Exceptional presenting conditions and outcome of augmentation mammaplasty in male-to-female transsexuals

Driven by a persistent and unchangeable need to undo the discrepancy betwee n reality of the body and gender of the mind, most male-to-female transsexu als seek physical feminization through hormonal and surgical treatment. The authors report some rare presenting conditions and exceptional results of augmentation mammaplasty in 11 male-to-female transsexuals treated between January 1979 and January 1998, as well as describe how to treat these condi tions. In patients in whom gynecomastia was treated previously, the remaini ng subcutaneous fatty tissue may he insufficient to cover the implants safe ly, and subpectoral implantation should be considered. Augmentation after u nilateral correction of gynecomastia requires different sizes of implants. Although exceptional in male-to-female transsexuals, mastopexy is the treat ment of choice to correct any mammary ptosis, but the patient may request a ugmentation mammaplasty to fill out the breasts. Previous stacking mammapla sty may have been performed subglandularly, subpectorally, or both. Stackin g may not have been noticed prior to corrective surgery. Extrusion of the i mplant may be associated with avascular necrosis or infection, but also wit h the use of high concentrations of steroid placed within the lumen of flui d-filled implants. The correction involves removal of the implant, with ski n graft or flap reconstruction of the affected area. Replacement of the imp lant may have to be delayed. Symmastia results from overzealous medial diss ection coupled with overaugmentation, Combined restoration of the presterna l subcutaneous integrity, and medial closure of the pocket by subcutaneous approach only, leads to satisfactory reconstruction of the presternal media n cleavage. Galactorrhea may be the result of hyperprolactemia but is more often caused by stimulation of the intercostal nerve by the implants.