Female-to-male (FTM) chest wall reconstruction, or “top surgery,” is a gender-affirming procedure which involves removal of breast tissue and excess skin as well as repositioning and reshaping of the nipple-areolar complex (NAC). A variety of surgical techniques for transgender FTM chest surgery has been described. One well-described approach is the double incision mastectomy with free nipple grafts. The nipple-areolar complex is harvested as a full thickness skin graft. It can then be resized and repositioned to conform to a more masculine aesthetic. As there is little documentation regarding the healing process of free nipple grafts, it is common for patients to have many questions and concerns about “normal” postoperative recovery.
At the time of surgery, the original NAC is marked with a 25mm (approximately 1 inch) sizer and removed like a full thickness skin graft. It is then sewn into a new position, slightly lateral to the mid-chest along the inferior edge of the pectoralis muscle. The nipple graft is then fixed into place with a “tie-over” bolster dressing made of moist bacteriostatic gauze. This dressing prevents sliding or shearing of the nipple graft as well as prevents collection of blood or fluid under the graft. The bolster is left in place for 6-7 days, then removed in clinic. At this point, the nipple graft looks gray-brown but should have attached. Over the next 2 weeks, the top layer of the nipple graft will gradually peel off, leaving pink healthy nipple tissue underneath. Pigmentation to a typical brown color will occur over the next 1 year.
The following collage is photo-documentation of the typical healing process of free nipple grafts:
Day 7: The bolster is removed in clinic and the NAC looks gray-brown but is checked to confirm it is attached and that there is no infection.
Day 11: The top surface layer is beginning to peel or slough off. This is an expected part of the healing process. Healthy pink tissue can be seen underneath.
Day 13: The sloughing process continues.
Day 15: At least half of the top layer of epidermal tissue has exfoliated off.
Day 17: Most of the top layer has come off. The new pink nipple-areolar complex is seen underneath.
Day 18: The process continues.
Day 20: All of the top epidermal layer has come off; the new NAC is smaller and flatter, and will have permanent changes in sensation.
3-Months: The nipple graft is still pink but pigmentation is beginning to be seen as the cells that make melanin return over the next 3-6 months. Pigmentation can continue to be seen for up to 2 years after surgery.
This scientific research article was published on 4/26/20 in Sage Journals by The American Journal of Cosmetic Surgery by Alvina Won, M.D. and E. Antonio Mangabut, M.D., titled “Free Nipple Grafts: What to Expect During the Healing Process.”
Dr. Alvina Won, Board Certified Cosmetic Surgeon
During your free consultation with Dr. Won, she will go over with you what will be required to get the desired results that you are looking for and advise you what to expect during the recovery process.
Dr. Won is passionate about creating personalized care for each of her patients. She strives to understand your vision and goals for your body, and offers her services and guidance to achieve exactly what you are looking for. She believes that self-confidence is one of the key foundations for living your best life and offers high-quality care, both in surgery and during the recovery process to achieve the best results possible.
It’s natural to be a little anxious before undergoing any type of procedure, however Dr. Won can answer all of your questions and give you an idea of what to expect in order to put your mind at ease. You will be able to realize immediate results after your surgery and your confidence will certainly be boosted, so we hope you are as excited as we are to see the new and improved you!
Dr. Won is an experienced, Board-Certified surgeon. She is also a Fellowship trained cosmetic surgeon through the American Academy of Cosmetic Surgery, having completed hundreds of procedures. Her experience and passion for what she does ensures that you can feel confident by choosing her for your cosmetic surgery needs.
Are you a Candidate for Cosmetic Surgery?
Not everyone is a candidate for cosmetic surgery. If you are in the process of losing weight, it is best to wait until you have reached your goal weight before undergoing any kind of cosmetic procedure. Additionally, if you are still planning on having children, it is best to wait until you have had your child and recovered from the pregnancy. The reason for this is because weight fluctuations can affect the long-lasting benefits that are gained from having cosmetic surgery. Additionally, if you are currently a smoker, you will need to stop completely prior to undergoing any type of procedures since smoking can affect both the healing process and the results gained from a procedure. Also, it is important that you have a positive attitude and a realistic outlook about what surgery can do for you. An unhealthy lifestyle and poor overall health and fitness can wreak havoc on your appearance.
Dr. Won is Now Offering Free “Virtual” Consultations
The safety of our patients is of utmost importance. To limit your exposure and keep you safe, Dr. Won is now offering her Free Consultation appointment via Telemedicine! In your Consultation, Dr. Won will provide you with all of the information that you need about your options and what procedures would be best for what you want to accomplish. She’ll explain exactly what is involved and give you a price quote.
In accordance with the recommendations from the Centers for Disease Control, Dr. Won is still available for a free, no-obligation consultation. You will be able to see her, face to face, through your computer or tablet, and receive her expertise, get your questions answered, and learn more about any procedure that you may be interested in having!
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