Transfeminine Top Surgery

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CHEST FEMINIZATION SURGERY (MTF):

Various techniques can be used to feminize the chest. Ultimately, the goal is to add tissue, projection, and shape to the chest. The technique that is best suited for you depends on your goals.

Often, patients who are already taking hormone therapy develop softening of their skin and some breast growth. This may lead to development of enough breast shape such that fat transfer or grafting is all that is desired. In this technique, fat is liposuctioned from different areas of your body, processed, and then injected into your chest. Dr. Li prefers to process his fat using the PureGraft® system to have the highest quality fat for injection. The higher the quality of the fat, the greater the likelihood of its survival. The technique of injecting the fat also influences the fat survival and Dr. Li has significant experience with fat transfer to the face, breasts, and buttocks. After the fat is injected, it eventually becomes a part of your chest, such that if you lose weight, the fat will get smaller, but on the other hand, if you gain weight, the fat will get larger. The liposuction performed to retrieve the fat can also help feminize the torso. Lastly, fat transfer or grafting can be combined with breast augmentation with saline or silicone implants to further improve results, e.g., it can be used to target certain areas like the upper half and medial half of the breasts to make it fuller. This is especially helpful in patients who are thinner as fat transfer can make results appear more natural and minimize visibility or palpability of implants.

The limitations of fat transfer or grafting are that you may not always have enough fat to liposuction, and there is a limit to which fat can increase the size and projection of your breasts. This limit is determined by the current volume of your tissues and the tightness of your skin, and generally you can expect the breasts to increase 1 cup size with each surgery. Notably, the skin can sometimes be tighter and stiffer in patients hoping to have MTF top surgery. If larger increases in volume and projection are desired, breast augmentation with saline or silicone implants may be a better option.

The techniques used to place breast implants for transgender patients are the same as those used for cisgender patients, with several nuances to consider. Different incisions can be used to access the chest tissues, including transaxillary, peri-areolar, or inframammary incisions, through which either subglandular/prepectoral or submuscular/subpectoral pockets are created for the implants. Both saline and silicone implants can be placed, although Dr. Li prefers the latter because they are lighter for the same volume and have a more natural feel. To read more about breast augmentation, click this link (https://www.caaesthetics.com/contents/for-her/breast-surgery/breast-augmentation1).

As aforementioned, patients hoping to have MTF top surgery can sometimes have stiffer and tighter skin, and so there may be greater benefit in placing implants in a subglandular/prepectoral pocket to allow maximum stretch and shaping of the skin by the implants. It may also be helpful to use higher profile implant styles as well as more filled implants such as the newer Mentor Xtra or Boost implants to help shape the breasts. If the skin is very tight, it may be necessary to progressively create larger breasts through multiple or staged procedures with gradually larger implants or use special implants called tissue expanders to stretch the skin in a controlled fashion over time.