Navigation guide for chest construction surgery
(Site under development)
NOTE: Updates coming soon. Please see Trans Care BC’s Surgery page for some pathway and practice changes related to the new WPATH Standards of Care for the Health of Transgender and Gender Diverse People (Version 8) for gender-affirming surgical care.
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- Chest Construction – Procedures
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.
Procedures
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.
Keyhole
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.
Periareolar
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)
Hematoma
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
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
Seroma
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
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.
Keyhole
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.
Periareolar
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.
How to Access
Step 1
Connect with a practitionerStep 2
Readiness AssessmentStep 3
Choose a surgeonStep 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:
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 Trans Care BC’s Health Navigation team for help connecting 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 upper surgeries (chest/breast construction or reduction surgeries). 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:
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:
What should I bring?
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:
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:
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:
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.
Transportation
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:
- Ask your doctor or nurse practitioner to fill out a Travel Assistance Program (TAP BC) form.
- Two weeks before surgery, call TAP BC to get your confirmation number. Write it on your form.
- 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.
Accommodations
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?
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.
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.
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
ATTENTION: It is important to follow your surgeon’s instructions for aftercare. The information here does not replace the information you receive from your surgeon. If there are any differences, you should follow the advice provided by your surgeon.
Signs of complications
Call your surgeon, doctor, or nurse practitioner if you experience:
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.
Itchiness
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 your healthcare provider how to manage this side-effect.
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.
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:
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:
First 4-6 weeks after surgery
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.
More general information about returning to activity after surgery
Upper Surgery Patient Experience Survey
Have you had gender-affirming chest or breast surgery in BC since 2015?
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: It is important to follow your surgeon’s instructions for aftercare. The information here does not replace the information you receive from your surgeon. If there are any differences, you should follow the advice provided by your surgeon.
Resources
- 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
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:
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.
Assessments
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
Additional resources
Further information about gender-affirming surgeries and surgical complications can be found on the Trans Care BC website.
Additional helpful information and contacts:
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