For many people undergoing FTM (female-to-male) or FTN (female-to-nonbinary) top surgery, returning to their usual routines, including working out and going back to their job without restrictions, is very important—psychologically, emotionally and financially. Getting to this stage brings patients closer to a full recovery.
It must be emphasized that gender affirming top surgery is a major operation. Your body needs time to heal. While it can be very tempting to jump back into workouts and unrestricted activities not too long after surgery and when you are feeling great, doing too much too soon can cause complications and lead to less-than-ideal long-term results. Some examples include bleeding, fluid accumulation (seroma), wound separation, thick scars or even jeopardize the viability of the nipple-areola complexes.
This article explores what you can expect when returning to physical activity after top surgery, why wound strength is a key part of healing and how different factors—like surgical technique, nutrition, and overall health—can shape your recovery timeline.
The Science of Healing: Why Wound Strength Matters
A very important concept in surgical recovery and wound healing is wound strength. Understanding this process helps explain why plastic surgeons impose activity restrictions and why patience and compliance really pay off.
- The fragile beginning (0–2 weeks): In the early days after surgery, your incisions are held together mostly by sutures and a thin layer of early scar tissue. At this stage, wounds are weak and can easily separate if strained.
- The gradual build (3–6 weeks): During this time, your body begins laying down collagen fibers to reinforce the incision sites. The scars gain stability but they are still immature. Even small repetitive stresses can stretch or widen them.
- The remodeling phase (3–12 months): By 3 months, your scars have attained most of their long-term strength. Over the ensuing several months, collagen fibers reorganize and scars grow stronger. They also flatten and fade in appearance. It may take up to a year or more to generally see what the long term results are.
Because scar strength develops slowly, early activity restrictions are designed to protect your chest while it is most vulnerable. Every extra week of precautions and restrictions increases the likelihood of thinner, smoother and flatter scars and long-term results that you’ll be proud of.
Factors That Influence Recovery
No two patients are the same, which is why plastic surgeons often tailor recommendations based on individual circumstances. Several factors can affect both wound healing and the timing of when you can safely return to physical activity:
- Surgical technique: Double incision, keyhole, concentric circle and other methods each carry different recovery demands and, therefore, restrictions.
- Nutrition and diet: Protein, vitamins and minerals are essential for wound repair. Restricted diets—such as vegan or vegetarian—can sometimes slow healing and lead to wider scars if not supplemented with adequate, necessary nutrients.
- Ethnicity: Darker skin types (Black, Hispanic, Native American and Asian) may be more prone to raised or darker pigmented scars.
- Age: Younger patients may recover a little bit faster but often are less compliant – not closely following instructions – as compared to older individuals. Scars in older individuals often heal less wide and flatter.
- Body weight: A higher BMI can increase the risk of wound healing issues and complications.
- Smoking or vaping history: Both impair circulation, delay tissue repair and can result in a high risk for tissue necrosis (tissue death), wound separation and wide scars.
- General health: Conditions like diabetes or connective tissue disorders (such as Ehlers-Danlos syndrome or Marfan syndrome) can slow or complicate healing.
- Genetics: Some people are simply more prone to heavy or very visible scarring.
Early Movement: The First Several Weeks
Your plastic surgeon may provide you with guidelines relating to physical restrictions and activities following your top surgery. They may very well be different from what is outlined below. Regardless, you need to closely follow your surgeon’s recommendations.
Walking
Walking is encouraged almost immediately after surgery. Gentle, slow-paced walks not only keep blood circulating but also reduce the risk of blood clots, support lung function and can improve your mood. Think of walking as your first safe step back into movement.
Daily Activities
Repetitive arm or chest movements—such as vacuuming, doing dishes or washing a car—should be avoided for at least the first 6 to 8 weeks. These seemingly harmless tasks can put repetitive strain on healing tissue, increasing the risk of fluid buildup (seroma), bleeding (hematoma) and wider scars.
Lifting
For at least the first 4 – 6 weeks, avoid lifting anything heavier than 10 – 15 pounds. Even occasional heavy lifting, such as picking up grocery bags, children or pets, can strain healing incisions. Heavier lifting should be postponed until around 2–3 months after surgery.
Returning to Exercise
Chest Workouts
Chest-specific exercises—push-ups, bench presses, chest flys—place direct stress on incision lines and scar tissue. These should be avoided for at least 3 months, and longer if you have higher risk factors for poor scarring or wound healing. Patience here is especially important: chest workouts too early can lead to scars that are wide, thick and elevated, clearly compromising your results.
Cardio and Outdoor Activities
- Walking: Safe immediately after surgery, as tolerated.
- Hiking: Usually safe after 2 months, once your balance and stamina improve.
- Cycling: Safe after 2–3 months; mountain biking should wait until closer to 3 months.
- Running or jogging: Best avoided until around 3 months, when the incisions have greater wound strength.
Swimming and Pool Activities
Water adds resistance, which can stress healing chest muscles. In addition, immersing incisions before they’re fully closed increases the risk of infection.
- You can usually submerge yourself in a pool around 6–8 weeks, provided all incisions are sealed and nipple grafts are healed.
- Swimming laps or vigorous water activity should wait until around 3 months.
Sports and High-Intensity Activities
- Recreational sports (softball, basketball, tennis, golf): Safe after about 3 months.
- High-intensity sports (rock climbing, martial arts, boxing, archery): Delay for at least 3 months, sometimes longer depending on your healing progress.
Returning to Work
Your ability to return to work depends largely on the demands of your job:
- Sedentary jobs (office, desk work): Often possible within 2–4 weeks.
- Physically demanding jobs (construction, landscaping, warehouse, barista, grocery check-out): May require up to 3 months off given the lifting and repetitive upper body activity involved.
If returning sooner is financially necessary, talk with your plastic surgeon about modified duties or restrictions that may allow you to work safely while protecting your results.
Tips for a Smooth Transition Back to Exercise … and More
Listen to your body: Mild soreness is expected when resuming activity, but sharp pain, swelling or bleeding are red flags. Stop and consult your surgeon if these occur.
Ease into it: When cleared, start with light weights and gentle movements before working up to more intense routines.
Commit to scar care: Medical grade silicone tape or gels, begun around 3–4 weeks after surgery (once incisions are fully closed) can facilitate you obtaining superior results, everything else being equal. Treatment is typically continued for 6 months or more.
Protect from the sun: Scars are sensitive to UV damage for up to 9 months. Use SPF 50+ or wear a protective UPF sun shirt outdoors.
Prioritize nutrition: Adequate protein, vitamins A and C, zinc and overall balanced calories are crucial for wound healing and collagen production.
💬 Frequently Asked Questions About Working Out After Top Surgery
Gentle stretching that doesn’t engage the chest can usually be started after 4–6 weeks. Deeper stretches, inversions, or poses that put pressure on the chest should wait at least 3 months.
One accidental lift usually isn’t catastrophic, but it may cause swelling or discomfort. If you notice bleeding, sudden swelling or sharp pains, contact your plastic surgeon immediately.
Non-chest-focused exercises (like bicep curls with very light weights) may sometimes be started around 6 – 8 weeks, but only if your surgeon clears you.
Resistance bands still engage chest and shoulder muscles, so they aren’t automatically safer. Wait until you are cleared for chest and upper-body workouts, usually around 2–3 months.
Warning signs include sharp pain, swelling, bleeding, fluid buildup or separation of the incision. Stop immediately and notify your plastic surgeon.
Exercise itself doesn’t improve scars but proper nutrition, silicone scar therapy and sun protection can help scars become flatter and less visible over time.
Final Thoughts
Your recovery is not a race—it’s a process. Returning to workouts after top surgery requires patience but the payoff is worth it: better scars, reduced risk of complications and superior results.
That’s exactly what you want!
By respecting your body’s healing timeline, fueling it with good nutrition and following your surgeon’s advice, you’ll not only return to exercise—you’ll do so with confidence in yourself and happiness and peace with your chest and in yourself.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
