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

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.

Thank you for your question and for providing the photo. There is no single profile implant that universally works best in transgender patients. The implant selected should be chosen based on a 3 dimensional approach, and take into account the skin, muscle and other specific considerations of top transformation procedures. It is best to first select the proper width of the implant so that it matches your chest width.This will avoid a large space between the breasts and give the most natural shape. The projection can then be determined based on your desired look and the laxity of your chest skin. This often varies between a moderate profile or a moderate plus profile implant. In my experience in transgender surgery, the high profile implants are rarely useful as their lack of width combined with the tightness of the overlying skin makes them look quite unnatural. Your photos would be an example of someone who would likely not have a natural result if high profile implants are used.The best next step for you would be to consult with a plastic surgeon well versed in this type of surgery. Read reviews of his/her work with transgender patients. During the consultation, they can discuss the implant options with you, and help you to decide how best to proceed.Best of luck with your top surgery.Jeff Rockmore

You would benefit by considering form stable shaped textured implants.  I would place them under the muscle through an incision at the bottom of your breast.  While these are not the only option, they would provide a very natural breast shape.  They also have a lower complication rate than round smooth implants as you referenced above. 

Regarding size, while I don't have the chart in front of me, typically the surgeon will measure your breast width and then arrive at a breast implant size that will fit your shape.  Transgender patients can often handle larger sized implants mainly due to the broadness of the chest and shoulders.  You don't seem to have this issue can then choose amongst the different profiles based on how large you want to be post operatively.  Hope this helps. 

Based on your height, weight, and body habitus, the moderate profile implants would look the most natural. I would use a higher profile implant if you are narrow, and the moderate profile implants in your size range are too wide. It sounds like you are on the right track with what you have chosen.

Moderate profile usually give the most natural results, but the choice has to be individualized to each patient.  This determination is made using your anatomy, chest measurements and skin quality.  Good luck with your surgery.

It appears that you are tall and relatively slim. Your chest does not seem to be wide. Generally for this kind of surgery I usually recommend a round implant compared to teardrop. You will end up having more cleavage. The implant needs to be wide enough that it adequately covers your chest and gives you cleavage, so I am going to suggest any profile implant such that you get enough satisfactory projection. The volume 400cc seems to be adequate. Your surgeon needs to measure your chest dimensions and determine which profile you need. Generally for my patients, first after measurement of chest dimensions, then I decide the profile. Typically a high profile. So for you, if the dimensions from nipple to inframammary fold, form nipple to sternum and nipple to anterior axillary line, are the dimensions that need to be used.

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.

There are, of course, several differences in breast augmentation between transgender patients and females.  The basics of the the planning process, however, are reasonably similar.  The variables include 1. Desired size and shape, 2. Chest shape and structure, 3. Skin envelope, 4. Nipple position and size, 5. Implant type and size.  The other--perhaps most important variable--is patient expectation.  Your existing breast size, skin envelope, and breast diameter are key in deciding on which profile of implant to place.  Most M to F patients have only nominal amounts of breast tissue to work with, even with hormone use.   The use of hormones prior to augmentation is important to lay the "groundwork" for the procedure.   The relationship between breast diameter (the width of the base of the breast) and desired final breast size will be the key factor in determining whether to use a moderate or high profile implant.   The skin envelope is usually very tight in transgender patients and often takes several months to fully relax.  There may be a small number of M to F patients that benefit from tissue expansion prior to placement of the final implant, especially in those with a very constricted (tight) inferior pole (the area beneath the nipple).  The best way to come to a decision is to consult with a Board Certified Plastic Surgeon with experience with breast augmentation in M to F transgender patients.   Be sure to share your goals and expectations with the surgeon.  Best of luck!

I would recommend the Mentor High Profile implant.  You have a small torso.  The high profile implants will give you nice projection.