MTF Breast Augmentation for Gender-Affirmation

To perform a gender-affirming breast augmentation, your surgeon can choose from a variety of techniques to enlarge or construct breasts: principally through implants or liposuction-fat grafting. Transgender and non-binary patients often have different needs than cisgender women seeking breast augmentations. For example, wider breast implants and specific placement techniques may be necessary to help a trans patient meet their goals due to common anatomical factors (e.g., a wider sternum and rib cage, more space between nipples, etc.). For this reason, we encourage patients to consider board-certified surgeons who are specialized in working with trans patients.

Surgery for Trans and Non-Binary Patients at the GCC

At the Gender Confirmation Center (GCC), we have performed over 5,000 gender affirming procedures since 2009 using state-of-the art medical technology. In an effort to make the safest, highest quality surgical care financially feasible, our insurance concierge service has successfully secured insurance coverage for 90% of interested patients. At the GCC, we are unique in our commitment to making gender-affirming surgeries accessible to patients of all gender identities, regardless of hormone usage, body mass index (BMI), age or disability.
If you are interested in surgery, you can request a free, virtual or in-person consultation with us today. If you have already undergone surgery and have questions about recovery, complications or revision surgeries, you can click on the hyperlinked articles.

Transgender Breast Augmentation Techniques and Options

When it comes to feminizing top surgery, patients can personalize their procedure when it comes to the following factors we discuss below: implant type, implant shape, implant size, incision location, and implant placement. Our surgeons can help you navigate these choices based on your unique anatomy and goals in a free consultation.

Augmentation type: fat grafting vs. saline & silicone implants

The fat grafting technique is less common amongst transfeminine patients because of its low success rate when a large amount of volume is needed and the skin is particularly tight. This means that the first choice for most patients is between silicone and saline implants. Fat grafting can be used in addition to implants, for example, to increase medial cleavage between the breasts.

Silicone implants have become the most popular choice amongst our patients because of their durability, softer feel and appearance, especially for those starting out without a lot of breast tissue.

Implant Shape

A patient can also choose the shape of their implants. Specialists in transgender care know that trans patients will often need wider implants than their cis counterparts to meet their goals.

At the GCC, we prefer round or circular to teardrop-shaped implants for a number of reasons. First, if your implants rotate, round implants will not pose a risk to breast symmetry. Second, circular implants allow for more options around placement and a smaller incision for insertion, which reduces the size of the scar. Third, once patients results have healed, the difference between tear-drop shaped and round breast implants on breast contour is practically imperceptible, especially for implants placed below the muscle.

Breast or Implant Size

Rather than measuring by cup or bra size, the size of breasts are determined by the implant size, which typically ranges from 200cc-500cc. The final appearance of your breast size will have a lot to do with your unique anatomy. We encourage patients to try out the rice bag test at home to figure out which size would best suit your needs. Likewise, during an in-person consultation we allow patients to try on implant sizers.

MTF Top Surgery Scars & Incision Type

Your surgical scars are determined by the incision location, i.e., where the breast implant will be inserted. Patients main concerns tend to be about minimizing scar visibility and creating an incision that allows for optimal implant placement. For these reasons, we most commonly make an incision along the inframammary fold, which conceals the scar at the fold at the bottom of the breast. Scar texture and discoloration can often be reduced with proper care.

Patients can also opt for an incision along the border of the areola (periareolar) or through the armpit (transaxillary). Most transgender patients we see do not have large enough areolas to insert a silicone implant. Although the scar is hidden, inserting implants through the armpits is associated with higher rates of capsular contraction, bleeding and placement complications, which is why we no longer offer this option at the GCC.

Implant Placement

Placement refers to the option to place the implants below the muscle (submuscular) or above the muscle and below the mammary glands (subglandular). Some surgeons who offer a submuscular placement will offer to score the pectoral muscles to help the implants settle.
Surgeons can also perform a dual plane technique (placing the implant partially under & partially over the pectoral muscle) or a subfascial technique (placing the implant below the fascia). You can read more about the advantages and disadvantages of each technique here.

Implant Texture

Due to increased risk of breast cancer associated with textured implants, the GCC only offers smooth implants to our patients,

How Can I Get Feminizing Top Surgery?

There is a lot that goes into preparing for top surgery, which can make it confusing and even overwhelming for some. The information below is meant to help guide you on the steps that most patients go through in order to schedule their surgery date. Afterwards, there are steps you will need to take to prepare yourself for surgery.

What are the steps involved to undergo MTF top surgery?

The first step in a patient’s journey is requesting a free consultation. From there, we have you covered with our feminizing top surgery timeline guide.

Will my insurance cover transgender breast augmentation?

Some insurance providers do cover gender-affirming surgeries as medically necessary procedures. For those that do, requirements often include:

• Patient must have been on at least 12 months of continuous feminizing HRT, unless there is a medical contraindication
• Patient must present a support letter from a licensed mental health provider

At the GCC, you can leave the insurance worries to us. We provide a free insurance concierge service to interested patients. After soliciting any necessary documents from you, our insurance advocacy team will get to work to secure full or partial coverage for your medically necessary, gender affirming procedure(s). Our team has a 90% success rate in securing coverage for insured patients. Learn more about those services here.

How can I finance my surgery if it’s not covered by insurance?

We have compiled a list of grants for gender affirming surgeries alongside trusted, medical credit agencies you can use to help finance your surgery with us. On the same page, you can also find estimated costs for each procedure we offer if you plan on paying entirely out of pocket.

How long should I be on HRT before getting a breast augmentation?

Generally, patients who are taking feminizing HRT are recommended to let their breast tissue develop for 1.5-2 years under treatment. Patients who microdose estrogen may be advised to wait longer to maximize mammary tissue growth and, in turn, breast augmentation results. That said, we have no HRT requirements to undergo this surgery. That said, we have had successful results with patients who come in with no initial mammary tissue. There are several non-binary patients that have undergone breast augmentation surgery with us that have no interest in taking HRT.

What can I do if I need to travel for surgery?

Many trans, non-binary and gender expansive patients need to travel to access quality, reliable gender affirming surgical care. At the GCC, we are very accustomed to working with patients that come in from out of town. For recommendations on travel and lodging, click here. We have also compiled a guide on preoperative consultations and post-operative follow-up protocols for patients who do not live in the San Francisco Bay Area.

What should I do to prepare for MTF breast augmentation?

We have prepared a guide specifically for breast augmentation patients on how they can prepare for surgery in the days leading up to it. Additionally, exercise and drug consumption are two of the most important factors to monitor before your surgery that can help you maximize your results and speed up your healing process. Learn more about our guidelines and recommendations around exercise and drug use here.

Recovery from breast augmentation varies depending on the type of procedure you undergo. During the first weeks of recovery, you will need to wear a compression bra for support. Generally speaking, patients that have desk jobs can return to work 1-2 weeks after surgery. That said, you will not be able to return to full physical activity—especially heavy lifting––until 6 weeks after your procedure.

Breast implants are generally placed high on the chest during surgery because gravity will pull them down during the recovery process. Between implants settling and inflammation resolving, patients can expect to see their final results between 6-12 months post-op.

If you have more questions about recovery, you can consult the following guides:

First week of recovery
Returning to exercise
Bruising and swelling
Complications and revision

How much does breast augmentation surgery cost?

After your free consultation, once your individual surgical plan is created, we can provide you with a quote for your surgery. Generally, breast augmentation surgery, including some recovery materials, comes out to $8,500 – $10,000, plus additional costs like facility fees. Insurance coverage can help significantly reduce these costs for patients.

Will the sensation in my breasts and nipples change after top surgery?

All of the breast implant options we offer involve a risk of sensation loss. While most patients report an overall loss in sensitivity of their breasts and nipples post-op, they tend to report higher levels of sexual satisfaction because of feelings of euphoria and alignment with their bodies. We encourage you to ask your surgeon about nerve rehabilitation exercises if you are interested in recuperating sensation.

Can a breast augmentation be performed alongside other procedures like body feminization surgery?

The most common procedure to accompany a breast augmentation is body feminization surgery, which often includes trunk liposuction, BBL, hip augmentation and/or abdominoplasty. In some cases, patients may be able to undergo a small amount of Facial Feminization Surgery (FFS) procedures alongside a breast augmentation. You can speak to a surgeon during a free consultation about your options.

Do implants impact breast cancer risk?

So far, there is little evidence linking saline or silicone breast implants to an increased risk for breast cancer. Otherwise, for patients who have developed breast tissue through hormone replacement therapy (HRT), there is some evidence to suggest that estradiol can increase your breast cancer risk. As a result, it is recommended that if you are over the age of 50 and have been undergoing HRT for 5 or more years, you undergo screening mammography every 2 years.

On the other hand, there is a type of lymphoma that is associated with breast implants. You can read more about risk evaluation and best practices for breast cancer detection in transgender patients here.