In this guide12 sections
- Key Points
- What Do Top Surgery Scars Look Like?
- How Long Does It Take for Top Surgery Scars to Heal and Fade?
- Do Top Surgery Scars Ever Go Away?
- What Is the Best Scar Care After Top Surgery?
- Can Top Surgery Scars Stretch?
- Top Surgery Keloid Scars: Who Is at Risk?
- Top Surgery Scar Removal: What Treatments Can Help?
- When Should I Contact the Clinic About My Scars?
- Frequently Asked Questions
- FTM Top Surgery in London
- References
Key Points
- Top surgery scars are permanent, but most fade a lot. They usually start red and raised, then become flatter, softer and paler over 12 to 18 months.
- The technique decides where your scars sit. Double incision leaves two long scars along the lower edge of the chest muscles; keyhole leaves a small curved scar at the lower edge of the areola; periareolar leaves a ring around the areola.
- Tension is the enemy of a fine scar. Keeping your arms down early, wearing your binder and taping or silicone sheeting when your surgeon advises all reduce stretching and thickening.
- Silicone and sun protection have the best evidence. Silicone gel or sheets once the wounds have healed, and SPF 50 or clothing over the scars for at least the first three months.
- Keloid and hypertrophic scars can be treated. They are more likely in darker skin types and in people who have had them before, and steroid injections, laser and revision can all help.
- Revision waits until scars mature. Surgical scar revision and dog ear correction are usually considered from around 9 to 12 months, once the chest has settled.
No, top surgery scars never disappear completely, but for most people they fade into flat, pale lines that are far less noticeable than they look in the first few months. How they end up depends on three things: the technique your surgeon uses, how your skin tends to heal, and how well the scars are protected from tension, sun and smoking while they mature. Double incision top surgery leaves the longest scars, while keyhole top surgery leaves the smallest.
This guide to top surgery scars explains what the scars from each FTM top surgery technique look like, how long they take to heal and fade, what the evidence says about top surgery scar care (including taping and silicone), who is more likely to get keloid or hypertrophic scars, and which treatments can improve a scar that has not settled well.
What Do Top Surgery Scars Look Like?
Every technique leaves a scar. What varies is where it sits, how long it is and what shape it takes. Your surgeon recommends a technique based on your chest size, skin elasticity, droop and nipple position, and the scar follows from that choice.
Double incision top surgery scars
Double incision removes breast tissue and excess skin through two horizontal incisions, leaving two scars along the lower border of the chest muscles, usually curved to follow the natural line of the pecs. They may stop short of the midline or, in some chests, join in the centre, and they are longest in larger chests. With free nipple grafts there is also a circular scar around each grafted nipple, which often looks darker or patchy for the first few months.
Nipple-sparing double incision and inverted T scars
Nipple-sparing double incision leaves the same two horizontal scars along the lower chest, but there is no graft scar around the nipple, as the nipple stays attached. An inverted T (anchor) pattern, used for some larger or looser chests, adds a scar around the areola and a short vertical line running down to the horizontal scar.
Keyhole top surgery scars
Keyhole surgery removes tissue through a small curved incision along the lower edge of the areola, often with liposuction, and no skin is removed. The scar sits where the darker areola meets the lighter chest skin, which helps to hide it. It suits only small chests with firm, elastic skin, so it is not an option for everyone.
Periareolar top surgery scars
Periareolar top surgery is a different operation from keyhole. A ring of skin is removed around the areola, which tightens the chest skin and makes the areola smaller, so it leaves a circular scar right around the edge of the areola. Occasionally the scar stretches or the areola heals slightly larger or with an uneven outline, which can be refined later with a minor revision.
Top surgery without nipples
Some people choose a smooth, flat chest without nipples. The scars are then usually just the horizontal lines along the lower chest, with no scars around the areolas. Our non-binary top surgery page covers this and other flexible options.
How Long Does It Take for Top Surgery Scars to Heal and Fade?
The wound itself closes within two to three weeks, but the scar underneath keeps remodelling for much longer. A typical pattern looks like this:
- Weeks 0 to 2: the incisions are closed with stitches and dressings, and you wear a compression binder. Your first wound check is usually at day 7 to 10.
- Weeks 2 to 6: the wounds have sealed. The scars look thin but pink, and may feel tight or itchy.
- Months 2 to 6: scars are often at their reddest, firmest and most raised. This active collagen-building phase worries people most, but it is normal.
- Months 6 to 12: scars soften, flatten and lighten.
- Months 12 to 18: most scars have matured into flat, pale lines, so judge your final scar at around a year, not at three months.
Scars on darker skin often stay darker (hyperpigmented) for longer before they fade, while on lighter skin they tend to go from pink to silvery white. Our FTM top surgery recovery guide covers the rest of the healing timeline week by week.
Do Top Surgery Scars Ever Go Away?
Not completely. Any cut through the full thickness of the skin heals with scar tissue, which never becomes normal skin again. What changes, a great deal, is how the scar looks: a well-healed top surgery scar is usually flat, soft and close to your skin colour. In a 2026 cross-sectional survey published in JPRAS Open ↗ of 96 people who had gender-affirming mastectomy, mostly double incision with free nipple grafts, 86% said they were not embarrassed by their scars and 81% did not dislike them[1]. Many described their scars as a source of pride. Concerns, where they existed, were mainly about thickness, colour and length, and 19% reported a raised (hypertrophic) scar, which is why good scar care in the first year matters.
What Is the Best Scar Care After Top Surgery?
No product guarantees a fine scar, but a few simple measures have good evidence behind them. Always follow the plan your surgeon gives you.
Weeks 0 to 2: wound care
Keep the dressings clean and dry until your wound check unless told otherwise. Do not pick at scabs, avoid creams or oils on open wounds, keep your arms below shoulder height and wear your compression binder, usually for six weeks.
Taping and tension reduction
Tension pulling across a healing incision is one of the main triggers for scars that widen or thicken. Supporting the scar with tape reduces that pull. In a 2005 randomised controlled trial in Plastic and Reconstructive Surgery ↗, 41% of people whose caesarean section scars were left untaped developed a hypertrophic scar by 12 weeks, compared with none of those who applied paper tape to their scars for 12 weeks[2]. Some of the taped group developed thicker or stretched scars only after the tape was removed, which supports the idea that tension is the trigger.
More recent evidence points the same way. A 2026 systematic review in JPRAS Open ↗ of 14 studies found that taping surgical incisions after closure improved how the scars looked compared with no treatment, and that low-cost microporous paper tape may give results similar to silicone sheets[3]. Your surgeon will tell you whether to use paper tape, silicone tape or sheets, and when to start; stop and let us know if tape causes a rash or blistering.
Silicone gel and silicone sheets
Silicone is the most widely recommended first-line treatment for preventing raised scars. It is thought to work by keeping the outer layer of the scar hydrated, which calms the overactive scar-forming cells underneath. A 2022 systematic review and meta-analysis of randomised trials found that silicone gels had both a preventive and a treatment effect on hypertrophic scars, although many trials were at risk of bias[4].
- When to start: only once the incisions are fully closed with no scabs, and your surgeon agrees. After top surgery this is usually from around six weeks.
- Sheets or gel: sheets and silicone tape suit long, flat scars such as double incision scars and add a little tension support; gel is easier around the areola and under clothing.
- How long: wear sheets for 12 hours or more a day, or apply gel twice daily, for at least three months, and longer if the scar is still red or raised.
Our article on whether silicone strips help scars heal explains how to apply them correctly.
Sun protection
Ultraviolet light can darken a young scar permanently, particularly in darker skin. Keep your scars covered with clothing, or use a broad-spectrum SPF 50 sunscreen on them, for at least the first three months, including on holiday and on cloudy days. Sunscreen should not go under silicone sheets, so use one or the other at a time.
Scar massage
Once the wounds have fully healed and your surgeon is happy, a few minutes of gentle massage a day can help a firm scar soften and stop it sticking to the tissue underneath. Use slow circles along the scar with a fragrance-free moisturiser or the silicone gel. It can also ease the itchy, over-sensitive feeling that is common as nerves recover.
Stop smoking and nicotine
Nicotine narrows the small blood vessels that heal the wound and feed nipple grafts, raising the risk of wound breakdown and poorer scars. We ask everyone to stop smoking, vaping and all nicotine products for four weeks before and four weeks after surgery. Vitamin E, onion extract and bio-oils are popular, but the evidence for them is weak, and they are no substitute for silicone, tension support and sun protection.
Can Top Surgery Scars Stretch?
Yes. Widened scars are a common concern after double incision, where the scars run across the lower chest and are pulled every time you lift or stretch your arms. Stretching happens gradually over the first three to six months, while the scar is still weak. You can reduce the risk by:
- keeping your arms below shoulder height for the first two weeks and avoiding big overhead reaches until your surgeon says otherwise;
- wearing your compression binder for the full six weeks;
- avoiding heavy lifting, push-ups, pull-ups and chest-focused gym work until about six weeks, then building up gradually;
- using tape or silicone sheets across the scars when your surgeon advises.
Our guide on when you can work out after top surgery sets out a safe return to the gym.
Top Surgery Keloid Scars: Who Is at Risk?
Most top surgery scars that look thick at three months are simply immature and will settle. A small number become abnormal raised scars:
- Hypertrophic scars are raised, red, firm and sometimes itchy, but stay within the line of the incision. They often improve over a year or two and respond well to treatment.
- Keloid scars grow beyond the edges of the incision into the surrounding skin, rarely improve without treatment and can come back after removal.
The chest is one of the areas most prone to raised scars, partly due to the constant movement across it. The risk is higher if you or close family members have had keloids before, including from piercings, if the wound becomes infected or breaks down, and in darker skin. A 2025 review noted a higher burden of hypertrophic and keloid scarring in people with skin of colour, usually described as Fitzpatrick skin types IV to VI[5].
If any of these apply to you, tell your surgeon at consultation. It may influence the choice of technique, and it means your scars can be watched closely and treated early. Our article on whether hypertrophic scars go away explains how these scars behave over time.
Top Surgery Scar Removal: What Treatments Can Help?
No treatment can remove a top surgery scar completely, but several can make a raised, red, wide or uneven scar much less noticeable. At Centre for Surgery, scar revision covers steroid injections, laser scar treatment and scar revision surgery, used alone or together depending on your scar and skin type.
Steroid injections for raised scars
Injecting a corticosteroid directly into a hypertrophic scar or keloid reduces inflammation and slows the overproduction of collagen, so the scar flattens and softens. Injections are usually repeated every four to six weeks over a few sessions. In a 2025 systematic review comparing treatments for hypertrophic and keloid scars, triamcinolone, the corticosteroid most commonly used, gave the greatest reduction in scar scores of the treatments compared[6]. Injections can start before the scar is fully mature, often as soon as a scar looks like it is becoming abnormally raised.
Laser scar treatment
Laser treatment can improve a scar’s redness, texture and thickness, and can be combined with injections. International consensus recommendations published by 26 dermatologists and plastic surgeons describe lasers as a first-line therapy for scars after injury, with special considerations for treating darker skin types[7]. A course usually involves a few sessions several weeks apart, and laser can start sooner than surgical revision.
Scar revision surgery
A scar that is still wide, stretched or puckered once mature can be cut out and closed again with careful attention to tension, replacing a noticeable scar with a finer one. Surgical revision is usually considered from around 12 months, and minor revisions are usually short day-case procedures. Scar refinement is common after top surgery: in a 2026 cohort of 100 people having gender-affirming mastectomy, scar revision was the most frequent later issue, and most problems were managed as outpatients, with minor revisions done under local anaesthetic[8].
Dog ears at the end of the scars
Dog ears are small folds of skin and fat at the outer ends of double incision scars, near the armpit. They often flatten as swelling settles; if they remain after 9 to 12 months, a minor revision can correct them. Read more about dog ears after surgery.
When Should I Contact the Clinic About My Scars?
Contact us if a wound opens or oozes, if redness, heat or discharge suggest infection, or if a scar starts growing beyond its original line or becoming more raised and painful after the first few months. In the first 24 hours after surgery you have your surgeon’s direct number; after that you can call us on 020 7993 4849, 9am to 6pm, Monday to Saturday. Out of hours, call NHS 111, or 999 in an emergency. Your surgeon review at six weeks and assessment at three months are also good times to raise any concerns.
Frequently Asked Questions
Do top surgery scars ever go away?
No, top surgery scars are permanent, but they fade a great deal. Most start red and raised and, over 12 to 18 months, become flat, soft and pale lines. Silicone, tension support and sun protection while they heal give them the best chance of settling well, and treatments such as steroid injections, laser and revision can improve a scar that does not.
What do top surgery scars look like?
It depends on the technique. Double incision leaves two horizontal scars along the lower edge of the chest muscles, plus a circle around each nipple if free nipple grafts are used. Inverted T adds a short vertical scar. Keyhole leaves a small curved scar at the lower edge of the areola, and periareolar leaves a ring around the areola.
How long does it take for top surgery scars to fade?
Most top surgery scars are at their reddest and firmest between two and six months, then fade gradually. By 12 to 18 months most have matured into flat, pale lines. Scars on darker skin can stay darker for longer before they fade, so judge your result at around a year.
When can I start scar care after top surgery?
Keep the wounds clean and dry for the first two weeks and follow your surgeon’s dressing advice. Silicone gel or sheets and scar massage start once the incisions are fully closed and your surgeon agrees, usually from around six weeks. Sun protection on the scars should start as soon as they are exposed.
What is the best scar care for top surgery?
The measures with the best evidence are silicone gel or sheets, taping to reduce tension across the scar, and keeping scars out of the sun with clothing or SPF 50 for at least three months. Not smoking, wearing your binder and avoiding heavy lifting and overhead stretching for six weeks also help.
Can you get keloids from top surgery?
Yes, although it is uncommon. Keloids grow beyond the edges of the original scar and are more likely in darker skin and in people who have had keloids before. Tell your surgeon at consultation if this applies to you. Keloids and hypertrophic scars can be treated with steroid injections, laser, silicone and sometimes surgery.
Can you get rid of top surgery scars?
Not completely, but you can make them much less noticeable. Steroid injections flatten raised scars, laser treatment improves redness and texture, and scar revision surgery can replace a wide or stretched scar with a finer one, usually from around 12 months. Some people also choose to tattoo over their scars once they have fully matured.
Can you tattoo over top surgery scars?
Yes, many people do, but wait until the scars have fully matured, usually at least 12 months and often longer. Tattooing over an immature scar can irritate it and the ink may take unevenly. Ask your surgeon before you book, and choose a tattoo artist experienced in working over scar tissue.
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. We offer double incision with free nipple grafts, nipple-sparing double incision, inverted T, keyhole and periareolar top surgery, and your surgeon will explain where your scars will sit and how to care for them before you decide. No diagnosis or referral letter is needed, and the consultant who assesses you is the consultant who performs your surgery. Your initial consultation fee is 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 healed scars in our top surgery before and after photos. Finance is available, subject to status.
Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation
References
- Tao LA, Cafro CB, Kim EA. Patient perceptions of postoperative scarring after gender-affirming mastectomy: a cross-sectional study. JPRAS Open 2026;51:118–128. doi:10.1016/j.jpra.2026.05.049 ↗
- Atkinson JA, McKenna KT, Barnett AG, McGrath DJ, Rudd M. A randomized, controlled trial to determine the efficacy of paper tape in preventing hypertrophic scar formation in surgical incisions that traverse Langer’s skin tension lines. Plastic and Reconstructive Surgery 2005;116(6):1648–1656. doi:10.1097/01.prs.0000187147.73963.a5 ↗
- Lee DKR, Duru DO, Nicolet G, Kiew CYK, Abood A, Wong KY. Cosmetic outcomes of postoperative scar taping after surgical incisions: a systematic review. JPRAS Open 2026;51:374–386. doi:10.1016/j.jpra.2026.07.002 ↗
- De Decker I, Hoeksema H, Verbelen J, et al. The use of fluid silicone gels in the prevention and treatment of hypertrophic scars: a systematic review and meta-analysis. Burns 2022;48(3):491–509. doi:10.1016/j.burns.2022.03.004 ↗
- Kazemeini S, Nadeem-Tariq A, Hajian P, et al. Hypertrophic and keloid scar management: advances in diagnosis, perioperative care, and anesthetic modulation. Cureus 2025;17(7):e88810. doi:10.7759/cureus.88810 ↗
- Jackson K, Lee A, Ahmad N, Nguyen HP. Analysis of therapeutic interventions for hypertrophic and keloid scarring: a systematic review. Journal of Drugs in Dermatology 2025;24(8):770–776. doi:10.36849/JDD.8895 ↗
- Seago M, Shumaker PR, Spring LK, et al. Laser treatment of traumatic scars and contractures: 2020 international consensus recommendations. Lasers in Surgery and Medicine 2019;52(2):96–116. doi:10.1002/lsm.23201 ↗
- Libondi K, Libondi G, Sobieszek KA, Wysocki WM. Early and late surgical complications after gender-affirming mastectomy in predominantly young adults: a single-center cohort study. Plastic and Reconstructive Surgery Global Open 2026;14(8):e7995. doi:10.1097/GOX.0000000000007995 ↗
Related Articles
- FTM Top Surgery Recovery and Aftercare
- Nipple Sensation After Top Surgery: Will You Still Feel Your Nipples?
- Do Silicone Strips Help Cosmetic Surgery Scars Heal Better?
- When Can I Work Out After FTM Top Surgery?
