Augmentation of the breasts in male-to-female transition has been shown to increase both the internal and external manifestation of one’s passing in their identified gender. For many trans women, and cisgender alike, breast augmentation has provided them with the surgical means to enhance these features by providing a breast shape that complements their figure.
Although there is some breast growth from hormonal therapy, we have often found that patients will opt to improve the size and shape of their breasts with breast augmentation surgery. Dr. Christopher Salgado is here to provide you with the form you have long desired.
Breast Augmentation Surgery
Hormones or Surgery
The development of the breasts in transgender women begins with Hormone Replacement Therapy (HRT). The effects of HRT trigger the growth of the breast and increase the sensation in the area. However, due to a number of factors including genetics and the age when hormone treatment begins, the breasts will grow about ½ to a full cup size.
While this has not been a problem for some transgender women, many will turn to enhancement surgery in order to improve the size of their breasts and adequately define the female contours of their bodies.
Breast augmentation uses implants to surgically enhance the size of the breasts while providing added volume to the area. The implants are made using either silicone (gel) or saline (saltwater) and come in various shapes, sizes, and textures.
Before the procedure
Dr. Salgado will meet with you to discuss the procedure. You must provide him with your complete medical history and discuss your goals. He will guide you through each step of the procedure, including:
- Incision type
- Underneath the breast
- Around or under the areola
- Underneath the arm
- Placement of implants
- Above the chest muscle in most cases
- Below the chest muscle
- Type of implant to be used
- Saline (saltwater)
- Silicone (gel)
To ensure you get the best results, it’s important to keep an open mind and expect a realistic outcome.
Preparing for the procedure
You must refrain from eating or drinking for at least eight hours prior to surgery. Smokers are also advised to quit at least one month before surgery. The effects from these vices may interfere with recovery. We have seen that some health insurances do cover the procedure and every effort will be made to accomplish this first. If not covered, then a price quote will be given for the operation. The size will be determined by implant sizers that may be placed inside your bra at the time of the consultation. Hormonal therapy must be discontinued for 4 weeks prior to surgery. (This includes the estrogen patch). Some insurances do cover the procedure and we may submit the case to insurance prior to a price quote being given.
During the Procedure
The surgical techniques used by Dr. Salgado and his team will depend on his evaluation during the initial consultations. Surgery will take between 1–3 hours and may require an overnight stay at the hospital. An IV line is inserted into your veins to administer fluid and medication. You can expect general anesthesia to be administered by board certified anesthesiologists.
Dr. Salgado begins by making an incision to create a deep pocket that will hold the implant. If you opt for a saline implant, Dr. Salgado will have the implant filled at this time. If silicone implants are to be used often silicone sizers will be used to determine the ideal size for you during the surgery. Once the implant is secure in both breasts, the incisions will be closed with surgical glue, sutures, or a combination of both. To aid in the healing process, a tube may be placed into the incision to drain excess fluid from the wound. In some cases modification of the position of the nipple areola complex is required (mastopexy or breast lift) for placement at the apex of the breast mound. This may be done at the time of surgery or at a second stage.
After the Procedure
It will take approximately 6 weeks for your body to heal from the surgery. As you recover, it is advised that you take any medications prescribed to you by Dr. Salgado as directed. After you are discharged from the hospital, you will be instructed to wear a special bandage or bra every day for 3–4 weeks. You can only remove it to shower after 3 days. You must avoid wearing a bra with an underwire for at least 6 weeks when your wounds have healed, and implants are settled.
It is essential that you look after your incisions. You are instructed to avoid submerging the wound in water for one week. This includes bathing in a tub and swimming. You must not raise your arms above the level of your breasts for at least ten days and avoid lifting, pushing, or pulling anything heavier than 10 pounds for 6 weeks.
You will be advised to sleep on your back and to use pillows that will keep your upper body elevated. When riding in a car or driving, you must carefully place the seatbelt over the affected area to ensure it does not put any pressure on your breasts.
Risk & Complications
As with any surgical procedure, breast augmentation poses a number of risks, including:
- Complications from general anesthesia
- Risks of hematoma, thrombosis, and hemorrhage
- Capsular contracture (hardened scar tissue) around the implant (risk is generally 1-2% per year and is cumulative)
- Implant leak, rupture or infection
- Change in sensation or loss
- Movement of implant and asymmetry
- Animation deformity
It is important that you follow the post-operative instructions given by Dr. Salgado, as this will provide you with a smooth and relatively stress-free recovery.
Unfortunately, scarring is unavoidable however it is commonly imperceptible. Depending on your surgical plan, Dr. Salgado will ensure that your scars are easily concealed under your bra and any article of clothing. In addition, due to the low placement of the nipple in the chest compared to cisgender women, a breast lift may be needed and this is at times done in a second surgery.
The results of your breast augmentation will take 3-6 months to settle, but the results will show almost immediately. For many transgender women, the results from breast augmentation have provided them with a body figure and contour that is undoubtedly feminine.
While Dr. Salgado will try to keep the costs at a minimum, the overhead will depend on factors, including:
- Location of the surgery and the facilities
- Anaesthesia and other medications to be administered
- Medications prescribed
Insurance Issues & Financing
Only a handful of insurance agencies will cover Gender Confirmation Surgery. Because of this, Dr. Salgado and his team are here to help you find the coverage you need. Click here to learn more about your financing options*.
For many transgender patients, men and women alike, surgery of the chest may the only step they need to take in order to complete their gender transition. Surgery of the chest enhances the shape, size, and overall contour of the chest following the development of the breast buds during Hormone Replacement Therapy (HRT).
The results from chest surgery leave transgender women with a shape and figure that is undeniably female, thereby easing the distress brought on by dysphoria.