In the recent posting “Do Postoperative Activity Restrictions Reduce Risks for Thick Scars in FTM and FTN Top Surgery?”, I detailed the effects that various activities can have on the ultimate scar appearance. Recommendations were also made regarding activity restrictions in order to help facilitate obtaining more ideal scars.
Activities and various movement of our bodies can and do impact more than scar healing. They can also affect the healing process including the occurrence of postoperative complications and less desirable results.
Most people want to avoid complications and minimize the risk of their occurrence. The same goes for the final result – they want more ideal results, not less than ideal ones.
Below, we will explore recommendations and guidelines with regard to activities in order to help you achieve the best possible results while minimizing the risks of developing complications.
There is No One Correct Answer for Activity Restrictions
The recommendations and guidelines presented below are those presently provided to my FTM and FTN top surgery patients. They are based on science, years of experience, critical thinking and common sense. In some instances, patient financial concerns need to be considered – like returning to work in order to pay bills, buy food, etc.
Some of these may change in the future if I find that other approaches are even better.
The recommendations made here are based on science and “art”. Consequently, different guidelines and recommendations can be made by other plastic surgeons and they may be quite effective for them and their patients. There is not just one right answer for all of this. However, there are also inadvisable ones.
Individual Factors Can Affect Guidelines
Each person undergoing top surgery has their unique constellation of factors and variables that can ultimately affect their results. These must be factored in when making recommendations for activity restrictions. Some of these include:
- Mastectomy technique used
- Ethnicity
- Nutrition/Diet – normal versus vegan, vegetarian or other restricted diet
- Obesity – higher risks with higher BMI (obese)
- Age
- Smoking or vaping history
- Genetics
- General health – including diabetes
- Connective tissue disorders – like Ehlers-Danlos syndrome or Marfan’s
- Compliance with instructions
Restrictions on Repetitive Upper Extremity Activities
Engaging in repetitive upper extremity activities early on can increase the likelihood of developing a hematoma or seroma (fluid accumulation), impact wound healing, scar quality and jeopardize the revascularization of a free nipple graft. It is recommended to minimize these types of activities for around 4 to 6 weeks after surgery.
Common examples include doing dishes, vacuuming, cleaning your house or apartment and washing your car.
What are My Weight Lifting Restrictions?
It is recommended to avoid lifting more than 10 pounds for around 4 – 6 weeks after surgery – and this is occasionally. This weight is slightly more than that of a gallon of milk.
For substantially heavier weights, you should wait around 2 – 3 months.
Restrictions on Chest Workouts
Due to its effects on wound healing, scar quality, bleeding and fluid accumulation, you should wait at least 2 – 3 months before engaging in these types of activities and workouts. Three months is more ideal.
Those with higher risks related to wound healing and scar formation, more than 3 months is better. Examples are those individuals with diabetes, Ehlers-Danlos syndrome, are darker complected (black, Hispanic, Native American, Asian) or are a vegan or vegetarian.
Restrictions on Repetitive Reaching and Stretching
The recommendations for this are the same as the restrictions on chest workouts – ideally 3 months.
Recommendations for Specific Sports and Activities
- Walking – You can begin limited, slow walking the day of surgery. Casual walking thereafter is fine and even encouraged.
- Driving – It is recommended that you wait for your initial surgical dressing to be removed before driving. You also must be off narcotic pain medication, be alert and feel comfortable driving. Avoid driving a car with a manual transmission (rare nowadays) for 2 – 3 months.
- Getting in a pool – Once all the incisions have closed, the nipple-areola complexes are healed and any scabs on them have come off, you can completely submerge yourself in a pool. Ideally, that is around 8 weeks. You can get in a pool at 6 weeks but you need to keep it below your top surgery incisions. For the keyhole or concentric circle procedures, you may be able to submerge yourself by 4 – 6 weeks. Importantly, don’t go out in direct sunlight for around 9 months without scar protection that can include a sun shirt with an SPF greater than 50.
- Swimming – Avoid for 3 months
- Hiking – Avoid for 2 months
- Bicycling – Avoid for 2 – 3 months. For mountain biking – wait 3 months.
- Running or jogging – Ideally avoid for 3 months
- Softball, baseball, basketball, football, golfing, tennis – Avoid for 3 months
- Rock climbing, martial arts, boxing, archery – Avoid for at least 3 months
- Other activities – Ask!
- Returning to Work – This depends on the nature of your job and its requirements. For a relatively sedentary desk job this may be 2 – 4 weeks. If your job is a physically demanding one or where there is a lot of upper extremity activity, you may need to take off 3 months. Examples include being a barista at Starbucks, working in a warehouse (like Amazon), construction, painting and landscaping.
If you have any questions about your activity restrictions, please ask as they can impact your risks for complications as well as your long-term results.
Your Consultation
For more information on either FTM or FTN gender affirming top surgery or if you would like to schedule your consultation with me, Steven H. Turkeltaub, MD, please call our office at the Arizona Center for Aesthetic Plastic Surgery at (480) 451-3000 or contact us by email.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
