How Long Should I Continue to Cover My Nipple Grafts
Female-to-male (FTM) chest wall reconstruction, or "top surgery," is a gender-affirming procedure which involves removal of breast tissue and excess skin as well as repositioning and reshaping of the nipple-areolar complex (NAC). A variety of surgical techniques for transgender FTM chest surgery has been described. One well-described approach is the double incision mastectomy with free nipple grafts. The nipple-areolar complex is harvested as a full thickness skin graft. It can then be resized and repositioned to conform to a more masculine aesthetic. As there is little documentation regarding the healing process of free nipple grafts, it is common for patients to have many questions and concerns about "normal" postoperative recovery.
At the time of surgery, the original NAC is marked with a 25mm (approximately 1 inch) sizer and removed like a full thickness skin graft. It is then sewn into a new position, slightly lateral to the mid-chest along the inferior edge of the pectoralis muscle. The nipple graft is then fixed into place with a "tie-over" bolster dressing made of moist bacteriostatic gauze. This dressing prevents sliding or shearing of the nipple graft as well as prevents collection of blood or fluid under the graft. The bolster is left in place for 6-7 days, then removed in clinic. At this point, the nipple graft looks gray-brown but should have attached. Over the next 2 weeks, the top layer of the nipple graft will gradually peel off, leaving pink healthy nipple tissue underneath. Pigmentation to a typical brown color will occur over the next 1 year.
The following collage is photo-documentation of the typical healing process of free nipple grafts:
Day 7: The bolster is removed in clinic and the NAC looks gray-brown but is checked to confirm it is attached and that there is no infection.
Day 11: The top surface layer is beginning to peel or slough off. This is an expected part of the healing process. Healthy pink tissue can be seen underneath.
Day 13: The sloughing process continues.
Day 15: At least half of the top layer of epidermal tissue has exfoliated off.
Day 17: Most of the top layer has come off. The new pink nipple-areolar complex is seen underneath.
Day 18: The process continues.
Day 20: All of the top epidermal layer has come off; the new NAC is smaller and flatter, and will have permanent changes in sensation.
3-Months: The nipple graft is still pink but pigmentation is beginning to be seen as the cells that make melanin return over the next 3-6 months. Pigmentation can continue to be seen for up to 2 years after surgery.
This scientific research article was published on 4/26/20 inSage Journals byThe American Journal of Cosmetic Surgery by Dr. Won and E. Antonio Mangabut, M.D., titled "Free Nipple Grafts: What to Expect During the Healing Process."
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Source: https://www.drwoncosmeticsurgery.com/2020/05/01/what-to-expect-during-the-healing-process-of-nipple-grafts-female-to-male-chest-wall-reconstruction/
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