Top Surgery Recovery Updates (a place for all members to update after surgery)

[Bimmer Guy]

Hey, guys.  Thanks so very much for the support.  Thanks for another idea, Sebryn.  Interesting concept.  I think for right now I will let the body do it's thing.  I don't think I will be going without a shirt for a time, so I do have the time (even if it stinks!).  But again, ideas from anyone is greatly appreciated!  Mr. Clone, as always, I appreciate your input!

FB, I would strongly suggest you let the scab over the nipple just be.  Mine were still on there probably 2 weeks after there were no scabs over the areolas.  The body heals itself.  No reason to get them off early.  Our bodies know when scabs should come off.  I wouldn't do anything to speed the process along.  Long term gain for short term pain (well, not pain exactly...you know what I mean!).

Also, FB, I can't believe it has been six weeks!  i think you are in the clear when it comes to hypertrophic scarring.  The process usually starts at 2-3 weeks.  Mine seems to come in slowly.  Keloids come in much later, but unless you have had keloid scarring before this, no worries on that one!  Your chest looks great.  Congrats to you! 

Nathan, you are looking like some seriously healthy healing, as well!  Good areola placement and size for you chest, me thinks!  Congrats on a great chest!

[FlightyBrood]

The scabs were already peeling off, and i poked a bit and off they came! they look pretty good, theyre a bit puffy but i assume this goes away with time. ill post pictures...sometime. im off to do my t shot and go to vegas!

thanks for all your help with healing, guys. pretty sure i wouldnt be nearly as well off as i am without it! i LOVE the work, everything about it, i have no complaints! cant wait to see whats next in this

-FB

[Kreuzfidel]

Update - 9 weeks post-op

Surgery Date: 23 January 2014
Surgery Type:  Bilateral Subcutaneous Mastectomy - left nipple stalk preserved, right nipple free grafted
Location:  Sydney, Australia
Surgeon:  Dr. Megan Hassall

So I've included two photos taken today - I'm now 9 weeks post-op. 





Some of the "wrinkles" or creases that I was previously complaining about have smoothed out a bit - but they're still there.  I think that time is the only thing that will tell what the ultimate outcome of it will be.

It's not perfect - there are some "dents" and lumps - but it's still heaps early, so I will reserve judgment on the final look after about a year - then, if I need a revision, I need a revision.

Overall, I'm bloody happy with the result.  My troublesome right (grafted) nipple is no longer an issue - it's completely healed up now.  I was pretty worried about it for a while.  My incisions are still thin, no stretching *knock on wood* or keloids forming.  I'm now working on getting into shape - I've started a weight training program and hope to develop my pecs a lot more so that the look isn't quite so "hollow" in the few "dented" spots.  But yes...quite happy. 

[Bimmer Guy]

You're looking GREAT, Kreuzfidel.  Hassall really did a good job.  I can already see where you are getting some muscle development from working out, based on your last pictures.  Can't see a dent or lump from here!  Do you have sensation in the areola/nipple stalk was preserved?  That is the hope, right?

I am glad that you gave us an update along with picture.

How was it going back to work for you?  I believe you said you had 6 weeks off?  Do you have a physical job?

[Kreuzfidel]

You're looking GREAT, Kreuzfidel.  Hassall really did a good job.  I can already see where you are getting some muscle development from working out, based on your last pictures.  Can't see a dent or lump from here!

Thanks heaps, Brett!  Really made my day (work's been stressful and just feeling bleh), so thankies thankies 

Do you have sensation in the areola/nipple stalk was preserved?  That is the hope, right?

That's definitely the hope, but no sensation yet. 

How was it going back to work for you?  I believe you said you had 6 weeks off?  Do you have a physical job?

It wasn't too bad - I had light duties for the first couple of weeks.  After this week I'll be going back to doing my usual (which does involve a little heavy lifting twice a week).  Luckily it's mostly a desk job except when I'm on the floor.

[Bimmer Guy]

Interesting stuff to share:

So, I got home today from the Keystone Trans Conference in Harrisburg, PA.  I met Dr. Kathy Rumer today, the surgeon who did Darrin Scott's chest.  I introduced myself after her talk because one staff person she had with her is the person who does all the skin work, including scars, for the practice.  They were kind enough to take a quick look at my chest even though I was not signed up for an actual "consultation".

Well, you know it is never a good sign when the surgeon's eyes widen.  ->-bleeped-<-.  Bottom line, she was surprised at the hypertrophic scarring.  Just surprised it happened.  Also was surprised that there was so much of it, so to speak.  Asked what my surgeon said about it.  I told her I haven't contacted him.  I had read that hypertrophic scarring never had anything to do with the surgeon, just what the body does and I would assume he wouldn't admit it if it was his fault anyway.  She looked closely and actually asked if he did internal stitches or did I have staples or something?  It seemed as if she was actually confused as to how this could have happened.  When I asked her if it could have been his work that created the hypertrophic scarring (and not just what one's body does), she got skiddish and said that she can't comment on another surgeon's work, you know because she doesn't know exactly what his surgical process was.  :-(  So, ummmmm, yeah...

The whole thing was so fast because she had people waiting and was kind enough to see me right after her presentation.  It was actually QUITE kind of her being that her office is an hour away from me and I chose to travel over 1,000 miles from my home for my surgery instead of just going to her.  She could have told me to ->-bleeped-<- off.

Anyway, she says that at one year post op, the woman who does the skin work, can start doing some laser and such to help fix it.  I am just guessing it is laser, I didn't want to hold her up, so I didn't really ask any questions.  I mainly just wanted to confirm that it was hypertrophic scarring and find out when it would make sense for me to seek out scar treatment (if I decide to do so).

I really didn't think that what I had was that unusual.  Her face was also a bit humorous looking back.  You would think she would have thought to hide her shock!  lol

As an aside, she was a great person, great personality.  I won't say I am sorry I went to Garramone, no matter what happens with the scarring, as his contouring is spot on, and that is what is most important to me (and the areolas!), but as a person, she was great.  If there is anything else I might want plastic surgery wise, I would check into her.

I plan to take some pictures and send them to Garramone.  Evidently, Rumer will work on your scars for free if you get your surgery from her.  That's pretty awesome.  I don't know what Garramone will say.  I mean, is there really anything to say?  Sorry, for your luck, mate?

I do feel like I am taking it all in stride though.  I just keep returning to my happiness that I got this done.  Also, I do believe that it will all work out in the end.  The width of the scar will always be there, but I should be able to get this thick scar at least flattened and lighter in color (I hope).

The silicone strips do seem to help with the scar getting lighter and I suppose may have kept the scar from getting even worse than it could have been.

Will post a picture tomorrow.  I am 24 weeks (6 months) post op this week, plus with me talking about my scars so much, I should put up a pic for you guys to see, anyway.

[Kreuzfidel]

Brett, that would be good to see a photo if you're okay to post one - just to have context, I suppose.

I think it was good to have another doctor's opinion of your chest, though.  Even though Garramone has yet to weigh in, you will have another perspective (even if it was just a reaction and an insinuation).  Hopefully Garramone will have some suggestions for you.  I also think it will all work out in the end - even if you have to travel to see a specialist. 

[aleon515]

My understanding is that scar repair is a separate speciality kind of. I don't know if Dr G does this. I have not heard that he does but then again, I don't know. I have never heard that it was the surgeon's fault and that the body does odd things during healing sometimes. Like the guy I know who's body spit out half the stitches! Also if it were his technique, wouldn't he have tons of guys with hypertropic scarring?

BTW, I think Dr Rumer has a much more varied practice than Dr G, and does a little of all sorts of things including GCS/SRS and has cis patients as well. AFAIK, Dr G does only FTM top surgery and the occasional lipo (on trans men).

BTW, speaking of odd stuff, my scars are black and blue on the incision line (still). My PA was going to look into it, but she hasn't yet, otoh, I have a weighed blanket, and wondering if I lie across it wrong. It has these little plastic beads in it and I wonder if it could have injured me.

Kruez: You look great!!!

--Jay

[Bimmer Guy]

Jay and Kreuzfidel,

Thanks for the constant support.  I feel like we have been going through this together.  I has been cool to have gotten to know the two of you.

Yes, Jay, Dr. Rumer does many different surgeries and FTM top surgery is certainly not her main focus.  However, any kind of surgery gives scars, so she would know about hypertrophic scarring.  I think it is notable that she was surprised and curious about this having happened, so it is not something I can just push aside based on the fact that FTM Top Surgery is not her specialty.

You are right about scar work being a specialty.  She has a professional (I don't know what her credentials are) skin person who does that specifically for her.  They were both there when I showed them my chest.

It's weird, I just said to my girlfriend, that I prefer to think that Garramone's hand had nothing to do with it.  I suppose I like to keep him in my head as a Master of sorts!  I just didn't like the fact that 3 times Rumer avoided answering my question as to whether or not the surgeon's work itself could cause hypertrophic scarring.  You are right though, he does 500 a year, so why haven't we heard about this before?  On the other hand, the guy can't do things perfectly all the time, can he?  Maybe he cut too much of my skin and pulled too tight?  I don't know, just trying to make sense of it.

I don't know if I will get any kind of treatment for the scars.  I read stories about the steriod shots and lasering and such not really working on these scars.  Some people say it makes things worse.  I am glad that she said wait another 6 months.  That was my original plan, anyway.  I might email her with a couple questions after I email Garramone.  I hope he is responsive to my concerns and can give me some thoughts as to why this might have happened.  I'm sure that will make me feel better.

I will get some pictures up.  Carry on, Gents!

P.S. If anyone knows of any videos of hypertrophic scars on FTM top surgeries, I would appreciate you passing them along.  I can't find anything on youtube, but I may not be the best "searcher".

EDIT: I did see http://neutrois.me/2013/02/26/top-surgery-2-years-post-op/ has the same problem, though.

EDIT AGAIN: looks like he put up a 3 year update.  http://neutrois.me/2014/03/21/top-surgery-3-years/  Check out the progression of 1-3 years.

I can see my scars going this same road.  Could be worse, I think!

[neutrois]

I'm Micah, the one who wrote the posts linked above.

The number one thing I recommend for hypertrophic scarring is cortisone injections. By far this made the biggest difference. Within a few days (days!) the scars flattened. This has the side effect that they widen and stretch (given finite space, the tissue has to go somewhere I guess), which didn't bother me as much as the raised texture was.

Take a look at my 5-month update photos to see the hypertrophic scars up close. I had my first shot 7 months post-op, and had 3 rounds in total a few months apart. If you look at month 10 vs month 12 in the 1 year post, you can see a huge difference in the coloring and texture; I probably had that 2nd cortisone shot somewhere in between.

The second booster was the silicone gel. Objectively it's hard to measure the effect of this, but for the periods when I stopped using it my scars would swell up and start to raise again. When applying, my partner massaged my scars for 5 mins every time. I'm still applying this sporadically, even after 3 years.

The third element was laser. There are different kinds of laser, and the first try was an new one the dermatologist was experimenting with which did nothing. The second one he tried was Intense Pulse Light (3 rounds), worked very well to improve the coloring. That is, it turned them from a deep purple and bright red to light reddish, closer to skin tone.

I've also researched the pin-prick roller and it sounds painful, though the "reviews" are promising. I'd rather get a professional massage at some point.

In general, the sooner you treat scars the better, though I'm 3 years in and still seeking treatments and still seeing results.

The last factor is time. I think we don't see enough pictures of 5-10+ year post-op chests. I'm confident that my scars will eventually fade, they're just going to take a lot longer to get there.

[Bimmer Guy]

Hi, Micah.  You may have guessed, but I am the "Just another guy", who wrote on your blog.  It does make sense that flattening means becoming more wide.

In terms of scar management, these guys here know that I am have been obsessive with my silicone strips and silicone gel.  24 hours a day, I never miss a beat.  I think/assume that this is the reason why they are fortunately pink in color.

I see how massaging makes a difference.  Lately, I have been massaging at night with jojoba oil, and then putting on the gel before bed.  They are flatter in the morning.  However, I am wondering if that is a function of me laying horizonatally/no upright moving around, so there is less blood moving around there.  Ok, maybe sounds stupid, but I know that the hypertrophic scars have blood vessels in them.  Did you notice the same thing?  I only started noticing it since I have been massaging the last week or two.

You may have seen in my post that Dr. Rumer said that I shouldn't consider scar treatment until one year.  I read that in most places, as well.  Where did you get your information that said otherwise?

Thanks for your response here, as well as on your blog.

[Bimmer Guy]

Surgery Date: 10/10/14 (24 weeks/6 months)
Surgery: Double Incision with nipple grafts
Surgeon: Garramone
Scar Treatment:  Scar Away Strips/Scar Away Gel.  Used 24 hours a day, every day, beginning week 3.
Testosterone: No
Strength Training: No


You will note the hypertrophic scarring.  The scars are raised and thick.  They are worse, rather than better, if you compare to my first picture (Opening Post), when I was at 3 months.  Thickening started happening at 3 weeks and has increased over time.

Scars are significantly lighter than they appear in below pictures taken with iPhone 3 camera.  They are a light pink.

I continue to have a slight puffiness under my right armpit.  I am very pleased with my areolas/nipples.  Still some jagged edges on the areolas, which should continue to disappear.

[neutrois]

Ok, now I put 2 and 2 together Brett! 

The blood flow fluctuation is a good theory. Mine are usually more red and swollen after exercising, for example, and flatter in the morning.

Scar treatment isn't an exact science, every person and doctor will give you different advice, so just do your research and conclude what you think is best. For instance I think that most oils or creams don't actually work beyond just moisturizing your scars. I used vitamin-e stuff for a while and personally felt it was counterproductive; then again the Castor Oil seems to be helping a little. A lot of it might also be individual reactions to different products. The general advice I heard most often is to treat them the sooner the better, though you should wait until the incisions are fully healed (so don't put anything on them until ~8-12 weeks post-op!).

Another useful tidbit that I learned is that the surgeon can inject cortisone directly into the incision in the OR when they close it up, so if you suspect you are prone to hypertrophic scars ask about this option (although in my case, I had no idea). My doctor did this for my hysto scars and even though they are tiny it was a good precaution, I can barely see those anymore.

Feel free to email me if you want more info, but I think I laid out all I know here already!

[Bimmer Guy]

Thank you, Micah.  Yes, I don't expect that the jojoba oil will actually improve the scars, I am only using it for lubrication.  I understand that jojoba is good for our skin, so that is why I chose this one.

Interesting information on being able to inject cortisone at the time of surgery.

I actually had a colon resection which means I had a cut (actually they had to do it twice) from above my belly button down to the top of where my pubic hair starts in 8/2010.  No hypertrophic scars that time.  So weird.

Last thing, your understanding is that there is never a case of surgeon error that causes these scars, correct?  Were your stitches internal?

[aleon515]

Hey Micah buddy!   Glad to see you here (so to speak). Sounds like you gave my clone Brett some good advise, for which I thank you. Want my clone happy.
Brett, you look good, think that you should go for the cortisone shots (I mean it's what I would do). Actually the scars look a bit like our other clone on youtube. I have certainly seen these scars from different surgeons.

BTW, Dr Rumer does top surgery, but not too many I think. Has a varied practice, and I know someone getting her GCS/SRS from her (I think).

Yes, Brett feel like we've sat around for hours talking.

--Jay

[Bimmer Guy]

Hey Micah buddy!   Glad to see you here (so to speak). Sounds like you gave my clone Brett some good advise, for which I thank you. Want my clone happy.
Brett, you look good, think that you should go for the cortisone shots (I mean it's what I would do). Actually the scars look a bit like our other clone on youtube. I have certainly seen these scars from different surgeons.

BTW, Dr Rumer does top surgery, but not too many I think. Has a varied practice, and I know someone getting her GCS/SRS from her (I think).

Yes, Brett feel like we've sat around for hours talking.

--Jay

I agree that this is how our friend's looks.  I have thought this before.  His appear a bit wider on his videos then mine, actually.  You really don't think it looks too bad?  Maybe I built it up to seem worse.

I know Rumer does top surgery.  That is why I felt like a douce bag asking her for advice on my scars...here she is an hour away from me and I didn't go to her...only to ask her for advice/help later! 

Darrin (on this thread) went to her.  I think his chest looks good.   

[Darrin Scott]

I did have my surgery with Dr. Rumer and no, she's doesn't do top surgery primarily, but I'm very happy with my chest. I think it fits my body very well and I have no complaints. There are some pros to her not only doing top surgery. I had one on one attention, she is always available to answer my questions and we are able to speak a lot before and after the surgery about my expectations going into surgery.

I would highly recommend looking into her for someone who wants surgery. I'm not trying to sound like an infomercial here, but there seems to be an idea that because she doesn't do top surgery primarily that she isn't as good as other surgeons or is no good at all. This simply isn't the case and I feel like I have to say something about that.

As far as her not commenting on another surgeons work, I don't think you really can as each surgeon does the surgery different. Plus, if it gets back that she said something against another surgeon it could affect her reputation as a surgeon herself.

[Bimmer Guy]

Yes, Darrin, I certainly understood why she would hesitate to comment on another surgeon's work.  There is more than one reason.

I found her to be incredibly personable and I found myself thinking that I understood why you chose her for your surgeon.

I can see her as wanting to be very accessible, as well.

------------------------

Ok, guys, so I sent an email to Garramone, so I will see what he has to say.  I originally had it in my head that I wouldn't do the cortisone shots because of the possibility of indentation of the skin (bad effect of tx).  I figured I would wait and see.  Then after reading what neutrois said and doing some research, some surgeons say to get on it right away and start injections, and some say to wait and see.  Regardless as to what Garramone says, I am not sure how I am going to decide with all the differing opinions out there!

ugh.

[Kreuzfidel]

Surgery Date: 10/10/14 (24 weeks/6 months)
Surgery: Double Incision with nipple grafts
Surgeon: Garramone
Scar Treatment:  Scar Away Strips/Scar Away Gel.  Used 24 hours a day, every day, beginning week 3.
Testosterone: No
Strength Training: No


You will note the hypertrophic scarring.  The scars are raised and thick.  They are worse, rather than better, if you compare to my first picture (Opening Post), when I was at 3 months.  Thickening started happening at 3 weeks and has increased over time.

Scars are significantly lighter than they appear in below pictures taken with iPhone 3 camera.  They are a light pink.

I continue to have a slight puffiness under my right armpit.  I am very pleased with my areolas/nipples.  Still some jagged edges on the areolas, which should continue to disappear.

Brett, your scars don't look nearly as bad as I was thinking based on your descriptions previously.  I know that you are self-conscious of them, but for what it's worth - they don't look too bad to me.

Overall, your chest is amazing!  I really think you've got something to be proud of there, mate. 

Do you think that the puffiness under your arm is swelling, even at this stage? 

*By the way, did Garramone get back to you?

[Bimmer Guy]

Brett, your scars don't look nearly as bad as I was thinking based on your descriptions previously.  I know that you are self-conscious of them, but for what it's worth - they don't look too bad to me.

Overall, your chest is amazing!  I really think you've got something to be proud of there, mate. 

Do you think that the puffiness under your arm is swelling, even at this stage? 

*By the way, did Garramone get back to you?

Thanks, Kreuzfidel.  Thanks for bolstering me up a bit.  I do need to focus on the positive.  The shape is very good.

I don't know if it is swelling or not.  I would say no, but people say there is a whole year before it goes down.  I think Jay (who also had Garramone), still has some.  It is where are drains were.  I would think that if it were something that didn't go away more people would talk about it (if both Jay and I have it, must be common from Garramone, or drains in general?).

Maybe a better way to look at it is that it is not swelling that has to go down, but rather it is skin that still has to retract.  Don't know.  That drain was a very painful one for me.

I have not heard from Garramone.  I emailed him Sunday night asking for a call.  Today is Wednesday night.  I suppose I will have to put in a call.  I assume he will just say, sorry dude, it happens.  What I am curious about is if he thinks I should wait on treatment (as Rumer suggested, but as we know that was a fast and quick conversation), or if I shouldget some cortisone shots now.  My research has found mixed results.  My preference is to wait and see what happens.  Only one or two random surgeons have made the statement that getting treatment sooner rather than later is wise (and neutrois/micah said this).

For me, hearing that the cortisone shots result in the scars widening (they are flattening against the body, so they would have to), makes me unhappy.  I would prefer to have raised scars than wider scars.  I really would prefer that my body do the healing.  Eventually they go down.  I like to think that when they do, they will just soften and shrink so to speak, no widening.  Maybe that makes no sense. 

I understand that they could continue to "grow" up to a year.  They will start to go down after that.  My hope is that with constant silicone treatment I can keep them from getting worse, or at least stunt their growth.  I have been thinking about the cost of this, though.  I am guessing I am spending about $40 in scar treatment per month.  Also, being hyper conscious of always having something on 24/7 is draining, as well.

I am now massaging every day.  Sometimes twice a day.  That is really important for these scars. 

If Garramone tells me I should get some treatment now I will feel in a pickle.  I would rather wait, but I respect his opinion.  Bottom line, I'm not sure what I would do.

I don't want to bother him, but I think I will give his office a call.  I really thought I might hear from him today, as Wednesdays are his consult days, so he is not in surgery.