Breast Augmentation in Transgender Women: A Prospective Comparative Study

Breast augmentation is a key component of chest feminization in assigned male at birth patients (AMABp). Although both the inframammary and periareolar approaches are used, few studies have compared their outcomes in transgender women. This study aimed to evaluate both techniques regarding surgical outcomes, complications, and patient-reported satisfaction using the BREAST-Q questionnaire.

A prospective study was conducted on AMABp undergoing primary breast augmentation performed by two senior surgeons between November 2016 and December 2024. Inclusion criteria included age 18 years or older, body mass index below 30, and at least 12 months of hormone therapy. Patients with previous breast surgery or filler injections were excluded. The type of incision (periareolar or inframammary) was chosen by each patient after preoperative counseling. Postoperative outcomes and satisfaction were recorded. The BREAST-Q Version 2 Augmentation Module was administered online at least 12 months postoperatively. Data were analysed using Mann-Whitney U and Fisher's exact tests (p < 0.05).

Ninety-five AMABp were included (55 periareolar, 40 inframammary). Groups were comparable except for implant pocket location. The overall complication rate was 3.7%, with no significant intergroup differences. Secondary aesthetic revisions were more frequent in the inframammary group (28.6% vs. 7.5%; p= 0.026). BREAST-Q scores were high across all domains, without significant differences between groups.

Periareolar and inframammary breast augmentation resulted in similar complication rates and BREAST-Q outcomes. In a patient-selected setting, both approaches were associated with high levels of patient-reported satisfaction.