Gender dysphoria is dissatisfaction with one’s own body due to a discrepancy between one’s gender identity and one’s sex assigned at birth. The treatment of this disorder is multimodal and multidisciplinary, including hormonal treatment and sex-reaffirmation surgery. Surgery often achieves optimal physical and emotional results in these patients.
There are very marked differences between the female and male thorax, from the amount of gland (larger in women), the size of the base (larger in men), the width of the lower pole and the size of the nipple areola complex (smaller and ovoid in men).
Breast and thorax surgeries are the most frequently performed in transgender patients, both breast augmentation and mastectomy, since it is a very visible part of the body that conditions their presence in the world and the sex in which they present themselves in their lives. In many occasions transgender patients only have breast surgery and do not have genital surgery because they are much more aggressive surgeries and with higher risks.
Regarding the surgical technique of prosthetic augmentation in transgender patients:
- The plane where the implant is placed is the dual plane (under the muscle, the sternal insertions are sectioned).
- The scar is placed in the inframammary fold (although it must be placed below the initial submammary fold of this patient).
- Freeing the initial groove of the breast to avoid irregularities, and a round breast.
- Generally, the nipple areola-nipple complex of the male breast is located more laterally than the female breast. This must be taken into account when making the prosthetic pocket and placing the prosthesis, so that the areola is centered.
- The prostheses chosen vary according to the case and the patient’s preferences: from round and with smooth coverage, to anatomical and rough…
The usual postoperative period after breast augmentation in transgender patients consists of: relative rest for 2 weeks, removal of stitches in 10-12 days, and they have to wear a sports bra for 6 weeks. It is advisable to sleep on your back for those 6 weeks.
On the other hand, in some cases it may be necessary to perform two-stage surgeries:
- Inclusion of breast expanders to expand very little extensible skin, or to achieve quite significant volume increases. The expander would be placed in the first stage and later it would be replaced by the definitive prosthesis.
- Lipograft or lipofilling- Sometimes it can be a complement to prosthetic augmentation, the breast would also be filled with the patient’s own fat.
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