Breast Augmentation in Transwomen: Can We have a Formula?

Background Breast augmentation in transwomen is a surgical challenge as there is no available guideline for preoperative assessment of breast implant size, which caters to them specifically. The aim of our study is to derive a formula for preoperative breast implant size estimation, which would remove the personal bias, help in one-to-one discussion, and better understanding, reducing operative time, cost, and revision surgery rate. Methods This is a retrospective study conducted from October 2018 to December 2020. We maintained a routine protocol for measurements in our patients, which has been previously published. Linear multivariate regression equation was applied to derive a formula using minimum of parameters, namely, CC (chest circumference at the inframammary fold [IMF]), POMP (circumference at the point of maximum projection of breast mound), and LOWERDIFF (lower value of difference in each breast between the stretched nipple [IMF] and the nonstretched nipple [IMF distance]). Results A total of 51 transwomen underwent surgery in this period. The mean volume of implant used was 354.51 mL. Complications consisted of pain and discomfort in six patients, delayed healing in two patients, and wound dehiscence in one. A formula for preoperative calculation of breast implant was obtained with these data. A mathematical correlation was found between complications encountered and the percentage by which the inserted implants exceeded the calculated size. Conclusion We could estimate the breast implant size preoperatively through a simple formula that require only four anthropometric measurements. This equation is a significant advantage for the surgeon and a useful tool for patient education. Its usefulness will be established if applied in prospective studies. From our study, it appears 9% above the calculated size is better avoided.

Hundred and Eleven Cases of Subfascial Breast Augmentation in Trans Women-A Single-Center Experience.

Hundred and eleven patients of breast augmentation in trans women operated between January 2004 and September 2019 are presented. Two surgeons conducted the study with a slightly different antibiotic regime. Only round implants were used. Till December 2017, 72 implants used were textured. Thereafter, we switched over smooth silicone gel implants more for reasons of availability than others. It was used in 39 patients. We did not notice any difference in results. Our postoperative regimes consisted of antibiotics (usually amoxicillin + clavulanic acid) for 10 days, restricted shoulder movements for 3 weeks, use of an inner brassiere and outer sports vest for 2 months. Routes of implantation were either periareolar or inframammary, former being selected as per choice of the patient, provided the hemicircumference of the areola was 4.5 cm or more. We never used transaxillary route. The implants were always placed in a subfascial pocket. Routine irrigation of the pocket with 5% povidone iodine was done before insertion of implant. From 3 weeks postoperatively, routine massage of breasts for a period of 6 to 8 weeks were advised. Complications included delayed minor wound healing problems usually in periareolar technique requiring secondary suture under local anesthesia. This was negligible with inframammary technique. Capsular contracture was found in 12 patients. Two of these merited intervention but one of them refused operation. In one patient, implant had to be extracted due to severe suppurative infection resulting from a separate incidence of traumatic injury with hematoma formation 2 weeks post operatively. Poor scarring including one keloid were noticed in 11 patients.

A simple method of injecting tumescent fluid for liposuction.

Injection of tumescent fluid is essential to obtain a painless and relatively bloodless liposuction. There are many methods of injecting the tumescent fluid like power pumps, syringes and pressure cuffs. Our method consists of applying air pressure within the plastic transfusion fluid bottle by pricking with a wide bore needle and connecting it to a sphygmomanometer balloon pump. By inflation of the balloon pump and thus increasing pressure inside the plastic bottle, the rate and volume of infusion can be controlled. By applying the cuff outside the bottle the visibility inside is impaired and the bottle gets collapsed preventing a continued pressure and thereby impairing both the quantity as well as the rate of infusion. Power pumps are expensive. This method is inexpensive, infused volume of fluid being visible and the rate of infusion controllable.

Ventral hernia--darning with prolene: a cost-effective management.

Fifty-three cases of ventral hernia admitted between 15th July, 1993 and 31st December, 2001 in the IPGME&R, Kolkata is being presented with analysis of causes, method of repair and complications. The study was intended to find a simple, universal cost-effective repair of the deformity. Most cases can be repaired with a method of closure consisting of plication of the inner layer and 2 to 3 layered darning in the outer layer with '0' prolene. The main factor appears to be a tensionless closure and avoidance of postoperative infection and stress like cough and constipation. While in the west, use of prolene mesh has become a routine, the authors feel that darning is not only less expensive but reduces the amount of foreign body introduced.