Top Surgery Timeline

The process of undergoing chest reconstruction top surgery, formerly known as FTM top surgery, can seem like a daunting task. However, by understanding the steps involved and what to expect, you can feel more prepared and confident throughout the process. This article provides a general timeline of the steps you can follow in your journey toward your gender confirmation surgery. It covers important milestones such as scheduling a consultation, obtaining insurance approval, preoperative visits, and top surgery recovery, including instructions on care and follow-up visits. Once you’ve decided to pursue gender confirming surgery, the following is a general outline of the steps that you will follow in your transformative process: 

1. Request a consultation 

Schedule a virtual or in-person consultation to learn about surgery, discuss your expectations, and bring up any continuing concerns that you have about outcomes, recovery, or any other issues that might come to mind. If you have questions, make a list. If you have ideal results for your body type, gather photos to show your ideal surgical outcomes while keeping your body type in mind.

2. Complete the consultation

Your consultation may be in-person or virtual. You should feel fully informed and very empowered at the conclusion of the consultation process. All of your questions should have been answered without being rushed. You should have a good idea of what will happen from that point on and a general timeline for all the milestones that follow.

3. If needed, obtain insurance approval

If you are hoping to have insurance pay for your surgery, you’ll need to get approval. Our office will send codes and, if needed, a letter from your therapist. Our office uses the informed consent model and therefore doesn’t require letters of support from therapists (except for in the case of minors), but the insurance approval process usually requires it. We have a dedicated Insurance Concierge who handles the entire process of insurance approval for patients.

4. Schedule surgery

Once surgery has been approved by your insurance or you have decided to pay out-of-pocket, you can schedule your surgery date! If you are traveling for surgery you can plan travel, book airfare, request time off work for recovery, and if necessary, find accommodations.

5. Preoperative visit

About 3 weeks before surgery, you will have a preoperative visit where you can ask any additional questions you may have. You will sign consent forms that are part of the informed consent process. This visit can be virtual for patients who don’t live in the San Francisco Bay Area, or in-person if you live locally. If your visit is in-person, photographs will be taken. If virtual, photographs will usually be taken one day before surgery in The Gender Confirmation Center office. You’ll receive lots of information regarding what to expect around surgery, how to stay comfortable, what conveniences you should put in place to be ready for your recovery, medications to stop taking (if any), and your activity milestones after surgery. At the conclusion of your preoperative visit, you should feel 100% comfortable with all of the details surrounding the surgical process.

6. Photography appointment (out of town patients only)

For patients who don’t live in the Bay Area and have had their consultation and preoperative visit virtually, there will be an in-person visit with your surgeon 1 to 2 days before surgery. At this visit, your photographs will be taken and a physical exam will be done.

7. Surgery date!

Once your surgery is completed, you’ll recover for an hour or so and then be able to leave the surgery center or hospital. Rarely, patients are admitted to the hospital for one night and discharged the following morning.

8. Early recovery (up to day 6-7)

During this first week after surgery, you’ll need to take it easy and keep comfortable. Your body knows how to heal. If you have any questions, you can reach out to your surgeon. It’s extremely important that you attend the first postoperative appointment, which is usually 6 to 7 days after surgery.

9. First visit

On day 6 or 7 after surgery, you will have an appointment to see your surgeon. If you have drains, they will be removed along with all of the dressings. You’ll receive instructions about what to do next, including care for simple dressings, if needed.

10. Travel home (for out of town patients).

After that first visit, you can head home. It is a good idea to have help with any heavy luggage and make sure the trip is not too strenuous.

11. Subsequent follow-up visits

There is a routine schedule for follow-up appointments. These visits can be done in-person or virtually. If done virtually, you will use our secure and private patient portal where you can upload photos, ask questions, and quickly get responses from your surgeon.

12. Activity and recovery milestones

You will receive comprehensive information about your recovery process and resuming activity during the educational process around surgery. In brief, you should limit lifting to no more than 5 pounds until day 21 after surgery. On day 21, you can begin cardio activities such as running or cycling. You may then lift up to 20 pounds until day 42 (6 weeks) after surgery. After 6 weeks, there’s no limitation on how much you can exert yourself or lift. However, if you’ve had a procedure with a horizontal incision across the chest (double incision, buttonhole, inverted T, fish mouth), then it’s important not to lift your elbows above your shoulders for up to 3 months after surgery. This kind of movement can stretch your scars, causing them to thicken or widen. Most activities of daily life can be accomplished without lifting your elbows over your shoulders.