IJ TRANSGENDER - London Congress - Abstract - Exceptional Presenting Conditions for, and Outcome of, Augmentation Mammaplasty in Male-to-Female Transsexuals

Editors:
Friedemann Pfäfflin,
Ulm University, Germany

Walter O. Bockting,
University of Minnesota, USA

Eli Coleman,
University of Minnesota, USA

Richard Ekins,
University of Ulster at Coleraine, UK

Dave King,
University of Liverpool, UK

Managing Editor:
Noelle N Gray,
University of Minnesota, USA

Editorial Assistant:
Erin Pellett,
University of Minnesota, USA

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ISSN 1434-4599

XVI Harry Benjamin International Gender Dysphoria Association Symposium
17 - 21 August 1999, London

Reflections on "Transsexualism and Sex Reassignment" 1969 -1999

Exceptional Presenting Conditions for, and Outcome of, Augmentation Mammaplasty in Male-to-Female Transsexuals

Hage JJ, Kanhai RCJ, Karim RB, and Mulder, JW

Department of Plastic and Reconstructive Surgery, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands.

We report on some rare presenting conditions for, and exceptional results of augmentation mammaplasty in 11 male-to-female transsexuals treated between January 1979 and January 1998, as well as on how to treat these conditions.

In cases where gynecomastia was treated previously the remaining subcutaneous fatty tissue may be insufficient to safely cover the implants and subpectoral implantation should be considered. Augmentation following unilateral correction of gynecomastia will require different sizes of implants. Although exceptional in male-to-female transsexuals, mastopexy is the treatment of choice to correct any mammary ptosis, but the patient may request augmentation mammaplasty to fill out the breasts. Previous stacking mammaplasty may have been performed subglandularly, subpectorally, or both. Stacking may not have been noticed prior to corrective surgery. Extrusion of the implant may be associated with a vascular necrosis or infection, but also with the use of high concentrations of steroid placed within the lumen of fluid-filled implant. The correction involves removal of the implant with skin graft or flap reconstruction of the affected area. Replacement of the implant may have to be delayed. Symmastia results from overzealous medial dissection coupled with overaugmentation. Combined restoration of the presternal subcutaneous integrity and medial closure of the pocket by subcutaneous approach only, leads to satisfactory reconstruction of the presternal median cleavage. Galactorrhoe may be the result of hyperprolactaemia but is more often caused by stimulation of intercostal nerve by the implants.