Gender Affirming Breast Sugery

A Guide to Gender Affirmation Breast Surgery

Breast surgery is a significant and affirming step for many transgender and non-binary individuals. Procedures are carefully tailored to align with each person’s unique body, gender identity, and aesthetic goals.
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For transfeminine individuals (male-to-female), breast augmentation is the most common approach to create a more feminine chest contour. For transmasculine (female-to-male) and non-binary individuals, surgical options typically involve breast reduction or mastectomy techniques. We are here to provide clear, supportive information to guide you through your options.

Transmasculine and Non-Binary Top Surgery (FTM/N)

Top surgery for transmasculine and non-binary individuals is typically an outpatient procedure performed under general anesthesia. The goal is to create a masculine chest contour. The best technique depends on breast size and skin elasticity.

• Partial Mastectomy with Free Nipple Grafts: This technique is often recommended for individuals with medium-to-large breasts (B-cup or larger) or those with sagging skin. The surgeon removes breast tissue through an incision made in the crease beneath the breast, positioning the final scar along the lower border of the pectoral muscle for a natural look. The nipples are resized, reshaped, and grafted into a new, masculine position on the chest. Liposuction may also be used to contour the chest and underarm area.

• Periareolar ("Purse String") Method: This approach is suited for individuals with smaller breasts and good skin elasticity. An incision is made around the areola, and breast tissue is removed through this opening. The nipple remains attached to its underlying tissue to help preserve sensation and blood supply. The areolar size is often reduced, and the skin is tightened around it. While some skin puckering can occur initially, it typically smooths out over several months.

Anatomical precision is key to achieving a masculine appearance. The nipple-areola complex is carefully repositioned to be smaller, more oval-shaped, and placed in the lower, outer quadrant of the new chest mound.

Transfeminine Breast Surgery (MTF)

For many transfeminine individuals, hormone therapy initiates breast development, but the final size may not feel proportional to their frame. Breast augmentation is the most effective procedure for achieving a fuller, more feminine chest.

• Single-Stage Breast Augmentation: This is the most common approach, where breast implants are placed to achieve the desired size and shape.

• Two-Stage Reconstruction: In rare cases where the chest skin is very tight, a two-stage process may be recommended. First, a tissue expander is placed to gently stretch the skin and create space. In a second surgery, the expander is replaced with a permanent breast implant.

Frequently Asked Questions

Who is a good candidate for gender affirmation breast surgery?
The best candidates are healthy individuals who have realistic expectations. Following the World Professional Association for Transgender Health (WPATH) standards of care, we require pre-operative evaluations from a qualified mental health professional and a primary care physician. Ensuring you are medically and psychologically prepared helps ensure a safe procedure with low overall risk.

How is the surgery performed?

All procedures are performed under general anesthesia.

• For Transfeminine Patients: Breast augmentation with implants is the standard approach.

• For Transmasculine & Non-Binary Patients: The technique is customized, ranging from minimally invasive periareolar incisions to partial mastectomy with nipple grafting.

What is recovery like?

Recovery is an important part of the process, and while it varies, here is a general timeline:

• Downtime: Most patients can go home the same day and require one to two weeks of downtime from work or school.

• First Week: Expect moderate swelling and minor bruising. Discomfort from swelling and along the incisions is the most common complaint.

• After One Month: The majority of swelling will have subsided. Gentle massage may be recommended.

• Activity Restrictions: You should plan for 4-6 weeks of restricted physical activity to allow your body to heal properly.

It is essential to follow all post-operative instructions provided by your surgeon to ensure a smooth and safe recovery.

If you’re ready to explore your options, consult with Dr. Han Hoang, a board-certified, UCLA-trained plastic surgeon, to create a customized plan tailored to your unique needs.

📞 Call us at 714-584-3507
 📧 Email us at hanhoangmd@gmail.com