Transgender (M-F) Breast Augmentation

Transgender breast augmentation differs from breast augmentation in genetic females in important and unique ways. Male-to-Female transgender patients often undergo hormone therapy as well as testosterone-reducing medications as part of their transition process. Female hormones can stimulate some degree of breast development, while softening the skin and diminishing muscle bulk. Usually, hormone-induced breast enlargement in transgender patients has reached its maximum after 18 months of hormone therapy; less than a cup, or no more than cup and a half bra size enlargement is usually seen.

This breast size may be inadequate and still-disproportionate, especially in tall patients with wider chest dimensions, thicker pectoralis muscles, and tighter breast/chest skin; breast augmentation to enlarge the breasts is possible, but requires knowledge and experience with the anatomic details and characteristics in transgender females who request breast enlargement with implants.

Many transwomen have sufficient softness of their skin and muscle to perform single-stage augmentation with saline or silicone gel implants of the desired size and dimensions to create beautiful, proportionate breasts with attractive cleavage. However, after over three decades of experience with transgender patients, we have found that it is wrong to assume this is true for every transwoman requesting breast enlargement, especially to a size proportionate for a larger, taller frame.

Transgender (M-F) Breast Augmentation Photos

1 of 5 Cases

Before (after hormones only)

After (4 months after 2nd stage)

Before (after hormones only)

After (8 months post-op)

Before (after hormones only)

After (5 months post-op larger implants)

Before (after hormones only)

After (1 week after second stage)

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Transgender (M-F) Breast Augmentation 124

This 25 year-old M to F transgender patient has been living as a female for several years, has been on hormone therapy for nearly 2 years, and came to Minneapolis Plastic Surgery for breasts that were more proportionate with her chest and overall size. Estrogens had caused some breast enlargement, but this was now stable and insufficient for the patient's desired goal of a full C-cup. Because of tight skin and muscle, and high infra-mammary creases, two-stage augmentation with tissue expander placement at one operation, outpatient expansion over several months, and placement of final silicone breast implants at a second operation was recommended. In this type of anatomy, this approach often avoids multiple re-operations for inadequate size, malposition, or firm, unnatural-appearing breasts that can occur when single-stage augmentation is attempted. Two planned operations are less costly than multiple unanticipated operations and re-operations. Post-op photographs are 4 months after her second stage procedure.

Transgender (M-F) Breast Augmentation 125

This 29 year-old M to F transgender patient has been living as a female for several years, has been on hormones for the past year and a half, and has noted no additional breast growth for the past 4-6 months prior to coming to Minneapolis Plastic Surgery for breast augmentation. Because of her tight skin and minimal nipple-to-crease distance, we recommended tissue expander placement, outpatient expansion over several months, and then a second operation to remove her expanders and place permanent implants. She was moving out of the country within the year, and instead requested single-stage placement of breast implants. The post-operative results are good, though you can see a slight indentation (inferior pole concavity) in her new breasts where her old crease was located. Tissue expansion generally improves or prevents this concern, and can allow larger augmentation if desired. This patient was extremely happy and proceeded to genital surgery (elsewhere) and her move overseas.

Transgender (M-F) Breast Augmentation 126

This 68 year-old M to F transgender patient spoke with the staff at Minneapolis Plastic Surgery several times over the years during her transition, and at the time of evaluation for breast enlargement, had been on hormone therapy for over a year with minimal breast growth. Her medical history was significant for cardiac rhythm problems for which an implanted ICD was placed over her left ribcage. Despite her age and heart concerns, she came to MPS cleared for surgery by her cardiologist, and subsequently underwent single-stage breast implant placement in our nationally accredited (AAAASF) office surgical facility under a light general (TIVA) anesthetic given by our superb head of anesthesia (former Mayo cardiac CRNA). A Medtronic technician was present to verify proper function of her ICD during and after surgery, which proceeded uneventfully. 6 months later, she underwent genital surgery (elsewhere), and shortly after that returned to MPS for larger breast implants. She is now "the happiest I have been my whole life."

Transgender (M-F) Breast Augmentation 127

This 38 year-old male to female transgender patient has been on hormone therapy for some time, and developed nearly no breast tissue for her 6'0" height and chest/breast base diameter. Single-stage breast augmentation was judged to be inadequate to give a pleasing, feminine, proportionate result, so two-stage surgery was recommended as a way of minimizing the likelihood of multiple unplanned operations that may have followed failed single-stage implant placement. Crescent-shaped expanders were placed in her first surgery, then gradually expanded over two months. 7 months after her first surgery, her expanders were removed and 700cc moderate plus profile cohesive silicone gel prostheses were placed in a second operation. This size of implants would not have been possible with a single stage (or would have yielded a hard, round, unnaturally tight appearance, usually leading to multiple unanticipated re-operations). Post-op photographs are shown at one week after her second operation. Inframammary scars are still pink but barely visible.

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Individual results may vary.

Some M-F transgender patients may not be able to achieve the desired natural results (in terms of size, proportion, and softness) with single-stage implant placement. This may be due to thicker pectoralis muscles and more taut skin that will not allow large enough implants. In these cases, replacing the initial too-small implants with larger ones at a second operation in 6-12 months (once tissues have stretched, softened, and scar tissue matured) can achieve the desired size. Adjustments in pocket size, shape, or position can also be carried out at this second (optional) procedure.

Another subset of transgender breast augmentations patients will benefit from a planned two-stage procedure, rather than hoping for adequate size and natural appearance with too-small, too-tight, wide-cleavage implants in one operation, followed by multiple (expensive) re-operations to try to correct problems associated with a failed or inadequate single-stage operation.  These transgender patients will benefit from placement of crescent-shaped submuscular tissue expanders in the chest/breast area at one operation, followed by healing for 2-3 weeks. Then, outpatient expansion of the tissues is carried out over several weeks to months as sterile saline is injected into the expander via a remote or integral filler port, gradually stretching the overlying tissues much like abdominal tissues stretch with pregnancy. When adequate tissue capacity and softening has occurred (usually several months to as long as a year), a scheduled second operation is then performed to remove the expanders, make any pocket adjustments needed for optimal position, and place the final appropriate-sized implants. Of course, touch-up or revisionary surgery is always possible with any surgical operation, but this planned 2-step approach has been shown to actually reduce the need for multiple unplanned operations in appropriately-selected patients.

Cost for Transgender Breast Augmentation

Total cost for single-stage transgender (M-F) breast augmentation with cohesive silicone gel implants is approximately $10500; two-stage placement of tissue expanders (1st operation) is approximately $11000, with second stage removal of expanders and placement of permanent silicone gel prostheses (2nd operation) approximately $8500. While the two-stage process is more costly and time-consuming than a single stage, we have found that in the appropriate patients who are better served by tissue expansion to create proper-sized pockets for proportional and beautifully-shaped breasts, total costs and time to achieve the desired result is actually less than 3 or 4 individual $8000 to $10000 operations, not to mention the time off work or social activities! Exact cost quotes are always given at the time of complimentary consultation with our American Board of Plastic surgery-certified plastic surgeons. Financing options are available.

Because of the high demand for free consultations with our plastic surgeons, our staff will ask for a credit card number in order to schedule a consultation; there is no charge whatsoever for appointments that are kept–you will be charged $100 only if you fail to keep a scheduled appointment, or fail to cancel at least 48 hours in advance of your appointment time–for Monday appointments, you must cancel no later than noon on the previous Thursday; for Tuesday appointments, you must cancel by noon on the previous Friday.