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.