly as possible, but then they forgot part of my order and I like couldn't help it. And so she had like turned around and was at the, like at like the pass through window to where the cook is and sound just like. And then I just was like, Oh excuse me, sir. I was really mad and she like huffed and gave me the stuff. And then as I'm stepping away, the woman that was behind me in line, I hear her very loudly say excuse me, sir. I would like to place an order.

Brooke McNally 23:34

Okay. Well, you know, like, but it was it's so yeah, I've had some, some weird kind of interactions. And like I said, like that person, I don't, whatever it was, was making their life not great that maybe it was that they're working on Christmas Eve and the airport or whatever. I don't know. But some people are just mean.

Dr. Javad Sajan 23:55

And you don't have to tell us if you don't want to. I just, I fly through C tech all the time. I'm just curious. We're not going to boycott anyone or say anything. What was the name of the store?

Brooke McNally 24:03

It was actually they're not there anymore. Uh it was Ivers. Oh yeah, they left. Yeah. And now it's some other fish and chips. Wow. Yeah. So yeah, that was, that was, yeah. So that, so there's been a couple of things like that. I know, like when I was in Las Vegas for a conference I you know, I've had people, you know, it's like, I walked by this group of guys that were like walking across, like the SkyBridge and they kind of walked past me. And then I hear one of them like announced all of his friends, like, Hey, I think that was a dude, you know, like, and it's just like people for the most part. I mean, we live in this like really, you know accepting environment here. So I'm always kind of taken aback and alarmed when I do get something like that, it's just like, I'm both disgusted and kind of surprised, like, wait, that just happened. You know? So,

Dr. Javad Sajan 25:18

And going back to your plan, so you started, you know, presenting as a female. And I'm assuming you hadn't started hormones at this point?

Brooke McNally 25:26

I had started yeah, I had started at that point. And that was part of the program that was part of the plan, you know, start hormones. Don't freak out about it, stick with the plan, practice, you know, just figure things out, figure out how to like live as me. And then at the same time, you know, parallel, you know, timeline with that is also like coming out to all of you, all of the people, you know, it's like all the people, you know, like

Dr. Javad Sajan 26:01

How did the hormones make you feel?

Brooke McNally 26:03

Ooh, that was kind of a roller coaster of good times and bad.

Dr. Javad Sajan 26:09

I've had some patients who tell me they had depression and it went away and some say made it worse.

Brooke McNally 26:15

Oh, I was pretty depressed. And.

Dr. Javad Sajan 26:18

On the hormones or before?

Brooke McNally 26:20

Before I was pretty depressed, like leading up to transitioning. And then like once I kind of like made a commitment to transitioning, I felt like I was working towards something that was gonna be good for me. Once I started hormones, those just like, it took a little while to sort out my hormone levels. I went into you know, my baseline, like when I first went in and got started hormones, like my baseline levels were like really not normal for like a CIS man. I had super, super low testosterone and I also had super high estrogen to start with. And so then, like when I started on hormones, it was like, my levels were just crazy, crazy. And then I was crashing really hard.

Brooke McNally 27:21

I was on injections doing, you know, basically a seven day injection cycle. And I was crashing horribly in like the fifth and sixth days. Like just awful, like really bad headaches, getting super depressed. We ended up reducing my dose and then also having that dose and taking and doing my injections twice a week instead. And then ever since doing that things have been great. My levels have been good. I don't have that kind of like rollercoaster action. I have really stable hormone levels, now.

Dr. Javad Sajan 27:58

Did your depression get better that you had pre hormones?

Brooke McNally 28:01

Yeah. And I don't, I think that my kind of depression and treatment of my gender dysphoria as a whole was improving just by transitioning and then just being on hormones kind of helped that too. But being on hormones is a weird thing. Like, you know yeah, I mean, it's just, I don't know, you cry a lot and all that other stuff that I didn't do before and sometimes it's worse than others and then, but I'm very happy and I think I'm pleased with the results like that I got from hormones. And I yeah, I'm glad, and I don't have any reservations about continuing with hormone therapy for ever, like definitely makes me feel better.

Dr. Javad Sajan 29:04

So after you were presenting more and doing the hormones, what was next on the plan?

Brooke McNally 29:09

So it was basically just increasing frequency for presenting, increasing the amount of people that I came out to figuring out how to deal with the work piece, which was like a big deal. And the construction industry. Isn't exactly widely known as, you know, one of the most you know inclusive or kind of like not known for their, to the care community and really we didn't when I started talking to our you know, president CEO of our company about what was happening with me, like none of us really had any idea what to do. We, like I had been there for, you know, well, over a decade everybody knew me and we had no idea what to do. We didn't, so we just came up with a plan. We said, okay, well, how are we going to communicate this to all of our people? And what does that look like? And what is it that we want to say? And what does the company want to say about it? And, you know and.

Dr. Javad Sajan 30:30

Was your work accepting of it?

Brooke McNally 30:32

Yeah, yeah, it was this it's actually like a great story, in my opinion. I mean, we, nobody there really had any real experience with trans people, at least not a lot of people did. At least not that they knew of, you know? And and so we ended up writing up this like really nice memo that talked about kind of like, okay, this person has talked to us about, you know, their you know, their gender transition. This is, we made it very matter of fact, we said, this is who this affects. This is what's happening. This is when it's happening. This is what you can expect to happen between now and then here are some links to some articles that you can go read in your own time so that you can better understand what this person has gone through, et cetera, et cetera. And then we came because our work is so fragmented. We have job sites all over the place. This isn't like an office building where like everybody comes to every day and you can just call like a big meeting, you know?

Brooke McNally 31:45

And so we kind of, and we didn't want the rumor mill to do it. And so we just, we approached all of our project managers and superintendents on a Friday or Thursday, Friday before talk to them, and then had them have a meeting with their teams at their job sites, the following Monday before new. And it was, and then after those meetings, then we sent out the actual memo so that they could share it with the team. But in that, by doing it that way, we made sure that everybody in the company got the same information. Basically at the same time, there was no need for a rumor mill.

Dr. Javad Sajan 32:26

That's the way to do it.

Brooke McNally 32:27

And and then we didn't want it to be like, just an impersonal, like here's an all company email that says this about this person because it was something that we hadn't in our organization dealt with before. I don't know whether we would do it the same way. If the next person who transitions in our company, what that looks like, maybe then it's like, Hey, we just let everybody know, because everybody already has experience with a trans person. Right? It is not brand new, you know? So but yeah, I'm pretty proud of how that played out. And I'm just like the way the people in our company and the, the way I was treated by the leadership of our company and the people in our company is just, it's hard for me to talk about without getting emotional about it. It's it was really something special.

Dr. Javad Sajan 33:30

I can tell. I can feel it. Yeah. Since then, How has life been since you've transitioned?

Brooke McNally 33:35

My life is a lot better in that I know like a different type of content than I ever did before. Like I wake up every day and a body that I'm comfortable in and I don't have this kind of like feeling that like I didn't get the memo, you know, I live a life that doesn't have any like secrets in it. I can be transparent with my friends about the people that I'm attracted to and the things that I want to do. And it's, I just feel like me all the time.

Dr. Javad Sajan 34:37

Are you happier than before you transitioned?

Brooke McNally 34:39

Oh, yeah. I'm way happier. There's no question about that. I know that a lot of people, I remember, like, as I started, like sharing, like pictures of myself or whatever, like on my Facebook, I remember a lot of people commenting. Like, I don't know that I've ever seen a picture of you smiling, you know? And I kind of just like smile and laugh, like most like 99% of the time now, like I'm not laughing about something there's something really wrong.

Dr. Javad Sajan 35:11

Where do you think that new happiness is coming from?

Brooke McNally 35:14

Uh I just think it comes from a freedom of being, I don't know, just being who I am.

Dr. Javad Sajan 35:25

You think not having secrets contributes to that.

Brooke McNally 35:27

Oh my God. Huge. Like, it's crazy. And being able to live like fully and out loud. It's yeah. It's man, I recommend it for everybody. It's nice. It's almost indescribable. But then one day it like dawned on me. I was like, Oh, wow. This is what normal people feel like all the time. Like they just get to go through life, feeling like this all the time. I didn't get to figure it out until I'm like 48 years old or whatever, you know, but no, it's pretty sweet. Like I like it.

Dr. Javad Sajan 36:13

Do you find yourself still waiting in the car before you go into the store?

Brooke McNally 36:16

No, I don't. I just, I it's really freeing actually to be at a point in my transition and kind of like embracing who I am that like, I very rarely even think about my gender. Like it doesn't enter into my mind. Like I'm just out just doing my thing. Like, I tend to talk about gender related or trans topics a lot because it's kind of like my experience and you know, someday it will be the least interesting thing about me and that will be cool, but.

Dr. Javad Sajan 37:02

You're an amazing person.

Brooke McNally 37:05

The day that me being trans is like the least interesting thing about me will be so cool. But in the meantime, I'm happy to talk about it, but most of the time, like I just go through my day-to-day life and I don't even really think about it anymore and then like, it's kind of been weird because my first day of living full time was the, at the end of September, 2019, that was when I came out at work. That was it like done deal. And, but then, you know, I only had whatever six months before everybody got to stay at home. So like, there's been a huge chunk of that time that has been, you know, kind of at home, you know, and seeing kind of very limited people. And so, in a way it's kinda like a blessing because I get to, like, you know, when I first started presenting as myself, I was wearing a wig you know, growing out my hair, basically I got to spend like, all of COVID growing out, terrible haircuts, you know, without anybody having to see, you know so I mean, there's been some silver lining in that, you know, it's like, I got to do a lot of that. I got to have my surgery you know, and work from home and all of those things.

Dr. Javad Sajan 38:29

So a lot of the things you did were, you know, for lack of a better way of saying it reversible, right? You take hormones, you'll have some changes. If you stop. A lot of them will go back here. You can recut makeup, dressing, presentation can all change. A surgery is irreversible. What made you consider that?

Brooke McNally 38:51

I kind of like when I first started transitioning, I was kind of like, ah, you know, I'm going to do hormones and then we'll see what I get out of it. Maybe it'll be fine, whatever. And then I don't know. I started looking at potentially doing breast augmentation kind of early 20, 20. It's kind of when I started thinking, well, I would really like to have, I think it would be very complimentary of my body shape. I don't, I mean, there's parts of my body that I'm like not super stoked about, you know, and, but I could from this up or that, or whatever, you know, but like you know, but I've also kind of gotten to a place where I'm generally a lot more accepting of my body now than I ever have been, but it was just one of the areas that I was like, I think that this would make a really big difference for me because hormones did give me some growth and it made it, it was nice because I could just wear like a padded push-up bra and just be fine, you know, but I kinda wanted to be able to just like wake up and, and feel like my body was consistent with what I was putting out there. And.

Dr. Javad Sajan 40:14

Were you stuffing your bra?

Brooke McNally 40:15

No, I just used a padded bra, so I and then I had a friend who is a trans person who is roughly the same, like height you know, kind of billed as I am. And she had, had surgery done kind of like really early in my transition. I remember her having hers done. And so then I remember it like talking to her about like what her experience is like, and, you know, like she was happy she did it and et cetera. And she was like, Oh yeah, like a hundred percent.

Dr. Javad Sajan 40:52

Was there a surgery local?

Brooke McNally 40:53

Yeah. She actually had her surgery done by you. So that's how, and then that was how I ended up, like, you know, I said, well, who did yours and et cetera, you know? And so that was what ended up leading me to getting my consult here. And and so it was definitely her pointing me in those directions.

Dr. Javad Sajan 41:13

Did you do research before coming to me?

Brooke McNally 41:16

Yeah. I had done some research. And then I just, and then I talked to a couple of people about their experience. I had friends, I had sis, like friends and coworkers that had had breast augmentation and I kinda got their input on it too. And then the person that I had mentioned before she had just, she had spoke very highly of how she was treated kind of across the board by the entire staff process and all of that. And I was like, yeah, I'm into that. And then, you know, I just kind of made the call and I didn't even, I didn't even go to any other consultations once I had like a super high level of comfort after our first consultation. And I felt like you listened to what I had to say and that you actually heard me. And I and I just, I felt very comfortable and said, okay, let's do this.

Dr. Javad Sajan 42:17

How was that first consult? Were you nervous the night before?

Brooke McNally 42:22

Not really. Like, I don't really get nervous about stuff because I tend to like overthink and plan things so far in advance that I'm like, by the time it actually happens, I'm just like, Oh, well, here, we're here now. Like, you know, like, this is the consultation. Like in my mind, I had already made up my mind that I was going to get surgery. I wasn't, I didn't come to the consultation to find out if I might, it was, this was a necessary step. And so I was there to take care of the necessary step of getting a consultation and finding out more information and then moving forward from there. Like, and that was so I really wasn't all that nervous about it because in my brain, I had already said, I'm doing this, you know, so, and I had to actually plan what, you know, in my early thinking of it, my plan was to like find a doctor. And I had planned on trying to have the surgery in December. And it was kind of timed around bike racing at the end of the season and then bike racing didn't happen. And so we advanced it and then I called and said, Hey, I'd like to get in earlier, you know? And then and it all worked out great. You know, the timing worked out great to do it in October. And it was, yeah.

Dr. Javad Sajan 43:59

So when we met, we talked about different kinds of approaches and implants. So we talked about doing either saline, regular silicone and gummy bear. And we decided on going with a gummy bear implant. The reason we decided that was because I wanted to give you the most shape, form and figure. And as we discussed, there's a lot of different kinds of gummy bears, but what we went with, the teardrop shaped implant, and the reason I chose that implant was I wanted to give you the most female assigned at birth, if you will look, and that would fill in the bottom breasts. Many people take progesterone or hormones to grow breast tissue, whether they're male assigned at birth, what you see oftentimes is they get something more like tuberous breasts. What that means is the breast tissue develops where the fold is. There's no real tissue on the undersurface of the breast. You see the areola be puffy and sticks out. So the reason I like the gummy bear in these situations is it gives the best shape form and contour.

Dr. Javad Sajan 45:01

And the other advantage with this implant was I felt it was the lowest risk implant. I've been doing breast augmentation for gender affirming reasons for many years now. And the one thing I found is that traditional round implants actually have a higher rate of rejection or capsular contracture in people who are male assigned at birth. So that's why I chose the gummy bear. And I put the implant in below the muscle. I mean, as you know, there's two ways to do it above or below. And we talked about some of those pros and cons. The biggest issue with going above the muscle, in my opinion, in a gender case is there's not that much breast tissue. It's very thin. You're more likely to ripple see the implant and long-term, it becomes like a rock in the sock because there's no support what supports the body is muscle and bone tendons. So that's why I put the implants below the muscle to give you the best contour to give you the best longevity. The other thing is when you go below the muscle, there's a much lower risk of implant rejection for various reasons that we could talk hours. I'll save that.

Brooke McNally 46:04

That's your wheelhouse.

Dr. Javad Sajan 46:05

Yeah. Yes, yes. So we talked about approaches that I put implants in through the armpit, through the areola, through the fold because of your anatomy type of implant, choice selection. I decided to go through the fold because it would give me the best access to create the shape form and figure we wanted. And then we did sizing, right? And that's such a complicated thing. There's so many different options. How was the sizing process when you were trying on different implants?

Brooke McNally 46:30

So the sizing process I, it was good. It was you know, it was informative. It was I kind of went into it with not knowing really much about the sizing. Like I just kind of was like what I knew and what I had communicated to you or what my goals were. And, you know, it's like, I wanted them to be fuller. I wanted them to look natural. I wanted them to not get in the way of my life in that I like to ride mountain bikes and race cyclocross and run and all of these things. And, and so I wanted to be able to have, you know, bigger, fuller breasts, but without limiting those other activities, because those are a very big part of my life. And then, you know, and then there's that the appearance piece of it.

Brooke McNally 47:31

And so, you know, we kind of tried on a few different sizes and shapes and and then when you came in and started talking about like side, we kind of landed on two different ones. And I think that you ended up saying, okay, we're going to do actually, in-between the two that we were looking at. I can't remember the exact sizes and say, because you had some concern about, you know, like the bigger one would give me like too much on the side yeah. And interrupt running and cycling or just be uncomfortable. And I was like, yeah. So like, yeah, you're hearing, I'm like concerned about like,uand then,I kind of just said, I, in my mind, and I don't know that I've said it out loud in the room or not, but like, I don't do breast augmentation that you, like, this is what you do.

Brooke McNally 48:32

And I just had a lot of faith in that. You listened to what I had to say, and you were going to make a recommendation that fit what I was, what my goals were. And so I didn't, spend a lot of time dwelling on the numbers of what the size was or any of that sort of stuff. I was like, because that's not really important. And 440 CCS on me is gonna look way different than 440 on somebody else, you know? Like they're just like, and so a lot of people get really wrapped up in like the numbers and I'm just like, ah, just kind of, mine was very goal-driven and, you know, like afterward in the initial healing process, I was like a little worried. I was like, Whoa, this is crazy. Like, you know, like it, because it was really swelling. And I know I told you that in our first post-op, I was like, Oh yeah, like I was a little like, wow, this is, I don't know if I did the right.

Dr. Javad Sajan 49:43

I remember that. Yes, yes.

Brooke McNally 49:46

I make a mistake now? I'm like, no way, like, I'm like, I'm super happy with like the size and really the shape. Like, I mean, there's the size piece, like, there's this part, you know? And I think that like the size that you chose and kind of the placement of it, I kind of like really underestimated how important this like side shape was in kind of how your body appears. I and it's one thing to just have like a high projection out the front that might look good in profile. Like, I don't know, like for a window sticker or something, it's not like reality. Right. You know, some mud flaps or something, but it's not like what people really look like. So

Dr. Javad Sajan 50:41

Many of my doctor colleagues, Brooke, when they're doing these surgeries, they just think, Oh, it's a gender case. Let me give them volume. There'll be happy. That's the wrong approach. You have to create shape, form, and a figure that compliments the body. And people forget that. With choosing sizing, there's two philosophies. One philosophy is let the patient pick and make it work. The second philosophy is let the doctor pick and patients should be happy. So I'm in the middle. So what I do is this, I get your opinions, your wants desires. Like I did. Then my assistant does sizing where we do sample trials on you. Then I come in, I get the number from the assistant, what you ballpark like between 450, 440, 430. And then I take that number. Think about what you told me. And then I do measurements. And then I measured the chest.

Dr. Javad Sajan 51:35

I measured the height of the nipple, the height of the fold, where things are, and then put all that together to give a recommendation like that fits you. And direct commendation could be more than one option sometimes. Or sometimes it's one option. A lot of people think when, you know, I think they think, no one's ever told me this, that when I recommend a size there's not a hundred decisions into it. But when I recommend a size, I've actually thought about a hundred to 200 different things, how they would impact you, how they fit you before we get to that number.

Brooke McNally 52:06

Yeah. I, and that's like, I, like I said, I mean, this is like, this is your wheelhouse, you're the expert. You're the one who's got to know what you can safely do. And you know, the complicate. And I don't even want to hear the details of like what you do. Like, because I can't handle it. I'll pass out. I remember like, cause like you did them live, you know? And I remember like one of my friends, like in like this message board group that I'm in, like she was like live commenting on it to the group, like, Oh, they've got one in and now they've got both in. And I was like, I don't even, I would never watch that. I wouldn't make it. I wouldn't make it one second into it. And I would be completely-

Dr. Javad Sajan 52:57

You sharing your experience, you know, it helps other women realize SIS or, you know, gender affirming trans or, you know I hate to say, just say trans, because there's just such a spectrum, right? Yeah. that this is possible. And although it's a big, huge deal, it's not insurmountable operation.

Brooke McNally 53:17

No, I was a little, I think, just kind of going back to like what my experience was with the surgery a little bit. I feel like in my head I underestimated the recovery. I, and I think there's two components to that. Like, I might've had too high of opinion on myself. And then also I had a lot of feedback from people that were like, Oh yeah, you know, I had a week off. And then I was back at work in a week. And, you know, I think that some, those people had, they gotten them done like 15 years ago. So your brain you're like, your mind gets a little, your memory gets fuzzy, you know, like, but in my experience, I would it was tough, you know, and if I could do it all over again, like the couple of things I would change in my recovery is I would have bought or ordered or something, or rented like the coolest sweetest, electric recliner, money combined, whatever I could afford out or rented it, whatever, because I would have just lived in it, like, you know, like the whole, like, not being able to sleep on your stomach and having to like, be kind of propped up was just like, it was tough.

Brooke McNally 54:41

Like and I underestimated how hard that was going to be. And I underestimated how little good sleep I was going to get in for how long. And then, you know, like after a month I was better, but the first, you know, first month was really tough. Like it shouldn't, I it doesn't do anybody, any service to downplay what it really does take, but now it's like, you know, I'm like two months in a week or, you know, somewhere in that timeline and I'm just fine. Like, I'm just doing all the things I do. I'm back to running. I'm. I'm just okay. Like, I have a little bit of swelling still, but it's, I'm good.

Dr. Javad Sajan 55:30

You know, a lot of athletes, their recoveries are sometimes a little bit longer because I remember your case because the muscles, so they can tight at the more muscle work you do, the more sore the person is, and you, are actually doing an extensive release and to get an implant in there that fit nicely and gave you that side profile, it just comes with it.

Brooke McNally 55:52

Yeah. Yeah. And so, I, I that was just the thing that, of, of all the things and it wasn't through no fault of any of the communications by you or anybody else. It was just, I underestimated how, how tough it was going to be in. I remember at two weeks I had two full weeks off and I'm at two weeks and I'm listening and I'm thinking back to people that I talked to, that they said, Oh yeah, I went back to work after a week. And I'm like, I don't even know how I'm going to go back to work after two weeks. Like, who are these people?

Dr. Javad Sajan 56:28

No, that's true. It's, you know, it hurts.

Brooke McNally 56:32

Yeah. And but I now there's, I wouldn't change it. Like I wouldn't change size. I would like it. I'm I am very, very happy with the results. Just, I can't say enough. Good things. I'm like, thank you really, really excited about the results.

Dr. Javad Sajan 56:52

Brooke. Thank you so much for our guests today. I've learned a lot. I know your ordeal will teach our listeners how and what to expect as they start their own journey and plastic and reconstructive surgery. I appreciate your time. And I'm honored to have you as a good patient. I hope you feel as a friend.

Brooke McNally57:08

Thank you.

Dr. Javad Sajan 57:09

Thanks for listening to the plastic surgeon podcast and please rate and review us on Apple podcast for more great content. Tune in next week for an amazing podcast for my live surgeries on Snapchat and adventures throughout the week, catch us on all social media at @realdoctorseattle. See you next time. Bam what.

Episode 12

Episode 14