Chest Reconstructive Surgery / Top Surgery
The purpose of this surgery is to create a more masculine or androgenous chest. During the surgery, there will be:
- Contouring of chest wall with removal of breast tissue and skin excess
- Proper reduction and repositioning of the nipple areolar complex
- Obliteration of the inframammary fold
- Minimisation of chest wall scars
Top surgery involves removal of the breast tissue and skin from the chest wall. The type of operation suitable for each patient depends on the amount of both tissue and skin they have to be removed, as well as the elasticity of the skin.
Binding makes the skin less elastic and it also stretches the skin sometimes making it difficult to assess the right amount to remove at the time of surgery.
The different types of operation that are available and can be performed are:
This is the smallest incision and only suitable for patients with a small amount of breast tissue.
Often called a doughnut incision. A ring of tissue is excised from around the nipple areolar complex.
“Double Incision” – Low Scar
This is probably the most common approach. It involves placing a scar near the level of the pectoralis muscle insertion, and curving up toward the armpit laterally. The nipple areolar complex is replaced as a graft or can be left off (See Nipple Reconstruction below).
“Double Incision” – High Scar
This incision is set at the level of the new nipple position. Some patients request a scar at this level. In some patients, it may be the only option if they do not have enough spare skin in the upper part of their chest to pull all the way down to the infra mammary fold for a ‘low scar’. The nipples can then either be grafted or left attached on pedicles.
Secondary Nipple Reconstruction
Secondary Nipple Reconstruction
This is only possible with the low scar approach. Some patients have very large nipples, or wide nipples that following reduction of the areolar would take up most of the areolar area, no longer being in proportion to the areolar.
Also some patients don’t want any ‘reminders’ of their previous chest, preferring to ‘start anew’. In these patients a new nipple is created from their skin in the correct position, in the same way as a nipple is recreated in cases of breast reconstruction following cancer treatment.
This surgery is performed after a minimum of 6-8 weeks after the initial surgery using local anaesthetic. They then get the areolar tattooed on 8-12 weeks after that. Some patients may decide that they don’t want to have a nipple reconstruction immediately, and it can be performed at any time after the initial 6-8 week period, sometimes years later.
The nipple reconstruction is performed as a day case and takes about 40 minutes. They can usually return to work the following day with only a small dressing over the new reconstructed nipple, which is removed a week later. Gym and other strenuous activities can be resumed after a week.
Frequently Asked Questions
During your consultation with Mr Ives, you will be asked about your past medical history and your general health. You will also be asked about your journey to date, including if and when you started your hormone therapy.
Mr Ives will then examine your chest looking for lumps or abnormalities. Skin quality and tissue volume will assessed and any asymmetries noted. Some measurements of your chest will also be taken.
Mr Ives will then discuss with you the options available to your top surgery, the operation that you prefer (if you know at the time), and the postoperative regime.
If you are one of our many patients from interstate, Mr Ives will take some photographs as part of your medical record at the initial consultation. No one gets to see this pictures apart from Mr Ives and yourself, without your permission. A second consultation will be arranged. If you are one of our interstate patients this can be done over the phone.
At the second consultation, Mr Ives will discuss the operation and the risks of surgery with you again. If you know which surgical option you would like, this can be confirmed with Mr Ives. If you have not already done so, Mr Ives will take some photographs of your chest as part of your medical record.
You can book surgery for whenever. However, Mr Ives will not perform the surgery without the WPATH criteria being met and having the relevant report(s). See “WPATH criteria”
Everybody’s body is different and so everybody’s result will be different. Some things to consider before surgery include:
- Weight loss either before or after surgery and the likely effects on results
- The effects of surgery on nipple sensation
- You must also consider your weight. Mr Ives WILL NOT operate if your BMI is >35
Mr Ives performs surgery at Masada Hospital in East St Kilda.
Any operation has risks associated with it. Mr Ives will discuss these with you during the consultation.
Complications from surgery can be divided into ‘General Complications’ that you can get from this or any other operation, and ‘Specific Complications” that are specific to the operation itself.
General complications include:
- Keloids (lumpy scars)
- Deep Vein Thrombosis (DVT) – clots in the legs
- Haematoma (collection of blood in the wound)
- Anaesthetic complications
Specific complications include:
- Loss of the nipple +/or areolar
- Asymmetry of nipple /scar placement
- Dog ears
- Contour irregularities
- Need for secondary surgery
Mr Ives will discuss with you the risks of surgery during your initial consultation.
Mr Ives performs this surgery in an accredited hospital, under general anaesthesia. All patients will need to stay in hospital after surgery for at least a night.
The scars will depend on the approach of surgery that you have had. In all instances, the scars will be as short as possible. It is important to care for your wounds and scars afterwards. Mr Ives will discuss with you the postoperative cares of these, both initially, but also when you see him for you post operative visit following surgery.
After surgery, you will need to rest for about two weeks. This means no heavy lifting for that period. This is anything over about 10kgs.
After the two weeks, you can steadily increase your activities back to your pre operative level. You should not drive for 10 days. You should not attend the gym for 3 weeks after surgery (if you go in the first place!!) and then only perform light cardiovascular exercises such as gentle walking on the treadmill or gentle exercise on a bike (no running a marathon or trying to win the Tour de France!)
Weight training and any team sports or swimming should not be performed for six weeks.