Long-term Follow-up and Trends in Breast Augmentation in 527 Transgender Women and Nonbinary Individuals: A 30-year experience in Amsterdam

Isha Sijben,Floyd W Timmermans,Oren Lapid,Mark-Bram Bouman,Wouter B Van Der Sluis

doi:10.1016/j.bjps.2021.03.107

Isha Sijben, Floyd W Timmermans + Show 3 more

Open Access

https://doi.org/10.1016/j.bjps.2021.03.107

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Abstract

Transgender women and transfeminine spectrum nonbinary individuals may opt for breast augmentation. The aim of the study is to analyze the complications, surgical trends, and long-term follow-up of breast augmentations in this population over the past 30 years. All transgender women and nonbinary individuals who underwent breast augmentation at our center between 01-1990 and 01-2020 were retrospectively identified. A retrospective chart study was conducted, recording individual demographics, implant characteristics, surgical timing, postoperative complications or other reasons requiring reoperation, and implant survival. A literature search was performed in MEDLINE on clinical outcomes and revision surgery of this procedure. A total of 527 individuals were identified. Median clinical follow-up time was 11.2 years (interquartile range 3.3-17.5). Median implant size increased significantly over the last years (1990-1990 median 275cc, 2000-2009 252cc, 2010-2019 375cc, p<0.01). Most individuals underwent breast augmentation and genital gender-affirming surgery in one-stage. Reoperations due to short-term complications were infrequent (hematoma (0.4%) or infection (0.4%)). Reoperations due to long-term complications comprised: implant rupture (5.7%), capsular contracture (4.9%), aesthetic problems (3.8%), low-grade infection (0.4%), or seroma (0.6%). In total, 2.5% of individuals requested larger implants. After performing the literature search and manuscript screening, 9 out of 115 identified studies were included for review. Follow-up time ranged from 30 days to 5.5 years. Reported complications requiring reoperation were capsular contraction (range 0.0-5.6%), asymmetry (3.6%), hematoma (range 0.0-2.9%), infection (range 0.0-0.9%) and implant rupture (0.7%), CONCLUSION: Implant-based breast augmentation is a safe procedure in transgender individuals.

Highlights

The reported prevalence of transgender and nonbinary people seeking medical and surgical care increased in the past decades.[1]
The aim of this study is to provide information and long-term follow-up of implant-based breast augmentation in transgender women and nonbinary individuals
All transgender women and nonbinary individuals who underwent breast augmentation with or without genital gender-affirming surgery from January 1990 to January 2020 were identified from the hospital registry

Summary

Introduction

The reported prevalence of transgender and nonbinary people seeking medical and surgical care increased in the past decades.[1]. Before any gender-affirming surgical procedure is performed, transgender women and nonbinary individuals have to meet criteria set by the World Professional Association for Transgender Health (WPATH). These include persistent and well-documented gender dysphoria, legal ability to provide informed consent, being of legal adult age, and other medical or mental problems, if present, should be well controlled. Feminizing hormone therapy often only results in moderate breast growth.[4] some individuals may opt for surgical breast augmentation to achieve a satisfactory result. Satisfaction with breasts, psychological well-being, and sexual well-being are known to improve after breast augmentation in this population.[5]

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