There is some variation to how surgeons prescribe dressing changes and care for the nipple graft after FTM/N Double Incision chest reconstruction. However, the milestones for tissue recovery are about the same for healing, and therefore the instructions that are laid out here should be reasonably consistent regardless of the doctor who performs the surgery.
Within the first 7 days after surgery, there are dressings in place over the nipple graft called bolster dressings (which usually look something like a yellow cauliflower on each side of the chest). The bolsters serve to compress the graft against the patients’ tissue so that the grafts are more likely to take (survive). After the surgeon has remove this dressing, approximately at 1 week post-operatively, the surgeon will likely recommend some dressings on the nipple grafts to be changed daily or twice daily.
Dr. Mosser removes the bolster at your follow-up visit about 7 days after surgery after which time the patients should use a nonstick gauze (Dr. Mosser’s office provides a 7 day supply of a very nonstick material called Adaptec) and then this is covered with a typical nonstick bandage such as a large Band-Aid.
At day 14, the Adaptec is no longer necessary, but The Band-Aid type dressing is still applied, and is changed daily for 1 more week. Around day 10 to 14, you will see a thicker crusting that is initially present on the grafts but then flakes off. This is not the graft dying, but is just the outer layer of thickened skin flaking away. Beneath this there should be relatively healthy nipple graft tissue, surviving and thriving.
At 21 days, the graphs are very resilient. It is very uncommon for there to be problems after this period. However, you should not submerge the grafts in water for any length of time, such as a day swimming in the pool, until about 6 weeks after surgery.
One of the most important things in the early draft survival is to reduce the incidence of a “sheer” force. A sheer force is a sideways force across the surface of the graft, like if you were to somehow inadvertently rub your hand firmly across the surface of the graft. This can be especially problematic in the first 14 days after surgery, but it’s unlikely to cause any problems beyond 21 days after surgery. There are some changes that happen in the nipple graft even in the weeks to months following surgery. These changes can be a thickening of the graft or sometimes a thickening of the circular scar around the graft, or sometimes there are grafts which have temporarily lost their pigmentation, which will usually be regained over a period of months.
The sensitivity of the nipple area should gradually improve over time in the weeks to months following surgery. Sometimes sensation after surgery is heightened and sometimes it is decreased, but it usually is fairly normal by 3 to 4 months after surgery and will continue to stabilize for an entire 2 years after surgery.