Fun fact: while top surgery is often described as a “mastectomy,” that’s actually usually inaccurate. Many surgeons perform a “subtotal mastectomy,” which involves removing most, but not all, of the breast tissue. This prevents a sunken or fallen appearance after surgery, and makes it look like you have a sweet set of pecs (if you aren’t already sporting them). It does mean, however, that enough breast tissue may remain for you to think about breast cancer risksexternal link, opens in a new tab. You should make sure your health care provider knows that you had a subtotal mastectomy so you can determine which, if any, preventative and screening measures (like mammograms) you should undertake; guidelines for breast care are always evolving, but are still more limited when it comes to trans patients, so make sure your provider is informed about working with trans patients. If you have a family history of breast cancer and/or have genetic testing suggesting you’re at greater risk, that may affect your surgical planning, so be sure to discuss it with your surgeon.
Many top surgery procedures are performed on an outpatient basis. There are a number of options for approaching the surgeryexternal link, opens in a new tab, primarily dictated by the size of your breasts. Those with larger breasts will likely need a double incision, while others may be able to have a t-anchor or periareolar surgery, which involves a much smaller incision. That means less scarring and less healing time. Surgical outcomes can also be better for patients who don’t carry a lot of fat in their upper bodies, though your surgeon may perform a little liposuction around the surgery site to contour your chest.
For those eagerly looking forward to taking off their binders, sorry: For about a month after surgery, you’ll need to wear a compression garment to help shape your healing chest. You may also be directed to wear surgical drains, tubes that allow fluid to drain from your chest and collect in a little bulb. They’re about as gross as they sound, but you’ll need to empty them regularly and report any problems to your surgeon. The use of drains in top surgery is starting to decline—a recent study found no big difference in outcomesexternal link, opens in a new tab but did note that drainless surgery was accompanied by less postoperative pain—but they can be a surprise to wake up with, so ask your surgeon about whether they use them and what to expect when taking care of them.
Once your compression garment comes off, you may need to take special care of your nipples if they were removed and grafted, to ensure that they heal well. Your chest will likely be swollen, bruised, and uncomfortable, and it will take around two years for it to completely settle. You will probably also notice some changes in sensation in your chest, depending on the type of surgery you had—for example, you may lose sensation in your nipples or touch elsewhere on your chest may feel different. If you had a double incision and are feeling self-conscious about the scars, know that they do fade! If you’re not happy with your outcome, you can meet with your surgeon to discuss a revision.
This section is part of a larger piece, Trans Summer School: The Wide World of Surgical Transition.
