San Diego MTF Transgender Breast Augmentation | Dr. Tim Sayed

MTF Transgender Breast Augmentation

San Diego MTF Transgender Breast Augmentation in Newport Beach – Dr. Tim Sayed

Breasts have been a lasting symbol of femininity. While hormone replacement therapy can increase breast volume for trans women patients, it is often limited. Many of our patients seek to enhance their breast contours to fit their gender identity, resolve gender dysphoria, and increase self-esteem.

An MTF transgender breast augmentation, also known as MTF top surgery, is designed to convert a male chest into feminine breasts when hormone replacement therapy proves insufficient to complete your breast enhancement.  

To learn more about MTF Transgender breast augmentation in La Jolla and Newport Beach, CA, call 858-247-2933 or Schedule a Consultation with Dr. Sayed today.

MTF TOP Surgery Candidates

The best candidates for MTF transgender breast augmentation in San Diego include patients in good physical and mental health who desire gender-affirming top surgery. They don’t suffer from medical issues like cancer, hypertension, bleeding disorders, or diabetes. 

They also:

  • Are at a healthy weight without planning to lose or gain weight
  • Are nonsmokers or willing to quit before surgery
  • Have undergone appropriate preoperative testing and evaluation for emotional and physical attributes
  • Have begun hormone replacement

Patients should exhibit the emotional maturity to undergo cosmetic surgery and be at least 18 years old (22 if they consider silicone implants). 

MTF Transgender Breast Augmentation Consultation

You and Dr. Sayed will discuss the best options to plan your personalized MTF breast surgery. Most male-to-female transgender patients have undergone hormone replacement therapy, as the results of this therapy will stimulate breast development. Dr. Sayed’s team will provide instructions to download our clinical patient engagement app, Symplast, to learn about your medical history. Out-of-town patients can also furnish photos through this system and set up a video telemedicine consultation.

The consultation process lasts 45-60 minutes for most patients. It involves a thorough survey of patient goals, a review of patient safety and technique videos, a physical examination, and dialogue on desired outcomes, including aftercare. Dr. Sayed will also discuss considerations of revision surgery or other potential (but rare) post-surgery issues. 

We will provide a detailed quote, including the cost of the surgeon’s fee, the estimated time for anesthesia and facility fees, plus surgical garments and any add-ons. We will not pressure you into any decision; instead, we will work with you to determine if MTF Transgender Breast Augmentation with Dr. Sayed is a good fit for your cosmetic goals and needs.

The MTF Transgender Breast Augmentation Procedure

Our Newport Beach MTF transgender breast augmentation is performed under general anesthesia. The surgery takes about two hours, offers multiple options for a personalized result for each patient. These include implant type—the size, shape, and projection of the implant—and implant placement. 

Implant Type

Your breast implants will have a silicone shell with either a saline or silicone gel interior. Silicone implants offer a natural appearance, a firmer feel, and a smoother surface. Saline breast implants have a rounder contour, have a fluid-feeling when touched, and are less costly.

The most advanced implant devices are cohesive gel implants. Also known as gummy bear, these silicone-gel implants were created for more stability once inserted. Dr. Sayed will help you determine the most suitable implant type based on your goals and budget.

Implant Placement

Implant placement can be subglandular (placed above the pectoral muscles, below the breast tissue) or submuscular (placed above the chest wall, over pectoral muscles).

Incision Placement

Your MTF Top surgery may involve incisions within the armpits, the inflammatory folds, or around the areolas.

MTF Transgender Breast Augmentation Recovery

After your surgery, you will awaken in the surgical center’s recovery room with bandages and a surgical compression garment. We ask you to wear the compression bra for two weeks night and day, then during the daylight hours for one month.

Dr. Sayed will prescribe oral medications to prevent infection and help with any discomfort after surgery. You can return home the day of your surgery, but you will need someone to be there with you to help drive you home and look after you until you can take care of yourself. 

MTF Transgender Breast Augmentation Benefits

When performed by an expert of Dr. Sayed’s qualifications, MTF breast augmentation can:

  • Improve breast symmetry
  • Increase breast size
  • Alter nipple shape
  • Enhance overall breast appearance
  • Instill a new sense of identity and body confidence

Why Choose Dr. Sayed for my San Diego MTF Breast Augmentation?

Dr. Sayed is an expert in all things related to breast implants. He has performed thousands of breast augmentation operations in his distinguished career. He also manages any post-surgery concerns effectively, including capsular contracture, implant removal, revision surgery for implan’ complications by other surgeons, and breast reconstruction for cancer patients.

Dr. Sayed uses a combination of surgical simulation software, sizing kits, clinical analysis, and above all, listens to the patient to craft a personalized approach. Dr. Sayed is comfortable using different implant styles. As an expert in implant removal, he can have a very frank and informative discussion with you to help you understand the nuances of implant surgery.

Dr. Sayed was trained in leading institutions of cosmetic breast surgery and has also worked with many transgender patients at the University of California San Fransisco, where he attended medical school and did his residency. Dr. Sayed is well-versed in transgender patient’s unique needs and is a resource for his colleagues in other cities who wish to refer patients in Southern California to a trusted local surgeon.

MTF Transgender Breast Augmentation FAQ's

Gender-affirming breast augmentation can provide significant emotional and physical benefits to transgender patients. It is important to understand some anatomic differences between cis-gender and transgender females, which may impact the techniques and approaches for augmentation. Transgender females may have more muscle bulk and a lower natural nipple position, so the surgeon may need to consider whether to place the implant under or over the muscle. Because most transgender females do not have a large natural breast, there can be less tissue coverage to protect the implant, particularly if a large implant is desired. The nipple position may look a bit lower over the breast implant mound, or the fold under the breast may need to be lowered to allow the nipple to be more centralized. Breast lift techniques may also be considered in transgender patients, depending on the individual anatomy. Preoperative hormone therapy to rebalance estrogens and other female hormones vs. testosterone may be helpful in naturally augmenting the breast partway. This may allow for a smaller implant in some patients. Occasionally, the unique anatomy may call for a shaped (teardrop) implant, rather than a round style, to create a more natural slope of the breast.

Candidates for transgender breast augmentation are patients who desire gender-affirming top surgery, have undergone appropriate preoperative testing and evaluation for emotional and physical attributes that may impact the procedure, and are in generally good health. Dr. Sayed generally performs this procedure in patients age 18 or older; due to FDA guidance on silicone breast implants, it is preferred to perform silicone implant augmentation only in patients 22 and older.

Dr. Sayed’s philosophy is simple: Aesthetics Done Right. What this means is a thorough evaluation of the patient’s goals, an examination of the patient’s unique physical anatomic features, and a personal respect for all patients, being mindful of the significance of making such an important decision. Dr. Sayed believes in patient autonomy and self-identification, empowerment, and choice. He trained in institutions like UCSF and Mass General, and from the beginning of his career, he was instilled with a profound reverence for patient diversity. Many of the techniques for transgender patients were pioneered in San Francisco, where Dr. Sayed spent his medical school and plastic surgery residency years learning from the best.

Regarding bottom surgery, Dr. Sayed recognizes the importance of a multidisciplinary clinic environment that can deliver microsurgical results with minimal complications. He is trained in microsurgery but refers patients for bottom surgery to his colleagues in San Francisco, focusing his MTF practice on top surgery, including certain facial feminization procedures and primarily breast work.

Dr. Sayed’s team will deliver you instructions to download our clinical patient engagement app, Symplast, for you to provide your medical history. Out-of-town patients can also furnish photos through this system and set up a video telemedicine consultation. The consultation process lasts 45-60 minutes for most patients. It includes a thorough survey of patient goals, review of patient safety and technique videos, examination, and a dialogue on potential outcomes, including aftercare and considerations in the event of revision surgery or other postop issues (rare). Patients seeking augmentation can undergo state-of-the-art 3D simulation using Crisalix, an iPad-based cloud image morphing software tool that can give you photorealistic projections of potential outcomes. While not a guarantee of the final result, this technology helps take out a lot of the guesswork about what size and style implant to select for your idealized result.

You will be provided a quote including the cost of the surgeon’s fee and the estimated time for anesthesia and facility fees, plus garments and any add-ons. You will not be pressured into any kind of decision, but rather, we will work with you to be sure that you are a good fit for the procedure and that our office is the right fit for your needs.

Dr. Sayed is an expert in all things related to breast implants. He has implanted thousands of implants in his long career and is experienced in the management of implant-related concerns. These include capsular contracture, implant removal, “Breast Implant Illness,” revision surgery for cosmetic complications of implants by other surgeons, and breast reconstruction for cancer patients. He trained in leading institutions among giants of the field of cosmetic breast surgery. He was exposed to the unique needs of transgender patients during his medical school and residency years at UCSF and is a resource for his colleagues in other cities who wish to refer patients in Southern California to a trusted local surgeon.

Dr. Sayed prefers that patients be at the age of consent for important medical conditions, 18. For silicone implants, Dr. Sayed prefers to follow the FDA guidance indicating age 22 and up. Special exceptions may be made depending on the unique emotional care needs of individual patients.

Hormone therapy is not required, although many patients will benefit from the anatomic combination of the implant and some natural augmentation. Of course, hormone therapy can confer a number of emotional and gender-confirming psychologic advantages. This should be discussed with your primary care provider and an endocrinologist with expertise in transgender care.

Dr. Sayed is not in-network with insurance and does not accept insurance payment for this procedure. This is cosmetic in nature, and we are able to deliver a very high level of personalized service by focusing on boutique, concierge-level care rather than immersing our office in the bureaucracy of insurance red tape. You are welcome to file a claim of your own to your insurance company. If we can help you by providing documentation (operative report, initial consultation, codes), we are happy to do so. However, we caution all patients that we are not able to be the primary point of contact to submit a claim, nor will we accept insurance reimbursement. If you receive any remuneration back from your insurance company, it will need to be issued by the carrier directly to you.

There is no specific timeline. Patients should decide their own priorities, and we can work in tandem with other specialists to help you schedule your top surgery when it makes the most sense to you.

This will vary from patient to patient, as it does for all operations. In general, if implants are placed below the muscle, which may be required in patients with little native breast tissue, there may be more discomfort in the initial weeks when compared to implants placed in a subfascial (between the muscle and the supporting lining of the muscle) or subglandular (above the muscle and the lining) plane. Going under the muscle may reduce the risk of capsular contracture but may be a “less anatomic” approach to augmenting the breast. If implants are placed under the muscle, they may move with exercises of the chest and shoulder area.

Yes, we must be mindful of your native anatomy. Very large implants can lead to a higher rate of complications, including implant exposure, infection, “bottoming out,” displacement of the pocket, and cosmetic dissatisfaction in the long run. After examining you and taking measurements, Dr. Sayed can counsel you on an approach that is reasonable for your goals and anatomy.

Fat grafting is best used as an ancillary technique to try to help blend the transition in the upper breast or to provide a small degree of additional tissue coverage and shaping of the breast. Fat grafted to the breast has not served as a perfect substitute in terms of shaping the breast when compared to implants. However, if a patient is concerned about implant safety, fat grafting may offer an alternative for consideration in order to achieve a modest amount of breast enhancement.

There is some clinical evidence that incisions in the breast fold (inframammary) have the lowest risk of capsular contracture. However, some patients may prefer an incision along the areolar border, even if the capsular contracture risk may be slightly higher, in order to have a more blended scar. If areolar tattooing is being considered, the incision at the areolar border may allow for camouflaging the final scar. However, it is important to candidly discuss and learn the tradeoffs between different incision approaches in order to help you with your decision.

There is data from around the 1990s to suggest that capsular contracture rate is statistically less likely if implants have more tissue coverage, and consequently, surgeons in the United States began to preferentially offer augmentation under the muscle. In years since we have learned that the most likely culprit of capsular contracture is a phenomenon known as biofilm; think of this as a mixture of microbes, skin cells, proteins, and other material that can get onto the implant. There is evidence that incisions in the fold are less likely to expose the implant to biofilm materials than incisions near the nipple, where bacteria may live. Additional techniques, like the use of an implant “funnel,” irrigation of the breast pocket with antibiotics/antiseptics, and other handling approaches, may also reduce the risk.

Placement under the muscle may allow for a flatter upper breast slope. However, the implant will be more likely to move in potentially unusual ways with the movement of the chest muscles— a phenomenon sometimes called “animation deformity.” This can be bothersome to some patients.

For this reason and some others, going under the muscle is NOT the way most surgeons in other countries approach augmentation. Some of these reasons include the fact that under-muscle augmentation can be more painful, has a higher risk of bleeding, and involves working on the rib cage. Additionally, the muscle may hold up the implant in a higher position, which may be disadvantageous in transgender patients who naturally have a lower nipple position. If the implant is held up by the muscle but the natural breast tissue should descend and sag (in larger breasted individuals or those with higher weights), there can be an imbalance of the breast mound leading to what we call a “waterfall” deformity.

Dr. Sayed will review these and other considerations for you during your consultation for MTF augmentation.

Dr. Sayed uses a combination of surgical simulation software, sizing kits, clinical analysis, and above all, listens to the patient to craft a personalized approach. Dr. Sayed is comfortable using different implant styles, and as an expert in implant removal as well, he can have a very frank and informative discussion with you to help you understand the nuances of implant surgery.

Dr. Sayed prefers smooth round silicone implants for most patients. The likelihood of a stiff or unnatural appearing breast is lower with silicone implants, and the breast typically feels softer. Some patients are concerned about silicone leakage or the development of certain reactions to implants and would prefer a saline device. Dr. Sayed has extensive experience with both types of implants and can cater your surgical approach to your preferences.

Nipple enlargement can sometimes be achieved with injection of fillers, fat transfer, or grafting of cartilage and other materials. However, permanent nipple enlargement can be unpredictable. There are also nipple reconstruction techniques, which Dr. Sayed has used in hundreds of breast reconstruction patients, that may be appropriate in selected MTF breast augmentation patients.

Some breast lift techniques can be used to partially enlarge the areola (in fact, spread of the areola is one of the downsides of some lifting techniques, but can be utilized for this specific circumstance in some patients). However, medical tattooing by a qualified tattoo artist is the least invasive way to achieve a wider areolar appearance. Lifting techniques may increase the risk of loss of sensation in the nipple, whereas tattooing is less likely to do so.

Transgender patients tend to have thicker, stronger muscle, a short distance from the nipple to the fold, and a tighter skin envelope. This can lead to a higher likelihood of a low nipple position, a double bubble fold, or other cosmetic compromise, especially if very large implants are used. There may be some tradeoffs required for the MTF patient seeking augmentation, but in general, the results are highly satisfying in most patients.

Most patients will have preserved nipple sensation. Incisions in the fold are less likely to cause even temporary nipple sensory loss when compared to incisions around the areolar border. Breast lifts require incisions along the border, and this increases the risk somewhat, although most patients have preserved sensation long term.

Breast cancer in genetically XY individuals is uncommon but not impossible. The use of female hormones may increase the risk of breast cancer in transgender patients. You should confer with your primary care doctor and endocrinologist regarding the advisability of mammography in your case, particularly if you have a strong family history of breast cancer or a history of breast cancer in male relatives. MRI studies are recommended every few years by the FDA for patients with silicone implants in order to monitor for “silent leakage,” since the newer generations of implants are more cohesive than previous devices.

Contact us today!

If you’re in the San Diego or Newport Beach areas and would like more information about MTF transgender breast augmentation, we invite you to call 858-247-2933 or schedule a consultation with Dr. Sayed today!


View real patient before & after results in our photo gallery.

before and after transgender breast augmentation front view female patient case 1