Top surgery scars vary significantly depending on the surgical technique used, but the most common result is two horizontal lines running across the lower chest. Over time, these scars flatten, soften, and fade, though they never disappear completely. What your scars will look like depends on the procedure, your skin tone, your body’s healing tendencies, and how you care for them during recovery.
Scars by Procedure Type
The technique your surgeon uses determines where your scars sit, how long they are, and how visible they’ll be long-term. Chest size, skin elasticity, and your goals for final contour all factor into which approach is recommended.
Double Incision
This is the most common technique, and it produces the most visible scarring. Two incisions run in a horizontal elliptical pattern, leaving a scar near the lower border of each pectoral muscle. The scars typically stretch most of the way across the chest. Some surgeons place them in a straighter line, while others curve them to follow the natural contour of the chest muscles. In the early months, these scars appear red or dark pink and feel firm and slightly raised. Over time they flatten and lighten, eventually settling into thin lines that can range from pale white to slightly darker than surrounding skin.
Periareolar and Keyhole
These techniques are used for people with smaller chests and good skin elasticity. Keyhole surgery uses a semi-circular incision at the base of the areola, while periareolar uses a full circular incision around it. Both leave scarring confined to the edge of the areola, which makes them far less noticeable than double incision scars. Once healed, the scar often blends into the natural border between the areola and surrounding skin. These approaches also tend to preserve more nipple sensation.
Inverted T (Anchor)
For people with larger chests or less elastic skin, the inverted T technique adds a vertical incision that runs downward from the horizontal chest scars, creating an anchor-shaped pattern. This produces more scarring than a standard double incision, but it allows for more extensive reshaping. It’s sometimes recommended when a double incision alone can’t achieve a flat, natural-looking result. The vertical component of the scar sits on the lower chest and typically fades more slowly than the horizontal lines.
Nipple Grafts and How They Heal
Double incision surgery usually involves removing the nipples and grafting them back onto the chest in a more typically masculine position. Immediately after surgery, the grafts are held in place with a cushion-like dressing called a bolster, which stays on for about five to seven days. When the bolster comes off, the grafts often look dark, scabbed, or discolored. This is normal.
Over the following weeks, the grafted nipples go through phases that can look alarming if you’re not expecting them. They may appear very dark, then lighten unevenly. Some temporary loss of color is common. A circular scar forms around the edge of each graft where it meets the chest skin. In most people, this border eventually becomes subtle, but it can remain visible as a faint ring, especially if the graft heals lighter or darker than the surrounding skin.
How Scars Change Over Time
Fresh surgical scars look nothing like their final form. In the first few weeks, they’re red, swollen, and firm. Over the next several months they go through an active remodeling phase where the body lays down and reorganizes collagen. During this time, scars may feel itchy, tight, or ropey.
It takes six to 18 months for a scar to reach its final appearance. During that window, scars gradually soften, flatten, and fade from pink or red to a lighter tone. Some scars settle into a thin, pale line that’s only noticeable up close. Others remain wider or more pigmented. If a scar stays persistently pink after 12 to 18 months, it may benefit from revision.
Sun exposure during the healing period can cause permanent darkening of the scar. Using sunscreen on exposed scars is one of the simplest ways to prevent uneven pigmentation that won’t fade on its own.
How Skin Tone Affects Scarring
Melanin levels play a meaningful role in how scars heal and what they look like long-term. People with darker skin tones (Fitzpatrick skin types IV through VI) face a higher risk of keloid formation, where scar tissue grows beyond the original incision line. Scars on darker skin are also more likely to become hyperpigmented, appearing noticeably darker than surrounding skin.
Some scar treatments can create their own pigment problems on darker skin. Cryotherapy (freezing) can damage melanocytes and cause lighter patches. Laser treatments can trigger hyperpigmentation, particularly in people prone to melasma. Steroid injections, while effective at flattening raised scars, cause complications like lightened skin or tissue thinning in roughly 63% of cases. If you have darker skin, discussing these risks with your surgeon beforehand helps you plan a scar care approach that minimizes pigment disruption.
Raised and Overgrown Scars
Not all surgical scars heal flat. Two types of abnormal scarring can occur after top surgery, and they look quite different from each other.
Hypertrophic scars are raised, firm, and sometimes reddish, but they stay within the boundaries of the original incision. They typically develop within four to eight weeks after surgery, grow over the next six to eight months, then stop progressing and gradually improve. Many hypertrophic scars flatten significantly on their own over one to two years.
Keloids are a different situation. They grow beyond the edges of the original scar, sometimes substantially, and this horizontal spreading is the defining characteristic that distinguishes them from hypertrophic scars. Keloids can appear anywhere from three months to several years after surgery, rarely mature on their own, and don’t follow the typical pattern of gradual improvement. They’re more common in people with darker skin tones, though they can develop in anyone.
Scar Care During Recovery
Silicone-based products are the most widely studied option for scar management after surgery. Both silicone gel (applied like a lotion) and silicone sheets (adhesive strips placed over the scar) have been shown to improve scar stiffness, thickness, and surface irregularity compared to pressure garments alone. The catch is consistency: most treatment protocols call for wearing silicone sheets or applying gel for 23 to 24 hours per day, removing them only to shower. This level of commitment matters, and results are best when treatment starts once the incision is fully closed and continues for several months.
Beyond silicone, gentle massage of healed scars can help break up collagen buildup and improve flexibility. Keeping scars moisturized and protected from the sun rounds out the basics. Most surgeons recommend waiting a full 12 to 18 months before considering any revision procedures, since scars continue changing throughout that window.
Scar Revision Options
For scars that remain wider, more raised, or more discolored than expected after the full healing period, revision options include steroid injections to flatten raised tissue, laser therapy to address pigmentation or texture, and surgical re-excision to create a thinner scar line. The best approach depends on the type of scarring. A keloid, for instance, requires a different strategy than a scar that simply healed wider than expected.
Revision results vary. Some people achieve a dramatically thinner, less visible scar after a single treatment. Others, particularly those prone to keloids, may need multiple rounds of treatment or a combination of approaches to see meaningful improvement.