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Breast Augmentation In Trans-female Patients: A Case Series Of 81 Consecutive Patients.
Andre Alcon1, Adrienne Kennedy1, Ines Gueneau2, Dhivya Srinivasa1, Kelsey McClure1, Esther Kim1.
1University of California, San Francisco, San Francisco, CA, USA, 2University of California, Berkeley, Berkeley, CA, USA.

Background: Many trans-females seek breast augmentation in addition to hormone therapy to achieve a physical appearance more congruent with their gender identity. The psychosocial benefits of feminizing mammaplasty are well established, however little has been published regarding techniques and outcomes of this procedure in the trans-female cohort. We report our experience with trans-female breast augmentation at the University of California, San Francisco (UCSF).
Methods: All trans-females undergoing breast augmentation at UCSF between 2017 and 2019 were retrospectively reviewed. Those with previous breast surgery or those who did not meet WPATH standards of care were excluded. Demographics, standardized breast measurements, surgical details and clinical outcomes were recorded.
Results: A total of 81 patients were included, with a median age of 35 years (IQR=28-46) and a median body mass index of 24 (IQR=22-29). All but one patient was on hormone therapy for a median length of 36 months (IQR=19-62) with 59% taking both estrogen and spironolactone. Patients presented with a mean chest base-width of 12.4 cm (95% CI=11.9-12.9 cm) and a mean difference between the bust and chest circumference of 7.0 cm (95% CI=6.1-7.8 cm). Most (69%) of patients received a dual plane III sub-pectoral anatomic silicone implant with a mean volume of 490 mL (95% CI=469-514 mL). Patients experienced a mean increase of 6.7 cm in the bust-chest circumference difference (95% CI=5.7-7.7 cm) and a mean increase of 3.7 cm (95% CI=3.3-4.2 cm) in the nipple-to-inframammary fold distance after breast augmentation. With a median length of follow-up of 16 weeks (IQR=5-35 weeks), only one patient required reoperation within 30 days for hematoma evacuation and 12 (16%) patients underwent revision, mostly for larger implants.
Conclusion: Most patients experienced a significant increase in the post-operative breast dimensions; however, a notable number of patients requested revision surgery for larger implants. Techniques for breast augmentation have evolved significantly since then. Further prospective studies are warranted to best delineate technique and patient specific effects on clinical and aesthetic outcomes.


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