MTF Surgery Procedures » MTF Breast Augmentation

MTF Breast Augmentation 101 – Everything You Need to Know

MTF Breast Augmentation is a surgery procedure that transforms a male chest into women's breasts, with a feminine breast shape and size. Using breast implants, MTF Breast Augmentation, also known as MTF Top Surgery, can provide a female breast contour when hormone replacement therapy alone has proved insufficient for breast development.

While hormone therapy can increase breast volume somewhat, many trans women still seek to enhance the feminine shape and contour of their breasts to alleviate gender dysphoria, match gender identity to presentation, and improve confidence and self-esteem.

Breast Augmentation is associated with high patient satisfaction. In a 2019 study co-authored by Dr. Thomas Satterwhite, a Gender Surgeon in San Francisco, 92.7% of patients reported being happier and feeling more satisfied with their chest than before their operation. All respondents reported improvement in their gender dysphoria and would undergo the operation again.

Breast Augmentation Techniques

Experienced MTF surgeons custom design your Breast Augmentation surgery around your goals, going for a result that enhances your feminine curves.

Breast Augmentation is performed on an outpatient basis, under general anesthesia. An incision about 1" long is made and a "pocket" for the implants is made behind each breast. Incisions are made carefully to keep scarring as invisible as possible. Once the implants have been inserted and positioned, the incision is closed. The total surgery time is about 1 hour.

Breast Augmentation can take place at any point during your transition, and can also be combined with other surgeries, such as Body Feminization and Facial Feminization.

If hormone therapy did not result in much breast development, you may not have enough skin tissue to accept an implant as large as you might like. In this case, your Breast Augmentation Surgery can be broken into two stages, with skin expanders placed in the first stage. Positioned where your implants will eventually go, the expanders are gradually filled, slowly stretching the skin tissue on the chest to accommodate breast implants, which are placed in stage two.

All About Breast Implants

Breast implants have a silicone polymore outer "shell" and are filled with either silicone gel or saline. Silicone implants are firmer, with a smooth surface, and provide a very natural look. Saline implants are rounder and more fluid-feeling than silicone implants, but also have a greater risk of rippling, particularly around the outer edges of the implant. However, they are less expensive than silicone implants and require a smaller incision.

"[Dr. Meltzer] used 650 CC Mentor Memory Gel implants through the nipple. I have virtually no scars and they feel totally natural." - Patient of Dr. Toby Meltzer, 2020

Cohesive gel or "gummy bear" implants are also available. These are made of "highly cohesive" silicone gel and are designed to be very form stable. That stability also means a reduced spread of silicone in the case of a ruptured implant. They are more expensive than silicone breast implants though, and also require a larger incision.

How To Choose?

"Silicone implants are more expensive and require a larger incision and a more involved surgery," says Dr. Alvina Won, a cosmetic surgeon who performs gender-affirming surgeries in the Seattle area. "For our transgender patients, they are the most popular choice since they work best for someone who has minimal breast tissue to start with. They also have a very natural look and feel to them."

When choosing an implant size, it's important to consider the overall appearance of your physique so your breasts appear balanced and proportional. Breast implants also come in a variety of shapes, or profiles. A high profile implant has more projection and less width than a low or medium profile implant. Your surgeon will discuss with you how much breast projection, width and volume you would like and will make appropriate recommendations for breast implant size and shape. You will also be able to try out breast implants in the surgeon's office.

Breast implants can last a lifetime, but sometimes require replacement after about 10 years.

MTF Top Surgery Considerations

Location of Implant: Implants can be placed over the pectoral muscles (subglandular) or under the muscles. Submuscular placement creates a gentler breast slope and may appear more natural. This placement also provides more support for the implants.

Incision Placement: Incisions are most commonly made under the inframammary fold of the breast, which naturally conceals scarring. Implants can also be placed through peri-areolar incisions (around the edge of the areola-nipple complex) or trans-axillary (under the armpit.)

Recovery from Breast Augmentation

When you wake up from surgery, you will have bandages and will be wearing a surgical bra that you will have on 24/7 for about two weeks and then only during the day for another four weeks.

After discharge, bed rest is recommended for the first few days after surgery. Plan on having someone stay with you during this time to provide assistance. You won't be able to drive for the first week after surgery; plan accordingly.

The day after your surgery you will be seen by your surgeon and have dressings changed.

You will need to avoid stretching your arms above your head and heavy lifting for the first two weeks after surgery. Two weeks after your surgery, you will be able to resume light exercise like walking.

Those with desk jobs or similar can return to work in as little as 5-7 days. More strenuous exercise and activities should be delayed for at least six to eight weeks.

Your breast shape and size will be settled by about 10-12 weeks.

Potential Complications

MTF Top Surgery, like any surgery, carries some risk but comparatively the rate of complication is quite low. Potential complications include:

• Need for revision surgery
• Capsular contracture: scar tissue that forms around the implant and squeezes the implant
• Breast pain
• Negative changes in nipple and breast sensation
• Rupture with deflation of saline-filled implants
• Rupture with or without symptoms (silent rupture) of silicone gel-filled implants

Also see: FDA list of local complications and adverse outcomes that occur in at least 1 percent of breast implant patients at any time.

Eligibility for Breast Augmentation

• Patients must be physically healthy, and have realistic expectations of outcome;
• 18+ years of age;
• Capacity to make a fully informed decision and to consent for treatment;
• If you smoke, you will need to quit, preferably for good.

If your surgeon follows the WPATH Standards of Care, or if you are using insurance to pay for surgery, you will need to provide a letter from a qualified mental health care provider that supports additional criteria:

• Persistent, well documented gender dysphoria;
• Significant medical or mental health concerns must be reasonably well controlled.

Although not an explicit criterion, a minimum of 12 months of feminizing hormone therapy prior to breast augmentation surgery is recommended, to maximize breast growth in order to improve aesthetic outcome.

What to Look For in a Breast Augmentation Surgeon

• Board-certification in Plastic Surgery
  
• Ample experience working with trans patients, preferably specializing in transgender surgeries, with extensive training in transgender procedures including MTF Breast Augmentation.
  

Breasts can play an important role in how women view and express themselves, and MTF Breast Augmentation is a reliable way for you to achieve the breast look and feel you desire.

 

Last updated: 06/22/22