Gender Affirming Breast Augmentation Sydney

Breast Augmentation

Gender affirming breast augmentation uses implants to build breast volume and projection for transfeminine and non-binary people. It is planned differently from cosmetic augmentation, because the chest it is built on is different, and those differences drive implant choice, pocket position and what one operation can achieve.

A transfeminine chest is typically wider with a broader sternum, so the breast footprint sits further apart. Breast tissue tends to sit lower on the chest wall, the skin envelope is tighter with less give, and the areolae are usually smaller with the nipple lower on the breast.

If you have had gender affirming hormone therapy, the breast development that has already happened determines how much tissue covers an implant and how far the skin will stretch. Development can continue for around two years, so timing is discussed at consultation with Dr Maryam Seyedabadi, Specialist Plastic Surgeon, MBBS FRACS, in Paddington, Sydney.

Who it may suit

• You are transfeminine or non-binary and breast development after gender affirming hormone therapy has plateaued below the volume you want.
• You are not taking hormone therapy and accept a tighter skin envelope and thinner tissue cover over an implant.
• Your goal is proportion to your frame and shoulder width rather than a particular cup size.
• You accept that implants are not lifetime devices and that further surgery is likely at some stage.
• You are in reasonable general health and either do not smoke or will stop well before surgery.

What gender affirming breast augmentation involves

The operation is done under general anaesthetic, usually as a day case or with one night in hospital, most often through an incision in the fold under the breast.

1. Measurement: chest width, sternal width, nipple position, skin stretch and tissue thickness are recorded. Implant diameter is chosen to fit your chest, then profile is chosen for projection.
2. Pocket: the implant is placed behind the breast tissue or partly under the pectoral muscle, depending on tissue cover, and the fold is set so the implant does not sit too high.
3. Where the skin envelope is tight, a staged approach is sometimes discussed: a smaller implant first with an exchange later, or tissue expansion, rather than forcing a large implant into skin that cannot cover it.
4. Closure, dressings and a support garment, then review. Areolar size and nipple position are assessed once things settle, and adjusting them is a separate procedure.

Recovery

Timeframes below are approximate and depend on implant size and pocket.

• Home the same day or after one night, with a support garment worn for several weeks as directed.
• A feeling of pressure or tightness across the chest is usual for the first one to two weeks.
• Desk work is often manageable within one to two weeks, while lifting, overhead work and gym are restricted for around six weeks.
• Oedema settles over about three months, and implants generally look and feel more settled between six and twelve months.

Risks and considerations

Breast implants are not lifetime devices. Further surgery may be needed to replace, reposition or remove them, and that likelihood increases the longer implants are in place. Recognised risks include capsular contracture, where the scar capsule tightens and causes firmness, distortion or discomfort; implant rupture; changes in nipple or skin sensation, which can be permanent; infection, which can require implant removal; haematoma, seroma, rippling, visible implant edges where tissue cover is thin, implant malposition and asymmetry. Rarely, breast implant associated anaplastic large cell lymphoma, written as BIA-ALCL, can develop in the capsule around an implant.

On a wider chest wall, implants sit further apart than you may expect, and cleavage is limited by sternal width rather than by implant size. Keep your implant record card, and have any new swelling, lump or change in shape reviewed. General anaesthetic carries risks including blood clots.

Your consultation with Dr Maryam

Consultations are private and take place at 2c Heeley Street, Paddington. Assessment in line with recognised standards of care is part of the pathway, and letters from a GP, endocrinologist or psychologist involved in your care are useful if you have them. How long you have been on gender affirming hormone therapy is discussed, since it affects what your own tissue contributes and which implant suits.

Where the procedure is classified as cosmetic surgery, a referral from a registered medical practitioner is required before consultation and a cooling off period of at least seven days applies, or at least three months with an additional assessment for patients under 18. Some gender affirming procedures may attract Medicare item numbers and others do not, so out of pocket costs vary. Surgery is performed at St Luke’s Hospital in Potts Point, East Sydney Private Hospital or Double Bay Day Hospital. Call 1300 067 668.