As transgender plastic surgery becomes more prevalent, the number of patients seeking such face and body transformations are steadily increasing in number. In the male to female transgender patient, facial feminization surgeries and body enhancements of the breasts and buttocks are the mainstays of the physical metamorphosis.
In considering breast augmentation, there are initial obvious differences in the shape of the female vs. male chest. The absence of the development of a natural breast mound, the thickness of the pectoralis muscle and location/adherence of the inframammary fold are all considerations in how the phenotypic male chest will respond to the stretch of a breast implant.
The ability of the overlying skin to stretch is essentially the same between male and females. Male chest skin and underlying soft tissues is going to be tighter due to the absence of an overlying breast mound. This makes many transgender breast augmentation results look very round and have a lot of upper pole fullness. This may not relax as much over time and, if this breast mound shape is bothersome, one needs to consider an anatomic (tear drop) implant shape initially.
The pectoralis muscle is thicker in males and will thin to some degree with hormone therapies. The greater muscle thickness will contribute to increased upper pole fullness when the implant is placed in a partial submuscular or dual plane position and may be an accompanying reason with tighter skin that a rounder breast implant look often occurs. This can become even more evident or magnified when high profile saline implants are used.
The inframammary fold poses an interesting issue as all transgender breast augmentations require its release and lowering. This runs the traditional risk of a persistent horizontal crease across the lower pole of the new breast and the creastion of a double bubble problem. But my experience has been that this is less likely to occur in transgender breast augmentations than in traditional female breasts. This may be because the male inframammary fold is actually less adherent and defined as that of the female one which was developed to hold up the position of the lower breast mound.
Transgender breast augmentation is a very successful procedure that creates a satisfactory breast mound despite some anatomic differences in the shape of genetically formed male chest.
Dr. Barry Eppley
Indianapolis, Indiana