Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Perspective
  • Published:

Male-to-female gender affirmation surgery: breast reconstruction with Ergonomix round prostheses

Subjects

Abstract

People with gender dysphoria are becoming more prevalent and more universally accepted. Social, hormonal, and surgical gender transition are able to substantially improve their quality of life. Various gender affirmation surgery (GAS) options are available to address gender dysphoria in the male-to-female (MtF) population, including facial and chest feminization, body contouring,  and genital surgery. While hormone replacement therapy may result in some degree of breast development, it is often insufficient to effectively result in an adequate female-like breast contour. The creation of a female chest is generally the first surgical step in the transition. The primary aim of this manuscript is to describe the surgical technique with ergonomix round prostheses used at our high-volume GAS center and to point out how anatomical differences between trans-female and cis-female patients impact surgery. Furthermore, we provide an overview of the demographic data and postoperative outcomes.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Preoperative markings: The midline and the footprint of both breasts are marked, the latter also defining the position of the inframammary fold (IMF).
Fig. 2: Pre- and postoperative result.
Fig. 3: Long term result.

Similar content being viewed by others

References

  1. Murad MH, Elamin MB, Garcia MZ, Mullan RJ, Mura A, Erwin PJ, et al. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol. 2010;72:214–31.

    Article  Google Scholar 

  2. World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. Version 7. East Dundee, Ill: World Professional Association for Transgender Health; 2012.

    Google Scholar 

  3. Miller TJ, Wilson SC, Massie JP, Morrison SD, Satterwhite T. Breast augmentation in male-to-female transgender patients: technical considerations and outcomes. JPRAS Open. 2019;21:63–74.

    Article  Google Scholar 

  4. de Boer M, van der Sluis WB, de Boer JP, Overbeek LH, van Leeuwen FE, Rakhorst HA, et al. Breast Implant-Associated Anaplastic Large-Cell Lymphoma in a Transgender Woman. Aesthet Surg J. 2017;37:83–7.

    Article  Google Scholar 

  5. Ettner RMS, Monstrey S, Coleman E. Principles of Transgender Medicine and Surgery. 2nd ed. Abingdon: Taylor & Francis LTD.; 2016. p. 105–33.

  6. Iwamoto SJ, Defreyne J, Rothman MS, Van Schuylenbergh J, Van de Bruaene L, Motmans J, et al. Health considerations for transgender women and remaining unknowns: a narrative review. Ther Adv Endocrinol Metab. 2019;10:1–27.

    Article  Google Scholar 

  7. Berli JU, Knudson G, Fraser L, Tangpricha V, Ettner R, Ettner FM, et al. What Surgeons Need to Know About Gender Confirmation Surgery When Providing Care for Transgender Individuals: a Review. JAMA Surg. 2017;152:394–400.

    Article  Google Scholar 

  8. Safa B, Lin WC, Salim AM, Deschamps-Braly JC, Poh MM. Current Concepts in Feminizing Gender Surgery. Plast Reconstructive Surg. 2019;143:1081–91.

    Article  Google Scholar 

  9. Tebbetts JB, Adams WP. Five critical decisions in breast augmentation using five measurements in 5 min: the high five decision support process. Plast Reconstr Surg. 2005;116:2005–16.

    CAS  PubMed  Google Scholar 

  10. Morrison SD, Wilson SC, Mosser SW. Breast and Body Contouring for Transgender and Gender Nonconforming Individuals. Clin Plast Surg. 2018;45:333–42.

    Article  Google Scholar 

  11. Blondeel PN, Hijjawi J, Depypere H, Roche N, Van Landuyt K. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part IV - aesthetic breast surgery. Plast Reconstr Surg. 2009;124:372–82.

    Article  CAS  Google Scholar 

  12. Weigert R, Frison E, Sessiecq Q, Al Mutairi K, Casoli V. Patient satisfaction with breasts and psychosocial, sexual, and physical well-being after breast augmentation in male-to-female transsexuals. Plast Reconstr Surg. 2013;132:1421–9.

    Article  CAS  Google Scholar 

  13. Cohen WA, Mundy LR, Ballard TN, Klassen A, Cano SJ, Browne J, et al. The BREAST-Q in surgical research: a review of the literature 2009-2015. JPRAS. 2016;69:149–62.

    PubMed  Google Scholar 

  14. Clemens MW, Miranda RN, Butler CE. Breast Implant Informed Consent Should Include the Risk of Anaplastic Large Cell Lymphoma. Plast Reconstr Surg. 2016;137:1117–22.

    Article  CAS  Google Scholar 

  15. Al-Ajam Y, Marsh DJ, Mohan AT, Hamilton S. Assessing the augmented breast: a blinded study comparing round and anatomical form-stable implants. Aesth Surg J. 2015;35:273–8.

    Article  Google Scholar 

  16. Heden P, Montemurro P, Adams WP Jr, Germann G, Scheflan M, Maxwell GP. Anatomical and Round Breast Implants: How to Select and Indications for Use. Plast Reconstr Surg. 2015;136:263–72.

    Article  CAS  Google Scholar 

  17. Sforza M, Hammond DC, Botti G, Heden P, Quiros MC, Munhoz AM, et al. Expert consensus on the use of a new bioengineered, cell friendly, smooth surface breast implant. Aesthet Surg J. 2019;39:95–102.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Fien Decuypere.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Decuypere, F., De Wolf, E., Vyncke, T. et al. Male-to-female gender affirmation surgery: breast reconstruction with Ergonomix round prostheses. Int J Impot Res 33, 720–725 (2021). https://doi.org/10.1038/s41443-021-00425-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-021-00425-8

This article is cited by

Search

Quick links