Transgenders who had their implants removed in Chennai. (Express photo by Ritu Sarin) Transgenders who had their implants removed in Chennai. (Express photo by Ritu Sarin)

IN FEBRUARY this year, the Tamil Nadu government announced a scheme to provide free breast implants for women at the Stanley Hospital in Chennai. Eight months later, only P V Mahalakshmi, a 38-year-old from Chennai, has undergone the free implant surgery. Prof V Ramadevi, who heads the department of plastic surgery at Stanley Hospital and performed Mahalakshmi’s surgery, has an explanation. People of Tamil Nadu, she says, are very conservative, one reason why the free breast implant campaign is yet to pick up.

“People in Chennai do not come forward for even free vaccination, let alone breast augmentation. But a lot of transgenders have made inquiries at the hospital and the patient waiting in line for a free breast implant is also a transgender,” she says. Weeks before the surgery, Mahalakshmi had told The Indian Express that she wanted the implants since her breasts had shrunk after she gave birth 12 years ago.

“I felt guilty and was disturbed for many years. I found that my sex life too had been affected,”’ she said. “So when my husband read about the free government scheme in a newspaper, I thought this is the best solution. He is a shopkeeper and we cannot afford to spend Rs 1 lakh in getting the surgery done privately.”

The implant surgery was conducted at Stanley Hospital on September 14. But two months later, Mahalakshmi says she is not happy with the outcome of the procedure. “I wanted 400 cc silicone implants to fit my skin size but what has been put is 275cc, it is too small. And there is already some sagging in the breasts, so my problem has been resolved only partially,” she says. Plastic surgeons in Chennai and New Delhi say they frequently encounter post-surgery complications and demands for larger breast implants, especially among members of the transgender community.

Prof V Ramadevi of Stanley Hospital , Chennai, which offers free breast implants. (Express Photo by Ritu Sarin) Prof V Ramadevi of Stanley Hospital , Chennai, which offers free breast implants. (Express Photo by Ritu Sarin)

A visit to Sahodaran, an association of transgenders in Chennai, reveals that many among their 3,500 members are either waiting for breast implant surgery or have had one recently. A Jaya, general manager at Sahodaran, says: “There is a desperate desire among transgenders for bigger breasts. Since many of them are sex workers and cannot afford to take long rest after surgery, their implants either leak or the stitches open.”

Three transgenders say they procured their silicone implants from a stockist in New Delhi for Rs 25,000-30,000 and handed them to doctors at Kilpauk Medical Hospital or the Rajiv Gandhi Government General Hospital for surgeries. Each now complains of the stitches getting ruptured or of having contracted fungal infection. According to Priyanka, one of the transgenders who has got the implants removed, the “bad experience’’ at government hospitals has had at least 20 members of Sahodaran heading to Thailand for surgeries in the last few months.

“In Bangkok, transgenders from India get a package deal of Rs 1 lakh which includes the hospital stay expenses. Doctors in Bangkok are placing heavier and heavier silicone packs, maybe even 600 cc, which hospitals in Chennai refuse to do,” says Priyanka. Plastic surgeons at Chennai’s Kilpauk Medical Hospital say they used to conduct two-three breast implant surgeries every month for transgenders. The problems they faced were twin-fold: transgenders wanted bigger and bigger implants and rarely came back for reviews.

Dr G Karthikeyan, Associate Professor at Kilpauk Medical Hospital, says: “We do get a lot of cases of complications like capsule formation or severe infection after implant rupture.” Another plastic surgeon in Chennai, who handles a lot of transgender cases for breast implants, is Dr A Sivakumar of Desire Asthetics. He does not charge a fee for the surgery. The transgenders only have to meet the hospital expenses.

“Yes, many transgenders bring the implants with them and want a big size. But since the skin has to be stretched so much, there are frequent ruptures and infection sets in. Soon, revision surgeries have to be done. As far as other patients are concerned, there is a clear trend of loss of confidence among women and depression over the sagging of breasts after childbirth,” he says.

The Indian Express visited A Lakhanpal Trading Company, located in Malviya Nagar in New Delhi, from where the transgenders say they have have been getting their stock of silicone implants via courier. The staff at the warehouse, which has a huge stock of devices associated with plastic surgery and hair transplant, are willing to sell silicone implants, and offer a Hong Kong brand called Refinex.. Asked about off-the-counter sales without medical prescription, the proprietor, Ashok Paul, says: “We were just going to ask you for a doctor’s reference.’’

To a query on whether the implants have FDA approval, he says, “Customers want these implants and we sell these in all sizes without any complaint. I do not know about any international or FDA approval. Whenever we have approached the CDSCO (Central Drugs Standard Control Organisation) for a licence for a device we want to introduce in the Indian market, we have found the paperwork too cumbersome. We have now given up our efforts.’’

This precisely is the problem with breast implant sales and regulation, say leading plastic surgeons. According to Dr Monisha Kapoor, who runs the Asthetics Centre at Saket in New Delhi, grey market sales of silicone implants are rising rapidly. “Nowhere in the world can patients hand over the implants to the doctor as happens in India. I have transgenders come to me with such offers but I insist on procuring licensed implants myself from authorised dealers,” she says. While transgenders from Chennai say they are going to Thailand for breast implants, Dr Narendra Kaushik of the Olmec Clinic in Delhi says transgenders from several countries, including the United States and Canada, are getting implant surgeries done here, along with other sex reassignment surgeries. So good is the business that Dr Kaushik plans to build a new hospital exclusively for transgenders in Delhi.

At Apollo Hospital in Chennai, Dr K Ramachandran, another leading plastic surgeon, sums it up: “As a segment, transgenders are a huge segment of society looking for breast implants but they are looking at short-term gains. What they do not realise is that getting a breast implant is only the first step in a journey. It is also a lifetime of risks.”

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