Best Profile Implants for Flat-Chested Transgender MTF?

The reason you are confused is because many plastic surgeons have minimal experience with M to F transgender patients, or have a tendency to use a certain profile implant with all their patients, female and transgender alike. This is wrong, IMHO.

At 5'8" tall, you would be considered a tall female, but your present chest and breast base anatomy is masculine (relatively wide, with taut skin and youthful robust musculature). Your surgeon and you should first determine the implant size needed to give you the breast volume you wish (that presumably is proportionate to the rest of your body), and once that is determined choose the implant profile that achieves that volume with the best match to your breast base diameter. Depending on size this would likely be moderate profile implants, or with somewhat larger implants, moderate plus profile implants.

This should be considered only when hormone therapy has enlarged your breasts as much as possible (12-18 months after initiation of hormone therapy; most patients will develop no more than about one cup size of breast tissue).

Because M to F transgender patients do have more pectoralis muscle bulk and taut skin than their physiologically-female flat-chested counterparts, anywhere from 1/3 to half of transgender patients will benefit from consideration of tissue expander placement to stretch the lower pole muscles and skin to yield a natural teardrop shape and adequate skin/muscle coverage for appropriately-sized implants. Simply placing implants in every transgender patient unfortunately can yield too-small, firm, convex-up, concave-down shaped breasts with wide cleavage. Totally unnatural look AND feel.

Obviously, it's not just about profile!

Assessment of muscle and skin tightness must be determined before recommending this two-stage surgical approach (or not), but doing this when appropriate will often minimize the need for multiple re-operations to try to obtain adequate size, position, shape, and softness of implants in the transgender chest.

As you can see, one approach and profile does NOT fit all!

There are a few plastic surgeons who perform significant numbers of transgender surgeries, and have office staff, nursing staff, and the associated capabilities that many plastic surgical practices do not have. Seek these practices and surgeons out, and obtain a few more consultations. It will be worth the time, effort, and (saved) expense of an improper choice. As anyone who does do significant numbers of transgender augmentations will tell you, this is NOT simply placing implants as we do in our non-trans female patient! For several examples of my transgender patients click on the web reference link below. Best wishes! Dr. Tholen

Thank you for the question and picture.Despite good intentions, online consultants will not be able to provide you with  meaningful specific advice.  Ultimately, in person consultation with well experienced board-certified plastic surgeons will be necessary. Careful measurements, dimensional planning, and careful communication will be key.In your case, based on your photograph, I think you are starting at a great starting point for breast augmentation surgery and should have a very nice outcome.   Generally speaking, the best online advice I can give to transgender patients who are considering  breast augmentation surgery ( regarding breast implant size/profile selection) is:



1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you're looking for. Ask to see lots of examples of his/her work.






2. Have a full discussion and communication regarding your desired goals  with your plastic surgeon. This communication will be critical in determining  breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as  “natural”  or “C or D cup”  etc means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup  size may also be inaccurate.







3.  Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery.



I hope this (and the attached link, dedicated to transgender patient breast augmentation) helps.

The first thing to do is determine which volume it is that you like.  This is accomplished by trying on sizers.  Once you have determined which size is best for you, the implant choice should be made based on the base diameter of your chest, and the look that you are trying to achieve.  If you are narrow and want more upper pole projection, then a high profile implant would be best for you.  Even with high profile implants, if you fill them to the low end of the volume range they are more natural, while at the upper end of the range they are more projected.  Because you are thin, filling them in the higher end of the range may reduce your risk of rippling.