Top Surgery: How to Prepare

Getting ready for top surgery, or gender-affirming chest reconstruction, is generally pretty straightforward. Your surgeon will likely want you to be in as good health as possible. Knowing how to prepare for your surgery and recovery may help lessen some pre-surgery anxiety.

Doctors in hospital operating room
FangXiaNuo / Getty Images

Location

Top surgery may take place in a hospital or an outpatient surgical center. This surgery can be done as either as day surgery (ambulatory surgery) or with an admission. Different surgeons have different preferences, and whether you are admitted to the hospital after top surgery may also reflect any underlying health conditions.

In the absence of any significant complications, it is unlikely that people would stay in the hospital longer than overnight after having top surgery. Many people will go home the same day.

Top surgery is performed under general anesthesia. In most cases, you will check in and then be bought to a pre-operative area. There you will be asked to change into a surgical gown.

You will also probably meet with your anesthesia team and your surgeon before being brought back to the operating room. Depending on hospital policies, you may be able to have someone stay with you in the pre-operative (pre-op) area while you are waiting.

Timing of Top Surgery

Top surgery is a medically necessary procedure to address gender dysphoria in some transmasculine individuals. However, the timing of this surgery may need to be flexible, as it is not performed in response to an acute medical need.

Some surgeons will require patients to work to optimize their health before having surgery. This could involve changes in diet or exercise or working on controlling chronic conditions.

What to Wear

On the day of your operation, you will want to wear comfortable clothes that are easy to pull on and take off. On your upper body, you should wear a loose button or zip-up shirt or hoodie, because you will be restricted to a limited range of motion with your arms after surgery. Therefore, it's better not to wear clothing that requires to lift your arms over your head.

You will likely be sent home in a surgical vest and with drains. A zip-up hoodie or something similar will keep you warm and covered when you're heading home. In addition, if you are staying overnight, you may want to bring a change of underwear and socks.

You will be asked to change into a gown for this surgery. You should expect the doctors and nurses to give you privacy to change. If you wear contact lenses, you should bring the case with you so that you can remove them prior to surgery. Glasses may be a better option for the day of surgery.

Unless you are told otherwise, it is a good idea to shower before leaving home to come to the surgical center. You will probably not be able to shower for at least a week after having top surgery.

Do I Need a Pregnancy Test?

In general, hospitals will require a urine pregnancy test for anyone of reproductive age with a functional uterus and ovaries before going under general anesthesia. This is true even for transgender men who have been on testosterone for a significant period of time.

Testosterone is not a guarantee against pregnancy. However, if you have had a hysterectomy (removal of the uterus), you should not be required to do a urine pregnancy test.

In general, surgical teams that perform a lot of gender-affirming surgeries should have procedures in place to make this process as painless as possible.

However, newer teams, or teams that do not specialize in gender care, may not be sensitive to how these requests can increase gender dysphoria or discomfort. It is reasonable to discuss any concerns about pre-operative pregnancy testing in advance.

Food and Drink

Depending on when your surgery is scheduled, you may be asked to discontinue all food and drink the night before surgery. If your surgery is late in the day, instructions may vary. However, there is usually a period of time prior to surgery where you will not be allowed to eat or drink.

Specific instructions around food and liquid consumption will vary by surgeon and surgery center. Therefore, make certain your surgeon gives you detailed instructions prior to having surgery. They may be able to provide these instructions in writing. You may also discuss these questions at any pre-op appointment.

Medications

You will not generally need to take any new medications prior to having top surgery. However, you may need to discontinue certain medications, such as systemic acne medications.

It is important to inform your doctor of any medications or supplements you are taking in order to reduce the risk of complications. This should include any topical products you apply to your chest.

What to Bring

On the day of surgery, you should bring any distraction items that you would like while waiting for surgery and having your IV placed. Some patients like to listen to music, have a fidget toy, or bring a stuffed animal to keep them company.

You should also bring a bag that you can put your clothes and belongings in when you are brought back to surgery. (The hospital will usually provide one, but it can be helpful to bring your own—particularly if you will have someone with you who can hold onto it.).

You will not be able to drive yourself home after surgery. It is important to arrange for someone to bring you home. You should also be prepared to have someone help you out, at least a couple of times a day, for a few days after surgery.

If you will be staying overnight, check with the surgical center in advance if someone can stay with you. If not, you will need to arrange for them to come back to pick you up the next day.

Safe Housing after Surgery

You will need to have a clean, safe place to stay for at least a week following surgery. If you are homeless or transitionally housed, talk to the hospital social worker to see if they can help you find respite housing or a medical shelter for the recovery period.

If you are living with people who do not affirm your gender, it may be safer to stay with affirming friends or other relatives in the immediate post-surgical period. Local transgender support groups may be a good option for brainstorming safe housing after surgery.

Pre-Op Lifestyle Change

Some surgeons may have a maximum body mass index (BMI) on which they will operate. Many surgeons may require you to discontinue all nicotine (smoking, patches, vaping, gums, etc.) for a period of time before surgery.

The purpose of these requirements, particularly stopping nicotine, is to reduce the risk of complications after surgery. There is less clear data about any risks of having a higher BMI.

A Word From Verywell

For many people, top surgery is something they have looked forward to for years. Therefore, it can seem strange and confusing to start to feel anxious or nervous when getting ready for surgery. However, being nervous about surgery is completely normal.

Even if the outcome of top surgery is something you are looking forward to, the experience of getting surgery can be scary. That's particularly true for people who have never had surgery prior to this procedure.

If you are starting to feel anxious about top surgery and wondering if that means you are making a mistake, it can help to ask yourself questions like the following:

  • If I could snap my fingers and the surgery would be over, would I be worried about my decision?
  • Am I worried about whether I will regret having had surgery, or am I worried about going into the operating room?
  • Do I think I might want to change my mind about surgery?

If you do decide that now is not the right time for surgery, or that you don't want surgery, don't judge yourself. Talk to your surgeon about canceling or postponing your surgery. It's better to wait and have surgery when you are sure.

However, if you are certain you want surgery but are just nervous about the process, talk to your therapist or the surgical social worker about ways to deal with anxiety in the pre-operative period. That type of anxiety is common, and they should have good ways to help.

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