Breast augmentation as part of gender transition
Breast feminization surgery as part of gender transition
Overview
Breast augmentation is a procedure that creates or increases breast volume through the insertion of breast implants.
As part of gender transition, some patients already experience breast development as a result of hormone therapy. However, this development may not be sufficient to achieve the desired shape or volume. Surgery can then be used to complete this feminization of the figure.
The procedure also aims to improve the balance between the chest, shoulders, and upper body in order to achieve a proportionate and natural-looking result.
A careful assessment of body structure is essential, as the chest may be wider and the skin may sometimes be tighter than in a cisgender woman. The choice of implants and their placement must therefore be fully customized.
Explanation of the technique
The choice of implants is determined during preoperative consultations based on several criteria:
- the volume of the implants
- their shape
- their projection
- their position
- the location of the scars
The placement of breast implants requires the creation of a custom pocket. To this end, several surgical approaches are possible:
- Scar around the areola : The incision is made in a semicircle around the areola. Because of the difference in color between the areola and the breast skin, this scar is generally very discreet, or even virtually invisible to someone who is not a surgeon. It is important to note that breastfeeding is still possible despite this procedure.
- Scar under the breast : The incision is made in the inframammary fold. This approach is particularly beneficial for women with small areolas that do not allow the implant to pass through. When standing, the scar remains hidden, covered by the slightly sagging breast. It becomes visible only when the patient is lying down.
- Scar in the armpit : The incision is made under the arm. This method has the advantage of leaving no visible scar on the breast. However, it may be noticeable in the armpit when the patient wears a swimsuit or a tank top.
Each method has its own advantages and disadvantages. Dr. Vairinho will be able to guide you toward the approach best suited to your breast anatomy and your expectations.
The surgeon’s customized design of the pocket will depend on various individual characteristics specific to each patient, such as implant size, skin thickness, glandular volume, musculature, and the morphology of the breast and chest.
There are three types of boxes available:
- Retropectoral compartment : The implant is placed behind the pectoralis major muscle. The benefits of this approach include muscular support for the implant, resulting in a more natural-looking outcome. The muscle exerts pressure on the implant, giving the breast a pear-shaped contour, while the implant becomes less palpable, resulting in a more natural feel.
- Retroglandular or pre-muscular compartment : The implant is placed behind the breast tissue and in front of the pectoralis major muscle. This method is particularly beneficial for women who are very active in sports and for those with sufficient breast tissue, as it helps to soften the contours of the implant.
- Dual-level suite : This is the most advanced technique. The upper part of the implant is positioned beneath the pectoralis major muscle, while the lower part is placed beneath the breast gland. This approach aims to achieve a natural, pear-shaped result with less noticeable implant contours.
All breast implants used by Dr. Vairinho bear the CE mark (European Community) and are approved by the ANSM (French National Agency for Medicines and Health Products Safety).
The characteristics of a breast implant include:
- The envelope : Made of smooth silicone elastomer, Dr. Vairinho does not use textured implants or polyurethane implants.
- The content : The implants are pre-filled with cohesive silicone gel, which means that if they rupture, there is no leakage of silicone. When palpated, they feel soft, providing a natural feel. Implants filled with saline solution are currently less commonly used.
- The form : The implants used by Dr. Vairinho are round in shape, creating an aesthetically pleasing cleavage. The implant projection can be low (particularly useful in reconstruction cases), moderate (commonly used in most situations), or high (recommended in cases of associated breast ptosis).
Dr. Vairinho avoids using anatomical implants due to the increased risk of rotation and the need for a textured shell. Although the risk of anaplastic large cell lymphoma is extremely rare, it is primarily associated with textured implants.
Overview of the procedure
The procedure is performed in the operating room under general anesthesia at a specialized clinic.
The surgery lasts an average of 1h30 to 2 hours.
Before the procedure, several consultations allow for:
- to discuss the patient's expectations
- to examine the morphology
- to choose the implants
- to explain the postoperative care and precautions to follow
On the day of the procedure, preoperative markings are made to precisely guide the surgical procedure.
Depending on the situation, outpatient treatment or an overnight hospital stay may be recommended.
BEFORE / AFTER
Postoperative Care and Expected Results
Postoperative recovery is generally straightforward. Postoperative pain is usually mild and can be relieved with standard painkillers. A feeling of tightness or discomfort may be more pronounced when implants are placed behind the pectoral muscle, particularly with larger implants.
In the first few days, breast swelling and bruising may occur. Discomfort when raising the arms is also common. These symptoms gradually subside over the course of several weeks and do not affect the final cosmetic result.
Depending on the situation, the procedure may be performed on an outpatient basis or require an overnight hospital stay. Follow-up appointments are routinely scheduled to monitor healing and track postoperative progress.
It is recommended that you wear a compression bra day and night for 4 to 6 weeks to minimize strain on the scars and help the implants settle into place.
Showering is generally permitted the day after the procedure. A sick leave or rest period of about 7 days may be recommended, depending on the nature of your work. A gradual return to physical activity is usually recommended after 4 to 6 weeks.
The results gradually improve in the weeks following surgery. The breasts become softer over time, and the implants gradually settle into their final position. The goal is to achieve a natural, harmonious bust that complements each patient’s body type and transition plan.
Comme pour toute intervention chirurgicale, des complications restent possibles, même si elles demeurent rares. Toutes les chirurgies comportent une part de risque, y compris les interventions les plus courantes. L’essentiel repose sur un diagnostic précoce et une prise en charge adaptée lorsqu’une complication survient.
In some rare cases, a complication such as a hematoma or an infection may require further surgery. Among the specific complications associated with breast implants, there is also a risk of capsular contracture—a thickening of the membrane that naturally surrounds the implant—or, more rarely, implant rupture.
These points are systematically explained and discussed during preoperative consultations to ensure that patients receive clear and comprehensive information prior to the procedure.
Claims for reimbursement of breast augmentation procedures may be reviewed as part of an application for Long-Term Illness (ALD) coverage. In that case, you will need to fill out a request for prior authorization and send it to your health insurance provider.
Outside the ALD framework, coverage may be obtained in the following situations after updating one’s civil status with Social Security: if breast development remains limited despite several years of hormone therapy, in cases of tuberous breasts, or in cases of marked asymmetry corresponding to a difference of at least one cup size. In all cases, a request for prior approval is also required.
FAQ
Frequently Asked Questions About Breast Augmentation as Part of Gender Transition
Surgery is generally considered after a sufficient period of hormone therapy to allow natural breast development to stabilize.
The choice of implant size depends on the shape of the chest, the condition of the skin, and the desired outcome. The decision is made in consultation with the patient.
Scars gradually fade over time. Their location depends on the technique used and is discussed before the procedure.
Yes. The goal of the procedure is precisely to achieve a bust that is in harmony with the overall silhouette and suited to each patient’s body type.
Recovery varies from patient to patient, but it is often possible to gradually resume daily activities after a few days. It generally takes several weeks to resume sports activities.
>> This page is intended to provide general information. Only a consultation with Dr. Vairinho will allow for an accurate assessment of your situation and the recommendation of an appropriate treatment plan. A personalized quote is provided only during a consultation.
