Top Surgery Recovery

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Top surgery, or gender affirming chest reconstruction, is a surgical procedure used to address chest dysphoria in binary and non-binary transmasculine patients. There are a number of different techniques that can be used for top surgery. As such, your specific recovery period may vary from what is described below.

If you have any questions about the recovery process, it is important to discuss them with your surgical team.

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Surgery Follow Up

Top surgery follow-up will vary depending on a number of factors, the most significant of which is whether you have undergone nipple grafting. The other major factor is whether or not the surgeon placed drains.

Drains are plastic tubes used to remove excess fluid from the surgical site and promote healing. The vast majority of surgeons performing top surgery use drains, and drain care is an important part of top surgery follow up.

If you go home from the surgery with drains, you will be instructed to empty the drains one or more times a day and to keep track of the amount of fluid they are producing.

Once the amount of fluid has dropped below a specified level, you will need to return to the surgeon's office to have the drains removed. This is done as a simple outpatient procedure. Most people find themselves substantially more comfortable after the drains are removed, which usually takes place at about one week.

If you had nipple grafting, you will usually be asked to return to have the nipple bolsters removed at about seven to 10 days after surgery. Nipple bolsters are special dressing used to protect the fresh grafts and keep them safe.

Ideally, the bolsters will be taken down at the same time as your drain removal, but the timing does not always work. Once your nipple bolsters have been removed you will generally be allowed to start taking showers again. (Prior to that, you can only wash your lower body)

Recovery Timeline

The first week after top surgery is usually the most uncomfortable, due to the presence of drains and the fact that you will be advised not to shower. However, top surgery activity restrictions last significantly longer than that.

For the first four to six weeks after surgery you will be told to avoid lifting your arms above shoulder height and also avoid any significant carrying. That said, most people can go back to modified work or school after approximately one week, unless they have highly physical jobs.

For students, it is recommended that they avoid using a backpack for at least four to six weeks and instead get help from their friends to carry their books or use a rolling bag (if an elevator is available). People with jobs that involve lifting, carrying, or having their arms raised above their shoulders should discuss modified duty with their employer.

Preparing Your House for Recovery

Leading up to top surgery, pay attention to what you use in your house that's located above your head. Move items like glasses, plates, or snacks to a lower level for the duration so you won't need help to retrieve them. If you didn't do this before surgery, ask a friend to help rearrange things soon after.

If after you are fully healed from top surgery you have concerns about scar size or "dog ears" (excess skin), reach out to your surgeon. They may suggest a revision surgery to address your worries. The frequency with which top surgery revisions are needed is highly dependent on both the surgeon and the type of technique used.

Coping With Recovery

Many people experience an initial period of elation after having top surgery. However, it is not uncommon to then have a mood crash.

Depression is common after any significant surgery, and there are additional factors that may affect risk after top surgery. One of those factors is that patients have been working towards top surgery for a long time, and sometimes people can feel directionless after they've achieved what had been an all-encompassing goal.

In addition, some people believe that top surgery will address all the challenges that they face in their life, and that is almost never the case. Realizing that some difficulties and challenges still exist after this big life-changing event can lead to disappointment and depression.

People may also experience some frustration with activity limitations after having top surgery. This may be particularly true for people who have surgery in the summer.

Many people who have had top surgery have spent a long time looking forward to going shirtless outside, but patients will be instructed to keep their surgical site out of direct sunlight for a period of time in order to help with healing.

Wound Care

Refer to your surgeon's instructions for wound care after top surgery. Wound care is highly specific to not just the way the procedure is performed but the type of dressings that are used.

If you have any questions, do not hesitate to reach out to the surgical team. It is important to follow instructions, particularly around any compression garments and nipple bolsters.

After your surgical site has started to heal, your surgical may recommend scar massage. Scar massage is used to try and keep the size of the surgical scar smaller and less red.

It should be done gently and carefully as aggressive scar massage could potentially cause more harm than good. You should not begin scar massage until your surgeon says that it is safe to do so.

Although most people heal well from top surgery, your doctor will give you some symptoms to keep an eye out for that could indicate a need to return urgently for care. These usually involve pain or swelling on a single side of your body.

If you experience one of those symptoms, do not hesitate to reach out to your surgical team. They are used to hearing from worried patients, and it's better to be safe than sorry.

A Word From Verywell

Everyone's experience of healing from top surgery will be a little different. Some people have more difficulty dealing with the drains and discomfort than others. If you are one of those people, it doesn't mean that anything is wrong.

Try not to judge yourself for having a difficult time, or even experiencing depression, after surgery. It's normal to feel down or disappointed at the same time you're happy to finally have a flat chest. Big changes in your life are difficult and scary, even when they are good changes.

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