So you just underwent gender affirming top surgery because of your gender dysphoria. The double incision free nipple graft mastectomy was performed several days ago and you have been doing great. There is little discomfort and your chest is flat and beautiful!
Then you notice your postoperative surgical garment has a wet spot on it overlying where the nipples are. And, it is enlarging in size (photo A).
A.) The encircled area is typically where the wetness is seen.
What is going on?
Are my nipples leaking?
Should I be concerned?
Well, this actually is a real scenario. I have, in fact, received a few late-night calls over the years from worried patients who have experienced this exact situation.
Fortunately, as you will see, there is absolutely nothing to worry about here. It is actually normal though many patients either don’t notice it, disregard it or don’t experience it.
Why Do I Have a Wet Area on My Garment?
So are your nipples leaking?
No! Of course not. They can’t be since they were just put on as skin grafts and have no connection to the underlying tissue.
And to address another issue – this wet area is not a sign of an infection.
Instead, the cause of this wet area is the mineral oil used in the “bolus” dressing which secures and immobilizes the nipple-areola complex grafts in place (photos B and C). By minimizing any movement of the grafts, this “bolus” dressing provides superior conditions that allow for ingrowth of blood vessels into them. This is needed in order for the nipple areola complexes to survive.
B.) Bolus dressings covering the nipple-areola complex grafts at 10 days. The mineral oil in the cotton can seep into the overlying garment/sports bra resulting in the wet spot.
C.) Close up view of a bolus dressing which consists of cotton saturated with mineral oil.
The mineral oil used with the sterile cotton dressing often will spread to the surrounding areas, as it is a liquid, which can include the overlying garment which is worn over the chest in the postoperative period. The garment will just naturally absorb this moisture. This is more apparent with lighter color garments as compared to the black ones.
A way to reduce the risk of this being seen on your clothes is to place some gauzes on top of the bolus dressing which can absorb this fluid.
Can This Issue Occur with All FTM or FTN Top Surgery Techniques?
No.
This issue only occurs when a free nipple graft is part of the top surgery procedure. Typically, that means it may only occur with the double incision mastectomy with the free nipple graft technique. It is not seen when the double incision approach is performed without nipple areola complex placement or with any other technique.
Of course, this applies to how I apply the postoperative dressings. This may not necessarily apply to how another plastic surgeon applies their postoperative dressings.
Are There Other Causes of My Postoperative Garment Being Wet?
Depending on wound dressings and other factors, there can definitely be other causes for your postoperative garment to be wet. Typically, this would involve areas not directly over where the nipple areola complexes are. This can occur with all the different FTM/FTN surgical techniques. The most likely possibilities for this would be:
- There is leakage around your drain site.
- You are experiencing active bleeding.
- A hematoma has developed and some blood is leaking though the incisions.
- You have developed a seroma (fluid accumulation deep to the skin) and some of it is leaking out through the incision.
- A suture is coming out through the skin (“spitting” suture) leading to inflammation that is associated with some tissue fluid.
- There is an infection along a portion of the suture line.
If you are not sure what is going on, you should contact your plastic surgeon in order to get an answer.
Of course, try to avoid seeking that answer to your concern at 2am in the morning.
Just saying!
Your Top Surgery
If you have questions about the above or anything related to gender affirming top surgery or if you would like to schedule a consultation for top surgery, please feel free to contact the Arizona Center for Aesthetic Plastic Surgery. You can do this either by calling (480) 451-3000 or by sending an email.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
