Breast augmentation for transfeminine patients: methods, complications, and outcomes

Abstract

Gender-affirming procedures are critical steps in helping transgender patients reach identity actualization and maximal quality of life. Although there are many techniques for gender-affirming care, surgical breast augmentation, or "top surgery," is often cited as the most important-and sometimes onlyprocedure sought by transfeminine patients. Unfortunately, years of individual and systemic prejudice placed barriers between transgender patients and the healthcare providers needed to affirm gender identity. Policy has recently begun to change as research proving the safety, need, and outcomes of breast augmentation in transfeminine patients dismantles long-established systemic inequalities. With this change, more patients are seeking knowledgeable and respectful providers who can address their unique gender-affirming needs.Overall, breast augmentation in transfeminine patients is technically similar to procedures performed in cisgender peers, but with significant considerations. The most common method of augmentation relies on breast implants, since removable prostheses, exogenous hormones, and fat grafting alone often produce unsatisfactory results. Special attention needs to be directed towards anatomic differences in transgender versus cisgender patients in order to achieve optimal size and position of the breast and nippleareolar complex. Complications for transfeminine patients undergoing breast augmentation are rare, and complication rates are equivalent with cisgender peers who pursue similar procedures. Short-and longterm benefits to quality of life have been well-documented. The aim of this review is to give providers the technical knowledge concerning breast augmentation options, pre-surgical evaluation, post-surgical care, and special considerations in transfeminine patients so that provider and patient can have a successful, respectful partnership in reaching gender-affirming goals.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

“…The impact of these changes for patients may be mixed (Holmberg et al., 2018). Chest surgeries (breast reduction, mastectomy, and breast augmentation) and body contouring surgeries, for example, may offer desired changes in form and appearance thereby reducing psychological distress that can disrupt sexual functioning but may adversely affect erogenous sensation (Bekeny et al., 2020 ; Claes et al., 2018 ; Rochlin et al., 2020 ). Genital surgeries in particular can potentially affect sexual function and pleasure in adverse ways, although they are likely to be experienced positively as the patient’s body becomes more aligned with their gender, potentially opening new avenues for sexual pleasure and satisfaction (Hess et al., 2018 ; Holmberg et al., 2018; Kerckhof et al., 2019 ).…”

Complications and satisfaction in transwomen receiving breast augmentation: short- and long-term outcomes

“…This is a peculiarity of the anatomically male developed upper body, which has a narrower, more oval and laterally seated nipple–areola complex (NAC) and more developed pectoralis muscles than the female. In addition, the sternum is much wider and the distance between the nipple and inframammary fold is much shorter [ 1 ]. Unfortunately, the insertion of silicone implants cannot remedy this situation.…”

“…Many male-to-female transgender individuals (transwomen) seek surgical feminizing procedures throughout their lives to improve their gender dysphoria and quality of life. An important part of feminization is developing natural shaped, feminine breasts [ 1 ] which psychologically plays a central role in the femininity, attractiveness and sexuality of women [ 2 ]. However, cross-sex hormone therapy (CSHT), which is often performed initially, usually results in inadequate breast growth that often does not even correspond to cup size AA and does not change after the first six months of therapy [ 3 ].…”

Validity and Reliability of Malay Language Breast Cancer Awareness Scale for Male-to-Female Transgender

“…This estimation indicates that more than one out of every 200 individuals in Malaysia is a transsexual. 6 However, the numbers may be underreported due to discrimination and social stigmatization. Gender minority is meant to be an inclusive umbrella term that includes people who identify as transgender or have other genders.…”