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Preparing for Chest Reconstruction Top Surgery

This article provides a basic guideline for getting physically, emotionally, and mentally ready for your chest reconstruction or breast reduction top surgery–formerly referred to as FTM or FTN (non-binary) top surgery. We discuss our suggested diet and exercise as well as emotional support you might need during your top surgery recovery. We also cover some recommendations for quitting smoking, alcohol, and drugs that can help you set yourself up for success.

Request a free surgical consultation

At the Gender Confirmation Center (GCC), we offer free virtual and in-person consultations to our patients. Offering consultations free of charge allows us to maintain our promise of keeping medically necessary gender-affirming surgery accessible to the community we serve. Once patients have scheduled a consultation, our patient care team can help you fulfill requirements to undergo surgery; for example, we can assist you with getting a therapist support letter or a referral letter from your primary care provider. For more information on the surgical consultation process, click here. In the video below, Dr. Jacobs (he/him) gives advice on how you can make the most out of your surgical consultation:

Getting Physically Healthy Before Chest Reconstruction Top Surgery

Maintaining a balanced diet and engaging in consistent exercise are some of the keys to a healthy lifestyle. Being healthy means something different for everyone. These are general guidelines, but it is best to work with your care team and surgeon to determine what is best for you.

The Gender Confirmation Center does not have a weight or BMI cutoff for folks who are considering gender-affirming surgery, and it’s best to be at your healthiest prior to any surgery. Here are a couple ways our patients have been able to maintain a healthy lifestyle before and after surgery:

• Avoid Fad Diets: A ‘fad diet’ is a term that promises quick weight loss (usually through an unbalanced or unhealthy diet). An unbalanced diet means you’re usually cutting out one food group (or multiple), which means you could be losing out on important vitamins. A lot of these fad diets claim that you’re losing fat, but most likely you’re really losing water weight. Losing weight quickly may be appealing but can be dangerous for a number of reasons.
• A Balanced Diet: Focus on eating whole foods, vegetables, and fruit. If you’re currently using government assistance for food, you might want to look into your local farmers’ market. A lot of farmers’ markets have a service where you can use your EBT debit card in exchange for coins you can use at the vendors’ booths to buy food. An incentive for you would be that they double your money; if you withdraw $10, they’ll give you $20 worth of coins. A healthy diet that is balanced with vegetables, carbohydrates, and protein is the best place to start.
• Personal Trainer: Finding a trans friendly or trans-identified personal trainer can be a great motivator. If finances are a challenge, you can ask the personal trainer if they offer a sliding scale. Sometimes attending just one session is enough to gain some confidence in different exercises you can do on your own. If you don’t have these resources in your area, there are people who offer the same services online instead of in person. There are also hundreds of online videos you can follow along with. If you’re local to the Bay Area, previous patients of ours have used a personal trainer named Ace Morgan, who owns ‘Ace Morgan Fitness’.
• Workout Friend: Find a workout buddy! Transgender and nonbinary Facebook pages are a great place to start. If you feel too vulnerable posting first, try searching the group for keywords to see if anyone has made a similar post. Local trans meetups and support groups are a great way to connect with the community and can be mutually beneficial if someone is in the same boat as you. If you’re more of an introvert and all of this sounds overwhelming, sometimes a secluded walking path in nature is a great way to find some peace as well as exercise.
• Chest Exercises: For those who want more defined pectoral muscles after surgery, chest exercises can be helpful.
• Vitamins:  Vitamins help your body heal, which is especially useful when recovering after surgery. Although some folks load up on micronutrients or natural supplements that are supposed to help with healing before top surgery, this isn’t necessary if you’re currently eating a balanced diet. It’s important to note that you have to limit your Vitamin E intake 7-10 days before your top surgery.

Emotional Help & Support Post Chest Reconstruction Top Surgery

We have a lot of information on our site regarding what to expect emotionally after surgery, which can be found here. Here we’ll go over briefly how to set yourself up for success before top surgery and the level of support that may be most beneficial to you post-op.

• Assistance for the first 24 hours post-op: With any surgery during which you are put under anesthesia, you need to have someone pick you up and stay with you for the first 24 hours.
• Assistance for the first week post-op: The reality of being post-op is that you’ll want someone around for at least the first couple of days, if not up to 7 days after surgery. This is not to say that you will need their assistance 24 hours a day (except for the first 24 hours after surgery), but company throughout the week can go a long way in recovery. If you have a support network, reach out and let them know what you need. If you don’t have a support network, we have some resources on finding support groups at the bottom of this article.

Quitting Recreational Drugs Before Chest Reconstruction Top Surgery

We ask our patients to stop using certain drugs before surgery to prevent negative impacts to healing. Nicotine is especially important to stop before surgery, and we will discuss other drug use as well.  We’ve already created content on the logistics of quitting smoking and how it’s harmful to your surgical outcome that can be found here.

Quitting Nicotine and Tabacco Before Surgery

• All nicotine use must be discontinued 3 weeks before and 3 weeks after top surgery
  • No smoking, no patches, no vaping
• While different surgeons have different policies about the use of medical marijuana, we ask our patients to switch to edibles for the 3 weeks before and after surgery to eliminate any smoking during this time.
• If you’re a nicotine user, you can learn more about quitting before surgery here

Quitting Alcohol Before Top Surgery

• You must stop alcohol one week prior to surgery
• You cannot drink alcohol until 7 days after your surgery

Quitting Other Drugs Before Top Surgery

The following drugs have to be stopped 3 weeks before and 3 weeks after your surgery. If you’re wanting to use some of these drugs for pain management, stick to the prescriptions your surgeon supplies you with. Some of the drugs listed below can be prescribed by your doctor but have been flagged as drugs that are often abused, which is why we are listing them.

If you’re being prescribed any of the drugs listed below by your doctor, talk to your surgeon and primary care physician about how they will affect you before, during, and after surgery. Additionally, always disclose the drugs you are currently using (whether prescribed or un-prescribed) to your surgeon or other medical healthcare professionals who ask for your drug use history.

• LSD & Psychedelics
• Meth
• MDMA (ecstasy & molly)
• Cocaine
• Ketamine
• Oxymorphone
• DMT
• Carisoprodol (Soma)
• Lorazepam (Ativan)
• Morphine
• Buprenorphine
• Heroin
• Zolpidem (Ambien)
• Diazepam (Valium)
• Clonazepam (Klonopin)
• Methylphenidate (Ritalin)
• Methadone
• Tramadol
• Alprazolam (Xanax)
• Oxycodone (OxyContin)
• Amphetamine (Adderall)

If you’re struggling with substance abuse and are looking for support, you can contact the national help hotline SAMHSA (Substance Abuse and Mental Health Services Administration) at 1-800-662-HELP (4357). They are available 24/7 365.

How does diabetes effect my eligibility for top surgery?

In the clip below, Dr. Facque (he/him) talks about how having diabetes might affect someone’s eligibility for top surgery. Generally speaking, high levels of blood sugar are associated with a higher risk of infection or delayed wound healing after surgery.

How does a previous stroke affect my eligibility for top surgery?

In the following informational video, Dr. Facque answers the question: how does a previous stroke affect someone’s eligibility for top surgery?