Chest Feminization (Male to female top surgery) is a gender-affirming surgery, similar to traditional breast augmentation, but with significant differences in surgical planning due to the anatomical difference between male and female chest structures. The surgery aims to create full, rounded, and natural-looking breasts, helping transgender patients achieve their desired feminine appearance.
Miss International Queen 2018 Huong Giang had Breast Implant Rippling due to Subglandular implant placement
She underwent revision surgery to place the implant under muscle at Viet My Plastic Surgery Hospital
Miss Queen Hương Giang chose teardrop shaped implant for the revision surgery
Top 6 Miss international Queen 2022 underwent Endoscopic breast augmentation
Hormone Therapy can not help patient archive desired breast.
Tiêm hormone nữ (estrogen) là một phần không thể thiếu của quá trình chuyển đổi giới tính. Mặc dù liệu pháp này giúp mô ngực phát triển, kết quả thường không làm hài lòng bệnh nhân với xấp xỉ một nửa bệnh nhân không đạt cup size nhỏ nhất (AAA), chỉ hơn 3% đạt cup A.
Therefore, breast augmentation through implants or autologous fat transfer becomes a more effective option, with implant surgery offering the best outcomes.
Breast sizes illustrator
The unique anatomical challenges of the male chest.
A beautiful breast depends on many factors beyond size. However, the male body has distinct anatomical characteristics that create significant surgical challenges.
Anatomical difference between male and female breast.
Ideal Breast Characteristics
Pre-operative Patient Anatomy
Surgical Solutions
Natural slope in the upper pole with soft, curved contours at the edges and lower pole
Limited glandular tissue with high risk of implant visibility when placed subglandular
Implants must be placed under total or partial submuscular position
Significant projection
No natural projection
Use larger implants
Natural-looking lower pole, the ratio of nipple-to-inframammary fold distance to breast width approximately 0.63
Male chest is wider but with shorter lower pole; this ratio in males is 0.4
Create a new inframammary fold at a lower position
Well-defined inframammary fold
nonexistent inframammary fold
Upper pole is more exposed, with upper-to-lower pole area ratio of 55:45
High inframammary fold, with wide and flat area above the nipple
Appropriately positioned areola, elevated and demonstrating projection
Male areola is typically lower; the distance from sternal notch to nipple is approximately 2cm longer in males than females
Elevate and reposition the areola toward the center of the breast
Appropriately sized cleavage, defined by nipple-to-midline distance of approximately 9cm
This is11.7cm in male patients
It is clear that breast implant surgery for male-to-female transgender patients involves more variables to consider and must achieve multiple significant objectives beyond volume enhancement. This requires a surgeon with high expertise in implant placement and pocket design.
Surgical Expertise: The Key to Success
Transgender breast augmentation has no 'one-size-fits-all' approach—each patient requires an individualized plan. A skilled surgeon must accurately assess each person's unique anatomy and develop the optimal plan within the body's limitations. Key decisions include:
Dr Chiem Quoc Thai examined super model transgender Mong Thuong
Beauty transformation of super model transgender Mong Thuong after breast augmentation
Balancing cleavage shaping with areola positioning: A delicate challenge:
Because the distance between nipples in male bodies is greater than in females, surgeons face a paradox: 'Implants cannot simultaneously create deep cleavage while keeping the nipple centered on the breast mound.' If the implant is placed directly beneath the nipple, the breast will appear balanced and natural, but the cleavage will be wide. Conversely, if the implant is positioned more medially to create deeper cleavage, the nipples will deviate outward in an 'east-west' orientation, appearing unnatural.
Typically, patients must make the difficult choice between having well-proportioned, aesthetically pleasing breasts when unclothed, or achieving attractive cleavage suitable for low-cut outfits without the need for a push-up bra.
East West breast orientation , when the nipple is far away from each other
Implant Placement Techniques and Incision Options
There are various implant placement methods, categorized by incision location and implant position:
Incision
Suitability
Explanation
Periareolar incision
No
Glandular tissue is underdeveloped at male patients, causing potential sensation loss
Inframammary fold incision
High
Allows simultaneous creation of a new inframammary fold along with the implant pocket
Transaxillary endoscopic incision
High
Offers superior aesthetic outcomes and faster recovery
Due to limited glandular tissue in transgender patients, implants can only be placed in total or partial submuscular position (also known as dual plane method). For patients with adequate glandular tissue, the surgeon may perform dual plane type 1 placement, which creates a fuller, rounder lower pole while achieving appropriate areola elevation, further enhancing feminine contours.
Conclusion
Due to differences in physical anatomy, breast augmentation with implants in male-to-female transgender patients requires distinct surgical approaches. Selecting a skilled and experienced surgeon capable of balancing the additional variables and requirements of this procedure is of paramount importance.
* The final results also depend on individual physiology
