How to Prepare for and Recover From Masculinizing Top Surgery

Chest masculinization, also called masculinizing top surgery, is a gender-affirming surgery done to give the chest a permanent masculine appearance.

This procedure falls into the more general category of "top surgery," which also includes feminizing top surgery (which gives the chest a more feminine appearance).

As someone who has gotten masculinizing top surgery, I'll draw from my own experience and tap health care and mental health professionals to give the full picture on what to expect from this surgery, how to prepare for and recover from it, and offer tips on adjusting to life after top surgery.

There are several different methods plastic surgeons use when it comes to masculinizing top surgery, according to the UCSF Gender Affirming Health Program. Common options include the following, per the Mayo Clinic:

• ‌Double incision mastectomy:‌ This type of masculinizing top surgery is often recommended for people with larger breasts and involves removing breast tissue and some chest skin, as well as resizing and repositioning the nipples, per the Mayo Clinic. After this type of mastectomy, you will no longer have sensation in your nipples. This is the most common type of masculinizing top surgery, per Johns Hopkins Medicine.
• ‌Periareolar mastectomy:‌ This is also referred to as keyhole top surgery, and can be preferable for people with smaller breasts. During this procedure, breast tissue is removed, but not skin. The nipples and areola remain intact, so sensation remains in this area.
  
• ‌Subcutaneous mastectomy with nipple preservation:‌ This is another procedure for people with smaller breasts that involves removing breast tissue and keeping the nipples and areolas attached. Note that nipples may be reshaped during this procedure, per the Mayo Clinic.
  

As you can see, the size of your breasts is a factor in determining the right approach. Other considerations may include your body type, skin type and nipple size and position, per the UCSF Gender Affirming Health Program.

No matter which method you choose, masculinizing top surgery is typically an outpatient procedure, taking around three to five hours, per Johns Hopkins Medicine. That means you will arrive at and leave the hospital in the same day.

During the procedure, you'll get intravenous anesthesia and won't be conscious.

If you're considering top surgery, take these steps to prep yourself mentally and physically for the procedure:

Spend some time researching your top three surgeons and the types of surgery they perform, recommends family nurse practitioner Dana Cassidy Delgardo, APNc, AAHIVs, the primary care clinical director of Transhealth Northampton.

"See if the surgeons have pictures [of procedures they've done]. If not, go on Transbucket or [a] Facebook top surgery group and see what folx are saying about the surgeons," Delgardo says. "If they are good surgeons, they will allow you to see pictures prior [to getting your] top surgery done."

Before you arrive at the hospital for your procedure, you'll need to figure out some logistical matters, including:

• ‌Where you'll stay:‌ If you're traveling long distances, you may need to reserve a hotel room to stay before and after the procedure. Out-of-state travel may require flights and other transportation arrangements.
• ‌Who'll take care of you:‌ You'll need help with some everyday tasks in the days and weeks following the surgery, and you should arrange that beforehand.
• ‌How you'll rest comfortably:‌ Figure out how to make your bed or couch as comfortable as possible. Consider being in a recliner, or having several pillows to keep yourself propped up as you sleep.

You'll have several consultations with your surgeon before the procedure. Exactly what you'll do at each appointment will depend on your medical history, says Keith Blechman, MD, a plastic and reconstructive surgeon with Blechman Plastic Surgery, but the list typically includes a physical exam and bloodwork.

During pre-procedure consultations, Delgardo gives patients a head-to-toe assessment, which includes a health history and checking for contraindications that might complicate the surgery. He also uses the time to discuss tactics to help people manage or improve their lifestyle after surgery, such as healthy eating and exercise.

"I make sure they understand the importance of tissue healing techniques, using appropriate compression stockings and binders, and I discuss wound care, signs and symptoms of complications and infections and what to do about them," Delgardo says.

Other topics Delgardo addresses around the healing process include when dressings and drains can be removed, when the person can start exercising and having sex again and when they can go without a top.

Getting masculinizing top surgery can involve an extra layer of paperwork. Aim to get your administrative requirements sorted at least one month before surgery, Delgardo recommends.

One thing you may need is a referral or letter of readiness from a mental health provider who has experience treating gender dysphoria.

The World Professional Association of Transgender Health (WPATH) recommends all top surgery patients have this referral, Dr. Blechman says. And many insurance companies and surgeons also require it before approving top surgery.

"This is one of the reasons clients seek out therapy, but there is often a lot more that is done to help in sessions," says Lana Lipe, LCSW, licensed clinical social worker and owner of Hawaii-based Honu Therapy Services. (More on that next.)

"Throughout the process for getting top surgery, we spend a lot of time in therapy exploring and processing their hopes, expectations and fears," Lipe says. "We work together to come up with a plan to strengthen their access to emotional, financial, social and physical support, as they will need it to navigate the whole process."

Delgardo also stresses the importance of being ready to navigate mental roadblocks that may come up during the healing journey.

"What I have learned from doing this work is preparation for realistic expectations is key to successful surgery," Delgardo says.

For example, he and his patients explore how their chest may heal differently from other surgical results they've seen.

Also important: understanding that recovery may take awhile. "We also talk a lot about managing personal expectations during recovery," Lipe says. "We find ways the client can prioritize rest and recovery, while having compassion for themselves for not being able to do as much as they would like to."

Delgardo also recommends reviewing all the information the surgeon provides carefully. This includes both the pre-op checklist and post-op instructions. These details will help you know any pre-surgery adjustments you'll need to make, and give you a sense of how long it'll be after surgery before you can engage in sex, swimming and other activities.

"Preparation and realistic expectations are key to success," Delgardo says.

The short-term recovery process is fairly standard across the field, but your exact long-term recovery may look different from mine, or from anyone else who gets the same procedure.

Short-term recovery typically consists of physical and mental recovery:

For your physical recovery, you'll have to wear a compressive surgical binder over your bandages to prevent swelling. Some people, like me, may also have a temporary drain(s) installed to prevent fluid from collecting in the incision area.

In order to allow for the best healing, you won't be able to shower for at least two weeks after the procedure.

Expect to be way more tired than usual, as your body is spending a lot of energy on healing.

The most intensive part of the physical healing process will be the first week after your procedure. Most people return to their normal daily lives after six weeks.

Most people expect the physical recovery to be the hardest, but the mental adjustments you'll need to make after surgery can be far more challenging.

"Be aware that your body is undergoing a significant physical change, so you need to give it time and care so it can recover," Melissa Heckman LICSW, MEd, psychotherapist and mental health director of Transhealth Northampton, tells LIVESTRONG.com.

Heckman suggests preparing for surgery by asking people you trust and feel safe with to help care for you afterward, as you heal. "It can feel complicated to allow yourself to be vulnerable and cared for by others during recovery, when your ability to care for yourself is limited," she notes.

As someone who has gotten this surgery, I strongly recommend you don't schedule surgery until you're sure you'll have at least one person to help you with basic everyday tasks the first few weeks after the procedure. There's no way around it: You will be unable to do some things.

If you try to take care of yourself by yourself right after surgery, there will be complications that make your life much more challenging, possibly for years to come.

Personally, I could not have gotten through the first week of recovery without the support of my incredible partner. He took a few weeks off of work to help me, which included clearing and changing my drains and helping me move around the house.

The best way to care for yourself after top surgery is to rest and nourish yourself.

"Allow your body to sleep, rest and eat healthy foods," Heckman says. "Take care of this physical self that you have."

You'll also want to make sure you have people there to help you deal with changes in mood and energy.

"It's common to experience changes in mood and energy levels as you readjust and recover from surgery," Lipe says. "As a therapist, I help my clients address these changes by working on strategies to help them manage their stress and mood symptoms."

One of the most common things people experience after getting surgery is shock over how bruised and beat-up their bodies look and feel. (This isn't exclusive to top surgery; many surgeries can leave behind these temporary side effects.)

"Swelling, bruising and stitches can be shocking and scary," Lipe says. "We work on normalizing this experience, taking things one day at a time and remembering that this is not how their body will always look."

Even months after top surgery, you'll likely find yourself navigating parts of your life differently than you did before. This includes your romantic and physical relationships.

"Sexuality and sensuality can undergo a shift when your body makes a change such as this," Heckman says. " There can be a need to re-learn your physical self, alone and with partners, which people don't always foresee or know how to talk about with partners and therapists. Allow this change to have nuances, and allow yourself time and space to understand what this new version of your body feels like."

In my experience, having this patience is worth it. Once I got my drains out and was able to take my compression vest off, I was hit with a wave of gender euphoria that I had never felt before. For the first time since I'd gone through puberty, my body felt like ‌me‌, and not like I was living in the body of a stranger.

Preparing both mentally and physically for masculinizing top surgery is key to recovering well from the procedure. Finding the right medical and mental health support beforehand can help you best achieve the results you're looking for.

"In the right hands, top surgery is a very straightforward procedure with predictable outcomes, minimal downtime and few complications," Dr. Blechman says. "We love what we do and feel the same excitement along with our patients as they get ready for surgery and then enjoy their results."