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Mr Andrew Yelland
Consultant Breast Onco-plastic & Cosmetic Surgeon

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The Breast Augmentation Procedure

The breast augmentation procedure for MTF surgery usually takes between one and two hours, with variations in time depending on the positioning of the implant, the site of incision, and other choices you have made with your surgeon.

THE PROCEDURE

The operation will be conducted under general anaesthetic so you will be unaware of sights, sounds, noises, and sensations during the procedure.

Shorter procedures may use anaesthetising gas with an intravenous anaesthetic favoured for lengthier operations.

You will be monitored throughout the operation to ensure that the anaesthetic is working as it should.

Options for a local anaesthetic and sedatives may be available if you are unable to have a general anaesthetic although this is a far less common approach to breast augmentation surgery.

IMPLANT PLACEMENT

There are two main techniques used during breast augmentation implant surgery:

  • the subglandular placement
  • the submuscular placement of the implant

Many transwomen choose a submuscular implant position in order to achieve a more natural look, particularly as there may not be a large amount of breast tissue and skin available to adequately support an implant in the breast itself.

A submuscular implant will be positioned underneath your chest wall (pectoral) muscle. This can reduce the risk of rupture but is more invasive and may take a little longer to recover from.

This type of placement may also reduce the risk of altering nipple sensation.

If hormone therapy has given you a degree of breast tissue under which the implant can be placed then your surgeon may consider a subglandular placement as your better option.

This type of placement has both a shorter procedural and recovery time thereby reducing the risk of complication.

Rupture risk is, however, higher with subglandular placement, and the implant may interfere with the accuracy of mammograms that you may require in the future.

Skin wrinkling may occur in those transwomen with thinner skin and tissue to cover the implant and further surgery may be necessary.

SURGICAL DRAINS

If you are having a submuscular placement of breast implants then the surgeon may insert drainage tubes to minimise the bruising, haematoma, and swelling of the tissue.

This is occasionally used in subglandular placement too, but is more rare.

These tubes can aid a faster recovery from the more invasive surgery to place the implant under the pectoral muscle, but they are usually removed within a few days so as to allow the incision site to heal.

LOCATION OF INCISION

As the scar from breast augmentation usually never fully disappears, despite fading significantly, the location of your incision is very important.

Your surgeon will talk you through the options offering guidance on the incision site most appropriate for your particular priorities, such as appearance or sensation.

Your individual physique, size, and chosen implant will affect the incision site with some transwomen choosing an areola incision to minimise visible scarring.

Women with large breasts often opt for an inframammary incision as their breasts will naturally conceal the scar as they settle; as a transwoman you may, however, have a smaller amount of breast tissue, or none, making an alternative incision site often more appropriate.

A transaxillary incision may be preferred or the TUBA incision site, in the navel, may be available depending on the size and type of implant you are having.

STITCHES AND YOUR SUPPORT BRA

After the surgeon has positioned the implants and sutured the incision site closed they will apply gauze bandage to the area to keep it clean and dry.

This bandaging can help to support your new breasts as they heal and you may also be fitted with a support bra to wear for a number of weeks after MTF surgery.

Although it may be tempting to wear newly bought lingerie and enjoy your new breasts, these usually provide little support and have problematic under-wiring which is likely to lead to pain and stress on the breast tissue.

Most surgeons favour the use of dissolving sutures which do not require a specific follow-up appointment to remove them.

Instead, the body simply absorbs the sutures as the incision heals.

It is key to a good recovery to keep the area of the incision clean and to avoid the use of cosmetics, deodorants, and lotions in the area.

Also, avoid allowing the incision site to become submerged in water, whether this is a bath or swimming pool.

Refraining from stretching, any lifting, or other strenuous activity is also very important during the healing process.

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