Nipple graft survival is one of the most common concerns after double incision top surgery. Although complete failure of nipple graft is rare in our practice, it is important to take note of the instructions for care after your gender affirming surgery to ensure proper healing and success of your nipple grafts. This article provides instructions on how to take care of your nipple graft based on a general top surgery recovery timeline.
There is some variation to how surgeons prescribe dressing changes and care for the nipple graft after 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 survive.
Your surgeon will remove the bolster at your follow-up visit about 7 days after surgery, after which time the patients should use a nonstick gauze (The Gender Confirmation Center 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. This should be changed once or twice daily, per your surgeon’s recommendation.
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 rather 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 grafts 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 swimming in the pool or taking a bath, until about 6 weeks after surgery.
One of the most important things in the early graft survival is to reduce the incidence of a “shear” force. A shear force is a sideways force across the surface of the graft, like if you were to 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.
Nipple and areola sensation 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 stable by 3 to 4 months after surgery and will continue to change and improve for approximately 2 years after surgery.