Gender reassignment surgery is typically a lengthy string of surgical procedures designed to increase feminization of the transgendered body's more masculine features. The surgeries can often be grouped together into a single session, or broken up into parts. A very common male to female surgical procedure and perhaps the one with the most immediate effect is breast augmentation.

Pre-Op: Hormones

Prior to any surgeries, transwomen begin a regimen of hormone replacement therapy. With some luck, depending on the woman, hormone therapy may yield success in producing breasts. Estrogen adds fat to breast tissue, hips and buttocks; therefore some hormone replacements may produce suitable results.

Typically, however, the breast size of relatives is not indicative of breast growth for transwomen, and the resulting breast size will likely be smaller, if dependent on hormone therapy alone. If the individual intends to get surgical augmentation, hormones must be stopped prior to surgery to avoid complications.

Herbal Remedy

Unfortunately, a hormonal imbalance (essentially, too much estrogen) can raise the potential for hypothyroidism, depression, mood swings and even breast or liver cancer. Massage and herbs may help in generating a larger breast without the use of estrogen. Phytoestrogens also help your body create more estrogen. A common ingredient in these breast-enhancing herbs is saw palmetto, and a full-length program will take about six months to show results.

Effective herbal remedies should cause the body to produce its own estrogen, which will convert any phytoestrogen provided by the breast enhancement into human estradiol, yielding long-lasting results. While there are no conclusive scientific studies on how effective herbal breast enhancement is, it is a potential part of the overall breast enhancement process.

Augmentation Surgery

A more permanent and definite solution is breast implant surgery. There are many options for this type of surgery that are similar to female enhancement, including: type of implant, shape, texture, location of implant (above or under the pectoral muscle) and incision (nipple or belly button). Sizing, shape and placement can present great surgical challenges in order to achieve a natural look suited to the frame of the transwoman undergoing the procedure.

Furthermore, the breast envelope of the MtF is often undeveloped and tight, and with less breast tissue to start from, more stretching and settling is involved, leading to a more complex surgery and potentially longer recovery period. Musculature can also be a problem.

According to Florida plastic surgeon Dr. Greenwald, The pectoralis muscle in genetic males is very much more developed than in the genetic female, so going under the muscle in a patient transitioning MtF means working through a much more robust (read: strong; bloody) muscle."

Some surgeons recommend a step-up approach to implants; moving up in size over several surgeries in order to acheive a more natural shape and better prep the body. In addition, you may consider a device like BRAVA which expands the breast envelope before surgery to allow more room for a final implant, though this adds cost and the risk of additional surgery.

Have Realistic Expectations

Augmentation is not a perfect solution. One example of its failure is difficulty in creating cleavage and age-related changes in the breast. The positive aspects are that the procedure is very simple, extremely common and serious complications are rare. In fact, the most major problems are cosmetic, essentially that implants can never perfectly imitate adult breasts.

As a patient, it will be most helpful for you and for your surgeon to have realistic expectations and to learn as much about the surgery as possible beforehand.

Thoroughly research your surgeon and make sure they have experience in doing male-to-female breast augmentation surgeries. While the procedure is similar to female breast augmentation, it’s critical to have a surgeon who is comfortable and confident working with diverse populations. Ideally, you should be able to feel at ease, and have any very specific questions about the operation and recovery answered.