Top Surgery: Long-Term Care

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Top surgery, also known as gender affirming chest reconstruction or double mastectomy, addresses gender dysphoria. This surgical procedure is a way for binary and non-binary transmasculine persons to achieve a flat chest.

The primary element of the surgery is the removal of the breast tissue. The nipples may also be made smaller and moved to a more lateral position to achieve a more masculine appearance. Some surgeons also include chest contouring as part of top surgery.

Portrait of Transgender Male
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Benefits of Top Surgery

Top surgery can have profoundly positive effects on a person's physical and emotional well-being. Individuals who have undergone top surgery may feel more comfortable both in their own skin and with how the world perceives them.

This can lead to reductions in conditions such as depression and anxiety that are affected both by self-perception and by the experience of stigma or harassment in an often transphobic society.

There are several things that people can do to maximize the benefits that they experience from surgery. The first is to avoid nicotine exposure in the months both before and after surgery.

Nicotine affects healing, and people have fewer complications and healing problems when they can avoid cigarettes and other sources around the time of surgery.

It's also important to follow your surgeon's instructions about what you can and can't do after surgery. Lifting and carrying will be restricted for several weeks to avoid putting tension on the healing skin. You will also be told to avoid direct exposure to the sun until your scars are well healed. This can help to minimize scar appearance.

Scar massage can also have an impact on the appearance of post-surgical scars from top surgery. Although top surgery scars will never go away entirely, scar massage can help reduce the risk of them becoming raised or thickened.

Talk to your surgical team about when it is safe to start scar massage, as well as the best way to manage the healing process.

Possible Future Surgeries

Most people who undergo top surgery will not need any future surgeries on this area. In rare cases, someone may need to have a surgical evacuation of a hematoma after surgery. If necessary, this would usually happen in the first few days to a week after top surgery.

However, it is also possible for hematomas to form and need care during later stages of healing, particularly if activity restrictions after surgery aren't followed. Infections requiring surgical intervention are also rare but possible.

In some cases, people may choose to undergo a surgical revision for aesthetic reasons. Revision surgery may be used to address concerns about the size of scars or excess skin. Dog-ears (extra skin under the arms on the sides of the chest) are a frequent reason for revision requests.

When considering top surgery, it is important to discuss the surgeon's rate of revisions. Revisions may be more common with procedures that do not use the double incision technique.

Lifestyle Adjustments after Top Surgery

In the first four to six weeks after having top surgery, you will need to make some adjustments. You will not be able to lift your arms above your head.

You will also be told to restrict lifting, pulling, and other movements that strain the muscles and skin of the chest. This may include not driving for several weeks and avoiding exercise for several more.

Following your surgeon's restrictions reduces the risk of complications and improves the odds of a good, aesthetic outcome. It may be hard not to show off your new chest at the beach for the first few months while it's healing (as you should avoid direct sun on your chest), but doing so will leave you better off in the long run.

Once you are fully healed after top surgery, no lifestyle adjustments are necessary. Many binary and non-binary transmasculine persons actually become more active after top surgery. This is because they find themselves able to be more comfortable and more active when they're not restricted by binding.

Depression After Top Surgery

It's important to know that post-surgical depression is common across a variety of procedures, and top surgery is no exception. People are uncomfortable. They're on restricted movement. They had an invasive procedure. That's a lot to process.

Patients may experience some depression after top surgery and wonder if it means that they've made the wrong decision. Given the amount of assessment that takes place before top surgery, the answer is usually no.

Most people can recognize that as soon as they think about the answer to the question, "are you happy with your chest?"

Also, sometimes people are depressed after top surgery for a different reason. People occasionally go into top surgery thinking that the procedure is going to solve all their problems. They think it will cure their dysphoria, stop all misgendering, and address any number of other sources of stress.

Unfortunately, while top surgery is great at helping with chest dysphoria and often reduces misgendering, most people have other sources of stress in their life. There's an irony in the fact that sometimes taking a literal weight off a person's chest makes it easier for them to see and pay attention to their other problems.

Many people who have had top surgery have been focused on getting it for years. Once it's done, they may not know how to think about what happens next. That's true about their gender dysphoria as well as other areas of their life.

A Word From Verywell

Top surgery can make it easier for transmasculine people to live in their bodies and the world. While not every transmasculine person wants top surgery, it can make a profound difference in people's lives. The early days after surgery can be stressful, but a little preparation can make a big difference in making it through. Things to consider:

  • Stock up on snacks and other necessities before surgery to avoid shopping or carrying things into the house.
  • Pay attention to the objects you use often and move them to storage at chest level or below for the first six weeks after surgery.
  • Plan for ways to distract yourself when you're feeling blue.
  • Arrange for people who you know will be happy to talk with you when you have a need.

Most importantly, remember that top surgery may be a happy surgery, but it's still surgery. Your body is going through a lot. No matter how good your brain feels, your chest needs time to heal.

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