Year 2020 Vol. 28 No 2

REVIEWS

A.L. ISTRANOV, A.A. ZAKIROVA, YU.I. ISAKOVA

MODERN ASPECTS OF FEMINIZING MAMMOPLASTY IN PATIENTS WITH A MALE FORM OF TRANSSEXUALISM

I.M. Sechenov First Moscow State Medical University, Moscow,
The Russian Federation

The main surgical operations in the birth-assigned male patient being affirmed as female include feminizing of the chest (breast augmentation) and genital reconstruction. Woman-shape breast formation is an important part of feminization for most trans-women, more often augmentation mammoplasty is performed first. Significantly increased requirements for the aesthetic result of any sex reassignment operations in this group of patients should be noted.
The purpose of this review is to summarize modern concepts and standards for augmentation mammoplasty in transgender individuals who want to change their sex from male to female. Knowledge of these aspects is necessary to achieve the best aesthetic result and patients’ satisfaction, ensuring their psychosocial and physical well-being. The following sections have been studied and presented in details: proportions of the ideal breast, breast development in transsexuals under the influence of hormonal therapy, anatomical differences between the male and female chest, size and position of the nipple-areola complex, choice of operative access and the implant position, choosing the volume and shape of the implant, formation and fixation of the inframammary fold, possible complications after augmentation mammoplasty, satisfaction with the results of the operation.

Keywords: transgender, transsexual, breast augmentation, nipple-areola complex, inframammary fold, hormonal therapy, quality of life, sex reassignment surgery
p. 207-221 of the original issue
References
  1. American Psychiatric Association. Cautionary statement for forensic use of DSM-5. In: Diagnostic and statistical manual of mental disorders. 5th ed. Washington. DC: Author; 2013. http://dx.doi.org/10.1176/appi.books.9780890425596.CautionaryStatement
  2. Frey JD, Poudrier G, Thomson JE, Hazen A. A Historical Review of Gender-Affirming Medicine: Focus on Genital Reconstruction Surgery. J Sex Med. 2017 Aug;14(8):991-1002. doi: 10.1016/j.jsxm.2017.06.007
  3. Standarty meditsinskoi pomoshchi transseksualam, transgenderam i genderno nekonformnym individuumam. 7 versiia [Elektronnyi resurs] [data dostupa: 2019 Avg 15]. Professional’naia Assotsiatsiia po zdorov’iu transseksualov; 2013. 139 s. Rezhim dostupa: https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_Russian.pdf (In Russ.)
  4. Sutcliffe PA, Dixon S, Akehurst RL, Wilkinson A, Shippam A, White S, Richards R, Caddy CM. Evaluation of surgical procedures for sex reassignment: a systematic review. J Plast Reconstr Aesthet Surg. 2009 Mar;62(3):294-306; discussion 306-8. doi: 10.1016/j.bjps.2007.12.009
  5. Istranov AL, Mkhitorian OA, Zakirova AA. Endoprotezirovanie molochnykh zhelez u patsientov s muzhskoi formoi transseksualizma. Annaly Plast, Rekonstrukt i Estet Khirurgii. 2018;(4):92. https://elibrary.ru/contents.asp?titleid=9557 (In Russ.)
  6. Blondeel PN, Hijjawi J, Depypere H, Roche N, Van Landuyt K. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Plast Reconstr Surg. 2009 Feb;123(2):455-62. doi: 10.1097/PRS.0b013e3181954cc1
  7. Lewin R, Amoroso M, Plate N, Trogen C, Selvaggi G. The Aesthetically Ideal Position of the Nipple-Areola Complex on the Breast. Aesthetic Plast Surg. 2016 Oct;40(5):724-32. doi: 10.1007/s00266-016-0684-z
  8. Mallucci P, Branford OA. Shapes, proportions, and variations in breast aesthetic ideals: the definition of breast beauty, analysis, and surgical practice. Clin Plast Surg. 2015 Oct;42(4):451-64. doi: 10.1016/j.cps.2015.06.012
  9. Nahai F, ed. The Art of aesthetic surgery principles and techniques. 2nd ed. St Louis, MO: Quality Medical Publishing, Inc; 2011. 2500 p.
  10. Bensimon E. Commentary on: long-term outcomes in breast augmentation in trans-women: a 20-year experience. Aesthet Surg J. 2019 Mar 14;39(4):391-92. doi: 10.1093/asj/sjy200
  11. Claes KEY, D’Arpa S, Monstrey SJ. Chest surgery for transgender and gender nonconforming individuals. Clin Plast Surg. 2018 Jul;45(3):369-80. doi: 10.1016/j.cps.2018.03.010
  12. Morrison SD, Wilson SC, Mosser SW. Breast and body contouring for transgender and gender nonconforming individuals. Clin Plast Surg. 2018 Jul;45(3):333-42. doi: 10.1016/j.cps.2018.03.015
  13. Beer GM, Budi S, Seifert B, Morgenthaler W, Infanger M, Meyer VE. Configuration and localization of the nipple-areola complex in men. Plast Reconstr Surg. 2001 Dec;108(7):1947-52; discussion 1953. doi: 10.1097/00006534-200112000-00015
  14. Atiye B, Chahine F. Metrics of the aesthetically perfect breast. Aesthetic Plast Surg. 2018 Oct;42(5):1187-94. doi: 10.1007/s00266-018-1154-6
  15. Yonguc GN, Kurtulus A, Bayazit O, Adiguzel E, Unal I, Demir S, Acar K. Estimation of stature and sex from sternal lengths: an autopsy study. Anat Sci Int. 2015 Mar;90(2):89-96. doi: 10.1007/s12565-014-0235-0
  16. Seal LJ, Franklin S, Richards C, Shishkareva A, Sinclaire C, Barrett J. Predictive markers for mammoplasty and a comparison of side effect profiles in transwomen taking various hormonal regimens. J Clin Endocrinol Metab. 2012 Dec;97(12):4422-28. doi: 10.1210/jc.2012-2030
  17. Murad MH, Elamin MB, Garcia MZ, Mullan RJ, Murad A, Erwin PJ, Montori VM. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol (Oxf). 2010 Feb;72(2):214-31. doi: 10.1111/j.1365-2265.2009.03625.x
  18. Wierckx K, Gooren L, T’Sjoen G. Clinical review: Breast development in trans women receiving cross-sex hormones. J Sex Med. 2014 May;11(5):1240-47. doi: 10.1111/jsm.12487
  19. Wesp LM, Deutsch MB. Hormonal and surgical treatment options for transgender women and transfeminine spectrum persons. Psychiatr Clin North Am. 2017 Mar;40(1):99-111. doi: 10.1016/j.psc.2016.10.006
  20. Lawrence AA. Transgender health concerns. In: Meyer IH, Northridge ME, eds. The health of sexual minorities: public health perspectives on lesbian, gay, bisexual and transgender populations. New York, NY: Springer; 2007. р. 437-505.
  21. de Blok CJM, Klaver M, Wiepjes CM, Nota NM, Heijboer AC, Fisher AD, Schreiner T, T’Sjoen G, den Heijer M. Breast development in transwomen after 1 year of cross-sex hormone therapy: results of a prospective multicenter study. J Clin Endocrinol Metab. 2018 Feb 1;103(2):532-38. doi: 10.1210/jc.2017-01927
  22. Dittrich R, Binder H, Cupisti S, Hoffmann I, Beckmann MW, Mueller A. Endocrine treatment of male-to-female transsexuals using gonadotropin-releasing hormone agonist. Exp Clin Endocrinol Diabetes. 2005 Dec;113(10):586-92. doi: 10.1055/s-2005-865900
  23. McGuire P, Reisman NR, Murphy DK. Risk factor analysis for capsular contracture, malposition, and late seroma in subjects receiving natrelle 410 form-stable silicone breast implants. Plast Reconstr Surg. 2017 Jan;139(1):1-9. doi: 10.1097/PRS.0000000000002837
  24. Li S, Mu D, Liu C, Xin M, Fu S, Xu B, Li Z, Qi J, Luan J. Complications following subpectoral versus prepectoral breast augmentation: a meta-analysis. Aesthetic Plast Surg. 2019 Aug;43(4):890-98. doi: 10.1007/s00266-019-01404-7
  25. Shi H, Cao C, Li X, Chen L, Li S. A retrospective study of primary breast augmentation: recovery period, complications and patient satisfaction. Int J Clin Exp Med. 2015 Oct 15;8(10):18737-43. eCollection 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4694389/
  26. Araco A, Gravante G, Araco F, Delogu D, Cervelli V, Walgenbach K. A retrospective analysis of 3,000 primary aesthetic breast augmentations: postoperative complications and associated factors. Aesthetic Plast Surg. 2007 Sep-Oct;31(5):532-39. doi: 10.1007/s00266-007-0162-8
  27. Benito-Ruiz J, Manzano ML, Salvador-Miranda L. Five-year outcomes of breast augmentation with form-stable implants: periareolar vs transaxillary. Aesthet Surg J. 2017 Jan;37(1):46-56. Epub 2016 Sep 30. doi: 10.1093/asj/sjw154
  28. Kerfant N, Henry AS, Hu W, Marchac A, Auclair E. Subfascial primary breast augmentation with fat grafting: a review of 156 cases. Plast Reconstr Surg. 2017 May;139(5):1080e-85e. doi: 10.1097/PRS.0000000000003299
  29. Coombs DM, Grover R, Prassinos A, Gurunluoglu R. Breast augmentation surgery: Clinical considerations. Cleve Clin J Med. 2019 Feb;86(2):111-22. doi: 10.3949/ccjm.86a.18017
  30. Kanhai RC, Hage JJ, Mulder JW. Long-term outcome of augmentation mammaplasty in male-to-female transsexuals: a questionnaire survey of 107 patients. Br J Plast Surg. 2000 Apr;53(3):209-11. doi: 10.1054/bjps.1999.3298
  31. Fakin RM, Zimmermann S, Kaye K, Lunger L, Weinforth G, Giovanoli P. Long-term outcomes in breast augmentation in trans-women: a 20-year experience. Aesthet Surg J. 2019 Mar 14;39(4):381-90. doi: 10.1093/asj/sjy143
  32. Atiyeh B, Ibrahim A, Saba S, Karamanoukian R, Chahine F, Papazian N. The Inframammary Fold (IMF): a poorly appreciated landmark in prosthetic/alloplastic breast aesthetic and reconstructive surgery-personal experience. Aesthetic Plast Surg. 2017 Aug;41(4):806-14. doi: 10.1007/s00266-017-0854-7
  33. Swanson E. Photometric evaluation of inframammary crease level after cosmetic breast surgery. Aesthet Surg J. 2010 Nov-Dec;30(6):832-37. doi: 10.1177/1090820X10386943
  34. Campbell CF, Small KH, Adams WP Jr. The Inframammary Fold (IMF) fixation suture: proactive control of the IMF in primary breast augmentation. Aesthet Surg J. 2016 May;36(5):619-23. doi: 10.1093/asj/sjv178
  35. Pozzi M, Zoccali G, Buccheri EM, de Vita R. Technique to achieve the symmetry of the new inframammary fold. Can J Surg. 2014 Aug;57(4):278-79. doi: 10.1503/cjs.026913
  36. Ching JA, Dayicioglu D. The stylet technique for inframammary fold definition in breast reconstruction. J Plast Reconstr Aesthet Surg. 2014 Feb;67(2):273-75. doi: 10.1016/j.bjps.2013.08.009
  37. Nakajima Y, Kondoh S, Nishioka H, Kasuga W. A new percutaneous method for inframammary fold reconstruction in implant-based breast reconstruction: Vertical pendulum suture. Medicine (Baltimore). 2018 Aug;97(33):e11964. doi: 10.1097/MD.0000000000011964
  38. Eichler C, Schell J, Uener J, Prescher A, Scaal M, Puppe J, Warm M. Inframammary Fold Reconstruction: A Biomechanical Analysis. Plast Reconstr Surg Glob Open. 2016 Mar 7;4(3):e634. doi: 10.1097/GOX.0000000000000568
  39. Egeberg A, Sørensen JA. The impact of breast implant location on the risk of capsular contraction. Ann Plast Surg. 2016 Aug;77(2):255-59. doi: 10.1097/SAP.0000000000000227
  40. Henriksen TF, Hölmich LR, Fryzek JP, Friis S, McLaughlin JK, Høyer AP, Kjøller K, Olsen JH. Incidence and severity of short-term complications after breast augmentation: results from a nationwide breast implant registry. Ann Plast Surg. 2003 Dec;51(6):531-39. doi: 10.1097/01.sap.0000096446.44082.60
  41. Henriksen TF, Hölmich LR, Fryzek JP, Friis S, McLaughlin JK, Høyer AP, Kjøller K, Olsen JH. Incidence and severity of short-term complications after breast augmentation: results from a nationwide breast implant registry. Ann Plast Surg. 2003 Dec;51(6):531-39. doi: 10.1097/01.sap.0000096446.44082.60
  42. Handel N, Garcia ME, Wixtrom R. Breast implant rupture: causes, incidence, clinical impact, and management. Plast Reconstr Surg. 2013 Nov;132(5):1128-37. doi: 10.1097/PRS.0b013e3182a4c243
  43. Namnoum JD, Largent J, Kaplan HM, Oefelein MG, Brown MH. Primary breast augmentation clinical trial outcomes stratified by surgical incision, anatomical placement and implant device type. J Plast Reconstr Aesthet Surg. 2013 Sep;66(9):1165-72. doi: 10.1016/j.bjps.2013.04.046
  44. Hillard C, Fowler JD, Barta R, Cunningham B. Silicone breast implant rupture: a review. Gland Surg. 2017 Apr;6(2):163-68. doi: 10.21037/gs.2016.09.12
  45. Gorczyca DP, Gorczyca SM, Gorczyca KL. The diagnosis of silicone breast implant rupture. Plast Reconstr Surg. 2007 Dec;120(7 Suppl 1):49S-61S. doi: 10.1097/01.prs.0000286569.45745.6a
  46. Hidalgo DA, Spector JA. Breast augmentation. Plast Reconstr Surg. 2014 Apr;133(4):567e-83e. doi: 10.1097/PRS.0000000000000033
  47. de Boer M, van Leeuwen FE, Hauptmann M, Overbeek LIH, de Boer JP, Hijmering NJ, Sernee A, Klazen CAH, Lobbes MB, van der Hulst RRWJ, Rakhorst HA, de Jong D. Breast implants and the risk of anaplastic large-cell lymphoma in the breast. JAMA Oncol. 2018 Mar 1;4(3):335-41. doi: 10.1001/jamaoncol.2017.4510
  48. El-Hadi H, Stone J, Temple-Oberle C, Harrop AR. Gender-affirming surgery for transgender individuals: perceived satisfaction and barriers to care. Plast Surg (Oakv). 2018 Nov;26(4):263-68. doi: 10.1177/2292550318767437
  49. Sohn M, Bosinski HA. Gender identity disorders: diagnostic and surgical aspects. J Sex Med. 2007 Sep;4(5):1193-207; quiz 1208. doi: 10.1111/j.1743-6109.2007.00580.x
  50. Löwenberg H, Lax H, Neto RR, Krege S. Complications, subjective satisfaction and sexual experience by gender reassignment surgery in male-to-female transsexual. Z Sexualforsch. 2010;23:328-47.
  51. Hess J, Rossi Neto R, Panic L, Rübben H, Senf W. Satisfaction with male-to-female gender reassignment surgery. Dtsch Arztebl Int. 2014 Nov 21;111(47):795-801. doi: 10.3238/arztebl.2014.0795
  52. Weigert R, Frison E, Sessiecq Q, Al Mutairi K, Casoli V. Patient satisfaction with breasts and psychosocial, sexual, and physical well-being after breast augmentation in male-to-female transsexuals. Plast Reconstr Surg. 2013 Dec;132(6):1421-29. doi: 10.1097/01.prs.0000434415.70711.49
  53. Cardoso da Silva D, Schwarz K, Fontanari AM, Costa AB, Massuda R, Henriques AA, Salvador J, Silveira E, Elias Rosito T, Lobato MI. WHOQOL-100 before and after sex reassignment surgery in brazilian male-to-female transsexual individuals. J Sex Med. 2016 Jun;13(6):988-93. doi: 10.1016/j.jsxm.2016.03.370
Address for correspondence:
119991, Russian Federation,
Moscow, Trubetskaya Str., 8,
I.M. Sechenov First Moscow
State Medical University,
Department of Oncology,
Radiotherapy and Plastic Surgery.
Tel.: +7 917 914 26 06,
e-mail: albinazakirovasno@gmail.com,
Albina A. Zakirova
Information about the authors:
Istranov Andrey L., MD, Professor of the Department of Oncology, Radiotherapy and Plastic Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-0222-2910
Zakirova Albina A., Resident Doctor of the Department of Oncology, Radiotherapy and Plastic Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-1117-9427
Isakova Yuliya I., Resident Doctor of the Department of Oncology, Radiotherapy and Plastic Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-7695-0078
Contacts | ©Vitebsk State Medical University, 2007-2023