What you can expect

Top surgery for transgender women is typically done as an outpatient procedure. You'll be given general anesthesia.

During the procedure

The principles of breast augmentation are similar for transgender women and cisgender women. But transgender women typically have broader chests, larger and thicker pectoral muscles, smaller and more lateral nipple and areola positioning, and shorter distances between their nipples and the creases under their breasts (inframammary). Because of their wider chest walls, transgender women often have a wide space between their breasts, even with use of larger implants.

During top surgery your surgeon can make incisions around the areola, near the armpit or at the level of the inframammary fold. Silicone or saline implants will be placed through the incision under breast tissue.

You'll have saline or silicone implants placed, based on your preference. When the implant is in place, the surgeon will close the incision — typically with stitches (sutures) — and bandage it with skin adhesive and surgical tape.

If feminizing hormones haven't made your breasts large enough, you might need an initial surgery to have devices called tissue expanders placed in front of your chest muscles. You'll visit your doctor every few weeks after surgery to have a small amount of saline injected into the tissue expanders. This will slowly stretch your chest skin and other tissues to make room for the implants. When your skin has been sufficiently stretched, you'll have another surgery to remove the expanders and place your implants.

After the procedure

You might need someone to accompany you home after surgery. Your surgeon might require that you stay locally for a few days.

Soreness and swelling are likely for a few weeks after surgery. Bruising is possible, too. Expect scars to fade over time but not disappear completely. You'll wear a compression bra for three weeks.

To decrease the risk of displacing a breast implant, limit upper body exercise for the first several weeks after surgery.