Today, I would like to share about breast augmentation for male to female (MTF) transgenders (TG) and questions related.

1. What are the differences in breast augmentation between females and MTF TG? 

From my experience, TG patients have wider and thicker pectoralis muscle compared to female patients. Also, they have more tissue cells near the breast that may be due to the hormone treatments.

If the TG patients were treated for a short period of time or the treatment was not as effective, then there is not much difference in the breast tissue compared to other female patients.

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Therefore, all the TG patients need to talk in depth with the doctors for several decision makings and here are some examples.

Long surgery time is required if the pectoralis muscle is thick (Fascia is tight, therefore it is difficult to get visibility. A lot of energy is spent on retraction)

If the pectoralis muscle is on top of the implant, it can limit the volume enlargement effect, therefore, we need to consider breast augmentation above the pectoralis muscle.
If you have a lot of subcutaneous fat, then augmentation above the pectoralis muscle is recommended.

If you do not have that much subcutaneous fat but a lot of pectoralis muscle, then dual plane is recommended.

The original breasts are less female-like, therefore volume enlargement is a priority in making the breasts look normal.

2. Is there any relationship between hormone treatment and breast augmentation?

Female hormone treatment does not cause any problem when conducting breast a breast augmentation surgery. But, theoretically, hormone treatment with breast augmentation can cause bleeding, so it is recommended that you stop hormone treatment one week before the breast augmentation. You can start the hormone treatment again after a few days of breast augmentation.

3. Are there any complications that you can find specifically for MTF TG?

Capsular contracture, implant collapse, moving of the implant, rippling, being able to feel the implant, bleeding, hematoma, etc are all common complications but the incidence rate is not higher because you are a TG patient.

TG patients have larger upper body therefore we need to desquamate more for the implant pocket. This may lead to more bleeding and hematoma. TG patients have wider breast width therefore they use larger implants that require larger pocket leading to higher chance of bleeding. But this is only a possibility.

There is no statistics that TG patients suffer more cases of bleeding or hematoma.

4. What procedure is recommended to MTF TG for breast augmentation?

First, dual plane is preferred over below the pectoralis muscle. If you have enough subcutaneous fat and tissue, then above the pectoralis muscle can be considered, but the dua plane is recommended.



Most of the TG patients do not have properly shaped breasts therefore, shaped implant, ie. anatomical implant is recommended for better outcome. Usually, when we talk about yoyo-syndrome, we share that the skin elasticity worsens really quickly therefore it is not good for cosmetic purposes.

But the TG patients have strong breast skin layer that influences the implant acceptance. The yoyo-syndrome for TG patients do not always have a negative effect. If TG patients try to control their weight, they should do it continuously and slowly. Repetitive yoyo effect of weight leads to negative effect on the health as well.

Today, we shared contents on the things that MTF TG patients are curious about. I hope that this content has helped you out.

Thank you and have a good day.

The objective for sagging breast corrections are as the following;

- Changing the location of areola-nipple
- Providing volume to the upper part of the breasts
- Recovering the overall elasticity of the breasts

There aren’t many methods in correcting a severe case of sagging breasts. We need to pull up the breast tissue, lift up the bottom part as much as possible. In my experience, those patients with moderate level of problem that may need regular breast correction can look at each problem one by one and try to solve these problems respectively.

Patients have different level of importance on sagging, volume size, etc, therefore, it is efficient to set priority to result with good planning.

- Changing the location of areola-nipple -

If the distance between the collarbone to the nipple is too long compared to the height of the patient, and if the position of the nipple is too low compared to the overall shape of the breast, you would consider changing the location of the areola-nipple. If the sagging is severe, we could conduct breast correction and lift up the breasts so the location of the areola-nipple also changes. But we could only change the location of the areola-nipple without any other procedures also.



There are some things to consider when we just change location of the areola-nipple. We need to consider where the nipple is facing. If we only change the location of the areola-nipple, the new location may look awkward because it is placed at the higher point of the breast mound. So this correction would be most effective if the nipple is facing downward. It would also be effective if the nipple is not at the high point of the breast mound. Another point that we need to consider is that the location should not be moved too much. There is a lot of tension when relocating the areola-nipple that may lead to wounds and skin troubling. We need to minimize this tension by relocating the areola-nipple with minimal movement.

- Providing volume to the upper part of the breasts - 

This is one area that almost all sagging breast patients want to achieve. There would be some swelling after the correction and so there is volume on the upper part of the breasts naturally. But as time passes and the swelling goes away, the volume disappears leading to disappointment.

There are few methods in getting that volume on the upper breast.

The breast correction surgery leads to the pulling up effect of the sagging breasts but if the breast correction is not applied, the most common and the easiest procedure is the implantation. (Also it is the least costing method) If we plan to do implantation, we need to use an implant that will stand up stiff and maintain its strength so that the upper breast volume can be sustained.



We would need to use stable and durable implant. The stable implants are, Allergan Style 410 > Silimed natural gel > Mentor CPG, Allergan Soft touch, Allergan Inspira >  Other round type implants, Polytech shaped implants.

Apart from Inspira, only the anatomical type implants can securely maintain the volume. The gel inside the implant needs to be sticky and dense to maintain its stiffness and height. Without the stickiness and the density, the implant would not be able to fill up the upper breast volume.

Another method would be the fat transplant. If the engraft success rate is guaranteed, then this would be the best method. there are two problems with fat transplant, cost and engraft success rate.

Let’s talk about the cost first. If we conduct large amount of fat transplant, the cost would be about 4~5 million KRW. But fat transplant requires more than just one time procedure. Most patients who conduct this 2~3 times additionally. Then the cost would be…. The engraftment success rate is still a problem. There are news that stem cell has helped out this success rate, but if the success rate of the engrafted fat follow up within the 5 years is 40% or higher, this would be one for the Nobel Prize

- Recovering the overall elasticity of the breasts - 

The best solution for breast elasticity is through implants. The pressure from the implant gets shared directly to the breast outer skin therefore the implant can make the wrinkles spread out and make the skin elastic. Such natural work of giving volume leading to better elasticity provides the best result possible (Its the least costing method). At times, we cut off the skin to make the shape better during the breast correction. But this only applies to sever sagging breasts.

As above, we looked at how to plan about the problems with moderate level of sagging breasts. Areola relocation, breast augmentation with implant, fat transplant, etc can all lead to good results if applied appropriately.

Thank you for reading. Have a great day.

I have collected my own data for three years regarding breast augmentation and not I would like to share some statistical findings on the width of the breast comparing with the size of the implant here in Korea.

When we decide on what size implant to use, we need to measure the width of the patient’s breast and the width of the implant. If the width of the patient’s breast is 12cm, then the width of the implant should not be larger that that. Of course there is a problem with extensibility (but this applies more to those who give birth) but the main issue would be that the size of the implant should not affect the thickness of the outer breast layer and should not lead to complications.



Anyway, the easiest measurement would be according to the size of the width. In my past 3 years of experience, they average width size for those who wished to get breast augmentation was 11cm. Also, if I look at the data of the 3 implants brands that I have used, the average volume is 284cc and the width of the implant is 11.4cm. The data is a little different according to the brands and the yearly distribution is also a little different but we can see that the width of the implant is little larger than the width of the breast.



There is difference between the implants used in Seoul and other cities as well. Some prefer round type, others prefer anatomical type. The preferred sizes are different also so we cannot say everything with just the average numbers. Those who come to Gangnam are prefer large sized implants. Those in the rural areas are very conservative on the implant size (both doctors and patients). The younger the patient is, she prefers larger sized implant for visibility reasons. The older the patient is, the requirement is different. In the past (2011~2013), those who preferred anatomical wanted large sized implant but this is not the same any more.

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There are patients who have same width size in both their breasts but are asymmetric and the two breast volumes are different because of the bone structure. In such case, we might have to use large implant for the small volume breast and smaller implant for the large volume breast. This would decrease the overall average of the implant size.

When I interview the patients I find out that those who want large breasts want their breasts as large as they can get without any severe complications. Those at the opposite request so that the augmented breasts are not too large. The size of the implant decides on the breast volume nowadays. I am currently in Kangnam so I feel that there are many young women who want large sized implants. Whenever such requirement is made, I tend to talk a lot with the patients. In overall, Korean women do not require a large sized implant, but those who come to Kangnam require large sized ones. I hope that they can step back a little and be less greedy.

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Today, we looked at the data of the implants used and the characteristics of different patients in finding out if the appropriate sizes of implants have been used.
Thanks and have a great day.

 

Science does not allow us to talk about something that is not proven. The difference between science with myth or religion is that science only talks about things that have been confirmed. Medical sector is a part of science therefore, the doctor should only communicate about scientific truth as well.



However, the medical field has a lot of technical and professional terminologies that cannot be understood without any basic knowledge. Therefore, it is important to change these terms to what the patients can understand. We need to use some daily life words or terminologies when we treat the patients.

In the internet, we see contents that both professionals and nonprofessionals have written. We do not know what is scientific or not, and we do not know what is for marketing purpose or not. I think that as a doctor, it is important to let the patients know what contents are reliable or not.

This applies to fat / stem cell transplant as well.

In this era of capitalism, people are excited and concentrate on new products and want to purchase these products. The professionals need to provide evidence that these products are effective and safe to use. The patients should listen to these evidence and make decision on the purchase. However, there are millions of false information on the internet with marketing purposes.



Fat transplant in exact terminology is called ‘Free fat graft operation by injection’. As soon as the fat is removed from the donor site, the supply of oxygen/nutrition is stopped. The core question then would be how long this fat can last without oxygen/nutrition until it is transplanted to a new site.

If we conduct the surgery in a quite, stable and ready environment, there would be less trauma on the patient and the overall transplant process would be quick with high success rate. The fat that has been transplanted does not grow its vessels but gets oxygen/nutrition from the surrounding areas. So engrafting large amount of fat would not be meaningful. Small amount of fat transplanted in a large area would lead to better success rate.




But if this is applied, there would be many complaints from patients. They would think that there is no effect with the given cost. In order to satisfy the patients, the hospital now puts much more fat than necessary and also provide 2nd, 3rd, and 4th revision if necessary.

There still is a problem with the graft success rate. In order to improve on this, stem cell transplant has been carried out simultaneously. We also provide an explanation to the patients that this simultaneous activity increases the success rate.

In 2013 during the US Plastic Surgery Association Meeting, it was notified that stem cell transplant is still not reliable as there are not enough related data, findings and complications that may arise. Also it was notified that stem cell transplant should not be used as a marketing tool to gather the patients. However, not much has changed since.



The studies on the stem cell transplant are still under say and there is no concrete finding that we can share. We only presume that something would happen with a few concrete facts. We derive preadipocyte and enrich it to put into an area such as your wrinkles on the face. The preadipocyte are young compared to other cells therefore one can presume that they can last longer and result in higher success rate. It is still believed that minimum of 5 to 10 years are required for us to find if the stem cell transplant is safe and has no complications.



I do not recommend stem cell transplant unless it is really necessary (for example, when you need a revision, have a severe scar, or if there are no other choices). I hope that the patients too ,would give much thought into fat and stem cell transplant.

This is all for today. Thank you.

Surgical procedure such as a “temporary boob job” is very popular in NY and other parts of the world. we do not know exactly how many people get this does. We are just talking about it with our basic perception that this is very popular.

Breast augmentation can be perceived as the most applied surgery in the world (in US, there were 300,000 cases in 2013). This led to a cosmetic surgeon in NY to develop InstaBreast concept that she tested on herself, which can estimate the size of the breast after the breast augmentation. This InstaBreast is actually applied in a different way now. People today, look for it when they want to temporarily make their breasts bigger for a dress or a bikini.



InstaBreast is really simple. First, you can rub it on the breast, then inject saline liquid (0.9% salt water) into the breast…. It is durable for 24 hours. The body intakes the saline water in time and this saline water is discharged through urine.

There might be a bruise but it does not last long. It costs about $2500~3500 in NY, so this is not something that is cheap. Of course, breast augmentation would cost a lot more.

You can do a simulation for InstaBreast. The simulation result is much more effective than that 3D computer simulation of T-shirt Test. So I think that this is the best method today to estimate how your breasts would be before the breast augmentation.



Once the surgery starts, the patient will be on anesthesia The patient would not be able to communicate with the doctor until the implantation and stitching are complete. The dissatisfaction with the size of the breast can arise as the patient cannot communicate with the doctor during the procedure. If you are one who is really worried about the final result, you could try out the InstaBreast to estimate the outcome. But, I really wonder if the cost is good enough for the people to try it out.

The cost could really be a big problem if you are the one (maybe if you are afraid to put implant in your breasts) who wants to use the InstaBreast temporarily for a party or a summer vacation.



I think that many methods are brought up in US because it is such a huge country. People think a lot, and there are many things advancing there compared to our country.
I would like to introduce Macrolane, a large capacity filler for breast enlargement. It is hyaluronic acid that was used a lot in Europe but became restricted in UK from 2012. It was restricted because one could not identify the difference between the bundles that the filler made with the cancer tumor through the mammogram. This Macrolane could not get FDA approval as well and it is not imported to our country as well.

There are some patients who ask me if I recommend InstaBreast to the patients. I think that InstaBreast can be applied in limited terms. If you are really resistant to implant and want temporary enlargement of the breasts, do not know how your breasts would end up, then you should consider InstaBreast.

Currently, it is not too expensive to get a breast augmentation, and the recovery is really quick without much pain. So, I do not think that InstraBreast is something that I should recommend aggressively.

Thank you for reading. Have a good day.

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