close up of a woman's breast covered with her hands in white surgical gloves

More often called top surgery or male-to-female (MTF) breast augmentation, transgender breast enlargement is similar to breast augmentation for cisgender women. For those undergoing a gender transition, MTF breast augmentation can help your secondary sex characteristics better match your gender identity. The decision to undergo breast enlargement surgery is highly personal. Some transgender women find feminizing hormone therapy alone helps them develop their desired breasts, but many trans women want more dramatic changes that can typically be achieved through hormonal therapy alone. Below, we will provide a brief overview of

Preparing For MTF Breast Enlargement Surgery

While it is common for transgender women to start hormonal treatment as early as adolescence, breast enlargement surgery is typically put off until adulthood. Prior to undergoing MTF breast augmentation, you will have a consultation with your surgeon to discuss your goals and expectations. Make sure to come with any questions you have prepared.

In addition to talking about your desired results, you’ll be required to undergo a medical evaluation to ensure you are healthy enough to undergo surgery. This will include a review of your personal and family medical history, a physical exam, routine blood work, and discussions regarding your lifestyle. You may need to make certain changes – like losing weight or quitting smoking – prior to being cleared for surgery.

Most surgeons and health insurance companies require a mental health evaluation by a provider with expertise in transgender health as well.

What Happens During MTF Breast Enlargement Surgery?

You can undergo one of two types of MTF breast augmentation: fat grafting or implants. Fat grafting is less invasive and comes with a shorter recovery time, but the results may be less dramatic than they would be with implants.

Fat Grafting

During fat grafting, your surgeon removes fat via liposuction. That fat is then purified and transferred to your breasts via a series of small injections. Your surgeon uses this technique to sculpt and reshape your breasts according to your desired outcome.

With fat grafting, you can remove unwanted fat deposits that do not respond to diet and exercise, which is an added benefit to the procedure. 

Breast Implants

Your surgeon will make incisions around the areola, in your inframammory fold or near your armpit. Then, they will insert silicone or saline implants through the incision and under your breast tissue before closing the incision with sutures. In some cases, additional steps may be needed for an ideal outcome. Male chest anatomy is different than female chest anatomy in that the nipples tend to be more laterally placed. In patients where this is more obvious, an initial tissue expander placement to enlarge the lateral chest skin may be necessary to create an optimal aesthetic breast. After expansion, the expander is removed an a permanent saline or silicone implant can be placed.

What Happens During Recovery?

Fat Grafting

After fat grafting, you need about 14 days of downtime. During this time, you’ll need to avoid strenuous exercise and may have bandages in place. Swelling should go down within 6 to 12 weeks, at which point you’ll see your full results.

Breast Implants

Full recovery after receiving breast implants usually takes between 4 to 6 weeks. During the first two weeks, you will need to minimize any vigorous activity. This will decrease the risk of post-operative bleeding. You may also have to wear a post-surgical bra or bando for approximately two weeks to help ensure ideal implant placement.

Within 3 weeks, you can resume most normal activities, but will need to avoid strenuous upper body physical activity until you are fully recovered. You will have regular follow-up appointments with your surgeon to discuss your specific timeline for recovery.

Are There Risks Associated With

Every medical procedure comes with risks. For healthy adults working with reputable surgeons, the risks associated with MTF breast augmentation are very low.

Breast Enlargement SurgeryImplants can sometimes cause complications such as breast pain and changes in nipple sensation. Implants can rupture, which may require follow-up surgery to correct. An issue called capsular contraction can cause scar tissue to form around the implant, which – in serious cases – can be painful.

Fat grafting has a lower risk of complications. Some patients experience mild issues such as fat necrosis and oil cysts. Fat necrosis – death of fat cells in the transfer site – is more likely if you have had a larger amount of fat transferred.

Working with an experienced surgeon and following all medical advice carefully decreases your risk for complications.

The Bottom Line

MTF breast augmentation can be hugely beneficial to transgender women. Studies indicate that gender-affirming surgeries are associated with substantial improvements in mental health and a significant reduction in psychological distress. In the majority of cases, the benefits of breast augmentation and other gender-affirming operations greatly outweigh the risks. 

Ready to get started? Leif Rogers, MD is an Ivy League-educated, board-certified plastic surgeon and a standing member of the American Society of Plastic Surgeons. If you’re considering breast augmentation, get in touch with his team to schedule a consultation.

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