How To Prepare Your Body For FTM/N Top Surgery

Months to years ahead of time (long term preparation):

You may not realize there are things you can start doing this early to prepare your body for surgery and these WILL optimize your top surgery result

Build Your Chest Muscles

The single most important thing is to take care of your body and build your chest muscles. Building your chest muscles ahead of time and maintaining that musculature over time WILL help your top surgery result aesthetically. Pay attention next time you are scrolling through postop photos and look specifically at how much muscle definition is present for the chest that has a result that stands out to you. It is amazing how much of a difference a muscular chest wall has on the aesthetic result of top surgery.

Optimize Your Weight



BMI optimization is ideal prior to top surgery because this well help you reduce the amount of fatty tissue that is present on your chest, especially laterally (under your armpits) and medially (over your sternum in the midline). Top surgery may help to flatten your lateral and medial chest wall if you extend your lateral incisions further out laterally or medially, or if your surgeon adds liposuction to your procedure, which may add to the total cost of your surgery. If you have excess hanging skin laterally you will not be able to get rid of this with weight loss alone, and you should talk to your surgeon about the possibility of treating this surgically. If you have excess fatty tissue (fullness that you can pinch without hanging skin) this is something you can optimize yourself with weight loss, though liposuction is also an option. It is important to note that if you are planning on losing weight in the future, you should ideally do this BEFORE your top surgery. If you were to lose a small amount of weight (less than 20 lbs) after surgery, it is unlikely to make a difference. But if the weight loss is larger, you could end up with a less-than-optimal aesthetic result on your chest because you might develop looser skin

Optimize Your Nutrition

Eating a healthy, balanced diet with lots of fruits and vegetables will prepare your body for optimal healing after top surgery. Your body needs certain nutrients to use as building blocks in the healing process, so it is important you are not in the middle of any fad diets at the time of surgery or actively losing weight at the time of surgery. You would ideally be at your optimal weight well ahead of surgery day and focusing on providing your body with adequate nutrition months in advance.

Work On Your Therapy Letter

If you are going through insurance for top surgery, you are almost guaranteed to be required to supply a letter of support from a licensed therapist, which means the therapist needs to have a master’s degree (ex. LPC, LCSW). The letter may also come from a psychiatrist. Some insurance companies require two letters for top surgery, so it is a good idea to check with your insurance company about their specific requirements. If you are having trouble finding a therapist, you can check out https://thegalap.org/, a group of mental health clinicians dedicated to helping patients with these types of letters. Another possible option is www.betterhelp.com.

4-6 weeks prior to surgery:



These are things your surgeon may want from you around this time:

• Primary care doctor clearance–may or may not be required by your doctor
• Blood work – may or may not be required by your doctor (ex. CBC, BMP, PT/PTT)-EKG and/or Chest XR in patients with a history of cardiovascular disease or over a certain age (usually age 50).
• Mammogram if over age 40–this will generally be required to get a baseline and to make sure you don’t have any areas that may need to be biopsied prior to top surgery
• See our list of Medications to Avoid(link to downloadable PDF “Medications to Avoid”)which generally should be stopped 2-4 weeks prior to surgery depending on the medication. Always double check with your surgeon before you start or stop any medications or vitamins/herbal supplements prior to surgery. Pay attention to avoiding ibuprofen/NSAIDS/aspirin products and products with added Vitamin E (ex. some almond milks) which can increase risk of bleeding after surgery.
• Stop Smoking.
• It is important not to consume NICOTINE PRODUCTS OF ANY KIND INCLUDING SECOND HAND SMOKE. Nicotine increases risk of infection and wound healing complications by over 50% and should be AVOIDED FOR AMINIMUM OF 4 WEEKS PRIOR TO SURGERY AND 4 WEEKS AFTER. Your surgeon may require a longer time period than 4 weeks, so it is important to check with your surgeon about their specific guidelines. It is important to also avoid Marjuana, which can interfere with anesthesia medications and increase risk of complications from anesthesia.
• Avoid alcohol at least one week prior to surgery.
• This can increase risk of bleeding and interfere with anesthesia.
• Avoid other recreational drug use which can interfere with administration of anesthesia.

Set up your physical and emotional support system:

• After general anesthesia, you will need someone around to drive you home from surgery and stay with you for 24 hours.
• You may want someone around to help you for a few days, if not for the entire 7 days after surgery. You will not necessarily need their constant assistance, but company can be helpful during the initial recovery period.

In general, you want your body both physically and emotionally to be completely optimized so that you are physically and emotionally healthy and prepared to undergo top surgery!

Things you may need from the pharmacy

1. Bacitracin Ointment and/or Aquaphor for incision and/or nipple graft care
2. Tylenol
3. Chapstick (for dry lips)
4. Throat lozenges (for sore throat after anesthesia)
5. Tums or Maalox (for a sensitive stomach)
6. Colace and Senna (for constipation)
7. Silicone scar tape or gel (cannot be used until ~4 weeks after surgery, but ok to get it ready ahead of time) this will help prevent thickened scars and can be purchased from the pharmacy or on Amazon.

Days before surgery:

• COVID test or proof of COVID vaccination requirements vary based on the facility where you are having surgery.
• Schedule a postop visit with your surgeon, usually about 1 week ahead of surgery.
• If you have Diabetes: Do not take medication for Diabetes on the day of your surgery. This is because you are not eating, and your blood sugar could drop too low if you take your medication. If you take metformin, it is usually recommended that you do not take metformin about 48 hours prior to surgery. Check with your surgeon or primary care doctor if you have Diabetes to confirm their specific instructions regarding your individual medication regimen.
• Stay hydrated the day before surgery, since your body may be devoid of fluids for a time prior to surgery depending on whether your surgery is in the morning or afternoon.

On The Morning Of Surgery

• NO SOLID FOOD for 8 hours prior to your surgery.
• You may have small sips of water with medications only.
• If you take blood pressure medication, make sure you TAKE THIS MEDICATION on the morning of surgery unless otherwise instructed by your doctor.
• Shower as usual, but do not use any creams, lotions, oils, deodorants, or products with fragrances such as cologne.
• Brush your teeth but avoid swallowing much water.
• TAKE OUT ANY METAL JEWELRY. If you have metal piercings you will probably be allowed to replace them with plastic, as long as there is no metal at all. This is because of the electrocautery that is used during surgery and the risk for thermal injury from conduction of the metal piercing.
• Take out contact lenses. You may bring glasses on surgery day and there will likely be a place where a small number of personal belongings will be stored.
• Leave all valuables at home
• Bring a photo ID, insurance card and a contact number for the friend or family member who will be around on your surgery day.
• Usually you need to arrive about 1.5-2 hours prior to your surgery time.
• Someone will need to drive you home from the facility after your surgery and stay with you for 24 hours (no taxis or ubers).