Breast augmentation is a surgical procedure that can be used to enhance the size, shape, or fullness of the breasts.  This procedure has a number of important benefits for the transwoman.  It can provide a greater sense of congruence between her inner and outer selves, enhance her confidence and self-esteem, and help her to “blend in” more effectively in society as a woman.  For these reasons, breast augmentation is a vital step in the male-to-female transition.

During the breast augmentation procedure, which is also known as augmentation mammoplasty, implants are placed either over (sub-glandular placement) or under (sub-muscular placement) the chest wall muscle. Placing the implant under the muscle can create a more natural look, but recovery time and pain tend to be a bit more with this method. 



In the submuscular breast augmentation or subpectoral, the implant is placed behind the pectoral muscle. Because the muscle is only attached to the chest wall at the edge, there is a space under the muscle where the breast implant can be placed. In most cases, the pectoral muscle can cover about two-thirds of breast implant. When the muscle does not completely cover the implant, the procedure is called ‘partial’ submuscular breast augmentation. Complete, or total, submuscular breast augmentation, is achieved by using other muscles of the chest wall to cover the remaining third breast implant. Dr. Cardenas can achieve a complete submuscular placement of breast implants through trans-axillar incisions, areolar incisions or infra-mammary incisions.


Unlike sub glandular breast augmentation, in which breast implant is placed in front of the muscle, in submuscular breast augmentation, the implant is completely covered by muscle and breast tissue. This helps to hide the edges and ripples of the implant and thus creates more natural looking and feeling breasts. Moreover, submuscular placement of breast implants seems to generate more favorable results than subglandular increased in women with smaller breasts.

The location of the implant under the pectoral muscle breast augmentation can reduce the fear of breast enhancement surgery hindering breast cancer detection. Although the possibility exists that any breast implant hide some breast tissue during mammography, clinical studies have shown that submuscular placement does not interfere with mammography exams.

Submuscular breast augmentation also entails lower risk of capsular contracture, i.e. the stress on the scar tissue and squeeze the breast implant. Capsular contracture can distort the appearance of the breast and create an unnatural strength, which could also be painful. Further, submuscular placement of breast implant decreases the likelihood of downward displacement of the implant, which is a complication of breast augmentation where the implant ends located too low on the chest wall and, therefore, the nipples seem too high on the breasts.

The procedure is performed under general anesthesia by an anesthesiologist.

While breast augmentation is similar for trans and cis gender women, transgender women do have some special considerations to keep in mind.  Generally, the transgender woman has a broader chest and shoulders, so a larger implant may look more natural and proportional.  Additionally, transwomen tend to have slightly lower nipples, which means that the natural breast crease may need to be lowered during surgery so that the nipple is properly centered on the implant. Finally, compliance with after-care measures is particularly important for the trans patient.  Transwomen typically have a larger pec muscle that causes the implant to be held higher on the chest wall, but diligent breast massage and compression will allow the implant to “drop” into a more natural position.

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