Chest Reconstruction Top Surgery Nipple Graft After Care

There is some variation to how surgeons prescribe dressing changes and care for the nipple graft after double incision chest reconstruction top surgery. However, the milestones for tissue recovery are about the same for healing, and therefore the instructions that are laid out here should be reasonably consistent regardless of the doctor who performs the surgery.

Within the first 7 days after surgery, there are dressings in place over the nipple graft called bolster dressings (which usually look something like a yellow cauliflower on each side of the chest). The bolsters serve to compress the graft against the patients’ tissue so that the grafts are more likely to survive.

Double incision nipple graft bolster still in place

Your surgeon  will remove the bolster at your follow-up visit about 7 days after surgery, after which time the patients should use a nonstick gauze (The Gender Confirmation Center provides a 7 day supply of a nonstick material called Adaptec) and then this is covered with a typical nonstick bandage such as a large Band-Aid. This should be changed once or twice daily, per your surgeon’s recommendation.

At day 14, the Adaptec is no longer necessary, but the Band-Aid type dressing is still applied, and is changed daily for 1 more week. Around day 10 to 14, you will see a thicker crusting that is initially present on the grafts but then flakes off. This is not the graft dying, but rather the outer layer of thickened skin flaking away. Beneath this there should be relatively healthy nipple graft tissue, surviving and thriving.

At 21 days, the grafts are very resilient. It is very uncommon for there to be problems after this period. However, you should not submerge the grafts in water for any length of time, such as swimming in the pool or taking a bath, until about 6 weeks after surgery.

Nipple and areola sensation should gradually improve over time in the weeks to months following surgery. Sometimes sensation after surgery is heightened and sometimes it is decreased, but it usually is fairly stable by 3 to 4 months after surgery and will continue to change and improve for approximately 2 years after surgery. That said, patients who undergo the nerve reconstruction top surgery, also known as a double incision with neurotization, can expect to recover heightened levels of sensitivity in the nipples by around 3 months post-op. It may take some patients longer for this to start happening. In the initial stages of nerve healing, it is normal for patients to experience uncomfortable sensations, like itchiness and tingling.

How should I care for my nipple grafts?

One of the most important things in early graft survival is to reduce the incidence of a “shear” force. A shear force is a sideways force across the surface of the graft, like if you were to inadvertently rub your hand firmly across the surface of the graft. This can be especially problematic in the first 14 days after surgery, but it’s unlikely to cause any problems beyond 21 days after surgery. There are some changes that happen in the nipple graft even in the weeks to months following surgery. These changes can be a thickening of the graft or sometimes a thickening of the circular scar around the graft, or sometimes there are grafts which have temporarily lost their pigmentation, which will usually be regained over a period of months.