Chest Construction Surgery Guide

Navigation guide for chest construction surgery

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This Guide

This guide outlines the steps for accessing publicly funded chest construction surgery in British Columbia. Please note that you don’t need to be masculine or male to have this surgery.

There are many diverse experiences people have had with chest construction surgery, and it isn’t possible to capture it all in one resource. It is valuable to connect with other people who have had this surgery and learn from their experiences.

Explore this guide

To explore this guide, click through the categories listed above.

To use the menu feature, click on the green bar located on the left side of the page (computers), or at the top of the page (mobile devices).

Contact us

Trans Care BC’s Health Navigation Team is available to help you at any point in this process. You can find a link to our contact page in the bottom right corner of this guide.

Workbook for Chest Construction Surgery in BC

Preparing for chest construction surgery is a physical, emotional, mental, and spiritual process. We’ve created a workbook called the Workbook for Chest Construction Surgery in BC to help you along the way. It contains some of the information on this website, along with worksheets, checklists, and exercises.

You may wish to download and print the full passport or individual support tools, which can be found throughout the guide, and on the Support Tools page in the resource section.


Click on a box below to learn more about the subject.

Chest Construction

Chest Construction – Procedures

Chest construction surgery involves the removal or reduction of breast tissue and skin to make a flatter chest. It may involve changing the size and/or position of the nipples.

The goal is to have a chest with sensation, nipples with sensation (varies by technique), a fairly symmetrical chest with aesthetically pleasing contouring and minimal scarring (varies by technique).

Chest reduction is another option for those who prefer to minimize their chest tissue. These surgeries are done by a plastic surgeon.

Types of Procedures

There are many different techniques that can be used for chest construction. The technique used depends on factors like cup size and skin elasticity, as well as the size and position of your nipples. The three most common techniques are described below. Your surgeon will recommend a technique suited to your body shape and goals.


This technique may be used for those with an A cup size and lots of chest skin elasticity.

  • A small incision is made along the bottom of the areola.
  • Chest tissue is removed via a liposuction needle through the incision.
  • The incision is closed. The nipple is usually not resized or repositioned.

This technique results in a small scar on the lower part of the areola and nipples with sensation.


This technique may be used for those with a B cup size or a C cup size and moderate to lots of chest skin elasticity.

  • An incision is made all around the outside of the areola.
  • A second circular incision is made a few centimetres away from the first.
  • The doughnut shaped skin between the two incisions is removed.
  • Chest tissue is then removed with a scalpel, or with a combination of scalpel and liposuction.
  • Some trimming of the nipple areola complex may be done but the blood and nerve supply remain intact.
  • The skin is sutured together around the areola.
  • Drains (long thin tubing) may be placed in the chest to help drain off excess blood and fluid so that it will not build up under the skin.

This technique results in scarring that goes around the nipple-areola complex and nipples with sensation. There may be some puckering around the incision.

Double Incision

This technique may be used for people with a C cup size and reduced skin elasticity, or a D cup size.

  • Large incisions are made horizontally across the chest, usually beneath the nipple.
  • The skin is peeled back. Chest tissue is removed with a scalpel.
  • Excess chest skin is trimmed.
  • Incisions are closed, leaving two scars below the pectoral muscle lines.
  • The nipple-areola complex is removed completely, trimmed to a smaller size and grafted to the chest in a higher position.
  • Two drains (long thin tubing) are placed along each incision to allow blood and fluid to escape.

This technique results in prominent scars. (You may be able to grow chest hair to cover the scars or building your pectoral muscles may make the scars less noticeable. 

Some people choose to get tattoos over their scars.) There may be possible changes to the pigment or the areola. The sensory changes include complete loss of sensation in the nipples.

Chest Construction – Complications

All surgical procedures involve some risks. Risks include negative reactions to anesthesia, blood loss, blood clots and artery blockages. These complications can, in extreme cases, result in death. It’s important to discuss these risks in detail with your surgeon. Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise, and respond to them appropriately. They will also inform you about what you can do to minimize your risks.

Some complications are particularly associated with chest construction. Below are a list of some possible complications of this surgery. Please note – this list is not comprehensive and you should have a detailed discussion of risks with your surgeon.

Absess Formation

An abscess is a collection of pus caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon

Contour irregularities

When the skin tissue isn’t the expected shape. Major contour irregularities can be corrected through liposuction. This is necessary in about 5 to 25% of cases, depending on the surgeon and the technique

Decreased sensation

This is possible with the keyhole and periareolar surgeries and an expected result of double incision surgery (in which the  nipple-areola complex is removed completely and re-grafted to the chest)


When blood collects in the surgical site, causing pain, swelling and redness. It is the most common complication. Drains and compression bandages are used to prevent hematomas. Smaller hematomas can be sucked out, but larger ones require removal through surgery

Nipple asymmetry

When the shape or location of nipple on one side looks different from the nipple on the other side. Some asymmetry is common; very noticeable asymmetry can be corrected through a surgical revision

Nipple necrosis

When the nipple, or part of it, falls off. If this happens within hours after surgery, saving the nipple may be possible; otherwise, the nipple may need to be replaced or reconstructed. This complication is rare.


Scarring is to be expected; the degree varies by technique. Severe scarring may require surgical revision. You can take steps to prevent severe scarring by following your surgeon’s advice about getting rest, avoiding the sun, doing massage exercises and using ointments


when clear fluid accumulates in the surgical site. Small seromas may need to be aspirated, or sucked out, once or more by the surgeon. Big seromas may need to be removed through surgery


Planning for gender-affirming surgery in BC during the COVID-19 pandemic

If you plan to have surgery in BC during the COVID-19 pandemic, prepare with pandemic safety in mind. Take time to review the checklist that is right for your situation with your GP or NP and the people who will be supporting you after surgery.

Here is a checklist of things to consider if you are having gender-affirming surgery in BC during the COVID-19 pandemic.  

How to Access

  • Step 1

    Connect with a practitioner
  • Step 2

    Readiness Assessment
  • Step 3

    Choose a surgeon
  • Step 4

    Surgical Consult

Step 1

Connect with a practitioner

The first step to accessing chest construction surgery is to connect with a doctor (GP) or nurse practitioner (NP). The role of the GP or NP is to support you in accessing the care you need. This includes:

  • referring you for a Surgical Readiness Assessment,
  • helping you meet surgical requirements, and
  • assisting with things you need after surgery.

Your GP or NP can access the referral form for upper surgery and a checklist for referring a patient for gender-affirming surgery, on the Trans Care BC website.

The criteria for chest construction surgery are guided by the World Professional Association for Transgender Health’s Standards of Care. Currently, the standards of care recommend a surgical assessment by a Qualified Surgical Assessor.

Ask your GP or NP to refer you to a qualified surgical assessor. If they don’t know of one, they can refer you to Trans Care BC’s Health Navigation Team. This team will coordinate an assessment appointment for you.

If your GP or NP happens to be a qualified surgical assessor, they can do the Surgical Readiness Assessment with you.

Frequently Asked Questions

I don’t have a doctor or nurse practitioner. What can I do?

Contact a Health Navigator at Trans Care BC. They may be able to help connect you with a doctor or nurse practitioner.

How long is the wait for an assessment?

The waitlist to have a publicly-funded Surgical Readiness Assessment varies widely, depending on the availability of qualified surgical assessors near you.

Are there private pay options for Surgical Readiness Assessments?

Yes. Some people choose to pay for an assessment if they are having difficulty getting an appointment with an assessor. If you are interested in this option, you can contact us for help.

How many assessments do I need?

Usually only one readiness assessment is needed for chest construction surgery. There are times when additional assessments may be recommended by your doctor, nurse practitioner, Qualified Surgical Assessor, or surgeon.

There are no assessors in my area. What are my options?

You can contact  Trans Care BC to confirm whether there are any assessors near you. If there aren’t, we can help you arrange a Telehealth or Virtual Health appointment with an assessor.

Step 2

Readiness assessment

You will meet with a Qualified Surgical Assessor for a Surgical Readiness Assessment. The Surgical Readiness Assessment confirms that you meet the criteria for publicly-funded chest construction surgery. It also helps ensure you are prepared and supported before, during, and after your surgery.

Many people feel anxious about the Surgical Readiness Assessment. They worry about saying the wrong thing and being denied a surgery that is very important to their health and well-being.

These assessments have changed as understandings of gender and human rights have evolved. The focus of the assessment should be on supporting you. To learn more about questions you might be asked in an assessment, checkout the Common Surgical Readiness Assessment Questions in the FAQ section below.

Together, you and the assessor will discuss your gender, your health, your support people, and details about the surgical procedure.

After the appointment, the assessor will write a recommendation for surgery based on the criteria for approval and the information you’ve shared with them.

The assessor will send their recommendation to your doctor or nurse practitioner, who will send your surgical assessment along with their referral to Trans Care BC. Your name will then be added to the central waitlist.

Frequently Asked Questions

What are the criteria for publicly funded chest construction surgery?

In BC, surgical readiness assessments are provided by Qualified Assessors, who are trained to provide readiness assessments for gender-affirming surgeries. A Qualified Assessor has experience working with trans, Two-Spirit and gender diverse clients and their name is on the list maintained by Trans Care BC.

The criteria for chest construction surgery are guided by the World Professional Association for Transgender Health’s most current Standards of Care. In British Columbia, the criteria are:

  • Persistent gender dysphoria
  • Age 18 years or older, with some exceptions
  • Ability to understand and consent to the surgery
  • Physical and mental health conditions are reasonably well-managed

What kinds of questions will the assessor ask?

The assessor may ask questions…

… about your gender:

  • What pronouns do you use?
  • How would you describe your gender?
  • When did you start living outwardly as yourself?
  • How long have you been thinking about gender-affirming treatment?

…about your physical and mental health:

  • Have you ever been diagnosed with a physical health condition?
  • Have you ever been diagnosed with a mental health condition?
  • What is your height and weight?
  • What medications are you on?
  • Have you had any surgeries before? Did you receive anesthesia? Did you have any problems with it?

…about your support people:

  • Who are your main support people? Will they be able to help you after surgery?
  • Do you have a GP or NP, and are they supportive?
  • Is there anything you think would be important for me to know to help with your care planning?

Here is a downloadable list of common question that you may be asked, during a readiness assessment for a gender-affirming surgery.

What do I need to know to make an informed decision about getting surgery?

It’s important to understand the following information:

  • details related to the procedure,
  • potential benefits and risks of the surgery,
  • permanence of the surgery,
  • possible need for revisions,
  • timeline for healing, and
  • what to expect for aftercare in the months after surgery.

To learn more about the information above, visit the Trans Care BC Chest Construction page.

Your assessor will help you understand these details. You should ask them any questions you have.

Do I need to be on hormones to qualify for chest construction surgery?

No. The most current WPATH Standards of Care do not require you to be on hormones to qualify for surgery.

Can I have a gender-affirming chest reduction surgery?

The most current WPATH Standards of Care support access to Top Surgery (including double mastectomy with chest contouring and chest reduction). You can speak with your surgeon about your surgical goals.

I don’t identify as masculine or male. Can I still get chest construction surgery?

Yes. The most current WPATH Standards of Care support access to chest construction surgery for people who have a non-binary gender and/or people who do not dress or identify as masculine or male.

I have a non-binary gender. Can I still get Top Surgery?

Yes. The most current WPATH Standards of Care support access to chest construction surgeries (including double mastectomy with chest contouring and chest reduction) for people who have a non-binary gender and/or people who do not dress or identify as masculine or male.

I am Two-Spirit and am seeking gender-affirming surgery. Can I still get Top Surgery?

Yes. The most current WPATH Standards of Care support access to Top Surgery for people who are Two-Spirit and seeking gender-affirming surgery.

How long will the assessment take?

Surgical Readiness Assessments are usually completed in one appointment. The visit lasts for 1-2 hours and there is no physical exam. Extra visits maybe booked for individuals that need extra support. 

What happens if the assessor decides I’m not ready for surgery?

If there are areas of your health or well-being that need attention to make sure you recover safely after surgery, the Qualified Surgical Assessor will recommend that you make a plan with your doctor or nurse practitioner to address them. This can include managing acute or chronic health conditions, getting help with housing, or finding mental health supports that you may not already have.

This does not mean you will be denied surgery. Instead, you will be presented with ways you can work towards a safer surgery and recovery, reducing your chances of having complications.

Step 3

Choose a surgeon

In BC, chest construction surgeries are provided by several surgeons and you are able to choose your preferred surgeon.

Factors you might consider when choosing your surgeon include:

  • Surgeon’s wait time
  • Surgeon’s requirements regarding age, body mass index (BMI) and smoking status
  • Surgeon’s location and costs associated with out-of-city travel (transportation and lodging are not covered by MSP, however, you might qualify for the Travel Assistance Program or Hope Air).

To learn more about the surgeons, check out Meet the Surgeons.

If you have questions about a surgeon’s requirements or would like up-to-date estimates of wait times, you can call the surgeon’s office or Trans Care BC.

When your name is next on the central waitlist, Trans Care BC will contact you to talk about your choice of surgeon. TCBC will then send your information to the surgeon of your choice. The surgeon’s office will contact you to book a surgical consult.

Step 4

Surgical consult

A surgical consult is an appointment with your surgeon to talk about your goals for surgery and your options in terms of procedures. It’s also an opportunity for you to ask questions.

Tips for preparing for this visit:

  • Read up on different surgical techniques and common complications for chest construction surgery
  • Search online for before-and-after photos of each surgery type, including photos of people who have a body similar to your own.
  • Consider inviting someone to write notes so you can focus on the conversation.

What should I bring?

  • A pen for taking notes.
  • A list of your current medications and supplements (including traditional medicines, such as herbs and teas; vitamins; minerals; amino acids; and probiotics). Include the dose and how often you take them.
  • A list of questions you have for the surgeon.

Click this support tool to review both lists.

These lists are included in the Workbook for Chest Construction Surgery.

What to expect from this visit:

Each surgeon does things a bit differently, but generally the surgeon will:

  • ask questions about your gender, general health, and family history
  • ask you to remove your shirt and binder for a physical exam of your chest and underarm area
  • use a tape measure to record chest measurements
  • take pre-operative photos of your chest
  • check blood pressure

  • talk about possible surgical outcomes
  • give instructions for aftercare, including return to physical activity
  • ask you to get blood work done before surgery
  • depending on age and risk factors, the surgeon may ask for a mammogram or an anesthesia consult
  • you might book the date of your surgery, or the surgeon’s office will call you later with the date

Frequently-Asked Questions:

What if the surgeon recommends a type of surgery that is different from the one I want?

The surgeon will recommend the type of surgery that they think will provide you with the best surgical outcomes. Their recommendation is based on their extensive training, research, and experience.

If this is different from the surgery you want, you are encouraged to let them know. This will lead to a conversation about the pros and cons of the different techniques as they apply to your goals.

If you would like to have a consult with another surgeon to explore other options, you can contact Trans Care BC. Booking a consult with another surgeon will require extra wait time.

I have been referred for an anesthesia consult. What does this mean?

Before surgery, you will be given anesthesia. Some health conditions can put you at higher risk for complications from anesthesia. In this case, your surgeon may refer you to an anesthesiologist for further assessment.

Having a consult with an anesthesiologist is a normal part of the surgical process for many people. We are all complex beings and some of us need more support than others. The purpose for anesthesia referrals is to make sure all measures are taken to keep you safe both during and after surgery. Because there are a number of different of anesthesia options, meeting with the anesthesiologist will help determine which one will best suit you and your health needs.

The anesthesia consult can be different based on the provider, but the doctor generally looks at a number of factors, including blood pressure, Body Mass Index and the presence of other medical conditions such as asthma or diabetes.

Depending on these factors, some patients with higher anesthetic risks may need to have surgery in a hospital operating room (rather than a private surgical centre) for safety reasons. In this case, having surgery in the US may be possible by applying to the Out-of-Country program. If appropriate, a qualified surgical specialist can complete an application for Out-of-Country Surgery. Clients can call Trans Care BC for more information.

Waiting and having challenges accessing surgery can be stressful. Many people find it helpful to connect with others who have gone through similar experiences. You might meet people who have had gender-affirming surgery through friends, support groups, or online networks.You may also find it helpful to talk to a counsellor during this time.

If you are experiencing challenges accessing surgery, or if you have questions about this process, call Trans Care BC.

The waiting process:

Waiting and having challenges accessing surgery can be stressful. Many people find it helpful to connect with others who have gone through similar experiences. You might meet people who have had gender-affirming surgery through friends, support groups, or online networks. You may also find it helpful to talk to a counsellor during this time.

If you are experiencing challenges accessing surgery, or if you have questions about this process, call Trans Care BC.

How to Prepare (COVID-19 Disclaimer)

  • Buy, borrow, and do
  • Arrange help
  • Make travel arrangements
  • Make a self-care plan
  • Know What to Expect the Day of Surgery

Buy, borrow, and do

From post-op compression vests to prune juice, there are lots of items you’ll need to gather and prepare in advance of your return from surgery.

Check out this checklist of items to gather and prepare before surgery.

This checklist is included in the Workbook for Chest Construction Surgery.

Frequently Asked Questions

What costs associated with surgery are not covered by MSP?

While MSP pays for the cost of certain surgeries, there can be additional costs that are not covered. These include costs associated with:

  • Travel and accommodation
  • Supportive garments
  • Compression garments
  • Wound care supplies for dressing changes at home
  • Any extra supplies you would like to have while you heal
  • Costs associated with travel to and from your appointments

Important: You may want someone to travel with you. Keep in mind that this person’s travel and accommodations will not be covered by MSP.

How do people pay for the extra costs associated with surgery?

Here are some funding strategies people have used to cover these costs:

  • First Nations Health Authority benefits:
    • Individuals who are Indigenous, have status, and live in BC are able to access FNHA benefits.These benefits can provide coverage for gender-affirming resources, like binders and post-operative supplies, like compression vests.  To learn more about how to access gender-affirming products available through FNHA benefits, you can call the FNHA Benefits Program call 1-800-317-7878 and select option 2.
    • FNHA benefits can also cover the costs of travel, accommodation and meals when you need to travel for medically necessary care (including chest construction and revision surgeries). You can learn more about this by:
      • calling the FNHA Benefits Program call 1-800-317-7878 and select option 2
  • If you are on provincial disability assistance, you can contact the Ministry of Social Development and Poverty Reduction to discuss funding for travel,support garments and other medically necessary supplies. Your GP or NP can write you a letter of support to access these funds
  • Medical EI can be an option for individuals who are working and meet the eligibility criteria
  • Speak with your employer or Human Resources department about any Short Term Disability, sick time, or vacation time you can use during your time off work for surgery
  • Check your extended benefits program if you have one
  • Consider organizing online or in-person fundraisers

Arrange help

You’ll likely need some support after surgery. For example, you might need someone to help with meal preparation, childcare, elder care, laundry, pet care, or garbage and recycling.

Important: After surgery, you will need someone 18 years or older to escort back to your home or accommodations. You won’t be able to drive. You will also need someone to supervise you for 24 hours following surgery.

If you find it hard to ask for help, you aren’t alone. Many people have a hard time with this.

Fortunately, lots of people like to help. It gives the helper a chance to feel good and show they care.

People often feel flattered and happy to pitch in, especially if you ask for help with something specific.

Support Checklist

Here is a checklist that you can give to people looking for ways to support you before and after surgery.

The checklist is included in the Workbook for Chest Construction Surgery.

You can also send people to the Tips for Family and Friends page, in the Resource section.

Make travel arrangements

If your surgery is taking place outside your home community, you will need to arrange transportation and accommodations.


Book your mode of transportation (bus, air, rail, or ferry). If you are travelling by car, you will need someone else to drive you from the surgical centre to your accommodations and later on, back home.

If you qualify for the First Nations Health Authority’s Health Benefits Program, you may be able to access Medical Transportation Benefits.

If travel costs are a barrier, you might qualify for the Travel Assistance Program.

To access the program:

  1. Ask your doctor or nurse practitioner to fill out a Travel Assistance Program (TAP BC) form.
  2. Two weeks before surgery, call TAP BC to get your confirmation number. Write it on your form.
  3. Show your form at the time you make air, rail, or ferry reservations.

If you are approved for TAP BC, you may also qualify for Non-Local Medical Transportation Assistance to help with food and accommodation costs. Ask your doctor or nurse practitioner to fill out a Request for Non-Local Medical Transportation Assistance form.

If you qualify for the First Nations Health Authority’s Health Benefits Program, you may be able to access Medical Transportation Benefits.

If you are flying, find out if you qualify for Hope Air, a Canadian charity that arranges free flights for low-income Canadians who must fly to get healthcare. 

Otherwise, book your flight early to get the best deal.


Find out how long your surgeon requires you to stay nearby. Around three days is common. Book your lodgings early to get the best deal. Some hotels provide lower rates for people travelling for medical reasons. You can contact hotels directly or search the Government of BC’s Medical Travel Accommodation Listings.

If you qualify for Hope Air, you may also qualify for their Hope Air Accommodations Program- details are available on the Hope Air Frequently Asked Questions page, in the Accommodations section.

Frequently asked questions

I don’t have a ride home from the hospital– are there any patient transportation services available?

You are expected to arrange a ride when you are discharged from the hospital. If you do not have someone who is able to drive you, you have some options available:

I’m travelling by plane. What else do I need to arrange?

  • Ensure you have the necessary ID documents/passport.
  • Ask your doctor or nurse practitioner for a travel letter if you feel worried that your appearance differs from the picture on your ID documents/passport.
  • Ask your doctor, nurse practitioner or surgeon for a letter indicating that you just had surgery and should not raise your arms when going through security.

Make a self-care plan

It is important to follow your surgeon’s instructions for how to prepare for surgery. The information below is a brief summary and does not replace the information you receive from your surgeon. If there are any differences, you should follow your surgeon’s instructions.

You can reduce complications from surgery by starting the healing process beforehand. Below are some steps you can take before surgery to help your body recover. For most of us, these strategies are easier said than done. Remember that self-care includes doing what is manageable and trying to love ourselves no matter what. 

  • Enjoy foods that promote wound healing. Look for foods with protein (meats and nuts); zinc (whole grains, spinach, nuts); vitamin A (carrots, broccoli, eggs); & Vitamin C (citrus fruits, strawberries, peppers).
  • Do simple and fun exercises to build strength and support your heart and lung health, like dog walking, dancing, hiking, stretching or weight training.
  • Drink enough water to have clear, light yellow-coloured urine.
  • Get 7-9 hours of sleep each night. If you have any trouble sleeping, speak with your doctor or nurse practitioner about strategies for better sleeping.
  • Take time to slow down and relax before your surgery. Practice the deep breathing or coughing exercises, since this can help with relaxing and will speed up your recovery after surgery.
  • Work towards your personal health goals- this might include controlling blood sugar or improving anemia (low iron). Good iron stores allow you to heal better and have more energy when you go home. Maintaining blood sugar helps with wound healing after surgery.
  • Quit smoking. We know – it’s a big ask. Lung health is an important helper in healing, and smoking cigarettes can disrupt the healing process. This is why surgeons and healthcare providers recommend avoiding cigarettes before and after surgery. Smoking cessation supplies are provided at no-cost to people with MSP at any pharmacy in BC. If avoiding smoking for 2-3 months will be hard for you, call Trans Care BC for more information on your options.
  • If you smoke marijuana and going 2-3 months without it will be hard for you, consider switching to edibles, concentrates, or tinctures.
  • Other substances like methamphetamines, cocaine, heroin and alcohol also disrupt the healing process. It is recommended to avoid these substances before and after surgery. If you need help with this, your healthcare provider can help you make a plan.

Self-care planning exercises

Here are some holistic self-care planning exercises to help you prepare for before and after surgery. These exercises are also included in the Surgery Workbook.

Know what to expect the day of surgery

Below is description of what generally happens on the day of surgery. Each surgical centre is different, so your experience may vary.

  • Follow the instructions from your surgeon for when to stop eating and drinking.
  • Follow the instructions from your surgeon about bathing your chest.

  • Arrive at the surgical centre and check in.
  • You’ll get a wristband with the same name and gender found on your BC Services Card. If this is different from the name you use and your gender, you can ask for an extra “Name Alert” wristband with your correct name and pronouns. You can also ask for this information to be put on the front of your chart.
  • Spend some time in the waiting room until you are called.

  • You will either be taken to a room or a curtained area with a hospital bed.  There may be a chair for someone to sit with you (or you can ask for one).
  • A nurse will talk with you about what to expect. You’ll be given a hospital shirt to change into and a basket to hold all of your clothing, including undergarments. The nurse will remind you to remove your jewelry. You can ask the nurse any questions you have.
  • The nurse will check your blood pressure and may give you some pills or start an IV.
  • The surgeon will make some drawings on your chest to guide to the procedure. 
  • The anesthesiologist may visit you to talk about the anesthetic and answer questions.

  • You will be taken to the Operating Room.
  • The nurses will help you onto the surgical table and put on a blood pressure cuff and some monitors. The surgeon may ask you to confirm the name of the procedure you are receiving. The anesthesiologist will talk you through going under anesthesia.
  • Once the anesthesia has made you fall asleep, the surgeon will begin the procedure.

  • When the surgery is over, you will be taken to a recovery area. Nurses will monitor you closely until the anesthesia wears off. They will help you get out of bed, walk around, and go to the washroom. They can also call your supports at that time with an update.
  • You will likely be discharged from the hospital the same day. Before you leave, the nurse will give you papers containing your Discharge Instructions and maybe a prescription.

ATTENTION: During the COVID-19 Pandemic, having surgery may require extra considerations and safety precautions. Click here for the Planning for gender-affirming surgery in BC during the COVID-19 pandemic checklist.

Post-Surgical Care (Disclaimer)

  • Monitor your surgical site
  • Take good care of your body
  • Beat the post-surgery blues
  • Mindfully return to usual activities
  • Upper Surgery Patient Experience Survey

Monitor your surgical site

Signs of complications

Call your surgeon, doctor, or nurse practitioner if you experience:

  • Excessive wound redness
  • Excessive bruising or swelling
  • Excessive yellow or green pus-like drainage
  • The area around the incision is hot or hard and painful to the touch
  • Chills or a fever over 38.5 degrees Celsius (101.3 Fahrenheit) by mouth
  • Pain that is not relieved by prescribed medications or gets worse a few days after surgery

If necessary, go to the Emergency Room.

Bruising and swelling

It is normal to have bruising and swelling after surgery. You may have more swelling on one side than the other, and it can change throughout the day. It will go down gradually, taking up to 6 months to resolve.

Changes in sensation

It is common to have changes in sensation on your chest. You maybe less sensitive to pressure, temperature, pain, or sexual stimulation. It can take 6-12 months for the nerve endings to heal or grow back into these areas.  Once in awhile, you might even feel prickly, stinging, or burning sensations as the nerves heal and grow. There can be permanent changes to sensation, including areas of complete numbness.


Recovering from top surgery can involve some itchiness. Itchiness is caused by the reduction of swelling. It can also be caused by your compression garment or an allergic reaction to the adhesive in your bandages. If it’s accompanied by swelling and redness, itchiness can be a sign of infection. Ask with your healthcare provider how to manage this side-effect.

Incisions and scars

It is normal to have redness along the incision and sutures that can be seen or felt. Surgeons will often recommend that you avoid getting direct sun on your scars and nipples for up to a year, to help prevent colour changes on the scar tissue. Talk to your surgeon if you find that your scars are starting to thicken up.

Surgical revisions

Chest construction revisions are fairly common, especially if you had more chest tissue to remove or if you have less skin elasticity. Six to eight months after your surgery is complete, you and your surgeon can determine whether a surgical revision is needed. With a letter of recommendation from your surgeon, the cost of your revision will be covered by the BC Medical Services Plan.

Common reasons for a surgical revision include:

  • To improve contour (with liposuction)
  • To address scarring
  • To correct skin excess, bulges or puckering
  • To adjust the nipple-areola complex position or size

Take good care of your body

Get lots of rest

Plan to do less activity during the day and allow yourself to nap. Your body needs extra sleep while you are healing.

Relaxation techniques can help your body heal from surgery, too. They reduce the effects of stress on your body, letting your body’s systems focus on the healing process.

Limit arm movement

Do your best to limit your arm movements. Some people find it helpful to imagine they are a T-Rex. A T-Rex has short little arms that cannot reach far forward or be raised above the shoulders. To be like a T-Rex, keep your elbows at your sides.

Avoid using your arms to stand up, sit down, or get in and out of bed. You should also avoid lifting objects over 10 pounds. This will prevent pulling on sutures and stretching your scars.

Wear your compression vest

You will come out of surgery wearing a compression vest to help reduce swelling. It may feel uncomfortable over time, but it is very important to continue to wear the vest as directed by your surgeon.

If you have problems or concerns related to the vest, contact your healthcare provider.

Manage constipation

Constipation is a common side-effect of pain medication. If you experience this, try increasing the number of walks you take, drinking more water, eating more fruits and vegetables, eating prunes, or taking a stool softener. Get protein from food sources other than dairy.

If constipation continues for several days, call your healthcare provider.

Manage nausea

Experiencing some nausea and vomiting after surgery can be normal. You can try taking Gravol or ginger.

If it persists for several days, call your healthcare provider.

Manage pain

It is normal to experience a moderate amount of pain during the first few days after your surgery. Take your pain meds on time to keep your pain under control, manage stress, promote healing and decrease complications.

You may wish to use the pain medication tracking chart, featured in this support tool.

This chart is included in the Workbook for Chest Construction Surgery.

Empty your drains

It is common to have surgical drains inserted during top surgery. A surgical drain is a tube placed at the surgical site to allow fluids (like blood and pus) to leave your body. The fluid will collect in a plastic pouch.

Once the flow slows or stops, your surgeon, doctor, or nurse practitioner will remove the drains. The amount of time drains are needed varies from person to person.

You will be taught to regularly empty your drains into a small measuring cup and record the amount of fluid each time.

A drainage record sheet is provided in this support tool. This record will help your healthcare providers decide when the drains can come out.

This chart is included in the Workbook for Chest Construction Surgery.

Move to promote healing

Go for little walks after your surgery. Walking increases your blood flow, which speeds up the healing process.

If walking is not an option for you, or if you are lying down for long periods of time, leg exercises and breathing exercises will also increase your blood flow and support your healing.

See the Workbook for Chest Construction Surgery for exercise suggestions.

Attend your check-ups

You will make a plan with your surgeon for check-ups after surgery. Your health care providers will make sure your incisions are healing well.

They may ask about pain, bleeding, bowel movements, fever, and how you are feeling physically and emotionally.

Beat the post-surgery blues

The after-effects of medications, surgery and the activity limitations required during recovery can lead to something called ‘post-operative blues.’ This can include feelings of low mood, loss of appetite, difficulty concentrating and even self-doubt. This is a temporary and normal part of the healing period. Here are some suggestions for making it easier.

  • Put your self-care plan from your Surgery Workbook into action. See below.
  • Before surgery, ask yourself:
    • What does it look like when I start to feel low?
    • How will people know that I’m feeling that way?
    • Who can I share this information with in advance?
  • Make lists of things you love and reflect on how you can experience more of what you love while you heal from surgery (eg. lists of activities that bring you joy, ways that you connect with others, ways that you show yourself love, foods you love to eat, smells that calm & refresh you, sounds that inspire you, textures that you love to feel on your skin).
  • Write letters expressing thanks to people who helped you during surgery
  • Keep a journal

Self-Care Planning Exercises

Here are some holistic self-care planning exercises to help you prepare for before and after surgery. These exercises are also included in the Surgery Workbook.

Mindfully return to usual activities

Ask your surgeon when you can resume your usual activities, such as:

  • Taking a bath or shower
  • Going to work
  • Driving a car
  • Swimming
  • Participating in a sweat
  • Having a sauna
  • Playing instruments

  • Lifting more than 10 pounds
  • Exercising
  • Participating in rituals and ceremonies
  • Dancing
  • Sunbathing
  • Sexual activity

First 10 days after surgery

Avoid activities that can lead to elevated blood pressure. Increased blood pressure in this post-operative time frame increases the risk of internal bleeding (hematoma).

This includes:

  • Having any kind of sex (alone or with a partner)
  • Having an orgasm
  • Activities that create risks for bleeding, increase the risk of discomfort or pain or that may disrupt your anatomy while it heals. This can include:
    • Running (increases heart rate, can lead to elevated BP)
    • Biking (increases heart rate, can lead to elevated BP, extending arms to reach the handles)
    • Driving (extending arms to reach the wheel)
    • Walking a dog (risk of pulling on the leash)

First 4-6 weeks after surgery

  • Keep in mind that any activities involving another person (or a pet) are less predictable than those done on your own 
  • Avoid activities that can cause rubbing/shear on the incisions or nipple areola complex: this can cause infection, graft failure and inflammation of incisions, etc
    • Be careful about activities running, walking, biking etc, where a repetitive motion causes a garment to subtly rub over the healing tissue
  • Avoid activities that can lead to internal or external bleeding, compromised blood flow, and injury to nerves and healing tissues:
    • tiring and repetitive movements
    • activities that could affect (stretch/tear) incisions (inner or outer) until your surgeon confirms that your incisions have healed
    • reaching/extending arms
    • sudden or vigorous movements
    • lifting more than 10 lbs
    • strenuous activity (including certain kinds of sexual activity)
    • bondage, suspension, pinching, squeezing, vigorous massage
    • giving or receiving percussive activities, including flogging, spanking and paddling 
    • very hot and very cold temperatures until nerves have fully healed

More general information about returning to activity after surgery:

  • Follow your surgeon’s recommendations regarding return to sexual and other physical activities.
  • Ease back into your regular activities (shorter and less intense)
  • Pay attention to whether your swelling or tenderness increases after activity- if so, you may want to wait until you are a bit further along in your healing before trying that activity again.
  • You may find that your energy and stamina are different from before surgery. This is a normal part of your healing journey and will balance out over time.
  • You may find that your endurance or tolerance for different activities and sensations is affected by your surgery or pain medications. This is a normal part of your healing journey and will balance out over time
  • Stop or take a break if you feel pain, or you feel anxious or scared.

Sexual activity

Lots of people have questions about returning to sexual activity after surgery. This can include, but is not limited to, masturbation and sex with other people. The above recommendations apply to sexual activity. As with all other activities, speak with your surgeon about when it is safe for you to be sexually active after surgery. 

It can be helpful to speak with your surgeons before starting any BDSM activities in the months after surgery. Your surgeon will likely welcome these questions. If you are shy, you can be creative and ask about returning to full contact sports, swinging a tennis racket, receiving vigorous massage, riding a horse, using a heating pad or wearing restrictive or tight body-shaping clothing, etc.

Upper Surgery Patient Experience Survey

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Tell us about your experience through the Trans Care BC Upper Surgery patient experience survey and enter into a draw for a $25 Starbucks gift card.

Feedback will be used to improve the surgical experience for future clients in BC. Click here to take the survey.

ATTENTION: This section is to supplement what you receive from your surgeon. If there are any differences, you should follow the advice provided by your surgeon.


  • Tips for family and friends
  • Support tools
  • Additional resources
  • Guide feedback

Tips for family and friends

It can be very helpful for people having surgery to have support from family members and friends. This section is to learn more about how to help.

Support person

We suggest that everyone getting surgery ask someone to be their support person. The support person can coordinate a team of friends or family to help out. Here are some important things to know.

As a support person it will be important for you to also make sure you are taking care of yourself, in order to offer support to others. Here are a few considerations to help support people prepare. 

Considerations for support people

  • I have scheduled time to take care of myself (eat, shower, have some quiet alone time, participate in meaningful activities, go to work, etc).
  • I have a good sense of what to expect leading up to, during, and after my friend or loved one’s surgery.
  • I have spoken with my family or loved one and we have the same understanding about what kind of support I will be providing.
  • I feel as prepared as I can be to handle supporting someone after they have surgery.
  • I feel as prepared as I can be to care for myself during this time.
  • I have a plan for what to do if I feel stressed while my friend or loved one is healing from surgery.

Supporting someone having surgery

Here’s a checklist for people supporting someone having surgery. This checklist is also included in the Surgery Workbook.

Some helpful ideas for support

Help in advance

It can be a lot of work to prepare for surgery. Here some suggestions on how to help your friend or loved one leading up to surgery:

  • offer rides to and from appointments
  • offer to take notes during appointments
  • pick up supplies and helpful items
  • help prepare food and groceries
  • help coordinate a group of people that can prepare meals, help with chores and visit after surgery
  • ask if there are any specific ways you can support them as they get ready for surgery
  • remember that it can be hard to ask for help, so check-in regularly to see how they are doing and what they need

Take over some of their responsibilities

After surgery, your friend or loved one will not be able to take care many of their day-to-day responsibilities for many weeks. This includes physical tasks like household chores and taking care of family members or pets, as well as more subtle activities, like re-arranging pillows, putting fresh sheets on the bed and preparing food.

Doing these things or helping to organize friends who can help, is one of the best ways to support someone after surgery. Keeping a schedule to make sure these things are taken care of can be a huge help in avoiding restricted activities and focusing on resting and healing.

Be present after surgery

Letting people know you are thinking of them is a great way to show how much you care. This can include visiting them, bringing a card or some games,or simply sitting with them and watching a show.

When a person knows they are cared for, it reduces stress and helps with healing, and it also just feels good!

Be a positive distraction

Distractions help people manage pain, avoid boredom and recover more quickly.

This can include listening to an audio book together, going on walks, sending texts and pictures, and dropping in for short visits.

Take care of yourself

Caring for yourself is one of the most important things you can do as a caregiver. When your needs are taken care of, the friend or loved one you are helping will benefit too.

If you are a primary support person, it is important to regularly take time to be alone or to go out and do something you enjoy. There may be other people who would be more than happy to help out if they knew what was needed, so just ask.

Preparing yourself

Seeing someone you care about feeling pain or discomfort can be hard, and taking on extra responsibilities can, at times, be stressful.

This is a temporary and normal part of the process of care giving, and it can be made easier by reflecting in advance about what’s ahead and thinking of ways to also care for yourself during this time.

How to be there

It’s also helpful to remember that your role isn’t to be a magician and fix everything or make all pain or discomfort disappear – it is just to be with your friend or family member on their healing journey.

Just knowing someone understands can be a really big help. Even though it doesn’t “fix” anything, empathy creates connection and makes it just a little easier to live through the harder parts of healing.

Support tools

Here are the  worksheets, checklists, and exercises found throughout the chest construction surgery navigation guide. Most are included in the Workbook for Chest Construction Surgery.


Assessment Questions

Surgical Consult

Buy, Borrow, and Do

Self-Care Before

Self-Care After

Supporting Someone

COVID-19: Surgery Checklist

Day of Surgery

Track Your Medication

Track Your Drains

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