Understanding the procedure

Breast construction A gender-affirming upper surgery (also called breast augmentation) that creates, enlarges or shapes one’s breasts by placing implants underneath natural breast tissue or muscle. (also called breast augmentation) is a gender-affirming surgery that creates, enlarges or shapes one’s breasts by placing implants underneath natural breast tissue or muscle. The goal is to have breasts and nipples with sensation, a larger cup size and minimal scarring.

Depending on what you discuss with your surgeon, incisions will be made under the breasts, in the armpit and/or around the areola. Implants can be placed just under the breast tissue or under the muscles of the chest.

Sometimes breast construction is a two-part process. In the first surgery, breast tissue expanders are inserted to stretch the skin, so that it will be able to accommodate the implant. Saline is injected into the tissue expander. This process will gradually fill the breast tissue expander until the desired volume is achieved. This can take a few months. Once the skin has stretched enough to fit the implants, another procedure is done to remove the breast tissue expander and insert the breast implants. 

Breast construction is usually an “outpatient surgery,” meaning the patient gets discharged from the hospital later the same day.

The lifespan of breast implants

Breast implants need to be replaced every 10–15 years. Continue to check in with your primary care provider A person’s main health care provider in non-emergency situations such as check-ups and referrals. Family doctors, general practitioners (GPs) and nurse practitioners (NPs) are all primary care providers. to ensure your implants remain safe.

Surgical options

With breast construction A gender-affirming upper surgery (also called breast augmentation) that creates, enlarges or shapes one’s breasts by placing implants underneath natural breast tissue or muscle. surgery, there are a number of options available to you, including the type, size and placement of the implant. Your goals and anatomy will influence what your surgeon recommends. It’s important to note that you may not be eligible for all options. 

Procedure type

There are two types of procedures for breast construction: implants and fat grafting. Implants (which are either saline or silicone) are the most common procedure used for gender-affirming procedures.

Implant size

Implant size is measured in ccs, millilitres or grams, not cup sizes. This is because cup size measurement is a concept based on the size of your body and ratio of your breast volume to your body shape. 

Usually, you and your surgeon will choose a size range (including the height and width of your implants) beforehand. During your surgery, the surgeon will use their judgment and experience to narrow down to the ideal size of implant for your goals and anatomy. 

Implant placement

Placement of the implant can depend on a number of factors but are typically either under the pectoral muscle or under the glands.

Incision location

Surgeons will typically make the incision in one of three locations. These locations are intended to reduce the visibility of scaring, but some scarring may still be visible. 

Potential risks and complications

Like any surgical procedure, breast construction A gender-affirming upper surgery (also called breast augmentation) that creates, enlarges or shapes one’s breasts by placing implants underneath natural breast tissue or muscle. surgery involves risks. It’s important that you understand these risks so that you can make an informed choice about surgery.

A discussion of possible risks and complications is not intended to scare or deter you from having surgery but rather to ensure you have all the information you need to make a decision about surgery. Ask your surgeon which complications are more or less common and how they would be managed if they occur.

Potential risks

The primary risks from breast construction include:

• Anesthesia issues — Some people experience a negative reaction to anesthesia
• Cardiovascular issues — Such as blood loss, blood clots and artery blockages
• Results that don’t meet expectations — When the shape or size of your breasts don’t align with your hopes

In extreme cases, some of these issues can result in serious injury or death. However, your surgical team will take a number of steps to prevent and minimize these risks. The team will monitor you closely and will be ready to respond quickly. They will also talk to you about what you can do to minimize your risks before surgery.

Important

Make sure to discuss these risks in detail when you consult with your surgeon before surgery. 

Potential complications

Complications that can occur as a result of a breast construction surgery include:

• Scarring — All incisions cause a scar. Although incisions are usually located in a way that reduces the visibility of scarring, they may still be visible to varying degrees. Scars can become thickened, hypersensitive, and may even affect the shape of your breasts. Severe scarring may require surgical revision A follow-up procedure or adjustment to a previous surgical operation or treatment to correct or improve its outcome. . You can mitigate the risk of this complication by following your surgeon’s advice for recovery. 
• Capsular contracture A complication in breast construction that involves the shrinking and tightening of the scar tissue around an implant. This may cause the breast to feel firm, look misshapen or rupture. — Scar tissue that develops around the implant may become tight or painful. This may change the shape of the breast. Sometimes the capsular scar tissue may need to be removed and the implant may either need to be removed or replaced. Your surgeon will give you postoperative instructions to follow that will help reduce the chances of this happening.
• Complications with the implant — The implant may break (rupture), leak or deflate. If this happens, it will need to be replaced.
• Migration or dislocation — The implant may migrate (move) or change position (rotate) in the breast.
• Skin necrosis — Poor blood supply may result in death of the skin surrounding the implant. 
• Implant extrusion — The skin around an implant may break down, resulting in the implant being visible through the skin. If this happens, the implant will need to be removed temporarily, then replaced a few weeks or months later.
• Calcification — Calcium deposits can form in the scar tissue that surrounds the implant. These may feel firm and even painful. If you develop any bumps or lesions, contact your surgeon or primary care provider A person’s main health care provider in non-emergency situations such as check-ups and referrals. Family doctors, general practitioners (GPs) and nurse practitioners (NPs) are all primary care providers. . Any bumps and lesions need to be examined to determine whether they may be a normal bit of calcium buildup, or a sign of breast cancer.
• Changes in sensation — You may experience changes in sensation in the skin of the breast and in your nipples. This may be an increase in sensation, a reduction in sensation or areas of complete numbness. These changes may be temporary or permanent.
• Tenderness and inflammation — Sometimes veins under the breast become inflamed and clotted (also called superficial thrombophlebitis). This can result in a tender lesion An area of abnormal or damaged tissue caused by injury, infection or disease. These areas may need to be removed or treated during surgery. that looks and feels like a vertical cord beneath the skin. This is often a temporary complication.
• Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) — This is a rare form of non-Hodgkin lymphoma which may occur next to the implant. To learn more about this, see Trans Care BC’s handout about Textured Breast Implants and BIA-ALCL.          
   

Important

This list of potential complications isn’t comprehensive so be sure to have a detailed discussion about complications when you consult with your surgeon before surgery.