A closer look at breast augmentation surgery with Dr Aditya Narayan Choudhary

Last Updated on September 27, 2023 by Shabnam Sengupta

Breast augmentation surgery for gender affirmation is a medical procedure to help people align their physical appearance with their gender identity. It can play a pivotal role in helping a person become the most authentic version of the person they identify as. There can be a lot of doubts and insecurities about a surgical procedure which has the potential to impact a person’s life in such magnitude. Therefore, to explore breast augmentation surgery in the context of gender affirmation and to understand the nitty-gritty of the procedure, THIP Media spoke to Dr Aditya Narayan Choudhary.

Dr Aditya Narayan Choudhary is a skilled and dedicated plastic surgeon currently affiliated with the Heritage Institute of Medical Sciences in Varanasi. He specialises in a wide range of plastic, aesthetic, and reconstructive surgical procedures.

Can breast augmentation surgery aid in aligning an individual’s physical appearance with their gender identity?

Dr Aditya Narayan Choudhary: Breast augmentation surgery can be a component of gender-affirming procedures. There are various procedures that patients undergo to align with their gender identity. For example, trans-feminine individuals are those individuals who are assigned male sex at birth but identify themselves as females.

Breast augmentation can help create a more feminine chest contour, which can contribute to a greater sense of gender congruence. But here I must point out that it is very important to note that not all transgender individuals pursue the same procedures. Therefore, you should make decisions with regard to such surgeries in consultation with healthcare professionals who specialize in transgender healthcare, rather than going on whims and fancies or chasing the social norms as we see on social media and other platforms.

Excerpts from the interview:

What distinguishes breast implants used in gender affirmation surgeries from those used in cosmetic breast augmentation surgery?

Dr Aditya Narayan Choudhary: The breast implants used in breast augmentation surgery are more or less similar material-wise. However, there are certain differences in the procedure and in the surgeon’s approach to the procedure. For example, there are saline implants, there are silicone implants. In gender affirmation surgeries, the main goal is to create breasts that are proportionate to an individual’s gender identity and body frame. We aim for a natural and feminine appearance. Whereas in cosmetic surgery, the goal is to enhance the breast shape or size based on the patient’s preference without a specific focus on gender identity.

For transgender individuals, when they decide to undergo this surgery, we have to take them through a thorough psychological evaluation to ensure that the surgery aligns with their gender identity and anatomy wise also. While performing surgeries on these people, for example, there are differences in chest size. A narrower chest may require a different kind of implant or we may need to reposition the nipple aerial complex. Also, it is important to emphasise that each individual comes with their specific needs. So, we have to cater to those needs and in this case more than surgical, the needs are emotional and mental to a certain extent. So we have to be sensitive towards that.

What are different types of breast implants, and what are their advantages and disadvantages?

Dr Aditya Narayan Choudhary: The two main categories of breast implants used in breast augmentation surgeries are saline implants and silicone implants. So the saline implants, have the advantage that we can inflate them in varying amounts of saline. Its shape can be changed intraoperatively and also postoperatively. Also, since they are not already inflated, we can place them through smaller incisions. They have a much lower cost as compared to the silicone implant.

However, there are certain disadvantages that may come with them like they feel less natural than the silicone implants. In some patients, there is a risk of rupture because they are not as sturdy. There is also a potential for visible rippling. For example, in very thin individuals the edges of these implants can be visible which gives it a more of an artificial look.

On the other hand, silicone implants look and feel more natural. There is a low risk of this rippling and a low risk of rupture but they are very costly. We have to use larger incisions to place these implants. So the scar marks for surgery are possibly more visible for these. They also come in a fixed size. Therefore, you cannot alter the size. For example, if I order a 250 ml implant, and during the surgery, I feel that I can go for a higher volume implant like 280 ml or 300 ml, I cannot change that.

Silicone implants are also classified based on several factors. For example, the filling material can be simply gel-based or they can have a structured silicone inside. The shapes can vary. The most commonly used implants are round. They are the previous generation implants with which we have various studies. But nowadays teardrop-shaped implants have come which resemble the slope of a natural breast. Then the texture of these implants can be smooth.

So when there is a smooth texture, the scar on the outside of the implant has a tendency to grow very strong. When these implants are textured, it can reduce the risk of the capsular contract. Also, they can be classified on the base of profile, for example, if a patient wants greater projection. So we have profiles based on that, low profile, moderate profile, high profile. And then there are certain coatings which are done to more or less get similar results.

What is the recovery process for individuals undergoing breast augmentation surgery?

Dr Aditya Narayan Choudhary: Right after the procedure, since the operation takes place under general anaesthesia. The patient usually wakes up in the recovery area of a hospital room. There will be pain and discomfort that are manageable by pain medications. There are drainage tubes in place to remove excess fluids that form post-surgery. The doctors restrict the arm movement to minimise the strain on incisions in the first week. Following that, the swelling, bruising and discomfort will be the maximum. Patients will need to wear supportive bras or compression garments and they’ll have to avoid strenuous activities.

Following this, in the second week, all the abovementioned problems start to subside. Patients are able to return to light activities. They can start wearing the pressure garments and start following a gentle stretching and range of motion exercise routine, which is still not proper exercise. Then, from the 3rd week to the 6th week, the swelling usually subsides in most of the patients. Patients can resume light exercises, and the incisions begin to heal. Obviously, at this stage, the scarring is still visible. They have to continue to wear supportive garments.

From the 2nd to the 6th month, the final results begin to appear. When the edema has subsided, the scars usually start to fade by this time. It is very important that the patient follow up on their appointments religiously during this time. This is important so that very basic things like scars and all this can be managed to give a very better appearance. As far as the management part on our side is concerned, most patients can return to light activities in two weeks.

For scar care, we use certain gels and silicone sheets so that we can diminish it to the maximum possible extent. As per the patient’s physiology, long-term care definitely is needed. Patients need to go and consult their doctors. It helps in monitoring the implant’s integrity and overall breast health. Also, apart from them, the most important point of concern that we discussed earlier was emotional control. So, these people need to have a social support network. It could consist of us, their family, their friends, or probably best if all of us are involved in the process and have access to mental health resources if needed.

What are the potential risks associated with breast augmentation surgery in the context of gender affirmation?

Dr Aditya Narayan Choudhary: Definitely. Like any other surgical procedure, there are certain risks and complications. For example, there’s a risk of infection, so we usually put the patients on antibiotics to avoid that. There’s a risk of a capsular contractor. So, what happens is the scar around this implant contracts. As a result of this, the implant becomes hard or the shape may distort. Such cases usually need revision surgeries to correct this.

Then there can be a risk of implant rupture or leakage in case of trauma or rough handling. Certain individuals complain of a change in sensation in their breasts, which is totally normal. However, in some cases, there is hypersensitivity, which may extend for longer periods of time. In some other cases, we see implant migration. It moves or shifts, which leads to an uneven appearance and unnatural look. There is also scarring, which is partially a concern for the patient as far as breast implant illness is concerned. It is said that some people who undergo breast implant procedures have reported symptoms like fatigue, joint pain, and memory problems which they attribute to the implants. However, there is very limited scientific evidence to establish the direct link between the procedure and these symptoms.

Some patients do need to go for implant removal because they struggle with these complications. In some other patients, as their bodies age and change, they choose to go for implant replacement. Some even go for breast revision surgeries for asymmetry or migration. Therefore, it is very important to discuss all this with the patient beforehand so that they are not doing anything that is uncomfortable for them.

Are there any other options available apart from breast implants to achieve the desired changes?

Dr Aditya Narayan Choudhary: Depending upon the extent of change that we are hoping for, there are certain options. We can augment breasts with fat transfer. In this, we liposuction the fat out of abdominal and other fatty areas and use that same fat to change the breast size or to enhance volume. Apart from this, there are certain negative pressure or vacuum devices known as brava devices which are worn like brassiers. They help enlarge the breast size over a certain period of time.

Then there are various top surgery options. For example, after a breast implant surgery, there is marginal visibility or scarring. We can hide these margins using the fat from other areas. There can also be chest contouring for individuals who seek subtle changes through liposuction or tissue reduction. Also, there is hormone therapy, which may increase or change breast size by one or two cup sizes in certain individuals.

What are the dos and don’ts to ensure the long-term well-being and durability of breast implants after a breast augmentation surgery?

Dr Aditya Narayan Choudhary: Let’s start with the do’s. A person who has undergone breast augmentation surgery has to go for regular follow-up. You cannot avoid that. That is a must with any surgery. Self-examinations are very important in this case. The patient is usually the first person to come to know or to detect any changes in the breast beat, or any abnormality or any loss. So self-examination is very important.

Then we have certain screening modalities like mammograms, which are breast X-rays. We can schedule these mammograms according to the age to see if any other changes are occurring in the breast. Accordingly, they can prescribe patients to do regular massaging of the breasts which have undergone implant procedures. This reduces the risk of capsular contracture. So the scar that forms is relatively soft and easy to manage. Then these patients have to maintain a healthy lifestyle. If they undergo serious or wide changes in body weight or in any other aspects in regards to their lifestyle, their appearance will affected and they will not be very happy with the results.

For example, if they gain a lot of weight, the implant will not be as prominent. If they lose a lot of weight, then this implant will not have adequate support and will tend to Breast Ptosis. So these are certain areas that we have to take care of.

As far as don’ts are concerned, one must avoid trauma, rough handling, and any activities that could result in chest injury. We suggest that patients avoid smoking because it increases the risks of complications and affects the healing process a lot. We also suggest them to avoid using illegal drugs. They should not undergo any unapproved procedures without the knowledge of the primary surgeon. They also should not skip any follow-up.

The last and most important thing is to ignore any changes. So, if the patients see or see any changes in the breast, for example, pain or asymmetry or changes in shape or texture, they should promptly report these to the surgeon. They should not neglect.

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