Top surgery

WHO IS A GOOD CANDIDATE?

Patients who want a flatter more contoured chest are ideal candidates for top surgery. Hormone treatment is not required prior to top surgery, however treatment with testosterone can sometimes shrink breast size and turn firm fibrous breast tissue more fatty. Hormone treatment can also help build up the underlying pectoralis muscles, which helps the plastic surgeon contour the chest.

There are 2 main procedures for top surgery: keyhole and double incision. The keyhole procedure is ideal for patients who have a small amount of breast tissue without a lot of extra or overhanging skin. The double incision procedure is suited for patients who have a larger amount of breast tissue and excess or overhanging skin. The double incision procedure has the advantages of removing all excess breast tissue and completely reshaping the chest, moving the nipple lower and more lateral, and decreasing the size of the nipple, areola or both. They keyhole procedure does not allow relocation of the nipple and areola.

THE PROCEDURE

Top surgery is done under general anesthesia at an outpatient ambulatory surgery facility. The procedure takes around 1½ hours for keyhole and 1½-2 hours for double incision. For the keyhole procedure, an incision is hidden in the underside of the areola. Breast tissue is removed through this small incision. Liposuction of the chest is often done at the same time to help smooth out the entire chest contour. A drain is placed and stays in for about a week.

Double incision top surgery incisions are placed along the underfold of the breast tissue along the line of the pectoralis major muscle. The nipple and areola are completely removed then sutured back on as a skin graft. Liposuction can be done in the armpit areas to remove excess fatty tissue and decrease the chances of having a "dog ear" after surgery. Some patients choose not to have nipple grafts placed back on. There are options for 3D nipple tattooing for patients who choose not to have nipple grafting. Drains are always placed and will stay in for 1 week. For patients with nipple grafts, bolsters are placed to help the grafts "take" and stay in place for 1 week. All incisions are closed with dissolvable sutures and skin glue, and outer dressings consist of padding and an ACE wrap or binder for compression.

RECOVERY

Recovery is different for the keyhole and double incision procedures. For the keyhole procedure and double incision WITHOUT nipple grafting, patients are wrapped in a binder and are permitted to shower after 24-48 hours, even with the drains in place. They will need to wear the binder at all times for 4-6 weeks after surgery.

For the double incision procedure WITH nipple grafting, patients must stay in the binder at all times until they follow up in 5-7 days for bolster and drain removal. During the first 5-7 days, patients may not get the surgical areas wet as this will interfere with skin graft healing. With the free nipple graft, the outer layer of skin which contains pigment may slough off, and this color will slowly come back over several months.

For all types of top surgery, patients should avoid overhead reaching and lifting over 5 lbs for 1 week after surgery. High end exercise should be avoided for 4-6 weeks after surgery. Driving may be resumed after 1 week or when patients are off prescription pain medications for 24 hours. In terms of returning to work, patients who have desk jobs may go back after 2 weeks, but 4-6 weeks off are recommended for jobs that involve heavy lifting.