Transfeminine Top Surgery
Breast augmentation tailored to the transfeminine chest. Performed after the chest has had time to develop on hormone therapy, this is one of the most safely covered gender-affirming procedures.
Transfeminine top surgery, more formally augmentation mammoplasty, places carefully selected silicone or saline implants into the chest to create a fuller, more feminine contour. While the procedure is technically similar to cisgender breast augmentation, the planning is meaningfully different—the transfeminine chest typically has a wider base, narrower nipple-to-fold distance, and limited breast tissue, all of which influence implant size, shape, and placement.
We recommend at least twelve months of feminizing hormone therapy before augmentation to allow native breast tissue to develop, which improves both the aesthetic result and long-term implant coverage.
“Patience with hormones rewards you with softer results—more natural in feel, more natural in shape, and better protected over decades.”
The four key decisions.
At your consultation, we will work through these decisions together, taking measurements, reviewing implant sizers, and looking at your goals.
Silicone vs. Saline
Cohesive silicone gel implants offer a more natural feel and lower risk of visible rippling, particularly important for transfeminine patients with limited native breast tissue. Saline implants are FDA-approved at age 18 and may be preferred for cost or cohort considerations.
Round vs. Anatomic (Teardrop)
Round implants give more upper-pole fullness; anatomic implants taper to mimic the natural slope of a developed breast. Both are options; selection depends on chest dimensions, skin envelope, and aesthetic goals.
Submuscular, Sub-fascial, or Subglandular
Submuscular (under the pectoralis muscle) is most common in transfeminine patients to provide adequate soft-tissue coverage. Sub-fascial and subglandular placements may be considered when there is sufficient existing breast tissue from hormone therapy.
Inframammary, Peri-areolar, or Trans-axillary
The inframammary fold (IMF) incision allows the most precise pocket dissection and is our most common choice. Peri-areolar incisions place a scar at the areolar border. Trans-axillary placement avoids visible chest scars but may limit pocket precision.
Are you ready for top surgery?
We follow the World Professional Association for Transgender Health (WPATH) Standards of Care, Version 8, in determining surgical readiness. The criteria below are reviewed at your consultation.
- Age 18 or older
- Diagnosis of marked and sustained gender dysphoria
- Capacity to provide informed consent
- Stable on feminizing hormone therapy for at least 12 months (unless medically contraindicated)
- One letter of assessment from a qualified mental health professional
- Significant variation between current chest appearance and affirmed gender
- Mental and physical health conditions assessed and optimized for surgery
What surgery day looks like.
Top surgery is performed under general anesthesia at an accredited surgical facility. The procedure typically takes ninety minutes to two hours, and most patients are discharged home the same day with a responsible adult to drive and remain overnight.
- 01.Arrive 90 minutes before your scheduled surgical time for check-in.
- 02.Pre-operative markings are made with you standing.
- 03.General anesthesia is induced; surgery takes 90–120 minutes.
- 04.You wake up in a soft surgical bra; drains are not typically required.
- 05.After 1 to 2 hours of recovery monitoring, you are discharged home.
Recovery, week by week.
- Days 1–3
Discomfort, tightness, and chest pressure are common; controlled with prescribed medication. Sleep upright on your back.
- Week 1
First post-op visit. Surgical bra worn continuously. Light walking encouraged; no lifting more than 5 lbs.
- Weeks 2–4
Most patients return to desk work. Driving resumes once off narcotics. Implants begin to settle.
- Weeks 4–6
Light exercise (lower body, walking) can resume. Continue surgical bra full-time.
- Weeks 6–8
Upper-body activity gradually reintroduced. Implants continue to soften and settle into final position over 3–6 months.