Susan's Place Transgender Resources

Hi All

I would like to understand more about breast augmentation/implants. I have noticed there isn't too much information on this subject in any forum thread and I think, I, like many users on here, are considering this surgical procedure and so would find a discussion on this beneficial.

I am aware you can have implants placed above or beneath pectoral muscle tissue. Can anyone explain the advantages and disadvantages for having either of these procedures?

I also strangely happened to have a chat with a man who worked in a surgical team one time who I met at an airport - and he mentioned something about, that in order for breasts to look natural they need to positioned appropriately to your muscle tissue. So the surgeon needs to look at the direction in which your breasts 'point'. Has ANYONE heard of this? Or could he have meant they change your muscle tissue. I don't know whether this was nonsense or not. Is anyone aware of considerations a surgeon may make when performing a breast augmentation on a patient, is there more to it than 'what cup size do you want'?

There is also the issue that as trans women we naturally have a heavier build up top than genetic women do, who have a heavier build around their hips/bum area. So I worry that having implants that are too large can make you stand out as being trans. I personally prefer to blend in rather than to walk around with what may appear as oversized breasts. Trans-women have bigger chests than genetic women and therefore if the breasts protrude, from a profile view, it doesn't look natural in my opinion.

I have currently been on HRT for around 15 months and have small A cups. When I am topless I do not pass as a female as my breasts are too small relative to the rest of my body.

Has anyone here noticed a similar pattern or had similar thoughts with regards to this? I'd like to know more and I'm sure this will be an informative discussion for others too.

I have 375ml naturals over the muscle from Allergan. They are called gummi bear implants because the silicon is not liquid.

My doc me a bra and different sized implants to test how it would look. We also discussed the shape, I wanted a very natural looking shape.

He is experienced with transgender which helped a lot because the chest is different to a CIS women. I would suggest you to ask your MD how much experience he has with trans women and if he could show you some examples from earlier surgeries.

We choosed to place the implants over the muscles because of the strength of the muscle. But the resulting shape is also a little bit different especially when you move your arms.

Hi,

You bring forth a very good question!

I can give you my experience and what I considered before having breast augmentation. 

First relating to the placement of the implant underneath the muscle.......my surgeon said that the implants look more natural.  I am sure you have seen women, both transgender and cis, who have very large implants that were placed above the muscle.  They often look like water balloons in how they project.  They tend to not have the "natural" look that most people desire.  I had saline implants and they were the kind that with a very small procedure could be easily enlarged after an initial period to allow for proper stretching of the skin.  I am not a large person in any way and was happy with starting out with a C cup.  Having said that, I am older and knew that I would be considered in not too many years as a "mature" woman.  Mature cis women on average have a D cup breast so five years after I had breast augmentation I had them enlarged to a D cup.  The procedure took very little time in the surgeons office and was, for the most part, painless.

As to placement, I do remember that being a major consideration as for the breasts to look natural it is best that the distance between the two is not too great.  Doing that is often difficult as the implant has to be more or less centered under your nipple.  This is more important it you desire to wear tops that plunge or tend to show more of the breast. 

The type implant is also important.  I had a choice between a teardrop shaped implant or one that was more or less round.  In any event, they tried to "sculpt" mine such that they looked the same as a cis woman where the breast fell downward naturally but moved up a bit where the nipple was located so there would be some projection forward with the nipple.  I remember the doctor showed me how that was common with most cis women.

You have a choice between saline and silicone filled implants.  I chose the saline because at that time there were stories about where some women had the silicone leak from their implants and cause some health problems.  Looking back now I wish I had gone with the silicone because the implants feel more natural and are less likely to "ripple" after a number of years.

You may know that when choosing the size implant you need to take into consideration the breast growth you have had with HRT......and the fact that depending on your age and how long you have been on HRT how much further  breast growth you might expect as that growth will increase your cup size beyond the implant size you choose.

I was also told that I probably would have to have the implants replaced in about ten years time.  I guess I am lucky in that when I had them checked about six months ago the doctor said they are in great shape and he does not see any reason why I should do that.  It has been almost 15 years now.

Good luck.  I have always felt that my breasts were not only a key to my transition but also to enhancing my internal feelings regarding my womanhood. 

My doc told me the main advantage in placing the implants under the muscle was they were not going to sag over time. He said that in a short term implants placed above the muscle looked way better and patients healed way faster, but over time (i think that quality skin and other factors play a major role here) they were prone to sag.

Above the muscle are specially indicated to those patients who got significant breast tissue before and go for small-medium implants.

I went under the muscle, of course.

I have a large upper body and decided on the silicone teardrops. I purposely didn't want to "stand out" as you mentioned in your post and I settled on 270 ccs. under  the muscle. That was a year ago. This may sound small, but I knew that I would soon begin cross sex hormone therapy. (Mar. '15) and I expected natural development to occur with the hormone therapy.  This is happening now and although I can comfortably wear a 38 C bra, my measurements call for a 40.  It's all about the bra manufacturer and we have to learn this on our own. It will be a min. of 6 to 9 mos. before the swelling subsides, but you won't notice the swelling much after a few months.  If I'm right I may get to a 40 D, but I don't anticipate or want more. One of the pluses about sub-muscular is that what you see is all yours. Haven't developed any stretch marks (yet) either.  Another plus is that there is little danger of effecting the nerves in the breast and the nipples.  Just some food for thought. 

And on the lighter side, what ever size you choose after it's done, you'll probably wish that they were a little bit bigger. After the surgery my surgeon told me that 10 ccs. was equivalent to about a teaspoon in volume and I said to myself dammit, wish she would have told me that B4.

Good luck!
Hugz,
Joi   

I was on HRT for 3 years before I decided my little barely B cups were not enough for my 5'9 wide-shouldered frame.

I interviewed 6 docs and picked the one I liked the best. We negotiated about size and type based on what I said I wanted and I ended up with high profile Round/Smooth 500cc silicone implants under the muscle, inframamory incision.

As you can see from my ticker that was 3+ years ago....and it was the best thing I ever did for myself. I love them so much! They're big enough to be sexy but small enough to hide if I want to play them down too. And most importantly, they are in proportion to my body.

If you want to do more research, try joining a breast implants forum. I liked justbreastimplants.com during my process and it helped to talk with other girls who have gone through the process.

As far as under or over the muscle, I've heard lots of different opinions. When I had mine done, they said over the muscle was more for body builders and yet my best friend (who's natal) got hers a year ago and hers are over the muscle and she's NOT a bodybuilder lol. So I dunno, it almost seems more like a surgeon preference or something. She looks just as natural as I do under the muscle.

Quote from: Lara1969 on December 13, 2015, 02:05:03 PM
I have 375ml naturals over the muscle from Allergan. They are called gummi bear implants because the silicon is not liquid.

My doc me a bra and different sized implants to test how it would look. We also discussed the shape, I wanted a very natural looking shape.

He is experienced with transgender which helped a lot because the chest is different to a CIS women. I would suggest you to ask your MD how much experience he has with trans women and if he could show you some examples from earlier surgeries.

We choosed to place the implants over the muscles because of the strength of the muscle. But the resulting shape is also a little bit different especially when you move your arms.

Interesting...I hadn't known about "gummi bear" implants - what are the proc/cons of having these over other types?

I did actually speak to the surgeon in Thailand I was considering having BA with. I am also considering having FFS as the same time and hence sought out, primarily a surgeon who I could trust with the FFS and also perform a BA. He has reccommended I have at least 500cc per breast as 'I have a large chest area'. I have a 37" chest (overbust), am 5'3" tall and weight around 125 pounds. I thought that far exceeded the size of breasts I was actually going to have, I was thinking more in the range or something that would give me a comfortable B cup. But i think 500cc's would give me more like C/D cup!!!

Out of curiosty, Debra, what happens when you move your arms? Not sure I understand fully.

Quote from: Karen5519 on December 13, 2015, 02:14:22 PM
Hi,

You bring forth a very good question!

I can give you my experience and what I considered before having breast augmentation. 

First relating to the placement of the implant underneath the muscle.......my surgeon said that the implants look more natural.  I am sure you have seen women, both transgender and cis, who have very large implants that were placed above the muscle.  They often look like water balloons in how they project.  They tend to not have the "natural" look that most people desire.  I had saline implants and they were the kind that with a very small procedure could be easily enlarged after an initial period to allow for proper stretching of the skin.  I am not a large person in any way and was happy with starting out with a C cup.  Having said that, I am older and knew that I would be considered in not too many years as a "mature" woman.  Mature cis women on average have a D cup breast so five years after I had breast augmentation I had them enlarged to a D cup.  The procedure took very little time in the surgeons office and was, for the most part, painless.

As to placement, I do remember that being a major consideration as for the breasts to look natural it is best that the distance between the two is not too great.  Doing that is often difficult as the implant has to be more or less centered under your nipple.  This is more important it you desire to wear tops that plunge or tend to show more of the breast. 

The type implant is also important.  I had a choice between a teardrop shaped implant or one that was more or less round.  In any event, they tried to "sculpt" mine such that they looked the same as a cis woman where the breast fell downward naturally but moved up a bit where the nipple was located so there would be some projection forward with the nipple.  I remember the doctor showed me how that was common with most cis women.

You have a choice between saline and silicone filled implants.  I chose the saline because at that time there were stories about where some women had the silicone leak from their implants and cause some health problems.  Looking back now I wish I had gone with the silicone because the implants feel more natural and are less likely to "ripple" after a number of years.

You may know that when choosing the size implant you need to take into consideration the breast growth you have had with HRT......and the fact that depending on your age and how long you have been on HRT how much further  breast growth you might expect as that growth will increase your cup size beyond the implant size you choose.

I was also told that I probably would have to have the implants replaced in about ten years time.  I guess I am lucky in that when I had them checked about six months ago the doctor said they are in great shape and he does not see any reason why I should do that.  It has been almost 15 years now.

Good luck.  I have always felt that my breasts were not only a key to my transition but also to enhancing my internal feelings regarding my womanhood.

Hi there

Thanku so much for your considerate response, very helpful to me!

Out of curiosity - why did you opt at first for a C cup if you mentioned your not a very large person? I too am not very large and have always thought smaller breasts just look more elegant - but I guess it is the chest size, which with a larger cup, you can masquerade...?

Did it cost much more to have the implants planted beneath the muscle? On average what are the price differences and advantages and disadvantages for the procedure above and beneath the muscle?

I have the problem with the nipples, mine sort of point outwards rather than directly ahead - which as you mention could be a problem when working out where to centre the breast implants. I too hope for natural looking breasts above all...

Quote from: Joi on December 13, 2015, 10:56:41 PM
I have a large upper body and decided on the silicone teardrops. I purposely didn't want to "stand out" as you mentioned in your post and I settled on 270 ccs. under  the muscle. That was a year ago. This may sound small, but I knew that I would soon begin cross sex hormone therapy. (Mar. '15) and I expected natural development to occur with the hormone therapy.  This is happening now and although I can comfortably wear a 38 C bra, my measurements call for a 40.  It's all about the bra manufacturer and we have to learn this on our own. It will be a min. of 6 to 9 mos. before the swelling subsides, but you won't notice the swelling much after a few months.  If I'm right I may get to a 40 D, but I don't anticipate or want more. One of the pluses about sub-muscular is that what you see is all yours. Haven't developed any stretch marks (yet) either.  Another plus is that there is little danger of effecting the nerves in the breast and the nipples.  Just some food for thought. 

And on the lighter side, what ever size you choose after it's done, you'll probably wish that they were a little bit bigger. After the surgery my surgeon told me that 10 ccs. was equivalent to about a teaspoon in volume and I said to myself dammit, wish she would have told me that B4.

Good luck!
Hugz,
Joi

Thank you Joi

Ahh it sounds you've sold it to me. I definitely like having sensitive nipples and knowing that there is a lower risk of it interfering with nerve enddings by having them sub-muscular is definitely a big one for me.

Quote from: kitten_lover on December 16, 2015, 02:26:25 PM
Interesting...I hadn't known about "gummi bear" implants - what are the proc/cons of having these over other types?

I did actually speak to the surgeon in Thailand I was considering having BA with. I am also considering having FFS as the same time and hence sought out, primarily a surgeon who I could trust with the FFS and also perform a BA. He has reccommended I have at least 500cc per breast as 'I have a large chest area'. I have a 37" chest (overbust), am 5'3" tall and weight around 125 pounds. I thought that far exceeded the size of breasts I was actually going to have, I was thinking more in the range or something that would give me a comfortable B cup. But i think 500cc's would give me more like C/D cup!!!

Out of curiosty, Debra, what happens when you move your arms? Not sure I understand fully.

Yeah I ended up with 34DD myself but it looks really proportionate to my body because of my 5'9 height and wide shoulders. It also matters whether you go high, med, low profile too depending on your body type.

What do you mean moving my arms? I don't understand the question.

Quote from: kitten_lover on December 16, 2015, 02:47:49 PM
Hi there

Thanku so much for your considerate response, very helpful to me!

Out of curiosity - why did you opt at first for a C cup if you mentioned your not a very large person? I too am not very large and have always thought smaller breasts just look more elegant - but I guess it is the chest size, which with a larger cup, you can masquerade...?

Did it cost much more to have the implants planted beneath the muscle? On average what are the price differences and advantages and disadvantages for the procedure above and beneath the muscle?

I have the problem with the nipples, mine sort of point outwards rather than directly ahead - which as you mention could be a problem when working out where to centre the breast implants. I too hope for natural looking breasts above all...

Jenna,

I am 5'7" about 158 pounds.  A C cup looked fine at the time that I had my breast augmentation.  I knew that at sometime thereafter I would want to increase my bust size as I had completed a lot of research and even discussed that with a couple of doctors who performed breast augmentations.  Let me just say that you could classify me as a "mature" woman.  I am now in my later 50's.  The average cup size of a woman in my age group is a D.  This is for any number of reasons, perhaps the biggest being menopause.  Although some women see a reduction in breast size after menopause the majority gain at least one cup size.  As I got older I further confirmed this with a couple of girlfriends.  So, when I felt the time was right, I had the doctor add the appropriate amount of saline to my implants to increase my breast size to a D cup.  My chest size is certainly not large and the increase is not really that noticeable.  I wear a lot of skirt suits or blouses with pencil skirts to work and my larger size looks great and most appropriate in the office.  I look in the mirror and am very comfortable.

As I noted earlier, my surgeon told me that the breast looks more natural if the implant is placed beneath the muscle.  Since HRT had been kind to me with natural growth prior to surgery the implants do look more natural.  I am sure that other people have different thoughts on the implant being above or below the muscle and that is fine.  We are all different in desire and body shapes.  I just know that under the muscle worked for me very nicely.  No one I know has ever made a comment about implants to me.  Thus, I can only believe that they have no idea that I had augmentation.

As to pricing.........I did not ask if there was a price differential between above or under the muscle placement when I had my surgery.  I have not heard of it costing more either way.  I do know that it costs more if you choose silicone over saline.  There is no set price for breast augmentation.  I live in a larger city and you see pricing anywhere from $3,500 to $8,000.  I would say you can be confident that you will get a good result at the $5,000 level.

Regarding your nipples, I think you will find that surgeons can do all types of things that might be able to insure that you get the outcome you desire.  And even if they are not perfect I would not worry.  I don't think many people meet the  criteria of having a perfect body!  I know I don't!

I wish you the best of luck.  After you have your implants you will not only feel more confident, your sense of womanhood will blossom and that is a wonderful feeling!

Best,

Karen

As I posted in another b00bie thread, a common thing I've heard from a few surgeons is that the biggest regret patients have post-op is that they didn't go bigger when they wanted to just look "natural" or "not stand out".  Ask your surgeon him/herself.

Everyone's personal choice of course, but it's food for thought nonetheless.

[Hi,
I was a 40D before 700 ml saline implants under the muscle.  I got better shape and only went to a DDD.  However, at 6'1", even huge is proportional. Healing has been slow.  I do think 600 would have been better.  Its hard to find regular bras and sports bras are almost impossible to find.

Cost from Zukowski (Chicago USA) was $6000.

Hugs

Jen

Quote from: Ⓥ on December 17, 2015, 04:14:43 PM
As I posted in another b00bie thread, a common thing I've heard from a few surgeons is that the biggest regret patients have post-op is that they didn't go bigger when they wanted to just look "natural" or "not stand out".  Ask your surgeon him/herself.

Everyone's personal choice of course, but it's food for thought nonetheless.

Totally this. I went larger than suggested and I'm really satisfied with my choice. I got 600cc high profile silicone round implants under the muscle and now I have 34DD at 5'7" and 125 lbs and they dont look so huge at all (anyway they are flashy lol).

Also on a side note, if you go for big implants (breast and butt) you can be very skinny (flat tummy) while keeping your curves (and this makes most men go crazy).

Quote from: Wednesday on December 17, 2015, 08:19:47 PM

Totally this. I went larger than suggested and I'm really satisfied with my choice. I got 600cc high profile silicone round implants under the muscle and now I have 34DD at 5'7" and 125 lbs and they dont look so huge at all (anyway they are flashy lol).

Also on a side note, if you go for big implants (breast and butt) you can be very skinny (flat tummy) while keeping your curves (and this makes most men go crazy).

Glad to hear everything went well with your surgery!

Quote from: JLT1 on December 17, 2015, 07:50:14 PM

Its hard to find regular bras and sports bras are almost impossible to find.

You are so right Jen!  I forgot to mention that the larger one goes the smaller the selection & variety in bras.  Not to mention the price escalation.

Quote from: Ⓥ on December 17, 2015, 04:14:43 PM
As I posted in another b00bie thread, a common thing I've heard from a few surgeons is that the biggest regret patients have post-op is that they didn't go bigger when they wanted to just look "natural" or "not stand out".  Ask your surgeon him/herself.

Everyone's personal choice of course, but it's food for thought nonetheless.

Yep. This is very much the case on the natal female BA forums as well. They call it 'boob greed'. The second you get your boobs, you wished you'd gone bigger.

My doc asked me if I'd be more upset about them being too big or too small....and I said too small. So we went on the bigger side....and it worked perfectly for me.

Quote from: Wednesday on December 17, 2015, 08:19:47 PM

Totally this. I went larger than suggested and I'm really satisfied with my choice. I got 600cc high profile silicone round implants under the muscle and now I have 34DD at 5'7" and 125 lbs and they dont look so huge at all (anyway they are flashy lol).

Also on a side note, if you go for big implants (breast and butt) you can be very skinny (flat tummy) while keeping your curves (and this makes most men go crazy).

Wow, 600cc sounds good. The doctor I'm considering to go with has suggested 500cc. I thought it was too large - but with your advice echoed I feel like I might go in that direction. I need something that will suit my chest size and so with more cc's i imagine the circumference of the implants will be greater.

I'm 5'3" and 125 pounds - see my profile photo for how my body looks...oh and by the way I'm also considering hip/butt implants - totally with you on what you say about getting that hourglass figure!

Quote from: JLT1 on December 17, 2015, 07:50:14 PM
[Hi,
I was a 40D before 700 ml saline implants under the muscle.  I got better shape and only went to a DDD.  However, at 6'1", even huge is proportional. Healing has been slow.  I do think 600 would have been better.  Its hard to find regular bras and sports bras are almost impossible to find.

Cost from Zukowski (Chicago USA) was $6000.

Hugs

Jen

Heya

Great to hear yours went well! I'm having FFS in Thailand in the summer and from what I have seen he performs pretty good breast augmentation as well. The guys name is Dr Chettawut. Here on his website you can find before and after pics: http://www.chet-plasticsurgery.com/breast-augmentation-surgery-example-result-of-300cc-breast-implant/

I like the jaw/chin surgery he performs, appears very consistent and to have BA on top of this it is only another  £2,500 - and also will mean I'm only under general anesthetic once for two procedures.

Quote from: Debra on December 17, 2015, 08:05:22 AM
Yeah I ended up with 34DD myself but it looks really proportionate to my body because of my 5'9 height and wide shoulders. It also matters whether you go high, med, low profile too depending on your body type.

What do you mean moving my arms? I don't understand the question.

Ah sorry the question about the arms was in response to Lara's comment, got confused...

Thanks for sending the pics, yours look awesome. My chest is quite high, as you can see from the profile pic i have on here. Which would mean breast implants would sit quite high on my chest, would you agree?

For that reason I think I'll ask for the implants to be placed slightly lower...I hadn't realised you could do that before you mentioned this. Is that what you had meant?

Quote from: Wednesday on December 17, 2015, 08:19:47 PM
Also on a side note, if you go for big implants (breast and butt) you can be very skinny (flat tummy) while keeping your curves (and this makes most men go crazy).

Yeah that's kind of what sent me over the edge to get BA. I had lost 25 lbs and looked pretty good but my boobs had shrunk! Not anymore though =)

Quote from: kitten_lover on December 20, 2015, 10:23:24 AM
Ah sorry the question about the arms was in response to Lara's comment, got confused...

Thanks for sending the pics, yours look awesome. My chest is quite high, as you can see from the profile pic i have on here. Which would mean breast implants would sit quite high on my chest, would you agree?

For that reason I think I'll ask for the implants to be placed slightly lower...I hadn't realised you could do that before you mentioned this. Is that what you had meant?

Thanks! No sorry, High, Low, and Medium profile are how the implants are shaped. The low are wider but project less and the high are narrower but project the most.

(https://www.susans.org/proxy.php?request=http%3A%2F%2F40in8xoptyu34m9bupx3f61b.wpengine.netdna-cdn.com%2Fwp-content%2Fuploads%2F2014%2F07%2Fct-img09.jpg&hash=d0fd74028298d6447078e01c02c02bf83a485e5c)

Your surgeon will probably have a suggestion for what's best. I originally had wanted low or medium but we went with high based on her suggestion and it worked great.

Quote from: Debra on December 20, 2015, 10:56:10 AM
Thanks! No sorry, High, Low, and Medium profile are how the implants are shaped. The low are wider but project less and the high are narrower but project the most.

(https://www.susans.org/proxy.php?request=http%3A%2F%2F40in8xoptyu34m9bupx3f61b.wpengine.netdna-cdn.com%2Fwp-content%2Fuploads%2F2014%2F07%2Fct-img09.jpg&hash=d0fd74028298d6447078e01c02c02bf83a485e5c)

Your surgeon will probably have a suggestion for what's best. I originally had wanted low or medium but we went with high based on her suggestion and it worked great.

Oh I see... More food for thought

I think I need to have a consultation with someone here in the UK before deciding on where I go around the world to have mine done lol