When to consider breast implants for transgender women?

Breast development while on hormones can be quite variable for many transgender women. It is not uncommon for transgender women to consult at Cosmetic Surgery Affiliates about the timing of breast implants as they are unsure of what to expect. During the complimentary consult, I discuss the expected breast development and timeline of development for an average trans-woman. 

With regard to hormones, many of my patients are on both estradiol and progesterone.  What is interesting about estrogen, is that it not only causes feminine side effects but also can block gonadotrophic effects. With greater than 200 pg/ml of estradiol, it can suppress 90% of testosterone levels and production.  But at 500pg/ml, it suppresses 95% which is consider equivalent to castration. (1)

Although my academic brain finds the above facts interesting, what does that really mean to my patients? The most common questions I receive are, “When will I start to see breast development?” And “When will I see my peek breast development will be seen?  According to Wiercks et al, the mean breast to chest difference is increased by 7.9 cm after one year. Typically ~2cm breast to chest increase result in one cup, so approximately 8 cm would be 4 cup sizes. In my experience this amount of increase is quite generous, and many are lucky to see one to two cup size increase. Needless to say, the timeline seems to be quite consistent, and most start to see breast development in 3-6 months, peeking at  6 months.  After one year, the majority of the breast development is complete and modest for most, but maximal effects are expected after 2-3 years of HRT. That being said, approximately 70% of trans-women on hormones choose additional breast reduction enhancement in the future. (2,3)

Hormone dosages can also be quite variable. Although I do not prescribe HRT myself, I work will a fantastic network of providers who do an excellent job. The take home points I get from them are that oral prescriptions are most common and can be adjusted most easily, however, can increase the risk of blood clots.  Therefore transdermal patches ares often recommended but can cause skin irritation, along with being more noticeable. 

Ultimately, my trans-female patients are very similar to my cis-female patients, in that what is most important is their own personal goals.  For a patient wanting a small natural chest, I often recommend trying hormones to see how she developed first and then deciding if breast augmentation is right for her. If her goals are achieved, no need for surgery.  If she is wanting to be larger or possibly as large as possible for her frame, I often recommend going forward with surgery, when timing is right for her, and if she gets any additional growth (as small as it may be) great! Either way, our team at Cosmetic Surgery Affiliates in Oklahoma City, is always honored to be a part of your journey!

Stege R, Carlstrom K, Collste L, Ericsson A, Hendrickson P, Pousette A (1988). “ Single drug polyestadiol phospate therapy in prostratic cancer”. Am, J, Clinton, Oncol. 11 Suppl 2: S101-3.

Wierckx K, Gooren L, T’Sjoen G. Clinical review:breast development in trans women receiving cross-sex hormones. J Sex Med. 2014, 11(5):1240-1247

Christel Josefa Maria de Blok Maartje Klaver, Chantel Maria Wiepjes, Nineveh Marije Nota, Annemieke Corine Heijboer, Alessandre Daphne Fisher, Thomas Schneider, Guy T’Sjoen, Martin den Heijer, Breast Development in Transwomen Afetr 1 Year of Cross-Sex Hormone Therapy: Results of a Prospective Multicenter Study, the Journal of Clinical Endocrinology & Metabolism, Volume 103, Issue 2. Feb 2018. Pages 532-538