Jagasia Puja, Briggs Westby R, Nemani Sriya, Chaya Bachar, Kassis Salam, Assi Patrick
From the School of Medicine, Vanderbilt University, Nashville, TN.
Department of Plastic Surgery, Spartanburg Regional Healthcare System, Spartanburg, SC.
Ann Plast Surg. 2025 Mar 1;94(3):277-280. doi: 10.1097/SAP.0000000000004154. Epub 2024 Nov 12.
Feminizing top surgery, or mammaplasty augmentation, has multiple variables that surgeons can adjust to work synergistically with patient anatomy including plane of implant placement, pocket size, and inframammary fold (IMF) location. In the gender diverse population receiving this procedure to reduce symptoms of gender dysphoria, surgeons should be aware of differing anatomy and surgical approaches for feminizing top surgery.
A retrospective chart review was conducted using our institution's electronic health record between December 2019 and May 2023 with a minimum follow up period of 12 months. Inclusion criteria included transgender women, nonbinary patients, and all patients who did not identify as cis-gender women and who underwent feminizing top surgery. Demographic data including age, race, ethnicity, and gender were collected. Complication rates were recorded for hematoma, infection, seroma, wound dehiscence, hypertrophic scar, minor contour abnormalities, implant asymmetry, and revision surgery.
Our surgeons' subfascial approach, which uses 2 equations to calculate dissection pocket dimensions and determine placement of pocket and incision based on desired implant base diameter and projection, was performed on 140 gender-diverse patients and resulted in a hematoma rate of 4.29%, an infection rate of 2.86%, and a seroma rate of 1.42% with good cosmetic outcomes, as evidenced by our low rates of minor contour abnormalities (5.71%) and implant asymmetry (1.43%). Only 5 patients (3.57%) required revision surgery.
Bilateral breast augmentation with round implants in a subfascial plane using a concealed IMF incision following equations to determine the dissection pocket size and new IMF position and incision position is a reproducible technique that results in good aesthetic outcomes and minimizes complications.
女性化隆胸手术，即乳房增大成形术，有多个变量可供外科医生调整，以与患者解剖结构协同作用，包括植入物放置平面、腔隙大小和乳房下皱襞（IMF）位置。在接受该手术以减轻性别焦虑症状的性别多样化人群中，外科医生应了解女性化隆胸手术不同的解剖结构和手术方法。
使用本机构的电子健康记录进行回顾性病历审查，时间范围为2019年12月至2023年5月，最短随访期为12个月。纳入标准包括跨性别女性、非二元性别患者以及所有不认同为顺性别女性且接受女性化隆胸手术的患者。收集了包括年龄、种族、民族和性别的人口统计学数据。记录了血肿、感染、血清肿、伤口裂开、增生性瘢痕、轻微轮廓异常、植入物不对称和修复手术的并发症发生率。
我们的外科医生采用筋膜下入路，使用两个公式来计算剥离腔隙尺寸，并根据所需植入物基底直径和突出来确定腔隙和切口的位置，对140名性别多样化患者进行了手术，血肿发生率为4.29%，感染率为2.86%，血清肿发生率为1.42%，美容效果良好，轻微轮廓异常（5.71%）和植入物不对称（1.43%）发生率较低证明了这一点。只有5名患者（3.57%）需要进行修复手术。
采用隐蔽的IMF切口，在筋膜下平面植入圆形植入物进行双侧隆胸，通过公式确定剥离腔隙大小、新的IMF位置和切口位置，是一种可重复的技术，可产生良好的美学效果并将并发症降至最低。
