FTM Top Surgery – Feminine Chest Contouring

Often transgender women begin the affirmation process through the use of feminizing hormone therapy, which can stimulate breast growth. This growth is often inadequate to meet the patient’s goals. It is important to recognize that breast augmentation performed for trans females has unique differences from a breast augmentation performed on a cisgender female. Not only is the underlying muscle anatomy different but there will be other aspects of feminization to address including appropriate size of the nipple and areola complex as well as the removal of unwanted hair and chest wall fat. There is a myth that transgender patients typically seek unnatural breasts; in reality their requests are as varied as those of cisgender women, ranging from a subtle and natural change to a look that is fuller and more obviously surgical.

There are several important anatomic differences between cisgender female and transgender female augmentations that often go unrecognized by patients and surgeons:

1. The rib cage and breasts of a trans woman are usually wider than that of a cis woman of similar height and weight. To create an ideal breast shape and to have that breast fit on the chest wall means that the surgeon must take multiple, precise measurements, and select from a wide range of implants. While this “dimensional planning” is important in all breast augmentations, it is particularly important in the trans female patient.
2. A transgender woman’s nipples are usually situated more to the outside of the breast mound. This affects where the implant should be placed so that the nipple ends up relatively centered on the breast mound. 
3. A transgender woman’s nipples are also usually situated low on the breast mound. The ideal breast has about 55% of the breast volume below the plane of the nipple and 45% above. While sometimes the implant needs to be placed below the natural crease of the breast in a cisgender woman to achieve that balance, it is necessary far more often in the transgender patient. That position is critical to the result and must be planned exactly. Failure to properly determine where to situate the bottom of the breast and to keep the implant in that position are the two factors that account for most of the suboptimal results in transgender breast augmentation.
4. Transgender patients usually have thicker and tighter skin. Delete this line:(Years of fluctuating breast size from monthly periods, weight changes, gravity, genetically thinner skin, and of course the substantial stretch with pregnancy can all thin skin further.) This tighter skin often results in breasts that are somewhat fuller and perkier, especially in the upper portion of the breast.
5. The pectoralis major muscle is often (but not always) thicker in a transgender woman. Rarely is it thick enough to create a problem; it just requires a greater level of attention to anesthetic and technical considerations during surgery. There may be a greater tendency for the muscle to push the implants slightly down and out over time, though this also can be an issue for cisgender patients.

FTM Surgery in Toronto: Before & After Photo Gallery

Fat Injection for Transgender Breast Augmentation

Many transgender patients enquire about liposuction contour the waist and hips and help feminize the torso. Sometimes this fat is transferred into the buttocks or outer thigh. This fat can also be used for the breast. In most patients, fat alone does not produce a breast of adequate size, but it can help widen a breast that responded very well to hormones. It also can be used in conjunction with an implant to conceal the implant edges and make the breast look more natural than it might with an implant alone.

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