Breast augmentation for transgender women and transfeminine spectrum non-binary people

Also called: feminizing augmentation mammoplasty, fat grafting

We will give your chest a female appearance by placing implants underneath your natural breast tissue and muscle. Dr. Kim will discuss a selection of implant type (silicone or saline) as well as size and shape to match your body and your desires during your consultation. A small incision will be made in the crease underneath each breast or around the nipple. A pocket is made underneath the skin and muscle of the breast to give each breast a natural teardrop shape.

Some patients can benefit from fat grafting from the belly, hips, or thighs in conjunction with implant surgery to achieve additional fullness in specific areas of the breast. This procedure is not currently covered by insurance. Dr. Esther Kim performs this procedure in the Division of Plastic Surgery at UCSF. 

Options for gender-affirming chest augmentation

Breast implants can be placed in two different planes:

1. Subglandular or pre-pectoral: Under the breast tissue
2. Dual plane: Partially under both the muscle and the breast tissue

	Subglandular/Pre-Pectoral	Dual Plane
Characteristics of a Good Match	More breast development Thicker soft tissue in the upper pole of the chest	Less breast development Thinner soft tissue in the upper pole of the chest
Pros	Less invasive More predictable final breast contour Can generally accommodate larger implants Less post-operative pain	Less likely to have visible rippling Lower risk of capsular contracture
Cons	Higher risk of capsular contracture More likely to have visible rippling	More invasive May have increased post-operative pain Limited implant size Risk of animation deformity

Prepare for your initial consultation

We want you to have the best possible result from your surgery with the greatest satisfaction. UCSF criteria for surgery are based on the World Professional Association for Transgender Health Standards of Care (SOC) (version 8) and are required by most insurance companies.

Before scheduling your initial consultation, please send the following:

• Your insurance card and identification
• Documentation by your medical provider of current and consistent estrogen therapy for a minimum of 12 months (required as surgical results are superior after a minimum of 12 months of hormone therapy).
• Our surgeon requires that your BMI (body mass index) is less than 32 before scheduling your consultation. This policy has been determined by our surgeon.

Send us your referral documentation

You can email or fax us your documentation.
​Please include your legal name, chosen name (if different), and date of birth with all communication.

UCSF Gender Affirming Health Program
Tel: 415-885-7770
Fax: 415-353-3399
Email: [email protected]

How to prepare for surgery​

• A pharmacy and pharmacy plan should be in place to obtain postoperative medications.
• Schedule an appointment or phone appointment with the anesthesia PREPARE preoperative evaluation clinic. They will tell you what time to check in on the day of surgery.
• Two weeks before the operation:
  • Make sure you eat a healthy balanced diet, get plenty of rest, and stay active
  • If you are a smoker, you should absolutely quit smoking two weeks before and until six weeks after surgery to avoid poor wound healing and complications (or better yet, use this opportunity to quit forever!)
  • PREPARE clinic will tell you which medications to stop taking and which to take
  • Make sure you have transportation to and from UCSF for your operation (most patients go home the same day)
• The night before surgery:
  • Shower with antibacterial soap and hibiclens (chlorhexidine) scrub – this is available at most drugstores
  • Make sure your home is well stocked with light food, beverages, and items that you will need are within reach without needing to lift your hands above your head or bending over

Recovery: What to expect

Mild soreness, swelling, and bruising are normal. Pain is usually mild to moderate and is usually well controlled with Tylenol and Ibuprofen. The implants will settle over time, giving a more natural appearance. Expect scars to fade over 12-24 months, though not completely. You should avoid lifting heavier than 5 lbs for 6 weeks after surgery.

• Your incisions will be covered in surgical glue. Most patients will have no bandages or dressings to change
  • The skin glue will begin to fall off a few days after surgery as your skin heals
    • As your incisions heal, you can expect some itching and shooting pains. This is normal
• Plan to sleep on your back with several pillows to elevate the head of your bed. This is to reduce the amount of swelling and bruising you experience, which may get worse the first few days after surgery before getting better
• Showering is okay one day after surgery. Don’t soak or swim in a tub or swimming pool for at least three weeks after surgery
• You will be sore and will need to rest for 2-3 days after surgery. During this time, you may need someone to help you at home. We do want you to walk around the evening after surgery to prevent blood clots form forming in your legs
• Avoid strenuous activity or lifting more than 10 pounds for two weeks after surgery
• Scar care:
  • You can improve the appearance of your scars by using silicone sheets or scar gel on your incision, beginning two weeks after surgery. Your surgeon can advise you on which brands and size to purchase
  • Scars can be made more noticeable by sun exposure for up to one year after surgery. Make sure the scars are either covered, or apply a strong sunscreen to your scars

More information

Please visit our UCSF Gender Affirming Surgical Care Box folder to access this information in PDF format and to view an educational module on Gender-Affirming Chest Augmentation.

Access the GASC Box Folder