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Breast Augmentation Procedures Explained

Medically reviewed by Jennifer Richman on May 16th, 2025.

Breast augmentation is a deeply personal and significant step for many cisgender and transgender women, as well as non-binary individuals. With current surgical technology, patients can choose to augment their breasts with an analogous fat transfer or with the assistance of silicone or saline implants. There are many options patients can choose from for placement or other customization factors when it comes to augmenting breasts with lipofilling and implants. These procedures are also called: breast implant surgery, breast fat transfer augmentation, MTF top surgery, and chest feminization surgery. 

This guide walks you through breast augmentation options, preparation, recovery, and how to find a surgical team that centers around the needs of gender-diverse patients. There are key differences in breast augmentation surgery for transgender and cisgender women. In short, you want to work with a board-certified plastic surgeon who understands the nuances of gender-diverse bodies. That can result in better overall outcomes and overall integrity of results.

What is Breast Augmentation?

Breast augmentation encompasses a variety of ways to enlarge or construct breasts: principally through implants or liposuction-fat grafting. The fat grafting technique for increasing breast size is less common because of its low success rate when a large volume increase is desired and the skin is particularly tight. This means that the first choice for most patients is between silicone and saline implants. Fat grafting can be used in addition to implants, for example, to increase cleavage. In recent years, silicone implants have become the most popular choice because of their durability, softer feel, and appearance, especially for those without a lot of breast tissue pre-operatively.

What is a Gender-Affirming Breast Augmentation (MTF Top Surgery)?

It’s important to note that transgender and non-binary patients typically have different needs than cisgender women seeking breast augmentation. Specifically, transgender and non-binary patients may require different placement techniques and wider breast implants to meet their goals. This is due to anatomical factors such as the space between the nipples and the chest width. As a result, we encourage patients to choose board-certified surgeons who specialize in care for trans patients.

Since 2009, the Gender Confirmation Center (GCC) has provided customized, high-quality care to more than 4,000 patients in their transition journeys. Our state-of-the-art medical technology and skilled, compassionate team ensure patients receive the safest, highest-quality care possible. You can request a free, virtual consultation with one of our surgeons today. Please note that our practice only offers breast augmentation surgery to trans and non-binary patients. We are committed to making breast augmentation surgeries accessible to all patients regardless of body mass index (BMI), age, hormone usage, disability, or gender identity. 

Your Options for Surgery

Below, you can read more about our practice’s unique considerations for trans patients. If you are interested in surgery, and request a free, virtual consultation with us. 

Fat grafting vs. Implants

When considering chest augmentation, patients typically choose between breast implants and fat grafting, or a combination of both. Each option offers different benefits and limitations depending on anatomy and aesthetic goals.

Fat grafting uses liposuction to remove fat from one part of the body, like the thighs or abdomen, and transfer it to the chest. This method is less common due to limited volume retention, especially in patients with tight skin or minimal existing breast tissue. It may be used to supplement the choice between silicone and saline implants or enhance cleavage.

Silicone vs. Saline Implants

Many patients report that silicone offers a softer, more natural feel than saline. However, saline implants are filled after insertion and may require smaller incisions, which can also be a consideration. Likewise, silicone implants pose less of a health risk in the case of an implant rupture since the silicone gel will retain its form.

Implant Placement

Breast implants can be placed under the muscle (submuscular) or over the muscle (subglandular). We recommend submuscular placement for patients with minimal breast tissue growth before surgery. Generally speaking, the recovery time for submuscular implants is slightly longer than healing from a subglandular breast augmentation surgery.

Implant Shape

Generally speaking, patients can choose between round and tear-drop shaped implants. Round implants create more fullness and are typically slightly more cost-effective. Teardrop-shaped implants may mimic natural breast contours but come with the risk of unevenness in the case of implants rotating after surgery. Studies have shown that regardless of whether a patient’s implant is round or tear-drop shaped, their final results will likely look the same. For these reasons, our surgeons work more with round implants.

Implant Size

Rather than measuring by cup or bra size, the size of breasts is determined by the implant size, which typically ranges from 200cc-500cc. The final appearance of your breast size will have a lot to do with your unique anatomy. We encourage patients to try out the rice test at home to figure out which size would best suit their needs. Likewise, during an in-person consultation, we allow patients to try on implant sizers. Instructions for the DIY implant sizer rice test are below:

Breast Implant Scars and Incision Location

Your surgical scars are determined by the incision location or where the breast implant will be inserted. Patients’ main concerns are around minimizing scar visibility and creating an incision that allows for optimal implant placement. For these reasons, we most commonly perform an inframammary fold, which conceals the scar at the fold at the bottom of the breast. Scar visibility can often be reduced with proper care.

Patients can also opt for an incision along the border of the areola (periareolar) or through the armpit (transaxillary). Most transgender patients we see do not have large enough areolas to insert a silicone implant. Although the scar is hidden, inserting implants through the armpits is associated with higher rates of capsular contraction, bleeding, and placement complications.

Implant Texture

Patients can choose between smooth and textured implants. Textured implants are associated with a higher risk of cancer, which is why our practice no longer offers them to patients.

Breast Augmentation Revisions

Revisions involve removing, replacing, or adjusting implants to address complications or other aesthetic concerns. These procedures address concerns such as:

• Breast implant displacement
• Asymmetry
• Capsular contracture
• Saline implant deflation
• Silicone implant rupture
• Rippling
• Implant symmastia

A revision can also be used to change breast size or switch from saline to silicone implants (or vice versa).

How to Choose the Right Surgeon

The best outcomes start with a surgical team with specific expertise in gender-affirming care, like our team at the GCC (Gender Confirmation Center). When choosing a surgeon for breast augmentation, board certification is essential, as is experience with diverse anatomy and identities. Before moving forward with augmentation, look for:

• A surgeon with hospital privileges (this is essential for safety)
• A practice that regularly works with trans and non-binary patients
• Transparent before-and-after photos
• An inclusive, affirming staff and consultation process that respects your name and pronouns

If you have questions about which techniques would help you best achieve your goals, you can book a free, virtual consultation with one of our board-certified surgeons.

Preparing for Surgery 

Consider these factors when getting ready for your surgery. 

Candidacy Requirements:

BMI and Age

Factors such as BMI and age are not automatic disqualifiers for surgery. Instead, the focus is on optimizing any underlying health conditions, like hypertension or diabetes, to ensure safety during and after surgery.  Most cosmetic surgery practices have BMI cutoffs for surgical eligibility, but at the GCC, for gender-affirming breast augmentation, we do not.

Medical Clearance

Patients with chronic conditions may need clearance from their primary care physician or other medical specialists to confirm they are healthy enough for anesthesia and surgical recovery. Smoking, vaping, and other nicotine use should be discontinued at least 3 weeks in advance, as they interfere with healing.

Hormone Replacement Therapy (HRT)

It’s recommended that patients who choose gender-affirming breast augmentation take at least 12 months of consistent HRT to maximize breast tissue growth. However, this is not a requirement, and our surgeons have worked with patients who microdose or don’t take HRT at all.

Insurance Clearance

At GCC, our insurance concierge team helps patients navigate this process and has secured coverage for over 90% of patients. We proudly serve individuals regardless of BMI, age, disability, or hormone status. 

To qualify for coverage through your insurance provider, you will need a support letter from a licensed mental health professional stating a gender dysphoria diagnosis. Also, be aware that, while we don’t require a patient to be on HRT to have breast augmentation, most insurance providers will require 12 months of consistent HRT unless there is a medical contraindication.

Breast Augmentation Surgery: The Day of Your Procedure

The night before surgery, you should stop eating or drinking anything after midnight, except for clear liquids like water or Gatorade, which you can drink up until four hours before surgery. 

The augmentation procedure itself typically takes two to four hours under general anesthesia. After surgery, you’ll spend time in recovery as the anesthesia wears off before heading home with a designated caregiver.

What to Expect from Breast Augmentation Recovery and Healing

Recovery timelines can vary slightly between patients due to overall health, medical conditions, implant placement, and other factors. Here’s a general overview of what you can expect:

• Week 1: Limited arm mobility, significant swelling, bruising, and discomfort. Plan to rest and have help with daily tasks.
• Weeks 2–4: Some discomfort persists, but light activities (like walking, stretching, driving, and running errands) are typically permitted. Patients can usually resume a desk job that does not require strenuous labor at this point.
• Weeks 6–8: Most bruising and swelling subside. You can usually resume more intense activities, including exercising and returning to a labor-intensive job. At this point in time, you may be instructed to switch from wearing a supportive post-surgical bra to an underwire bra to promote optimal implant positioning.
• 3–6 Months: The implants settle into place, and the remaining swelling dissipates. The final results become mostly visible, although minor changes may occur in the following weeks.

Remember that recovery involves emotional ups and downs, and being prepared for them can help make healing easier. Having someone to talk to can make this part of the journey a better one.

Potential Risks and Complications

Breast augmentation through a board-certified surgeon is a very safe procedure. However, like any surgery, it carries potential risks. These may include:

• Infection
• Scarring
• Asymmetry
• Capsular contracture
• Temporary numbness or changes in nipple sensation

Proper post-op care, including rest, compression garments, and avoiding strenuous activities, is essential to healing. Always follow your surgeon’s advice for aftercare and reach out if you have questions or if something seems abnormal.

Frequently Asked Questions about Breast Augmentation

Does MTF breast augmentation differ from “traditional” breast augmentation?

Yes. Transgender women often have different chest anatomy than cisgender women, such as a broader ribcage, a less defined inframammary fold, and wider nipple spacing. As a result, implant selection and placement must be customized.

How do I prepare for breast augmentation surgery?

Preparation involves lifestyle changes like quitting smoking, adjusting medications, and getting medical clearance. Your surgeon will provide a complete pre-op checklist.

Is getting implants safe?

While getting implants is generally safe for most people, there are risks and considerations. That’s why it’s important to work with a board-certified surgeon and get all your questions answered to ensure a good outcome; for example, choosing surgical techniques that can minimize your risk of capsular contracture.

How long does it take to recover from breast augmentation surgery?

It takes six weeks or more for patients to be able to return to full physical activity; however, most patients can return to work two weeks after surgery. Depending on implant placement and other factors, you may have some discomfort and swelling for six months or longer after the procedure.

What is the best age to get breast augmentation surgery?

There is no single “best” age for breast augmentation, with many people over 50 choosing implants. However, younger people in good overall health typically recover faster than older adults. Your surgeon can help you with a recovery plan for your specific situation.