Offers and News

Transition Related Surgery – Trans Breast Augmentation

In January, Dr Brown had the pleasure of attending the 35th Annual Atlanta Breast Surgery Symposium, held in Buckhead, Georgia. This is North America’s largest annual meeting focusing on both aesthetic and reconstructive breast surgery.

Dr Brown was one of the invited international faculty and gave several presentations that included topics on breast implant selection, the use of fat in aesthetic breast surgery and, developing a successful transgender breast program.

One of the most unique aspects of this meeting is the live surgery component, in which surgeons are invited to perform surgery that is broadcast in to the auditorium to the symposium participants. This year, Dr Brown was asked to perform a trans gender breast augmentation on a trans female patient who came to Atlanta with Dr Brown from the TRS (transition related surgery) Program in Toronto. The surgery was very successful, but most impactful, our wonderful patient was able to share the important moments in her transition story with the surgeons in attendance and explain some of the unique challenges that exist during the journey.

If you are a trans female thinking about breast augmentation, here are some things to consider:

  1. The rib cage and breasts of a trans woman are usually wider than that of a cis woman of similar height and weight. To create an ideal breast shape and to have that breast fit on the chest wall means that the surgeon must take multiple, precise measurements, and select from a wide range of implants. While this “dimensional planning” is important in all breast augmentations, it is particularly important in the trans female patient.
  2. A trans woman’s nipples are usually situated more to the outside of the breast mound. This affects where the implant should be placed so that the nipple ends up relatively centered  on the breast mound. 
  3. A trans woman’s nipples are also usually situated low on the breast mound. The ideal breast has about 55% of the breast volume below the plane of the nipple and 45% above. While sometimes the implant needs to be placed below the natural crease of the breast in a cisgender woman to achieve that balance, it is necessary far more often in the transgender patient.  That position is critical to the result and must be planned exactly. Failure to properly determine where to situate the bottom of the breast and to keep the implant in that position are the two factors that account for most of the suboptimal results in transgender breast augmentation.
  4. Trans patients usually have thicker and tighter skin. Years of fluctuating breast size from monthly periods, weight changes, gravity, genetically thinner skin, and of course the substantial stretch with pregnancy can all thin skin further.  This tighter skin often results in breasts that are somewhat fuller and perkier, especially in the upper portion of the breast.
  5. The pectoralis major muscle is often (but not always) thicker in a trans woman. Rarely is it thick enough to create a problem; it just requires a greater level of attention to anesthetic and technical considerations during surgery. There may be a greater tendency for the muscle to push the implants slightly down and out over time, though this also can be an issue for cisgender patients.

For more information about transition related surgery please visit Transition-Related Procedures.

Update on Breast Implant Safety and ALCL

Dr. Mitchell Brown and Dr. Ron Somogyi, Toronto Plastic Surgery

Recently, there has been a surge in media attention regarding implantable medical devices. Coverage has focussed on regulatory agencies, the process for device approval, device safety as well as the importance of collecting accurate post-approval data on adverse events and outcomes. Many devices were discussed including pacemakers, hip and knee implants, cardiac stents, pelvic meshes as well as breast implants. One area of discussion has centered around breast implants and a possible link to a type of lymphoma called ALCL.

A great deal of research has been published regarding breast implants and cancer. We can say quite conclusively that breast implants do not cause breast cancer. For the past several years there have been published cases of women diagnosed with a rare type of lymphoma in the fluid or tissue surrounding a breast implant. This entity has been named BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma). ALCL itself is a cancer of the immune system and more commonly occurs in people who have never undergone breast implant surgery. Estimated rates of ALCL is approximately 1 in 10,000 people in the general population.

At present, there are approximately 600 cases of  BIA-ALCL reported worldwide and it is estimated that more than 10 million women have undergone breast implant surgery. To date, all cases of BIA-ALCL have been in association with breast implants that have a textured surface. The current lifetime risk with a textured implant is estimated to be 1:3800 – 1:30000. There is no risk of developing BIA-ALCL with smooth surfaced implants. It is important to know that all implants used at Toronto Plastic Surgery are fully approved by Health Canada as well as the FDA in the United States.

In the majority of reported cases, the initial presenting symptom is a distinct swelling of the affected breast. You would notice this as a substantial size change on the affected side. The breast might feel tense and firm. Usually the swelling comes on fairly rapidly, over several days or weeks, not over months or years. Typically, this occurs on one side only, but in exceptional cases, it can occur in both breasts.

If a person with breast implants notices any of these changes or symptoms, the appropriate action is to contact their surgeon for a follow-up visit. There are some very simple investigations that can be done to determine whether or not a person has BIA- ALCL. When detected early, it is very treatable.

It is important for you to know that both Dr. Somogyi and I have collectively been involved with the use of breast implants for over thirty years. We have followed our patients carefully and have published our experience on the safe use of breast implants and breast implant outcomes. We both attend medical conferences regularly and often participate as educators at these events. We want you to know that we stay up to date on the latest literature surrounding breast implants and breast implant safety.

In addition, it has always been our practice to encourage patients with any breast implant to return for regular follow up at least every 2-3 years. This is important so that we may inform you about new information or changes regarding breast implant technology and safety. Occasional assessment is recommended.

As new information becomes available regarding BIA-ALCL and breast implant safety, we will do our best to keep you informed. If you have any questions regarding breast implant surgery at Toronto Plastic Surgery, please feel free to contact us directly.

Dr. Brown at Breast and Body Contouring meeting in St. Petersburg, Russia

Dr. Brown attended the Advanced Aesthetics in Breast and Body Contouring meeting in St. Petersburg, Russia, from Oct 11 to 14, 2018. He was part of the international invited faculty and had an active role in the meeting with the following on his agenda:

  • Moderated the live surgery sessions on breast lift and augmentation
  • Presented a video of surgery to correct breast sagging
  • Gave a presentation on correcting the tuberous breast using fat
  • Gave two presentations on how to prevent and manage complications in breast augmentation

During down time, Dr. Brown met with colleagues in plastic surgery and aesthetic medicine from around the world.

Highlights included a visit to the world famous Hermitage Museum as well as the Peter and Paul Cathedral.

All about BRA Day in Toronto with Dr. Brown & Dr. Somogyi.

Toronto Plastic Surgery, Breast Reconstruction TorontoBRA (Breast Reconstruction Awareness) Day is an initiative founded by Toronto Plastic Surgery’s own Dr. Mitchell Brown, that promotes education, awareness and access for women considering post-mastectomy breast reconstruction.

BRA Day events are held in communities across Canada in October. This year’s Toronto event takes place on October 17th, 2018. Dr. Brown, Dr. Somogyi, and the Canadian Cancer Society are also hosting a free BRA Day event at Toronto Plastic Surgery on October 24th, 2018.

During these events, leading plastic surgeons have the opportunity to provide breast reconstruction education and answer patient questions. Attendees are given the opportunity to hear patient stories and connect with women who have been through it, and in the Show & Tell Lounge, volunteers share the real-life results of their breast reconstruction.

Leading up to this year’s BRA Day event, Dr. Brown and Dr. Somogyi have taken the time to answer some common questions about this event and why it is so meaningful to them.

1. First, what is BRA day?

Breast Reconstruction Awareness Day is an initiative that promotes education, awareness and access for women considering post-mastectomy breast reconstruction. Today, hundreds of educational events are held across the world on and around BRA Day, which typically occurs on the third Wednesday of October. These events bring physicians, surgeons, nurses, support staff and, especially, patients together to improve education and awareness around options for breast reconstruction.

2. Why is this event so important to you both?

We are so lucky to have many great reconstructive options for breast cancer patients. Unfortunately, there are still far too many women that are never presented with these options. Education and awareness are the first steps to ensure that women with breast cancer can make the best choice about whether or not to undergo reconstruction and what type of reconstruction is best for them.

3. Dr. Brown, tell us a bit about why you founded the event.

Breast Reconstruction Awareness Day was founded in 2011 to address a clear need for better access, education and awareness for options related to breast reconstruction. Over the many years of my career, I had been meeting with women who had previously undergone mastectomy and went years without knowing that breast reconstruction was even an option. To me, this was unthinkable, especially in an advanced country like Canada. The message certainly has grown and since 2011 BRA Day is now celebrated in over 30 countries worldwide.

4. Who can benefit from this event?

Breast cancer patients, their families and support networks, physicians, surgeons and other healthcare workers that look after breast cancer patients can all benefit from BRA Day events. This event will provide an overview of current options for reconstruction both in the immediate (same time as mastectomy surgery) and delayed (months or years later) settings. It will provide an opportunity to ask questions of the surgeons involved as well as from recent patients that have undergone reconstruction or even those that have chosen not to.

5. What effect have you seen the event have on attendees over the years?

Feedback from the BRA Day events has been excellent. Women frequently report having had an opportunity to be educated in an environment that is comfortable and safe. The ability for women to network with their health care professionals as well as other women who have undergone the reconstruction process is unique and incredibly beneficial. Attendance has continually increased over the years and this has stimulated educational events that are now held throughout the year.

6. What can people expect at this year’s event?

This year, in an intimate, informal setting, we will review current options for breast reconstruction, provide a list of questions for patients to consider while deciding on options for breast reconstruction and spend as much time as possible answering questions from patients and families. We have a number of excellent patients attending who will be able to share their story and answer questions first hand.

7. If someone cannot attend this year’s BRA Day event, but is interested in learning more about breast reconstruction options, what do you suggest?

Fortunately, through the efforts of BRA Day around the world, more and more resources have become available. First, there is likely another event near you that you may be able to attend. Most events are listed here. You can find excellent comprehensive information on the Toronto Plastic Surgery website, or from organizations such as the Canadian Cancer Society, and the Canadian Collaboration on Breast Reconstruction. Finally, don’t be afraid to ask your healthcare provider to organize a consultation with a plastic surgeon that performs reconstructive breast surgery.

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