Story 1

From the first meeting with Dr. Andrew Ives I found that he makes you feel very comfortable and is easy to talk to. Andrew is about making his patients happy in doing what he can in his field to accommodate what his Patients would like the outcome to be. My consultation with Andrew was about M/F Genital Gender Affirmation Surgery. Andrew has lots of knowledge on this surgery, with this we discussed which path is the best suited for the outcome I am looking for. I chose to have my surgery to be done without the vaginal canal being created for the reason being I have no intention the have intimate sexual activity with a male and as I am a long distance truck driver It would be very difficult to maintain the ongoing upkeep. After the surgery I was on pain medication for 3 days in which I experienced nil pain, then onto panadol in which I did feel slight discomfort and tenderness but way less then I expected. Day 9 I was feeling so good within myself I walked 3kms to do grocery shopping only suffering mild discomfort the next day from this little exercise. Day 10 I went back to see Andrew for my check up and he told me I was free to travel home anytime I felt up to it as I had to fly back to Brisbane. I did choose to stay another few day before returning home. Six weeks after my surgery I was back at work full time working up to 16 hour days and sitting for up to 3-4 hours at a time. Now at 4 months I have had no issues at all, I have continued through life like I was born this way, just one very happy lady. Through the whole process I found Andrews bedside manner fantastic always greeting you with a happy smile with his first priority being his patients well being. I totally recommend Dr. Andrew Ives for this surgery as I found his creative work nothing short of excellence.

Story 2

Breast Augmentation (BA) — My Personal Lessons Learned from a Transwoman’s Perspective

In May 2013 I had BA– surgery as part of my Male to Female transition. These are my ‘lessons learned’
which I have listed in order of importance:

1. What might work for women does not always work for transwomen

   As a transwoman seeking BA, I had very different physiologies to deal with than non–trans women. These key ‘differentiators’ were: broader shoulders with comparatively thinner hips;

   • less natural breast tissue growth and
   • a higher sternum or ‘barrel chest’.

   These male physiologies result in some typical BA post–op giveaways for transwomen such as:

   • slightly outward pointing or asymmetrical breasts;
   • an unnaturally large gap between breasts;
   • protruding and high breast profile and
   • poor positioning of the implants

   There is very little useful literature on how to deal with these trans–specific physiologies. Surgeons are not necessarily adept at understanding or dealing with our physiologies from either a procedural or surgical perspective. Furthermore, surgery is not able to resolve or minimise the full extent of these male physiologies. I continually and rigorously reviewed advice from my trans–specific viewpoint which often resulted in such advice being invalidated or irrelevant. Surgeons, I found, rarely have non– transwomen in mind when they provide BA advice.

2. Be clear on the “look” you are seeking

   My desire from the outset was for BA to achieve a more naturally feminine appearance. This might seem obvious but I found that very little of the available literature mentioned ‘feminising’ as an objective of BA surgery. Much of the available literature was instead focussed on achieving either, or both, a more youthful or sexy look.

   Cosmetic surgeons with whom I consulted often spoke of breast enlargement rather than augmentation/reconstruction. I felt that the processes for augmentation/reconstruction were more appropriate for feminising a transwoman than those processes applied through enlargements. In particular, augmentation/reconstruction often needs to deal with trans–specific physiologies such as extant minimal breast tissue from which to create a breast. There also appeared to be a much stricter and more extensive qualification and accreditation process for plastic and reconstructive surgeons rather than purely cosmetic surgeons.

3. Do your research, be informed

   I spent many hours delving into the plastic surgery/cosmetic industry. Much of the advertising appears to focus on the vulnerabilities in women (let alone a marginalised minority such as transwomen) by selling the dream of achieving a type of ‘beauty nirvana’. I needed to inform myself.

   Many trans and non–trans women I spoke to who had had augmentation procedures were all more than happy to discuss their own procedures, what worked for them and what didn’t as well as some of the pitfalls.

   I undertook a literature search via the internet as well as asking a number of medical professionals as to their thoughts on plastic/cosmetic surgery. I sourced a number of ‘before’ and ‘after’ photos and used these as the basis for my discussions with surgeons in particular why some breasts looked the way they did and how particular certain outcomes could be achieved or, conversely, avoided. In particular, I needed to view the before and after outcomes of BA from a whole of body perspective to understand why some outcomes were better than others.

   Whilst every breast is different they all have certain discernible characteristics that I wanted to replicate to maximise naturalness. These “natural” design ideals are generally acknowledged to be:

   • proportion of the breast below the horizontal (lower pole) is 55%
   • proportion above the horizontal (upper pole) is 45%.
   • angle of the nipple is pointing 20 degrees upwards.
   • upper pole is slightly concave
   • lower pole is slightly convex.

   These design ideals can be shown in picture form as follows:

   

4. Choosing a surgeon you can trust

   After talking at length to more than six plastic surgeons, I chose a surgeon with whom I was able to easily communicate and with whom I felt both an inherent trust and respect. My chosen surgeon was able to explain the process in detail, in simple terms and why he was suggesting a particular process or product over another. He had available ‘before’ and ‘after’ photos of his BA procedures. He explained why some “looks” were more achievable than others and he proved that he was well versed on transgender–specific physiologies.

   He was reassuringly thorough. He measured me from every angle as well as my weight and height and drew diagonal grid lines all over my chest. He used both geometry as well as aesthetics and recommended, through these two separate processes, the suggested size, shape and profile of the breast implant for me. He then let me ‘road test’ some of the implants at home over several weeks.

   My checklist of characteristics for choosing a surgeon was:

   Characteristic	Reasoning
   1. Communication	My surgeon had to be able to both listen and explain.
   2. Experience	Previous BA experience with transwomen is a must. BA was too important and too expensive for me to be a “guinea pig”.
   3. Process	Thoroughness both through science and through a ‘good eye’ for what works, using a combination of both aesthetics and science.
   4. Wholistic patient view	Both pre and post–operative care should be included in the service.
   5. Qualifications	A preference for breast reconstruction, aesthetic and/or augmentation skills rather than purely ‘cosmetic’ surgery skills.
   6. Trans aware	My surgeon needed to be someone who had an unqualified understanding and acceptance of the trans community.

5. It is not all about price

   I found the quotes for BA was in the range of between $6,000 to $18,000. Surprisingly, the more expensive surgeons tended to be the least convincing both in terms of their ability to understand what I was looking for and their experience with transwomen.

   Other major additional expenses often not quoted by the surgeons are the anaesthetist charge which added nearly $1,000 to my procedure. Additional hospital charges of some $2,500 to $3,500 are also not covered by public or private health insurance. My surgeon’s charges were “mid–range” and were ‘all–inclusive’ of pre–operative and post–operative consultations.

6. Be patient and let hormones work their magic

   Some plastic surgeons were prepared to perform BA surgery after me being on hormones for three months whilst others were prepared to go into surgery straight away. After three months I had negligible breast growth so I decided that I would spend two years on hormones to have maximum breast tissue growth prior to surgery. I felt that the more breast growth prior to surgery then the greater the likelihood of creating more natural looking breasts as well as providing a greater ability of the surgeon to position the breasts correctly on the chest by using my natural breast growth as a guide.

7. Understand the process and the post – operative care

   My post–op reality check was the level of discomfort and the restrictions to my body movements for at least a week or so after surgery. After surgery my breasts were quite hard and my chest was swollen and very sore. I wisely decided to stay in hospital for the first evening and then spent the next few days resting at home. The hardness subsided after about three months and after twelve months my breasts were softer with a nice cleavage.

   Scarring was evident for twelve months after surgery. I applied some specialist scar reduction cream each day as well as laser treatment which assisted in fading the scars. The areola stretched nicely due to the expanding effects of the implants which also produced slightly erect, and upward pointing, nipples.

8. Prepare your mind and body for a new appendage

   I had spent too many decades pondering the wistful delights of having my own breasts. When the realisation came that this seemingly unreachable goal was soon to be realised I wanted the entire process to be a life affirming and a poignant personal experience. I tried to make the days and weeks leading up to my surgery as calm and reflective as possible. Although I had thoroughly ‘interrogated’ the BA process I was still a little anxious and nervous as to the outcomes.

   It took some three to four months after the operation for the swelling and hardness to subside and a
   further three months before I actually felt emotionally and physically ‘attached’ to my new breasts.

   Nevertheless, immediately after I was discharged from hospital, I felt ‘both complete and legitimate…indeed, I felt as though I was now an ‘equal’ with other women. My breasts were proof of who I was not just to me but to the world. I was a woman.

   My life was suddenly and significantly enhanced: I would soon be able to swim, do yoga, go bra–less and, best of all, squeeze into my first ever bikini!

9. The decision

   Decision	Reasoning
   Naturelle Brand	There had been no reported leakages or warranty problems with this brand.
   Silicone Gel Filling	Gel is less likely than saline to fold once inserted and, in the event of rupture, is less likely to bleed. Gel implants tend to keep their shape for longer reducing the likelihood for replacement later. There are grades of firmness. I chose a mid–range firmness
   Tear Drop (Anatomical) Shape	These implants have less upper pole volume than round implants which minimises the impact of a high male chest plate. Tear drop implants are slightly wider than an equivalent round implant helping to overcome the broadening impact of a male chest and thus provide a semblance of cleavage.
   410 grams	Sized by using the broadness of my shoulders as a guide. Being too small is as big a potential problem as being too large.
   Textured	Textured implants have a higher propensity to remain in place than with smooth.
   Medium Profile	Medium, anything greater would make the implants protrude unnaturally on an already rounded male chest.
   Inframammary Insertion	Three insertion techniques are: through the arm pit (tansauxilliary), through the nipple (areola) and through an insertion cut below the breast (inframammary). The first two result in less scarring than the third but, from a surgical perspective, they increase the difficulty of positioning the implant for trans women.

   Based on all the science, geometrics, intuition and research, I decided on the following configuration:
   My surgeon and I also agreed that he would determine the exact sizing (we were also considering a 450 gram implant size) once I was on the operating table and he would consider each sizing once inserted. It was the only decision I left unresolved but by the time my surgery came about I had developed a lot of confidence in his understanding of what I was seeking.

10. and the result

    My BA story in pictures:

    

    April 2013: One month before surgery and after two years on hormones.

    

    May 2013: One week post-‐operative -‐ swollen, sore and hard. They felt like they were going to burst.

    

    June 2013: Six weeks post–operative — starting to soften.

    

    November 2013: Six months post -‐ operative -‐ softer and feeling a part of me.

    

    June 2014: Twelve months post-‐operative -‐ a more concave upper pole, convex lower pole and softer.

    .and my everyday view.