I Am a MtF Transgender Wanting Breast Implants - Options?

I would like to go as big as possible however I do not have a large amount of breast tissue and would preferably go over the muscle because of recovery and I do like to work out I am quite leand and 6ft 2 tall - however if I went under the muscle i would have more tissue to cover the implant I am definitely thinking silicone not saline. Any help would be appreciated xxx

Doctor Answers 10

Transgender breast augmentation options.

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I have been doing transgender breast augmentations for over two decades, so hopefully I can offer some useful thoughts.

First of all, transgender or not, below the muscle does NOT automatically imply "longer" or "more difficult" recovery. This is true for all augmentations, not just transgender patients. Careful surgical elevation of the pectoralis major muscle with precise control of bleeding points (as well as use of IV Decadron, oral Robaxin, oral Celebrex, and Marcaine in the breast implant pocket) makes this operation as "easy" (or hard) as submammary placement. Activity restrictions are identical in my practice for either implant placement position.

For a physically tall and probably wide breast base woman, particularly if you have thick or strong pec muscles and tighter, youthful skin, you need large implants to be proportionate. Although physical examination is needed to make a proper determination, you may wish to consider two-stage surgery, with placement of crescent-shaped tissue expanders below the muscle (inferomedial fibers divided), outpatient expansion, and then second stage placement of adequately-sized silicone gel implants (round, smooth, cohesive 5th generation). These will be teardrop-shaped when upright, but round when reclining, whereas shaped implants are textured to "stay in place" and remain teardrop-shaped when reclining (unnatural, IMHO). Not to mention, they don't move like real breasts because of the textured adherence to your tissues.

Although this seems like two guaranteed operations (it is) and no guarantee that revisions will be necessary (also true), I have looked at two decades of data and found a rather unfortunate tendency of so-called "single-stage" augmentations (in our transgender population) that ended up with 2, 3, or even 4 operations to get the final size, shape, and position required to look proportionate and natural for your height. Or, you can get the single-stage "Betty Boop" firm, tight, too-small look that leads to those multiple re-operations.

This 2-stage approach is not needed by every M-F transgender augmentation patient, but I find it beneficial in about half of my patients and they are happier for it as a result. Click on the link below for examples of my patients. Best wishes!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Breast augmentation for SRS

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I have been caring for patients with with GID for over twenty years and also have a busy breast augmentation practice.  It is rare that I recommend an under the muscle approach for the following reasons:

1) under the muscle is more painful;

2) under the muscle bleeds more and has a higher risk of post-op bleeding;

3) there is a potential space behind the muscle that extends into the neck, making implant migration more likely;

4) muscle activity can move the implant;

5) muscle activity during exercise distorts breast contours even in the best outcomes (and forever);

6) the breast is a modified skin organ and is naturally located on top of the muscle;

7) (IMPORTANT POINT) the pectoralis muscle in genetic males is very much more developed than in the genetic female, so going under the muscle in a patient transitioning MtF means working through a much more robust (read: strong; bloody) muscle.

New generation cohesive gel implants are so soft and have so few problems with wrinkling and rippling that they are very  well tolerated on top of the muscle, even in very slender patients. 

For the MtF patient implant size can be limited by the amound of available skin: overwhelming the skin envelope leads to an unnatural result.  Of course implant base diameter has to be sized to the patient's chest, but the volume that can be accomodated will depend on the overlying soft tissues.

Bottom line: for patients in MtF transition I never go under the muscle.


Feel free to contact me for additional information.


Dan Greenwald, MD FACS

Information on MTF Breast Implant Surgery

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It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery for MTF patients including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain the below link.

MTF breast implant options

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The size of the implant will depend on many factors, including the width of your breast.  The approach needs to be individualized for each person.  

Josef Hadeed, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Can you help with transgender breast augmentation?

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There are multiple considerations to determine who gets  breast implants In MtF Transgender. To me this is not a good forum to deal with this. A relationship with a Board Certified Plastic Surgeon is a necessity. In my practice the communication between myself and your evaluation and ongoing support from a mental health expert is a requirement. I need to know that the individual for whom I'm providing a service has the support to better deal with what is being confronted. The factors you outlined above are best approached between you, your Plastic surgeon and your health care provider.

Sizers are an important part of the process

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Generally speaking the advantages of going over the muscle are very few.  The recovery from sub muscular breast implants is not significantly different, but the longterm advantages are many.  I would suggest a sub muscular implant, even in patients that work out.  You need to try sizers on to determine which would be best for you.

I Am a MtF Transgender Wanting Breast Implants - Options? #transgender# breast augmentation

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At this current time, there are more options than ever before for breast augmentation.  There are saline (salt water) filled implants and silicone gel filled implants.  There are textured and smooth implants as well as round and, now, shaped implants.  So many options to choose from regarding implant types.  There are different options regarding technique as well.  For example, the incision to place the implants can be in the under-arm, around the areola, through the belly button, and in the breast crease.  The size of the implant depends on the broadness of your shoulders and the width of your breast.  Matching this to the shape of your body is another issue. Much will depend on the size you are requesting as far as the cup size.  Your surgeon should be able to help decide, with your input, the actual size of your implant.

Breast Augmentation for transgender

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I have had the privilege of taking care of transgender patients in all different stages. I have used both saline and silicone implants in the submuscular position with nice results.. it depends on what the patient is looking for. Sometimes a staged procedure is necessary to achieve the final goal - for example, if a patient wants a larger look than we can achieve on the first surgery, we can re-assess the situation after 6-8 months to see if the body will allow for a larger implant.

"I want to be as big as possible"

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I have zero experience with GID but it seems to me if your skin envelope is tight and you want to be as big as possible, would you consider wearing  a BRAVA to expand the envelope prior to augmentation and possibly to add fat to subcu space for better coverage?

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon

Breast implants

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It is hard to tell without looking at photographs. But from my experience with M to F going under the muscle is preferable for adequate coverage of the implant. I also agree that a silicone contour profile implant will give the most natural appearance.

Of course taking your chest measurements will help determine the size appropriate for you.

Good luck! 

Dana Khuthaila, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 76 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.