A patient’s support team, often made up of friends, family and partners, often have concerns about the the parts of transitioning that involve surgery. One of the most important is the safety of FTM/N chest reconstruction and MTF/N breast augmentation surgery. The “N” after FTM and MTF refers to the term “neutrois” and will be used throughout this page. If you’d like to learn more about neutrois, please visit our page Introduction to Top Surgery.
Plastic surgery—like any surgery– carries some degree of risk. An adverse reaction to anesthesia, infection, scarring, blood clots, or loss of sensation due to nerve damage are all possibilities. With appropriate preparation beforehand, these risks can be minimized. Being in good health, temporarily discontinuing certain medications, and screening for allergies can all lower the risks of surgery.
Breast augmentation and chest reconstruction are considered low risk procedures when performed by Board-Certified Plastic Surgeons (BCPS) in properly certified surgical facilities. Board Certification indicates that the surgeon has had specialized training, and hospital or clinic certification indicates that standards of hygiene and care must be met and are periodically monitored and confirmed. A BCPS is also required to perform surgery in an accredited surgical facility.
Transgender breast augmentation is similar in most respects to cisgender breast augmentation and carries the same risks and possible complications. In the former, depending on skin elasticity and size of implant chosen, some skin expansion may have to take place prior to placing the implants. According to current research, there is no significant difference in safety between silicone and saline implants used in breast augmentation.
Complications may include formation of scar tissue around the implant (capsular contracture), rupture of an implant, bleeding, infection, decrease or loss of sensitivity of nipples or breast skin, and excessive scarring. Although most breast implants will last a lifetime, implant manufacturers grant limited warranties and stipulate that replacement surgery may be required after ten years. Most follow up surgery, however, is a result of patients’ wanting to change the size or type of implant or to correct for bodily changes due to weight gain or loss.
Transgender chest reconstruction to the upper torso is similar to cisgender mastectomy procedures and carries the same risks. These include loss of sensitivity of nipples or breast skin which may be temporary or permanent, excessive scarring, bleeding, or infection. There is a potential loss of nipple graft from tissue death. Follow up surgery may be required to minimize scars or revise nipple placement to achieve a more pleasing aesthetic balance. Excessive weight gain or loss can also prompt revision surgery.
In the hands of a skilled surgeon chest reconstruction and breast augmentation surgery are low risk and produce high rates of patient satisfaction.
While the patient has the ultimate responsibility, a partner, relative, or friend can be very effective in helping to prepare for surgery. Regulating weight loss or gain and maintaining a stable weight before surgery is important. Also, achieving the best health possible by abstaining from smoking or drinking alcohol for as long as possible before and after surgery will minimize risk of complications. Drug use, prescription or otherwise, should be discontinued, under a physician’s supervision. This mainly refers to blood thinning medications which can cause excessive bleeding during surgery. A healthy diet and exercise program will also lower the risk of complications.
In the case of transgender surgery, patients coordinating plastic surgery with hormone therapy is important to consider. Therefore, timing and communication between the physician managing hormone therapy and the plastic surgeon is important. During a time of transition, many physical and social pressures can cause anxiety and raise stress levels for the patient, so a relative, friend or partner can play an important role in keeping communication open and scheduling and keeping appointments and encouraging pre-op preparation.
Choosing the Right Surgeon
A major consideration in ensuring FTM/N chest reconstruction or MTF/N breast augmentation safety is choosing the right plastic surgeon and the right surgical facility. Support group members can help by checking the credentials of potential surgeons, researching facilities and investigating patient reviews and online forums for patient comments. A few useful physician review websites are www.plasticsurgery.org, the official site of the American Plastic Surgery Society, or www.yelp.com, a collection of patient reviews by geographical location.
Transgender, non-binary and gender expansive patients will find the ideal choice in Dr. Scott Mosser, a Board-Certified Plastic Surgeon with offices in downtown San Francisco. Dr. Mosser has a well-deserved reputation as a compassionate and understanding physician and is highly regarded by his surgery patients for attentiveness before and after surgery as well as for his aesthetic successes.
Dr. Mosser does everything in his power to ensure all patients are physically, mentally and emotionally ready and able to make mature, informed decisions.