FEMINIZING TOP SURGERY

Pros

• The surgery can be combined with other gender-affirming procedures, including body contouring and facial feminization surgery. 
• It helps give patients more traditionally feminine contours that more closely align with their gender identity and expression.
• Results are immediately apparent, with the final look evident after 10–12 weeks. 
• The procedure itself is relatively fast—typically between one and two hours.
• Post-surgery discomfort is manageable. One RealSelf member reports, “I didn’t need pain meds the first night or the next day, only over-the-counter Tylenol. My chest felt very tight, but so far so good.”

Cons

• Recovery takes time. Plan on five to seven days of downtime and reduced exercise and activities (including sexual activity) for six to eight weeks.
• As with any surgery involving breast implants, there are risks, including breast pain, capsular contracture (where a reconstructed breast shifts, changes shape, or hardens), changes in nipple sensation, or implant rupture (with both silicone-gel and saline implants). Find out more in RealSelf’s guide to breast implant safety.
• You may need to start small. Oftentimes, the male chest does not have enough skin to accommodate a large implant, so you may need a two-phased approach. Stage one involves tissue expanders that mimic the shape of an implant and are inserted temporarily to stretch the skin in the exact place an implant would go. Stage two removes the skin expanders and places the implants.
• Results can vary drastically, based your surgeon’s level of experience and technique. Find a board-certified plastic surgeon with extensive experience in safely performing top surgery for transgender patients. One RealSelf member said, “I’m very disappointed with my breast augmentation. Results were horrible! My breast symmetry was wayyy off, breasts placed too far apart, and nipples were uneven.”

• Average Cost:
• $8,332

• Range:
• $3,999 - $18,139

Feminizing top surgery is not covered by most medical insurance plans, though it may be covered in some states.

Consult with your plastic surgeon and ask them to submit their approval and surgery codes as well as a letter from your therapist to your insurance carrier to request approval for coverage.

You can finance your treatment with CareCredit.

The feminizing top surgery photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Prior to this procedure, most patients have been on a regimen of hormone replacement therapy (HRT), which can increase breast volume but not fully shape and contour the breasts. 

Houston plastic surgeon Dr. Michael Eisemann explains that “you can have breast augmentation without hormones,” but “having hormones before your procedure can lead to a better outcome. By allowing your breasts to develop before your breast augmentation procedure, your board-certified plastic surgeon will have more information about the size, position, and orientation of your breasts.”

Patients are generally put under general anesthesia for the surgery, which should be performed in a hospital or surgical center. 

The surgeon begins by making an incision behind the breast and creating space within the breast tissue for the implant. 

• If you choose a silicone-gel or silicone implant, it will be placed in position and the incision will be closed with either stitches or sutures and surgical glue or tape. 
• If you choose saline, an empty implant will be placed and a fill tube will slowly add saline fluid until the breast reaches the desired fill and projection (how far forward and to the side your breast will project). When the fill tube is removed, the implant seals itself.

Most patients take about a week off work for their initial recovery. Your doctor may recommend that you spend a few days on bed rest and wear a surgical bra daily for two to four weeks.

In the days immediately after surgery, you may need someone to help you, since you’ll be advised to not drive a car for up to a week and to avoid any heavy lifting.

Side effects of transgender breast augmentation include bruising, swelling, and minor pain in the first few days and weeks afterward.

Avoid sexual activity for at least six weeks, allowing the implants to settle and the incisions to heal. 

Follow-up appointments to monitor your progress will usually occur within the first week and then monthly, until your surgeon is satisfied with your healing progress.

Related: The 5 Best Post-Operative Pillows for the Most Uncomfortable Surgeries