What is the Best Approach for a Transgender Patient to Get the Best Most Natural Feminine Result from Saline Implants?

I am a 5"9 238 transgender patient who has a A cup and wants a D cup. I want the most natural looking approach with saline implants, should I go above or below the muscle? Are transgender muscles harder to cut? I don't want my breasts to give me away. One surgeon says my skin is thick, but I don't want hard breasts. I've been taking hormones for 5 years now so I'm natural boobs are extremely soft. How many cc should I use to get the result I want. Given the info here what suggestions would you give me?

Doctor Answers 3


Without photos or a face to face examination it is impossible to make specific recommendations. Generally speaking you can only put in an implant that your body can hold. If you try to put in something larger you create problems like skin stretchmarks, indented ribs, bad skin scars etc. The factors that go into choosing implant size are the size of the rib cage, breast base width, size and laxity of the skin envelope and where the nipple sits on that envelope. Given your height and weight I suspect you should be able to fit a larger implant than most.

The main problem in transgender patients is getting natural looking cleavage and a slight droop to the breasts. Part of the end result is also due to how your body responds to the hormones you take in the transgender process. The best end result may require a combination of fat grafting and placement of breast implants.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

Best Breast Implant Size/ Profile for Me (Transgender Patient)?

Generally speaking, the best online advice I can give to transgender patients who are considering  breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you're looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals  with your plastic surgeon. This communication will be critical in determining  breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as  “natural”  or "D cup”  etc means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

3.  Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery.

I hope this (and the attached link) help.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,485 reviews

How to achieve natural feminine results in transgender breast augmentation patient.

Because of your height and weight, you need large breasts in order to be proportional to your physique, and single stage augmentation may not be physiologically possible, even with soft tissues. That being said, physical examination would confirm whether or not large(r) implants placed in a single stage is anatomically possible, or if this might better be performed via tissue expanders at one operation, outpatient expansion of your skin and muscles, and then second-stage placement of the appropriately-larger implants.

I would definitely recommend cohesive silicone gel below the muscle. Silicone implants cannot leak, do NOT require MRI evaluation (since they cannot leak), and have the softest and most natural "feel." Above the muscle has a much higher potential for capsular contracture (CC), and saline implants above the muscle have higher CC risks, as well as higher potential for palpable ripples, an unnatural water-balloon feel or hard feel (if overfilled too much), and the potential for leak and deflation requiring re-operation for new implant(s).

Just choose silicone in the first place, and ensure that you go to a surgeon who has extensive experience in dealing with transgender patients--this is not just implants like any other woman--trans women have unique issues that require being aware of. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 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.