M to F Transgender- Anatomical Shape over the Muscle?

Question

This is how I would like to have my implants done when I have them done next month. I am sure there are negative aspects to my decision but I would like to know of anyone who has performed a BA on a trans patient this way and had good results?

Rigo J. Mendoza, MD · Answer

Thanks you for your question. I have done many breast augmentation on transgendered women. I perform a lot of augmentation with silicone implants above the muscle but I always use round silicone implants with great results. The problem with anatomical implants is that they can rotate. also, because anatomical implants are textured to try to prevent rotation of the implants, the scar tissue can adhere to the implant and you can see more rippling or folding of the implant.

Jed H. Horowitz, MD, FACS · Answer

The most natural implant with least complications will still be submuscular, round ,  silicone, not too big at first.

	Transaxillary will limit scars or  saline transumbilcal   with increase in size to gel as a second procedure

Richard H. Tholen, MD, FACS · Answer

While your question is entirely reasonable, I can attest to this being a suboptimal choice for a M-F transgender patient, even if you have been on estrogens for some time, have developed some breast tissue of your own, and have lost some of your physiologic pectoralis muscle bulk.

	Submuscular (partial, since the inferolateral portion of your implant will be subfascial (submammary) placement of a smooth, round, cohesive 5th generation silicone gel implant is definitely your best option for the softest, most natural, and least-likely to develop capsular contracture result. You will have a natural teardrop shape when upright, and will flatten and round the breast mass when reclining, which is what normal breasts do. Textured anatomic implants are both position-sensitive (imagine upside-down, for example), and remain teardrop-shaped when reclining, which is decidedly UN-anatomic and unnatural! Plus, they cost more, require a larger incision, are more firm, and (especially above the muscle) have a more palpable and possibly visible "edge." Which of those do you really like?

	I have been doing transgender augmentations for over 2 decades, and the only question you should be asking is based on your height and chest anatomy, and the implant volume needed to give you a proportionate, soft, natural, feminine result. You really do not want high, firm, immovable, edge-visible implants that are disproportionate for your frame and physique.

	You may benefit from a 2-stage augmentation where tissue expanders are placed to allow the proper stretch of the lower pole of your breasts, so that adequate implant volumes can be utilized while preserving a convex lower pole instead of a concave tight lower breast, and a nicely-sloping or gently rounded upper pole without excessive protrusion. Too many single-stage M-F augmentations leave a bad result that requires re-operation after re-operation to finally get things right. For several examples of my transgender patients, please click on the link below. Best wishes!

Eric T. Emerson, MD, FACS · Answer

While there are a number of special factors that need to be taken into account when considering breast augmentation in a M to F transgender patient, I do not believe that my basic "rules" for augmentation change.   I typically recommend sub-muscular placement of round implants.  Sub-muscular placement increases soft tissue coverage and camouflage of the implant while (probably) decreasing the risk of capsular contracture.  I have operated on a number of M to F transgender patients and find that the outcome is similar to that seen in small breasted (small A cup) female breast augmentation patients.   I have found that it often takes longer for the final shape and contour to emerge.

	I did use a number of anatomically shaped implants in the past, but did not find any advantage to their use.  In fact, if the implant rotated in the pocket the outcome was compromised.   You should carefully consider the available information and your reasons for wanting subglandular-anatomical implants before proceeding.  Talk to your surgeon and get another opinion if appropriate.  Good luck.

Tom J. Pousti, MD · Answer

Thank you for the question.

	No, I generally advise all my breast  augmentation patients to have their procedures done in the partially submuscular position and use round breast implants.  In my opinion, there are a lot of advantages of placing implants in the submuscular position  and disadvantages in using anatomical shaped implants.

	Although no technique,  placement of implant,  or type of implant is perfect I think the potential need for revisionary surgery is greater when implants are placed on top of the muscle and when anatomic implants are used. You will find other plastic surgeons who differ in their views.

	I hope this helps.

M to F Transgender- Anatomical Shape over the Muscle?

Answers (5)