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Transgender Breast augmentation, where to correctly place incision

Dr. Reed, My friend who is a transgendered woman had a breast implant and there is a notable incision on her lower breast.  I am thinking the incision should be better concealed by placing it in the fold.  Nara

Dear Nara,

Of course you are correct. You’d be surprised how many women we see who have had breast implants (“at a big center”) with scars high up on the lower pole (half) of the breast

For transgendered women we favor a sub-pectoral or inframuscular approach so the implant is better concealed. Dr. John Tebbetts has a guideline for how far down, the incision should lie. For most patients the incision should not be in their present inframammary fold because after the breast implant  is inserted it will stretch the skin upwards and the incision along with that.  So we have to think in advance.  First, ladies are looking for cleavage, not a flat plate in between 2 breasts.  The cleavage should be not bra induced but look natural without a bra.  This means that the pocket has to come somewhat inwards about 3/4″ away from the midline.  When implants are kissing each other that’s called synmastia or uniboob and that is not acceptable.

The implant should not be so large it extends under your arm or lateral to the anterior axillary fold.  Once the base width of the implant is known the volume can vary somewhat depending upon the profile elevation. More elevation gives you more volume, but never desirable to go to extremes.  Keep in mind overly large implants will eventually sag, just as natal women with huge breasts will eventually require a lift.

A measurement of your present stretched nipple to infra-mammary fold is taken.  Implants of known sizes will generally require a predictable inframammary fold distance.  If your present measurements are smaller (usually is the case), the incision has to be placed further down, so it lies just right once the implant is installed.

Here is a formula I have found very handy from Dr. John Tebbetts.  See below. So for example if your desire a 400 cc volume implant, the inframammary fold should be at 9.5 cm below the nipple.  If not the case pre-op, then adjust accordingly.

Cordially,

Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami
1-305-865-2000
Tebbetsi nframammary fold

1/5 - Before

Pre-op before photo breast implant patient

 

1/4 - After

Post-op after photo of breast implant patient of Dr. Reed

 

1/6 - After
Post-op after photo of breast implant patient of Dr. Reed

 

I am a transgendered woman but am seeking just orchiectomy and scrotal removal at this time

Dear Dr. Reed,  I am 60 year old transgendered woman and have been passable as a woman for 5 years.  I’d like to stop the Spironolactone and reduce the estrogens because of my age. So what I am seeking is just an orchiectomy and scrotal removal. Would you consider that?  Reneeka Dear Reneeka, We do…Continue Reading

Will I be orgasmic after MTF male to female vaginoplasty

What is the likelihood I’ll remain orgasmic after male to female sex change vaginoplasty?  Since I’ve been on  testosterone blockers and estradiol my orgasms are not as powerful or throbbing, but sure would like to keep what I have.  Toni Dear Toni, Our excperience has been surprisingly favorable you’ll remain orgasmic after surgery.  Preserving the…Continue Reading

What is the average MTF vaginoplasty depth for your patients?

Dr Reed, Thank you so much for getting back to me, and for answering my questions. I have a few more if you’d be so kind I read on your site that you have a procedure to add depth to the neo vagina without a colon graft. Can you explain how that procedure works? What…Continue Reading

Labial and clitoral reduction for female athlete

Dr. Reed, While I know you have a large transgender practice, my background is in sports where I competed in eastern Europe and did take some performance enhancing dugs.  Last competition  about  years ago and am tied of being asked “what’s that” during intimacy. As you can see from my photos the clitoris is quite…Continue Reading

Do you do one stage MTF vaginoplasty

Dr. Reed,  I am a transgendered woman and live in Oklahoma.  I am hoping you can do a so called one stage vaginoplasty.  Your fees are very affordable but getting time off from work requires some planning, and of course there’s the cost savings. Nancy Dear Nancy, Last year we have shifted to one stage…Continue Reading

Will you accept my BC for MTF vaginoplasty?

Dr. Reed,  Was happy to learn my Blue Cross policy will pay for MTF transgender sex change vaginoplasty.  Will you accept the insurance?   Liz Dear Liz, We are not contracted providers with any insurance company, because they insist we accept their payment or portion of it as payment in full,  which usually amounts to 10 to…Continue Reading

Is electrolysis or laser necessary for sex change MTF vaginoplasty?

Dr. Reed, Do you advise electrolysis or laser to remove genital hair before vaginoplasty.  How about so called scraping during surgery? Lisa Dear Lisa, We absolutely recommend hair removal, ideally several weeks before feminizing vaginoplasty as some hair will grow back.  This will require a touch-up.  Our preference is for electrolysis with local anesthesia.  This permits…Continue Reading

Do you do butt and thigh implants

Dr. Reed,  Planning on having a sex change vaginoplasty.  Do you do buttocks and thigh implants? Carmela Dear Carmela, We do not, but if your considering vaginoplasty, please have your vaginoplasty first as implants in the buttocks and/or silicone injections impair wound healing and often interferes with creating a pelvic space.  If you are on…Continue Reading

Had tummy tuck after vaginoplasty and now my urethra and vulva are elevated

Dr. Reed, Had a MTF feminzing vaginoplasty about 2 years ago and a tummy tuck 2 months ago.  Happy with the tummy tuck, but now my urinary stream is very high, and I am thinking my entire vulva and clitoris seems elevated.  Any thoughts?  Am peeing on the rim of my toilet seat.  Stephanie Dear…Continue Reading