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Breast augmentation is one of numerous body contouring options that transfemales may undergo on their transformation journey. While many may assume that this is a surgery that every transfemale undergoes that has not been my observation. But for those that do they have the same potential risks and complications in getting breast implants that cis-females do. Because the chest wall anatomy has some differences this raises the question of whether the surgery complication rates are different.

In the June 2024 issue of the journal Plastic and Reconstructive Surgery an article on this topic was published ‘Complications following Breast Augmentation in Transfeminine Individuals: A Systemic Review and Meta-Analysis’. In this paper the authors reviewed the literature from 14 studies involving 1864 transfemales that underwent breast augmentation looking at the traditional complications from this type of body contouring surgery. This was then compared to the more extensive literature on similar complications in cis-female breast augmentation.

The rate of capsular contracture was 3.6%, hematomas 0.6%, infection 0.08%, and implant asymmetry was essentially 4%.  In comparing these complication rates to that of cis-females they were similar for capsular contracture and infection. However higher rates in transfemale were seen for hematoma and implant asymmetry.

The increase in implant asymmetry in transfemales can be explained by the chest wall differences between the two groups. The transfemale chest may have less overlying soft tissues that are naturally tighter. (although this may have changed because of hormone therapy) The nipple-areolar complex is also lower and more to the side. These can make getting implants in a good symmetric position more difficult and hence higher rates of asymmetry.

The increase in hematoma rate is more difficult to explain and has not been my experience.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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