The Transgender Dictionary
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z MISCELLANEOUS

Breast Augmentation

(also: boob job, mammaplasty, top surgery)

Table of Contents

Introduction

Originating as a cosmetic treatment for cisgender women (as well as a reconstructive treatment for cisgender female cancer survivors), breast augmentation refers to surgeries which create or enlarge breasts. In the context of this page, we will be discussing the role breast augmentation plays in gender affirming care.

Many transgender women seek out this surgery to alleviate gender dysphoria. While many trans women are able to obtain sizable breasts through undergoing HRT, some women are unfortunate in that department (though it is important to note that some transgender women do not desire breasts, and further still that some seek out this surgery without desiring hormones. Unfortunately, it can be difficult to find a surgeon when you are nonbinary or otherwise have non-traditional transition goals; and most surgeons require patients spend at least 1 year on hormones prior to this surgery). Looking in the mirror to finally see what she was unable to grow on her own is a major source of gender euphoria for the trans women who seek out breast augmentation.

Having breasts is, generally speaking, a major visual indicator that the person attatched to said breasts is a woman. Failing to have these protrusions often indicates to the observer that this person is not female. This can be very distressing to some people, even when in the should-be comfort of her bedroom. Reaching for an absent weight can be heartbreaking for she who lacks the breasts her genetics denied her. Looking in the mirror to see the wrong contour of her body can be difficult to cope with, which is why this surgery is so fantastic for those in need of it.

In many places, transgender women are forced to attend therapy and obtain both a letter of recommendation and a diagnosis of gender dysphoria prior to having breast augmentation. While a gender therapist is useful for those who are unsure of or questioning their gender transition, it is all too often a unnecessary mandatory hurdle put in place to gatekeep access to care. Some surgeons or local regulations require multiple letters. That combined with wait lists can make this (as well as other gender affirming surgeries) tedious to obtain.

Some transgender women will wear breast forms prior to having breast augmentation surgery. This can be a way of determining whether or not she wants to have breast augmentation.

General Information

During breast augmentation surgery, the chest is recontoured and enhanced with silicone or saline implants. For those who do not take estrogen prior to surgery, a temporary breast tissue expander may be placed to make room for the implant; followed by surgery a few months later to replace the breast tissue expander with the actual implant.

The surgery is short, lasting approximately 1-2hours. Incisions are typically covered with surgical glue (not bandages). Without insurance, the cost of this surgery can range from $4,000-$10,000.

As with any type of surgery, make sure to arrange for family or friends to help out with chores, and request the time off work you will need to recover. You will need someone to drive you home from surgery as you recover from anesthesia (its not as if any reputable surgical facility will send you home by yourself anyway). Obtain everything that you will personally need during the healing process ahead of time so that it is all available when you need it. If you smoke, stop smoking a month prior to surgery.

Recovery can take 6-8 weeks, with swelling taking up to an estimated total of 12 weeks to go down. Post-surgery medications typically consist of pain medication, a stool softener, nausea meds, and antibiotics (discuss this with your plastic surgeon). Take it easy, and adjust your living situation according to your own personal recovery (ex. avoid stairs for a bit).

On average, implants last anywhere from 10 to 20 years. Up to twenty percent of people have their implants removed or replaced within 8 to 10 years do to complications or cosmetic concerns. The cost of surgical revisions varies. The surgeon who removes your implant may not necessarily be the same one who put it in. Some people require breast lifts over time, as breast implants can sometimes sag. This sort of revision is down to personal preference, though not uncommon.

Types of Implants

Form-Stable Breast Implants (also known as: gummy bear implants)

These implants are made with a thick silicone gel that retains its shape even if the shell is broken. These implants require a longer surgical incision than other implants.

See below section regarding silicone breast implants in general for more information.

Saline Breast Implants

These are implants made of a silicone shell that is filled with sterile salt water. The implants are typically inserted empty, then filled with the fluid once they are in place.

If this type of implant were to be punctured, the fluid would leak out and be naturally absorbed by the body. This results in the silicone shell flattening, which requires surgery to be removed. A new implant can typically be inserted at the same time.

To obtain this surgery, you must be 18 years of age or older.

Silicone Breast Implants

These are implants made of silicone gel. They are often believed to be more realistic than the saline variation.

Those who choose this option may have to see a plastic surgeon more frequently, to make sure that they are working properly. If this type of implant were to be punctured, the silicone would leak out into other parts of the body, but not be absorbed. Most of the silicone remains where it is, due to the scar tissue surrounding the implant. It can be difficult to tell that the silicone implant has been torn, which is known as "silent rupture."

To obtain this surgery, you must be 22 years of age or older.

Structured Saline Breast Implants

Similar to regular saline breast implants, these have more structure to help feel more natural.

See above section regarding saline breast implants in general for more information.

Fat Grafting

With fat grafting, the surgeon uses liposuction to take fat from another part of the body, then injects the fat into the breasts. Most surgeons do not recommend fat grafting due to the 40-50% failure rate.

Potential Risks

Note that these are the same risks for this surgery regardless of if the surgery is performed on a cisgender or a transgender woman.