For years breast augmentation has been one of the most popularly performed cosmetic surgeries among women worldwide. Now the procedure is increasingly being sought by transgender women looking to achieve a more feminine figure. This outpatient operation traditionally involves making an incision in one of the following locations:
- Around the nipple (periareolar incision)
- In the armpit (transaxillary incision)
- Underneath the breast (inframammary incision)
Because male-to-female patients generally have little existing breast tissue, periareolar and transmaxillary incisions are the most common. Next, the surgeon inserts an implant shell behind the existing breast tissue (subglandular) or under the chest muscle (submuscular). If the patient is receiving silicone implants, they will come pre-filled to the desired size. If the patient has opted for saline implants, the empty shell will be filled with saline after insertion.
In recent years, pioneering cosmetic surgeons have also developed what’s known as fat-transfer breast augmentation, in which fat is removed from another part of the body (such as the thighs, belly, or buttocks) and injected into the breasts.
Although breast augmentation has most often been performed under general anesthesia, more cosmetic surgeons have begun offering the option of local anesthetic only, allowing patients to be fully awake during surgery and giving them more input about the size and shape of their new breasts.
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Because patients transitioning from male to female typically have larger pectoral muscles than patients assigned female at birth and little existing breast tissue, cosmetic surgeons usually recommend subpectoral implants over subglandular implants. This creates a more natural appearance and lets the patient avoid a globular, artificial shape.