Posted: February 5, 2018
What to do when you are disappointed with your top surgery
Firstly it is very important that patients know top surgery results can look really scary in the first couple of weeks of recovery, it can take a long time to see your final results. A golden rule is to avoid getting upset and spending time staring into the mirror in the initial recovery phase. The body needs time to do its best with the healing process. There is a general rule that healing will continue to improve for 12months after surgery and most surgeons may prefer to wait that long before undertaking any revisions.
“I don’t like my scars!”
In the first few months after surgery scars will evolve and may completely change in appearance. Patients who start out with bright pink scars are usually lucky as this will predict that they will ultimately heal very well and turn to white. So no problems there! However if thicker scars are beginning to form your doctor may recommend scar massage or silicone strips. Above all else stay out of the sun. If a year goes by and the scars are still unsightly it is possible a scar revision may help but doctors prefer not to do this until the full 12 months have passed.
Keloid and hypertrophic scars can be unfortunately common on the chest. Darker pigment patients are more prone to these scars. Sometimes steroid injections can help with the appearance and itchiness.
Unfortunately the best predictor of how you will heal in the future is how you have healed in the past so scar revision doesn’t guarantee a better result! Keloids sadly almost always return.
However we have been able to help a number of patients improve the appearance of their top surgery scars. If enough time has gone past since the original surgery it may be worth a look to see if we can make things better.
“I hate my nipples!”
Nipples are the slowest thing to heal after top surgery particularly in the case of free nipple graphs. In patients who have darker pigmented nipples, the pigment may return patchy at first. Patients should give this plenty of time as it will continue to heal over the first year. If however after a year pigment has not returned it may be the case that it is permanently lost. If this is so you may talk to your doctor about medical tattooing. Sometimes healing in one nipple will lag behind the other and this can even out in the weeks and months of recovery. In addition, particularly with some key hole procedures a nipple reduction may be necessary, and your doctor may chose to do this at a second stage.
I’m not happy with my “dog ears”.
Dog ears is a term used to describe extra tissue “lateral chest folds” these may be present in patients that have breast tissue which wraps around to the back. Doctors will usually make every effort to get rid of dog ears at the first surgery and in so doing may extend the scars quite far back. It is impossible to remove tissue without leaving a scar and in the long run it is much to have a scar that will fade rather than a lump of tissue which will never go away. In certain cases particularly in larger patients a second surgery may be necessary as the patients’ tissue extends quite far round the back and they will need to be placed on their side in order to have it removed. Talk to your doctor prior to your surgery to ascertain whether this is likely to be an issue for you. As surgeries go top surgery tends to have quite a few revisions and it may be difficult to hit a home run at the first procedure. Good communication with your plastic surgeon is essential and it is ok to let them know if you are disappointed, as your surgeon will want you to be happy with your procedure. If you are not comfortable doing that it is always possible to obtain a second opinion from another surgeon who is experienced in top surgery.
Dr. Sidhbh Gallagher
University Gender Affirmation Surgery