Breast Augmentation for 40 year old male. No HRT

Question

I would like to get small breast implants (cup A) in order to appear more feminine. I currently present as male and I am not on Hormone Replacement Therapy. The ambiguity of my situation made me afraid to reach out to a surgeon for fear of being rejected. Is it realistic to find a specialist in the U.S. who would perform breast augmentation on a male as a gender affirming procedure? Will I need additional proof from a mental health counselor? I'm in Minnesota but I am willing to travel.

Ellen Ozolins, MD · Answer

Thank you for your question. Yes, it is realistic to find a surgeon in the U.S. who will perform breast augmentation as a gender-affirming or aesthetic procedure for a male patient, even if you are not HRT. Surgeons base their decisions on your overall health, skin and tissue characteristics, and aesthetic goals. Some surgeons may ask for a letter of support from a mental health provider if the procedure is part of gender affirmation. However, this is often not a barrier, especially for smaller implants (e.g., A cup). Focus on finding a surgeon experienced in gender-affirming or aesthetic surgeries who respects your goals and provides a tailored, supportive approach. Be prepared for a standard health assessment, including a physical exam, lab tests, and potentially imaging if needed. Share your desired outcome (e.g., small A cup, subtle femininity) and provide reference photos if possible.

David J. Levens, MD · Answer

We do perform gender confirming breast surgery on adults including breast augmentation for transgender women and breast reduction for transgender men. We definitely prefer an evaluation with a gender affirming medical and/or mental health specialist before proceeding with surgery. We do offer free virtual consultations.

Krishna Vyas, MD, PhD, MHS · Answer

Yes, it is possible to find a specialist in the U.S. who can perform gender-affirming breast augmentation. Hormone Replacement Therapy (HRT) is not a requirement for chest/breast surgery, but if you are planning to start or stop hormone therapy, it is best to wait at least 6 months prior to scheduling surgery, as the hormone changes the breast anatomy, size, and shape.
Regarding the need for a mental health counselor’s approval, the requirements can vary depending on the surgeon or clinic. Some may require a letter or confirmation from a mental health professional, especially if you're seeking gender-affirming surgery for gender dysphoria. 
It’s important to find a surgeon with experience in gender-affirming surgeries, especially those with experience in male-to-female breast augmentation. You can search for a plastic surgeon who specializes in transgender care and breast surgery (use resources such as WPATH or medical or LGBTQIA+ organizations). 
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Bruce B. Kadz, MD, FACS · Answer

You will need an evaluation and recommendation by a professional. It's generally best to be on hormones for a while prior to Augmentation since it makes the pockets softer and with better soft tissue coverage. We do a lot of these procedures.

George Lefkovits, MD - Account Suspended · Answer

First, I don't think you should fear being rejected by a Plastic surgeon, I do think you should seek consultation before embarking on breast augmentation and possibly consider HRT. But breast augmentation could certainly be an option to appear more feminine. And I would suggest small implants. Good luck!

Breast Augmentation for 40 year old male. No HRT

Answers (5)

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