CC BY-NC-ND 4.0 · Indian J Plast Surg 2020; 53(01): 051-058
DOI: 10.1055/s-0040-1708227
Original Article

Hundred and Eleven Cases of Subfascial Breast Augmentation in Trans Women—A Single-Center Experience

Sasanka Sekhar Chatterjee
1   Consultant, Enhance Aesthetic and Cosmetic Clinic, Kolkata, West Bengal, India
2   Former Professor, Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
,
Manoj Khanna
1   Consultant, Enhance Aesthetic and Cosmetic Clinic, Kolkata, West Bengal, India
› Author Affiliations

Abstract

Hundred and eleven patients of breast augmentation in trans women operated between January 2004 and September 2019 are presented. Two surgeons conducted the study with a slightly different antibiotic regime. Only round implants were used. Till December 2017, 72 implants used were textured. Thereafter, we switched over smooth silicone gel implants more for reasons of availability than others. It was used in 39 patients. We did not notice any difference in results. Our postoperative regimes consisted of antibiotics (usually amoxicillin + clavulanic acid) for 10 days, restricted shoulder movements for 3 weeks, use of an inner brassiere and outer sports vest for 2 months. Routes of implantation were either periareolar or inframammary, former being selected as per choice of the patient, provided the hemicircumference of the areola was 4.5 cm or more. We never used transaxillary route. The implants were always placed in a subfascial pocket. Routine irrigation of the pocket with 5% povidone iodine was done before insertion of implant. From 3 weeks postoperatively, routine massage of breasts for a period of 6 to 8 weeks were advised. Complications included delayed minor wound healing problems usually in periareolar technique requiring secondary suture under local anesthesia. This was negligible with inframammary technique. Capsular contracture was found in 12 patients. Two of these merited intervention but one of them refused operation. In one patient, implant had to be extracted due to severe suppurative infection resulting from a separate incidence of traumatic injury with hematoma formation 2 weeks post operatively. Poor scarring including one keloid were noticed in 11 patients.



Publication History

Article published online:
17 April 2020

© .

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 
  • References

  • 1 Morrison SD, Wilson SC, Mosser SW. Breast and body contouring for transgender and gender nonconforming individuals. Clin Plast Surg 2018; 45 (03) 333-342
  • 2 Kanhai RC, Hage JJ, Mulder JW. Long-term outcome of augmentation mammaplasty in male-to-female transsexuals: a questionnaire survey of 107 patients. Br J Plast Surg 2000; 53 (03) 209-211
  • 3 Kanhai RC, Hage JJ, Karim RB, Mulder JW. Exceptional presenting conditions and outcome of augmentation mammaplasty in male-to-female transsexuals. Ann Plast Surg 1999; 43 (05) 476-483
  • 4 Laub DR, Fisk N. A rehabilitation program for gender dysphoria syndrome by surgical sex change. Plast Reconstr Surg 1974; 53 (04) 388-403
  • 5 Jinde L, Jianliang S, Xiaoping C. et al. Anatomy and clinical significance of pectoral fascia. Plast Reconstr Surg 2006; 118 (07) 1557-1560
  • 6 Graf RM, Bernardes A, Rippel R, Araujo LR, Damasio RC, Auersvald A. Subfascial breast implant: a new procedure. Plast Reconstr Surg 2003; 111 (02) 904-908
  • 7 Góes JC, Landecker A. Optimizing outcomes in breast augmentation: seven years of experience with the subfascial plane. Aesthetic Plast Surg 2003; 27 (03) 178-184
  • 8 Kim YJ, Kim YW, Cheon YW. Prevention of implant malposition in inframammary augmentation mammaplasty. Arch Plast Surg 2014; 41 (04) 407-413
  • 9 Adams Jr WP, Rios JL, Smith SJ. Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study. Plast Reconstr Surg 2006; 117 (01) 30-36
  • 10 Burkhardt BR, Dempsey PD, Schnur PL, Tofield JJ. Capsular contracture: a prospective study of the effect of local antibacterial agents. Plast Reconstr Surg 1986; 77 (06) 919-932
  • 11 Stevens WG, Nahabedian MY, Calobrace MB. et al. Risk factor analysis for capsular contracture: a 5-year Sientra study analysis using round, smooth, and textured implants for breast augmentation. Plast Reconstr Surg 2013; 132 (05) 1115-1123
  • 12 Yalanis GC, Liu EW, Cheng HT. Efficacy and safety of povidone iodine irrigation in reducing risk of capsular contracture in aesthetic breast augmentation: a systematic review and meta-analysis. Plast Reconstr Surg 2015; 136 (04) 687-698
  • 13 Spear SL, Baker Jr JL. Classification of capsular contracture after prosthetic breast reconstruction. Plast Reconstr Surg 1995; 96 (05) 1119-1123, discussion 1124