In this guide17 sections
- Key Points
- Does Top Surgery Hurt?
- What Does Pain After Top Surgery Feel Like?
- Top Surgery Pain Timeline: How Long Does It Hurt?
- Where Does It Hurt After Top Surgery?
- Is Nerve Pain Normal After Top Surgery?
- How Is Pain Managed After Top Surgery?
- What Painkillers Can I Take After Top Surgery?
- Do You Need Strong Painkillers After Top Surgery?
- How Should I Sleep After Top Surgery to Reduce Pain?
- How Long Do You Have to Keep Your Arms Down After Top Surgery?
- Is Keyhole Top Surgery Less Painful Than Double Incision?
- When Is Pain After Top Surgery Not Normal?
- Can You Have Long-Term Pain After Top Surgery?
- Frequently Asked Questions
- FTM Top Surgery in London
- References
Key Points
- Top surgery hurts less than most people expect. The usual description is tightness, pressure and soreness across the chest rather than sharp pain.
- Days 2 to 4 are often the worst. Pain then eases steadily, and over-the-counter paracetamol is usually enough from around day three or four.
- The sides of the chest and the armpits often ache most, where liposuction has been used to contour the chest, and drain sites can sting while drains are in.
- Zings, itching and numb patches are normal for weeks to months as the nerves in the chest recover.
- Take only what you have been advised to take. Some anti-inflammatory painkillers increase the risk of bleeding, so check with the clinic before adding anything.
- Pain that is getting worse, not better, is a warning sign. Call the clinic about sudden swelling on one side, spreading redness, a fever above 38°C or pain that keeps increasing.
Does top surgery hurt? Yes, there is some pain, but for most people it is more manageable than they fear. You are fully asleep during the operation, and afterwards most people describe a tight, bruised, heavy feeling across the chest rather than sharp pain. It is usually at its worst between days two and four, eases noticeably by the end of the first week, and by two weeks most people are back at a desk job and managing on simple painkillers or none at all.
This guide sets out honestly what pain after FTM top surgery feels like, a day-by-day and week-by-week pain timeline, which areas hurt most, how pain relief works, how technique affects pain, and the warning signs that mean you should call the clinic. For the full healing picture, including drains, the compression binder and nipple grafts, see our FTM top surgery recovery guide.
Does Top Surgery Hurt?
You will not feel anything during the operation itself. Top surgery at Centre for Surgery is carried out under TIVA (total intravenous anaesthesia), given by a consultant anaesthetist, so you are fully asleep for the two to three hours it takes. Most people go home the same day with a responsible adult, who stays with them for the first 24 hours.
The pain comes afterwards, as the anaesthetic medicines wear off and the chest begins to swell. Most people rate it as moderate at worst. In a 2025 study of 438 people having gender-affirming mastectomy with chest wall nerve blocks, average pain scores in the recovery room were around 3 to 4 out of 10, and only about 4 to 7% needed an extra prescription for stronger painkillers after going home[4]. Your own experience will depend on the technique, how much tissue is removed, whether liposuction or drains are used, and your own sensitivity to pain.
For many people the hardest part of the first week is the restrictions rather than the pain: sleeping propped up, keeping your arms down and wearing the binder day and night.
What Does Pain After Top Surgery Feel Like?
Pain after top surgery is usually tightness and soreness more than sharp pain. Common sensations include:
- Tightness and pressure across the chest, from swelling and the compression binder.
- A deep, bruised ache, like the stiffness after a very hard workout, especially along the sides of the chest.
- Pulling along the incisions when you reach, twist or lift your arms.
- Numbness across parts of the chest.
- Back, neck and shoulder stiffness from sleeping propped up on your back.
Sharp, stabbing pain that is getting worse, pain with sudden swelling on one side, or pain with a fever is not the normal pattern; see the warning signs below.
Top Surgery Pain Timeline: How Long Does It Hurt?
Healing follows a fairly predictable pattern. Your surgeon will give you advice based on your own surgery.
Day of surgery
You wake up groggy, tight and sore, with your dressings and compression binder in place, and go home with pain relief and written instructions. Many people feel surprisingly comfortable on the first evening, while medicines given during surgery are still working.
Days 1 to 4: usually the most painful
Swelling builds and the anaesthetic medicines have worn off, so days two to four are often the worst. Expect a constant ache, soreness at the sides of the chest and in the armpits, and discomfort getting up from bed or a chair. Take your pain relief regularly, as prescribed, rather than waiting for the pain to build.
Days 4 to 7: turning the corner
Most people notice a clear improvement by the end of the first week. Over-the-counter paracetamol is usually enough from around day three or four. Drains, where used, are removed within the first few days.
Weeks 1 to 2: soreness fading
Your first wound check is at 7 to 10 days. The pain is usually mild by now, and many people stop regular painkillers. Most return to desk work within about two weeks, and many drive again after one to two weeks, once they are off prescription pain relief and can wear a seatbelt comfortably.
Weeks 2 to 6: tightness, itching and zings
Most of what you feel now is tightness when you stretch, plus itching and occasional zings as nerves recover. Swelling settles over three to four weeks. Strenuous exercise and heavy lifting wait until about six weeks; our guide on working out after top surgery explains how to build back up.
3 months and beyond
Most people have no day-to-day pain by three months. Numb patches, occasional twinges and tight or sensitive scars are common and keep improving as scars mature over 12 to 18 months.
Where Does It Hurt After Top Surgery?
The middle of the chest is not always the sorest part. The areas that tend to hurt most are:
- The sides of the chest. In double incision top surgery, liposuction is used to contour the sides of the chest and reduce the risk of dog ears. This area often feels bruised and achy for one to two weeks.
- The armpits. Liposuction often extends towards the armpit, which is tender when you move your arms.
- Drain sites. Drains are used selectively. While they are in, the point where the tube leaves the skin can sting or pull.
- The incisions. The scars are often less painful than expected, partly because the nearby skin is numb at first.
- Your back, neck and shoulders, from sleeping propped up and holding your arms close to your sides.
Is Nerve Pain Normal After Top Surgery?
Yes. Top surgery inevitably stretches, bruises or divides small nerve branches that supply the chest skin. As they recover, it is very common to have brief electric zings, itching (sometimes intense, around the scars and nipples), burning or tingling patches, over-sensitivity to clothing, and numb areas that gradually shrink.
These sensations usually start a few weeks after surgery and are often strongest between one and four months. They are generally a sign that nerves are regrowing, and they settle with time. Once your wounds have healed and your surgeon is happy, gentle massage and touching the area with different textures can help over-sensitive skin get used to touch again. Our guide to nipple sensation after top surgery explains how feeling returns with each technique.
How Is Pain Managed After Top Surgery?
Pain relief is planned in layers. Medicines given during the operation help with the first hours, and you go home with pain relief to take regularly for the first few days. At Centre for Surgery we audit pain after surgery regularly, and our audits show that combining TIVA with local anaesthetic minimises, and often avoids, the need for opioid painkillers afterwards. A few principles make the biggest difference:
- Take pain relief regularly in the first few days, at the times you have been given. It is much easier to stay ahead of pain than to catch up with it.
- Use regular paracetamol as the base. It is usually enough on its own from about day three or four. Do not exceed the maximum daily dose, and remember some cold and flu remedies also contain paracetamol; the NHS guide to paracetamol for adults ↗ sets out safe doses.
- Use prescribed medicines exactly as directed, and step them down as pain eases. Stronger painkillers can cause constipation, nausea and drowsiness, so drink plenty of water and do not drive while taking them.
- Avoid alcohol while taking prescribed painkillers and in the first week.
- Keep heat off the chest. Numb skin can burn without you noticing, so avoid hot water bottles and heat pads.
What Painkillers Can I Take After Top Surgery?
Take only the medicines you have been given or advised to take, and do not add anything else without checking with the clinic. Some anti-inflammatory painkillers, including ibuprofen and aspirin, can increase the risk of bleeding, and bleeding under the skin (a haematoma) is one of the main early complications of top surgery. That is why you are asked to stop aspirin before surgery, and to stop ibuprofen unless directed otherwise. Fish oil, vitamin E and ginkgo can also affect bleeding. If your pain is not controlled by the medicines you have, call the clinic rather than adding something of your own.
Do You Need Strong Painkillers After Top Surgery?
Studies from other centres show that many people take some stronger painkillers for a few days, but not for long. In a 2025 prospective survey study in Plastic and Reconstructive Surgery Global Open ↗, 87.5% of 72 people who had gender-affirming mastectomy took some opioid painkillers, but they used a median of only 10 tablets, 94.4% also used non-opioid painkillers, and every respondent was satisfied with their pain control[1].
Researchers have studied several ways of reducing the need for strong painkillers after top surgery, mostly in the United States:
- Chest wall nerve blocks, such as pectoral (PECS) and erector spinae plane blocks, in which local anaesthetic is injected near the nerves that supply the chest. In a 2024 study comparing four approaches, nerve blocks reduced opioid use and early pain scores, but by the second day pain scores were similar whichever method had been used[2]. A 2025 study found blocks placed by the surgeon during the operation worked as well as blocks placed by an anaesthetist beforehand[4].
- Long-acting local anaesthetic placed in the surgical area, which one study linked with lower opioid use during surgery and at discharge[5].
The evidence is still limited. A 2025 systematic review in Regional Anesthesia and Pain Medicine ↗ found only four studies of regional anaesthesia for gender-affirming chest surgery, with mixed results, and concluded that the evidence is not yet strong enough to guide routine practice[3]. The 2024 study also found that taking testosterone did not change how much pain relief people needed during surgery[2]. Ask your surgeon and anaesthetist at your pre-operative appointment how your own pain relief will be planned.
How Should I Sleep After Top Surgery to Reduce Pain?
Poor sleep makes pain feel worse, and the first fortnight can be hard. These steps help:
- Sleep on your back, propped up at around 45 degrees, for at least the first two weeks. A wedge pillow, a stack of pillows or a recliner all work.
- Put pillows under each arm so your shoulders relax, and one behind your knees to stop you sliding down.
- Do not sleep on your side or front until your surgeon says it is safe.
- Take your evening pain relief on time, and keep water, medicines and your phone within reach.
To get out of bed, bend your knees, roll slightly without twisting your chest, and push up with your legs rather than your arms. Having someone to help in the first few days makes a real difference; our guide on supporting your partner through top surgery has practical tips for carers.
How Long Do You Have to Keep Your Arms Down After Top Surgery?
Keep your arms below shoulder height for the first two weeks. Raising them stretches the incisions and healing tissue, which hurts and can widen scars or encourage bleeding and fluid build-up. Keep your elbows close to your sides, wear loose front-opening tops, and move everyday items to waist or chest height before surgery. From two weeks you can usually start raising your arms gradually, if your surgeon agrees. Heavy lifting and upper-body exercise wait until about six weeks.
Is Keyhole Top Surgery Less Painful Than Double Incision?
Usually, yes, although the difference is one of degree. Pain depends mainly on how much tissue is removed, how far the surgery extends towards the sides and armpits, and whether drains are needed:
- Keyhole top surgery removes tissue through a small cut at the lower edge of the areola, mainly with liposuction, and drains are not routinely needed. Most people find it less painful than double incision.
- Periareolar top surgery removes a ring of skin around the areola and also avoids long chest scars.
- Double incision with free nipple grafts involves longer incisions, more tissue removal and liposuction to the sides of the chest, so the sides and armpits often ache more. Drains, where used, come out once the fluid output drops.
- Nipple-sparing double incision is broadly similar to double incision for pain. The inverted T variation more often needs drains, for around a week.
Larger chests usually mean more tissue removal and more swelling, so the first week can be a little harder. The right technique depends on your chest size, skin and goals, not pain alone; our guide to FTM top surgery options compares them in detail.
When Is Pain After Top Surgery Not Normal?
Normal pain gets steadily better after the first few days. Contact the clinic without delay if you notice:
- Sudden swelling on one side of the chest, which may feel tight, hard and painful. This can be a haematoma (a collection of blood under the skin). It is most likely in the first 24 to 48 hours and usually needs a return to theatre.
- Spreading redness or heat around a wound, or offensive discharge, which can be signs of infection.
- A fever above 38°C, or feeling shivery and unwell.
- Pain that is getting worse rather than better, or is not controlled by your medicines.
- Bleeding that soaks through your dressings, or a sudden change in drain output.
- A painful, swollen calf, which can be a sign of a blood clot.
Call 999 for chest pain that feels different from your surgical soreness, pain that is worse when you breathe in, or difficulty breathing.
For the first 24 hours after surgery you have your surgeon’s direct number. After that, call us on 020 7993 4849, 9am to 6pm, Monday to Saturday. Out of hours, call NHS 111, or 999 in an emergency.
Can You Have Long-Term Pain After Top Surgery?
Most people have no lasting pain, but some have occasional aches or twinges for months, and a small number have longer-term nerve pain. A 2021 Danish study in Transgender Health ↗ surveyed 84 trans men up to five years after mastectomy: 27.4% reported some persistent pain, but most described it as mild and intermittent, and non-opioid painkillers were enough for the few who used any. Four people (4.8%) had clear signs of nerve (neuropathic) pain[6].
Long-term pain after chest surgery is thought to come from injured nerves, small nerve bundles (neuromas) in scar tissue, and changes in how the nervous system processes pain[7]. If pain persists beyond about three months, or you have burning or shooting pain in one spot, mention it at your follow-up. Options include nerve-targeted medicines, scar treatment, desensitisation and, rarely, nerve surgery, which a 2025 meta-analysis found substantially reduced pain in people with persistent pain after breast surgery[7]. Scar tightness can also cause a pulling discomfort that improves with massage and time; our guide to top surgery scars explains scar care.
Numbness is different from pain. Numb patches are common and usually shrink over the first year or so, although some areas, especially around the scars and grafted nipples, may stay less sensitive in the long term.
Frequently Asked Questions
How painful is top surgery on a scale of 1 to 10?
It varies, but most people describe moderate pain at worst, peaking on days two to four. In one large study of people who had nerve blocks during surgery, average pain scores in the recovery room were around 3 to 4 out of 10. By the end of the first week, many people rate their pain as mild.
How long does pain last after top surgery?
The worst pain usually lasts three to four days. Most people are much more comfortable after a week, and by two weeks many no longer need regular painkillers. Tightness, itching and occasional zings can carry on for weeks or months as swelling settles and nerves recover.
Is it normal for your whole body to hurt after top surgery?
Yes, to a degree. Many people feel achy and tired all over for a few days. Lying still during surgery, sleeping propped up and holding your arms close to your sides can all cause back, neck and shoulder aches, which usually ease within a week or two. A fever or feeling increasingly unwell is not normal.
Can I take ibuprofen after top surgery?
Only if your surgeon has advised it. Ibuprofen and aspirin can increase the risk of bleeding after surgery, so take only the pain relief you have been given or advised to take. Paracetamol is usually enough from around day three or four. Check with the clinic before adding any medicine or supplement.
Does it hurt to have drains removed after top surgery?
Most people feel only a brief, strange pulling sensation as the drain slides out, lasting a few seconds. Drains are used selectively and, where needed, are removed within the first few days. Taking your usual pain relief beforehand can help if you feel anxious about it.
Why does my chest itch so much after top surgery?
Itching is very common and is usually a sign of healing nerves and skin. It often starts a few weeks after surgery and can be intense around the scars and nipples. Avoid scratching healing wounds. Contact the clinic if itching comes with redness, heat, a rash or discharge.
FTM Top Surgery in London
FTM top surgery at Centre for Surgery is performed by GMC-registered surgeons at our CQC-regulated Baker Street hospital, rated Good overall by the CQC, for trans men and non-binary people aged 18 and over. We offer double incision with free nipple grafts, nipple-sparing double incision, inverted T, keyhole and periareolar top surgery, all under TIVA as a day case, with written aftercare and pain relief advice, follow-up reviews and your surgeon’s direct number for the first 24 hours. No diagnosis or referral letter is needed, and the consultant who assesses you is the consultant who performs your surgery. Your initial consultation is £100, redeemable against the cost of surgery if you go ahead; our FTM top surgery cost guide explains what the price includes, and you can see real results in our top surgery before and after photos.
Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation
References
- Arivoli K, Kim GJ, Kenney B, Haley C, et al. Postoperative opioid prescription size and patient-reported consumption following gender-affirming mastectomy: a prospective survey study. Plastic and Reconstructive Surgery Global Open 2025;13(8):e7023. doi:10.1097/GOX.0000000000007023 ↗
- Sivakumar S, Kressel A, Mendonca R, Girshin M. Battle of the blocks: which pain management technique triumphs in gender-affirming bilateral mastectomies? Journal of Clinical Medicine Research 2024;16(6):284–292. doi:10.14740/jocmr5159 ↗
- Katsnelson G, Brenna CTA, Girón-Arango L, Abdallah YM, et al. Analgesic benefits of regional anesthesia in the perioperative management of transition-related surgery: a systematic review. Regional Anesthesia and Pain Medicine 2025;50(5):441–448. doi:10.1136/rapm-2024-105479 ↗
- Jagasia P, Battistini A, Kienzel S, Jordan S, et al. Analgesia in gender-affirming mastectomy: intraoperative pectoral blocks are equally effective as preoperative, ultrasound-guided PECS I/II blocks. JPRAS Open 2025;45:379–385. doi:10.1016/j.jpra.2025.06.023 ↗
- Edalatpour A, Seitz AJ, Warden AM, Gunderson K, et al. Outcomes of enhanced recovery protocols and tranexamic acid on double-incision versus periareolar gender-affirming mastectomy: a retrospective study of postoperative outcomes. Journal of Plastic, Reconstructive and Aesthetic Surgery 2024;88:360–368. doi:10.1016/j.bjps.2023.11.027 ↗
- Lang CL, Day DL, Klit A, Mejdahl MK, Holmgaard R. Low risk of persistent pain, sensory disturbances, and complications following mastectomy after gender-affirming surgery. Transgender Health 2021;6(4):188–193. doi:10.1089/trgh.2020.0070 ↗
- Nag S, Kennedy P, Aris K, Moore AM, et al. The role of nerve surgery in the management of post-breast surgery pain syndrome: a systematic review and meta-analysis. Annals of Plastic Surgery 2025;95(6):625–629. doi:10.1097/SAP.0000000000004516 ↗
Related Articles
- FTM Top Surgery Recovery and Aftercare
- Nipple Sensation After Top Surgery: Will You Still Feel Your Nipples?
- Supporting Your Partner Through Top Surgery: A Practical Guide for Carers
- Working Out After Top Surgery: When Can You Exercise Again?
