Complications After Breast Augmentation with Silicone Implants in a Transgender Population
Hope Xu, BA, Aki Kozato, BS, Stefani Fontana, MD, PhD, John Pang, MD, Jess Ting, MD, Frank Fang, MD.
Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
Background: Breast augmentation is one of the most commonly performed procedures in plastic surgery, and it is a particularly significant intervention in the transition process for male-to-female transgender patients. In cisgender patients, surgical and aesthetic outcomes after primary and secondary breast augmentation with implants have been extremely well documented, with complication rates reported between 10-30%. In transgender patients, however, there is little to no literature that describes comparative outcomes after breast augmentation. The present study seeks to address this gap in the literature by examining rates of complications and revisions associated with male-to-female reassignment breast augmentation with implants.
Methods: A retrospective review was conducted of male-to-female transgender patients who underwent breast implant augmentation for gender affirmation at a single institution from 2017-2019. Preoperative clinical parameters, procedural details, and postoperative surgical outcomes were recorded and compared. Additional complications were also recorded, including reoperations.
Results: A total of 96 patients underwent augmentation and had a mean age of 37.9 years (range, 21 to 60 years). Primary augmentation was performed in 81% of patients, and 19% of patients presented at consultation for secondary augmentation to revise a prior augmentation performed by an outside provider. Mean follow-up was 5.5 months (range, 4 days to 27.4 months). Of the 92 patients that received follow-up, 24 developed postoperative complications, 19 of which required revision. Complications included 17 cases of capsular contracture, 4 wound dehiscence, 2 seromas, 2 synmastias, 2 implant migrations, 1 hematoma, 1 SSI, 1 implant infection, and 1 implant extrusion/exposure. The overall complication rate was 20.5% in primary augmentation patients and 44.4% in secondary. The rate of Baker grade III/IV capsular contracture was 7.7% in primary augmentation patients and 33% in secondary. Of the 5 patients with recurring capsular contracture, only one patient had undergone primary augmentation.
Conclusions: Complication rates after breast augmentation with implants in transgender patients are comparable to reported rates for cisgender populations, and secondary augmentation patients are more likely to have new and recurrent complications. Future research should include comparison to previously published outcomes using z-tests. As both breast augmentation and gender affirming surgery continue to become more popular, a knowledge of such rates and surgical outcomes in this unique patient population is crucial for optimal management of transitioning male-to-female individuals.
| Complication | N (%) | Required Re-operation |
| Capsular contracture | 17 (18.5) | 13 (14.1) |
| Wound dehiscence | 4 (4.3) | 3 (3.3) |
| Seromas | 2 (2.2) | 2 (2.2) |
| Hematomas | 1 (1.1) | 1 (1.1) |
| Synmastia | 2 (2.2) | 1 (1.1) |
| SSI | 1 (1.1) | 0 |
| Implant infection | 1 (1.1) | 1 (1.1) |
| Implant migration | 2 (2.2) | 2 (2.2) |
| Implant extrusion | 1 (1.1) | 1 (1.1) |
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