Breast Augmentation By Implant for Beginners

  • Creator
  • #92882
    Michelle Larsen


    I converted this topic by Michelle Larson to a Sticky as it often comes up and has broad application for the transgender community. It’s a great starting point for folks beginning to consider this option.


    DeeAnn Hopings

    Okay; maybe that isn’t the best title, but I’ve been mulling this over for awhile, and it is what I came up with. I’m hoping that this will be a forum where we can all post information we have found helpful in getting breast augmentation or questions we have wrestled with in getting it done. For me, this is just about the actual process of getting from ‘I’m needing to have breast augmentation’ to ‘wow, I can now check that off my list’. So I guess I will start posting snippets and chunks of what I have so far. As it is a work in progress (at least until I have my surgery), I will be posting updates as I get new, more, or better information. I do hope any of you reading this, find it helpful. And if you have a question, or comment, and you don’t want to post it here in the Forum, please feel free to message me. Hugs, Michelle

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  • Author
    • #94072
      Emily Alt

      Hi Michelle,

      Thanks for taking the time to research and post this valuable info.

      Sorry if I missed it, but I didn’t see anything about having existing breast tissue before getting implants.  Of course this isn’t a requirement.  However, implants do look more natural when there’s already some tissue to work with.  I think it’s important for new girls to understand that.


      1 user thanked author for this post.
      • #94082
        Michelle Larsen

        Thanks Emily. So far, all I have posted are section I and II… I have lot’s more to go…. Thanks, Michelle

        1 user thanked author for this post.
    • #93768

      Wow  Good Job Lots if info here  Thank you

    • #93235
      Michelle Larsen


      This does not pertain to the surgical procedure, or after care, but rather for the safety of the actual product. There are three implant safety issues that seem to be predominant from my research; Capsular Contracture, BIA-ALCL (cancer), and physical failure.

      From Wikipedia – Capsular Contracture is a response of the immune system to foreign materials in the human body. Medically, it occurs mostly in context of the complications from breast implants and artificial joint prosthetics.

      The occurrence of Capsular Contraction follows the formation of capsules of tightly-woven collagen fibers, created by the immune response to the presence of foreign objects surgically installed to the human body, e.g. breast implants, artificial pacemakers, orthopedic prostheses; biological protection by isolation and toleration. Capsular Contracture occurs when the collagen-fiber capsule shrinks, tightens and compresses the breast implant, much like the collapse of a bubble gum bubble.<sup>[1]</sup> It is a medical complication that can be painful and discomforting, and might distort the aesthetics of the breast implant and the breast. Although the cause of Capsular Contracture is unknown, factors common to its incidence include bacterial contamination, rupture of the breast-implant shell, leakage of the silicone-gel filling, and hematoma.

      The placement of the implant under the muscle, as opposed to above the muscle, or the use of textured implants seems to lessen the likelihood of Capsular Contracture.

      2 users thanked author for this post.
      • #93236
        Michelle Larsen

        Safety (pt 2):

        The second safety issue of note is Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL). While numerous articles have been written on this subject, an article from CHH Health, dated February 7, 2019, was one I found helpful. In the article it mentions that “at least 457 women in the US” have been diagnosed with this condition. And the consensus seems to lean to the condition being more predominant with textured implants. According to the NIH; “Although rare, all cases with adequate history have involved a textured breast implant.” Indications I have seen are that ‘between 1 and 3 million women in the US have breast implants’, but without a valid number of women with textured implants as a basis to calculate risk, I have not been able to determine a risk level.

        The risk of breast implant related cancer has been something I have been aware of for many, many years, so it is nothing new.

        2 users thanked author for this post.
        • #93470
          Michelle Larsen

          Safety (pt 3):

          The third issue centers on the physical failure of the implant. This seems to be primarily from a physical defect in the implant, although there could be outside reasons for an implant to rupture. With saline implants, any rupture would result in the sterile saline solution quickly being released into the body, and absorbed, and ultimately discharged. There would also be a quite obvious deflation of the breast containing the ruptured implant. Silicone would more slowly leak into the body, but seems to be more contained in the cavity where the implant is positioned; although there has been cases, and concern, of silicone particles migrating to other parts of the body and causing health problems. The best, in the event of a rupture seems to be ‘gummies’. From several articles, and demonstration videos, these seem provide for the silicone to not leave the implant upon rupture. In fact, it appears that the silicone will retract back into the implant in the event any is expelled at the site of the rupture.

          There are undoubtedly other safety issues related to breast implants, but these three seem to be the most predominant. So the bottom line is that, safety issues surrounding breast implants is something to be seriously discussed with your doctor and surgeon.

          2 users thanked author for this post.
    • #92933
      Michelle Larsen


      This should have come before I posted about Construction Type; but oh well, here it is. This Outline is just a list of topics I put in my research document. If anyone else has any suggestions, I would love to include them. I have probably overlooked a few…..

      I. Construction Type

      II. Safety

      III. Maintenance

      IV. Longevity

      V. Look and Feel

      VI. Size

      VII. Surgical Concerns

      VIIa. Pain

      VIIb. Bruising

      VIIc. Blood Flow

      VIId. Drop & Fluff

      VIIe. PostOp Massage

      VIIf. PostOp Clothing

      VIIg. Cleaning

      VIIh. Incision

      VIIi. Anethesia

      VIII. Side Effects

      VIIIa. Temperature

      VIIIb. Allergic Reactions


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      • #93809

        im concerned about the type and size i want silicone and the largest implant that i can safely get

        1 user thanked author for this post.
        • #94083
          Michelle Larsen

          KristiAnn, I know you will, but get what you and your doctor and surgeon feel are best. You will have them for a long time, so everything needs to be considered and done correctly. Michelle


          1 user thanked author for this post.
    • #92884
      Michelle Larsen


      First off, I am NOT a doctor, nor am I any sort of medical professional. This is just from the research I have done, and nothing more. You may find information that is different, and I encourage you to share it.

      Resources: Now, I have not vetted most of these. In fact the only one I have had personal experience with is the last one, West End Plastic Surgery, because they did my orchiectomy. They were great. I have also talked with Amelia Aesthetics (Jen Eden) via their online video resources and online blog.
      Amelia Academy –

      Amelia Aesthetics –

      American Society of Plastic Surgeons –

      The Cosmetic Concierge –

      Wendy Gottlieb, MD –

      GrS Montréal –

      The Philadelphia Center For Transgender Surgery –

      Kotis Plastic Surgery –

      RxBra –

      West End Plastic Surgery –

    • #92883
      Michelle Larsen

      <u>Construction Type:</u>

      The three types are Saline, Silicone, and ‘Gummy Bear’. From what I have seen, the ‘Gummies’ seem to be the preferred type. Now, that is based on what research I have done, so you may be finding something different. As most of you know, saline has been around the longest, followed by silicone, and finally the ‘gummies’. And of the three types, I have seen smooth surfaced implants and textured surface implants. One thing I found interesting about the ‘gummies’ is that if there is a puncture of a cut/tear, the ‘gummy’ part might come out, but will get pulled back in so it stays in place…..

      • #92937
        Michelle Larsen

        This is from another comment posted by Dr. Michelle Roughton at Amelia Aesthetics: This is a tough decision.  I have placed Sientra textured implants and I think there’s good reasoning behind doing so.  Essentially the risk of a second surgery is higher than the known risk of the ALCL (lymphoma occurring in capsules around textured devices).  Here’s the rub though and how I’m leaning at present…more and more cases of ALCL are arising.  We didn’t know to look for it until the last few years.  So more cases are being diagnosed which means the risk is ‘increasing’.  I think you’ll have to make the decision that helps you feel the most comfortable.  Risk a second surgery or risk a rare lymphoma.  I’m favoring smooth only implants these days myself.

        As for me personally, I will have all of this information with me when I talk to my surgeon. She/he, will be the one that sees me specifically, and will be better situated to discuss the best path for me.

      • #92934
        Michelle Larsen

        This is from a comment posted by Dr. Michelle Roughton at Amelia Aesthetics: So under the muscle I don’t see a lot of benefit from textured implants.  Over the muscle is a different story.  Textured implants, as I am sure you know, are associated with a rare form of lymphoma (which is a cancer).  It’s super rare and even more rare to die from it, but you can.  Most of my patients freak out (and I would too, no shade!) about that and I’ve just switched to smooth all the time except for very specific cases.  The rate of capsular contracture with a smooth implant OVER the muscle is 6 x higher than when placed UNDER.  So I talk to most of my over patients about considering texture devices.  Time changes every woman’s body, breasts, etc with or without surgery so I don’t think anyone can claim that textured devices STOP drooping.  I’d just be really informed and know what to look for for the ALCL (lymphoma), which is late onset (think over 1 year later) seroma or fluid collection.  I hope this was helpful and not too scary.

        More on the cancer and capsular contracture in the Safety (II) section, so stay tuned…..

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