FTM Top Surgery Guide
This guide provides detailed recovery instructions for patients who have undergone Double Incision or Anchor FTM Top Surgery with Free Nipple Grafting at Evita Clinic.
Most Important Notes
- No Smoking: Do not smoke, vape, or use nicotine products for at least 3 weeks after surgery.
- Protect the Nipple Grafts: The first few weeks are critical for establishing blood circulation.
- Wear Your Compression Garment: Wear it 24 hours per day for 4 weeks unless instructed otherwise.
- Do Not Pick Scabs: Crusting and discoloration are normal and should be allowed to resolve naturally.
- Scar Management Matters: Use Steri-Strips and scar care products as instructed to help improve scar quality.
Nipple Graft Care
Establishing Blood Supply
During the first week, the nipple graft survives by absorbing nutrients from the surrounding tissue. New blood vessels gradually grow into the graft.
- Mild bleeding and drainage are common.
- Swelling and redness are expected.
- Do not manipulate or rub the nipple graft.
- Avoid unnecessary pressure on the chest.
Crusting Phase
The nipple graft often looks worse before it looks better. Dark discoloration, dryness, and crust formation are normal parts of the healing process.
- The graft may appear black, brown, or very dark.
- Crusting does not necessarily mean tissue damage.
- Do not peel off scabs.
- Allow crusts to separate naturally.
Improving Circulation
As blood circulation improves, crusting gradually loosens and healthier tissue becomes visible.
- Color may remain uneven.
- The graft may still appear swollen.
- Healing progresses differently for every patient.
Maturation Phase
The graft becomes softer and more stable. Pigmentation gradually settles and nipple projection may decrease.
- Minor asymmetry may still be present.
- Redness gradually fades.
- Scar maturation continues.
Long-Term Healing
Final color, texture, scar quality, and nipple appearance continue to improve over many months.
Nipple Graft Healing Timeline
Typical healing progression of a free nipple graft after Double Incision or Anchor FTM Top Surgery. Appearance varies among patients, but crusting, color changes, and gradual improvement are normal parts of healing.
The appearance of a nipple graft changes significantly during recovery. Dark crusting, redness, uneven pigmentation, and temporary color changes are expected and do not necessarily indicate a problem.
Compression Garment
- Wear your compression garment 24 hours per day for 4 weeks.
- Remove it only when showering unless instructed otherwise.
- Compression helps reduce swelling and supports chest contouring.
- Follow your surgeon's instructions regarding duration of use.
Showering and Hygiene
- You may generally shower 1–2 days after surgery if permitted by the clinic.
- Use warm water rather than hot water.
- Pat the surgical area dry gently.
- Do not scrub the nipple grafts.
- Avoid bathtubs, hot springs, swimming pools, saunas, and ocean swimming for at least 1 month.
Activity Restrictions
Rest and Light Activity
- Avoid running, weightlifting, and strenuous exercise.
- Avoid push-ups and upper-body workouts.
- Walking is encouraged.
Gradual Return to Activity
- Gentle stretching may begin.
- Continue avoiding heavy chest exercises.
Exercise Progression
- Gradually return to weight training.
- Increase exercise intensity slowly.
- Stop if discomfort develops.
Scar Management
Example of Steri-Strip placement around the nipple graft after suture removal.
- Apply Steri-Strips after suture removal as instructed.
- Continue use for approximately 2 months.
- Steri-Strips help reduce tension on the incision.
- Replace them only when they naturally loosen or fall off.
- Do not stretch the strips excessively during application.
Scar Gel and Silicone Therapy
- Begin scar therapy only after the wound has completely healed.
- Scarheal Gold Gel or silicone-based scar products may be used.
- Continue scar management for several months for optimal results.
When to Contact Evita Clinic
- Fever above 38°C (100.4°F)
- Increasing redness around the surgical area
- Persistent bleeding
- Severe swelling
- Foul-smelling discharge
- Sudden worsening of nipple graft appearance
- Severe pain not relieved by medication
- Any symptom that concerns you
Important Note
Free nipple graft healing requires patience. The graft often looks worse before it looks better. Temporary discoloration, crusting, uneven pigmentation, and changes in nipple projection are normal parts of recovery. Final healing and scar maturation may continue for up to one year after surgery.