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Why Surgeon Experience Matters in Gender-Affirming Breast Augmentation

Why Surgeon Experience Matters in Gender-Affirming Breast AugmentationAccording to the American Society of Plastic Surgeons (ASPS), breast augmentation remains the #1 cosmetic surgical procedure in the U.S., with a 4% increase in 2018. With over 8,000 ASPS members, plus osteopathic and cosmetic surgeons offering breast augmentation, patients today have thousands of options.

But as the saying goes, buyer beware.

Recent research on breast augmentation for trans feminine patients highlights that there are significant anatomical differences between trans and cis female chests. These differences affect implant selection, surgical approach, and overall outcomes. For anyone considering surgery, this underscores the importance of choosing a surgeon with specific experience in gender-affirming breast augmentation.

Choosing a Breast Implant Size

Dr. Eric Bensimon, experienced plastic surgeon offering breast augmentation in Montreal, CanadaWhile there are similarities between trans and cisgender breast augmentation, the differences are clinically important. In the largest study on trans feminine breast augmentation to date1, researchers from Switzerland and Germany reviewed 21 years of outcomes. They found that implant sizes increased significantly from 1995–1999 to 2011–2016, while revision rates dropped dramatically (from 52.9% to 6.9%). The most common reason for revision? Requests for larger implants.

According to Dr. Eric Bensimon, a plastic surgeon specializing in transgender surgery in Montreal, this trend aligns with his own practice.

"In general, many transgender patients require larger implants than cis women," says Dr. Bensimon2. "They often have a wider chest circumference and need larger implants to reach their desired cup size. Most of my trans patients aim for a C cup or higher."

A 2019 study published in Plastic and Reconstructive Surgery – Global Open further supports this:

"If the clinician considers that a typical trans patient is likely to be a tall endomorph patient with elevated BMI and larger [breast width] on clinical examination, it may be prudent to select a larger implant that accommodates the trans-verse chest dimensions. Selection of the appropriate implant under these circumstances will allow the surgeon to achieve feminine proportions with medial fullness and perhaps more cleavage." — Dr. Jens Berli et al.3

Breast Shape and Surgical Considerations

Dr. Dustin Reid, plastic surgeon specializing in breast augmentation in Austin, Texas"The goal of Breast Augmentation surgery isn't just large breasts but rather an overall female shape to the breasts," says Dr. Dustin Reid, a plastic surgeon in Austin, Texas. "It's to create an overall feminine breast shape."

In addition to implant placement, this often involves lowering the inframammary fold (IMF) and enhancing the areola. The IMF, where the lower breast meets the chest wall, plays a key role in aligning the implant with the nipple-areola complex (NAC). For trans feminine patients, this alignment can be particularly challenging.

"The most difficult challenge in trans women is the short distance between the nipple-areola complex and the inframammary fold," explains Dr. Bensimon. "Sometimes it’s as short as 2 cm. This requires significant adjustment of the fold to center the implant correctly behind the nipple, which is essential for a natural result."

Researchers agree that lowering the IMF is often necessary to achieve the desired contour. Dr. Bensimon notes that he primarily uses round, high-projection implants with a smaller diameter:

"Low-projecting implants can ride too high because the nipple sits low on the chest. High-projection implants help center the implant behind the nipple with less manipulation of the fold, leading to higher satisfaction."

What to Expect From Surgery

While estrogen therapy can increase breast volume, many trans feminine individuals seek augmentation to enhance feminine shape, contour, and proportion. Because of anatomical differences, such as wider chest width and shorter nipple-to-fold distance, the surgical plan must be individualized.

An experienced gender-affirming surgeon will guide you through implant selection, incision placement, and projection to ensure the most natural and affirming result.


Watch Dr. Breanna Jedrzejewski explain breast augmentation considerations and expectations in the video below.



Silicone Implant Safety

The Swiss/German study referenced earlier used textured silicone implants exclusively. However, these implants have since faced international scrutiny due to health concerns.

In 2020, Dr. Thomas Satterwhite reported his own experience: among more than 200 trans feminine patients (70% with textured implants), none exhibited breast implant illness (BII) symptoms4.

Breast augmentation for trans feminine patients involves unique anatomical, technical, and aesthetic considerations. The best outcomes come from surgeons who understand these distinctions, not only in implant choice and fold adjustment but in the holistic goal of creating a natural, affirming silhouette.

When choosing your surgeon, experience in gender-affirming breast augmentation isn’t just beneficial — it’s essential.

References

  1. Fakin RM, Zimmermann S, Kaye K, Lunger L, Weinforth G, Giovanoli P. Long-Term Outcomes in Breast Augmentation in Trans-Women: A 20-Year Experience Aesthetic Surg J. 2018.
  2. Bensimon E. Commentary on: Long-Term Outcomes in Breast Augmentation in Trans-Women: A 20-Year Experience. Aesthetic Surg J. 2018.
  3. Nauta AC, Baltrusch KM, Heston AL, Narayan SK, Gunther S, Esmonde NO, Blume KS, Mueller RV, Hansen JE, Berli JU. Differences in Chest Measurements between the Cis-female and Trans-female Chest Exposed to Estrogen and Its Implications for Breast Augmentation. Plastic and Reconstructive Surgery – Global Open. March 2019; 7(3): e2167.
  4. Latack K, Adidharma W, Nolan IT, Crowe CS, Sowder LL, Satterwhite T, Morrison SD. Staying on Top of Breast Implant Illness: An Analysis of Chest Feminization Experiences. Plast Reconstr Surg. 2020 Apr;145(4):885e-886e.

 

Last updated: 11/07/25