Top Surgery Scars: Care and Results Over Time

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 27 September 2026· How this site is researched

Every top surgery technique leaves a scar, and each technique page describes its own. This page puts them side by side, explains the parts of the outcome that are settled before you wake up, and covers what can be fixed later and what cannot. The day-to-day routine of silicone, tape and sunscreen has its own page, scar care.

The four scars side by side

The small-scar techniques hide their line in the colour change at the areola edge, which is why a good one is hard to spot from a metre away. Their scar problems tend to show up in the skin around the line rather than the line itself.

Settled before you wake up

Placement matters more than healing. A double incision scar is usually drawn along the lower border of the pec muscle, which is often higher than the crease your chest has now. Placed well, it reads as the edge of the muscle from across a room. Placed too high, too straight, or running up towards the armpit, it reads as a scar, and no amount of silicone changes where it is.

Those lines are drawn with you sitting up, before the anaesthetic. So when you look at a surgeon's results, judge the scars separately from the flatness. Flatness is the part most competent surgeons get right. Scar placement is where they differ. Look at whether the line follows the pec or cuts straight across, whether the two sides match, and how the outer ends finish. If there are photos with arms raised, look at those too, because a dog ear that hides with arms down shows when you reach up. The people I have watched go through this with the best-looking scars at a year were rarely the ones who did the most scar care. They were the ones whose surgeon drew the line in the right place.

How a scar changes over eighteen months

The curve is the same for every technique, and it gets worse before it gets better. In the first couple of weeks the incision closes and looks tidy. Then, somewhere between week four and week twelve, collagen piles in and the scar goes redder, thicker, raised, itchy and tight. That is the stage people photograph and panic about, and it is normal.

From about month three the redness starts to drain out. From around month six the scar flattens and softens. Most people's scars are as pale and flat as they will get somewhere between twelve and eighteen months, and some keep fading into a second year. Judge the scar at a year, not at month two.

Skin tone changes the endpoint more than the pace. On darker skin the scar tends to settle as a line darker or lighter than the skin around it rather than pink, and it can take longer to settle. On very fair skin it stays pink the longest. Neither is a complication.

How often scars thicken

Two recent studies, both mostly of double incision patients, show how much the answer depends on who is asked. In Vico and Salmon's 2024 series of 155 double incisions, where the surgeons assessed the scars, raised (hypertrophic) scarring was recorded in 1.3%. In Tao and colleagues' 2026 survey of 96 patients, 19% described their own scars as hypertrophic. Some of that gap is who is looking and how closely, and it is a reason to ask a surgeon what they count.

The same survey found 86% said their scars did not embarrass them, though 28% still limited shirtless activities.

Scars that need extra care

• Hypertrophic scars are raised and red but stay within the incision line. Most improve with silicone and time, and a steroid injection from the surgeon or a dermatologist if they do not.
• Keloids grow beyond the line and do not regress on their own. They are more common on darker skin and in people with a personal or family history of them. If that is you, tell the surgeon at the first consultation. Some plan early steroid injections, and it is a reason to weigh total scar length when you choose a technique.
• Widened scars come from tension, most often at the outer ends of a double incision and at the T-junction of an inverted-T.
• Dog ears are small folds of skin at the outer end of a scar. Small ones often settle by six months. In Vico and Salmon's series, 8.4% of double incision patients needed a second operation for them, done from month six onwards.
• Spread or puckered areolas after peri-areolar are a skin problem rather than a scar problem, and scar care does nothing for them.

What a revision can and cannot do

A revision can cut out a dog ear, re-close a widened scar under less tension, and even up a mismatched side. Most of that is done under local anaesthetic once the scar has matured, usually after six months and often after a year. What it cannot do is remove a scar, only replace it with a new one that usually heals better. Moving a scar that was placed too high is a bigger job and not always possible, which is why placement is worth judging before you book.

Nipple grafts and tattoos

A grafted nipple heals inside a ring of scar that usually blends in once pigment returns. For some people the graft comes back paler or patchy, and areola tattooing is a common, low-key fix for that.

Plenty of people tattoo over their chest scars once they have matured. Most artists want to wait at least a year. Scar tissue takes ink differently from the skin around it, so an artist who has worked over top surgery scars before is worth finding.

What to do in the first year

In outline, keep incisions clean and leave them alone until they are fully closed, usually two to four weeks. Then use tape and silicone consistently for at least three months, start firm massage once your surgeon clears it, keep scars out of the sun or under a high-factor sunscreen for the first year, and avoid stretching the chest early. Of that list, sunscreen is the one I would enforce if I could, because it is the cheapest and the one people drop first. Scar care has the timings and what is not worth buying.