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Understanding Reverse Top Surgery: A Guide to Detransitioning

| February 27, 2024 | , |

Close up photo of doctor showing silicone implant

Navigating the Journey of Reverse Top Surgery

Pursuing reverse top surgery can be an empowering yet challenging decision for those seeking alignment with their gender identity. For some, embracing one’s authentic self may lead to detransitioning and reconsidering medical transitions made in the past. If you previously underwent FTM top surgery and are now seeking reconstruction or augmentation, know that there is a range of options available to help you feel like yourself again. 

Detransitioning medically and socially poses many hurdles beyond your physical recovery. But you are not alone in facing them – we are here to champion you through each step with sensitivity, support, and care.

What is Reverse Top Surgery?

It is normal for gender identity and expression to fluctuate throughout your life, so some people come to the thoughtful decision to detransition after undergoing FTM top surgery. Reversal procedures involving breast reconstruction aim to restore and align your physical femininity with your inner sense of gender identity. The procedure typically requires breast implants to increase the size of the breasts. During a complex, meticulously planned operation, the implant material and size are carefully chosen to match the existing breast and tissue structure as closely as possible. The implants are placed under the chest muscle for the most natural look and feel.

The purpose is to restore the appearance of breasts, though they may feel and look different than your original ones. Outcomes depend greatly on existing skin, tissue, scarring from previous surgery, muscle integrity, and other factors that our team will consider during an in-depth consultation. While the breasts will not be exactly the same as they were pre-transition, our skilled surgeons work in tandem with patients to understand aesthetic goals and develop a customized surgical plan to create the most natural, proportional result possible within individual limitations.

Can I Detransition After Top Surgery?

The decision to detransition medically after gender-affirmation treatments like hormones and surgery requires careful consideration. Feasibility depends greatly on your unique medical history and a host of personal factors. 

Anatomically speaking, those with previous top surgery often have chest scars, skin grafts, and loss of glandular tissue that pose immense challenges to completely reversing prior procedures. Patients must set expectations accordingly – while skilled surgeons can reconstruct the appearance of breasts, they cannot recreate the original breasts or function. 

Those with complicating health issues may not be cleared as candidates. Factors like smoking, obesity, bleeding risks, chronic conditions, and inadequate tissue integrity can preclude surgery. We conduct in-depth health screenings to determine if detransition procedures are achievable. If you have any of the following conditions, you may not be a good candidate for reverse top surgery:

  • Obesity/high BMI: Excess weight makes surgery technically more difficult and raises risks of complications during and after surgery.
  • Bleeding disorders: Patients taking blood thinners or who have bleeding risks may not be cleared due to a high chance of post-op bleeding.
  • Autoimmune disorders: Diseases like lupus that can attack healthy tissue pose added risks of poor wound healing.
  • Insufficient tissue: Prior top surgery may have removed necessary tissue, making the remaining skin, fat, and muscle inadequate for reconstruction.
  • Certain chronic illnesses: We must clear patients medically; complex conditions like diabetes or HIV can complicate safe surgery/recovery.

The path of detransitioning should never be embarked on lightly. Our multidisciplinary team can provide thoughtful support for those who decide to detransition. We aim to clarify what is realistically achievable so patients can make profoundly personal decisions from a place of understanding and self-acceptance.

The Emotional and Physical Aspects of Reverse Top Surgery

Detransitioning and pursuing reconstructive surgery can be psychologically turbulent. Moving intentionally toward bodily changes that better align with your gender identity can bring up complex feelings before, during, and after surgery. Even positive growth can bring up feelings of loss and dysphoria. Speaking openly with counselors and loved ones for clarity and support is advised throughout the entire detransition process. Additionally, setting realistic goals for your body and life ahead plays a significant role in readiness and long-term satisfaction.

Psychologically, your evolution of self-identity calls for deep internal reflection as well as a network of external support. When considering this surgery, we encourage our patients to communicate effectively with counselors, loved ones, and support communities. While detransitioning may reflect inner truth for some, embracing this next external phase often brings new emotions to the surface that need to be explored internally. It is essential to explore all options available before choosing to surgically detransition. 

Post-Surgery Care and Recovery

The recovery timeline after reverse top surgery can vary from person to person, and it’s essential to note that individual experiences may differ. However, here is a general overview of what individuals undergoing reverse top surgery can expect during the recovery process:

Immediate Postoperative Period (First Few Days to Weeks):

In some cases, patients may stay in the hospital for a day or two immediately after the surgery, allowing medical professionals to monitor their initial recovery. Discomfort and pain are common during this time and can be managed with prescribed pain medications. Patients are advised to limit physical activity and movement during the first few days to weeks. Patients should carefully monitor their surgical sites for any signs of infection, excessive swelling, or unusual changes and report any concerns to their surgical team.

First Two Weeks:

Patients typically have a follow-up appointment with their surgical team within the first week or two to assess initial healing and address any concerns. Proper wound care is crucial during this period. Patients may need to change dressings and keep the surgical sites clean per the surgeon’s instructions. While some light activities may be permitted, heavy lifting and strenuous exercises are usually restricted during the initial weeks.

Weeks 2-6:

Swelling and bruising will gradually subside during this period, improving the overall appearance of the chest. Depending on the individual’s progress, they may gradually resume light activities and daily routines as their surgeon recommends. Patients are often advised on scar care, which may include the application of ointments or silicone sheets to promote optimal scar healing.

Weeks 6-12:

With the surgeon’s approval, patients can begin reintegrating more strenuous activities into their routine. As the physical healing progresses, individuals may also experience emotional and psychological adjustments. Consulting healthcare professionals, support groups, or therapists can be beneficial during this time.

Beyond 12 Weeks:

While most physical healing occurs within the first few months, the complete resolution of swelling and the maturation of scars may take several months to a year. Patients continue to have follow-up visits with their surgical team to monitor long-term healing and address residual concerns. By this stage, patients should be able to resume all normal activities, including exercise and physical activities, in consultation with their surgeon.

Choosing the top surgeons at Midwest Breast & Aesthetic Surgery means trusting a team who will be there every step of the way to guide you along your journey. We offer extensive patient resources to help prepare for surgery and life after surgery, including educational videos, patient stories, our podcast, and more. Our team performs hundreds of successful gender reassignment procedures each year, and we take pride in providing personalized care and achieving results that empower our patients on their transition journey, wherever it takes them.

*Our blog entries are written in order to further educate our patients and raise awareness towards topics related to plastic surgery. Any solutions offered on this blog are intended to help possible patients develop educated decisions before undergoing a consultation with our doctors.

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