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.