Trans Surgical Scars

Welcome back to Queering the Narrative!

This week, I’m going to talk about a topic that has been very front-of-mind for my partner and I recently. If you listen to our podcast, then you know that my partner El is scheduled for top surgery next week!

This is extremely exciting, and made me think about the fact that folx who haven’t interacted with someone who’s gotten gender-affirming surgery probably don’t know a lot about what trans surgical scars look like.

Surgical scars can affect characters’ physical descriptions in ways that make them visibly trans. This means that, if you understand how these surgeries affect the body, you can more authentically describe a trans or nonbinary bodies and respectfully utilize them to illustrate or hint at the character’s identity.

However, if you don’t understand these medical procedures, then you have a pretty solid chance of tripping and falling into some misconceptions or harmful tropes.

So today, we’re going to discuss writing about trans surgical scars.

Top Surgery

Perhaps the most distinctive and notable of all trans surgical scars are top surgery scars.

“Top surgery” generally refers to a procedure sought out by some AFAB (assigned female at birth) trans and nonbinary folx to achieve either a more masculine or more neutral chest appearance, via the reduction and reshaping of the breasts.

This is not the same as mastectomy, because the goal in a mastectomy is the complete removal of all traces of breast tissue to treat or prevent breast cancer. Top surgery, on the other hand, focuses on achieving a desired aesthetic goal by strategically leaving behind breast tissue and repositioning/resizing the nipples. 

The most commonly portrayed type of top surgery scars are double-incision, or “DI,” which refers to a specific procedure. The scars are either straight or slightly curved lines that run just below where the breast was, or along the bottom of the pectoral muscle, which may or may not meet in the middle. These scars also often extend to a person’s underarm, though this is generally not visible unless they choose to show it off.

Because they are distinctive to top surgery, DI scars are sometimes used in media to signal that a character is trans. However, it is important to keep in mind that these scars are neither necessarily dramatic nor permanent, and this is not the only way to get top surgery.

To the first point, the way many people think of “scars” -- corded, raised, dark, or somewhat bunched up -- tend to be scars that have healed in somewhat unhealthy ways, like “keloid” scars, which can limit mobility and cause pain. Some folx want their scars to be prominent and so pursue this result, but doctors tend to advise patients on how to care for their scars to prevent such outcomes.

Additionally, bear in mind that some people experience scar dysphoria. These folx often pursue mitigate, obscure, or minimize their scars. With proper treatment, these scars can be almost completely invisible. This means that not all afab trans/nonbinary people have top surgery scars, even if they’ve have a double-incision surgery!

The flip side of this, of course, is that some people love their scars, and prefer that they’re visible. These folx, however, will still take measures to ensure they have full range of movement and minimize lasting pain!

DI is also not the only way to get top surgery. A variety of other methods are available to people with smaller breasts who want top surgery, which don’t leave large scars, such as keyhole or circumareolar. There are also versions of top surgery which have prominent scars that are different from those of DI. You can find more details on the various common types of top surgery here.

As a final note on DI, that procedure is one of a handful of top surgery options which generally requires nipple grafts. During the surgery, the nipples are removed entirely, reshaped, and then grafted back onto the chest. Nipple grafts don’t always regain full sensory function, especially erotic sensation.

Not all folx who get top surgery opt for nipple grafts. Sometimes this is because it can be difficult to predict the shape the grafts will heal into, and folx prefer tattoos to make sure they have full control over the appearance. Other times folx opt for no nipples at all, because that better matches their desired aesthetic -- this in particular has been growing in popularity among the nonbinary community.

To get a bit of a feel for how to describe trans surgical scars and how to understand how they work, I highly recommend doing your research and looking for pictures and information on the surgeries themselves. HOWEVER, don’t just go to google -- you’re bound to get a whole bunch of transphobic scaremongering and some nasty pictures designed to make people fear top surgery. Rather, if you want more info, I highly recommend the Gender Confirmation Center’s webpage on top surgery. If you want to see these scars on real bodies, you can look at the before and after images on the website as well. Bear in mind that many of these images are taken not long after surgery, and so may not be fully healed.

Hysterectomy

Hysterectomies are a common procedure for afab trans and nonbinary individuals. This procedure, like many abdominal surgeries, often leaves a straight scar across the lower belly.

This scar can be somewhat dramatic, but it’s important to realize that it resembles the scars for things like c-sections and other abdominal surgeries. Because it’s relatively common on cis folx as well, it’s not always considered a trans-distinctive scar.

Breast Augmentation

For AMAB (assigned male at birth) individuals, HRT cannot always achieve the breast fullness they desire, and so they seek breast implants. However, because breast augmentation is relatively common among cis women, this isn’t really a good “tell” that someone is trans.

There are a variety of breast augmentation procedures, some of which are more or less likely to result in scars. Overall, though, breast augmentation scars are not all that apparent. Because they are either minimal or consistent with scars for similar procedures for cis folx and they aren’t visible nearly as often, these scars are not great markers of transness in a narrative.

Other Procedures

There are a great many other surgeries that a trans or nonbinary person might pursue in order to alleviate dysphoria. These include “bottom” surgery, facial feminization/masculinization surgery, body contouring, and many others.

Most of these surgeries, however, are not generally notable for their scars.

Bottom surgery is far more notable for the radical reshaping of the anatomy than for any scars that might be left behind (which are themselves usually minimal or obscured). Facial surgeries utilize specific techniques to minimize or hide scarring. Think of literally anyone who has gotten a nose job (a common component of facial feminization surgery) -- you generally cannot see scars from that procedure! Scars from other procedures are again usually not visible, either for being small or strategically placed.

Conclusion

If you have more questions about any of trans surgical scars, or want to see more images to help you get a feel for how to describe them, you should definitely check out the Gender Confirmation Center!

That’s it for this week! I’m taking next week off to help my partner recover from their own top surgery, but I’ll be back soon with more tips! Until then, stay safe, stay healthy, and keep writing!