Two years (HRT), is it time for breast augmentation (BA)? Or should I wait? (33MTF)

You have been on hormones long enough. However, size needs to be determined by you and your surgeon.  Your breasts are not symmetrical, and you have high inframammary folds.  Therefore, it is not a routine breast augmentation. Trans breasts are often much more difficult and require considerable experience.Gary J. Alter, M.D.Beverly Hills, CA - Manhattan, NYC

After two years of a stable hormone regimen, your breast development has likely reached a point where it may not progress much further naturally. At this stage, many individuals find that their breasts reach a plateau, and if you're not satisfied with the current appearance, breast augmentation could be a consideration. The implant size will depend on various factors like your body frame, chest width, and your goals for the result. Your surgeon will use a combination of techniques like physical measurements, external sizers, and photos to help you visualize potential results. You can also bring in "wish pics." It's also important to note that the choice of implant shape and profile (low, moderate, or high) will impact the overall look, so you should feel comfortable discussing these options with your surgeon.


ABOUT DR. VYAS
Dr. Krishna Vyas, MD, PhD, MHS, is a highly trained plastic surgeon specializing in aesthetic surgery and breast surgery, including breast augmentation, reduction, lifts, and gender-affirming surgery (such as chest masculinization and feminization). With advanced training from institutions like Harvard, Mayo Clinic, and Johns Hopkins, Dr. Vyas is recognized for his expertise in breast and chest sensory nerve restoration. His PhD in clinical and translational science focused on stem cells, fat grafting, and improving outcomes in aesthetic surgery and breast surgery. Dr. Vyas has served on the editorial board for several medical journals and platforms and has over 200 research papers and talks. His research focuses on aesthetic surgery, regenerative medicine, stem cell biology, fat grafting, breast surgery, and gender-affirming surgery. Recognized for his expertise, Dr. Vyas was appointed an Instructor of Surgery at Mayo Clinic and served as an Assistant in Surgery at Harvard Medical School and Massachusetts General Hospital.


Dr. Krishna Vyas, MD, PhD, MHS
Harvard, Johns Hopkins, & Mayo Clinic Educated
Double Fellowship Trained
Aesthetic Plastic Surgeon
New York, New York

Breast augmentation is a personal choice, and many factors can influence whether it’s the right time for you. If you feel that your breast development is not meeting your expectations, consider a consultation with a board-certified plastic surgeon who specializes in breast augmentation for transgender women.

It ultimately depends on your personal goals, body proportions, and how you envision your results. It's essential to discuss this in detail with your surgeon, as they can help you choose the size and placement that will achieve your desired look while considering your anatomy.

It
is really difficult to answer your question as there is a lot that goes into
sizing our patients.  We perform measurement, evaluate the skin envelope
elasticity, look at photos, look at what the patient came up with the rice
test, look at diagrams and finally use the Allergan/Mentor sizing system to
size the patient in the office.  We obviously listen and discuss exactly
what the patient wants and doesn’t want so that we can deliver the expected
results.
Your
best path to determine what size would work and how big you can be would be to
seek out a board certified plastic surgeon to discuss your options.  Make
certain the surgeon you choose has great deal of experience in breast implant
surgeries.
Hope
that helps.

Dear Atomic princess,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for the questions and photos. It appears you have had an excellent response to your hormonal treatment! You may proceed with augmentation.  
Your plastic surgeon will determine your optimal size with you, and this will partially be based on the diameter of your breast. Various sizing systems are available, so ask your surgeon which he or she typically prefers and this may help you settle in a size. 

Hi -Thanks for your photos. It sounds like you have been on hormone therapy long enough to have developed as much native breast tissue as you are going to have, as there is typically a clear time when breast growth plateaus. If you are wanting to go larger or change the shape of your breasts, you will want to consider an augmentation. Now would be an appropriate time if you're not making any further gains on stable levels of hormone treatment. In regards to sizing, surgeons have many ways of recommending sizes. Some helpful tips for sizing include going to a bra store and looking at the various cup sizes in your band size. This will give you some idea about the volume differences between A, B, C, D, etc. I advise my own patients to purchase a bra in the size they would like to be, and during their implant sizing visit we place implants into the bra while they're wearing it.  I then have them bring clothing such as a tank top to wear, and we can take photos for them of the various sizes of implants so they can make a decision looking at the photos (and trying to see themselves more objectively). I always tell people that it is not often beneficial to get stuck on a number of cc's but to base their decision on how they look with implant sample sizers in place. Best of luck with your surgery!

Thank you for the question and photos and size is an individual decision based on measurements and putting implants in a bra till you see the volume on your chest that you .   Then your surgeon can pick the best shaped implant for you at that volume Dr Corbin