Breast Restoration Surgery:
Having breasts is a huge factor affecting one’s sense of femininity. For transmasculine people who want to detransition, the lack of breasts can contribute to gender dysphoria. Fortunately, MTF detransitioners can undergo breast restoration surgery to complete their journey back to womanhood.
If you’re thinking of undergoing MTF detransition surgery, read this article to know more about breast reconstruction surgery for MTF detransitioners
Dr. Gary J. Rosenbaum is a board-certified plastic surgeon with extensive experience in breast-related surgeries.
If you’re looking for a doctor who understands your needs and can help you with how to detransition MTF through breast restoration, schedule a consultation here.
What is Breast Restoration?
Breast restoration is a top surgery that enlarges the breasts and alters the chest contour. It is also called chest reconstruction, breast reconstruction surgery, and restorative breast surgery.
This procedure might involve placing breast implants or tissue expanders under chest tissue. In some cases, fat from other body regions is extracted and injected into the chest. Both methods might be used if necessary.
Getting breast reconstruction surgery boosts your self-esteem and physical confidence. It’s also essential to keep your expectations in check during the consultation and surgical procedure. After all, every type of surgery has trade-offs and possible risks.
Breast reconstruction can be different for transgender people. In the next section of this article, we will briefly discuss these differences.
How is Breast Restoration Different for Transgenders?
For transgender people, hormone replacement therapy (HRT) may cause some breast growth. However, research shows that HRT is frequently insufficient in providing an appropriate female-like breast shape. Thus, the need for the development of a female chest arises.
Transgender women often have bigger and thicker pectoral muscles and broader chests. They usually have smaller nipples and areolas as well.
They also have smaller gaps between their nipples and the folds beneath their breasts (inframammary fold). Due to their wider chests, transgender women often have a wide space between their breasts, even with larger implants.
This is because of the significant anatomic differences between male and female chests. These differences cannot be thoroughly addressed with the current reconstructive methods and devices.
How is Breast Restoration Done for Detransitioners?
Various breast procedures can be done for detransitioners. While MTF restorative breast surgery is more common, we will also discuss the FTM (female-to-male) or FTN (female-to-non binary) chest restoration.
Breast Reconstruction After Mastectomy
Typically, breast reconstruction is done after a mastectomy—surgery to remove the entire breast for the treatment or prevention of breast cancer.
But in the case of transgender people, breast reconstruction may be performed after a detransitioner decides to reverse their mastectomy. Most of these cases are done long after their mastectomy incisions have healed, usually months or even years after their breast removal surgery.
The final stage almost always involves the recreation of the nipples and areolae, especially if they weren’t preserved during mastectomy.
MTF Breast Reconstruction
There are various techniques used in breast reconstruction surgery. Two of the most commonly used are implant reconstruction and autologous reconstruction. Surgeons may even combine these two to produce the best results.
Implant Reconstruction
In implant reconstruction, the surgeon will place silicone or saline implants through the incision under the breast tissue.
The implant is positioned precisely behind the NAC (nipple-areolar complex), allowing only little cleavage. It can also be placed somewhat further medially, ultimately leading to nipples located more lateral on the breast mound.
Autologous or “Flap” Reconstruction
Autologous or “flap” reconstruction, on the other hand, creates the breast mound by utilizing tissue from another region of your body, such as the abdomen, thigh, or back.
An implant may also be placed to provide extra support. For non-trans augmentation, implants can be placed on top or under the muscle.
What’s unique about this surgery is that the implants are often put on top of the muscle. Doing so creates far less discomfort afterward.
The sub-glandular pocket might appear great depending on the female’s physique. However, if the patient is skinny, the implant may be more visible.
If feminizing hormones haven’t increased the size of your breasts sufficiently, you may require an initial operation to put tissue expanders in front of your chest muscles before any of these breast reconstruction surgery options.
The American Society of Plastic Surgeons provides further information about transfeminine top surgery.
FTM Chest Reconstruction
Through various procedures, you can achieve a flatter and more masculine, male-looking chest. The most common techniques surgeons use in chest reconstruction are double incision, periareolar, and keyhole.
Double Incision Top Surgery with Nipple Grafts
Double incision top surgery with nipple grafts is also known as a bilateral mastectomy with nipple grafts. It is a procedure typically recommended for people with larger chests and bodies.
In this top surgery procedure, the nipples are removed, typically decreased in size, and positioned on the chest to match a more male or masculine appearance.
This is often an outpatient procedure that takes the surgeon between 3 and 4 hours to complete. It frequently results in reduced nipple sensitivity and more significant scarring.
Periareolar Top Surgery
Periareolar top surgery is also known as peri or circumareolar surgery. It is often recommended for those with smaller chest sizes (size A or B cup) before surgery.
While periareolar top surgery results in less noticeable and severe scarring, roughly 40 to 60 percent of patients require revisions to attain a totally flat chest.
This is typically an outpatient procedure that takes between 3 and 5 hours.
Keyhole Top Surgery
Keyhole top surgery is only recommended for those with very small chests and tight chest skin.
Only a few people are good candidates for keyhole top surgery because no excess skin is removed.
To produce an aesthetically acceptable and flat outcome, you must have a small chest and tight chest skin.
An FTM or FTN top surgery operation typically takes 1.5 to 4 hours and is an outpatient operation.
Even though it is not directly specified in the World Professional Association for Transgender Health (WPATH) standards of care, a doctor must request a referral letter from a licensed mental health professional before starting MTF breast augmentation.
Getting Breast Restoration Surgery for Detransitioners
Getting a restorative breast surgery is not the end of a detransition journey. Detransitioners need support as they go through this journey in their lives.
Detransitioners could benefit from some form of counseling. They need psychological support on gender dysphoria, comorbid conditions, feelings of regret, social and physical changes, and internalized homophobic or sexist prejudices.
Many detransitioners also need medical support to address concerns about stopping or changing hormone therapy. It also includes awareness of surgery and treatment complications and access to reversal interventions.
Detransitioners still find it difficult to find ample medical support nowadays. If you are considering detransition, consult an empathetic and open-minded surgeon to get you the help you need.
Schedule a consultation with Dr. Gary Rosenbaum to openly discuss your goals and detransition surgery needs.
References:
- Decuypere, F., De Wolf, E., Vyncke, T., Claes, K., Monstrey, S., & Buncamper, M. (2021, March 15);
Male-to-female gender affirmation surgery: breast reconstruction with Ergonomix round prostheses. PubMed. https://pubmed.ncbi.nlm.nih.gov/33723376/ - Miller, T. J., Wilson, S. C., Massie, J. P., Morrison, S. D., & Satterwhite, T. (2019, April 17).
Breast augmentation in male-to-female transgender patients: Technical considerations and outcomes. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061686/ - Vandenbussche, E. (2021, April 30). Detransition-Related Needs and Support: A Cross-Sectional Online Survey.
Journal of Homosexuality. https://doi.org/10.1080/00918369.2021.1919479