The Ultimate Guide to Preparing for Top Surgery

Top Surgery 101
Written By Raf de Leoz

This latest installment in my Top Surgery 101 series will be a fairly comprehensive guide to preparing for Top Surgery, however, you should refer to your surgeon’s instructions and follow them as much as possible. If you have questions, reach out to your surgeon first.

I am not a doctor and am not making any concrete claims or guarantees. My goal is to simply compile the different information shared across various sources and supplement that information with my own personal experience, as well as the experiences of people that I personally know and have supported through their own top surgery journeys.

This guide is broken down into four main categories: Work and/or School, Medication and Medical Supplies, Health, Nutrition and Hygiene, and Home.

Work and/or School

This section covers the logistical and financial arrangements you should consider as you prepare for your surgery.

Tip #1: INFORM THEM

If you are working, studying, or both, you will need to inform the appropriate points of contact that you will require some accommodations during your recovery. This would most likely involve time off from work and adjustments for school requirements.

TIP #2: Medical Information is still PRIVATE information

You DO NOT need to tell your employer or instructors that you are getting top surgery. Of course, laws and rights vary from country to country so you may have to double-check what your rights are in your area, but don’t feel compelled to disclose if you don’t feel safe to do so or simply do not want to disclose that personal information.

For more specific legal reasons, such as for arranging insurance, you may need to give specific details about your surgery. Otherwise, there is no real reason for everyone at work or school to know about your surgery if you don’t want them to know.

If you do want to give some context without giving away too much information, you can say that you’ll be under general anesthesia and will have limited upper body mobility (such as not being able to raise your arms above your head) and will not be able to lift anything over a certain weight for a month.

TIP #3: Develop a plan for returning to work/school

On top of taking time off for your surgery and your recovery, you may also have to coordinate with work or school on what accommodations you would need so that your return can go as smoothly as possible. What that looks like will vary depending on the specifics of your situation. For some people, this might mean taking on lighter, less physical duties during your first week or two back at work.

Tip #4: Recovery Timelines vary but the more physically demanding your routine is, the longer you will need to ease back into it

The amount of time you’ll need to take off of work or school will largely depend on the nature of your duties and responsibilities. It is important to take into consideration any other preexisting health or medical concerns an individual may have that may increase the recovery time needed. Personally, I was able to work out and lift weights a month after my surgery, while other people I know couldn’t until two months later. Still, other people hold off for a few more months before going back to the gym since there is a risk of your scars stretching.

A general rule of thumb would be that the more physical your day-to-day routine is, the more time you’ll need to ease back into it.

I work a desk job in front of my computer at home so I only took a week and a half off from work but I was already starting to hang around at my desk a few days after surgery. More physical jobs that involve a lot of reaching, heavy lifting, and constant movement will need 4-8 weeks or more recovery time before returning to work.

TIP #5: Financially Prepare Yourself

How you approach your finances in the time leading up to surgery and after surgery will look different depending on your situation and your location. Where I live in Canada, top surgery was covered under the healthcare system here, but other expenses I accumulated before and after were out of pocket.

Consider looking into any benefits, income assistance due to medical leave, or short-term disability insurance you can use to help cover your expenses while you’re recovering and unable to work. If it’s possible in your situation, you can also try to save up some money to cover rent and other bills.

MEDICATION AND MEDICAL SUPPLIES

Your surgeon will prescribe painkillers and antibiotics for you to take and will also provide their own guidelines and recommendations for any other over-the-counter medications to supplement your recovery. Prioritize your surgeon’s instructions and check in with them first.

The suggestions I’m going to be making are things that helped with my recovery. The information I’m sharing is sourced from the websites of different surgeons that I have linked in the references section of this post.

In no particular order, these are the supplies you can stock up on as you prepare for surgery:

  • Tylenol, Advil, or whatever medication your surgeon recommends for pain management

    • Some surgeons advise against one or the other, listen to their advice

    • My surgeon prescribed a strong medication for pain relief but advised against using it unless the pain was severe and the over-the-counter painkillers weren’t enough. His instructions for me (and other patients he’s treated) were to take Tylenol and Advil together. That was enough for the first few days of my own recovery.

  • Lozenges

    • There is a possibility that your throat will feel dry and raw after the operation due to being intubated. Lozenges can help soothe that.

  • Vaseline or polysporin

    • Not particularly necessary if you aren’t opting for nipple grafts

    • The main purpose for having this on hand is to apply them to your grafts and lessen the chances of them drying out and failing

  • Tums, Maalox, or similar products

    • If you’re prone to acid reflux or have a sensitive stomach, these could be helpful in easing that

    • My acid reflux was especially bad when I had to lie on my back throughout the first week or so of my recovery

  • Gravol or Ginger

    • You’re likely to feel nauseous after surgery. Your surgeon may prescribe medication for nausea or you may have to get something over the counter.

  • Antihistamines

    • Benadryl or anything similar will be helpful for itchiness during your recovery. This is likely to happen as your skin will likely be irritated from the bandages or binder, or as your scars start to heal

  • Over the counter stool softeners

    • You may feel bloated and constipated after surgery. It helps to have stool softeners on hand in case the bloating doesn’t improve for a few days and you still haven’t had any bowel movements.

  • Bandages with a nonstick padding

    • If you are opting to have nipple grafts as part of your procedure, it would be ideal to find bandaids that are around 3”x3” or as big as you can find. These will be used to cover up your nipple grafts after the first dressing change (along with vaseline or polysporin) to prevent the nipple grafts from drying out.

  • Gauze and Medical Tape

    • I didn’t personally need to use these, but it’s good to have them in stock if you need to reinforce your dressings or if you don’t have large bandaids

  • Post-Op Compression Vest/Compression Binder or alternatives

    • Your surgeon will most likely provide you with one or sell you one, but it does help to have a secondary binder to switch to when one is being washed

    • Instructions vary between surgeons on how long you’re supposed to be wearing the compression binder. In my case, I had to wear it for about a month (24/7, aside from showering)

    • Ace or tensor bandages were a helpful alternative for me when my binders were either deteriorating or causing too much skin irritation

    • I also customized one of my old half binders by cutting it up and stitching strips of velcro onto the straps and sides to form a makeshift binder-vest

In the time leading up to your surgery date, make sure that your surgeon’s contact information is visible and accessible to yourself and to whoever will be part of your recovery team. Make sure you and your loved ones will know who to contact or what to do in case of any emergencies.

Health, Nutrition and Hygeine

This section will cover different ways you can physically prepare your body for surgery and optimize your healing, results, and overall comfort throughout your recovery. None of these are hard and fast rules, so don’t feel pressured to completely change your lifestyle if none of these are a priority to you or simply don’t fit within your day-to-day life.

Tip #1: Hydrate

If there’s anything in this section that should be prioritized, it would be this tip. Staying hydrated, drinking more water, and listening to your body when it needs more water are crucial in helping with your healing and recovery.

Tip #2: Meal plan and stock up on groceries

You don’t have to plan every single meal or blow hundreds of dollars on groceries, but it does help to stock up before your surgery. Keep in mind that you’ll have limited mobility in the first month and will very likely need help with preparing food over the course of your first week.

TIP #3: Consider shaving your chest and armpits

Doing this would help avoid body hair sticking to bandages and chafing against your skin. Some surgeons advise against this and some surgeons recommend it, so check in with them first. In my case, my surgeon suggests it but doesn’t require it.

TIP #4: Get a fresh haircut

If haircuts are typically affirming for you or contribute to your mental health, arrange to get a haircut in the days before surgery. It might help you feel fresh and presentable when dealing with the physical discomfort of the first couple of weeks post-op.

TIP #5: Try to eat healthier

This is something I’m still struggling with, but I can’t deny the benefits. You don’t have to completely change your eating habits or go down the rabbit hole of trending diets. Simply opting for more fruits and vegetables in your meals here and there or switching up your snack choices will help towards getting your body into a good place before surgery.

TIP #6: Stock up on Protein

Because protein is a big part of cell and tissue growth, it supports your immune system, strengthens your muscles, and boosts your healing. With that in mind, your recovery will benefit from consuming more protein before and after surgery.

While meat is a good source of protein, it’s not the only one. I recommend researching what foods are high in protein that coincide with any dietary restrictions you may have, and adding them to your diet.

Below are some examples of high-protein foods that you may want to consider having post-op. This isn’t an exhaustive list of protein sources, but it might help give you a general idea.

  • Meat (Chicken, Beef, Pork, etc)

  • Eggs and Egg Whites

  • Whey Protein

  • Fish (Salmon, Tuna, etc)

  • Dairy (milk, yogurt, cheese, etc)

  • Vegan Protein Powder

  • Soy Products (Tofu, soy milk, etc)

  • Seaweed

  • Nuts and Seeds (peanuts, almonds, peanut butter, etc)

  • Beans (black beans, kidney beans, etc)

  • Peas (chickpeas, split peas, etc)

  • Lentils

TIP #7: Have some soft, easy-to-eat food like jello, popsicles, or soup

For the same reason I recommend having some lozenges ready, it might help to prepare soft food like jello, popsicles, or soup for your first meal after surgery to avoid putting too much of a strain on your throat.

TIP #8: If fitness is a priority, build up your pecs

This tip may not apply to everyone, but if you do consider fitness to be one of your priorities, focus some of your training on building up your pecs. Once the layers of fatty tissue are removed by your surgeon, the hard work you’ve put into the muscle underneath will show. It can also be helpful as it gives your surgeon more of a base to work with as they contour your new chest.

Working out can be a very personal thing and sometimes people find their target muscles responding better to certain exercises but not others, so you may have to use trial and error or reach out to a trainer or a more experienced friend for advice. Below are some suggestions for exercises I use that target the muscles I am working on building.

Exercises that tend to be effective for targetting the pectoral muscles are bench presses, pushups, and various flye exercises using bands, weights, or cables.

Some people may also want to consider strengthening their shoulders and back before surgery. As your body recovers from the strain that surgery put it through, your chest will tend to be extremely tight and may pull your shoulders forward. Considering how many muscles in the shoulders and arms are directly or indirectly connected to your pecs, it’s common for people recovering from surgery to be in a hunched position with their shoulders forward, arms close to their body, and their upper back at a slight bend.

Exercises that tend to target the shoulders and back are rows (like bent-over rows, inverted rows, or seated rows that use cables or resistance bands), pullups or pullup alternatives (like negatives, holds, and hangs), and lateral raises using resistance bands or weights.

TIP #9: REST AND GET SOME SLEEP

Try to get as much sleep as you can before surgery. Being as well-rested as possible will be helpful for your recovery.

TIP #10: Quit Nicotine

Many surgeons will require that their patients stop smoking several months before surgery. If that’s the case with your surgeon, you should look into ways to you can wean off of it (at least for the time that you have your surgery).

Additionally, some surgeons will also advise against consuming alcohol and other substances for some time before surgery. Find out what your surgeon requires and follow that.

TIP #11: Have some wet wipes and washcloths ready

You typically won’t be able to shower for about a week after surgery, so wet wipes, and washcloths will come in handy with maintaining some level of hygiene until you’re able to properly wash yourself.

TIP #12: Remove your piercings before surgery

Most surgeons require you to remove your piercings before surgery. Keep this in mind if you have any plans to get a new piercing or if you have a piercing that would need professional help to remove.

HOME

This section covers any arrangements you should consider making around clothing, your household, and your living space.

TIP #1: Get a bed table or tray table

It’s not imperative to have one, but it might come in handy in the first week or so after surgery, especially if you find yourself too groggy and unsteady to properly get out of bed to eat. I had ordered this one before my surgery and it served me well.

TIP #2: Stock up on button-down or zip-up tops

You won’t be able to lift your arms above your head for a few weeks, so you’ll want to have a decent supply of shirts that open up at the front and are comfortable enough to sleep in and wear throughout the day.

TIP #3: Prepare loose-fitting, comfortable clothes that are easy to put on

Because of your limited mobility, it’ll help to have a good supply of clothes that are easy to slip into and out of like shorts and sweatpants. When you’re starting to feel more mobile, loose and baggy t-shirts can be an option midway through your recovery if you are able to put them on without lifting your arms up too high.

On that note, prioritize footwear that is also easy to slip into and out of since the first week or two after surgery may still be too soon for you to be fumbling with straps and laces that involve bending over and reaching forward. Consider wearing slip-on shoes to your surgery appointment as they will be easiest to put on before being discharged.

TIP #4: Consider getting a wedge pillow, maternity pillow, or body pillow

Different people have different preferences, so you may want to look into what pillow options will work best for you. Wedge Pillows are great for letting you sleep on your back without being too flat. They also make getting out of bed easier since they shorten the distance your torso needs to travel to get you upright. Maternity Pillows (also known as bed rest pillows) are helpful when you need to be more upright since they offer support for your back, arms, and head. Body Pillows help with trying to get more comfortable lying down by relieving some pressure on your back and helping you lie more on the side rather than flat on your back.

Tip #5: Wash and change your sheets

Try to wash and change your sheets the night before or the morning of your surgery so you can come home to a clean bed and feel as comfortable as possible on your first night.

Tip #6: Move things to elbow/waist height

Any toiletries, medication, or food you may need to access yourself should ideally be at elbow or waist height. You won’t be able to reach for the upper cupboards while you’re recovering. Reaching for lower cupboards may also put too much of a strain on your body in the first few weeks as well.

TIP #7: Arrange for support with child or pet care

If you have children or pets, you will likely need support in the first few weeks. Considering the restrictions you’ll have for lifting things, you won’t be able to pick up your child or pet for a while. Walking a dog will also be challenging in the first few weeks after surgery. I was able to gradually start walking my 30lb dog a week or so after surgery by looping her leash around my waist, but I still had less control over her if she got reactive. Other people aren’t able to walk their dogs until 3-4 weeks post-op, so it all depends on how your body feels with its healing, but you would very likely need help during at least the first week.

Tip #8: Cut your pet’s nails before your surgery

You don’t have to, but it is nice to lower the chances of sharp claws digging into your new chest :)

CONCLUSION

There are a lot of things to consider as you prepare for your surgery and different priorities come with each individual situation, but I hope this guide helps with breaking things down into smaller sections and actionable items so that things will hopefully feel just a little less daunting.

The best advice I can give is you get used to asking for and accepting help, and to try to be kind to your body.

Good luck with your surgery and I hope your recovery goes smoothly!

Raf de Leoz
Previous

International Transgender DAy of Visibility
Next

Types of Top Surgery