TRANSGENDER PROCEDURES

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1. Masculinizing Mastectomy (F-M)

WHAT IS IT FOR?

Reduces male breast and excessively broad areolas to provide a masculine breast appearance

HOW IT WORKS

F-M masculizing mastectomy surgery techniques are similar to those of gynecomastia. Surgical treatment usually requires liposuction complemented with direct excision of glandular tissue (usually harder and more difficult to aspirate) and reduction of the areolas. In cases of larger breasts, there may be a need to remove some skin as well, forcing a scar at the level of the inframammary fold

PROCEDURE DURATION

1h30 to 2h30

OPTIONAL ASSOCIATED PROCEDURES

Abdominoplasty, liposuction

TYPE OF ANESTHESIA

General anaesthesia

SCARS

The scar can be periareolar, that is, along the edge of the areola. In cases of larger breast size, there may be a need to remove some skin as well, forcing a scar at the level of the inframammary fold

HOSPITAL STAY

Outpatient or 1 day in hospital

RECOVERY

You can return to work in about 2 weeks as long as there is no weight lifting or exertion required. We recommend full arm lift to start only from week two onward. Sports activities can be performed after 6 weeks. You should also wear a compressive garment (recommended by our team) for 6 weeks. After a few months, the scars acquire a tone similar to the surrounding skin, becoming less noticeable

RISKS AND MOST FREQUENT PROBLEMS

Due to liposuction, there are usually bruises (bruising) that disappear in 1-2 weeks and discomfort that is easily tolerated and manageable with analgesia. There may be excessive fluid production a few days after surgery, which may need to be aspirated. Sometimes initially there is swelling or a change in nipple sensitivity (increased or decreased). Less frequent are excessive scarring or hyperpigmentation of the scars, hematoma and infection. There may be irregularities or adhesions of the skin and areola to the deeper planes, which may improve over time or need to be corrected in the future.

PROCEDURE LONGEVITY

The procedure is usually definitive

INITIAL NOTE

The surgeries indicated below are the ones that Dr. João Nunes da Costa is able to give an effective response to.

Surgeries and treatments of the genital region for gender affirmation and reduction of the Adam's apple are not performed by our team.

It is also important to inform that, regarding breast surgeries, they will only be performed if the patient has the necessary documentation from the multidisciplinary team, including medical reports from psychiatry favorable to their performance.

WHAT IS IT FOR?

Improves the shape, volume and projection of the breast

HOW IT WORKS

Breast augmentation is a surgical procedure that makes use of silicone implants to change the shape of the breast, improving its aesthetics. The determination of the ideal shape of the breast and the choices made during the surgery follow some rules and depend on the patient's characteristics, including her height, shape of the chest, thickness and quality of skin and subcutaneous tissue, and especially the previously existing breast. Some of the variables to consider are:

Shape and volume of the implant - The anatomical (or "teardrop") shape generally gives more natural results than a round implant, allowing a better adaptation to the shape of pre-existing breast, to create a more balanced final result. However, some patients already have enough breast volume such that a round implant may permit an equally attractive breast. The volume must be adapted to the patient, although there is some leeway; however, it must be borne in mind that the larger the implant, the greater the risk of complications and loss of natural aspect in the medium/long term.

Relative position of the implant - The discussion of the placement of the implant position, in front of or behind the pectoral muscle, is also relevant. The plane that we use in our technique to place the implant in front of the muscle is called the subfascial plane, which is an evolution of the subglandular technique, because it uses the muscle fascia as an additional layer of protection, while also reducing bleeding risk. Nowadays, the concept of placing the implant behind the muscle (submuscular plane), corresponds to the "dual-plane" technique, in which the prosthesis at its upper pole is behind the muscle and its lowest portion is (at a variable length) in a subglandular/subfascial position. The "dual-plane" technique is of particular advantage in patients who have a small breast, since it allows a better covering of the implant, reducing the visible stigmata of a prosthesis, such as "rippling" (skin creases), and at the same time allowing better expansion of the lower pole, providing the normal “teardrop” shape the breast usually has. However, placing the implant in front of the muscle may be a good option in patients who already have some breast tissue, allowing to better disguise the prosthesis, or in patients undergoing very intensive sporting activity, because it better avoids implant "bouncing" with the contraction of the pectoral muscles.

Incision/approach/scar - the most common approaches are inframammary (along the lower breast fold), periareolar (along the lower half of the areola) and axillary (as the name implies, through the armpit). They all have advantages and disadvantages and all can be performed as long as the anatomy and procedure safety allow it (for example, you cannot place a large volume implant using a periareolar approach in patients with very small diameter areolas; the risk of bleeding from the axilla is theoretically superior to the others due to reduced direct visualization). Scars typically have about 4 to 5.5 cm in length depending on the chosen approach and size of the implant

PROCEDURE DURATION

1 hour

Breast asymmetry correction, liposuction, fat grafting ("lipofilling"), tummy tuck (abdominoplasty), thigh lift, facelift, blepharoplasty

TYPE OF ANESTHESIA

General anaesthesia or deep sedation (always with a certified anesthesiologist)

SCARS

Scars typically have about 4 to 5.5 cm in length depending on the chosen approach (inframammary, periareolar, axillary) and size of the implant

HOSPITAL STAY

It can be performed on an outpatient basis or with 1 day in hospital

RECOVERY

You can return to work in about 5-7 days as long as it does not involve any effort. The most intense sports activity can be carried out from 6 weeks. You should also wear a compression bra (recommended by our team) for 6 weeks. After a few months, the scars take on a shade similar to that of the surrounding skin, becoming less noticeable.

RISKS AND MOST FREQUENT PROBLEMS

Initially there may be an easily tolerable discomfort (manageable with painkillers), mild swelling, a change in sensitivity of the nipple (increased or decreased). The breasts may be sensitive to stimulation for a few weeks. Over time, loss of elasticity of the tissues, physical trauma/injury, pregnancy or weight changes can alter the shape of the breast and may require revision surgery in the future. Either one or both breast implants may also need to be removed and/or replaced to treat problems such as bleeding, infection, rupture of the implant or the formation of scar tissue around the implant - capsular contracture, which can cause the sensation of tightness or stiffness in the breast. The concept that a young patient may, throughout her life, require at least one breast augmentation revision surgery is quite consensual nowadays, because we are dealing with many decades of life with an implant. Other risks are increased or decreased sensitivity of nipples or breast skin, which may occasionally be permanent

PROCEDURE LONGEVITY

Except for the indicated situations, the results remain throughout life, with the overall effect of an increase in breast size, as well as improvement in shape and appearance

2. Breast Augmentation with Implants (M-F)

3. Mentoplasty with Implant

WHAT IS IT FOR?

Improves the projection and contour of the chin, giving a more masculine appearance

HOW IT WORKS

Chin implants are solid, appropriately shaped to better define the contour and volume of the chin, and can be made of silicone or MEDPOR. They involve a surgical procedure in which, through an approach that leaves easily concealed scars (inside the mouth or under the chin), the implant is placed next to the bone and fixed using screws or sutures. It has the advantage over volume augmentation with hyaluronic acid or fat grafting of providing a more defined shape, with more demarcated features (e.g., mandibular border or chin) and in a permanent way, unlike hyaluronic acid.

PROCEDURE DURATION

1 hour

OPTIONAL ASSOCIATED PROCEDURES

Fat grafting, b. toxin, facelift, minilift, blepharoplasty

TYPE OF ANESTHESIA

Local anaesthesia or general anaesthesia

SCARS

Can be placed inside the mouth or below the chin

HOSPITAL STAY

Does not require hospitalization

RECOVERY

Return to work in 2-3 days for mild activity, although some swelling may remain for about 3 weeks

RISKS AND MOST FREQUENT PROBLEMS

Initially swelling and bruising often occur. Asymmetry, infection and capsular contracture are risks that must be taken into account, in particular due to the fact that the implant is definitive and can remain in the body for many years. The displacement of the implant and eventually irritation or mental nerve damage is also a possible complication. Sometimes, with these complications emerging, the only way to correct them is to remove the implant

PROCEDURE LONGEVITY

Definitive

4. Dermal Fillers

WHAT IS IT FOR?

It restores or increases the volume of areas of the face, increases projection in a temporary way and allows wrinkles to be corrected.

HOW IT WORKS

The injection of fillers is a non-surgical procedure (unlike the filling with fat tissue, which is a surgical procedure), which uses filler substances to improve wrinkles, furrows and irregularities or even increasing volumes. It could also improve skin hydration, in the case of more superficial fillers. In our practice the preference falls on hyaluronic acid (non-permanent filler) for its better safety profile. Several brands are known, such as Restylane, Perlane or Juvederm (registered trademarks) which vary in viscosity, water absorption capacity and characteristics of the molecule, with implication in the depth at which they can be injected, for the best results without visible "papules" and maximized durability.

The cosmetic indications to use hyaluronic acid include the emptying of the face with age, namely the disappearance of fat from the cheeks, deep furrows from the nose to the corners of the mouth, and in some furrows between the lower eyelids and cheeks. It is also one of the most common methods used for lip or chin augmentation. Furthermore, a filler can be used to smooth the irregularities present on the nose, improving its shape. In the specific case of transgender procedures, its use can help to better define the facial aesthetics of the male or female gender, through a judicious application.

PROCEDURE DURATION

15 minutes

ASSOCIATED PROCEDURES

B. Toxin

TYPE OF ANESTHESIA

Topical or regional anesthesia

SCARS

No scars

HOSPITAL STAY

Does not require hospitalization

RECOVERY

You can work on the same day, although some areas may be more swollen or red for 1 or 2 days