All About Top Surgery Revisions: Stats, Causes, Costs and Tips
A Top Surgery Revision is a secondary surgery that improves or corrects aesthetic irregularities resulting from Top Surgery. As with other plastic surgery procedures, a revision performed after Top Surgery can improve results.
Top Surgery Revisions are fairly common. Recent academic studies about chest masculinization report revision rates of 12.5% to 63.1%:
- In total, 26.5% required secondary operations. 1
- The overall revision rate was 23.8 percent. 2
- Two patients [of 16, or 12.5%] have undergone supplementary surgery for axillary dog-ear revision and nipple reconstruction. 3
- Corrections were required for the scar in 14.0% of the patients, the contour in 28.0%, the areola in 15.8%, and the nipple in 5.3%. 4
According to TransCareBC, patients with more chest tissue to remove or low skin elasticity have a higher chance of requiring a Revision.
San Francisco surgeon Dr. Scott Mosser reports that just 3-4% of his patients wind up needing a Top Surgery Revision.
The common causes of Top Surgery Revisions are:
- Contour irregularities (extra tissue and/or skin, bulges, puckering)
- "Dog Ears" (extra tissue and/or skin that "puckers" out at the primary incision line as it goes around the side of the chest toward the back, in Double Incision Top Surgery)
- Nipple/Areola irregularities: size, shape, or symmetry
- Failed nipple graft
- Poor scarring
The Top Surgery technique you choose can influence your chances of needing a revision. For example, Double Incision Top Surgery tends to result in more significant scarring. Dog Ears can also be a problem with this technique. By contrast, Keyhole Top Surgery results in very little visible scarring but has a higher risk of nipple/areola asymmetry. Overall, Peri-Areolar Top Surgery carries the highest risk of requiring a Top Surgery Revision, as documented in many recent studies:
- Secondary operations occurred significantly more often [with] periareolar skin resection (37.5%) than techniques without skin resection (19.0%), inferior pedicle [Lollipop] (27.9%), and [Double Incision with Nipple Grafts] (20.3%). 1
- Patients who undergo chest wall contouring through a transverse inframammary fold [Double] incision have decreased rates of revision surgery and trend toward having lower complication rates as compared with periareolar and limited scar techniques. 5
- [Peri] was associated with more secondary corrections (38.5%) 6
- Secondary corrections were needed more often in the concentric circular [Peri] (55.2%) than in the transverse [Double] incision group (25.0%). 4
- There was a statistically significant difference in the rate of aesthetic revisions [for Peri] (34% versus 8.8 %). 7
- The overall revision rate was 23.8% (free nipple graft, 12.7%; concentric circular, 37%;). There were 3.3 times the odds of total complications and 4.0 times the odds of revision surgery [with Peri].2
Despite a higher revision rate for Peri-Areolar Top Surgery, researchers in Vancouver, Canada determined that aesthetic scores for the technique were superior to Double Incision for scar and contour.2 The potential for retained nipple/areola sensation is another reason why Peri-Areolar remains a popular choice.
Top Surgery Revisions are delayed 6-12 months after the original Top Surgery. This allows for maximum healing and improvement of results, lessening the extent of revision needed (if at all!)
The cost of a Top Surgery Revision varies according to your surgeon's revision policy. For example, Dr. Mosser's patients are not charged any additional surgeon's fee for revisions, as long as the revisions are "within the scope of the original surgery" and as long is the revision is performed within one year of the original surgery. Dr. Hope Sherie's all-inclusive Top Surgery pricing includes the cost of "minor revisions," though some material and anesthesia fees may still apply.
The cost of a Top Surgery Revision also varies according to the extent of revision needed and where the surgery is performed. Minor revisions can be performed under local anesthesia at your surgeon's office, reducing costs significantly. More extensive revisions must be done under general anesthetic, requiring the presence of an Anesthesiologist. In most cases, patients must pay for the anesthesia and operating room costs for their revision surgery.
Dr. Daniel Medalie, a long-time provider of Top Surgery in Cleveland, estimates that the cost of a Top Surgery Revision at his practice tends to be in the area of $500-$1000.
You may be able to get the cost of a Top Surgery Revision covered by insurance if you can provide evidence that the surgery is medically necessary.
While there are numerous factors—many completely outside your control—that ultimately determine whether or not you will need a Top Surgery Revision, there are a few things you can do to help improve your chances of not needing a revision:
- Wait and see! Time and healing may provide you with satisfactory improvement of your results.
- Get into the best physical shape that you can before surgery. Maintaining a healthy weight and doing some push-ups will make it easier for your surgeon to sculpt the contour of your chest.
- If you're having Peri-Areolar or Keyhole, you may wish to talk to your surgeon about having a nipple reduction done with your original Top Surgery, rather than having it done as a revision.
- Quit smoking. Smoking can cause nipple grafts to fail.
- Follow your surgeon's post-operative instructions. This will help you avoid complications and the poor scarring that can result from them.
In the end, Top Surgery Revisions are common. While it's good to avoid having any more surgery than is necessary, revisions can improve Top Surgery results dramatically and should be considered if you're not satisfied with your results. If it's any consolation, Top Surgery Revisions are almost always easier to get through than the original Top Surgery!
Dr. Javad Sajan describes a Top Surgery Revision from the OR:
References:
1. Masculinizing Top Surgery: A Systematic Review of Techniques and Outcomes.Wilson SC, Morrison SD, Anzai L, Massie JP, Poudrier G, Motosko CC, Hazen A. Ann Plast Surg. 2018 Feb 2. [Epub ahead of print]
2. A Review of 101 Consecutive Subcutaneous Mastectomies and Male Chest Contouring Using the Concentric Circular and Free Nipple Graft Techniques in Female-to-Male Transgender Patients.Knox ADC, Ho AL, Leung L, Hynes S, Tashakkor AY, Park YS, Macadam SA, Bowman CC. (Vancouver, British Columbia, Canada; and Chicago, Ill.) Plast Reconstr Surg. 2017 Jun;139(6):1260e-1272e.
3. Masculine Chest-Wall Contouring in FtM Transgender: a Personal Approach. Lo Russo G, Tanini S, Innocenti M. (Department Plastic and Reconstructive Microsurgery, Careggi Universital Hospital, Florence, Italy) Aesthetic Plast Surg. 2017 Apr;41(2):369-374. Epub 2017 Feb 7.
4. Chest-wall contouring surgery in female-to-male transgender patients: A one-center retrospective analysis of applied surgical techniques and results.Kääriäinen M, Salonen K, Helminen M, Karhunen-Enckell U. Scand J Surg. 2017 Mar;106(1):74-79. Epub 2016 Jun 23.
5. Female-to-Male Chest Reconstruction: A Review of Technique and Outcomes. Donato DP, Walzer NK, Rivera A, Wright L, Agarwal CA. Ann Plast Surg. 2017 Sep;79(3):259-263.
6. Surgical Indications and Outcomes of Mastectomy in Transmen: A Prospective Study of Technical and Self-Reported Measures. van de Grift TC, Elfering L, Bouman MB, Buncamper ME, Mullender MG. Plast Reconstr Surg. 2017 Sep;140(3):415e-424e.
7. Top Surgery in Transgender Men: How Far Can You Push the Envelope? Bluebond-Langner, Rachel M.D.; Berli, Jens U. M.D.; Sabino, Jennifer M.D.; Chopra, Karan M.D.; Singh, Devinder M.D.; Fischer, Beverly M.D. Plastic & Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 873e–882e.
Find links to these studies here »