After you leave the surgery facility or hospital with your support person, you will feel relieved and happy that everything is finished. It is important to not have a large celebratory meal that evening, as the anesthetic medication will still be in your system, and you will likely vomit and possibly rip your stitches. Instead, have a small light meal that evening (smoothie, rice, juice, banana, soup, etc.).

After you leave the surgical facility, fill your prescription for antibiotics and pain medications at a pharmacy. If you don’t already have any, pick up Advil(ibuprofen) and Tylenol (acetaminophen) (unless you are allergic of course). Also consider buying an over-the-counter stool softener (since the stronger pain medications that we prescribe can cause constipation).  Also pick up some reinforcement bandages in case there is a little leak in your dressing that requires a little extra padding. A container of Fucidin and Vaseline will also come in handy during the dressing care after surgery. Gravol can help with after-surgery nausea. Benadryl can help if your bandages are itchy.

For pain management, most patients take only Tylenol (acetaminophen) and Advil (ibuprofen) taken together at the same time to manage their post-operative pain.  Dr Mckee prescribes a stronger pain medication (a narcotic) in case you need it.  

Unless allergic, take Tylenol and Advil for at least 5 days starting the evening that you go home from surgery.  Tylenol and Advil have an additive effect if taken together (it is safe).  These are available at the pharmacy without a prescription.  Take the maximum doses that it says on each box.  The side effects of these two medications are minimal/nothing. However, for some people, they require something a little stronger on top of the Tylenol and Advil (a third pain medication to relieve the additional 10% of discomfort at night-time only for example).   The prescribed narcotic should only be taken if necessary and should only be taken when the Tylenol and Advil are already taken and maximized.  There are side effects to prescribed narcotic (including: dizziness, nausea, itchiness, general weakness, and constipation); so only take a small amount if you need to. Maybe start with only half a pill. If you end up taking one or more of the narcotic medications that we prescribe, please also take an over-the-counter stool softener (for example: “Colace”) available at a pharmacy, in order to prevent constipation. Please note, that 1/10 people will become nauseous from the stronger pain medication - so we prefer that you do not take it.

The antibiotics prescribed should be taken completely and routinely however to help prevent the unlikely possibility of an infection.

For the first week, you should just hang-around the house: watching TV, reading books, working on the computer, walking around the house. But by 1 week after surgery, most patients are out-and-about in their regular clothes visiting friends, doing small errands, and shopping.  It is safe to go back to class or a desk job one week after surgery (as these activities don’t require heavy lifting or chest muscle straining), though some people need a more gradual return-to-work plan.

We provide a compression surgical vest (binder) at the time of surgery. The compression vest(binder) is applied over-top of the dressing and should always be warn (24/7) for one month after surgery. After that, there is no need for a vest/binder ever again.  For the first month, light external pressure from a vest/binder helps decrease the chance of complications after surgery (including bruising, swelling, seroma, and nipple issues). If the vest/binder is too tight then you are allowed to loosen it slightly. The goal of the vest/binder is to provide constant external pressure on the chest (night and day).

During your first follow up visit, you can  bring another binder if you own one, and we can switch you in to that one. As long as the binder provides external compression, then it will work.  After 1 week, the compression vest may be washed and dried in the washer and dryer, then quickly reapplied to your chest. The binder that we provide is enough, however if you are considering purchasing an additional binder, learn more about your options by reviewing this article on compression binders.

Do not lift your arms above your shoulders or stretching backwards for 1 month after surgery. We don’t want to stretch the scars in the front of the chest and risk ripping any internal stitches, or risk causing the incision to partially open-up.

Do not engage in sports or heavy lifts ( over ten pounds) for 1 month after top surgery.

Do not remove the original dressing yourself or change the original dressing yourself. Treat it like a sleeping baby: ‘don’t disturb it’. The original dressing should not get wet.  It is ok to shower directly after surgery, but only from the waist downwards. Sponge bath to armpits or face is fine. After you see Dr McKee for your first dressing change, you will be able to get the chest wet in the shower gradually (see section below). The shower water is clean/safe. No bathing or pools or lakes/ocean swimming for 1 month after surgery.

Nicotine products (such a cigarettes, cigars, vaping, nicotine patch) can not be used for 2 months after surgery. It is too risky given the increased complications that are associated with nicotine and fragile healing skin.

Marijuana does not have the same devastating effects like nicotine does when it comes to healing. The only reason to avoid smoking marijuana for a week after surgery is because your throat may be a little irritated after surgery from the breathing apparatus used during the procedure while you are under general anesthesia.  Avoid breathing any fumes in general for a week after surgery.

Vegetarians must make an effort to eat additional sources of protein (with essential amino acids) during the months after surgery.

Sleep in any position you find comfortable ( no restrictions). Some surgeons believe that sleeping on your back for the first week the best position in order to optimize nipple graft survival. We are unsure if this makes a difference.

Complications are very rare: but if they were to occur, they would occur usually within the first couple weeks of surgery.  A list of complications can be viewed at Rainbow Health Ontario’s surgical information sheet on Chest Construction and on Trans Care BC’s website. 

Complications to pay attention to include:

• Infection – this is very rare ( <1%) especially with the antibiotics prescribed. However, if they happened, the patient would likely feel a fever, unwell, and one side may become very red, painful and swollen with spread to the armpit, and down the abdomen. If this happens, go to the closest emergency room. 

•   Bleeding can be normal after any surgery or any time the skin is cut. If this happens within the first couple of days after surgery, apply firm constant pressure for 30 minutes – It is a similar principle to apply 30 minutes of pressure for someone who has just donated blood.   Stay calm. You may reinforce the original dressing with additional dressing material (but don’t remove the original dressing yourself .. especially if there are nipple grafts as these are fragile for the first couple weeks).  If the bleeding/staining is overwhelming and worries you, again the safest place to go is the closest emergency room.

• Make sure to notify Dr Mckee as well with any emergencies.