Top surgery preparation and after care

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Questions asked to Dr. Kreuzwirt (Clinic Landstraße, Vienna)

  1. When should I contact my doctor?

Swelling will occur. 

Dr. Mosser says that you can expect the pain to be 3-4 (on a scale from 1-10).

Source: https://www.youtube.com/watch?v=GEpLYTshuoM

 

Moreover you could feel a burning sensation in your chest either directly after the surgery or some days later. It can be compared to muscle ache, an abrasion or even a severe sunburn. This burning sensation can persist for about 3-8 weeks after surgery.

When nerves reconnect it can feel like needlesticks. 

 

Source: https://www.genderconfirmation.com/possible-setbacks-surgery and https://www.topsurgery.net/ftm-top-surgery-sensation.htm

 

Report to the hospital (emergency room) if one or more of the following symptoms occur. Always report to the hospital where you had the operation, as they will have all the necessary information about your progress to date.

  • fever
  • bleeding
  • the swelling on one side increases significantly, this could be a sign of internal bleeding
  • pus
  • strong pain
  • an area gets darker
  • an area gets unusually warm (inflammation)
  • heavily oozing wound (fluid, wound secretion leaks, dressing is wet)

 

2. When can I work out again?

You should not overstrain yourself. Too much blood circulation will lead to swelling. However blood circulation also promotes healing. So one has to find a good middle ground. 

After 3 weeks you can start to run at a slow pace.

After 4-6 weeks you can start weight training again.

 

How much you can lift in general after top surgery (Dr. Mosser):

Until 3 weeks after surgery: about 2,2kg / 5lbs

After 3-6 weeks: about 9kg / 20lbs

After 6 weeks: you can lift normally again

 

Source: https://www.youtube.com/watch?v=GEpLYTshuoM

 

3. Would it be useful to specifically train your chest before top surgery?

The chest muscles do not need to be trained to simplify the surgery for the surgeon. A good surgeon can find the chest muscles anyways.
However you can see the chest muscles after the surgery better. If one prefers a trained chest from an aesthetic standpoint, it would be beneficial to train beforehand.

 

4. How many days will you have to stay in the hospital?

At least 4 days. Varies due to patient condition.

Caution: This depends on the hospital! At some you will get sent home on the same day.

 

 

5. How does alcohol consumption affect the surgery outcome?

One could drink 2 weeks after the surgery. Beforehand one does not have to refrain from it.
Do not appear drunk at the surgery.

 

According to Transberatung-Nord:
Alcohol should be completely avoided one week before the planned surgery date.
So-called “wet alcoholics” should clarify with their treating doctor, if and which measures could be taken to minimize the scarring risk. (At which point after a surgery alcohol can be consumed again is scientifically not clarified!)

Source: https://transberatung-nord.de/wp-content/uploads/2016/10/Wundbroschu%CC%88re_2017.pdf
[is in german]

 

6. How long should I take sick leave? Where do I obtain said sick leave?

For an office-job: 2 weeks; You obtain the sick leave from your general practitioner. It must be collected directly after the dismissal from the hospital.

 

7. How soon should one be active (e.g. taking walks) after top surgery?

On the next day. Do not strain yourself. Too much blood circulation leads to swelling.

 

8. How long does one have to sleep on their back?

After one week one can sleep on their side again. 

According to Dr. Garramone:
One should sleep on their back for 6 weeks.

Source: https://drgarramone.com/pdf/apsipostopinstructions.pdf

 

9. Which scar cream should I use? At which point should I use it?

Use medical strips (Steri-Strips) as long as possible (until the skin reacts irritated, at least 6-8 weeks, in the best case 12-14 weeks). They hold the wound together. While sticking the strips on make sure to relax the skin. Leave the medical strips on for a week at a time.

Silicone creams/strips and scar creams are very good for scars that are in positions where not much stretching or movement takes place. However on the chest there is a lot of movement going on. Even if you are not raising your arms, you surely do so in your sleep.

Scar creams or silicone strips increase the elasticity of the scar and therefore, when the scar tissue is soft, it gets stretched easily. 

“Emollients are substances that moisten and soften your skin.”

Source: https://www.drugs.com/mtm/mederma.html#

“The convenient roller gently applies the scar gel to help soften, smooth and diminish the appearance of scars.”

Source: https://www.amazon.com/Scaraway-Scar-Diminishing-Gel-0-71/dp/B004H3QCPS

A more detailed explanation will be stated later in this document.

Only after 6 months scar creams should be used. For example Bepanthen.
Where you can buy the Steri-Strips is listed here.

However if one is not using scar creams, massaging the scars is essential. (More regarding scar massaging is written later in the guide.)

 

10. At what point am I allowed to shower again?

Two to three weeks after. Leave the medical strips on if they do not need to be changed.

 

According to Dr. Garramone:
Do not let the shower jets face the chest directly. Let it hit on the back and run over the front of your chest. After the scar is healed (6-8 weeks after the surgery) one can face the water jet directly again. 

 

11. How long do I have to wear the compression vest?

At least 6 weeks.

More information about the compression vest can be found here.

 

12. When can I raise my arms up again?

Wait at least 6-8 weeks. That is until the scab has healed by itself.

In the best case wait 6 months with raising your arms too high to prevent stretching the scars and the nipples.

 

13. When can I drive a car again?

2 weeks after surgery you can drive a car again. However as you have to move your arms a lot while driving it would be best to wait longer.

Moreover if you have an accident the insurance might not want to pay as you had surgery two weeks ago and thus “shouldn’t be driving anyway”.

 

General process in Clinic Landstraße (Vienna)

In order to get information about the general process in Clinic Landstraße please contact us via email (info@chaingepeergroup.at) or Instagram (@chaingepeergroup).

 

Disclaimer

The following information is collected from doctors of Clinic Landstraße in Vienna and from doctors, who are specialized on top surgery for trans people and share their information online.

The sources are always mentioned. The initial document was written in german (native language of the author). Therefore some sources are german pages.

The routines after surgery will differ from clinic to clinic. For example in my clinic I got a catheter and drains. In other clinics this might not be the case.

 

by @akataleptos

 

General Tips

  • A sporty, healthy body regenerates itself faster. Therefore eat healthy and be fit.
  • Pre cook meals and freeze them, so that you won’t have to cook after surgery.
  • Smoking disturbs wound healing and heightens the risk of losing nipples. Be careful with passive smoking!
    According to Transberatung-Nord it is recommended to stop smoking 4 weeks prior the surgery or to at least minimize it drastically.
    According to Dr. Mosser one can smoke 3 weeks after the surgery.
    Source: https://www.genderconfirmation.com/blog/quitting-smoking/
  • Clarify with your surgeon where they place the nipples and how the form of the scar will be. There are surgeons in America who place the scars over the nipples. Also there are doctors who make the scars look very round, others try to shape them as straight lines. The shape of your scar also depends on the shape of your boobs. Tell the surgeon how you would like the incision to be made (e.g. a continuous incision or not) and how large you would like your nipples to be, and how much fat should be removed from under the armpit (especially if you are heavier). If you are heavier, you can also consider whether you want to have a completely flat chest or whether you want to keep a bit of chest, as is the case with heavier cis men, for example.
  • Within the first 3 weeks post-op avoid every sexual activity. Caution: This also means masturbation 😉
  • Corrective surgery is generally also covered by the health insurance. Talk to us at the follow-up appointment after a few months.
  • If you have private insurance, you should definitely check what you can redeem, e.g. single room, refund of the deductible for compression shirts, etc

 

Compression vest

It is advised to get two tailored compression vests. Compression vests that are not tailored, do not fit optimally and thus cannot guarantee that the loose tissue will grow onto your body optimally.

The compression shirt should be washed after 24 hours with maximum 40°C. Use only liquid detergent and do not use fabric softener. As one should wear the compression vest 24/7 for the best possible result, one needs a second compression vest.

 

ÖGK (austrian health insurance) will cover two compression vests. 80% will be refunded. You need a prescription from the hospital. After deduction of the health insurance refund, a deductible of about 80 € has to be paid.

With the KFA (austrian health insurance) about 70 € of the compression vests are covered. One has a deductible of 140€.

With the BVA (austrian health insurance) one has a deductible of 74 €.

Attention: The health insurance refunds 2 tailored compression vests and only 1 non-tailored compression vest!

The prescription should say “24h wearing time” and “tailored”.

If you are not operated at the clinic Landstraße or clinic Göttlicher Heiland (Vienna), you may have to organize the compression vest yourself. This requires a prescription from the surgeon. You then use this to find a bandaging specialist at a medical store. Ortoproban or Bständig (Austria), for example.

As some branches only have a bandaging specialist on site once a week, the compression vests should be organized enough weeks in advance. If the models that can be ordered do not fit, they can get tailored by them.

Tip: one can visit the Bständig Competence Center 1 every workday without an appointment and on every workday there is a bandaging specialist present.
Address: Ranftlgasse 9, 1170 Vienna
Phone: 05 99 789 53
Kompression@bstaendig.at

There should always be plenty of pressure under the shirt. If this is not the case, you should have it sewn tighter by the bandaging specialist! Cost is about €15 per shirt. You can also temporarily stuff a clean folded towel underneath to increase the pressure. Just like a pressure bandage.
The compression shirt should go up to about the level of the elbows. As the nipples are normally at the level of the middle of the upper arm and the cut is usually slightly below this.
However, a long one is the most practical, as you can simply pull your pants over it and then it won’t roll up (especially if you are a bit heavier).

 

How to put the compression vest on, without lifting your arms too much:

 

Clinic Landstraße (Vienna)

You do not have to get the compression vest yourself beforehand.

An Ortoproban bandagist will come on the 1st working day after the surgery to take the measurements and will bring the tailored compression vests on the next working day or the day after. If you are discharged before then, the compression vest must be picked up here: Josefstädter Str. 33, 1080 Vienna
It is essential to come in person so that they can check directly whether the vest fits.

The compression vests are then sewn tighter by a bandage specialist 1-2 weeks later, as the swelling will be reduced by then. This is included in the price.

 

In the past you got a long compression vest, like this one in the picture below.

Hint: If the compression vest is too tight around the stomach you can use elastic bands to widen the vest. The vest only has to press on the chest area so that the tissue can grow together better.

 

Now you’ll get a short compression vest, like this one in the following picture.

Tip: You can wear a tight shirt under the compression vest. This way it won’t cut into the skin as much and the compression vest stays fresh a bit longer. The shirt should be changed daily.

 

Information and care instructions from Ortoproban for the compression vest:

Start of the compression therapy

In order to get most out of the compression therapy one should start wearing the tailored vest as soon as possible after the surgery.

  • the compression vest should be worn 24 hours each day
  • we recommend two compression vests
  • only take the compression vest of to clean your body or shower

 

Care instructions for the compression vest

The compression vest should be washed daily in order to remove ointment and grease residues.
This protects you from infections!

Only use liquid detergent and do not use fabric softener. Wash at maximum 40°C. Hand or machine wash possible. The compression vest should be rinsed thoroughly to avoid allergic reaction.

ONLY AIR DRYING! Avoid sun or other heat sources (dryer, radiators)!!

 

Tailoring and repair

The compression vest needs to be tailored regularly as the swelling will reduce after some time. Important: tailoring only will be done on washed compression vests!

 

Göttlicher Heiland Clinic (Vienna)

You do not have to get the compression vest yourself beforehand.

A Bständig bandagist will come on the 1st working day before or after the surgery. The size of the compression vest is estimated. You will not receive a tailored compression vests. A bandagist comes again after the surgery and brings 2 compression vests of different sizes. Dr. Hüttinger will then put the compression vests on to you, after drainage removal at the first dressing change and check for size and fit. After that, you can also order a 2nd compression vest right away.

They are short compression vests: Lipo-MTms comfort from Lipoelastic 23-32 mmHG pressure.
Available sizes: XS, S, M, L, XL, XXL.

If the vest becomes too loose during the healing process, you can go to the following Bständig address without an appointment and have 1 change per compression vest made.
competence center 1, Ranftlgasse 9, 1170 Vienna
Tel: 05 99 789 53
Kompression@bstaendig.at

For this you will be measured exactly. It costs nothing if you come through Dr. Hüttinger. This will be noted on the delivery bill by the bandagist who brings the vests to the hospital.

 

Cost:
Deductible for the first compression vest: €37.80 at ÖGKK.

The second compression vest is not covered by ÖGKK, BVA or KFA health insurance companies because it is not tailored. The second one costs additionally 85,30 €
(So you pay 37,80 € + 85,30 € for two compression vests).
The invoice is sent to the patient’s home via a payment slip.

A prescription is not necessary, the bandagist collects it directly from Dr. Hüttinger in the hospital. It is also submitted directly by Bständig to the health insurance company so that only the deductible is to be paid.

 

Timetable a few weeks before the surgery until 1 year after surgery

According to Dr. Kreuzwirt (Clinic Landstraße), Dr. Garramone and Dr. Mosser:
Sources: https://drgarramone.com/pdf/apsipostopinstructions.pdf and https://www.genderconfirmation.com/preparation-ftm-top-surgery and https://www.genderconfirmation.com/after-ftm-top-surgery

 

A few weeks before surgery

Utensils

Buy utensils early enough. Particularly the delivery of the Steri-Strips can take up to 3 weeks.
In some hospitals you get Steri-Strips for the first two weeks. For the following 10-12 weeks you will have to buy your own medical strips! You can try to ask for some packages of Steri-Strips in the hospital. They might give you 1-2.

 

A more precise explanation of the usage of the utensils is following at a later time in the document.

One package contains 4 strips. You will need 2 strips for each side. Thus one package will last for one week.

So when wearing the Steri-Strips for 12-14 weeks you will have to buy 10-12 packages, as you will get the Steri-Strips in the first 2 weeks in the hospital.

  • In the clinic Landstraße they use SUTURE STRIP Plus TP 1105 (25x125mm), as they stick best to the skin. However one can only buy packages containing 50 packages (with 4 strips each), which cost ~120€. So one package contains 200 strips.
    Information: https://www.novamedical.de/suture/suture_bestellinfo.htm
    Since November 2022 the SUTURE Strips are no longer available

In the past you could get it here: https://www.walter-cmp.de/produkt/suture-strip-plus-elastisch-25-x-125-mm/

One can also order them in the pharmacy in austria.

 

  • The best alternative is Omnistrip Wundnahtstreifen (25 x 127 mm). These strips stick just as well. But these strips are also only available in packs of 50 (each containing 4 strips) for 127€. Ergo one pack contains 200 strips.

Possibly you can also order the Omnistrips in the pharmacy. Otherwise here: https://www.shoepping.at/p/wundversorgung/omnistrip-wundnahtstreifen-200-stk-25-x-m00009S8IL

 

  • Another alternative is Leukostrips 26x102mm. However the edges of those strips tend to peel off quickly. To prevent this, one should additionally attach Leukotape over the Leukostrips. A picture showing this is here.

You might be able to order Leukostrips in a pharmacy. Otherwise online:

https://www.servusapotheke.at/produkte/arzneimittel-andere-produkte/haushalt-hygiene/desinfektion/leukostrip-4-stk-26-x-102-mm

 

  • The original brand Steri-Strips 25x125mm (R1548) sticks the worst to the skin. We would not recommend them. One can also order them in the pharmacy.

https://www.newpharma.de/3m/13537/3m-steri-strip-sterile-wundverschlussstreifen-25x125mm-stuck-1×4-streifen-r1548.html

Info: Steri-Strips 25x125mm (E4548) are too elastic to prevent the scars from widening.

 

Furthermore:

  • Skin sanitizer (e.g. Kodan) to clean and sanitize the nipples 
  • Rubbing alcohol to remove glue residue of the medical strips
  • Leukotape (to fixate Steri-Strips)

 

Other

Precook and freeze food.

Organize someone to take care of pets, walk the dog, etc.

 

One week before surgery

Place things that are stored higher up in the house/flat/apartment down to reach it without lifting your arms. Maybe buy a folding stepladder.

Hint: Put clean sheets on your bed. You will have a hard time doing this on your own after surgery.

Self-closing doors are difficult to open at first. You can tie a loop to your belt to pull the doors open. The resistance of the closing mechanism exceeds the weight that is initially permitted.

Knot a elastic band together shown in the following, to get hindered (and reminded not to do so) from moving your upper arms too much after surgery:

 

Food Supplements and Pills

Take daily 250mg vitamin c and 5 mg zinc. (a normal daily requirement of vitamin c is between 90 mg to 110 mg)

After surgery the body develops a lack of vitamin c.
Info: Vitamin C and zinc supports healing and is good for the immune system.

Sources: https://pubmed.ncbi.nlm.nih.gov/19770648 and https://www.everydayhealth.com/diet-nutrition/vitamin-c/

 

However do not take too much vitamin c, as vitamin c causes blood thinning.

 

Hint: Download the App “Medisafe” to keep an overview over the different supplements and pills.

 

Do not take Aspirin or Ibuprofen. These drugs can cause bleeding during and after surgery. Instead use drugs that contain Paracetamol.


Limit your vitamin E intake to 400 mg per day.

Reason: Vitamin E causes blood thinning.

 

3 days before surgery

According to Dr. Pollard: Last time weightlifting training to keep inflammation levels during surgery low.

If possible notify your fitness center and take a break from their services.

Source: https://www.epollardmd.com/preparing-for-surgery

 

Packing list for the hospital

  • PH skin neutral soap
  • shampoo
  • a thinner and a thicker pillow to lay comfortable.
    Hint: Don’t bother with a mastectomy pillow, it may even be unpleasant on the chest.
  • bathrobe
  • headphones
  • washcloth
  • drinking straws
  • pretzel sticks against nausea after surgery
  • pear juice (anti-inflammatory and laxative)
  • comfortable shoes that you can slide in easily to take strolls in
  • tape to attach drainage tubes on yourself
  • scissors for the tape
  • slippers
  • wide long and short sweatpants
  • short and long wide dress shirts (e.g. hawaii shirts)
  • compression socks (Clinic Landstraße: you receive them on-site)
  • hand sanitizer
  • disinfectant wipes to clean toilet bowl in hospital
  • chewing gum
  • laptop + charger
  • multi plug socket
  • underwear
  • deodorant-stick
  • handkerchiefs
  • earplugs
  • sleep mask (alternatively a sock you lay on top of your eyes)
  • garbage bag for worn clothes
  • maybe prepacked portions of protein shakes + shaker
  • water bottle
  • vitamin C
  • If necessary: Arnica C30
  • toothbrush and toothpaste
  • phone charger
  • books
  • DIY elastic band as mentioned one or two pages up
  • fruit
  • wet wipes/moist toilet tissues
  • Drinking bottle, with drinking tube, small volume since large ones are too heavy, half a liter is ideal
  • a bum bag to hang around your waist so that you have the most important things with you and to attach the drainage bag. Then you don’t have to hold them at the toilet, for example.
  • If necessary: tablets for food intolerances (lactase, fructase, etc.)
  • Take medication that is taken daily (blood pressure medication, psychotropic drugs) with you in the original blister! Sometimes it takes a few days until the hospital has the medication available. Not all hospitals accept/change such home medication. It is therefore always a good idea to take the medication with you for about 1 week. Always tell the doctors which additional medication you are taking so that interactions can be taken into account.

 

for at home:

  • bath brush with long handle
  • fascia roll (to treat possible back pain)
  • maybe a camping stool for grocery shopping (take it with you to reach things in the higher up shelves). This needs some balance skill:

 

The day before surgery

Trim the underarm hair so that nothing gets caught inside it. Furthermore you won’t get stinky that fast and it is more hygienic.

 

Arnica

Start to take Arnica c30:

Twice daily in an interval of ~12 hours. Take 5 globules orally and let them dissolve under your tongue. This should be done at least half an hour before or after a meal and not directly before or after a drink (except water). After intake contact to aetheric oils (e.g. camphor, menthol, camomile oil) should be avoided for at least half an hour. These are also sometimes in dental hygiene products. If caffeine or alcohol containing drinks influence the intake is not clarified at the present day. It is advised to spare these products during intake.

Do this for 2 weeks. (If it doesn’t help, you’ve just eaten a little sugar for 2 weeks).

 

Night before surgery

Do not drink or eat anything after midnight. If your stomach isn’t empty during the surgery it can lead to airway problems or can end lethal in the worst case. The surgery will get canceled if not sober.

Do not shave the spot where surgery will take place.

Take a shower in the evening before surgery, as you will not be allowed to shower for 2-3 weeks after surgery. Do not use body lotion.

 

Bromelain

A lot of plastic surgeons recommend bromelain (pineapple stem, counters pain, inflammation, swelling). However, according to gigas nutrition bromelain can slow blood clotting. Therefore it should be discontinued 2 weeks before surgery.

Source: https://gigasnutrition.com/de/Inhaltsstoffe/Bromelain
[german]

The doctors of Landstraße said to wait until the day after the last thrombosis injection just in case. (so 14 days after surgery)

The recommended dosage varies from 80-750mg per day.

Storage: In the fridge (2°C-8°C). During the treatment period it can be stored out of a fridge for 4 weeks, however do not store over 25°C.

 

 

Morning of surgery

You can brush your teeth but you shouldn’t swallow anything. Daily medication can be taken with a tiny gulp of water. 

As mentioned before: do not eat anything!

Do not use moisturizer for face or body lotion. Do not use hair spray, mousse or gels as many hair products are highly flammable. 

Source: https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/dev_005139.pdf

 

0-7 Days after surgery

Movement and exercise

At the Clinic Landstraße: Since you cannot stand up directly after the surgery, a catheter will be inserted during the surgery time. As soon as you can get up again it will be removed. This is approximately on the first day post-op.

Hint: Drink a lot of water to prevent cystitis.

As mentioned before: it depends on the hospital if you get a catheter.

You should rest a lot to give the body as much energy as possible to heal. However it is also important to move and walk around a bit on even the first day post-op. This is beneficial for circulation and digestion.
Listen to your body! If you get out of breath or feel your heart pumping faster, walk slower or take a break.

Do not lift the upper arms, this could cause the stitches to tear apart. Preferably only move your forearms. The upper arms should not be moved much for at least 6-8 weeks. So not before the scab has healed by itself. In the best case you will not lift your upper arms for 6 months (to reduce risk of stretching your scars and nipples.)

You can check before getting top surgery on how much your skin stretches when you lift your upper arms. Thus lifting your upper arms more than a 30° angle to your upper body will cause your scars to stretch.

Be careful when stretching and reaching for things!

Furthermore do not strain your chest muscles for at least 3 weeks. This could cause tears in the blood vessels and could lead to swelling. So when you are in your bed and you are trying to get from a lying position to a sitting position do not use your arms to push yourself upwards! Use your abdominal muscles paired with momentum. Do not use your arms to support yourself.

Do not lift anything heavier than 2,2kg / 5lbs for the following 3 weeks.

 

Lying/Sleeping

Lift your legs up for lying. Either through using a pillow or an adjustable bed.

Wear compression socks.

Sleep on your back for the following 6 weeks. It helps to lift the head side of the bed to prevent rolling onto your side.

If your arms are swelling, lift your arms over the height of your heart on pillows.

 

General remarks

Take a deep breath every 2-3 hours to extend the lungs.

Swelling is normal. According to Dr. Garramone you should not hold Ice Packs onto the chest. This could harm the nipples.

 

Nutrition

Eat light in the first 24 hours. Avoid very salty foods. Salt increases swelling. Eat fruit and vegetables. High-protein food would be beneficial since the repairing and building process of the destroyed tissue  needs a sufficient amount of proteins.

Source: https://www.sportaerztezeitung.de/sporternaehrung-abo/articles/naehrstoffe-nach-op
[ger]

Drink a lot of water to counteract the constipation after anesthesia.

Hint: Pear juice acts anti-inflammatory and as a laxative.

 

Nipples

The nipples are relatively stressable after 3 weeks. After that timeframe problems are unlikely.

In the first 3 week after the surgery a strong rubbing on the nipples should be avoided.

In the first months after the surgery the scar around the nipples can get thicker. Also the nipples can get thicker.
Sometimes the nipples lose their pigment, which normally comes back after a few months.

 

Contact your doctor if one or more of following symptoms appear:

  • fever
  • bleeding
  • the swelling on one side increases significantly, this could be a sign of internal bleeding
  • pus
  • strong pain
  • an area gets darker
  • an area gets unusually warm (inflammation)

 

8-14 days

Movement and excercise

You can and should go on longer walks at a strolling speed. Movement is beneficial for the healing process.

You can use a fascia roll/foam roll to treat possible back pain.

See here how to use a fascia roll/foam roll properly:

https://www.youtube.com/watch?v=NS73eSohTbc

https://www.youtube.com/watch?v=ePDIhxIf2CI

Keep your arms crossed on your chest while rolling.

 

General remarks

The compression vest should only be worn for 24 hours and then washed with 30°C at max. As you need to wear the compression vest 24/7 for best results you will need a second one.

The top layer of the nipples forms a crust that looks black/brown/green and gradually peels off. See here. However, the entire nipple should not die off. If a nipple is very black, this means that it is dying. If you have any concerns, please still have them checked at the hospital where you had the operation.

If a lot of tissue fluid accumulates, this can be reduced by means of manual lymphatic drainage. See https://chaingepeergroup.at/massagepraxen

 

2-3 Weeks

Showers

At the Clinic Landstraße: You get informed as soon as you are allowed to take showers again. (usually 2-3 weeks after surgery)

Do not let the shower jets face the chest directly. Let it hit on the back and run over the front of your chest. After the scar is healed (6-8 weeks after the surgery) you can face the water jet directly again. Use a pH-neutral skin soap.

Do not directly put soap on your nipples or rub firmly on them.

Only 6 weeks after surgery you can take a bath again.

 

Food supplements

Take 500mg (250mg twice over the course of the day) Bromelain every day for one week.
Take Bromelain at least 1 hour before or after a meal.

 

Nipples

At the Clinic Landstraße: The dressings get removed from the nipples. You should definitely place non-woven compresses on top of your nipples to prevent the compression vest from destroying your nipples.

Possible sterile non-woven compresses [german]:

FIWA® Vlieskompressen 7,5×7,5 cm steril (6 lagig, 50 Stück) 14€: https://www.shop-apotheke.at/arzneimittel/D4793842/fiwa-vlieskompressen-7-5×7-5-cm-steril.htm
VLIESKOMPRESSEN 7,5×7,5 cm steril (4 lagig, 50 Stück) 9,21€: https://www.shop-apotheke.at/arzneimittel/D4808302/vlieskompressen-7-5×7-5-cm-steril-4fach.htm

Change said non-woven compresses once a day. Clean the nipples twice a day with disinfectant (kodan) and then lubricate them with a thick layer of bepanthen ointment. Then place the non-woven compresses on top.


For people in the USA: ask in your local pharmacy for a wound healing ointment with the active ingredient “dexpanthenol”.



The upper pictures were provided by another trans man. 

Hint: There is a chance that the hospital does not offer non-woven compresses after removing the dressing of the nipples therefore you would have to wear the compression vest without non-woven compresses. In that case, absolutely ask for the non-woven compresses.

Wounds need moisture to be able to heal better.

Wear the non-woven compresses as long as you wear the compression vest.

If you don’t have to wear the compression vest for 6 weeks you can proceed lubricating your nipples with the bepanthen ointment until 6 weeks after surgery. If your nipples are very dry after 6 weeks you can continue lubricating your nipples with the bepanthen ointment.

However do not use scar cream on your nipples! Scar cream will make the tissue soft and thus your nipples will get an oval shape from stretching.

 

Steri-Strips (suture strips)

In some hospitals nursing staff will tell you that you will not need to proceed with the medical strips after 1,5-2 weeks. This is wrong! If one doesn’t wear medical strips (Steri-Strips) the scars would stretch.

 

Here (https://evitaclinic.com/how-can-steri-strip-reduce-the-scar) it reads the following:

“There are various reasons and types of scars that occur during the recovery of these wounds. The biggest reason is the movement of the body. When there is some tension to a wound that has not healed enough, the scar becomes increasingly larger with the wound open. When the Steri-Strip is attached, it will prevent the suture area from spreading and also prevent expanding the scarring.

In addition, hypertrophic scars may occur due to excessive production of keratin components, depending on the surgical site or immune difference of an individual. In this case, the effect of pressing the wound with sustained pressure helps. In this case, the Steri-Strip gives a compressing effect. It has the effect of preventing hypertrophic scars or keloid scars.”

 

This is what a hypertrophic scar looks like:

Here (https://www.skinrepair.net.au/how-to-reduce-the-appearance-of-surgical-scars/) it states:

“We were especially interested in improving the cosmetic outcomes of surgical scars on the back, chest or near joints (such as the knee or elbow), as wounds in these areas generally heal poorly due to excessive tension on the immature healing scar as the person bends and stretches.

We found that taping torso wounds for the first 12 weeks after skin surgery significantly improved the appearance of the scars at the 6 month end point of our study.”

 

„Paper tape is likely to be an effective modality for the prevention of hypertrophic scarring through its ability to eliminate scar tension.“

Source: https://sadpas.co.za/wp-content/uploads/2016/02/Randomized-efficacy-of-paper-tape-in-preventing-scar-formation.pdf

 

Also the misconception is big that wounds need air to heal better.

“Maybe you have heard somewhere that it would be best to let the wound heal in the open air. According to medical research the contrary applies: A wet wound site offers the optimal conditions for a speedy recovery of the wound. It even provides a lower scab development and therefore a smaller chance for scarring.”

Source: https://www.hansaplast.at/magazin/gesundheit-und-schutz/feuchte-wundheilung [german] and https://health.clevelandclinic.org/cover-wound-air

Note: However, if a superficial wound (e.g. the nipples) is oozing, it is a good idea to keep it dry. That’s why you get a silver net on it in hospital (for disinfection and to keep it dry).

 

Therefore use the medical strips (Steri-Strips 25x125mm) as long as possible (until your skin reacts irritated to the strips, a minimum of 6-8 weeks; or in the best case 12-14 weeks) as they keep the wound together.

 

Why 12-14 weeks? A scar reaches its maximum tensile strength after 12 weeks.

Sources: https://dermnetnz.org/cme/wound-healing/normal-wound-healing/ and https://sadpas.co.za/wp-content/uploads/2016/02/Randomized-efficacy-of-paper-tape-in-preventing-scar-formation.pdf

 

With upper mentioned sources: scars that have no tape applied to them will stretch more.

Also elastic material can be stretched more easily.

Thus if one does not use a tape on their chest wounds within the first 12 weeks the scars on their chest will stretch. If one additionally uses stuff that makes the tissue elastic it will stretch even more.

As mentioned before scar creams or silicone strips increase the elasticity of the scar. So it makes a lot of sense to me that I was advised by multiple doctors in my clinic to use Steri-Strips for 12-14 weeks after surgery instead of silicone strips.

 

Only after 6 months you should use scar creams. For example: Bepanthen Scar-Treatment or Contractubex gel.

Where you can buy the Steri-Strips is listed here.

 

Usage

Change the Steri-Strips once per week. Then clean your scars with skin sanitizer (e.g. Kodan). It is important that the sanitizer doesn’t have moisturizing properties as the Steri-Strips won’t stick as well to the skin as they should! You can rubbing alcohol to remove glue residue from the Leukotape.

Then place new Steri-Strips on your incisions (two on each incision). While sticking the strips on make sure to relax the skin and have an upright posture. Then stick the Leukotape on top of the Steri-Strips as shown above.

Caution: Leukotape will stick very well to your skin. So use smaller strips as in the picture below. Otherwise you will face horrible pain when removing them.

 

3-6 Weeks

Movement and exercise

At this point in time you can start by jogging, riding your bicycle or train on the crosstrainer. Be careful not to move your upper arms too much. You also shouldn’t strain yourself, this leads to a higher blood circulation which could cause the chest to swell again. Listen to your body.

Do not lift heavier than ~9kg / 20lbs.

Prevent from moving your upper body in a way that could stretch your scars.

 

General remarks

“Dog ears” decrease with the swelling.

 

Open spots on the scar

If open spots appear on the scar like here:

Clean the open spot with a skin sanitizer (e.g. Kodan). Then press the wound edges of the open spot together and place two small Steri-Strips on top – forming a cross. This way the wound edges can grow together and you prevent the scar from widening. 

Then place the big Steri-Strips on top.

Moreover change the strips two weeks later (instead of one week). Otherwise you might rip the wound edges open again.

Contact your doctor if you are unsure! 

The upper pictures were provided by another trans man. 

 

Scar care (for 1 year)

From the 3rd week on you can start to massage your scars. Leave the medical strips on for this and massage on top of the strips. Don’t start too early so that you don’t reopen the wounds or make the scars thicker by massaging too much. In general, 21-60 days after the operation is the period in which you should start massaging.

Massaging breaks hard scar tissue, promotes circulation and that helps the scar fade faster, because the red pigmentation gets reduced quicker. Scar massage improves wound healing and prevents adherences and therefore also prevents that the scar grows on to the underlying skin layers.

Source: https://www.memphisplasticsurgery.com/scar-massage

Else it could happen that the scars feel like two bra wires that grew on to your chest when the healing process is complete.

Massage the scars twice daily for 2 minutes per side with your index and middle finger. Keep in mind: do not pull apart the scars. this would cause it to stretch and be bigger in the end. Pain when massaging is a big no-no at the beginning! If this is the case, reduce the pressure of the massage or wait a few more days.

Do not massage the nipples, they only have to grow onto you. It would even interfere with healing or destroy the nipples.

 

You can use the following movements:

Start lightly and increase intensity from week to week. If you are massaging with too much pressure the scar could get stretched or in the worst case ripped open. The massage time can also be extended from 2 to 2,5 minutes.

Source: https://www.youtube.com/watch?v=2nEdXufLWog and https://www.youtube.com/watch?v=ArpC0yerVus
[first german, second english]

There is also the option of seeking advice at a trans-friendly massage practice. See https://chaingepeergroup.at/massagepraxen

 

Possible healing process for the nipples

alle “dunklen” Aufnahmen waren Abends = all “dark” pictures were in the evening

 

from 6 weeks on

Movement and exercise

You can lift normally again.

After 6 weeks weight exercises can be started again. A different approach is advisable. Do not use “progressive overload” (= training with maximum weight and increase of it). It is advisable to instead train with “time under tension”. With this approach the muscles will get trained through tension (= low weight, many repetitions).

Do not exceed 6kg in the beginning.

Since everyone is healing differently there is no timestamp as to when you can train with heavy weights again. You will have to listen to your own body and slowly raise the limit.

It is better to train with lighter weights for longer than necessary than to start with heavy weights too soon. (Doing this could overstrain the body and could cause your result to worsen.)

 

Possible workout plan

Day 1: dumbbell curls, hammer curls; running for 30 minutes

Day 2: standing wrist curls, tricep kickbacks, crunches

Day 3: dumbbell curls, reverse curls; running for 30 minutes

Day 4: tricep kickbacks, side crunches; Legs/Abs HIIT (cardio)

Day 5: standing wrist extensions, dumbbell curls, reverse curls

 

Weight training and HIIT with pictures, Warm-Up and stretching exercises: https://docs.google.com/document/d/1qo04-18O_t9gdOxYgPQHywvTd1iTYJukZSA7WQBU1B0/edit?usp=sharing

 

 

excel-spreadsheet to keep track of the weight and repetitions:

https://docs.google.com/spreadsheets/d/1vXm4yDfeclUFOW5EMYpzkzG_u09kFXfVdENPDyGnTOQ/edit?usp=sharing

 

General remarks to scar tissue

Scar tissue does not have sweat- or sebaceous glands, which would regulate the moisture of the skin. Therefore you need to support it with moisturizer.

Source: https://www.apotheken.de/krankheiten/krankheiten-und-therapie/haut-haare-und-naegel/7081-narbenpflege [german]

 

Massaging

From the moment on when you do not have to wear the medical strips anymore:

(As a reminder: the strips should be worn for at least 6-8 weeks. Best case: 14 weeks. You can start massaging as soon as the crust heals by itself (see above).)

You can massage the scars with or without lotion. If you massage them without lotion you can take off your fingers and place them on the next spot on your scar, then proceed massaging. 

Keep in mind: do not pull apart the scars. this would cause it to stretch and be bigger in the end.

Do not massage the nipples, they only have to grow onto you. It would even interfere with healing or destroy the nipples.

You could moisture your scar by using a in-shower body milk:

It differs from person to person how much moisture the skin needs. For some the in-shower body milk will be sufficient. Others will need additional creams.

 

A possible moisturizer would be the CeraVe Moisturizing Lotion. It doesn’t contain perfume and won’t make your skin more stretchable :

https://www.cerave.com/skincare/moisturizers/daily-moisturizing-lotion

 

 

Bi Oil (Bio Oil)

This oil gets sold as the best natural way to care for scars.
On the internet you can find a variety of reports. Some say that it helped, others say that there was no change for the better.

 

However there are no representative studies that would show scars to fade faster with the use of bi oil. It also gets advertised that the appearance of the scars should improve but it never gets defined how exactly it should improve.

 

Definition of a representative study:

“A population wide survey will ask at least 1000 people in most cases. A random sample of 100 or 500 participants can also deliver meaningful findings, if these feature the population well. This only creates one constraint: With lower random samples the chance rises for statistical errors, the so-called probability of error.
Therefore it delivers that the validity of a study is not solely dependent on the size of the random sample. But the accuracy of the results does rise with the size of the sample.”

Source: https://www.rnd.de/wissen/reprasentative-umfrage-wann-ist-eine-erhebung-serios-und-aussagekraftig-diese-faktoren-sind-relevant-DD2S6UPTKJE33P5DCTEL23MKGM.html [german]

 

Every human can obtain scars, therefore there would have to exist studies for the general population. (So at least 1000 people.) In the 4 listed studies on the homepage of bi oil only 44, 82, 24 and 36 people have participated.

Source: https://www.bio-oilprofessional.co.uk/resources/section-6-bio-oil-clinical-research

 

There was one other study with 80 participants. In this 40 had scars and 40 stretch marks:
https://pubmed.ncbi.nlm.nih.gov/29094366

 

Bi oil contains mineral oils and sunflower oil which helps with dry skin.

Moreover bi oil contains scents which could irritate the skin.

 

 

Here it was established that rosemary oil is not phototoxic:

https://www.cir-safety.org/sites/default/files/rosmarinus.pdf

Phototoxic substances irritate and darken the skin if it gets in contact with UV light. UV light also gets through T-shirts to the skin. This would be very bad for the scars.

Conclusion from Dr. Dray: Bio oil is basically just a moisturizer and in the worst case it could irritate the skin with the scents. There are many other moisturizers on the market that do not contain scents.

 

Here Jibril tested the product on himself: https://www.youtube.com/watch?v=GFBQIl6JgHg
His conclusion being: it is a good moisturizer but nothing more.

 

His conclusion: it is basically a very expensive moisturizer that could irritate the skin through its scents.

 

Summer

Do not expose the scars and nipples in the direct sun. Cover the scars and nipples with SPF50 sunscreen even when wearing shirts. Reapply the sunscreen after two hours, as it only lasts for two hours. T-shirts only have an SPF of 10.

Only after one year after surgery should you expose your upper body without a shirt.

If you want to go swimming after 6 months you can use kinesiology tape on your scars to physically block the sun. This way you can also go topless.

Scars will never be able to build melanin again, therefore they can’t protect themselves from the sun. This is risky due to skin cancer and will cause the scars to get darker.

So you should theoretically use sunscreen until you cease to exist.

Therefore cover the scars and nipples with sun protection even after 3 years after surgery.

 

Scars after 6 months

Comment from a Cha(i)nge admin and author of this article:
„The result depends a lot from your initial situation + the technique of the surgeon and if you had complications during or after the surgery. I had no complications.

My scars do not feel clotty due to the massage and move along well with my skin when I lift my arms. 

In the beginning of lifting my arms again I had feelings of tension as the muscles shortened a bit. This is settling slowly. Besides the skin gives away a feeling of tension as during the surgery it was tightened. However skin is elastic so it should stretch itself gradually so that this feeling of tension will vanish again.

I will not use scar creams as the scars are flat and healing well. Thus I do not want to risk the scars stretching. The body will reduce the red pigmentation by itself over time.

I can now finally train or do sports without restrictions again. Finally :D“

 

Scars after one year

Comment from a Cha(i)nge admin and author of this article:
„I continued to massage my scars on each side 2,5 minutes twice a day. I didn’t use any scar cream or silicone strips.

My scars are vanishing well and didn’t stretch after I started raising my arms again.

The feeling of tension as mentioned before is also gone.“

 

Scars after two years

 

 

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