How will I look after my Top Surgery? Here is how to tell!

Posted: December 13, 2017

Yay top surgery!! The countdowns …the saving up …the battles with insurance companies…you’re there!! But wait, what is this feeling of DREAD? Top surgery is scary and the scariest thing can be the uncertainty! The uncertainty of not knowing how you will look after going through the surgery can be very stressful and unfortunately it is not a case of just looking at a menu, and ordering what we want. Every person is unique and therefore, subsequent results will largely depend on your physique before surgery. However, there are some things that can help us predict what the result will look like:

  1. Scar Position. Take a good look at your chest in the mirror as it is right now. Your doctor is forced to place the scars where your breast tissue currently is in order to masculinize the chest. If the breasts are already fairly asymmetric, unfortunately your scars will have to be asymmetric also, although your surgeon will make every effort to avoid this. The length of your scars will depend on how far your breast tissue goes out to the side, and in the middle. I always emphasize with my patients, that it is very important to extend the scar out towards the sides, rather than leave behind extra tissue which will form what we call ‘dog ears’. These are small pockets of tissue that will protrude outward where you incision ends underneath your arms. Scars fade with time but extra tissue never goes away and often requires another surgery to remove. So as much as possible we try to get rid of ‘dog ears’ at the first surgery. Take a look at the middle of your chest and see how closely the breasts are spaced. Sometimes it is wise to have one incision straight across the chest, as patients whose breasts are very close together, may be left with a lump of tissue in the middle if the scars don’t join. Your doctor will decide this with you.
  2. Scar quality. The number one predictor of how you will scar in the future is how you have scarred in the past. Find other surgical scars on your body, and that will predict likely how much they are going to fade. However, often times on the chest, thick scars form. There are various techniques your doctor can use to help with that. Lighter skinned individuals will often scar less in the long run.
  3. Nipple position. The position of nipples is decided in top surgery once all the breast tissue is removed because it is very difficult when the breasts are still on, to figure out exactly where the nipples belong. There are standard measurements good top surgeons will use along with their own judgment to position the nipple. In the male chest the nipples are spaced further apart than in the female chest, and obviously are higher on the chest between the 4th and 5th ribs.
  4. Overall appearance. This often depends on the experience of the surgeon performing the top surgery and most plastic surgeons should be very happy to show you pictures of their own before and after results. Each doctor has his\her their own style and you should be able to plan with the doctor, whether or not they can help you in achieving your goals. It is also important to note that masculinization is not necessarily for every individual and some folks may opt not to have nipples replaced at all.

    It is very important to review pictures with your plastic surgeon to make sure they understand your goals.

    Now relax! Our top surgery patients are the happiest patients we have. We got this!

    Dr. Sidhbh Gallagher
    University Gender Affirmation Surgery

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