Breast Augmentation During Transition

Feminising hormone therapy stimulates breast growth, but the final volume remains more limited than desired for many trans women.

Indications and timing

Feminising hormone therapy stimulates breast growth, but the final volume remains more limited than desired for many trans women. International guidelines recommend waiting at least twelve months after starting hormone therapy to assess the natural result before considering surgery.

Technique

During breast augmentation, silicone or saline implants are inserted, usually beneath the chest muscle (subpectoral) or beneath the glandular tissue. The incision may be made around the areola, in the armpit or in the crease beneath the breast.

Risks

General surgical risks apply, including infection, bleeding and anaesthesia-related complications. Specific risks include capsular contracture (hardening around the implant), implant displacement, changes in sensation and, in the longer term, implant wear.

How much growth do hormones provide?

Dutch research among transgender women found that hormone-induced breast growth is modest. Most growth occurs during the first six months, and after one year around half of the women had less than an A cup. This explains why many of them later choose surgery. It has not been shown whether adding progesterone increases breast growth. The shape of the chest also plays a role: a broader chest, larger chest muscles and nipples that are farther apart determine what size and shape are achievable.

In the long term

Implants do not last a lifetime. After ten to fifteen years, another operation is often needed because of wear, a hardened capsule or a change in shape. A rare form of lymphoma has been described in connection with implants with a textured surface. Women with implants are advised to consult a doctor if they experience swelling or pain. Hormones also increase the risk of breast cancer compared with men; see cancer risk with hormone therapy. An alternative to implants is fat grafting using the patient’s own tissue, which results in a smaller enlargement.

Reimbursement

For a long time, breast augmentation was considered cosmetic in the Netherlands and was not covered by basic health insurance. A separate arrangement was introduced for transgender women; the conditions have changed over the years. Ask your health insurer and the treating centre about the current rules. See health insurance and gender care, oestrogen and surgical procedures.