When does an MTF patient normally engage in surgery (i.e. FFS, BBL, breast augmentation, etc)?

Thank you for your question.  In Canada, there is no firm rule.  Half of my patients are on hormones and and the other half of my patients choose not to take them.  An advantage of being on them is that the hormones may give you enough breast volume so you do not need breast implants.  It also helps to define the breasts.
Hormones will also change your fat distribution and this may also dictate a different procedure (when talking about facial feminization).
What won’t likely change with hormone replacement, especially if you are over 15-16 yrs of age, is your Adam’s apple, your nose and your frontal bossing.
Ultimately, it is a personal choice for my patients to go on hormones, something they discuss with their family physician and/or endocrinologist.
I hope this helps!
Kind regards,
Dr. Marc DuPéré, aesthetic plastic surgeon

 

In terms of Breast Augmentation surgery, I think it is best it patients have been on hormone therapy for at least 12 months. This allows for the development of their own breast tissue. This can be quite a variable response, and some patients may be satisfied with this alone. If a greater volume is desired it provides the grounding for a much more aesthetic and feminine result, because there is already a breast, however small. It is then not too dissimilar to a female with small breasts. Important differences are the muscle bulk and small wide set nipple areolas. 
If the overlying tissues are thin and there is a high change that the implant will be visible, it is best to place it under the muscle- however in genetic males, this may be quite bulky and it will also limit how far the implant pocket can be dissected medially. This can result in a high risk of animation deformity and a wide cleavage.The alternative is to place the implant under the new breast tissue only, this gives more control over the breast pocket, but the implant may be more visible. 
I hope this helps!

There are no standards for operating on transgender men and women.  In my experience, hormone therapy helps define the breast area and eases the surgical procedure with these operations.  HRT in MTF actually causes the breast tissue to enlarge and the soft tissue lying over the breast to soften, so placement of an implant is easier.  Testosterone therapy for FTM surgery causes the breast tissue to shrink and be more consistent, again helping to define the chest and pectoralis major muscle. However, I would not say HRT is a requirement for surgery.  That being said, I prefer all of my transgender patients to be on it because the aesthetic results are better.  Hope this helps!