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.


Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami
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


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