MTF Breast Augmentation

Every woman’s chest and breast are unique. It’s important to understand the desired size and shape of the breast relative to the current chest and breast anatomy. I want to know if I can accomplish the patient’s goals in one operation (single stage) or if a skin expansion stage is necessary. I am looking at the shoulder width, breast projection, areola size, sternal width relative to shoulder width, breast cleavage, skin quality (stretch marks), areola diameter, nipple projection and the location of the breast fold relative to the areola position. It’s also important to evaluate the pectoralis muscle, how defined is it, how much does it animate with contraction, because I am trying to determine if the implant should be in-front or behind the muscle.

In terms of candidacy for surgery, South Florida patients who are; informed about the risks and benefits of breast implants, healthy, able to tolerate downtime, in the care of a medical health professional who will support their candidacy for breast augmentation surgery.

My philosophy is no different than treating any other cosmetic patient. I try to understand my patient’s goals and use my experience to discuss if what they desire is possible. I share how their anatomy, skin, prior surgeries, or health may factor into my surgical approach. It’s been my experience that reasonable expectations and great intraoperative attention to detail lead to successful doctor patient outcomes.

Please come to your consult at my Jupiter or Palm Beach, FL office with an idea of what you desire for your breast. Photos of what you desire help me to understand your goals. I will review your prior medical and surgical history. Standard photos will be taken. We will review your anatomy, breast size, breast shape, pectoralis muscle size, muscle definition, breast fold location and areola size so I can recommend if you are a candidate for surgery. The consult is meant to be detailed but not overwhelming. It is helpful to bring a friend or significant other so they can take notes. I will also discuss anesthesia, post-surgical garments, when you can resume daily activities, workouts and answer your specific questions.

I have experience in breast reconstruction prior to becoming a dedicated cosmetic surgeon. I understand the breast and chest anatomy well. I am completely focused on cosmetic surgery and have performed thousands of breast augmentation surgeries in South Florida. I perform surgery in my own cosmetic surgery facility in Jupiter, FL. We have a dedicated team of nurses, surgical technician, anesthesia provider that work together full time. We only focus on cosmetic surgery. This is what we do.

Typically, 18 years old for a saline implant and over 21 years old for a silicone breast implant.

No although many patients I treat have been started on hormones at the time of surgery.
Is a note from a therapist or a certain amount of counseling required? Typically, yes, 3 months of counseling and a note from a licensed health professional is advised.

Breast augmentation can occur at any time to improve the size and appearance of your breasts.

Pain varies for every patient. Typically, most South Florida patients experience discomfort for a few days after surgery.

Yes, breast implants need to fit the size of the chest and overlying breast. Minor adjustment at the time of surgery can be made to recruit more skin so that a larger implant can be used. However, if the skin is very tight and large implant is desired you may need a tissue expander to stretch the size for a few months prior to placing the final implant.

Fat grafting can be used in select patients to smooth the transition from the upper edge of the implant to the chest.

I generally use an incision in the breast fold, although I am very comfortable using an incision around the areola when indicated.

It depends. I usually place the implant partially behind the muscle. However, the patient’s anatomy particularly their muscle development, skin thickness, sternal width (pre-existing cleavage), amount of breast tissue and muscle animation determine the best location for implant placement. Each patient’s anatomy, breast, muscle, and cleavage are carefully examined and reviewed in the context of the desired breast size in order to select the ideal implant position.

I listen and understand the patient’s goals first. I review their anatomy during the consult. I differentiate myself in the operating room by obsessively selecting and placing different size implants (known as temporary sizers) to simulate the final result. I spend a considerable amount of time in the operating room evaluating what you will look like with different sizers. There is no computer program or crystal ball that can provide this insight. I use the patient’s wish photo and my experience to select the best implant. I do not allow time or other distractions in the operating to comprise the best outcome for the patient.

I use smooth round implants, silicone or saline. I generally use silicone implants because they feel softer. Transgender breast augmentation patients tend to have less breast tissue, so the majority of breast volume is being made up of the implant. I prefer the implant feel soft and natural. I am open to saline implants and have placed them in patients who are concerned about silicone and willing to accept the tradeoffs in terms of feel.

Different types of soft tissue grafts and cartilage can be used to augment nipples. I have not found these grafts to be predictable after placement. I do not like to augment nipples due to lack of predictably in terms of size, shape and overall appearance because the grafts do not live with 100% certainty.

There are surgical mechanisms to make an areola larger although they are not predictable and often associated with adverse scarring. Therefore, I do not offer this procedure. A medical tattoo pigmentation expert can match the pigment of your areola in order to make the diameter larger. When desired, I refer patients to a medical tattoo pigmentation expert to avoid scarring and achieve their larger areola goals.

In terms of the safety of the surgery, the risks of anesthesia and breast augmentation surgery are the same. Transgender patients with tight skin and a short distance between their areola and breast fold maybe at greater risk of inferior implant malposition when attempting single stage surgery. Patients need to be realistic about the size of the implant they desire and the ability to accomplish the goal in one surgery. Obviously, no one wants to undergo an expansion phase it is not needed but sometimes it’s necessary. I will assess your anatomy in the context of your size goals at the consult.

Nothing really, your nipples may be more sensitive for a few months after the procedure. Your nipple hypersensitivity improves with time (months not weeks). Most patients do not experience any changes in nipple sensation.

Per the FDA, patients with silicone breast implants should have an MRI starting at 3 years after their breast augmentation operation then every two years thereafter. The same is not true for patients with a saline implant. The purpose of the MRI is to assess the integrity of the implant, not detect breast cancer. I recommend MTF patients discuss mammograms with their primary care physician and medical team to advise them on what preventive screening treatments are best for them.