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Table of Contents
Recovery Timeline
Coping With Recovery
Wound Care
Top surgery, or gender-affirming chest reconstruction, is a surgical procedure used to addressgender dysphoriafor people who identify as binary,non-binary, ortransmasculine. 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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Top surgery follow-up will vary depending on a number of factors, the most significant of which is whether you have undergonenipple grafting. The other major factor is whether or not the surgeon placeddrains.
Before your follow-up appointments and as you are healing, you will not be permitted to shower—you can only wash your lower body to prevent contamination of your surgical wound.
Drains
Drains are plastic tubes used to remove excess fluid from the surgical site. The vast majority of top surgeries involve the use of 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 that collects into the drains.
Once the amount of fluid has dropped below a specified level, you will be able to have your 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.
Nipple Grafting
If you had nipple grafting, you will likely be asked to return to have your nipple bolsters removed at about seven to 10 days after surgery. Nipple bolsters are special dressings 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 coincide. Once your nipple bolsters have been removed, you may be given the green light to start taking showers again.
The first week after top surgery is usually the most uncomfortable, due to the drains and the fact that you will be instructed not to shower. Additionally, 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 carrying heavy objects. 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 to avoid using a backpack for at least four to six weeks. Consider getting help from your friends to carry your books or use a rolling bag (if a ramp or 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
After you are fully healed from top surgery, if you have concerns about scar size or “dog ears” (excess skin), reach out to your surgeon. If it’s possible, they may suggest a revision surgery to address these issues. The frequency with which top surgery revisions are needed is highly dependent on the type of technique used.
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 commonafter any significant surgery, and there are additional factors that may affect your risk of depression after top surgery.
Factors that can contribute to depression after this surgery include:
Refer to your surgeon’s instructions for wound care after top surgery. Wound care is highly specific to the procedure and the type of dressings that are used.
If you have any questions, do not hesitate to reach out to your surgical team.
Although most people heal well from top surgery, your healthcare provider will tell you the signs that indicate a need to return urgently for care, such as pain or swelling on a single side of your body. If you experience any of those symptoms, do not hesitate to reach out to your surgical team.
After your surgical site has started to heal, your surgical team or surgeon may recommendscar 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.
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 these issues are bothersome for you, 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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