What is chest reconstruction (gender affirming care)?

Chest Reconstruction (Gender Affirming Care)
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Chest reconstruction surgery for gender affirmation: Overview

Chest reconstruction surgery for gender affirmation reshapes your chest to align with your gender identity. This is also called “top surgery.”

Here are the most common ways the surgery may be done.

  • The doctor makes incisions (cuts) across the breasts. Breast tissue and excess skin are removed to flatten your chest. Then the doctor reshapes and repositions the nipples (nipple skin graft).
  • The doctor makes incisions below the nipples. Breast tissue and excess skin are removed to flatten your chest. The doctor may reshape the nipples.

You will be asleep during surgery. You will likely go home the same day. Most people can return to their usual activities in 4 to 6 weeks. You will have scars from the incisions, but they will fade.

How can you care for yourself after chest reconstruction surgery for gender affirmation?

Activity

  • Allow your body to heal. Don't move quickly or lift anything heavy until you are feeling better. Do not lift anything over your head for 2 to 3 weeks.
  • Rest when you feel tired. Getting enough sleep will help you recover.
  • Your doctor will tell you when you can take a shower. Do not take a bath, swim, or use a hot tub until your doctor tells you it is okay.
  • Sleep on your back with your head and shoulders raised with a pillow.
  • Ask your doctor when it is okay for you to have sex.
  • Ask your doctor when you can drive again.
  • Your doctor will tell you when you can return to work. This will depend on the surgery you had and the type of work you do.
  • Be active. It can help prevent problems and help you recover. Walking is a good option for many.

Diet

  • You can eat your normal diet.
  • If your bowel movements are not regular right after surgery, try to avoid constipation and straining. Drink plenty of water. Your doctor may suggest fiber, a stool softener, or a mild laxative.

Medicines

  • Your doctor will tell you if and when you can restart your medicines, including hormones. Your doctor will also give you instructions about taking any new medicines.
  • If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
  • Be safe with medicines. Read and follow all instructions on the label.
    • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • Store your prescription pain medicines where no one else can get to them. When you are done using them, dispose of them quickly and safely. Your local pharmacy or hospital may have a drop-off site.
  • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

  • Follow your doctor's instructions for how to care for your incisions.
  • You may be wearing a tight elastic bandage after the surgery. Your doctor will tell you when it can be removed.
  • If you have strips of tape on your incisions, leave the tape on for a week or until it falls off. Or follow your doctor's instructions for removing the tape.
  • Follow your doctor's instructions for keeping the surgical wounds clean and dry.
  • You may have one or more drains. Your doctor will tell you how to take care of them.

Other instructions

  • Follow your doctor's instructions for scar care. Protect scars from the sun when you are outdoors. If the area isn't covered by clothing, use sunscreen.

How do you prepare for chest reconstruction surgery for gender affirmation?

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

  • Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
  • Understand exactly what surgery is planned, along with the risks, benefits, and other options.
  • Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
  • If you are taking hormones, your doctor will tell you whether to keep taking them or to stop before your surgery.
  • Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.
  • If you smoke, try to quit. Smoking slows healing and increases surgery risks. Your doctor may require that you quit for a period of time before and after surgery. You have the best chance for a healthy recovery if you quit smoking completely. If you need help quitting, talk to your doctor.
  • Be sure to tell your doctor if you have any changes in your physical or mental health that might affect the surgery or your recovery.

After chest reconstruction surgery for gender affirmation: When to call

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have sudden chest pain and shortness of breath, or you cough up blood.

Call your doctor now or seek immediate medical care if:

  • You have pain that does not get better after you take pain medicine.
  • You have loose stitches, or your incisions come open.
  • You are bleeding from the surgery site, and it won't stop with pressure.
  • You have symptoms of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the incisions.
    • Pus draining from the incisions.
    • A fever.
  • You have symptoms of a blood clot in your leg (called a deep vein thrombosis), such as:
    • Pain in the calf, back of the knee, thigh, or groin.
    • Swelling in the leg or groin.
    • A color change on the leg or groin. The skin may be reddish or purplish, depending on your usual skin color.

Watch closely for any changes in your health, and be sure to contact your doctor if:

  • You do not get better as expected.

After chest reconstruction surgery for gender affirmation: Overview

Chest reconstruction surgery for gender affirmation reshapes your chest to align with your gender identity. This is also called “top surgery.” The doctor most likely made incisions (cuts) across the breasts or below the nipples. Breast tissue and excess skin were removed to flatten your chest. Your nipples may have been reshaped and repositioned.

You may have soreness, swelling, and mild bruising. You may have a pulling or stretching feeling in your chest area. You will lose feeling in your nipples. You may get some feeling back. But it won't be the same as it was. You will have scars from the incisions, but they will fade.

You may need pain medicine for a week or two. You may get tired easily or have less energy than usual. This may last for several weeks after surgery. Most people can return to their usual activities in 4 to 6 weeks.

What happens on the day of chest reconstruction surgery for gender affirmation?

  • Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
  • Follow your doctor's instructions about when to bathe or shower before your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
  • Do not shave the surgical site yourself.
  • Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

  • Bring a picture ID.
  • The area for surgery is often marked to make sure there are no errors.
  • You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
  • The surgery will take about 2 to 4 hours.

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The content above contains general health information provided by Healthwise, Incorporated, and reviewed by its medical experts. This content should not replace the advice of your healthcare provider. Not all treatments or services described are offered as services by us. For recommended treatments, please consult your healthcare provider.