For the most part, putting breast implants in transgender patients is not significantly different that performing breast augmentation is women. The incisions are the same, the implants are generally best placed under the muscle and the same type and style of implants are generally used.
Larger Patients, Larger Muscles
The majority of patients seeking transgender augmentation mammoplasty are larger than most women undergoing breast implant surgery. For this reason, the muscles are also bigger making the procedure a little longer and somewhat more difficult for the surgeon. As a result, the cost for transgender augmentation is usually a little more.
Larger Blood Vessels
With larger muscles go larger blood vessels. Surgeons use an electronic cautery instrument during surgery to coagulate blood vessels and this typically has to be used to a greater extent in transgender implant surgery in an effort to effectively obtain a dry surgical field (hemostasis) and reduce the risk of bleeding after the procedure. For this reason, it is that much more important for transgender patients to take very seriously the list of medications to avoid that can thin their blood for two weeks before surgery such as aspirin and over-the-counter anti-inflammatories.
Larger Breast Implants
With larger patients also go larger implants, in general. Patients with larger chest circumferences require larger breast implants to achieve the same increase in cup size that more petite patients get with smaller prostheses. Most transgender patients have fairly large chests; therefore, significantly larger implants are generally needed. This means creation of a larger implant pocket, again making the surgery a little more involved and a little longer.
There is a limitation, of course, on the size of the breast implant that can be put in. Trying to go too large on the first go around can put enough stress on the closure of the incision to cause it to break open, which can result in loss of the implant. Therefore, it seems to be more common for transgender patients to undergo a second breast augmentation surgery in order to get them to their ultimate desired size.
One of the risks of breast augmentation surgery is rippling of the skin caused by wrinkling along the outer edge of the implant. This is not generally an issue for the one half to two thirds of the implant that is covered by the pectoralis major muscle but can be an issue in the lower, outer quadrant of the breast where there is no muscle is covering the implant. This is especially an issue in thinner patients who have very little breast tissue, which may be the case in many transgender patients who either have chosen not to take hormonal therapy or did not get much of a response in the form of natural breast tissue development. For this reason, transgender patients tend to lean more towards silicone breast implants as they have a lower risk of rippling than saline implants do.