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Healing After Top Surgery: Expectation vs. Reality

Major surgery is rarely the best day of someone’s life. Getting my top surgery in December 2022 was the exception – I woke up after surgery and immediately started happy-crying, excited just to find out what it would be like to sit up without the weight of a chest I’d never been comfortable with. Every motion and feeling was a discovery – what’s it like to walk down the stairs with nothing bouncing? What’s it like to feel a seatbelt flat against me? What’s it like when my girlfriend lays her head on my chest, REALLY on my chest, closer to my heart than ever?

The feeling of knowing I got to live with this chest for the rest of my life kept me going, even through the worst moments of body horror while healing. I wondered if the euphoria would ever wear off. A year since surgery, I can happily say it hasn’t.

Before my surgery, I read so many personal accounts of other top surgery experiences in an attempt to prepare myself for what was to come. Even before I had a consultation scheduled, I wanted someone to tell me exactly what it would be like. Maybe you’re reading this for the same reason. If that’s you, hopefully this breakdown of healing expectations vs. reality can offer you a little bit of comfort, a drop in the bucket of your curiosity about doing something life-changing.

I’m not a doctor, I’m just a guy who did something to feel more at home in his body. All I can speak to is my experience — yours may be nothing like mine at all. None of the following is medical advice. If you have questions about the medical nitty-gritty, contacting a health care provider is your best bet.


A trans masculine person showing their post-surgery scars.

Photo by David Canales/SOPA Images/LightRocket via Getty Images

Physical Healing

EXPECTATION: This is gonna hurt.

REALITY: Healing was much more uncomfortable than painful. My pain never got above a 4/10, and that was only from the brief feeling of drains being removed. Drain removal was by far the most uncomfortable sensation I’ve ever experienced, but I wouldn’t describe it as painful, just mindfuckingly weird. And feeling it two times for a total of less than 60 seconds, in the grand scheme of things, is nothing at all.

My surgeon used a nerve block, which was probably why healing was so relatively painless. I didn’t end up needing to take anything stronger than Advil, partially because the one time I took my prescribed Oxycontin I threw up so loud I’m pretty sure everyone else in the hotel could hear it.

EXPECTATION: The body horror of drains will be unbearable.

REALITY: Having drains was the most uncomfortable part of healing, but having the drains only lasted four days (this varies based on your surgeon and type of top surgery). My concern was that I would rip them out somehow, but that’s far more phobia than likely concern. I’m more squeamish than the average person, specifically about foreign objects in the body — for example, I don’t mind the needle part of an IV, but I do mind knowing there’s a tube in my vein. If this is something you’re squeamish about, do yourself a favor and don’t spend hours seeking information on how drains work that your doctor/surgeon doesn’t give you.

Be informed, but keep it specific to “will knowing this keep me healthy?” It’s not that there’s some horrible secret to be protected from. It just may make you hyper-focus on the bad feelings. Four days of body horror for a lifetime of gender euphoria is an easy trade.

EXPECTATION:My arms will be totally unusable.

REALITY: Everything I read online convinced me I’d be functionally armless, but this was never true. Raising my arms higher than chest-level was difficult at first, but everything outside that range of motion was totally fine. I was very hesitant to move my arms much in the days I had drains in, but that was more due to mental discomfort than physical.

EXPECTATION Getting dressed after surgery will be physically impossible.

REALITY: Some clothes will be too difficult to put on for the first few weeks, but you can’t go wrong with shirts that button in the front. I got a couple comfy PJ shirts to prepare for surgery, including one that had drain pockets sewn inside it. It was difficult to bend down to put on pants/shoes for the first 2-3 days after surgery, so I recommend being prepared with sweatpants, slippers, and anything that you don’t have to be bent over to pull on for long.

Some other comfort items I recommend: a mastectomy pillow for seatbelts if you’ll be in a car, a lapdesk, a drain pocket fanny pack to keep them wrangled, and laxatives for the post-surgery bloat.

Showering

EXPECTATION: I won’t be able to shower for weeks after surgery.

REALITY: I was showering within a couple days, even with my drains — this varies based on surgeon, but I was very relieved not to have to be greasy for long.

EXPECTATION: Okay, but showering will still be a hassle every time.

REALITY: Well, yeah, it was. But mostly because I was convinced my chest would come unraveled every time I had to take my compression vest off. As is the pattern here, my issues were far more mental than physical. My girlfriend helped me shower for the first month post-surgery, first by helping me wash my new chest scars when I was too nervous to look at them, later by letting me call her on speaker while I panicked in the shower that my scar tape was coming off (a thing it was supposed to do.)

Putting the foam inserts back under the compression vest after showering was slightly challenging, but we started using double sided tape to stick it to the vest and it got much easier.

Nipples

EXPECTATION: My nipples will lose sensation, but it’ll come back eventually!

REALITY: I’m still waiting on that “eventually.” I had double incision top surgery, and as part of DI according to TopSurgery.net, “the nipple-areolar complex (NAC) is completely removed and grafted on in a higher position on the chest. This severs the nerves that go into the nipple-areola, and as they are not microsurgically reconnected there is a substantial likelihood for loss of sensation in the nipples and areola.”

A year later, my nipple sensation is still 5% at best, and the only sensation it can really register is “chapped, please put lotion on.” My nipple scars/chest scars aren’t painful to touch, they’re just numb. It’s become a zone I tell people not to touch, and while I was a little bummed about the loss of sensation at first, it’s a small price to pay for having a huge weight off my shoulders (literally.)

EXPECTATION: Having had nipple piercings is gonna make my results turn out weird.

REALITY: I took out my nipple piercings about a month and a half before surgery to give them time to heal because of this concern. You can barely tell they were ever there at all, other than a tiny line on my left nipple that might be the scar.

The Gender Confirmation Center by Dr. Scott Mosser confirms that yes, nipple piercings need to be taken out pre-surgery, but it’s not a big deal: “If you have your nipple pierced at the time of top surgery, you will be asked to remove the jewelry (and all other facial and body jewelry) before surgery. Nipple piercings sometimes leave two very small circle scars, and in order to help maintain symmetry, let us know that you have had your nipples pierced so we can align those scars the best we can.”

Like I said, my scar is a faint line, so it might not even be from the piercings. As for getting pierced again in the future, I would’ve had to wait 6-12 months (so I could technically get them again now), but the idea of ever having a needle through that scar tissue makes me cringe too hard. RIP piercings, they were fun while they lasted, but I’m not going back.

EXPECTATION (unreasonable fear): Oh no, oh God, my nipples are going to fall off.

REALITY: They didn’t fall off. Every time a scab flaked off, I thought, “well, there it goes.” From talking to other trans mascs, this seems to be a common fear after surgery, but 100% of us have just as many nipples today as we did waking up from top surgery. If you’re really concerned about your nipple falling off, contact a medical professional, even if you just need to hear an expert say “you have nothing to worry about.”

Body Image

EXPECTATION: Getting dressed after I’m healed will be a million times easier.

REALITY: It is. It absolutely is. Before surgery, trying to get dressed had a 30% chance of causing a dysphoria breakdown so bad I’d cancel on whatever I was getting ready for. I am a better friend because of how much easier it is to leave the house. On my most confident days, I feel like I’m dressing a little Ken doll. Before surgery, I thought getting dressed could feel neutral, at best. I never knew it could actually be exciting.

EXPECTATION: All my dysphoria will be cured and I’ll live happily ever after. Right?

REALITY: My chest dysphoria is almost completely gone, other than my occasional medically unfounded panic that my boobs will somehow “grow back” if I feel the slightest jiggle.

I love my top surgery results. I love the (fake) pec definition my scars give me. I love how my new nipple size and shape turned out. I love having the scars to prove that I went through this.

Do I love the rest of my body? That’s not a given. Top surgery didn’t cure hip dysphoria, or the dysmorphia around my stomach, or thinking that my face looks too feminine. Top surgery helped what it was supposed to help, but it’s not a cure-all. Nothing is. And I thought I knew that, but there was a certain level of emotional crash that came with settling into a new body and realizing that solving one problem didn’t solve them all.

Top surgery is still a massive step forward, and from the second I woke up from surgery, I’ve never felt an ounce of regret. My discomfort with myself has nothing to do with top surgery — if anything, having had surgery means I can finally address deeper dysmorphia, since the number one cause of my dysphoria is out of the way. I’ve peeled back the first layer of body image issues, and now I can keep going, layer by layer.

Relationships

EXPECTATION: I won’t be able to be alone the whole time I’m healing.

REALITY: I was very lucky to heal at my parent’s house with both my parents and my girlfriend supporting me. I depended on them so much for that first week post-surgery, I was convinced it would be that way for weeks… but luckily (for me AND for them), I was mostly self-sufficient after 2 weeks.

The things I still needed help with were showering, laundry, and dishes, but the last two were because of my apartment layout: my laundry is down several flights of stairs and the basket was too heavy to carry longer distances, and my dishes needed to be put away on higher shelves. If I had an in-unit washer/dryer and was taller, those wouldn’t have been issues. A guy can dream.

I’ve had friends heal by themselves, and while it seems harder than doing it with support, their results turned out just as good as mine did. Doing it alone is difficult, but not impossible, and ultimately you’ll be just as happy with your results as you would’ve been otherwise. Unless something goes medically wrong, in which case, contact your surgeon!

EXPECTATION: My healing will be a burden to the people around me.

REALITY: My parents and girlfriend were just happy to be part of such a monumental moment in my life. My mom went back to my surgeon early the day after my surgery to learn how to take care of my drains and made me coffee every morning when I was home, even when I was too tired to ask for it. My dad continuously checked in about whether my doctor-prescribed Oxycontin was safe to take — it was, and I barely took it anyway, but he’s an anxious guy who worried about me the only way he knew how. My girlfriend, Rowan, ran a one-on-one Dungeons and Dragons campaign for me while I was healing, so instead of my memories of the first few days post-surgery being of pain and discomfort, they’re of magic and being a hero. I’m closer with everyone I let take care of me, and everyone I’ve met since becoming more comfortable with myself.


A year from now, I’ll still love my flat chest just as much as I do now. Maybe even more. Challenging every scary expectation I had was worth it, especially to find out recovery was not so scary after all.

Author’s Note (01/14/24): It turns out, my fear of my nipple falling off actually WAS a little founded. I’m lucky that it didn’t happen to me or anyone I know, but it does happen. According to the Centre for Surgery in London, “various factors, such as precise incisions, sterilization, and aftercare, play a role in ensuring the nipple graft takes well and heals properly.” Risks vary based on what type of surgery you have, since some resize and relocate the nipples while others only resize them. If something feels wrong, especially if you have symptoms of necrosis, contact a medical professional ASAP. You also have the option to get top surgery without nipple grafts. Can’t worry about a nipple falling off if you purposely don’t have them.

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Max Gross

Max Gross (he/him) is a trans writer and comedian based out of Brooklyn. His writing can be seen in The Onion, Reductress, Slate, and now, wherever you're reading this.

Max has written 3 articles for us.

12 Comments

  1. Most of this aligns with my experience! I was very grateful that I had people to help, but the whole thing was shockingly easier than I could’ve expected!
    Showering was the most obnoxious part. I will say having a shower seat was so helpful for me! And I have African net sponges from Omas Cosmetics that made trying to scrub myself so easy, because they’re really long I was able to use them without having to try to move my arms too much.

  2. Nipples falling off – by that I mean dying – does happen. It’s not an irrational fear. If you read top surgery subreddit in Reddit, you’ll see some folks who have had that experience. Sometimes it just happens. I don’t want folks who read this to think it’s impossible.

    • Yeah, I had top surgery last month and lost my nipple after a hematoma-caused swelling cut off its blood flow. I’ve been reading so many studies and articles and statistics about possible complications. They all say that it’s virtually impossible to get nipple necrosis. And while it’s comforting to know that most other trans people never have to go through the process of losing a nip, it maked me feel so sad and alone in my experience. It’s been 2.5 weeks since it happened and I managed to accept the situation, but it really overshadowed my post-op euphoria.

      I think better advice than to absolutely not worry about your nipple falling off would be to immediately call your surgeon when you notice any swelling or sudden bruising, even when your nurse doesn’t seem too concerned about it.

      • Hey, I’m so sorry to hear that happened! I’m learning a lot about nipples falling off from these comments, I’ll see what I can do about updating this information. I know multiple people who have had to get revisions for various reasons, while it’s true they’re not the majority you’re definitely not alone in experiencing complications. I hope the rest of your healing is complication-free, and congrats on having had surgery!

        • Aw, thanks! I really appreciate the kind words and updated author’s note.

          I got buttonhole surgery, never smoked and had daily nurse visits for the aftercare – I never considered the possibility of losing a nipple.

          It’s been a wild ride and a lot to process, but everything else healed beautifully (my one nipple is perfect!) and I’m still very excited about my flat chest. And once I get that nip reconstructed, I’ll burn all of my shirts and spend the rest of my life topless.

  3. I have a top surgery consult in April (though I may be denied bc of my size) and I want that euphoria so badly! Even though I know it won’t solve everything I know it will be life changing and I want this experience you describe, all of it!

  4. Well huh, I read this because I was curious about the experience but turns out as a cis woman who had breast reduction surgery, I have something to contribute! (Sounds like our surgeries were somewhat similar, although I only had drains in overnight, thank goodness.)

    Anyway: it took a couple of years for sensation to come back properly in my nipples, but it did come back. That’s not to say it’s guaranteed—our surgeries weren’t identical, and I know loss of sensation was also a risk with mine—but just mentioning that you may still be in the healing/settling down portion of the timeline there.

  5. Your nipples can unfortunately absolutely “fall off” if you’re unlucky enough to get tissue necrosis because of an infection. Being fastidious about hygiene and taking your prescribed antibiotics can help avoid this outcome.

    I would also add that my expectation was that post surgery I would have the literal chest of my dreams but really it’s more like now I have new things to dislike/learn to live with but that these things are/were much easier to accept than my old chest.

    Also, I’m jealous that you didn’t feel like a burden, my ex gf made it very clear to me that me getting surgery was basically ruining her life. So shout out to my ex for adding to my massive fear of being a burden! That’s definitely never coming back to haunt me!!!

    Also, re sensation…I’m also in the 5% ish club it sucks but it is what it is. Remembering to moisturise is also something I never thought about before surgery but I guess surgery destroyed their ability to retain moisture or something?

  6. This was so helpful! I’m anxiously awaiting my surgery date June 12 and just helped a friend through their top surgery in early December. I definitely still have some vague anxiety about surgery (I think everyone does) but having a real life example of what the process looks like and then other accounts like this that confirm that same impression helps A LOT.

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