Top Surgery Scars in FTM Individuals: Healing, Care, and Reduction
FTM Top Surgery Scars: Complete Guide
A comprehensive, medically-informed guide to understanding, healing, and treating scars after transgender chest surgery. From surgical techniques to long-term care, learn everything you need for optimal healing results.
Top Surgery (FTM chest surgery) is a life-changing procedure for trans men and non-binary individuals seeking a more masculine chest contour. While the surgery itself is a significant step toward gender affirmation, understanding scar formation and management is essential for achieving the best possible results.
This comprehensive guide provides medically-informed information about top surgery scars — including what to expect from different surgical techniques, the science of healing, evidence-based treatments, and long-term care strategies.
📖 What You'll Learn
- How different surgical techniques affect scarring
- The three phases of wound healing and what to expect
- Evidence-based treatments for scar reduction
- Long-term care strategies for optimal results
- When to seek professional intervention
Types of FTM Top Surgery & Resulting Scars
The surgical technique your surgeon recommends has a significant impact on the location, size, and visibility of your scars. The choice depends on chest size, skin elasticity, and your aesthetic goals.
Keyhole (Peri-areolar)
Best suited for:
- Small chest (A-B cup)
- Good skin elasticity
- Minimal excess skin
Also called: Periareolar, Keyhole Method
Double Incision
Best suited for:
- Larger chest (C+ cup)
- Excess skin present
- Maximum contouring needed
Also called: DI, Bilateral Mastectomy
Inverted-T / Anchor
Best suited for:
- Significant excess skin
- Large chest requiring extensive reduction
- Cases needing extra skin removal
Also called: Anchor Method, T-Anchor
Diagram showing scar patterns from different surgical techniques
📌 Key Takeaways
- The Keyhole method produces the least visible scarring but is only suitable for smaller chests with good skin elasticity
- The Double incision allows for the most chest contouring but results in visible horizontal scars
- Your surgeon's experience and technique significantly influence final scar appearance
- Discuss incision placement options with your surgeon — some offer "nipple-sparing" or "buttonhole" variations
Phases of Scar Healing
Understanding the three phases of wound healing helps you manage expectations and choose appropriate care at each stage. Scar maturation is a gradual process that takes 12-24 months to complete.
Inflammatory Phase
What Happens
Blood clotting begins, immune response activates. Expect redness, swelling, warmth, and discomfort around incisions.
What To Do
Keep area clean and dry. Take prescribed medications. Follow post-op instructions carefully. Rest.
Warning Signs
Increasing warmth, pus, severe pain, fever/chills — seek medical attention immediately.
Proliferative Phase
What Happens
Collagen production begins. Scar may appear raised, red, or purple. Itching is common and normal.
What To Do
Begin silicone gels/sheets (once wounds closed). Gentle massage if cleared by surgeon. Wear compression garment.
Warning Signs
Increasing pain, significant thickening — may indicate hypertrophic or keloid development.
Maturation Phase
What Happens
Collagen remodels. Scars gradually flatten, soften, and fade from red/purple to pink to white/skin-toned.
What To Do
Continue massage, moisturizing, and sun protection. Consider laser or steroid treatments if scars remain thick.
Warning Signs
No improvement after ~1 year, raised/itchy/dark scars — consult a dermatologist or plastic surgeon.
Factors That Influence Scar Appearance
The final appearance of your scars depends on a combination of genetic factors you can't control and external factors you can manage. Understanding both helps set realistic expectations.
⚪ Internal Factors (Not Controllable)
- Genetics: Some people naturally produce more collagen, leading to thicker scars. Family history of keloids or hypertrophic scars increases risk.
- Skin type: Darker skin tones are more prone to hyperpigmentation and keloid formation.
- Age: Younger people produce more collagen, which can lead to thicker scars initially (but also better long-term healing potential).
- Hormones: Testosterone therapy may affect wound healing and scar formation.
✅ External Factors (Controllable)
- Post-op care: Consistent, proper aftercare significantly reduces scarring.
- Activity level: Avoiding heavy lifting and stretching for 2-3 months prevents scar widening.
- Sun exposure: UV radiation darkens scars and makes them more visible permanently.
- Nutrition: Adequate protein, vitamin C, and zinc support optimal healing.
- Smoking: Impairs blood flow and significantly worsens healing outcomes.
⚠️ If You're Prone to Thick Scars
Discuss preventive options with your surgeon before surgery. Prophylactic treatments like silicone sheeting, pressure therapy, or post-operative steroid injections may be recommended for patients with a history of hypertrophic or keloid scarring.
Post-Operative Scar Care: Do's & Don'ts
Consistent, evidence-based care starting immediately after surgery and continuing for at least one year provides the best outcomes for scar appearance.
✅ DO
- Keep wounds clean and dry per surgeon's instructions
- Wear compression garments as prescribed to reduce swelling
- Begin silicone sheets/gels once wounds fully close (~2-3 weeks)
- Use SPF 30+ or cover scars when outdoors
- Stay hydrated and eat protein-rich, vitamin C foods
- Massage scars gently once cleared (usually ~4-6 weeks)
- Attend all follow-up appointments
- Be patient — healing takes 12-18 months
❌ DON'T
- Lift heavy objects or stretch arms above head for 2-3 months
- Expose scars to direct sunlight for 6-12 months
- Use alcohol, hydrogen peroxide, or harsh chemicals on wounds
- Pick scabs or scratch healing scars
- Smoke or use nicotine products (impairs healing)
- Skip compression garment wear
- Resume strenuous exercise too early
- Ignore signs of infection or complications
🚨 Risk Alert: Overexertion
Returning to upper-body workouts or heavy lifting too early is one of the most common causes of scar widening. Wait at least 2-3 months and get clearance from your surgeon before resuming any activities that stretch the chest.
Scar Reduction Methods & Treatments
Multiple evidence-based treatments can improve scar appearance. Options range from at-home topical treatments to professional procedures.
🧴 Topical Treatments (At-Home)
Silicone Sheets & Gels
The gold standard for scar treatment. Hydrates scars and regulates collagen production. Use 12-24 hours daily for 3-6 months.
Vitamin E & Onion Extract
May help with hydration and scar softening. Results vary. Mederma and similar products contain onion extract.
Retinoid Creams
Promotes collagen remodeling. May cause irritation on sensitive skin. Use only on fully healed scars.
🏥 Professional Treatments (Non-Surgical)
Laser Therapy
Reduces scar tissue, improves texture and color. Multiple sessions typically needed. Most effective 6+ months post-surgery.
Steroid Injections
Slows excessive collagen production. Flattens raised scars. May require multiple treatments 4-6 weeks apart.
Microneedling
Stimulates natural collagen production for smoother skin texture. Professional treatment recommended.
🔪 Surgical Options
Scar Revision Surgery
Surgically removes or repositions scar tissue. Usually considered no earlier than 12-18 months post-op when scars have fully matured.
✅ Treatment Timeline
- Week 2-3: Begin silicone sheets/gels once wounds closed
- Week 4-6: Start scar massage (if cleared by surgeon)
- Month 3-6: Continue silicone, massage, sun protection
- Month 6+: Consider laser or steroid treatments if needed
- Year 1-2: Evaluate for revision surgery if scars remain problematic
Long-Term Scar Care
Even after the initial healing period, consistent long-term care continues to improve scar appearance for up to 2 years post-surgery.
📋 Daily Scar Care Routine
Massage
5-10 minutes daily with gentle circular motions
Moisturize
Keep scar tissue hydrated and supple
Sun Protection
SPF 30+ daily, even after 1 year
Nutrition
Protein, vitamin C & zinc support healing
🎨 Embracing Your Scars
Many people come to embrace their top surgery scars as meaningful symbols of their transition journey. Some choose to:
- Leave scars natural as a badge of pride
- Cover with tattoos (wait at least 12-18 months)
- Use medical tattooing (micropigmentation) to blend with skin tone
- Continue treatments to minimize visibility
There's no "right" choice — only what feels right for you.
Potential Complications
While most scars heal well with proper care, some people develop problematic scarring that may require additional treatment.
Hypertrophic Scars
Red, raised, sometimes itchy. Usually improve over time. Respond well to silicone, massage, and steroid injections.
Keloid Scars
More challenging to treat. May require steroid injections, laser, or surgical removal. More common in darker skin tones.
Widened Scars
Often caused by too much activity too soon. May require revision surgery after full maturation.
🚨 When to Seek Help
Contact your surgeon or dermatologist if you experience:
- Scars that continue to grow or thicken after 6 months
- Significant pain, itching, or discomfort
- Signs of infection (increasing redness, warmth, pus, fever)
- No improvement in scar appearance after 12 months of care
- Scars that interfere with movement or function
Frequently Asked Questions
How long does it take for top surgery scars to fully heal?
Scars continue to mature and improve for 12-24 months after surgery. Most significant changes occur in the first 12 months, but subtle improvements can continue for up to 2 years. With proper care, scars typically fade from red/purple to pink to white or near skin-tone.
Can top surgery scars be completely removed?
No — scars cannot be completely eliminated. However, with proper care and appropriate treatments, they can be significantly minimized to the point of being barely noticeable. The goal is flat, soft, skin-toned scars that blend with surrounding tissue.
Can I prevent hypertrophic or keloid scars?
While you can't guarantee prevention, you can reduce risk significantly by using silicone sheets/gels, avoiding sun exposure, limiting movement/stretching, and following all post-op care instructions. If you have a history of problematic scarring, discuss prophylactic treatments with your surgeon.
When can I start scar massage?
Most surgeons recommend waiting until 4-6 weeks post-op when incisions are fully closed and healed. Always get clearance from your surgeon before beginning massage. Start gently with light pressure and increase gradually.
Is scar revision surgery worth it?
For significantly thick, wide, or raised scars that haven't responded to conservative treatments, revision surgery can substantially improve appearance. It's typically considered no earlier than 12-18 months after the original surgery to allow complete scar maturation. Discuss expectations with a qualified plastic surgeon.
When can I get a tattoo over my scars?
Most tattoo artists and surgeons recommend waiting at least 12-18 months after surgery before tattooing over scars. The scars should be fully matured, flat, and no longer changing in appearance. Consult both your surgeon and an experienced tattoo artist.
Your Journey, Your Scars
Top surgery scars are a normal part of healing — with proper aftercare and patience, they don't have to define your final results. Whether you choose to minimize them or embrace them as part of your journey, the most important thing is that you feel comfortable and affirmed in your body.
Have Questions? Contact Us📌 Summary: Key Points
- Healing takes time — be patient with your body (12-24 months for full maturation)
- Aftercare matters — consistent care has a major impact on final appearance
- Multiple treatments exist — from silicone sheets to laser therapy to revision surgery
- Scars are part of your journey — accept them, reduce them, or cover them with tattoos
- Seek help when needed — consult specialists for problematic scarring
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