Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management

healthtransgenderwomenkapak

BREAST AUGMENTATION SURGERY AND CARE IN TRANSGENDER WOMEN

Aziz Parspancı1
Emin Sır2
Yavuz Tuluy3

1Private Practice of Plastic, Reconstructive and Aesthetic, İstanbul, Türkiye
2İzmir Kavram Vocational School, Department of Plastic, Reconstructive and Aesthetic Surgery, İzmir, Türkiye
3İzmir Bakırçay University, Çiğli Training and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, İzmir, Türkiye

Parspancı A, Sır E, Tuluy Y. Breast Augmentation Surgery and Care in Transgender Women. Balsak D, Aksin Ş, eds. Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.105-112.

ABSTRACT

Breast augmentation is the most common surgical procedure performed on transgender women and one of the most important parts of the gender affirming process. Breast augmentation positively affects the individual both physically and psychologically and allows the individual to see themselves in the phenotype they feel they are. Techniques used for breast augmentation include breast implants and fat grafting to the breast. Sometimes these two techniques can be combined. Implants can be placed in the subglandular or subpectoral plane through inframammary fold, axillary or periareolar incisions. Hormone therapy also promotes breast formation, but its effect is limited. Postoperative recovery time is faster in patients with subglandular implant placement. However, in patients with subpectoral placement, the prosthesis is less palpable from the outside and a relatively more natural result is obtained. Infection, hematoma, seroma and wound dehiscence may be seen in the early postoperative period. Psychological recovery after surgery is also important. These individuals have body dysphoria and sometimes have unrealistic expectations of surgery. Psychologically positive results were observed in most individuals after breast augmentation. Capsule formation and implant displacement may be observed in the late period. Capsule formation is observed in every patient, it usually begins to form after the first postoperative year. Capsule reaction manifests itself with pain in the early stage and with external deformity in the late stage. Individuals should be informed preoperatively that these implants have a period of use and can be replaced by revision surgeries. Fat grafting is another option for breast augmentation, but sufficient volume may not be achieved. The patient should be informed that repeated fat grafting injections may be required and that some of the fat will be resorbed. Successful breast augmentation surgery is not just about surgery. A multidisciplinary approach should be adopted for transgender women to best manage this process. Close collaboration between surgeons, psychologists, and endocrinologists enriches patient care and ensures the creation of a personalized treatment plan. In the literature, there are few data on the surgery of transgender women and there is a limited number of patients in the studies. Future research should include larger, multicenter studies that evaluate longterm outcomes and complications. Additionally, studies on how surgical techniques can better serve the specific needs of transgender women are also important.

Keywords: Transgender persons; Breast implantation; Gender dysphoria; Sex reassignment procedures; Sex reassignment surgery

Referanslar

  1. Patel H, Samaha Y, Ives G, Lee TY, Cui X, Ray E. Chest Feminization in Male-to-Female Transgender Patients: A Review of Options. Transgender health, 2021;6(5), 244-255. [Crossref]  [PubMed]  [PMC]
  2. Weigert R, Frison E, Sessiecq Q, Al Mutairi K, Casoli V. Patient satisfaction with breasts and psychosocial, sexual, and physical well-being after breast augmentation in male-to-female transsexuals. Plastic and reconstructive surgery, 2013;132(6), 1421-1429. [Crossref]  [PubMed]
  3. Budge SL, Adelson JL, Howard KA. Anxiety and depression in transgender individuals: the roles of transition status, loss, social support, and coping. Journal of consulting and clinical psychology, 2013;81(3), 545-557. [Crossref]  [PubMed]
  4. Coon D, Lee E, Fischer B, Darrach H, Landford WN. Breast Augmentation in the Transfemale Patient: Comprehensive Principles for Planning and Obtaining Ideal Results. Plastic and reconstructive surgery, 2020;145(6), 1343-1353. [Crossref]  [PubMed]
  5. Bhatt N, Cannella J, Gentile JP. Gender-affirming Care for Transgender Patients. Innovations in clinical neuroscience, 2022;19(4-6), 23-32. [PubMed]
  6. Berliere M, Coche M, Lacroix C, Riggi J, Coyette M, Coulie J. et al. Effects of Hormones on Breast Development and Breast Cancer Risk in Transgender Women. Cancers,2022;15(1), 245. [Crossref]  [PubMed]  [PMC]
  7. Gelles-Soto D, Ward D, Florio T, Kouzounis K, Salgado CJ. Maximizing surgical outcomes with gender affirming hormone therapy in gender affirmation surgery. Journal of clinical & translational endocrinology, 2024;36, 100355. [Crossref]  [PubMed]  [PMC]
  8. Decuypere F, De Wolf E, Vyncke T, Claes K, Monstrey S, Buncamper M. Male-to-female gender affirmation surgery: breast reconstruction with Ergonomix round prostheses. International journal of impotence research, 2020;33(7), 720-725. [Crossref]  [PubMed]
  9. Claes KEY, D'Arpa S, Monstrey SJ.Chest Surgery for Transgender and Gender Nonconforming Individuals. Clinics in plastic surgery, 2018;45(3), 369-380. [Crossref]  [PubMed]
  10. Miller TJ, Wilson SC, Massie JP, Morrison SD, Satterwhite T. Breast augmentation in male-to-female transgender patients: Technical considerations and outcomes. JPRAS open,2019;21, 63-74. [Crossref]  [PubMed]  [PMC]
  11. Fanous N, Tawilé C, Brousseau VJ. Minimal inframammary incision for breast augmentation. The Canadian journal of plastic surgery = Journal canadien de chirurgie plastique, 2008;16(1), 14-17. [Crossref]  [PubMed]  [PMC]
  12. Morrison SD, Wilson SC, Mosser SW. Breast and Body Contouring for Transgender and Gender Nonconforming Individuals. Clin Plast Surg. 2018;45(3):333-342. [Crossref]  [PubMed]
  13. Sim HB. Transaxillary endoscopic breast augmentation. Archives of plastic surgery, 2014;41(5), 458-465. [Crossref]  [PubMed]  [PMC]
  14. Davis MJ, Perdanasari AT, Abu-Ghname A, Gonzalez SR, Chamata E, Rammos CK. et al. Application of Fat Grafting in Cosmetic Breast Surgery. Seminars in plastic surgery, 2020;34(1), 24-29. [Crossref]  [PubMed]  [PMC]
  15. van de Grift TC, Elaut E, Cerwenka SC, Cohen-Kettenis PT, Kreukels BPC. Surgical Satisfaction, Quality of Life, and Their Association After Gender-Affirming Surgery: A Follow-up Study. Journal of sex & marital therapy, 2018; 44(2),138-148. [Crossref]  [PubMed]
  16. Bekeny JC, Zolper EG, Fan KL, Del Corral G. Breast augmentation for transfeminine patients: methods, complications, and outcomes. Gland surgery, 2018;9(3), 788-796. [Crossref]  [PubMed]  [PMC]
  17. Thorne CH. An evidence-based approach to augmentation mammaplasty. Plastic and reconstructive surgery, 2010;126(6), 2184-2188. [Crossref]  [PubMed]
  18. Kyriazidis I, Antoniou A, Demiri E, Pavlidis L, Papas A. Bilateral Hematoma Following Air Travel after Breast Augmentation: A Cautionary Tale and Literature Review. Plastic and reconstructive surgery. Global open, 2024;12(3), e5639. [Crossref]  [PubMed]  [PMC]
  19. Glynn TR, Gamarel KE, Kahler CW, Iwamoto M, Operario, D, Nemoto T. The role of gender affirmation in psychological well-being among transgender women. Psychology of sexual orientation and gender diversity, 2016;3(3), 336-344. [Crossref]  [PubMed]  [PMC]
  20. Headon H, Kasem A, Mokbel K. Capsular Contracture after Breast Augmentation: An Update for Clinical Practice. Archives of plastic surgery, 2015;42(5), 532-543. [Crossref]  [PubMed]  [PMC]
  21. Gooren LJ, van Trotsenburg MA, Giltay EJ, van Diest PJ. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. The journal of sexual medicine, 2013;10(12), 3129-3134. [Crossref]  [PubMed]
  22. Stutman RL, Codner M, Mahoney A, Amei A. Comparison of breast augmentation incisions and common complications. Aesthetic plastic surgery, 2012;36(5), 1096-1104. [Crossref]  [PubMed]