Dr. Reed, I am an 18 year old transgender wishing breast implants. How long should I wait? Any practical suggestions? Should I have this done before vaginoplasty?
Thank you for your interest in the Reed Centre for Transgender Surgery. More important than whether you are 18 or 20, is that you be on estrogens (properly regulated) and testosterone blockers for 2 years to max out your home grown capabilities. Some patients elect to have implants first, others vaginoplasty. As a rule your breast size will be one cup smaller than your mother or sister. Lovely breasts are the defining feature of femininity and can be appreciated a block away and adds all sort of attractive display possibilities during dress. More than just a form, they should be sensual.
We use the Tebbetts’s formula which suggests that implants be no larger in diameter than your home grown breasts, lest you have the “double bubble” effect (Michelin tire man). You have a choice of saline or silicone “gummy bear” (cohesive gel) implants. We favor Mentor became it is a superlative product and they’ve been in this business for decades. I seriously doubt any casual examiner will be able to tell whether you have silicone or saline, because they are implanted under the muscle. In fact some silicones I have felt recently feel firmer and more unnatural. Soft is better. Because the salines can be passed through a smaller incision, they are inserted uninflated rolled like cigarette, the incision is always smaller than with silicone.
In your doctor intends to make the incision in the inframammary fold (IMF) , he/she must be aware that what seems like the perfect place to make an incision will rise up and appear on the lower pole of the breast after the implants are filled. You won’t be happy about this. For this reason, the incision line has to be offset lower than expected so once filled it appears in the IMF Don’t go for overly large implants as they will start to droop as you get older as with natal women with large natural breasts.
When implants are pushed to the midline to give more natural cleavage, there is a tendency for the nipple areolar complex to be displaced laterally. When implants are centralized under the nipple areolar complex which may be more lateral in natal men, the implant can wind up under your arm and leave an appreciable gap in the mid chest. This also is not very feminine. Your surgeon will compromise and may select a particular model, low medium or high profile to provide you with the best look, naturally discussing all this with you beforehand.
Honestly doing breast implants is one of the most gratifying surgeries we perform, because at least 4 people love the results: the patient, her lover, myself and Anne our assistant. Be beautiful and feminine, and you’ll turn many heads, and more imporiantly love the way you look..
Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami