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Top Surgery Recovery Timeline: Everything You Need to Heal

Medically reviewed by Paul Gonzales on March 18, 2024.

Welcome to our page on recovering from top surgery, also called “FTM top surgery,” non-binary top surgery, chest reconstruction and/or breast reduction top surgery. Here, we discuss the recovery timeline, tips for maximizing your results, things you should look out for during recovery and other frequently asked questions from our patients. To ensure the integrity of your results, it is important that your procedure is performed by a board-certified plastic surgeon with hospital privileges and experience with the type of surgery you will undergo.

Top surgery recovery changes from patient to patient depending on the incision type and whether or not you undergo any additional procedures. Still, the recovery timeline information below applies to all patients. Most patients, regardless of incision type, will need to follow some form of scar care protocol. That said, only patients that have a significant amount of tissue removed and/or undergo chest liposuction should expect to wear surgical drains for the first week post-op. Likewise, patients that opt to have their nipples grafted to have them resized and repositioned on their chest need to follow specific nipple graft care instructions.

How long is recovery from top surgery?

Healing from top surgery takes about 6 weeks before patients can return to full physical activity. The first 3 weeks post-op, which is the height of the recovery process, is where patients face the most restrictions, require plenty of rest, and experience the most discomfort and swelling. That said, most patients can expect to return to work 1-2 weeks after surgery with some limitations.

What can I do before surgery to maximize my healing? 

Generally speaking, the rapidness of your healing process has more to do with factors like your overall health, the intensity of the surgical procedure and your genetics than factors like age or BMI alone. That said, there are several things you can do before your operation to optimize your results and ease the recovery process:

• Smoking and edibles: Smoking can reduce blood flow and cause wound healing issues, especially for those with nipple graft procedures. We require all our patients to stop smoking or consuming any form of nicotine (e.g. vape, gum, patch, etc) 21 days before and after surgery. Edibles should be avoided at least 24 hours before surgery to minimize potential interactions with anesthesia on the day of surgery.

• Drinking alcohol: Alcohol can dilate the blood vessels and could increase the risk of postoperative bleeding. Don’t drink until you are taking prescription pain pills since the combination of alcohol and narcotic pain medications can be dangerous. Do not drink alcohol until 1 week after surgery.

• Exercising beforehand: Exercise helps to optimize overall health. If having contoured pectoral muscles is important to you, working out to develop these muscles before surgery may help your surgeon place the incisions near the muscle border, but this is not required. Learn more about a muscle border incision here.

• Letter to employer: Taking time off work to rest will be essential for your surgical recovery. Generally speaking, your employer is required to grant you an adequate amount of time off for both surgery and recovery. As soon as you have a surgery date scheduled, inform your employer about taking medical leave and your surgeon can provide medical documentation to support your leave due to activity restrictions. The doctor’s note will not include any information regarding your procedure but may include the type of activity you are not allowed to do. You are also not required to tell your employer the reason for your medical leave.

• Organizing a support system: We recommend patients have physical support available while activity restrictions are in place within the first 3 weeks after surgery. During this time patients are limited to carrying or lifting no more than 5 lbs which or lifting their arms above shoulder level. This means you may need help carrying things, opening doors, or changing your clothes. Some patients may experience signs of depression after that may require emotional support. Learn more about post-op depression here.
• For more tips on speeding up the recovery process, click here.

What is the first week of recovery like?

• • Leaving the hospital: Most top surgery procedures are out-patient, meaning you will leave the hospital or surgery center the same day as your operation. Top surgery can take at least 1-2 hours, but may be longer if you undergo an additional procedure like body contouring simultaneously. Patients with certain medical conditions may have their procedure performed at a hospital and may require an overnight stay for monitoring before getting discharged.
  • Sleeping: Patients should try to rest as much as possible within the first week after surgery. We recommend patients sleep on their back with their head and upper chest slightly elevated (at least 2-3 pillow height) to reduce the swelling and avoid any pressure on the chest.
  • Pain: Perception of pain varies between individuals after top surgery and can range from mild discomfort to pain that requires management with prescribed medications. Stronger pain medications will generally be prescribed but some may only need over-the-counter pain medications. Medications are taken on an as-needed-basis to manage pain within the first 1-2 weeks after surgery. Consult your doctor about which over-the-counter medications can be taken.
  • Swelling: A compression binder will be placed over your chest with dressings over the incisions and nipples. It’s important for compression to be applied 24/7; it should feel snug but not too tight. You can readjust the compression binder if needed, but should be minimized to avoid excessive contact. After the dressings are removed at the first-op appointment, we recommend that compression is applied for another week to minimize swelling (for a total of 2 weeks after surgery). Ice packs or warm compress may be helpful within the first 72 hours after surgery but are not required. Do not apply preassure directly on the incisions or nipples. We also suggest that you check the temperature on the back of your hand before placing ice or a heat pack on your skin to avoid any inadvertent injury.
  • Drains and dressings: Dressings should not be removed until instructed to do so. Generally, drains are placed in the chest after top surgery to prevent any fluid buildup (i.e. seroma) when liposuction is conducted and/or larger amounts of tissues are removed. Patients can opt out of drains but this may increase the risk of surgical complications that may require more procedures to manage. If fluid output is minimal at the 1-week post-op appointment, the drains can be removed. A member of our clinical staff will show you how to track fluid output and how to empty your drains before going home. Learn more about the drains here.
  • Showering or bathing: Patients are not allowed to shower until drains and surgical dressings are removed at the first post-op appointment (about 6-7 days after surgery).  We recommend washing yourself with wipes or a sponge bath during this time. Submerging the chest underwater should also be avoided at least 3 weeks after surgery.
  • Diet: Some surgeons recommend that patients go on a low-sodium diet to reduce swelling for the first 2 weeks after surgery. Additionally, staying hydrated with water or electrolyte drinks is essential to heal properly.
  • Activity: Avoid any strenuous physical activities or lifting anything more than 5lbs (about the weight of a gallon of milk), and minimize the use of stairs within the first 3 weeks after surgery. We encourage patients to take light, daily walks to avoid the formation of blood clots.

• Driving: Do not drive or operate any vehicles while on prescription pain meds or if the mobility of the arms and shoulder is still limited, which can limit the ability to operate or steer the vehicle.

When and how long do I need to stop drinking and smoking?

We require patients to avoid smoking or consuming any form of nicotine 21 days before and 21 days after surgery. Cannabis in the form of edibles should be stopped 24 hours before surgery and drinking alcohol is prohibited until 1 week after surgery.

Warning Signs: When should I call for help?

VERY IMPORTANT: If you experience the following, find the nearest emergency room and call your surgeon.

• Chest pain
• Shortness of breath
• Excessive bleeding or pain
• Pain on the calf or leg, accompanied by any redness or swelling in the area

Other signs or symptoms that should warrant a call to your surgeon:

• Fever
• Moderate to severe pain uncontrolled with pain medications
• Any bleeding, swelling, bruising, or redness of the skin that was not present previously

FOR GCC PATIENTS, CALL (415) 780-1515 TO SPEAK WITH THE CLINICAL TEAM.

How much time should I take off after top surgery?

After surgery, most patients usually feel physically capable of going back to work or school routine within 2 to 3 weeks. However, patients whose work involves heavy lifting may need to wait at least 3 to 6 weeks after surgery before they are able to perform their job duties. While this much time off may not be ideal for financial reasons, most patients can go back to work with physical restrictions.

Depending on local laws, most employers are obligated to make accommodations for employees with medical restrictions. This includes assigning alternative responsibilities and providing necessary accommodations to ensure their ability to work during their recovery period.

Your surgeon can provide documentation to request these accommodations or time off from your employer.

To maintain confidentiality, our letters will not state the name of the practice or specify the type of procedure perfomerd. Only the surgeon’s name and contact information will be present on the letterhead as well as medical restrictions and their expected duration. We recommend that you inform your employer of your planned medical leave at least a month before taking time off or as soon as you have a surgery date scheduled. Make sure to include any travel time before and after surgery when you request time off, if applicable.

When can I lift my arms after top surgery?

Some of the most common questions we get about the top surgery recovery timeline are about the limitations on arm movements and pain in the upper body post-op. Generally speaking, we recommend patients to avoid raising their arms above the level of the shoulders for the first three weeks after surgery. Doing so may create unwanted tension on the incisions that could affect your healing and the appearance of scars.

After the third week of recovery, it is common for surgeons to provide individualized instructions based on their own experiences and the specific needs of each patient. Oftentimes, there is a need to balance between maintaining good shoulder mobility and minimizing the appearance of scars. Given the variety of perspectives between providers on this matter, we convened with physical therapy experts to create a free physical rehab resource for patients post-top surgery.

When can I take up exercising again?

Below is a rough timeline of physical activities that can be performed after surgery:

• First 3 weeks after surgery: We recommend taking short walks (<15 minutes) but refrain from engaging in physical activities that could increase heart rate (i.e. long walks, running, sexual intercourse, etc). Do not lift anything heavier than 5 lbs (about the weight of a half gallon of milk). Be mindful of opening things that may require effort (i.e. front doors, car doors, refrigerator doors)
• 3 weeks after surgery:  Physical activities mentioned above may be gradually resumed but do not lift anything over 25 lbs or perform weight-bearing exercises, especially on the upper body.
• 6 weeks after surgery: Most patients can resume normal activities and exercise routines, including weight-bearing exercises.

You can read more about physical limitations during recovery here.

How should I take care of my incisions and scars?

• Incision care: After the first post-op appointment, dressings and ointments will need to be changed and applied daily to minimize infection on the incisions or nipple grafts while they heal.

• Scar care: Once incisions are healed and closed, scar formation begins. Scars can take up 12 months to fully mature. During this time, we recommend patients keep them out of the sun or protected by sunscreen. For more information on top surgery scars, click here.

Will I regain sensation after top surgery? 

Sensation after top surgery will vary between individuals and also depends on the type of top surgery performed. Procedures that do not involve removing the nipples (i.e., keyhole, periareolar, nipple-sparing double incision) generally have the best chances of maintaining sensation after top surgery. Double incision procedures that involve nipple skin grafts or removal of a large amount of tissue may retain regular tactile sensation (i.e. pressure sensation) but may limit the amount of erotic sensation.

If erotic sensation is important, procedures like the inverted T or butthonhole can help preserve this by leaving some tissue behind. Newer techniques such as the nerve preservation double incision employ peripheral nerve techniques to maintain sensation on the chest and nipples while achieving the flattest chest appearance.

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.

For more information on sensation recovery, click here.

How can I care for my nipple grafts? 

Nipple grafts can look and heal differently between individuals but the most important thing is to follow your surgeon’s instructions on how to care for them. This usually involves daily dressing changes and applying an ointment to make sure they are moisturized and do not get infected. It is normal for scabs to form and then come off after a few weeks. When scabs fall off, it can appear as if the nipple is lost or “fallen off”, but usually a new layer of skin has formed underneath. For more information on caring for your nipple grafts, click here.

In the video below, Dr. Facque (he/him) explains how you can take care of your nipple grafts after surgery:

Is top surgery painful?

Top surgery is performed under general anesthesia so patients do not experience pain during the procedure. After waking up from surgery, any pain or discomfort will be minimal due to the anesthesia’s effects. These effects can start to wear off within a couple hours of waking up and patients can take pain medications before then. Most patients stop taking pain medications 1-2 weeks after their surgery. Please notify your surgeon if you have persistent pain past 3-6 weeks from surgery.

What complications might come up?

Complications are rare but patients should regularly follow-up with their surgeon to monitor healing after surgery. Early complications can include a collection of fluid (seroma) or blood (hematoma) under the chest, infection, poor wound healing, or loss of nipple graft(s). Patients with hematomas may need to go back to the OR to remove the blood to avoid further complications. Later complications can affect the contour of the chest (such as dog ears) or the appearance of scars or nipples and are usually managed with revision surgeries.

When will I see my final results from top surgery?

The final results of your chest reconstruction top surgery can take at least 6 months to 1 year to become visible and will vary between each patient and how they heal. The final contour of the chest is dependent on when swelling subsides (at least 6 months).  Techniques with larger incisions to remove tissue may result in more swelling. In addition, pigmentation of scars and nipple grafts may take up to one year to show final results.

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Can I get any other surgeries simultaneously?

• Body contouring: It is common to combine top surgery with liposuction or other body contouring procedures like fat grafting or skin excision. You can read more about body contouring here.
• Bottom and facial surgery: These procedures can have more difficult recovery processes so we advise patients to carefully consider their options before deciding to undergo these procedures at the same time as top surgery.

When can I tattoo my chest after top surgery?

Aside from decorative purposes, many patients wish to tattoo their chest after top surgery to conceal their scars or correct nipple graft pigmentation. Some who opt to remove their nipples completely may also decide to have them tattooed instead to control nipple placement and minimize any uncertainty in the appearance of nipple grafts once they are healed.

We recommend waiting at least 3 months after surgery before tattooing any area of the chest where surgery was not performed, and at least 12 months before tattooing over scars or nipple grafts. You can read more about medical tattooing such as scar camouflaging and nipple restoration tattoos here. We have compiled a list of trusted, gender-competent tattoo artists who have worked successfully with GCC patients here.