About the Procedure

Before and after photos

Transgender breast surgery


Transgender patients who are experiencing the surgical transition process will undergo many different surgical procedures.  One major part of this process is the top surgery where the male chest is transformed to a female breast, and a female breast becomes a male chest.  There are several anatomic differences between male chests and female breasts that makes these procedures more complicated that other breast surgical procedures.  The male nipple and areola sit low and lateral on the chest, while female nipples and areolas are located in the center of the breast mound.  The lower pole of the female breast is more developed than the male, so the fold below the breast is located higher in males and lower in females.  Because every patient is different, there are many different ways to perform these procedures.  Board certified plastic surgeon Dr. Elliot Hirsch specializes in both cosmetic and reconstructive breast surgery, and he and his staff will help guide patients to their best possible result.

Male to female (MTF) transgender top procedures are most commonly performed with implants, either in one stage or two stages.  Patients who have smaller size goals or loose skin that can stretch to accommodate an implant may be able to perform the procedure in one stage.  Los Angeles transgender breast augmentation patients who have tight skin or wish to be larger may consider performing this procedure in two stages.  During the first stage, a tissue expander is used.  The expander is like a balloon.  It is inserted into the breast, and is inflated in the office with a series of injections so that the lower pole skin is stretched to accommodate a larger implant.  Once the expander reaches the desired size, it is removed in a second surgical procedure and the permanent implant is placed.  Fat grafting may be performed with either the one stage or two stage procedures.

Usually, female to male (FTM) transgender breast surgeries are performed with a combination of skin removal and breast tissue removal.  Breast reduction techniques such a the horizontal breast reduction are very effective in flattening the breast and repositioning the nipple to a lateral position.  Occasionally, areolar grafting and liposuction can be used as well.

Male to female breast augmentation and female to male breast reduction are performed as outpatient procedures, meaning that patients can go home on the same day.  Most patients experience minimal discomfort and soreness, and are usually able to resume their regular activities over a 2-4 week period.


Frequently asked questions about transgender breast surgery


Does insurance cover my surgery?


The answer is that it depends.  Some insurance companies will cover transgender procedures, including breast surgery, rhinoplasty, browlift, and other procedures.  Dr. Hirsch and his team will work with you and your insurance company to help determine coverage for your surgery.


Will I need drains after my surgery?


Most MTF top procedures do not require drains.  Occasionally, FTM breast reductions may require drains.  When this is necessary, the drains are removed in the office after one week.

How do I choose the implant size for my MTF breast augmentation?


When you come to your transgender breast surgery consultation with Dr. Hirsch in his Sherman Oaks office, Dr. Hirsch and his team will work with you to determine your desired breast size.  It is helpful if you bring in pictures of breasts in the size that you like to give them an idea of what you're looking for.  They will also use a sizing kit in which different size inserts will be placed into a sports bra so that you can see how you will look with different size breast implants!