Transgender Body Contouring

Q: Dr. Eppley, I am considering a series of separate body feminizing procedures (transgender body contouring) in this sequence:

1. Butt Implants with body lipo/fat grafting to complete hip/butt shape.

2. Then take 3-6mo to regrow some fat for Breast Implants with body lipo/fat grafting for cleavage and more natural finished shape.

3. Ribs removal. Front and back. Im not sure of the exact rib #s, but Im referring to both protruding ribs in front, and lower floating ribs. Would you kindly advise what exactly is possible, safe, and effective?

4. Tummy tuck with plication and for “internal corset” effect.

My thinking is that doing rib removal as a separate procedure before tummy tuck, allows for removal of more ribs than if removing ribs at the same time as tummy tuck, and will create more potential for the tummy tuck to draw in/around the trunk, for an overall slimmer torso and waist.

Would you kindly let me know your thoughts?

Thank-you Dr!:)

A: Thanks for detailing your transgender body contouring sequence, I would make the following comments to them .

1) Buttock implants with overlay fat grafting is a good approach to these needs. Fat grafting can only be done if the buttock implants are placed in an intramuscular position and not in a subfascial location. This would really be based on implant size. Any buttock implant bigger than 330cc would have to be placed in a subfascial location. In thus case, fat grafting is done first followed by implants secondarily.

2) I doubt once you harvest fat the first time there would be enough for the second time. The concept of growing fat is not usually a good idea for fat grafting since any weight loss will simply make what has been transferred to go away. It is important to remember that grafted fat acts like where it comes from, it retains its donor sit characteristics. It would make the most sense to rely on implants to do the complete breast augmentation/reshaping.

3) For waistline narrowing, ribs #10, 11 and 12 are commonly removed with small incisions from the back. For anterior protruding ribs (ribs 8,and 9) that is done through either a low subcostal incision or through tummy tuck incision.

4) If one is having a tummy tuck then that would be the ideal time to remove the subcostal ribs #8 and 9.

With this information, I would make the following recommendations based on how to best put the body contouring program together in two stages.

#1 Rib removal #10, 11 and 12, intramuscular buttock implants (300cc) and waistline/abdominal liposuction with fat grafting to the hips and around the buttock implants.

#2 Six months later….breast augmentation with implants, tummy tuck with rib removals 8 and 9.

This, in my opinion, would be the best way to put in all together and is actually how it is commonly done.

Dr. Barry Eppley

Indianapolis, Indiana