Transgender breast implants: options

There are a variety of options you need to discuss with your physician.


Shell types

Smooth - type of breast implant, the exterior surface of which is smooth.

Textured - Type of breast implant in which the outer surface, or shell, is rough and/or irregular instead of smooth.


Implant fill materials

Saline and silicone

At this point, FDA has banned the use of silicone implants in the United States except in certain cases of reconstruction following cancer. Almost all implants produced and used in the US contain saline.

Saline Implants

The following is from FDA's breast implant information site

Although many of the local complications of gel-filled implants are also associated with saline implants, the latter were permitted to remain on the market unrestricted for both reconstruction and augmentation. FDA considers saline-filled implants less risky, because although they have the same silicone rubber envelope as gel-filled implants, leakage or rupture would release only salt water, not silicone gel, into the body.

Nevertheless, FDA is requiring manufacturers to collect data on the saline implants as well, because the incidence of known risks (for example, deflation and capsular contracture) is not well defined. When the Medical Device Amendments were passed, it was determined that these devices would also eventually require premarket approval. In January 1993, FDA notified saline implant manufacturers that they would have to submit safety and effectiveness data for their products. In December 1994, the agency told them what type of safety and effectiveness data were needed, and delineated objectives and time frames for the trials. Saline implants will stay on the market while the studies are conducted, but the companies must report the laboratory, animal and clinical data in stages, and must provide written information on the known and possible risks of their products.

"Women considering saline implants should ask their doctor for a copy of the manufacturer's information sheet, a copy of the product insert sheet for the specific implant to be used, and a copy of the hospital informed consent form," says Barbara Stellar, FDA's breast implant information and outreach coordinator.

Stellar recommends women be given these documents at least a month before surgery is planned, if possible, so they can thoroughly discuss benefits and possible risks with surgeons, radiologists, and other women. These women should also ask their physicians about participating in the saline breast implant trials.

Brown hopes that further studies will more clearly define risks associated with all types of implants.

"It should be made clear that implants do not last forever, that they may break, and in what time period it is thought they might break. Most women have no idea implants break and there's very little information about rupture rates.

"The same is true for other complications, some of which may require further surgery or may cause the woman to be displeased with the cosmetic effect, which, of course, is the reason she got them," Brown says. "For a product that a person is putting in her body presumably for 20 years or more, we should have this information."

Silicone

a plastic material. When formed into a gel, it provides an excellent match for breast tissue and is used as a filler in breast implants. When formed into a slightly denser version, it is used as a shell for both silicone gel and saline implants. A solid form is used for implants for other parts of the body, including chin and cheeks.

Soy Implants

Soy oil-filled implants were conceived of by Dr. Leroy Young, and others at Washington University in St. Louis in the early 1990's. Their concept was to use presumably metabolizable Soy Triglyceride Oils (Trilipid Z6) to fill the implants, and thus provide a material less dense than silicone gel, or saline solution, to allow for better visualization of mammograms in the presence of implants. The goal was also to achieve a material of similar safety to saline to allow clearing once the implants eventually fail and leak. Approval by the FDA for use in the US is reported to be "at least 3-5 years away," if ever.


Internal placement of implants

Subglandular - under the breast tissue or gland. One of the locations for breast implant placement. Also known as above the muscle because placement is above the pectoralis muscle but below the breast tissue.

Submuscular - under the muscle. Another location for placement of the implant, i.e., under the pectoralis muscle. Also called "subpectoral."


Incision locations

Inframammary - underneath the breast. Indicates the location of one of the possible incisions for breast enlargement, namely, under the breast.

Periareolar - around the areola, which is the dark area around the nipple on the breast. Indicates the location of one of the possible incisions for breast enlargement, namely, around the lower one-third to one-half of the areola.

Axillary - of or referring to the underarm. Indicates the location of one of the possible incisions for breast enlargement, namely, under the arm.

Umbilical - of or relating to the umbilicus (belly button). Indicates the location of one of the possible incisions for breast enlargement, namely within or through the umbilicus. Sometimes called "transumbilical." The method of transumbilical breast augmentation is often referred to as the "TUBA" method.  TUBA or transumbilical - see umbilical.


Other options

Surgical procedure

  • Inpatient
  • Outpatient
  • With other surgery

Sizing

  • Fixed size
  • Adjustable: At the time of the implant operation a thin tube is inserted with a valve to an under the arm area. In the course of the follow up visits, the doctor can increase or decrease the size by injecting or removing a saline solution into or out of the implant.

Bra or not during recovery: some do, some don't.

Brands

  • McGhan
  • Mentor

Next: Choosing a surgeon

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