Your Questions

Q: Dr. Eppley, I’m currently looking for a surgeon to do my transgender breast augmentation, I’ve done my research for a few years and now. Looking for a surgeon, a little about my profile: I’m a transgender girl with a small rib cage and an overall very small frame and build. I’ve been on hormones for about two years now and believe I’ve achieved all I can naturally. I definitely know that I want to do cohesive gel ( “gummy bear”) implants, if you offer them (I think I read that you do). And would love to hear back from you! 

I also would like to ask about removing ribs 11 12 and maybe 10, I know you’ve recently removed them from two women before and I’ve read your feedback on RealSelf.com about the procedure. I’d love to hear back from you on what you recommend! Much appreciated!

A: All silicone breast implants today are of the highly cohesive gel variety known as the urban term, gummy bear breast implants. All three existing breast implant manufacturers use the same silicone gel today. What implant size, shape and profile remain to be determined. (volume in ccs, round versus tear drop shaped and medium vs. high profiles) Such selections are based on what your breast augmentation goals are.

The role of lower rib removal is for narrowing of the anatomic waist. This is for patients who are unable to achieve a more hourglass shape or any inward indentation at the level of the waistline at the umbilical level. This is often a particular body contouring issue in male to female transgender patients whose ribcages are phenotypcally wider with greater outward rib flare.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am having facial feminization surgery by you in a few months.  Is it possible for me to have breast augmentation at the time of my facial feminization surgery? Or will it need to be on a different day? How long after FFS would you recommend I wait to have it done?

A: The first thing to appreciate is That is too much surgery at one time. I don’t think you realize (understandably so) what is going to happen to your face and the recovery that is needed for that collection of facial procedures. Eight to ten hours of surgery is an extreme stress on both your face and body already. Adding breast augmentation to a facial feminization surgery can be done but let me give you several thoughts as to why that is not the best idea and how to think about staging it.

While a young person like yourself can undergo an extreme amount of stress (extensive surgery), there are numerous other issues that can develop from extensive surgeries that go well beyond 8 hours. Such potential medical issues such as blood clots (deep vein thrombosis) and the risk of infection increase significantly. With extensive facial surgeries that involve the nasal and oral cavities there is a bacteria load that is released into the blood stream from them. Placing a large synthetic implant at the same time becomes a great point of attachment for such bacteria floaring in the bloodstream and thus a potential source of implant infection.

When staging facial feminization surgery and breast augmentation there are numerous ways to do it. But the most practical one is to consider the risk of revisional surgery from the initial facial feminization surgery. While each procedure in a facial feminization surgery has its own inherent risks (mainly aesthetic outcomes) when all the procedures are put together that risk becomes additive or cumulative. So let’s say for example that each facial procedure has a 10% risk of revisional surgery, a combined ten procedures would then ensure a revisional surgery for at least one of them. Thus it is better to wait a few months to see the complete outcome of the facial feminization surgery and then combine breast augmentation with any revisional facial procedure if needed. This would be the prudent approach to lower the number of potential surgeries needed/desired.

Dr. Barry Eppley

Indianapolis, Indiana