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  • Writer's pictureIoannis Ntanos

Prepping for top surgery; here’s everything you need to know, by Ioannis Ntanos

There are different factors that are important, and you need to think about as you prepare for your top surgery. These include lifestyle choices as well as clinical factors, and despite the fact that they apply to everyone, they differ from person to person.



Weight Different surgeons may have different requirements when it comes to weight and the body mass index (BMI). This is a rather complicated subject because:

1. There seems to be a relation between BMI and the need for revision surgery; higher BMI is shown to be associated with higher risk of requiring a revision. Therefore, the choice of patients sometimes determines the risk of requiring a revision, and some surgeons may want to minimise that risk. 2. Higher BMI may affect the operation plan. Large BMI might come with a bigger chest, and in turn this might add time to the operation making the operating planning difficult. 3. There may be higher risk of certain complications occurring during and/or after surgery. A higher BMI may come together with increased risk of some perioperative complications, for example respiratory complications or delayed wound healing.


You should not attempt to lose weight rapidly for your operation. This is not healthy, it rarely works, and it can result in an eating disorder. If you need to lose weight to meet the criteria that your preferred surgeon uses in their practice, you will need to do this in a safe gradual way, with professional guidance, and combining a balanced diet with regular exercise.


You do not have to lose weight to match the assumptions that your preferred surgeon has of what an “acceptable” BMI is. Rather, you could look around on what options you have available and when relevant, moderate your expectations.


Some people will find the confidence and will to lose weight and exercise only after having top surgery, other people may never want to lose weight. Every possibility and choice are fine. You should not limit yourself by imprisoning your image to any stereotype.



Exercise Almost all of us know what a healthy lifestyle means. A healthy lifestyle will help you prepare better for a major operation like top surgery.


Developing an exercise routine prior to surgery will likely help you sticking to that routine after surgery, especially if your goal is to develop projected pecs for a more natural appearance. However, do not feel that you have to bulk up or exercise.


We are all different and it is important to work around your individual goals.


Some individuals will require some professional help, in which case you may consider a personal trainer.


There is recent guest post focusing on exercise consideration before and after top surgery.



Smoking Smoking is not an absolute contraindication for top surgery, but it significantly increases the risk of peri-operative complications. These can involve complications from the general anaesthetic, complications in the healing process, such as poor or delayed wound healing.


Quitting smoking for at least six weeks before and after surgery (in total 3 months), significantly increases the chances of a smooth and uneventful recovery. This is includes weed too, at least for the period leading to your operation.


Some surgeons will not accept smoking patients and they may consider a blood test to make sure this is not the case.


Testosterone Being on testosterone is not a prerequisite for having top surgery. Some surgeons will require you being on T for a certain period of time, before considering top surgery.


Testosterone does not have to be discontinued prior to the procedure.


If you are using T-gel, you should not apply it at the chest area on the day of the procedure. You can freely apply T-gel on things or shoulders.


If you are using injectable testosterone and the injection day coincides with the surgery date, you would need to consider having any injectables after the operation is completed.


If you wish to build up more muscle on your chest, being on testosterone will likely help, but in experienced hands it should make no difference in providing you with a flat/proportionate chest after surgery.



Other medical conditions and medications

Certain medical conditions and medications may affect the operation; not only they may interfere with the aesthetic outcome but may be necessary to adjust in preparation for surgery.


There are medications that you would need to discontinue (for example, Ritalin), other medications that would need to be changed (for example, blood thinners) and others which would need dose adjustment (for example, methotrexate).


If you take any medications, either systematically or occasionally, it is essential to speak with your surgeon and/or the anaesthetic team to ensure that your pre-operative preparation is timely and optimised.


Acute or chronic medical conditions may affect your experience after the operation. Everyone’s response to the major trauma of top surgery is unique; therefore, you should not take anything for granted. Someone else’s excellent or rough experience is not necessarily what you will be experiencing too, and what one may experience as good or bad may not necessarily be the same experience for you.


Some medical conditions may not be supported in certain hospitals/clinics. Make sure you discuss your medical history in detail with your surgeon.



Practicalities and support Before committing yourself to a date for your top surgery, make sure that you will have enough support for the immediate post-operative period. Be prepared that, at least in the beginning, you may feel exhausted with minimum exertion.


Make sure that you have made any necessary adjustments to your home or at the place where you will be recovering. This will allow your mobilisation and support you when you undertake certain activities, like washing.


You will need someone to be with you for the first few days, to help you if you need something and in case of an emergency.


Certain activities like arm overstretching and heavy weightlifting should be avoided for six weeks.


It is important for you to have access to your surgeon and know where you can seek care if you need to; make sure you that you know how to get in touch with your surgeon after surgery if required, and where the closest A/E department is in case you need it.

You should use common sense in making decisions that may affect the operation you are having. It is important that you continue to look after yourself. Top surgery is major surgery, irreversible and life changing. Prepare for it in all ways possible and avoid actions/activities that could jeopardize any plans that you have made with your surgeon. In case something changes, be in touch with your surgeon to make sure that there are any adjustments that are required before, during or after your operation.

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