Top surgery scars: Prevention, healing, and more

Here's the quick truth: top surgery scars are normaland there's a lot you can do to support healing and reduce scar visibility. Your results depend on the surgery type, your genetics, and how you care for the scars in the first 12 months.

Below, you'll find clear scar prevention tips before and after surgery, a realistic healing timeline, and evidence-based options to fade surgery scarsfrom silicone and massage to lasers, injections, and revision. Take what serves you, leave what doesn't.

Scar types

One of the most common questions I hear is: "What will my top surgery scars look like?" Totally fairyour scars are part of your story, and it's natural to want some control over how that story appears on your skin. Different techniques create different patterns and lengths of scars, and surgeons tailor approaches to your body, chest size, skin elasticity, and goals.

Keyhole and periareolar: smallest, areola-border scars

If you're a good candidate for keyhole or periareolar, your scars are usually the most discreet. These techniques are often used for smaller chests with good skin elasticity. The incisions sit at the edge of the areola or are hidden around it, which can make them blend in with the natural color transition. Pros: shorter scars and less visible placement. Cons: they're not ideal for larger chests or when there's significant skin laxity, and revisions can sometimes be needed for contouring. Think of these as "minimal footprint" options that rely heavily on your baseline anatomy.

Ideal candidates; typical scar placement and length; pros/cons for visibility

Ideal candidates typically have smaller breast volume and skin that will retract well. Scars usually trace the areola border in a circular or semi-circular pattern. The advantage is subtlety; the trade-off is that not everyone qualifies, and nipple/areola repositioning may be more limited compared with larger-incision techniques.

Double incision: horizontal/curved chest scars

Double incision is common for medium-to-larger chests or when skin excess needs to be removed. Scars typically run in a gentle curve along the lower pectoral line on both sides. If free nipple grafts are used, there will also be small scars around the areolas. Visibility can be higher simply because the incisions are longerbut this approach often delivers the best contour for many people, especially if skin laxity or ptosis (droop) is present. It's a trade-off between shape and scar length, and for many, the trade is worth it.

Why larger incisions are used; nipple graft considerations; visibility expectations

Larger incisions allow surgeons to remove extra skin and create a flatter chest contour. Free nipple grafts can reposition the nipples for a natural look, though they may heal with color changes. Expect that scars will be visible early on, then fade and soften over 1224 months with consistent care.

Other patterns (fishmouth, lollipop, buttonhole, inverted T)

Think of these as "bespoke" patternsyour surgeon chooses them to balance scar length with contour goals. A lollipop (vertical plus areolar) or inverted T can help shape and lift; a fishmouth or buttonhole can maintain nipple attachments in certain cases. Each pattern has pros and cons in visibility versus contour smoothness. There isn't a single "best" methodthere's the best method for your body and your goals.

When surgeons choose these; trade-offs between contour and scarring

These patterns come out when anatomy or goals call for precise shaping with moderate scar lengths. They can reduce dog-ears (little skin puckers) and improve chest symmetry. The trade-off is visible scar lines that may not be as concealed as areola-only approaches.

What determines scar visibility beyond technique?

Technique matters, but it's not the whole story. Scar appearance is a team effort between your genetics, aftercare, and day-to-day choices as you heal.

Skin tone, genetic predisposition to hypertrophic or keloid scars, tension on wounds, infection, sun exposure, age, hormones

Some of us are simply more prone to raised or keloid scars due to genetics. Higher skin tension, infections, and sun exposure all increase risk of thicker, darker, or wider scars. Age and hormones (including testosterone) can influence skin thickness and healing speed, too. And yesincision tension from arm movement can affect widening. This is why following your surgeon's early movement guidelines matters.

Many clinics emphasize that keyhole or periareolar techniques may scar less in eligible patients, while double incision scars are often more visiblethis aligns with common surgical guidance and community experience (according to resources from the Gender Confirmation Center, relayed in their patient materials, which you can find under their "scar care" guidance). When in doubt, ask your surgeon to show you healed results across skin tones and body types.

Healing timeline

Let's set expectations up front: scars evolve. Early on they're red, firm, and sometimes a bit lumpy. That's normal. Over months, they remodel, flatten, and fade. Here's a friendly roadmap to remind you what's typicaland what you can do at each step of the scar healing process.

Week 03: Incision protection and swelling control

Your main job is to protect the incisions and reduce swelling. Keep dressings clean and dry as directed. A compression vest or binder (as prescribed) helps limit swelling and tension. Watch for infection red flags: increasing redness or warmth, fever, pus-like drainage, spreading pain, or a wound that opens. If anything worries you, contact your surgical team promptly. Rest, hydrate, and give your body the calm environment it needs to start rebuilding.

Compression garments, dressing care, infection red flags; align with surgeon guidance

Follow your surgeon's wear-time rules for compression and dressing changes. Short, slow walks help circulation. Sleep in a position that avoids pulling on the chestmany find a reclined setup helpful. And yes, let people help you with groceries, pets, or high-shelf items. Your future scars will thank you for keeping tension low.

Week 312: Start silicone and gentle scar massage (with clearance)

Once your incisions are fully closed (often around 23 weeks, but only start when your surgeon says "go"), begin silicone therapy and gentle massage. Silicone is one of the most evidence-backed tools we have to reduce scar thickness and improve texture. Massage helps mobilize tissue, break up adhesions, and desensitize tender spots. Start slowlyyour skin will teach you what it likes.

Why silicone helps; massage frequency and technique; manage sensitivity

Silicone sheets or tape create a hydrated, slightly occlusive environment that can regulate collagen production. Gels or sprays are great for tricky spots or if you're sensitive to adhesives. Aim for near-continuous wear with sheets/tape (1224 hours a day), changing as needed, or twice-daily gel applications. Massage for 13 minutes per area, 23 times daily, using small circles and gentle pressure. If the skin becomes angry or inflamed, pause and resetcomfort is your compass.

Month 312+: Maturation phase and fading

Now the slow magic happens. Scars soften, the redness cools, and the edges integrate more smoothly. This phase takes patience. Keep up silicone as long as the scars are active (often 36 months, sometimes longer). Continue massage and prioritize sun protection. If you're considering treatments like steroids, microneedling, or lasers, this is the window to book consults.

Sun protection rules; when to consider non-surgical treatments

UV exposure can darken scars and set back months of progress. Use SPF 3050+ generously and wear UPF shirts when outdoors. If you're using silicone sheets by day, apply sunscreen at exposed times or use gel when sheets are off. Consider non-surgical treatments if your scars are raised, very red, tight, or textured despite consistent care.

Experience tip: take a quick photo on the first of each month. Over time, those pictures tell a story your day-to-day eyes might missand it's motivating to see the subtle wins accumulate.

Pre-op tips

Good scars start before surgery. Think of pre-op prep as laying rich, fertile soil before you plant a garden. The surgical technique is the seed, but your body's healing capacity is the soil.

Optimize healing capacity

Protein is your building material; aim for steady intake across meals. Vitamin C and zinc support collagen formationwhole foods like citrus, berries, legumes, seeds, and lean meats are solid options. Keep blood pressure and blood sugar well-managed if applicable. Review medications and supplements with your primary care clinician; certain drugs (like some immunosuppressants) can influence healing.

Protein, vitamin C, zinc; manage blood pressure; review meds (e.g., immunosuppressants) with PCP

Consider a simple checklist: daily protein target, hydration goals, a produce-rich plate, and a supplement plan approved by your medical team. Small, consistent steps beat last-minute overhauls every time.

Stop nicotine and vaping

I get itthis one can be tough. Nicotine narrows blood vessels, cutting off the oxygen and nutrients your skin needs to knit together strong, flexible scars. If quitting cold turkey is hard, ask your team about tapering strategies, patches, or medications. Your future self will thank you for this one change alone.

Why nicotine restricts blood flow and delays healing; realistic taper options

Even "just a little" slows tissue repair. If a taper is realistic for you, plan it 46 weeks before surgery and stay nicotine-free throughout early healing. Put reminders in your phone. Recruit a buddy. Celebrate milestonesyou're doing something hard and worthwhile.

Plan for incision placement with your surgeon

During consults, talk about scar position, areola size and placement, and what's most important to you: stealth scars, symmetry, or a sharper contour line. Bring saved photos of results you like on bodies similar to yours. Surgeons appreciate clarityand it increases your chances of loving your outcome.

Discuss scar position, areola options, and your aesthetic goals

It's standard of care to do a thorough pre-op screening. Use that time to ask about your risk of hypertrophic or keloid scarring and to develop a personalized aftercare plan. You're the expert on your body; your surgeon is the expert on technique. Meet in the middle.

Post-op care

Let's keep it simple: protect, then remodel. In the first weeks, protect the incisions and keep swelling in check. Once you're cleared, begin the steady work of fading surgery scars with silicone, gentle massage, sun protection, and smart movement.

Compression and incision care (first 23 weeks)

Compression supports the scar healing process by reducing fluid build-up and tension. Keep incisions clean and dry. If steri-strips fall off early, ask your clinic what to do. Reach out immediately if you see signs of infection, increased drainage, or a wound that looks like it's opening.

Reduce swelling, protect wounds; follow surgeon's protocol

More isn't more. Don't overtighten compression or stack bandages. Follow the plan. And restgood sleep is free medicine.

Silicone therapy (from ~3 weeks with approval)

For top surgery scars, silicone sheets or long strips are convenient; gels or sprays shine for sensitive skin or curved areas. Some brands offer skin-tone options for a low-profile look under clothes. Aim for consistent, daily use for at least 812 weeks, and longer if scars remain active (red or raised).

Sheets/tape vs gel/spray; use-cases for top surgery scars; wear time; skin-tone options

Sheets/tape: great for long lines; they offer gentle pressure and hydration. Gel/spray: quick to apply and layer under sunscreen, perfect for workouts or hot climates. Rotate if your skin needs a break from adhesives.

Scar massage

When your surgeon gives the green light, start with light pressure and slow circles. You're inviting the scar to softennot wrestling it into submission. Over time you can add firmer strokes or gentle stretches across the scar line. Stop if it hurts or if the skin gets irritated.

When to start; gentle techniques; 23x/day; stop if painful/inflamed; products to use

Use a simple, bland moisturizer or silicone gel for glide. Two or three short sessions daily beat one long, intense session. Think patient persistence, not aggression.

Sun protection for 12 months minimum

UV light is like an amplifier for scars. Keep them covered or protected for at least a year. If you're using silicone sheets during the day, apply sunscreen when they're off and choose UPF shirts for outdoor walks. This one habit can dramatically reduce scar darkening.

SPF 3050+; UPF clothing; timing sunscreen vs silicone

Apply sunscreen 15 minutes before exposure. If you're switching between silicone and sunscreen, allow products to fully dry to avoid pilling or irritation.

Movement matters: avoid early tension, protect range of motion

In early healing, keep arms below shoulder height if advised. That limit helps prevent incision widening. Around week four (varies), your team may start a gentle, graded mobility plan. The goal is to protect your scars while preventing shoulder stiffnessa balanced dance that keeps you feeling good long-term.

Keep arms below shoulder for first weeks if advised; graded PT starting ~4 weeks to prevent stiffness; balance widening risk vs shoulder health

Consider asking for a PT-guided plan. Many clinics now share mobility progressions so you can reintroduce reach, rotation, and strength without overloading healing tissues (resources referenced by clinics such as the Gender Confirmation Center often outline these timelines, according to their patient guidance, rel="nofollow noreferrer" target="_blank").

Fade options

If you want to further reduce scar visibility, there are solid non-surgical treatments. None are magic wandsbut layered thoughtfully, they can make a meaningful difference. The best results come from realistic expectations and a series of sessions rather than one-and-done fixes.

Steroid injections for hypertrophic scars

For raised, thick, or itchy scars, corticosteroid injections can calm collagen overgrowth and flatten texture. They're usually spaced every 46 weeks, with a handful of sessions depending on response. Risks include thinning if overdone, so work with an experienced provider who treats post-surgical scars regularly.

How they work; typical series every 46 weeks; risks and benefits

These injections dampen inflammation, reduce scar volume, and often ease tenderness. They're especially helpful if you tend toward hypertrophic or keloid scarring.

Microneedling/microchanneling

Microneedling creates micro-injuries that nudge your skin to remodel collagen more evenly. Timing mattersmany surgeons prefer you wait at least 3 months, sometimes allowing microchanneling earlier around 68 weeks if the skin is stable. Expect a series of 36 sessions, spaced 46 weeks apart.

Collagen remodeling; start timing (surgeon clearance ~3+ months; sometimes 68 weeks for channeling); session counts

Think of it as telling your scar, "Let's reorganize the furniture." Over time, texture can smooth, and color may blend better with surrounding skin.

Light and laser therapies

Light-based devices can target redness and pigment, while fractional lasers tackle texture and thickness. Broadband light (BBL or IPL) can dial down redness; fractional lasers like non-ablative erbium or ablative CO2 can smooth and flatten raised areas. You'll likely need multiple sessions, and downtime variesask about sun precautions and pre/post care.

BBL for redness/pigment; fractional lasers for texture/thickness

These tools are powerful in experienced hands. Clinics that frequently treat top surgery scars can tailor settings to your skin tone and scar type for safer, better outcomes.

Medical tattooing and camouflage

Tattooing can restore areola color after grafts or camouflage light areas of scars. Wait at least 12 months so scar color and texture stabilize. Choose an artist with medical tattooing experience and a portfolio on your skin tone. Decide whether you want artistic nipple-areola complex tattooing or true camouflage blending.

Wait 12 months; color-matching for hypopigmentation; artistic vs camouflage goals

Good artists are part technician, part painter. Ask about pigment selection, fade patterns, and maintenance.

Protocols vary by clinic, and most results require multiple sessions, according to common dermatology and surgical guidance as well as community-informed organizations like Point of Pride, which share practical notes on massage, sunscreen, and silicone options for trans people (see their "scar care" resources, rel="nofollow noreferrer" target="_blank").

Scar revision

Sometimes, despite great care, scars heal with widening, puckering, or contour issues. Surgical scar revision can helpespecially when tension or tissue excess is the culprit. The goal isn't perfection; it's improvement that feels better to you.

Who might benefit

If you have recurrent dog-ears, tight banding that limits movement, or scars that widened due to early tension, you might be a candidate. A review with your surgeon can clarify whether a lower-tension closure or contour smoothing would meaningfully improve your outcome.

Tension-related widening, contour issues, functional restriction

When scars are functionally limiting or aesthetically very distressing, a targeted revision can be worth it. Many folks also pair revision with non-surgical options later for extra refinement.

Timing and outcome expectations

Most surgeons recommend waiting 612 months before revision so tissue settles. After revision, the same principles apply: protect early, then use silicone, massage, and sun protection to guide better remodeling. Expect an improvement, not invisibility.

Typically 612 months post-op; lower-tension closure; realistic improvement vs perfection

Ask to see before-and-after examples of similar bodies and skin tones. Seeing realistic results helps align expectations with what's possible.

Darker skin

If your skin tone is darker or richer, you're not alone in wondering how pigmentation might change after surgery. Let's talk about common patterns and proactive care.

Hyperpigmentation and hypopigmentation risks

Scars can darken (hyperpigment) with sun exposure or inflammation, and sometimes become lighter than surrounding skin (hypopigment) after grafts or procedures. Sun protection is your best friend here, along with silicone to calm ongoing inflammation. If hypopigmentation bothers you, camouflage tattooing may be an option once scars mature.

Sun protection, silicone, camouflage tattooing as options

Ask providers about device settings and tattoo pigment choices tailored to your skin toneexperience here really matters for safe, beautiful results.

Keloid-prone scarring

If you or close family members develop keloids, tell your surgeon early. Prevention is the focus: early silicone, consistent compression (if advised), minimizing tension, and sometimes early steroid injections if a scar starts to overgrow. In select cases, pressure therapy or silicone taping strategies can help guide flatter remodeling.

Family history, prevention focus; early silicone; consider pressure, steroids; when to refer to a specialist

If a scar looks aggressive despite these steps, a referral to a dermatologist or plastic surgeon with keloid expertise is wise. The earlier you intervene, the better the chance of calming the process.

Emotional care

There's the skin partand then there's the heart part. Your scars can feel like liberation, like a soft whisper, or like a complicated companion. Any feeling you have is valid.

It's okay to love them, minimize them, or feel both

I've heard people say their scars feel like constellationsguides they chose. Others prefer to reduce scar visibility to feel safer at work, in locker rooms, or around family. You can celebrate them and still want them to fade. You get to choose what feels right todayno permission slip required.

Community narratives; safety/visibility considerations

Listening to others' experiences can be soothing and grounding. Seek stories from folks with your technique and skin toneyou'll find everything from "I love them" to "I barely notice them now."

When to seek support

If your scars stir up anxiety, dysphoria, or grief, reach out. An affirming therapist, peer group, or surgeon who truly listens can make the journey lighter. You deserve comprehensive carebody and mind.

What experts say

Surgeons commonly recommend starting silicone once the incision is closed (often around 23 weeks), massaging gently for a few minutes several times a day, protecting from sun for at least 12 months, and considering treatments like steroid injections or lasers if scars are raised or red well into the maturation phase. Timelines and specifics vary by clinic, but the fundamentals are remarkably consistent across reputable sources. For example, patient education from gender-affirming surgery clinics reiterates silicone, massage, sun protection, mindful arm movement early on, and waiting several months before microneedling or lasers; community resources such as Point of Pride echo similar guidance and add practical, lived-experience tips around product choices, massage frequency, and emotional care (these insights are available in their public "scar care" guides, rel="nofollow noreferrer" target="_blank").

As always, your surgeon's protocol comes firstindividual healing, meds, and risk factors matter. Ask questions. Take notes. And if something feels off, speak up early.

Internal links

Want to go deeper? Explore our "Top surgery techniques" guide to compare approaches, bookmark the "Recovery timeline" and "Rehab guide" for week-by-week movement support, grab our "Scar care" PDF for step-by-step routines, and read about "Post-op pain and sensation changes" and "Nipple tattooing/medical tattooing" if those topics are on your mind.

Mini checklist

Pre-op: Protein-forward meals, nicotine-free plan, incision placement talk, meds reviewed.

Week 03: Compression as prescribed, clean/dry incisions, watch for red flags, gentle walks.

Week 312: Start silicone and massage (if cleared), gradual mobility, sunscreen.

Month 312: Keep silicone/massage as needed, consider treatments if raised/red, protect from sun.

Red flagscall your surgeon: fever, sudden increase in redness/warmth, pus-like drainage, severe or escalating pain, a wound that opens, leg swelling or shortness of breath.

Conclusion

Top surgery scars are part of healingand you have real tools to shape how they look and feel. Choose the technique that fits your goals, prep your body for recovery, and stick to the basics: protect the incisions early, then add silicone, gentle massage, and sun protection for the first year. If you want more fading, treatments like steroids, microneedling, lasers, and medical tattooing can help, and revision is an option later. And if your scars feel like a badge of pride? That's valid, too. If you're unsure where to start, talk with your surgeon about a scar plan tailored to your skin, health, and lifestyle. Your body, your pace, your choice.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.