Trans women and transfeminine people seeking breast augmentation as part of medical transition face certain concerns distinct from cis women who may receive this surgery. Our anatomical baseline is very different from that of adult cis women, with a recent study finding that 7 in 10 trans women developed breasts of less than an A-cup after three years of feminizing hormone therapy, and only 58% stating that they were satisfied with their breast size.
This surgery is also in heavy demand among trans women, as around 80% either received this surgery or desired to receive it, and 85% of recipients stated they sought the surgery because of insufficient breast growth on HRT. Given anatomical differences in our upper body shape and size, the Johns Hopkins Center for Transgender Health has published information on specific techniques and approaches to produce the best aesthetic results for post-pubertal trans women.
This is a complex field, and even as breast augmentation is most commonly performed for cis women, this surgery can’t be assumed to be just the same for trans women with no modifications needed. Now, a new study offers further insight into the outcomes of breast augmentation among trans women and shifts in surgical trends over time (Sijben et al., 2021).
The gender clinic at Amsterdam’s VU University Medical Center studied the breast augmentation surgeries received by 527 trans women and nonbinary people from 1990 through 2020, examining medical outcomes, variations in surgeries, complications, and regret at a median followup time of 11.2 years after surgery. In this patient cohort, the typical size of breast implants was seen to increase substantially over the past decade. While the median implant size was 275 cc from 1990-1999 and 252 cc from 2000-2009, the median size of implant from 2010-2019 increased to 375 cc. This is concordant with the report from the Johns Hopkins Center, which has more recently “gravitated toward accepting patient desires for larger implants” as “more substantial implants successfully fill the horizontally broad chest, addressing one of the most challenging parts of obtaining a good result.”
A majority of trans women, 70.6%, received implants below the mammary gland and above the pectoral muscle, which Johns Hopkins has disfavored as it can create the appearance of an “unnatural double mound”. However, submammary implants were noted to be more frequent in the period from 1991 to 2007 than they are currently.
In terms of the development of complications from augmentation, 4.9% of patients experienced contraction of the tissue capsule around the implant after an average of 6.8 years, and 5.7% experienced rupture of the implant after an average of 12.9 years, both of which require another surgery to correct. One person out of 527 experienced BIA-ALCL, a breast implant-associated lymphoma linked to implants with a textured surface.
Regret after surgery was reported by 0.9% of patients, with three of these five patients choosing to have their implants removed. Conversely, 2.5% of patients (13 subjects) chose to undergo an additional surgery because they wanted larger implants, meaning that regret for the reason that implants were not large enough was 2.6 times as common as regret of having implants at all. While these new findings only represent the practices over time at one medical center in the Netherlands, and other clinics in different locations may have found different results in their experiences of performing breast augmentation on trans women and transfeminine people, this study further confirms that this is a safe and acceptable surgery as part of effective transition treatment for gender dysphoria when appropriate to the patient. ■
