The Dos and Don’ts of Recovery after FTM Top Surgery

Top surgery, also known as chest masculinisation surgery, is a surgical procedure that is often performed as part of gender-affirming surgery for transgender individuals striving for a more masculine chest appearance. The surgical process entails the meticulous removal of breast tissue and surplus skin, followed by the contouring of the remaining tissues. The ultimate goal is to achieve a more masculine chest contour.

The Recovery Starts before Surgery – Preparation Stage

If you are considering chest masculinisation surgery as part of your transition, there are several things you can do to prepare for the procedure:

• Understand the risks and reasons: Like any surgery, chest masculinisation surgery comes with potential risks and complications. Make sure you understand the risks and reasons for the procedure and carefully consider whether it is the right choice for you.
• Stop smoking: Smoking can increase the risk of complications during and after surgery. If you smoke, it is important to quit at least 6 weeks before the surgery date.
• Avoid blood-thinning medications: Certain medications, such as aspirin and ibuprofen, can increase the risk of bleeding during and after surgery. Your surgeon will provide you with a list of medications to avoid in the weeks before the procedure.
• Good physical health: Being in good physical health can help you recover more quickly from surgery. Eat a healthy diet, exercise regularly, and get plenty of rest.

Plan for Your Recovery

To ensure a comfortable surgical experience, it’s essential to make some preparations beforehand. Here are key steps to consider:

Arrange Time Off: Schedule a sufficient break from work to facilitate proper healing. Depending on the procedure’s extent and your occupation, plan for at least two to four weeks off.

Transportation Planning: Ensure you have a reliable person to drive you to and from the hospital or surgical facility post-surgery. Additionally, make arrangements for transportation to follow-up appointments during your recovery period.

Post-Operative Care: You might require assistance with daily activities like bathing, dressing, and household chores in the initial days or weeks post-surgery. Arrange for a friend or family member, or consider hiring a professional caregiver for support.

Stock Up on Supplies: Before the surgery, stock up on essential items such as gauze, bandages, and any prescribed medications. Also, invest in loose-fitting, comfortable clothing that’s easy to put on and remove during your recovery.

Home Preparation: Prior to surgery, ensure your home is clean and devoid of clutter. Consider rearranging furniture or moving objects to make navigating your home easier during the recovery phase.

Timeline for Recovery after Top Surgery – Breast Removal

Immediately after surgery

The immediate post-operative stage in top surgery (breast removal) for female to male (FTM) gender transition typically lasts for a few hours after the surgery while the patient is in the recovery room. During this stage, you will be closely monitored by medical staff to ensure that you are stable and comfortable. Here are some things that typically happen during the immediate post-operative stage:

• Monitoring vital signs: The medical staff will monitor your vital signs, such as your heart rate, blood pressure, and breathing, to ensure that you are stable.
• Managing pain: You may experience pain or discomfort after the surgery, and the medical staff will provide pain medication and other forms of pain management as needed.
• Managing fluid drainage: Depending on the type of surgery and the surgeon’s preference, you may have drains in place to help remove excess fluid from the surgical area. The medical staff will monitor these drains and ensure that they are functioning properly.
• Monitoring for complications: There is a risk of complications after any surgery. The medical staff will monitor you for signs of complications, such as bleeding or infection, and take action if necessary.
• Providing information and instructions: The medical staff will provide you with information and instructions for the post-operative period, such as when to take medications, how to care for incisions or drains, and when to schedule follow-up appointments.

First week after surgery

The first week after top surgery (breast removal) for female to male (FTM) gender transition is a critical period for recovery. During this time, you will need to rest as much as possible. Rest comfortably on your back, preferably propped up at a 45-degree angle, and avoid any strenuous activity. Here are some things that happen during the first week after surgery:

• Pain and discomfort: You may experience pain, swelling, and discomfort after the surgery. Your surgeon will prescribe pain medication and other forms of pain management to help manage these symptoms.
• Dressings and bandages: You will have dressings and/or bandages over your incision sites to help protect the area and promote healing. Your surgeon will provide instructions on how to care for these dressings and when to change them.
• Drain management: If drains were placed during the surgery, you will need to monitor and care for them according to the surgeon’s instructions.
• Follow-up appointments: You will have a follow-up appointment with your surgeon within the first week after the surgery to check on your progress and ensure that there are no complications.
• Rest and recovery: It is important to rest as much as possible during the first week after surgery to allow your body to heal. You should avoid any strenuous activity, heavy lifting, or exercise during this time.
• Emotional support: The first week after surgery can be emotionally challenging for some patients as they may be adjusting to their new body and dealing with feelings of discomfort or pain. Emotional support from friends, family, or a therapist is very helpful during this time.

Second and third weeks after surgery

During this time, you will start to see changes in your healing and may be able to start doing some light activities. However, you should still avoid any heavy lifting and vigorous exercise. Here are some things that you should keep in mind during this period:

• Pain and discomfort: You may still experience some pain and discomfort during this time, but it should be less severe than during the first week. Your surgeon may adjust the pain medication as needed.
• Dressings and bandages: You may need to change your dressings or bandages during this time.
• Light activity: Depending on the extent of the surgery and your individual healing process, you may be able to start doing some light activities during this time. This may include gentle stretching or walking around the house.
• Scars: The incision sites may start to look less red and swollen during this time, but it is normal for scars to continue to develop and change for several months after the surgery.

Fourth and five weeks after surgery

By the fourth week, you may be able to resume most normal activities, such as driving and returning to work. However, you should still avoid any heavy lifting or strenuous exercise for a few more weeks. You may also start to notice that your scars are starting to lighten.

Six weeks after surgery

By this point, most of the swelling and bruising should have subsided, and your incision sites will have mostly healed. You may be able to resume more strenuous exercise and activities, but it is important to follow your surgeon’s instructions and not overexert yourself.

Tips for a Smooth Recovery

Here are some general tips to help with recovery after top surgery (breast removal) for female to male (FTM) gender transition:

• Avoid showering. It is often advised by surgeons to avoid showering until after your first postoperative appointment, when the dressing is removed. However, in the meantime, there are alternative ways to maintain hygiene, such as using baby wipes and sponge baths, which are simple and effective.
• Exercise. During the initial recovery phase, it is important to avoid lifting or engaging in strenuous exercise. As you begin to feel better, you can gradually resume light exercise such as walking while being mindful to avoid activities that raise your heart rate excessively.
• Use scar treatments. Over-the-counter scar treatments can help during the healing process as well as decrease scar tissue and redness.
• Manage pain and discomfort: It is normal to experience pain and discomfort after surgery but there are several ways to manage these symptoms. Your surgeon will prescribe pain medication but you may also find relief from applying ice packs or using relaxation techniques like deep breathing or meditation.
• Eat a healthy diet: A healthy diet can help support your body’s healing process. Focus on eating a variety of fruits, vegetables, lean proteins, and whole grains, and avoid processed foods, sugary drinks, and excessive amounts of salt.
• Stay hydrated: Drinking plenty of water and other fluids can help prevent constipation, which can be a side effect of pain medication. Aim for at least eight glasses of water a day.
• Avoid smoking: Smoking can slow down the healing process and increase the risk of complications after surgery. If you smoke, try to quit before surgery and avoid smoking during your recovery period.

FAQs about the Recovery after Top Surgery – Breast Removal Surgery

How long do nipples take to heal after top surgery?

• Generally, it can take anywhere from several weeks to several months for the nipples to fully heal.
• During the initial healing period, the nipples may be sore, tender, or swollen.
• Your surgeon may place dressings or a compression garment over the chest area to support the healing process and protect the nipples.
• The nipples may also be numb or oversensitive during the initial healing period.
• Over time, the nipples should start to heal and regain sensitivity.
• The incision sites around the nipples may appear red or raised, and the nipples themselves may appear flat or misshapen. However, as healing progresses, the nipples should gradually regain their shape and projection.

How long after top surgery can you lift your arms?

• After top surgery (breast removal) for female to male (FTM) gender transition, it is generally recommended that patients avoid lifting their arms above their head for at least the first week after the surgery.
• This is because raising the arms can put strain on the chest muscles and the incision sites, which can slow down the healing process and increase the risk of complications.

Showering after surgery – How long after top surgery can I shower?

• The timing for when you can shower after top surgery (breast removal) for female to male (FTM) gender transition may vary depending on your surgeon’s specific instructions and the type of dressing or bandages used during the surgery.
• In general, most surgeons recommend waiting until after the first postoperative visit before showering, which typically occurs 1-2 weeks after the surgery.
• During the initial postoperative period, it is important to keep the chest area dry to avoid infection and to allow the incision sites to heal.
• Your surgeon will provide specific instructions on how to care for your incision sites during the initial healing period, which may include sponge baths or using baby wipes to clean the area.
• Once you are cleared to shower, it is important to avoid soaking the incision sites or scrubbing them vigorously. Instead, let the water run gently over the chest area and use mild soap to gently clean the area. Avoid using hot water as this can increase swelling and inflammation.

How long does swelling last after top surgery?

• Swelling is a common side effect after top surgery (breast removal) for female to male (FTM) gender transition and it can last for several weeks to several months after the surgery.
• The extent and duration of swelling can vary depending on the individual’s healing process and the extent of the surgery.
• During the initial postoperative period, swelling can be significant and may peak within the first 48-72 hours after the surgery.
• The swelling may gradually decrease over the following weeks and months as the body continues to heal. In general, most patients can expect to see a significant reduction in swelling within the first 4-6 weeks after the surgery. However, it may take several months for all swelling to resolve completely.
• If you have any concerns or questions about swelling after top surgery, it is important to discuss them with your surgeon.

Further Reading about Surgery

• FTM Female to Male Top Surgery Page
• Male Breast Reduction Page
• 10 Questions to Ask Your Transgender Surgeon
• Male Breast Reduction Without Scars

Medical References about Gender-Affirmation Surgery

• Gender Dysphoria – Mayo Clinic
• Gynecological Care for Trans Men – Mayo Clinic
• What To Know About Top Surgery – Medical News Today
• Chest Masculinization Technique and Outcomes – National Library of Medicine