Posted: February 13, 2018
This topic is about gender confirming top surgery for our female to male and non-binary patients and the problems associated with scarring. Many guys are pretty scared of nasty, ugly looking scars, which can be quite long, sometimes all the way across the chest, with the Masculoplasty technique (double incision). We do everything we can at the time of surgery to make them as pretty as possible, but really the best predictor of how you are going to scar after your surgery, is how you’ve scarred in the past. First thing to do is check out any surgical incisions you may have had in the past, and that will give you an idea of whether or not you are going to scar well. Unfortunately the chest is one of those parts of the body that is prone to what we call hypertrophic scarring. About 15% of patients will develop hypertrophic scarring, these are raised and red initially and can be pretty thick scars in the long run. There is so much out there about how to prevent these, but sadly not a lot of it has any science behind it. I am now going to tell you what you can do to optimize your scars.
Protect the scar. Even though summer may be round the corner and you may be super excited to get your shirt off and show off your fabulous chest, you really must protect your scar from the sun. In the first year (we are very strict about this) it basically means that during days of strong sunlight between the hours of 9a.m. and 5p.m. keeping your shirt on! You could try a very strong SPF but to be sure the official line is to protect that scar and keep it well out of the sun at least for the first year.
Scar Massage. Now this we know does work. I see there are so many products out there, topical products ointments and lotions which unfortunately don’t have a lot of evidence behind them. Therefore what I would recommend is that every day after your shower use a good moisturizer e.g. cocoa butter or whatever lotion you like to use, and do some scar massage as part of your daily routine. Scar massage is not started until 6 weeks after surgery and this is because it will take that length of time for your scar to have strengthened sufficiently to tolerate massage. Scar massage helps to break up the scar. What you do is apply the lotion and you can rub it pretty aggressively, you don’t want it to hurt, but the idea is not to be too gentle either. We do know that this is highly likely to help the appearance of the scar.
Silicone. The last thing I want to recommend is silicone products. These come in the form of sheets which you put on for usually about 12 hours a day. There are also silicone gels which do have some evidence behind them, and we see these as being somewhat effective for our burns patients. We are not 100% sure of the mechanism by which they work but those are really the only products out there that have some science behind them. Other than those you may unfortunately be wasting your money with other products. Some surgeons recommend not using the extremities, really limiting the range of motion in the shoulders for the first 6 months post surgery. I am not really sure I would buy into this particularly as it is a really tall order for our patients.
Those are my recommendations to give you good scars:
1. Protection and Sunscreen- bottom line stay out of the sun for first year
2. Scar massage
I hope this helps!
Dr. Sidhbh Gallagher
University Gender Affirmation Surgery