Breast Enlargement for Gender Affirmation
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What Is Breast Enlargement for Gender Affirmation?
Breast enlargement for gender affirmation is a surgical procedure that increases the size and alters the shape of the breasts. This procedure is most popular among transgender women or transfeminine individuals who want larger or more shapely breasts. Breast enlargement can be a powerful tool to help ease feelings of gender dysphoria or body dysmorphia related to transition.
What Can a Breast Enlargement for Gender Affirmation Achieve?
The goal of breast enlargement for gender affirmation (sometimes called 'MTF top surgery') is to increase the size and change the shape of the breasts to make them look more feminine. Many individuals may consider this surgery after they have used hormone therapy to help increase the size of their breasts. If you find that hormone therapy alone does not create the result you desire, you may want to consider having a breast enlargement.
Your surgeon may suggest that you have at least 12 to 18 months of hormone therapy before having surgery. This allows for breast tissue to develop before increasing the size of the breasts with implants.
There are two hormones that have an effect on the size of the breast:
- Oestrogen – This helps increase fat levels in the breasts, hips and buttocks.
- Progesterone – This helps the milk glands growth of milk glands and the rounding off of the breasts into an adult shape. It also matures and darkens the areola around the nipple.
What does breast enlargement mean to you?
It's important to know there is no strict order, checklist, or "right" way to approach surgery for gender affirmation. Your identity is not made more or less valid by the surgery you choose to have; this is simply an aspect and reflection of your individuality and identity.
Each individual has a different relationship to gender affirmation surgery and your priorities may be very different from those of your peers. Therefore, you should only consider breast enlargement if/when you feel you want to increase the size of your breasts.
At the moment, the only gender affirmation surgery currently offered by Medbelle is breast enlargement. Consequently, this overview only focuses on increasing breast size and not other treatments associated with gender affirmation.
Breast Enlargement for Gender Affirmation Candidates
Who are the best candidates for this surgery?
The ideal candidate is a healthy transgender woman or transfeminine individual who wants larger breasts and/or someone who has not achieved their breast size goals from hormone therapy alone. Though not a prerequisite, many trans individuals will have been on hormone therapy before looking into having breast surgery. Hormone therapy can help increase the size of existing breast tissue which can make it easier for a surgeon to increase breast size with implants.
Other features of ideal candidates for surgery include those who:
- Are over the age of 18
- Are Medically and emotionally healthy
- Have access to ongoing psychological support
- Have strong social support from friends and/or family
- Are at a stable weight
- Have a healthy BMI
- Have a referral letter from a specialist health professional
All of our Medbelle surgeons adhere to the guidance provided by The World Professional Association for Transgender Health (WPATH). By doing this, they can ensure that you are in the best position possible when you have surgery.
Why have breast surgery?
Breast surgery is a popular option to help any individual achieve a specific look to their breasts, including transgender women and transfeminine individuals. For transfeminine individuals, breast surgery can be especially powerful with regard to easing gender dysphoria or body dysmorphia, though you may be motivated by simply wanting to increase the size or alter the shape of your breasts. No matter the reason, breast enlargement can help many patients feel much more comfortable with their body.
It is vital to tell your surgeon what you hope to achieve from surgery during your consultation. They will discuss all aspects of the procedure with you and recommend the best course of treatment to get you the results you want.
Breast Enlargement for Gender Affirmation Procedure
How is breast enlargement surgery performed?
Breast enlargement surgery generally lasts 60 to 90 minutes.
Your surgeon will also give you information about what the procedure itself will involve. They will also give you strict instructions on what you can eat and drink before and on the day of your surgery.
Before you have your treatment you will need to sign a consent form. Before signing this, it is important that you understand the benefits and potential risks of the procedure. Your surgeon will go through these with you. Make sure that you ask any questions if you are unclear about anything. Your surgeon will then draw guidelines on your chest to mark where the incisions will go.
On the day of your procedure, you will meet your anaesthetist. This is the doctor who is responsible for putting you to sleep or numbing you during the operation. Depending on what you agree on with you surgeon, the procedure may either be done under a general anaesthetic or local anaesthetic with sedation.
All Medbelle surgeons aim to minimise scarring as much as possible. Generally, your surgeon will improve the aesthetic appearance of your breasts by placing incisions in the most hidden places. This may include making incisions in the following areas:
- Periareolar incision (around the border of the areola)
- Inframammary incision (just underneath the breast in the inframammary fold)
- Transaxillary incision (in the armpit)
Your surgeon will discuss which option is best for you and discuss the risks and benefits of each type of incision.
4. Implant placement
There are three different positions your surgeon can place the implant as seen in the diagram below: Over the muscle, under the muscle, or a combination of both.
The position that your surgeon will decide to use depends on which one will produce the best results for you. The options your surgeon can use are:
Over the muscle (Subglandular or Submammary)
An implant that is over the muscle can help improve the shape of the breast as it is nearer to the surface of the skin. Implants in this position can also lead to less postoperative pain in the first few days. The implants are also less likely to move when you flex your chest muscles. They are, however, more likely to be visible and more likely to interfere with future mammograms.
Under the muscle (Submuscular or Subpectoral)
Implants that are placed under the muscle have a much lower risk of being visible after insertion. This is because the chest muscle provides brilliant extra soft tissue padding over most of the implant. Implants in this position are also less likely to interfere with mammograms.
In some individuals, surgeons may opt to use a combination of both approaches mentioned above. This involves your surgeon placing the top of the implant below the muscle, and the bottom of the implant in direct contact with the breast tissue.
Breast Implant Type
There are three different implant types that are currently available. During your consultation, your surgeon will discuss these three types with you and suggest which one will best suit your needs.
The three breast implant types are:
A saline implant is made up of an outer silicone shell filled with sterile salt water (saline). The silicone shell is inserted into the breast empty and then filled with saltwater through a valve. Saline implants are no longer often used as they are at a higher risk of rupturing and do not produce very natural-looking results.
These implants are made up of a silicone outer shell that is filled with a viscous silicone gel. Silicone gel implants look and feel more natural than saline implants. They are also less likely to rupture.
Highly-Cohesive Silicone Gel
These are the most natural-looking and feeling type of implant. These implants contain a firm silicone gel that gives them a more stable form. Highly-cohesive silicone gel implants are the least prone to rupture, and even when they do, the contents do not leak out as readily.
Breast implants come in two shapes as seen in the diagram below: round or teardrop (also called anatomical)
Your surgeon will be able to recommend which implant shape can help create the look you want to achieve.
Round breast implants add volume to the lower and upper parts of the breast. It is for this reason that they are considered to be best for patients wanting to add overall volume to their breasts.
They are particularly suitable for patients who want to increase the volume in the upper pole meaning the upper part of the breast above the nipple.
Teardrop implants, also known as anatomical implants, add volume mainly to the lower pole meaning the lower portions of the breast below the nipple.
This shape generally provides a more natural-looking final breast shape.
7. Closing of incisions
After placing the implants into your breast, your surgeon will close the incision with sutures.
8. Return to the ward
When you wake up from your anaesthetic, you will be taken back to the ward to recover. You may be able to go home the same day, or you may need to spend an extra night in hospital. You will know before you have your treatment when you will be able to go home.
After your breast enlargement is complete, your surgeon will give you specific aftercare instructions which you must follow.
Surgeon Consultation for Gender Affirmation Breast Enlargement
What should I expect from my gender affirmation breast enlargement consultation?
If you think that breast enlargement is right for you and your transition, then you will need to have a consultation. This is usually a 15 to 60 minute meeting with a BAAPS/BAPRAS surgeon. In this consultation, you will discuss your motivations and expectations of breast enlargement surgery. Your surgeon will also ask you some questions which may include the following:
- Do you have any current medical conditions?
- Are you taking any regular medications? (Including herbal remedies and vitamins)
- Do you currently smoke?
- Do you currently drink alcohol or use recreational drugs?
- Is there anything you are allergic to?
- When did you begin your transition?
- Are you currently on hormone therapy?
- What would you like to achieve from the surgery?
Your surgeon will take into consideration your answers to these questions, examine your breasts and then recommend the best treatment plan for you. They may also take some photos of your breasts for your medical records.
How will my surgeon decide what implant size is right for me?
After discussing your desired breast size with your surgeon, they will take measurements of your breasts and recommend an appropriate implant size. Some surgeons will have implant sizers available during the consultation. You can try these different sizers on during the consultation to help you make your decision.
Some surgeons also have 3D imaging available which can also help with your decision. This device takes pictures of your breasts from different angles and formulates a computer image of what they would look like after surgery. The breast size in the images can be altered to show you what different sized implants may look like on you.
Although breast sizers and 3D imaging can help give you an idea of what your breasts might look like after surgery, these techniques are not 100% accurate and you should be aware that the final results may be different.
What questions should you ask during your consultation?
It is important that you are fully informed about the procedure and the potential risks it carries before you go ahead with surgery. We therefore recommend that you jot down a few questions to ask your surgeon during the consultation. A few questions that may be useful to ask include:
- Do you think what I want to achieve is realistic?
- What can I do to get the best results possible?
- What will my final scars look like?
- Have you done this surgery before? Are there any photos I can see?
- How long will my recovery take?
If you think of any other questions, write them down and take them with you to your consultation.
Risks & complications
Breast Enhancement for Gender Affirmation risks and complications
What are the main risks of a breast enlargement?
As with any surgical procedure, a breast enlargement carries some potential risks and complications. These may occur during or after the operation. It is important that you are aware of these in order to make a fully informed decision before you go ahead with surgery. Your BAAPS/BAPRAS surgeon will talk you through the gender reassignment male to female risks and complications. The gender reassignment male to female risks can include, but are not limited, to the following:
Capsular contracture is the most common long-term complication associated with breast implants. This occurs when your body creates a layer of scar tissue called a “capsule” around the breast implants. This scar tissue has a tendency to contract. The degree of contraction varies greatly from patient to patient. For some, this may result in a hard or painful feeling in the breasts.
As your surgeon will have to make an incision for this, scarring is unavoidable. Cosmetic surgeons aim to hide scars as much as possible and for most patients scarring is mild and fades over time.
Bleeding & bruising
Bleeding and bruising is common after this type of operation. In most cases, this is only mild, however it can become quite significant. If you begin to experience any sort of bleeding or bruising that concerns you, you should notify your surgeon straight away. Adhering to your surgeon’s advice regarding medication will reduce the risk of bleeding.
If you develop an infection after surgery, it is important to take this seriously. Often, infections are minor, allowing your surgeon to treat it easily with antibiotics. If this is left untreated however, it can spread and become very serious. It is therefore vital that you notify your surgeon if you notice any of the following:
- A temperature over 38 degrees
- Redness or swelling that is moving away from the incision site
- Foul-smelling discharge coming from the drains or incisions
- An increasing amount of pain or discomfort that does not go away after taking painkillers
Changes in sensation
It is quite common to experience some changes in sensation after surgery. These changes can include:
- An increase in sensitivity
- Pins and needles
Changes in sensation can occur if your surgeon damages a nerve during surgery. If any of the above occur, they are often temporary but they may take a while to subside. In some rare cases however, the changes may become permanent.
You should always keep in mind that you may be unhappy with your final results. You may not be happy with the final size, shape or symmetry of your breasts. This is the main reason why it is vital that you clearly communicate what you want to achieve to your surgeon, who will then tell you if what you want is achievable or not. In order to give yourself the best chance of being happy with your final result as possible, you should choose a highly-experienced and qualified BAAPS or BAPRAS surgeon.
The most common long-term complication of breast implants is capsular contracture. This occurs when a fibrous scar shell, or capsule, forms around the implant once it’s inside the breast. This capsule has a tendency to contract, which can lead to the breasts feeling very hard and painful.
A rupture occurs when the shell of the implant is split open or broken, leading to the contents of the implant leaking out. This may occur due to direct injury to the breasts, or damage to the implant itself before your surgeon inserts them into the breast. If a rupture occurs, you must have the implant removed or replaced.
Breast Implant Associated Anaplastic Large Cell Lymphoma is a rare type of cancer that is associated with breast implants. This association is still in the early stages of research. It is however important to be aware that this is a risk. Your surgeon will be able to discuss this in greater detail with you during your consultation.
Implant specific complications
There are a few more complications that can occur with breast implants. These include:
You can find more information on these complications here.
Make sure you read through and understand all the gender reassignment male to female risks and complications before you consent to having surgery.
Breast Enlargement for Gender Affirmation preparation
How can I prepare for my gender affirming breast enlargement?
Breast enlargement is an invasive procedure and it is important that you properly prepare for it. It is a good idea to put some things in order at home in the weeks and days before your surgery. We have put together a list of preparation tips below for you to consider before your gender affirmation breast enlargement. These tips may make your initial recovery at home easier.
Before having your breast enlargement, your surgeon may require that you be on hormone therapy for at least 18 months. There is a chance that the resulting breast development from hormone therapy will give you the size breasts you want. However, If you are still unhappy with the size or shape of your breasts after taking hormones for over a year, then the breast tissue that developed will make it easier for your surgeon to increase their size via implants.
You may find that seeing to some household chores prior to your surgery may make it easier for you to recover once you arrive back home. Some tasks you can take care of around the house include:
- Taking out the rubbish
Food and shopping
You will be unable to lift heavy bags for a few days after your operation. Therefore, it may be a good idea to do a big food shop before you come into hospital. Some individuals find batch cooking a few meals and keeping them in the freezer helpful as then you don’t need to worry about cooking when you get home.\
In the weeks leading up to your operation, it is important that you eat a healthy diet. This includes eating lots of lean protein, fruits and vegetables. Where possible you should reduce the amount of salty and fatty foods that you eat.
Furthermore, it is vital to stay well hydrated and drink lots of water and caffeine-free fluids. To further reduce the risk of complications, you should reduce your intake of alcohol while you heal.
You will not be able to drive straight after your operation. This means you must arrange for a friend or family member to take you home after your surgery. Your surgeon will be able to tell you exactly when it is safe for you to drive again.
Children and pets
It will be difficult for you to take care of young children and pets whilst you are recovering. In the few days immediately after your surgery, you may feel more tired than normal. As a result, you may benefit from asking a relative or friend to look after your children or pets to allow yourself to take the time you need to rest.
Another gender reassignment male to female preparation idea is to make sure you have plenty of comfortable clothing for after the surgery. It may be easier to pick items that open easily from the front so that you do not strain your stitches. Slip-on shoes may also be useful so that you do not have to bend.
Rest and sleep
Initially, after surgery you may find it more comfortable to sleep in an upright position. You may find that having extra pillows on your bed makes it easier for you to rest and sleep in this position. You should avoid sleeping on your stomach in the initial post-operative period as this can impact your final results.
It is vital that you follow your BAAPS/BAPRAS surgeon’s specific advice regarding how to prepare for your surgery. If you have any questions you can contact your patient care adviser who will be at hand to help with any queries you have.
Breast Enlargement for Gender Affirmation aftercare
What can I expect after having breast enlargement surgery?
During your consultation, your BAAPS/BAPRAS surgeon will inform you of the aftercare process for your gender affirmation breast enlargement. Following your surgeon’s aftercare advice will help you get the best results possible and is just as important as the surgery itself. As you will have a very invasive procedure, it is vital to take it slow during the first few days.
Some important aftercare points you should consider include the following:
After having your treatment, you will be given a post-operative appointment. During this appointment, your surgeon or nurse will assess how you are recovering, check your incisions and address any complications that may have occurred. It is vital that you attend this appointment to ensure that your recovery goes as smoothly as possible.
How will I feel after the operation?
If you are given a general anaesthetic, you may wake up after the operation feeling very groggy and drowsy. This is normal and should wear off after a few hours. If your surgeon uses a local anaesthetic, the treated area may feel numb for a while before sensation completely returns to normal.
Your breasts are likely to feel swollen and look bruised. This is also normal and will subside over the next few days to weeks. If you are worried about the level of swelling or bruising present, you should notify your surgeon immediately.
How much time do I need to take off work?
This depends on what type of job you have. If you have a physically active role then you will need to take a full week off work. For low-impact or office jobs you should take around 4 to 5 days off to allow yourself to recover well.
You should refrain from even light duties for at least 2 to 3 weeks.
When can I start exercising again?
In the first one to three weeks you should not do any form of exercise. This is because even a little bit of aerobic activity can increase the amount of swelling around your breasts. However, to prevent blood clots, we recommend that you do not spend all your time in bed. You should start light walking as soon as possible, every few hours whilst you’re recovering.
After week three, you can start sports which do not require any vigorous movements (e.g. cycling). You should continue to avoid other sports especially contact sports.
After week six, all sports and exercises should be possible again.
Will I have to wear a post-operative bra after surgery?
You will need to wear a post-operative bra immediately after your surgery. The amount of time you need to wear this garment depends on what your surgeon specifically recommends.
In general, you may need to wear the bra day and night for the first week after surgery. After the first week, you may still need to wear the bra during the day for the next 2 to 4 weeks.
It is very important to listen to your surgeon's advice in order to ensure your healing progresses well.
You will have some scarring on your breasts after your treatment. As part of your gender reassignment male to female aftercare advice, your surgeon may recommend some techniques that can aid in the healing of these scars. This may include the following techniques:
- Scar massage
- Silicone sheets, gels or creams
Your surgeon will also advise that you keep your scars out of direct sunlight to prevent them from darkening. Keeping your scars out of the sun will also protect the healing skin from skin cancer. If you do expose them to the sunlight, make sure that you wear a high-factor sunscreen to protect them.
For the first few days after surgery, your breasts may feel swollen, over-enlarged and tight due to the post-operative swelling. You may also find that your breasts feel very sensitive for several weeks and it may take time for this to settle. It is worth noting that it can take 2 to 9 months until everything completely settles and you can appreciate the final results.
Breast Enlargement for Gender Affirmation FAQs
What are some common FAQs regarding a gender affirming breast enlargement?
Deciding to have a breast enlargement can be a big decision. It is therefore important to ensure that you get answers to all of your questions. Below, we have put together a list of gender reassignment male to female FAQs which you may find useful. If you have more questions that do not appear on this list, you can reach out to your patient care adviser or ask your BAAPS/BAPRAS during your consultation.
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