I'm Transgender, Currently Looking Forward On Getting Breast Augmentation, Over or Under The Muscle? (Photo)

Age:19 H: 5'9 W: 170 Beast Size: 36A Been On Hormones For 1 Year & 6 Months. - Desired Look is, Close Together Full Cleavage When Im Nude, Full Side View That Helps The Nipples Be In The Middle& Bottom Part Of The Breast Should Be Round, Also Full Giving The Nipple Natural Look & Not So Apart. Also I Want My Nipples To Be Even & Straight Forward. Any Risk? Over Or Under The Muscle? If I Get Under The Muscle, Would I Develop Bump Under The Breast in Time?

Doctor Answers 6

Transgender Breast Augmentation

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There are a few options regarding breast implants and as you see, each plastic surgeon offers a different opinion. There is not one right answer, and it really depends on each person and the examination. You will likely do well with silicone gel implants over the muscle. There are also now anatomic shape implants available that can give you a more natural result without the upper pole fullnes.  I have significant experience with transgender breast augmentation, but would really need to see you first before I can give you a definitive answer.

Transgender breast augmentation

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It's hard to give you an exact answer without seeing you as male breast tissue can be tight.  Having done many of these surgeries, I get the best results with saline implants over the muscle.   Good luck! 

Transgender breast augmentation

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Thank you for your question and photos.  For transgender breast augmentations, most surgeons prefer to place the implants under the muscle.  This provides ample tissue to help hide the implant and prevent excess visibility of the implant.  Placing the implant above the muscle can lead to more robust scar tissue around the implant, can cause it to be more visible and easier to feel.  

As far as the nipple position is concerned, your breasts have a "footprint" on your chest.  The position of the nipples and the breast cannot be readily changed to a more central position.  Many people desire a "full cleavage" look, but that can only be achieve up to a certain point if you have a naturally wide chest and breast position.  

Good luck to you.


Brian C. Reuben, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 37 reviews

As a transgender pt. should I have breast implants place above or below the muscle?

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Having reviewed your history and photos and having treated transgender patients for breast augmentation I would recommend going below the muscle because it usually feels more natural this way. Whenever a patient has very little breast tissue I find the"below the muscle" approach preferable. Of course, the final decision would be made at time of consultation. God luck!

Saline implants are generally placed below the pectoralis muscle all things being.

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If you choose saline implants I think you would be best going below the pectoralis muscle. If you choose silicone gel I don't think it makes a difference.

Best Breast Implant Position for Transgender Patient seeking Breast Augmentation?

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Thank you for the question and pictures. Having taken care of many transgender  patients, my approach to breast augmentation is the same.

I think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).

The submuscular positioning  also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

On the other hand,  the sub muscular (dual plane) breast implant positioning does have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle).

Again,  overall I think the advantages of sub muscular (dual plane) breast implant placement far outweigh the  potential disadvantages associated with breast implants  placements of glandular position.
I hope this (and the attached link) helps.

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.