What do I need to do before having Top Surgery??

The guidelines for gender affirming Top Surgery state that you will need a referral to be completed by a GMC or HCPC registered psychologist/psychiatrist. This is very important and we will not be able to proceed with your Top Surgery without it. You can check the guidelines at https://www.wpath.org/

Following your face to face consultation a pre-operative assessment will be conducted. This is where we will assess your medical suitability for Top Surgery, it is also an opportunity to ask any questions you may have forgotten at your consultation.

It is very important that you stop smoking 4 weeks pre and post surgery. Smoking drastically effects the healing process and you will need to pay for revision should a complication arise with links to smoking.

You can find a wealth of information regarding Top Surgery online, this can often lead to confusion. For more information about gender affirming top surgery please got to the following links.



What happens on the day of surgery?

The time you should arrive at hospital will be advised prior to your Top surgery. When you arrive you will be greeting by the hospitals reception staff, you will then be taken up to the ward by one of the team. Once on the ward you will have three separate assessments. One by the ward nurses, an anaesthetist review and a final surgeon review. Once completed you will be brought to the theatre area where your anaesthetist will administer the general anaesthetic. The operation itself should take around 3 hours. Once your operation is completed you will wake up on the recovery unit where you will be monitored closely by one of the recovery nurses. Once you are awake and stable enough you will be brought down to the ward, as you will be staying overnight there is no rush and you will be able to properly rest and recover. The following morning you will be assessed by your surgeon and most likely be discharged home, it is essential you have someone to travel home with.

Your surgery will most likely take place at Fitzrovia hospital, for more information please follow - https://fitzroviahospital.com/

How long does FTM or FTN Top surgery take?

The amount of time Top surgery takes depends on two different factors, the method of Top surgery and the overall size of the chest. Double incision mastectomy is the most commonly used method and normally takes around 3 hours in total. Depending on body size, there may be the need to include liposuction to reduce the risk of dog ears. If liposuction is needed it will take around one hour extra. When the chest is smaller in size then you may be eligible for a Periareolar mastectomy, this method of Top surgery creates very good male contours with minimal scarring and good nipple sensation. This method of Top surgery is also frequently less expensive than double incision. A Periareolar mastectomy takes an average of 2.5 – 3hours.

What Aftercare will be provided for my Top Surgery?

After having Top Surgery, you will spend one night in hospital. This ensures that you are stable and feeling well before you go home. Many clinics do Top Surgery as a day case but this is a big surgery and we believe it is within your best interests to be monitored for one night. The day after your surgery you will most likely be discharged from hospital, occasionally there may be the need to stay an extra night but this will be assessed at the time. Upon discharge you will leave with two drains either side of you, you will have these for 3-5 days. You will be given a spare drain bottle in case one of your bottles suction stops working, this is rare but if it does happen you can call us and we will explain how to put the new one on. Little – medium amount of drainage is normal. If your bottle is getting full, you should call us.

Your first appointment will be at 3-5days post-surgery; this will be the appointment you have your drains removed. Drain removals can be very daunting for patients. Many of our patients describe the feeling as being an odd feeling, but report little pain. Others may experience a short and sharp pain that’s relieved quickly. On the whole, the apprehension is often worse than the process itself.

Two weeks after top surgery you will be ready to have your dressings changed. This will likely be the first time you will see your chest. Having top surgery is a huge change to the body and mind, a lot of patients describe a feeling of gender euphoria and others take time to adjust to the change, there is no right or wrong way to feel. TransgenderCare will support you in every way we can, this includes but is not limited to clinical concerns. Total healing time can be 12-18 months so at two weeks you may have scabs and bruises, this is all part of the healing process. Nipple graft failure is a big worry for patients, this does sometimes happen however it is quite rare. Once you have admired yourself in the mirror we will put some new dressings on, you will where these dressing for the next couple of weeks until you are advised not to. You will leave with all the dressings you need to look after yourself during your recovery. You will be asked to take and send pictures each time you change your dressings so we can monitor your recovery.

At 6 weeks we will see you again, your swelling will be assessed and your garment will likely not be needed. At this point you should also be able to begin exercising at the gym and returning to your normal way of life. This will be assessed at the time. We will then catch up with you at 6 months and then again for discharge at one year.

Throughout your care with us you will have a 24/7 phone number that you can call to speak with a clinical member of staff. Additional post-op appointments will be given to you should it be necessary.

If you need further support during your recovery then our team will be able to advise you, alternatively there are some other support networks you can look at….




What if any complications arise?

In the unfortunate event that complications happen our team will act promptly to ensure the best possible outcome. If there’s need for an additional operation during your recovery, then TransgenderCare will not charge you for this. You may incur charges from our hospital provider for the use of their facilities, unfortunately we have no control over this. At your one-year post-op appointment it may be decided that there is a need for revision, most revisions can be done under local anaesthetic. If you have followed the post-op advice given then TransgenderCare will not charge you, however again hospital fee’s may be incurred.

Do I need to be on hormones before my surgery?

Some professionals advise you to be on hormones prior to surgery however this is not essential. Many Top surgery patients decide to never go onto hormones. There is no clinical reason for top surgery patients to be on hormones.

Will I need to stop my hormones for Top surgery??

No you will not.