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MTF patients under hormone therapy will experience breast gland development under the influence of these hormones, but often this is only limited in volume. MTF breast enhancement can provide a solution for trans women (or non-binary persons) who want to give their breasts a more feminine appearance. Both the volume and the shape of the breast are discussed extensively with the patient before the procedure. The ultimate goal of this procedure is to make patients feel better because their physical characteristics are more in line with their self-image and how they can present themselves to the outside world. This increases self-esteem and self-confidence. However, it is extremely important to have realistic expectations for this procedure. There are disadvantages such as, for example, scars and complications are also possible. A number of choices need to be made by the patient. Dr. Myny will discuss the different options with the patient.
MTF breast augmentation with implants
When breast augmentation with implants is considered, a number of choices have to be made.
Filling of the implant: physiological water or silicone
The first choice are implants with silicone filling because they feel softer and provide a more natural result. A filling with physiological water is also possible, but that feels harder.
Cup size: size of the implant
The desired cup size is discussed with the patient. An important criterion is that it is best to choose a cup size that is proportional to the body stature. In order to determine this volume, exterior sizer protheses are used for visualization, and also a 3D simulation is made.
Shape of the implant
There are two forms. First of all, there are the ordinary round prostheses. These are most often chosen because they give a pronounced bulge to the upper pole of the breast, which transgender patients often prefer. Another advantage is that if these prostheses rotate in the cavity in which they are placed, no shape change of the breast occurs.
Teardrop-shaped, also called anatomical prostheses, are a possibility if the patient prefers to avoid bulging of the breasts, especially in the upper pole. The upper pole is flatter and that looks more natural. The main drawback is that when these teardrop prostheses rotate in the cavity, an unnatural change of shape of the breast can occur, which may even necessitate re-surgery .
Place of the incision
Here too there are various options . The first choice is a cut of about 3 to 4 cm in the breast fold. This is the best choice because it has been shown to have the least number of complications with this method. Other options include a cut around the nipple or a cut in the armpit. The latter method is least desirable given the high number of complications, possible breast asymmetry and reoperations.
MTF breast augmentation with fat transfer
Breast augmentation with the patient’s own fat (lipofilling) is one of the possibilities and will probably become the first choice treatment in the future. Nowadays this method is not often used because there are clear disadvantages. First, only a limited volume increase of about 250 cc is possible, especially when the patient's skin is very tight. This means that in the majority of cases multiple sessions will be necessary, which will greatly increase the costs. However, what is often done is combining a breast prosthesis with lipofilling. This is called a “composite” breast enhancement. This can be especially helpful in lean patients where the prosthesis is highly visible. By filling in the subcutaneous fat layer, so that this layer is made thicker, the prosthesis is better camouflaged and less visible, resulting in a much more natural result.
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