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Dr. Hugh McLean
A Top Surgeon Specializing in

Top Surgery


What is chest contouring? Is it necessary?
Contouring is an elective procedure that patient may choose to maximize the appearance of their chest.
Dr. McLean has always tried to make his patients chests look masculine. This involves techniques beyond what is necessary to remove the breasts (mastectomy).
Contouring may involve internal sutures to shape the chest. These sutures also prevent the need for drains. Contouring may also include modified incisions or incisions extended beyond those required for mastectomy to produce the best shape or avoid dog ears.  It may involve alteration to the areas peripheral to the breast to blend the mastectomy and the rest of the chest. Liposuction may be a component of this. 
The contouring fee also covers most revisions that may be needed later such as reduction of dog ears.
What are the best pain management tips?
Everyone is different when it comes to pain or discomfort after surgery. The goal of pain management is to maintain an optimal level of comfort after your procedure. You will have much better results controlling your pain if you take pain medication regularly and don’t wait until you are having severe pain before you take something.
You will be given a prescription for the management of your post-operative pain. We recommended that you take your medication on a regular schedule. Ibuprofen (Advil or Motrin) may be added to your prescription after surgery.  Do not add Tylenol (acetaminophen) if your prescription already contains this. Reassess your pain regularly and try to decrease your dose after 48 hours. Please notify us of any drug allergies, reactions or medical problems that would prevent you from taking any prescribed medications. 
Narcotics also can cause or worsen constipation, so remember to increase your fluid intake, eat high fiber foods such as prunes and bran and make sure that you go regularly for small walks.  Senokot (laxative) or Colace (stool softener) may help with your constipation and may be purchased over the counter at your pharmacy. 
Cold compresses or ice packs may help decrease discomfort and swelling, but do not put it directly on the skin. During surgery, you may have had a tube in your throat which can cause some discomfort for a few days following your surgery. Cold drinks or ice chips often help. 
You will have a compression binder on after surgery. Keeping it up high on the chest will reduce swelling and provide comfort.
How do I take care of my incisions and wounds throughout my recovery?
The First Few Days:
Your incisions have both stitches and surgical tapes and will be covered by a gauze dressing and a latex-free compression binder. Do not remove the dressings after surgery. We will remove the initial dressings on your first post-op visit which is usually the next day after your surgery.  
1 - 2 Weeks Post Op:
After your graft sponges are removed you will be able to shower. You can wash your hair using shampoo and conditioner as usual and you can use soap to wash with. Don’t have the shower spraying directly on your chest but rather let the water run gently off it. 
When you get out of the shower, let the grafts dry by leaving them open to the air. When you are ready to get dressed, put a small amount of Polysporin ointment (not cream) on a piece of gauze and place it directly over the graft. Scar Gel should be applied on the double incisions.
After your graft sponges are removed, you should limit your activity for the next couple of days to prevent anything rubbing against them. The grafts heal very quickly and they love air! If you are sitting around at home watching TV, take everything off and let them breathe.  If you are getting up to do anything, put the dressings back on.  At this stage, it is all about protecting the new grafts. 
The binder should be worn over a top for the next 2 weeks. Without the binder, you will get more swelling, which can put stress on the incision. The binder must be worn at night to protect the grafts.
During this stage, the grafts may look pretty scarey but this is usually normal. Slight bleeding around the graft is also sometimes seen.  Yellow/brown discharge may also appear on the gauze dressings. It’s pretty much like when you fall off your bike and scratch your knee.  This is why it is good for the grafts to get air and dry out for short periods. These things are all normal and should be expected. 
3 - 6 Weeks Post Op:  
Many people return to work within three to six weeks after surgery depending on the type of work that you do. If you do a lot of heavy lifting or stretching, it may be better to take a little longer time to convalesce. 
Within 7 – 10 days, you may shower after the sponge dressings are removed if you have had the double incision mastectomy.  If you have had the keyhole procedure, you may be able to shower the next day. Be sure to hang the drainage tubes on a lanyard while you shower to make it easier for you to wash your hair.
Bruising and swelling are common after surgery. A low-grade fever that is less than 100 degrees Fahrenheit is also normal after surgery.
If you have had the “keyhole” procedure, you may have two Jackson-Pratt (JP) drains after your surgery. These drains are plastic tubes that are put in under the arm and go just under the skin to remove any fluid that might accumulate in the area where the breast tissue was removed. A bulb is attached to the end of the tube and should be emptied when the bulb is full.  You will be given a drain record sheet to write down the amounts drained from each side.  You will notice that the amounts emptied will usually decrease over the first few days. The fluid in the drains is usually bright red at first and may also be seen around the insertion point for the first couple of days.  The fluid tends to lighten up and even become clear yellow by the end of the week. Your nurse will teach you how to empty your drain. 
If you have had the “double incision” procedure, you will not have any drains.  You will have tiny sponges that are placed over the top of the areolar/nipple grafts that will be held in place with a compression dressing for 7 – 10 days.  There are usually no sutures to be removed. After the graft sponges are removed, the nipple will look quite strange.  Sometimes they are very dark and scabby looking and others are pink with fresh bleeding. Do not be alarmed by what you see as it is usually normal. We have excellent success with nipple grafts and rarely see complications with them. Remember, we all heal differently. 
If you have had a “double graft” where the nipple is a separate graft inside the areolar graft, the nipple graft itself usually takes much longer to heal as it is a thicker graft than the areola. This is because we want it to project a bit. Sometimes it is several weeks before the center nipple graft scab comes off.
Should I be working out before my top surgery procedure?
Working out is great! It builds muscle and helps to trim fat. If you want to have a muscular look after surgery, it’s great to start out with one, especially before double incision surgery. 
However, that does not mean you can’t work out after surgery and also get great muscles and a more masculine look. 
The one exception is keyhole surgery. After a keyhole you may be left with some loose skin and building your pecs after surgery could help fill it out. While it could be less productive to build the pecs preop go ahead with any other body part. 
How soon after my top surgery can I resume my regular workouts?
Immediately Post Op:
Avoid any strenuous activity, heavy lifting and vigorous exercise until we say so! Usually, by 6 weeks you are back to your usual routine. Walking is a great way to promote circulation and this can and should be done right away.
It is important to note that you will not be able to drive right after surgery while you are taking narcotic medication. 
1-2 Weeks Post Op:
2 weeks after your procedure, most of our patients are able to return to the gym to do moderate lower body exercise but with no full exertion. It is important to avoid any form of strenuous physical activity, including sexual intercourse, that may cause you to sweat or raise your blood pressure for at least 3 weeks after your operation (ie: any activity where it requires you to lean on your arms or uses your chest or arm muscles). 
3-6 Weeks Post Op
After 4 weeks, you may begin to re-introduce light cardio into your workout routine and daily activities, such as returning to the treadmill or elliptical units but still avoiding full exertion or any activity that involves the arms. 
The large majority of our patients start to feel more comfortable in their new body and experience less pain between 5 to 6 weeks after their operation. At this time, you can return to your normal exercise regime and participate in weight lifting but listen to your body! Pain is a very good indicator to stop a certain activity. The internal sutures can take several months before they dissolve so don’t be alarmed if you still feel pressure and pulling inside.
Who Would Want Top Surgery or FTM Chest Surgery?

Chest masculinization is requested by those who find that feminine breasts do not suit their perception of themselves. If you are FTM, transgender, gender fluid, or identify elsewhere in the spectrum of those who are uncomfortable with their breasts, you may want to consider top surgery.

When should I contact the clinic?
Contact us for the following problems and ask to speak with a nurse during the day, or the answering service in the evening:
Unusual pain that is not relieved by medication
What Will Top Surgery Do For Me?

Top surgery is designed to remove the breasts and create a masculine appearing chest. Whether it is a "double incision", "keyhole" or "periareolar" procedure the aim is the same: to help your body conform to your self-image. No procedure is able to assure that sensation is retained and the main difference in the procedures is the amount of scarring. People who have top surgery often say that they are finally able to get on with their lives, that they now appear the way they should, and that they are more confident in their role in life.

What should I eat and avoid after I have top surgery?
If you have any postoperative nausea, dry crackers and carbonated sodas can help settle your stomach. Start by drinking liquids and eating bland food such as apple sauce and bread, and if your body is able to tolerate this, slowly progress to a regular diet. During your recovery, we recommend avoiding salt and sodium intake as it may increase your swelling and prolong your recovery. We recommend eating fresh fruits, vegetables, and clean protein. If you are eating canned, boxed, or frozen food, ensure the sodium percentages are low. 
The consumption of alcohol can increase postoperative bleeding due to its dilation effects on the blood vessels. Avoid the consumption of alcohol until you have stopped taking prescription pain medication, as the combination of pain medication and alcohol can be dangerous. 
We recommend that you do not smoke during the first 3 weeks after surgery, as smoking reduces capillary flow in your skin and can hinder your recovery. 
How Easy is Having Top Surgery?

The McLean Clinic’s philosophy is that the achievement of personal goals should not be hampered by artificial barriers. Whether you want breast implants, breast reduction or chest masculinization, we try to make it easy. You are not required to be taking testosterone, for example. We use an informed consent process to qualify you for surgery. The procedure is performed in the privacy of our Mississauga cosmetic clinic and you are asleep. Our doctors and nurses have cared for hundreds of people who have had this surgery and are totally familiar with your needs. We do not use drains or tubes for the double incision procedure. We follow your progress carefully. If you have nipple graft dressings, they are removed after a minimum of eight days. You may bathe or shower, as long as the graft dressings are kept dry. We will supply you with the materials you need for dressings, and show you a simple way to use them.

What are the best tips for follow up care?
It usually takes anywhere between 3 to 6 months for the majority of swelling to dissipate and about a year for your scars to fully heal and mature. You will be able to participate in your regular workout regime and normal day to day activity, however, you should still refrain from strenuous upper body exercise until 6 months post-op. A follow-up appointment will usually be scheduled within this time frame to ensure your recovery process is going well and for us to check in and track your progress. 
The first year of your recovery is the most critical time to take care of your scars to ensure they heal optimally. This can be achieved by keeping them protected from sun exposure and by using our Skinmedica Scar Recovery Gel.
Is There Any Downside to FTM top Surgery?

All surgery has potential risks such as infection, bleeding, healing problems and adverse scars. A mastectomy is irreversible: a normal breast can never be restored. No procedure can guarantee retention of nipple sensation. Scars are permanent.

What is Top Surgery?
Gender is a topic that can generate a lot of confusion and a lot of discussion. Our clients may consider themselves transgender or may describe their gender in many other ways. Some are simply female. Some are genderless. No matter how they define their gender, there appears to be one constant theme: the female breast is unwanted. Their body image emphatically does not include the breast. This may be described by the general term, "breast dysphoria", avoiding the conundrum of “gender dysphoria”.
Top surgery is a cosmetic or reconstructive mastectomy and involves the surgical removal of the breasts in order to achieve a desired appearance. The aim is to make your chest look the way you want. FTM clients usually wish to masculinize their chest.  It is important for you to let Dr. McLean know what is on your mind. He will discuss the options with you, discuss the limitations of treatment, and help you realize your wishes as effectively as possible.
How Can I Make My Top Surgery Even Better?

Those who want a masculine appearance may choose to combine other procedures with top surgery. Liposuction, for example, can remove some unwanted curves.

Do I have to qualify for top surgery?

For us, the diagnosis of breast dysphoria is made by the patient, not the doctor, in the same way that a patient seeking breast enlargement is the one who diagnoses her own breasts as being too small. Therefore, the responsibility of the surgeon is to assure that the client is aware of the nature and purpose of the proposed procedure, its alternatives, limitations and potential consequences including risks and complications. This process is called "informed consent". When we are reasonably certain that your information is adequate to allow you to decide whether or not to have the surgery, then we can agree to do it for you.

When will I be back to normal?

Generally speaking, most clients are back to full activities within 6 weeks.

Day 1 should be restful with limited activity although we encourage walking.

During the first week, some activities may be resumed such as light housekeeping and preparing meals but with no heavy lifting or stretching.

After the grafts are taken down (after 8+ days) or the drains (for keyhole procedure) are removed clients may consider returning to sedentary work but should limit their physical activity.

After 2 weeks, most clients may return to the gym to do moderate lower body exercise but no full exertion.

After 4 weeks, most clients are back on the treadmill or elliptical units but still avoiding full exertion.

After 6 weeks, most clients are back to full activities but listen to your body! Pain is a very good indicator to stop certain activity.

It takes about 3-6 months for most of the swelling to go down and about a full year for scars to mature.

During the first year it is important to take care of your scars to achieve optimal healing. You can do this by keeping them out of the sun and by using our Skinmedica Scar Recovery Gel.

Am I a candidate for FTM top surgery?

In order to proceed with the FTM top surgery, you must be in good physical and mental health. Although we do not require psychiatric evaluations, you must have a complete physical examination done by your family doctor and have routine blood work prior to having FTM top surgery.

We do not discriminate against smokers although it is highly recommended that you quit or at least cut back prior to your surgery. Smoking may delay healing or cause other complications.

Please advise us of all medications that you may be taking including vitamins, herbs and dietary supplements. Most medications including testosterone do not interfere with FTM top surgery and may be taken right up until your surgery. We do recommend that you avoid Vitamin E, ASA, or ibuprofen products at least 2 weeks prior to FTM top surgery unless they have been prescribed by a doctor. If you have any allergies to anything (not just medication), please let us know.

Please inform us of any medical conditions or recent surgeries that you may have had to help us optimize your surgical experience. All breast tissue removed during FTM top surgery is sent to a lab for pathology which takes approximately 2 weeks for the results. These results will be available to you as well as copies to your family doctor.

For more information, call 1-866-766-9280.

What Does FTM Top Surgery Cost?

The cost of top surgery is $8000 CAD + applicable taxes.

What does my $8000 get me???

This amount includes:

How do I pay??

A 10% deposit is required to reserve your surgical date. The remaining balance is due 2 weeks prior to this day. We do not provide financing, however, we do assist with obtaining financing through the widely respected finance companies, Crelogix and Medicard. The rates for financing your FTM top surgery are usually more reasonable than using a credit card although some patients prefer to go to their own bank and apply for a line of credit.

After your consultation with Dr. McLean, we will provide you with a surgical quote that you can take to your own finance company or we can also assist you to use ours.