Chest Reconstruction Top Surgery Nipple Graft After Care

There is some variation to how surgeons prescribe dressing changes and care for the nipple graft after double incision chest reconstruction top surgery. 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.

First week after surgery

If you undergo free nipple grafting (FNG) you may come out of surgery with a special kind of dressing sewn onto the skin grafts to protect them called a bolster dressing. A bolster usually looks something like a yellow cauliflower or dumpling on each side of the chest. At your first postoperative appointment, if used, the bolsters will be removed and you will receive the following supplies from your care team.

• For procedures with nipple grafts: 8-day supply of oil-emulsion dressing (4 sheets)
  • You will cut each square into 4 smaller Use regular scissors that have been wiped with rubbing alcohol. You will use 2 small squares per day so that each sheet lasts 2 days. (Instructions for use are in the next section).
• 14-day supply of non-adherent pads
• Aquaphor Samples

Second week after surgery

• Remove dressings
• You may shower with water (soapy water is okay) running over the front of the chest, avoiding direct contact of the nipple grafts with the pressurized stream from the shower head
• Do not aggressively rub or scrub the chest
• Gently pat or air-dry the surgical site
• Complete 8 days of daily “wet dressings”
  • Apply a thin layer of Aquaphor to the oil-emulsion dressing squares you cut up (please apply to the pad, not directly on the nipple). Place the Aquaphor-coated oil-emulsion dressing directly over the graft.
  • Cover with a non-adherent pad over the nipple and secure with tape

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. That said, patients who undergo the nerve reconstruction top surgery, also known as a double incision with neurotization, can expect to recover heightened levels of sensitivity in the nipples by around 3-6 months post-op. It may take some patients longer for this to start happening. In the initial stages of nerve healing, it is normal for patients to experience uncomfortable sensations, like itchiness, stinging and tingling.

Regardless of the procedure you undergo, some top surgery patients report feeling some level of disconnection from their chests during the initial stages of nerve healing. Nerve rehabilitation exercises can help stimulate healing, encourage nerve regrowth and retrain the brain to recognize sensory input post-op. For more information about recovering sensation in the chest and nipple-areolar complex, click here.

How should I care for my nipple grafts?

One of the most important things in 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.