Breast Augmentation for trans* women

What You Should Know!

Medically reviewed by: Dr. med. Timo Spanholtz
Specialist in Plastic and Aesthetic Surgery | Medical Director

Breast augmentation is a deeply personal and meaningful step for many cisgender and transgender women as well as non-binary individuals. Thanks to modern surgical procedures, various options are available today to enlarge the breast or shape it more femininely. These include breast augmentation with autologous fat (lipofilling) as well as breast augmentation with silicone implants.

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Introduction – Gender-Affirming Breast Augmentation

Depending on individual anatomy, aesthetic preferences, and medical requirements, patients can choose from different implant types, placement options, and individualizing factors. Breast augmentation is also referred to by the following terms: breast implant surgery, breast augmentation with autologous fat, top surgery for trans* women, or chest feminization surgery (breast feminization).

This guide provides a comprehensive overview of the various methods of breast augmentation, preparation for the surgery, the healing process, as well as how to find a surgical team specialized in the needs of gender-diverse patients.

What does breast augmentation mean?

Breast augmentation is a surgical procedure to enlarge or shape the breast. It can be performed using silicone implants or by fat transplantation (liposuction & lipofilling).

The latter method is an excellent option for trans*women who have already developed some breast tissue through hormone therapy and are looking for a more moderate increase in volume. Larger volume increases are also possible with multiple fat grafting sessions, making this a good alternative for patients who prefer to avoid implants. However, silicone implants remain the most effective option, when a more significant volume increase is desired, when there is not enough donor fat available or when the skin envelope needs to be expanded.

It is important to note that transgender and non-binary patients generally have different anatomical and aesthetic requirements than cisgender women who undergo breast augmentation. In particular, different implant placements as well as wider breast implants may be required for trans and non-binary patients in order to achieve the desired results.

The reason for this lies in anatomical differences, such as the greater distance between the nipples as well as the often broader chest shape. For this reason, we expressly recommend turning to board-certified, qualified plastic surgeons who are specialized in the treatment of transgender patients and who have the corresponding experience in gender-affirming breast surgery.

What is gender-affirming breast augmentation?

A gender-affirming breast augmentation (also called top surgery for trans* women or breast augmentation in transgender individuals) is a gender-affirming procedure. It helps to increase breast volume and create a more feminine-looking breast shape that aligns with one's own gender identity.

This procedure can be a significant step for many trans women and transfeminine or non-binary individuals – both physically and emotionally. The surgery can boost self-confidence and reduce dysphoric experiences in the chest area. Below you will learn more about the special surgical and medical aspects that we consider when treating transgender patients. If you are interested in surgery, you are welcome to schedule a personal or virtual consultation with us.

Good to Know

There are significant differences between breast augmentation in transgender and cisgender women. Crucial for an aesthetically harmonious, safe, and long-term stable result is treatment by board-certified, qualified, experienced plastic surgeons with a sound understanding of the anatomical characteristics of gender-diverse bodies. This expertise can significantly contribute to better functional, aesthetic, and sustainable results.

Breast Augmentation Options: Male to Female

Autologous Fat vs. Implants

When deciding on a breast augmentation, patients generally choose between breast implants, autologous fat transfer (fat grafting / lipofilling), or a combination of both methods. Each of these options offers different advantages and limitations, depending on individual anatomy and aesthetic goals.

With autologous fat transfer, fat tissue is removed from another body region – for example, from the thighs or abdomen – using liposuction and subsequently introduced into the breast area. This method is overall used less frequently, as the volume stability is limited. This applies in particular to patients with tight skin or little to no existing breast tissue.
The transfer of one's own fat tissue can thus be used for the enhancement of the décolleté by forming softer transitions and providing additional volume gain, but on its own usually does not achieve a large volume increase.

Breast Implants - Implant Types

Silicone implants: These are the most commonly used worldwide and are associated with a softer, more natural feel, especially when there is little to no existing breast tissue.

Saline implants: Are only filled with sterile saline solution after insertion, therefore allowing a smaller incision, but are hardly used anymore due to many disadvantages (more unnatural feel, rippling, poorer aesthetic results, etc.).

Implant Surface (Texture)

In principle, a distinction is made between smooth and macrotextured surfaces for breast implants. Smooth implants are characterized by a soft tactile feel, but can be associated with an increased risk of implant displacement, rippling, and capsular fibrosis. Macrotextured implants do offer a very stable position, but are increasingly being criticized due to their less favorable safety profile and the association with rare, implant-associated diseases (BIA-ALCL).
Against this background, microtextured implants have established themselves as the modern standard in recent years. They combine good positional stability with a reduced risk of capsular fibrosis and at the same time exhibit a significantly improved safety profile compared to heavily textured implants. For these reasons, we consistently use microtextured breast implants in our practice.

Implant Shape & Size

Round implants generally create more fullness in the upper breast area.
Teardrop-shaped implants can appear more natural, however there is a higher risk of rotation after surgery.
Studies have shown that regardless of whether an implant is round or teardrop-shaped, the final aesthetic result is generally very similar. For this reason, our surgeons work predominantly with round breast implants, as they reliably enable predictable and long-term harmonious results.
Sizes are typically given in cc (cubic centimeters) and frequently range between 200 cc–500 cc. The implant size ultimately selected depends to a considerable extent on the respective unique anatomy and physical conditions (e.g., skin envelope, width and height of the chest) of our respective patients.

Incision and Scars

The scar appearance after a breast augmentation is largely determined by the location of the skin incision through which the breast implant is inserted. The most important concerns of patients are generally to keep the visibility of scars as low as possible while at the same time enabling a precise and safe implant placement.

For these reasons, we most frequently perform breast augmentation through an incision in the inframammary fold. This incision allows optimal control during implant placement and conceals the scar in the natural fold at the underside of the breast. With consistent aftercare and appropriate scar care, the scar visibility can often be significantly reduced.

Alternatively, there is the possibility of an incision at the edge of the areola (periareolar) or via the armpit (transaxillary). However, most transgender patients do not have sufficiently large areolas to safely insert a silicone implant through them.
Although the scar is hidden with the transaxillary technique, this method is associated with higher risks, including capsular contractures, bleeding, as well as problems with implant positioning.

Implant Placement

Under the chest muscle (submuscular): Frequently recommended when there is little existing breast tissue and little soft tissue coverage.
Over the muscle (subglandular = under the gland): Shorter recovery time, but possibly more visible implant edges with less tissue coverage. Often a good indication for combination with autologous fat.

Frequently asked questions about Breast Augmentation trans* Woman - Background

We are happy to answer your questions about the treatment here.

Do I need to stop taking hormones before the breast augmentation for trans* women?

This depends on the preparation used and your individual medical history. As a rule, modern estrogen preparations no longer necessarily need to be discontinued today, as the risk of thrombosis is low. However, we will discuss this in detail with you and your endocrinologist as part of the surgery preparation.

What requirements must be met for breast augmentation for trans* women?

In addition to the already mentioned hormone therapy, accompanying psychotherapy as well as a corresponding diagnosis (gender dysphoria) is usually necessary for the costs to be covered by the health insurance. Medically speaking, you should be healthy and have realistic expectations of the result. In a consultation, we clarify all your individual requirements.

Is natural breast growth through hormones not enough? Do I need a breast augmentation?

This is highly individual. In many trans women, hormone therapy leads to a more feminine breast shape, but the volume often does not reach the desired size or projection. A surgical procedure can help close the gap between the growth achieved through hormones and your personal body image in which you feel comfortable.

Does the health insurance cover the costs for breast augmentation?

Yes, under certain conditions, coverage of the costs is possible. Health insurance companies usually require proof that natural growth through hormones is insufficient after two years (an A-cup is often cited as the threshold). We are happy to support you with the necessary medical documents for your application.

When is the right time for breast augmentation in trans* women?

Surgical breast augmentation should generally only take place after a certain period of hormone replacement therapy (HRT). We usually recommend a waiting period of at least 12 to 24 months under stable hormone administration. During this time, natural breast growth takes place. Only when this development is largely complete can the final surgical result be planned precisely.

What role does the original tissue play for the implant pocket in breast augmentation?

Since trans women often have less of their own tissue and firmer skin tension at the beginning, the implant is frequently placed under the chest muscle (submuscular). This ensures better coverage of the implant edge and a more natural result in terms of touch and appearance.

How does the broad chest affect the aesthetic outcome of breast augmentation in trans* women?

The bone structure in trans* women is often somewhat broader than in cis women. We take this into account when choosing the implants. Often, broader implants are chosen to create a harmonious décolleté and to prevent the breasts from appearing too far apart. The goal is a natural, feminine contour that suits your body proportions.

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