Breast Augmentation facts and numbers

The female breast is a symbol of femininity and fertility. The beauty ideal of the perfect female breast is an ever changing topic throughout the centuries correlating also with beauty ideals of the society the individual lives in. Personal preference and lifestyle also play an important role in what the perfect breast is for a particular individual.

Breast augmentation usually is one of the most widely performed gender confirmation surgeries for MtF transgender individuals. Apart from the size increase of the breasts, the self-confidence and the feeling of self-worth experience a similar boost.

In breast augmentation surgery a breast implant is placed in a well-defined layer inside the breast. These implants not only increase the size of breasts but also improve the shape of the breasts.

As per cosmetic surgery, Breast augmentation is one of the most common Transgender procedures. In our practice, we have carried out more than 4000 successful breast augmentation surgeries.

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Important features of an Ideal breast:

  • The main features which make a breast beautiful are sufficient volume and elasticity
  • The size, the shape, and the position of the nipples are also a relevant aspect to be considered
  • The nipples are positioned a little higher than the center of the breasts and should not be too large
  • The center of the collar bone and the nipples join to create an equilateral triangle
  • Ideally, the breast measurement is 5-10cm less than the hip measurement
  • The breasts are round and spherical, not too large or small, with proper elasticity

Procedure: In a completely sterile operation theater – exclusively dedicated to cosmetic surgery only – the implant gets inserted after the adequate pocket is made. Usually, high profile round textured and highly cohesive silicone gel implants are placed in a submuscular position. By meticulously repairing the incision line the scar becomes practically invisible and because dissolvable, invisible suture threads are used there is no need to take them out post-op.

Duration of Procedure: 1 – 2 hrs.

Anesthesia: General/Local with Sedation

Recovery Time: You can return home or leave for your hotel or accomodation in the evening or on the next day. The pateint can usually return to work within a week. Strenuous activities should be avoided for the initial 3 to 4 weeks post-op.

Longevity of Results: Permanent

Considerations before planning the breast augmentation surgery:

  1. Implants- Silicone filled:
    • Round / teardrop (anatomical)
    • Smooth/textured
    • Low/moderate/high/ultra high profile
  2. Incision location:
    • Transaxillary
    • Inframammary
    • Periareolar
  3. Size and shape consideration (How to choose Implant Size): You will be examined in detail to assess the size of the implants to be used. Size or volume of the implants depend on many factors like:
    • Patient’s desire
    • Amount of existing breast tissue and skin
    • Chest size
    • Sagging / drooping of breasts
    • Lifestyle and activity

There are various approaches for breast implant surgery but the aim always remains the same: to end up wit as little invisible scarring as possible.

Transaxillary Approach

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In this approach, a 3cm size incision is made in the axilla along the crease (armpit fold).

The resultant scar is practically invisible making this approach a scar-less breast implant surgery and that is why it is so popular with our patients.

Important features of axillary approach (scarless breast implant surgery)

  • The breast remains free of any scarring
  • Minimal disturbance to important blood vessels and nerves
  • Small/ minimal incision in armpit with a minimum possible scar which becomes practically hidden in the axillary creases
  • No effect on breastfeeding
  • No effect on nipple sensations
  • Accurate dissection and positioning of implants prevents asymmetry
  • Easy removal/replacement of the implant if needed, through the same approach without any scar on the breast
  • Minimum/ no pain and swelling, leading to rapid recovery to daily activities

Periareolar Approach

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An incision is made at the junction of the areola and breast skin at the lower half of the areola. If a simultaneous periareolar mastopexy is needed then an incision may be extended into the upper half also.

Key Points

  • A visible scar on the breast is possible though the scar tends to fade with time
  • Disturbance to breast tissues is possible (chances of breast duct transaction with chances of infection of staphylococcus epidermis)
  • Swelling and pain are more as the dissection is performed through breast tissue
  • It gives good access to the inframammary fold which can be readjusted according to breast implant size
  • Higher chances of nipple sensitivity change
  • Should not be used if areolar diameter is 40mm or more
  • May not allow introduction of larger gel or enhanced cohesive silicone gel implants

Inframammary Approach

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An Incision is made in the crease below the breast.

Key Points

  • As the incision is performed on the chest, arm movements are free from restriction
  • This approach permits a wide surgical view of the pocket
  • Minimal swelling and pain, leading to a fast recovery and a speedy return to daily activities
  • This approach does leave a scar below the breast. Scars on both sides do reveal that breast augmentation surgery was performed

Plan of pocket selection

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  1. Subglandular : The implants are placed above the muscle. Theoretically, this is the natural anatomical position. But this is associated with a higher chance of capsular contracture, implant visibility and/or palpability. This may interfere with an investigation like a mammography.
  2. Submuscular / Subpectoral: The implant is placed under the muscle. This is the most popular pocket used.
    Important features are:
  • Less chance of capsular contracture
  • Less chance of visibility and/or palpability
  • No interference with future investigations like a mammography

 

  • Dual Plan/ Subpectoral plan:  The lower part of the implant is being placed in subglandular position. The advantages are the same as in the submuscular approach
  • The recently introduced subpectoral fascia pocket is believed to provide the advantages of the sub-glandular pocket with a thicker soft tissue cover of the fascia. So far this approach is not so popular.

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