Breast Augmentations & Implants

Hormone replacement therapy typically triggers breast development in trans women. Breasts will normally attain a size similar to those of other women in the trans woman's family, though this process can take years for fully developed breasts. That wait can cause a great deal of anxiety. Additionally, some women aren't satisfied with their breast size, even after years on HRT. There is also a small minority of cross-dressers and non-binary identified transgender people who want breasts, but do not desire taking hormones. For these and other reasons, breast augmentation may be an option to consider.

Types of Implants

The two primary types of breast implant currently on the market are saline and silicone gel.

Saline implants are made of a silicone shell that's surgically placed within the breast, then filled with a sterile salt water solution. Because they are filled after being implanted, they require a smaller incision. Unfortunately, they're also more likely to have cosmetic problems. Rippling in the implant or its outline being identifiable through the breast are the most common complaints. Women who have some breast tissue already present and have saline implants inserted beneath the muscle have the best results.

Far more popular across the world, the silicone gel implants commonly provide a more satisfactory look. As the implant is full of the gel when inserted, it requires a larger incision. Round and teardrop shaped implants (mimicking the shape of the breast when standing) are available.

Incisions

The type of incision chosen will affect scarring, the potential for loss of sensation, certain complications, choice in implant, and general aesthetics.

The most common incision is the inframammary, where the breast is opened from below. This allows a larger incision for silicone gel implants, though the scarring may be visible and heal thickly. Women with larger natural breasts are more likely to be satisfied with this incision, as their breast tissue will naturally fold over the incision site and mask it.

Less common incision types are the periareolar and transaxillary. Periareolar incisions are around the border of the areola, which will help mask any scars. Because the incision is so small, it tends to be best for saline implants. Transaxillary incisions are through the armpit, which will leave no scars on the breast itself and provides an excellent approach to place the implants symmetrically.

Implant Placement

There's more to consider than implant type and the incision. Where the implant will sit inside of the breast also has to be decided. The two most common placements are subglandular and subpectoral, though variations exist. In subglandular placement, the implant is placed between the breast tissue and the pectoral muscles. This is widely considered to create the most natural and appealing appearance, though rippling in the implant and its outline are more likely to be visible. In subpectoral placement, the inferior muscle attachments in the pectoral are released and the implant is placed partially beneath the muscle.

Complications

The risk of complications is likely one of the scariest parts of considering breast augmentation. First, keep in mind that there are many risks that will be part of any surgery. There are potential complications with anesthesia, bleeding, infection, and nerve damage or pain. Another thing to consider is that while many trans women are able to lactate after HRT, breast implants could interfere with breastfeeding.

Breast implants are not forever. Eventually, they will most likely fail and need to be removed. If you're in good health and amenable to it, you can then have a new set implanted. In the case of saline implants, if they rupture the sterile salt water solution will be absorbed by the body and the implant will deflate. They are easily removable at this point. Silicone implants, on the other hand, will not typically deflate. The gel may extrude from the implant and there is a risk of it migrating through the body to cause complications.

Another complication to consider is capsular contracture. This happens when the immune system builds up collagen fibers around a foreign body, such as the implants, and then this capsule of collagen then contracts. It can cause a great deal of pain, distort the appearance of the implant, and even lead to rupturing the implant. Treatment for capsular contracture usually involves surgery, though there are some other methods now in use and in some cases massage may help.

Recovery

If all goes well, a breast augmentation patient should be able to return to normal activity within a week. Implants placed beneath the muscle may cause a longer recovery time in patients and any strenuous activity will need to be limited for up to six weeks.

Discuss your options and preferences with your surgeon. Remember that if you're within the first few years of HRT, it's possible your breasts may continue to develop.

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