Augmentation mammaplasty in male-to-female transsexuals

Hormonal therapy and gender-confirming surgery are the treatments of choice in appropriately selected male-to-female transsexuals. Penectomy and vagin oplasty are the paramount surgical requests of the male transsexual, but br east enlargement greatly increases subjective feelings of femininity. There are only limited reports on augmentation mammaplasty in male transsexuals, and hardly any attention has been paid to the differences between the fema le mammary anatomy and its male counterpart. The basic anatomic and surgical considerations of augmentation mammaplasty for 201 male-to-female transsexuals who were operated on from 1979 to 1997 are reviewed and discussed. They include the differences between male and f emale anatomy and how to feminize the male chest, the results of hormonal t herapy and the proper timing of surgery, the choice of implant size and sur gical approach, the results that may be expected after surgery, and the imp lications of all mentioned on the long-term outcome and follow-up after aug mentation mammaplasty. Because the referring doctor may not check on the br easts or may not be trained to examine augmented breasts for pathologic con ditions, the mammaplastic surgeon has an obligation to ensure the proper fo llow-up of these patients.