Questions about Transgender Patient Breast Reconstruction
What is transgender affirmation breast reconstruction?
Transgender breast reconstruction is breast reconstruction for patients who are seeking “top” affirmation surgery.
Gender dysphoria is a distress arise when the biologic sex does not not align with a person’s gender identity. The prevalence of gender dysphoria is 0.6% in the United States or 1.4 million adults. The global prevalence of gender dysphoria is estimated at 0.5% of the total population or 25 million transgender worldwide.
Since the affordable care act (ACA) was enacted in 2016, insurance companies are obligated to cover surgical and medical treatments for gender affirmation. This include “top” and “bottom” surgeries. Thus, there is an increased demand and acceptance for gender affirmation top surgery.
For “top surgery” or transgender affirmation breast reconstruction, there are two major categories “Male to Female” top surgery and “Female to Male” top surgery.
Female to male (FtM) top surgery
Female to male (FtM) top surgery: is the most commonly requested and performed procedures in the FtM transgender population. The main principles of aesthetic chest wall contouring in FtM transgender population involve removal of the breast tissue, skin excess, proper reduction and position of the nipple and areola, elimination of the breast folds (inframammary fold), and minimizing chest wall scars.
The ideal surgical approach depends of the patient’s age, breast size, breast ptosis, skin quality, and overall body habitus. The age of the patient is an important factor because age is associated with reduced skin elasticity.
Dr. Goldberg employs the following surgical techniques depending on the above key factors,
- “Keyhole mastectomy” – astectomy with periareola skin excision
- Double incision mastectomy with free nipple graft (DIFNG)
Male to Female (MtF) top surgery
Male to Female (MtF) top surgery: is feminization of the chest in the surgical treatment of transgender breast reconstruction.
The surgical treatment employs the most common procedure in plastic surgery that is breast augmentation. However, breast augmentation in transwomen population is very different than breast augmentation in a woman. Understanding the chest anatomical differences between a male and a female chest is an essential ingredient in establishing the desired aesthetic results. The differences include the quantity of glandular tissue, broader breast base diameters, shorter nipple to inframammary fold (IMF), and the nipple areola complex is often smaller and wider spaced than a female breast. Dr. Goldberg will utilize different techniques including an internal mesh to assist with lowering the IMF without implant bottoming out, tissue expander as a two-stage for patients desiring large augmentation, and fat grafting to deliver the best and most aesthetic results for her patients.