Background: In the transfemale patient, contrary to popular perception, breast implants are not always done or on a high priority for the patient. Many such patients who are on hormonal therapy give that ample time to try to achieve their desired breast size increase. For many this is adequate well for others they never came quite get to their desired size. In this case they have two options, fat injections or breast implants. If they have adequate fat stores fat injections can be an effective augmentation technique. However if they are lean and/or their breast size goal is considerable implants are the only treatment option.
Breast implants come in a wide range of size options from 100ccs to 800ccs. To no surprise the vast majority of breast implant patients are between these two end points on what is probably a bell-shaped distribution curve, most between 300cc to 500ccs. But on both ends of these options are patients who feel most comfortable with having a very modest change to a substantially larger one. It is thus important to get a very accurate preoperative sizing method to understand what the patient wants to achieve.
Some trans female patients want a very modest change to look the most natural as possible. They may already have a small amount of breast tissue development but this is not quite enough. To meet their very modest breast augmentation needs very small volume breast implants, in the 100 to 200 cc range is what is need it. To keep the procedure scarless a transaxillary approach works very well for these small breast implant sizes. Because of the naturally wider sternal spacing, the lateralization of the breast mounds and the small implant size the lateral pectoral muscle border must be kept intact.
Case Study: This female desired a modest breast augmentation increase with an existing development of modest breast mounds. The sternal spacing was wide. The breast base diameter was 9.5cm. Preoperative sizing was for 150cc implant of non-high profile projection.
Under general anesthesia and through 3cm high axillary incisions the submuscular pocket was developed.The 150cc implants were placed using a funnel insertion device.
Despite only being 150ccs in size a slightly fuller breast mound was created.
In upright position the modest increase in breast size did not make the sternal gap look wider nor did it make the breast mounds look more laterally displaced.
When see four years later the long term results of the reduction in the soft tissue cheek area could be appreciated.
Key Points
1) Breast implants are the surgical augmentation when hormonal therapy alone is inadequate in the transfemale patient.
2) Breast implants come in very low volumes starting at 100ccs so implants can look extremely natural.
3) For scarless breast augmentation the transaxillary approach with funnel device insertion is very effective.
Dr. Barry Eppley
World-Renowned Plastic Surgeon