Top Surgery Update: 5 Months Post-Op

First off, I can’t believe it’s been 5 months. It seems like such a long time ago; I can’t imagine my body any other way – even if it did used to be different, it feels so natural now it’s hard to believe that it was different. It also seems like such a short time, because I have many many many years ahead in my “new” self, and the scars still need a few years to heal completely. On that note…

The Scars

The most salient reminder that this ever happened are the scars. And I don’t mean to refer to the fact that they’re there and I can see them, and everybody else can see them. That was a given since the beginning. It’s how they’ve healed. In short, not as well as I had hoped.

Thankfully the small T line below the nipple remains light and fading. Also, the incisions around the nipple had begun to swell and get minimally hypertrophic. However, after some months of applying treatment options (described below), the nipple incisions seem to have completely flattened and thinned out. This makes me think that through prolonged use, the larger scars will eventually improve.

Hypertrophic

The two halves: hypertrophic and not. Also clean scar on the T and the nipple.

Hypertrophic scarring is genetic (apparently my father and brother scar like this, and didn’t bother to tell me until after the fact) and unpreventable (and if it isn’t, don’t tell me, it’s too late). It’s lesser in degree than keloiding, which is good, but it means that I no longer have clean and minimal incision lines. Instead, the skin on the incisions is red, swollen and raised. The onset was at about 2 months, and they continued to expand for half of the incisions on both the left and right sides, and then expanded onto the entire incision on the right side.

Pictures

Skip if you’re squeamish, click if you’re curious.

FTM Top Surgery Post-Op

The Left Side


FTM Top Surgery Post-Op

The Right Side

FTM Top Surgery Post-Op

The Treatment

Treatment for hypertrophic scarring is fraught with false claims. It’s hard to tell what is true and what isn’t, but here’s generally what I’ve concluded (which may or may not be correct):

  • It’s not preventable
  • It’s not treatable (there is nothing to make hypertrophic-ness go away)
  • The only “real” treatment is either laser scar removal (expensive and of questionable effectiveness) or cortisone injections (very painful, not recommended).
  • Most scar treatments are useless.
  • If you are going to use something at all, silicone is a key ingredient.
  • It doesn’t hurt to try, it just costs money.
  • The best treatment is time, lots and lots of time.

My Treatment History

I’m only listing this here for documentation and informational purposes, more to see what I’m doing and find out what works and what doesn’t. This section might be boring so feel free to skip it.

Derma-E Scar Gel

I started out using Vitamin E oil recommended for stretch marks, combined with a Scar Gel. At first I was slathering either of these 3-5 times a day, and then the frequency decreased, right around the 2 month mark. The oil was not doing anything, and since my scars suddenly flared up I decided to go with a more intense solution. Also at the 2 month mark I renewed semi-vigorous exercise – carrying grocery bags and yoga, going from nothing more than light jogging – which may or may not account for (but certainly coincides with) the onset of the hypertrophic scars.

Scar Strips

I tried the generic brand and wasn't as effective as this (slightly pricier) ScarAway one. Also, get the thick ones.

After some research I ordered Scar Away scar strips. I wore these all day every day, and took them off only for showering and exercising. Each strip lasts about a 5 to 7 days – you can reuse them until the adhesive stops working and you can cut them up to fit the necessary shape. On days when I didn’t wear scar strips (like Sundays) I used the Scar Gel, or Mederma Cream with SPF.

Observations

Overall the scar strips seem very effective. The days when I wear them the scars seem less red and more flattened, especially after a week of wearing them vs a week of not wearing them. After intense exercise (like rock climbing) the scars will be very red and swollen, and wearing them for a day afterwards returns them to normal, compared to just putting on a cream or gel or doing nothing where it takes longer for them to subside.

The first package of strips has run out and I’ve ordered a second Scar Strips package, along with a silicone based scar gel which is slightly pricier but will probably last for a few months too. Silicone seems to be the one element that people agree on that promotes healthy healing. I’ve only used it for a week so I can’t say yet what the effects are.

As I mentioned above, there was a more than noticeable improvement in the nipple incisions, which were already raised and turning hypertrophic. Now they are small and thin and flat, as they originally were, which gives me some hope.

Wait and See

Now, scar treatments are a somewhat controversial topic. Everyone from lay people to doctors have a different opinion on their effectiveness at preventing and/or improving scars. My philosophy is: at worst, nothing better happens; at best, I get minimal to dramatic improvement, which is better than if I do nothing. I’m taking my chances.

The Rest

Wowza – I just browsed my previous pictures and I can immediately see a dramatic decrease in overall inflammation. It is generally advised that it takes 3 months for the swelling to go down and the shape of your chest to settle. This is absolutely true, and very noticeable if you go back and see the other pictures from one month post op (four months ago).

Sensation returned very quickly over the entire chest and nipples, except for areas right on top of the scars or the nipples which are very very slightly numb (I can feel pressure and touch but also get the “numbness” sensation).

On some mornings I feel a tearing pain on the scars (not unbearable, but a little painful). I’ve asked around and people with scars from other surgeries mention this is normal for a few years – after all it is still healing.

After rock climbing and yoga for 3 months I’m getting some muscle buildup, which thanks to the base contour is making my pecs shape up nicely. A lot of people have asked me what the difference is to get top surgery if you’re on T (Testosterone), and I’d say the biggest difference is the contour. Without T you don’t build up muscle as easily, so you are much more dependent on the contour the surgeon leaves you with, rather than having the option of dramatically changing the shape of your chest, either to correct for flatness and make it look more like pecs, or to give the chest a more natural look, or just to get really really buff. This isn’t to say you can’t achieve great musculature without T, but it’s much harder (and the amount that some trans guys build up is not an attainable, or desirable, alternative for me right now).

Also, I definitely get a weird and indescribable sense of something being missing there. This isn’t to say that I feel ghost appendages, rather it’s the idea that the muscles and tissue are still incomplete and disconnected, and working hard at regenerating to become whole with the rest once again.

Oh yes, and I don’t pass any more or any less than I did before the surgery. Kind of a bummer, because now there is officially not much more I can do to pass less often as “female.” But also hopefully inspiring to others, as it shows top surgery is not the end-all be-all for transmasculine folk, and actually might have little to do with passing overall.

A Happy Ending is Just a Happy Beginning

Other than that my chest is doing great. And I’m doing great with my chest!

Feel free to post any other questions you might have, or if you’d like more pictures or more information on anything.

38 responses to “Top Surgery Update: 5 Months Post-Op

  1. I didn’t end up with hypertrophic scarring for mine, but I will say, yours are not that bad, they are much thinner than mine. Though I had my incision line with the pectoral muscle and left the nipples off, so I have different results in general. But seriously your results are pretty good.

    • Thanks! I do think my results are great overall, and I was expecting nothing less from the surgeon. I also healed quite quickly, and was probably more cautious than necessary in the recovery process.

      It was just disappointing to have such clean and straight incision lines flair up for some obscure genetic reason I didn’t know about šŸ˜› Also since it happened after the two month mark I thought I was beyond the point for complications. I know in time, years and years and years, and with proper care, they will look faint and faded.

  2. Thank you for sharing this. It seems to me that this is both fairly rare, and something that will hopefully heal over time.

    Regarding other aspects of passing, probably the biggest thing you can do would be your voice. Have you tried training your voice to be in a lower range? That’s something that takes a lot of work and unfortunately sounds very silly at first (my therapist still has his old pre-passing voice on his voicemail message wihch is a bit shocking every time I have to call him for whatever reason) but everything I’ve heard from professional actors with voice-thrashing characters (Michael Dorn’s Lt. Worf, Harry Shearer’s Dr. Marvin Monroe) is that their voices eventually adapted to their frequent roles enough to change it permanently. Maybe trying to talk like a Klingon will help.

    • Hmm, lower my voice in Klingon? At least you didn’t suggest Na’vi…

      Yes, voice is certainly a give away, and I have a middle-to-highish pitched voice, but it can definitely go lower if I tried. However, as you said, it sounds really silly if I do try, and to me it sounds very fake.

      But it’s not the voice that bothers me. Usually people gender me before I’ve even had a chance to speak – the waitress at the restaurant, the cashier at the coffee shop (“what would you like ma’am”). Even the homeless guy on my block says “good night young lady” when I walk by! It could be my height (5’0’0’00), my voice, my non-angular face, my build, definitely not my chest anymore, or other random stuff??? The biggest clue I’ve gathered so far is context: if it is expected that there are young teenage boys in the vicinity, then I am a boy. Otherwise, in SF, I’m usually not.

      Alas, I still haven’t figured out what they latch on to to make that instantaneous decision.

      • Well, i didn’t say to speak Klingon, just to talk LIKE a Klingon. šŸ™‚

        Maybe dressing in a more overtly-masculine way would help to cancel out some of those factors. Also, my therapist would have some pretty good recommendations about what to do (including the possible use of hormones); he’s an FTM so he’d know which parts of transition are important for recognition, and he’s also had many FTN clients in the past who have wanted to go “right up to the edge” (as he puts it). I’ll email you with his contact info.

  3. Hypertrophic scarring sucks! I feel really sorry for you that your scars are like this. I have hypertrophic scars too (on my leg and on my back) and that’s also the reason for my why I don’t want to do top surgery in future and just keep binding. :/

    For my own scars, I have been treated with the cortisone injections. Yes they hurt, but I must say that I am really pleased with the results. Before the injections, I had a lot of ichyness, sometimes even pain in the scars, and it was always red and swollen. Now the ichyness and pain are gone, and the scar tissue itself is quite flat and also turned really lighter, so they aren’t as much noticable as they used to be.
    So personally I really recommend the cortisone injections. Even though they are painfull, it only hurts for the time they put in the injection (not any longer), and the results are really good.

    Other than that, I really like the outcome of your chest. It looks really nice!

    • It sucks you’ve already had so many surgeries, but at least you know what you’re getting into.

      Thanks, this is encouraging to know, and I’ll definitely look into it.

  4. I can’t claim to be an expert on hypetrophic scarring. I am however an esthetician, skin therpaist if you will. I am also an aromatherapist. While I was in school studying aromatherapy, I concocted a blend of essential oils that I hoped would sped up scar healing. I used grapeseed oil as a carrier (approx. 1 oz.). To this I added a mix of geranium, sandalwood, helycrisum and carrot seed. Total # of srops of essential oils should not exceed 30. Of these helycrisum is the most expensive. At the time I had a scar on my bicep that had been reddish and raised for a number of years (result of removing a birthmark). I massaged the blend into the scar for 5-10 min. every morning and night. After 6 months or so the scar had lost it’s reddish hue and had flattened out so that it is now almost smooth. The combination of the oils (all known to aid in healing) and the massage (to help break down the tougher collagen fibers of the scar) I believe are what directly lead to my results. Especially the massaging part. My scar is still noticeable, as parts of it are 1/4″ wide. But it is no longer raised or red. I hope this helps.

    • Thank you for the very detailed instructions! I know there is an organic corner store that sells homeopathic oils, etc, and I’ll see what I can find. So far I’ve had noticeable results with the silicone though – I’ve seen a considerable improvement since I started using the gel two weeks ago, and the non-hypertrophic parts are already light and fading fast.

      I’ve also heard that massaging is a big factor. While I try to do it, the scar strips make me lazy cause I just put them on and forget about it, which is why I alternate them with the silicone gel. I’ll try to be more conscious of massaging that area.

  5. Will now be surreptitiously examining my family’s scars, hmm…

    I’m sorry you have to deal with that and I hope the remedies you’re trying help over time. Even with the redness, though, I think you look pretty great šŸ™‚

  6. Thanks for sharing your experience with us. I definitely hope that the scar treatments work for you.

  7. Glad you’re pleased with the results overall! I agree, it does look good. And I do hope the scar treatments help.

    This is another factor to bear in mind in my wrestling over the idea of top surgery, actually, and I’m surprised it hadn’t occurred to me before. Glad to have seen this! I’m prone to hypertrophic scarring too, though I didn’t know what to call it before. (They’re not keloids, but they sure are prominent and I can get a lump from small nicks similar to keloiding but smaller. It does run in the family.) This is less of a cosmetic concern with my ACL incisions–plural, yes, on both knees šŸ˜ –but those surgeries did leave scars that have stayed reddish and raised like yours. That would probably be more of an aesthetic problem on the chest. But, then, so is what’s there now, in a different way. *wry smile*

    • Yes, keloids are slightly different, in that they extend far and beyond the scar area, and are much more unmanageable. Hypertrophic just means red and raised, and very slightly extended.

      I already wrote somewhere on the idea of having scars, and how with my personality this was a very huge detractor for me, but not big enough as what was there – as you say.

      If you do have a DI you’ll have scars either way, and those scars will never fade or be completely invisible. If they’re hypertrophic it just means they’ll be redder for a longer time, what with my impatience it seems important now, but it will be a non-issue in 5 years. And yes, a little raised and not as faded. But if you know beforehand you can take steps to improve and treat them. Moreover, almost nobody ever sees my bare chest, and those who would a) don’t care (people close to me) or b) wouldn’t notice (people far away from me).

      Honestly, top surgery has made such a big difference in my life and my self-image that even if you had told me before about the scarring it would not have influenced my decision at all.

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  16. There’s studies out there that prove vitamin E does nothing for scars, it can actually cause a negative reaction for some people by causing contact dermatitis

    • It did absolutely nothing for me – it’s probably a placebo effect where the oils keep the scars hydrated. Through my research I concluded that silicone is the only effective ingredient for treating scars.

  17. Hey there! I’m six or seven weeks post op, never had surgery before, and I have some pretty crazy hypertrophic scars, as well. I looked at your chest and was surprised that mine looks so similar! I’m just wondering how you’re doing now, and if you have anything to add after an extended period of time. If you could do it all again and only buy one or two products for your scars, what would they be?
    Also, just wondering from your experience, when did you find your swelling to be completely gone? I still have residual puffiness in the armpit areas. But I’ve also long since gone back to work and lifting, running, and a bit of climbing, so perhaps slower healing is to be expected.

    (Oh, have you heard the “theory” that 100% silicone lube is worth trying?)

    • I’m almost at the 2 year post-op mark (and will do a post with pictures next week). My scars are WAAAAY better. Check out the 1 year post op for a good comparison.

      The puffiness didn’t go away until about after 6-7 months. It’s hard to believe, because you feel normal, but the pictures tell the story.

      The two products I would recommend are the silicone strips and silicone gel. I still use the gel every other day or so. They are both expensive, but they last a long time ($99 for 2 tubes of gel, they last 6 months each) and are the only thing that improved my scars. I used the silicone strips all day for about 6 months, and just overnight for the next 6. Cutting the strips in half lengthwise and replacing each strip every week I used 1 strip per week.

      The third thing I would highly recommend is cortisone shots. They absolutely work. If you go to your general doctor, they might do it, or they might refer you to a dermatologist. My insurance covered them automatically. They don’t hurt, and they flatten the scars instantly. So far I’ve had 3 rounds.

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  19. Hi, thanks much for this helpful information. I am about two months away from top surgery and wondering about the healing process. You seemed to imply that starting exercise again may have exacerbated the scarring? I’m wondering when it will be safe for me to resume regular exercise (typically yoga, dog walking and lap swimming) after the surgery. Do you wish you had waited longer? What would you recommend RE: post surgery exercise? Thank you!

    • The surgeon insisted “6 weeks” for everything. I started light jogging after 4 (dog walking would be equivalent) and yoga at week 8. Some people get back to full workouts after 4 weeks. Personally I wouldn’t recommend any upper body work until at least 6, better 8 or even 10 weeks post op. Above all, listen to your body.

      Also, you can’t swim for at least 6 months I think – no soaking the scars, as well as no sun / tanning on the scars for 1 year.

      • Thanks for the advice. I’ll probably feel pretty antsy after a couple weeks, but I’ll just have to tell myself that it’s all for the best in the long run.

        • It really does depend on your doctor, which goes to show some of these instructions you shouldn’t take too literally since they’re made up anyway šŸ˜›

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  21. Gel strips were recommended by my surgeon and so was the Dr Max Powers Scar Serum. Teh Strips did NOT work, but the Dr Max Serum did work. The scar does look better, and I could see a difference when I would remove the gel strip. Also, I would feel a faint stinging when it was on, which I felt meant it was doing its magic.

    IMPORTANT TO KNOW – you should use the serum TWICE per day. I saw a big difference when i used the dr max serum TWICE per day, not once per day.

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  24. Your chest looks awesome. I was just wondering, what was the starting point? I’m considering mastectomy myself, but I have pretty large breasts and it’s difficult to imagine what the outcome would look like.

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