Revisions of Top Surgery to Achieve a More Aesthetic Chest
I get contacted by many patients who have had FtM top surgery and are now seeking a revision of their chest. If they are my own patients seeking revision, the problems are almost always small and can be taken care of under local anesthesia in my clinic (touch up liposuction or dog ear revision). Usually when I am contacted by a patient who has had a procedure by another physician, the results are quite poor (because otherwise the patient would have gone back to his original surgeon), and the patient needs to go back to the OR for a successful outcome.
Below is the before and after photos of a patient who initially had his FtM top surgery by another surgeon. There is obvious loose skin and retained fatty tissue with stretching and distortion of the nipple areolar complex. I completely revised the scars and nipples by converting it to a full double incision with nipple grafting and was able to give him a much improved chest contour. He is shown two months after the surgery and is very happy with his early result. I would be happy to review any before and after photos a prospective patient wishes to send me, and I will do my best to give an idea of what might be necessary to improve the cosmetic outcome.
FtM top surgery can be life-changing, but not every patient achieves the result they envisioned the first time. Some experience concerns like asymmetry, visible scarring, or loss of nipple sensation. Understanding what revision surgery can accomplish helps you make informed decisions about your next steps.
At Cleveland Plastic Surgery in Beachwood, OH, Dr. Daniel A. Medalie is a board-certified plastic and reconstructive surgeon with over two decades of experience in advanced cosmetic treatments, including gender-affirming procedures. A Harvard and Cornell graduate, Dr. Medalie combines advanced surgical precision with an artist’s eye for symmetry. His unique background in photography sharpens his ability to create results that align with each patient’s goals.
When to Consider FtM Top Surgery Revision
While many patients are pleased with their first procedure, some may choose revision surgery to refine their results. Common reasons include asymmetry, scarring, or tissue irregularities that affect confidence and comfort. Typical concerns that revision surgery can address include:
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- Chest contour irregularities:Â Uneven or bulky tissue around the chest may require liposuction or excision for smoother results.
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- Asymmetrical nipple grafts:Â Adjustments can restore balance and improve aesthetic alignment.
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- Visible or raised scars:Â Surgical scar revision techniques can reduce their appearance and improve skin texture.
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- Loss of definition:Â Some patients seek additional contouring to refine the chest line or enhance muscle definition.
Each revision procedure is customized to your unique anatomy and prior surgical outcomes. During consultation, Dr. Medalie reviews your goals, evaluates tissue quality, and explains your surgical options in detail.
Correcting Asymmetry After Top Surgery
Asymmetry is one of the most common reasons patients pursue revision surgery. Even with experienced surgeons, differences in muscle mass or skin elasticity can affect healing. Revision procedures may include:
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- Liposuction for refinement:Â Removes excess tissue for a balanced chest shape.
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- Skin tightening:Â Addresses sagging or looseness, especially after significant weight change.
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- Nipple graft repositioning: Realigns the nipples for a natural, masculine appearance. This can be quite challenging if the grafts are too large or very much out of position and a patient may have to accept another scar to effectively re-position the nipples.
These refinements help create a more symmetrical and confident appearance while preserving prior surgical improvements.
When to Schedule Revision Surgery
Timing is key to safe and successful revision results. Most surgeons recommend waiting at least 6 to 12 months after your initial surgery before considering a revision. This allows scars to mature and tissues to settle fully. During your consultation, Dr. Medalie evaluates healing progress, discusses your aesthetic goals, and develops a personalized surgical plan.
Patients traveling from outside Ohio can coordinate virtual consultations and pre-surgical planning with Dr. Medalie’s patient care manager, Valerie at Valerie@ClevelandPlasticSurgery.com. This approach helps streamline the process and ensures continuity of care from consultation to recovery.
Begin Your Revision Journey with an Experienced Surgeon
If your first FtM top surgery did not deliver the outcome you wanted, expert revision care can help restore confidence. Contact Valerie at Cleveland Plastic Surgery at (216) 393-9924Â to schedule a consultation with Dr. Daniel A. Medalie. Discover how his artistic precision and experience in FtM top surgery revision can help you reach your goals.
Top Surgery Revision FAQ
Do I Need General Anesthesia?
Yes and No-Frequently smaller revisions such as scar correction or dog ear liposuction can be performed under local anesthesia in Dr. Medalie's office (he will also provide oral Ativan to help with anxiety during the revision). Larger surgeries with complete conversions to a Di (for example) need to be performed in the OR
How long does it take?
A typical in office revision takes around 1.0 to 1.5 hours and a typical in OR revision takes 1.5 to 2 hours.
What is the chance of infection?
I typically give my patients antibiotics on the day of surgery. Post operative infections are rare and are typically related to the dissolving sutures which can sometimes irritate the skin. Please be aware that smoking is the number one reason for post-operative infections and healing problems. I thus require my patients to STOP SMOKING/VAPING at least 3 months prior to top surgery revisions.
Are there bleeding risks?
During the surgery, local anesthetic is injected into the tissue using a tumescent technique-this blocks the sensation and also constricts blood vessels. As a result, there is very little bleeding during the surgery. I have NEVER had a patient have a severe bleeding complication post-op, but it is not impossible and a return trip to the OR may be necessary. No one has ever needed a blood transfusion for this procedure. Sometimes a patient will get a little bit of bleeding in the chest and not know it because of all of the dressings. This is called a hematoma and can be addressed under local in my clinic without a return to the OR
What is the recovery?
These are fairly well tolerated operations. Pain that may require narcotic pain medicine typically lasts 3-4 days. After that, ibuprofen (Motrin and Advil) is sufficient. I recommend that patients take at least 1 week off from work or school and driving. Liposuction or small scar revisions are obviously better tolerated than bilateral complete scar revisions with resection of retained tisue.
When can I resume my normal activity?
I recommend that patients refrain from exercise for at least 3 weeks after surgery. Even after 3 weeks, the incisions may be sensitive and patients need to use caution. Full activity including heavy lifting can not resume until the patient is 2 months out from surgery.
When will I be completely healed?
Some of the deep sutures under the skin can take up to three months to completely dissolve. For this reason, some patients may report sensitivity issues such as itching for up to three months post-op. Nipple and chest sensation may always be a little numb. Typically my patients have resumed full activity by 2-3 months. The final result including fading of the top surgery scars can take up to 1 year.
Can other procedures be performed at the same time as Top Surgery Revision?
Yes – I frequently perform multiple procedures on top surgery patients. Liposuction and tummy tucks are the most common simultaneous surgeries. I have frequently had revision patients contact me with a desire for a chest revision and also simultaneous body contouring to achieve a more masculine torso.
What does it cost?
The cost of top surgery revisions varies based on:
- Surgical location required (in office or OR)
- Duration of the procedure
- Procedures performed in his office are much less expensive because there are no anesthesia fees and the materials fee is much less than in the surgery center.
When you consult with Dr. Medalie he will explain your options and e-mail you a comprehensive price quote the same day that includes the top surgery, the anesthesia and the facility costs.
