Cis vs. trans breast augmentation

by Dr. Courtney Caplin
Trans Surgical Columnist

I am frequently asked, "What are the differences in performing a breast augmentation in a cis-female and a trans-female?"

With any breast augmentation several decisions are made, which include incision placement, type of implant and locations of the implant: above or below the muscle. Studying the differences in genetic male and genetic female anatomy and examining each patient's own anatomy and the resulting changes from hormones are what help determine those answers.

Over 90 percent of my cis-females prefer the incision to be placed below the breast. However, over 90 percent of my trans-females prefer a trans-axillary incision (through the armpit). Hiding the scar in a natural crease in the armpit allows a patient to avoid placing a scar on the breast itself. Once healed, the scar is completely hidden. By looking at the breast alone there is no indication that a surgery has been performed.

Augmentation options include saline, silicone and highly cohesive silicone ("the gummy bear"). All the implants are safe, but some have more advantages than others. Saline is usually most affordable and allows a smaller incision, because the implant is filled after it is placed in the body. Unfortunately, saline implants come with rippling, the risk of deflation, and the highest rate of scar tissue formation and without a doubt feel the least natural.

Silicone is a great option and feels much more natural. Silicone implants have less rippling, do not deflate and a lower rate of scar tissue formation, but the price often reflects these advantages. The "gummy bear" round implant in my opinion is the implant of the future. The highly cohesive gel has the least amount of rippling, the lowest rate of scar tissue formation and the best upper chest fullness for cleavage. In my opinion it is the best implant available, but its pricing reflects all of these advantages.

Size is surprisingly easy. The most important factor is that the width of the implant matches the patient’s chest size. No one wants two little hills with a big valley in the middle; nor do they want a "uni-boob". On average, my trans-females need wider implants than the average cis-female. If a cosmetic surgeon does not pay attention to this detail, the patient can end up with a large gap between her breasts. Most of my patients who desire augmentation want more cleavage.

The next decision is where to place the implant: above or below the pectoralis major muscle. This decision varies depending on the individual. Factors that must be considered include the patient's muscle thickness, breast tissue and fat distribution.

The amount of breast tissue and fat distribution varies greatly depending on the individual's response to hormones. Placing the implant below the muscle has been shown to decrease the rate of scar tissue formation. However, if a patient has very thick muscle, it can look unnatural, and when the pectoralis muscle contracts, the implant may be pushed to the side.

In summary, the main differences in breast augmentation between cis and trans females has very little to do with the surgery, but much more to do with the treatment planning done during the consultation.

Copyright 2017 The Gayly – March 27, 2017 @ 3:20 p.m.