Breast augmentation is an important part of sex reassignment surgery (SRS) in transwomen. It helps avoid the use of external padding to achieve a feminine appearance. It enables an individual to integrate better with the body image.
There are both similarities and differences in breast augmentation in SRS when compared to augmentation carried out in women to enhance the appearance of breasts. Breast augmentation is usually achieved with the help of silicone implants. The technique is largely similar to breast augmentations carried out in women for hypomastia. However, there are certain differences relating to the preoperative requirements, and outcomes.
As in other procedures carried out in SRS, breast augmentation requires the clearance and referral letter from a mental health professional. Most individuals are also on hormonal therapy under the guidance of a physician. Hormonal treatment helps in breast development and the enlargement of the nipple and areola. Improvement in the size of breasts with hormonal treatment leads to better soft tissue coverage over the implants. This helps in optimizing outcomes. Breast augmentation is usually carried out after two years of hormonal treatment.
The contour of a male chest is different when compared to a female chest. The male chest tends to be wider and more muscular. Also, the soft tissue cover including skin tends to be less yielding in a natal male when compared to a natal female. The crease that separates the breast from the lower part of chest is known as the inframammary fold (IMF). The distance between the nipple to IMF is lesser in men when compared to women. Breast augmentation leads to an increase in this distance. The nipple and areola (pigmented skin surrounding the nipple) are more laterally (towards the sides) placed in men when compared to women. In women, the nipple-areola is more centrally located in the chest. These variations in the anatomy also influence our decision making relating to the implant selection and outcomes.
Ideally, the nipple and areola should be on the apex of the breast mound. The lateral position of the nipple relative to the chest in a natal male can lead to a lateral position of the nipple after the placement of a large diameter implant. This is factored into the decision making during implant selection. Traditional silicone implants are hemispherical. Profile or projection refers to the height when the implant is kept on a flat surface. A high profile implant also has the advantage of helping us to achieve the maximum projection for a given breast volume. It is common to opt for a relatively lesser diameter and high profile (projection) implants.
The placement of the implant can be under the breast tissue (sub-glandular) or partly under the muscle (sub-pectoral). Both approaches have their relative advantages and disadvantages. The decision is taken after taking into account clinical examination findings and discussion with the individual. Breast augmentation is carried out as a short stay procedure. The recovery is similar to breast augmentation carried out in females for hypomastia. Most individuals return to work within a week of undergoing the procedure. The implant is initially found to have a prominent upper pole fullness. This settles into a more natural-looking appearance over the next few months.
Breast augmentation is a relatively simple procedure with significant benefits in suitable individuals. It is an important part of the gender confirmation procedures. It is associated with positive effects on body image, self-confidence.
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