Transgender Breast Surgery
There are many surgical options available today for transgender patients who seek to follow their arc of destiny to a complete physical transformation.
As an experienced surgeon at The Plastic Surgery Center in Sacramento, I have performed a wide range of procedures for transitioning individuals, including male-to-female and female-to-male breast surgeries.
The skill required is the same type of precision and artistry that is so essential for all plastic surgery. The aesthetic component is especially important to patients who are making the journey to their true identity and want their appearance to reflect that. Male-to-female patients want full, lifted and symmetrical breasts, with larger areoles and a natural nipple angle. Female-to-male patients want a flatter chest that is lean, taut and masculine.
Shaping Your Feminine Look
For male-to-female patients, the process is similar to the breast augmentation surgeries I have performed for all other satisfied patients. As with traditional breast augmentation, patients select the type and size of implant that will be surgically inserted under the skin, on or below the chest muscle, to add volume and create a beautiful new profile.
Implants have a flexible silicone exterior shell, and may be filled with either saline or silicone gel. The silicone gel varieties provide a more natural feel, while saline is preferred by some patients who may be wary of silicone.
Generally, I insert the implants after making incisions under the areola or where the breast’s lower crease will be after the procedure. Some types of saline implants can actually be filled after the shell has been surgically inserted. By placing the unfilled shell under the skin, a smaller incision can be made, resulting in less scarring.
If you choose larger implants, in addition to a larger incision you may first need a tissue expansion procedure that will stretch your skin to accommodate the implants.
Born to Be Alive
All of us are born with breast tissue, and so there is usually an ample amount for a plastic surgeon to work with when creating the structure of the new breasts for a transgender patient. This is an outpatient procedure that, depending on the complexity and the patient’s preferences, may be performed with a local anesthetic and sedation or under general anesthesia.
I encourage my patients to have fun with planning their new look, and to use their imaginations. After all, there are a variety of choices for you to make. There are computer programs that can help you visualize the post-operative you, and there is also the very simple technique that many of my patients have used for years: Buy a few bras in different sizes, fill them with sizers, and see which size fits your body best. I will advise you during our consultation and tell you what sizes of implants can fit your chest size.
Freed from Corsets
Just as some individuals transitioning from male to female first rely on hormone therapy to begin creating new breasts, some female-to-male patients have spent months or years wearing restrictive clothing to flatten their natural profile. When they tire of that, or simply want to feel fully male, it is time to consider a surgical fix, which in this context is often called “top surgery.”
Once again, the transgender procedure is similar to other types of breast surgery that I regularly perform. In this case, the technique is very much like what happens during breast reduction surgery. And with some patients who start the process with very small breasts (and supple skin), the optimal technique can start similar to liposuction: suctioning out enough fat to create the desired lean, flat look then removing the small breast mound through a small incision. Conversely, removal of larger breasts may require a breast and skin reduction procedure, calling for larger incisions.
Creating a masculine appearance often requires repositioning the areola, shrinking its size and adjusting the size and angle of the nipple. Depending on the volume of your breasts, the areola may be temporarily removed along with the breast during the surgery, and then grafted back in a position that will be consistent with masculine physiology.
Most female-to-male breast procedures are performed under general anesthesia, as they are essentially mastectomies, and therefore major surgery.
First, a Conversation
As someone who has been trusted by many transgender patients to sculpt their new look and open a window to their new life, I understand that you are seeking skill and experience — but also something beyond that. You expect empathy and understanding, and you want to share your vision for an exciting new phase in your life with your surgeon.
That dovetails perfectly with my own expectations: I want to get to know you and know that you have completely thought through all of the vital choices you will soon make. I want you to share with me your gender dysphoria or other diagnosis, and talk about your life experiences on the voyage that has brought you here. Professional counseling and support are important prerequisites. For your safety, I also want to make sure you are in good health and have completed hormonal therapy prior to your surgery. Matching your personal vision with the results we will achieve together is very important to me, and I will take the time to evaluate your anatomy and map out a detailed plan that leads to the completely natural look you seek. I will be the doctor you trust — and a traveler with you on your journey home.
I look forward to talking with you soon, answering all of your questions, and helping you become fully informed about the many extraordinary choices available to you. Please feel free to contact my Sacramento practice by calling or emailing my office at any time.
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