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Breast Augmentation for Gender Affirmation

There are a few ways to perform breast augmentation. During our meeting, I want to make sure that I get an understanding of what your goals for the augmentation are, as well as which sort of physical activities in which you engage in (especially with regard to the upper extremities) in order to help recommend a type of implant and a surgical technique that will work best for you.

Implant Location

For breast augmentation, the location of the implant matters. If the implant is placed between the muscle and the skin, narrow breasts can be made full more easily, but the risk of implant deformity from scarring is higher. Placement below the muscle decreases the likelihood of implant deformity from scarring, but may impact chest muscle strength, and there is a chance the implants will visibly move with movement of the chest muscles.

Silicone or Saline

Many patients prefer the feel of silicone breast implants, as they feel they mimic breast tissue more realistically. The former FDA (United States Food and Drug Association) moratorium on the use of silicone implants for breast augmentation was lifted in 2006, although the FDA does recommend MRI (magnetic resonance imaging) screening of silicone breast implants 3 years after they are placed and every 2 years thereafter to check for rupture or other problems. Not all insurance companies may pay for that screening study, however.

Older types of silicone implants were more prone to rupture and leak silicone; new implants are more resilient, however they can still rupture and expose your body to the silicone inside. Rupture is difficult to detect without advanced imaging like MRI.

Saline implants are essentially robust containers, initially empty, that are placed in your body and inflated with sterile saline solution. When properly inflated, they look similar to silicone implants from the outside, but some suggest that they do not feel as similar to breast tissue as silicone does. Additionally, they can be prone to rippling, especially if underfilled. Rupture of a saline implant results in relatively rapid deflation of the implant as the saline is absorbed by your body, so it can be relatively easy to detect rupture of saline implants as compared to silicone implants.

Problems with textured implants

Recent studies have demonstrated problems with textured breast implants, where they appear to be associated with a rare type of breast cancer (anaplastic large cell lymphoma, or ALCL). Patients who have gotten smooth (non-textured) implants appear to have a much lower rate of ALCL than those patients who have had textured implants used for breast augmentation.

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