5 differences between breasts of transgender versus cisgender women

Posted on June 22, 2018 by Ellen Defrancq

For many transgender women, MtF breast augmentation is top of the list to get the sense of femininity they are dreaming of. To have the right expectations, it’s important to know about these 5 facts about breasts of transgender versus cisgender women.

1-Larger sizes are often required

As opposed to cisgender women, transgender women naturally have broader chests. Because of this, they often require larger cup sizes in order for their chests to appear proportional. Larger cup sizes are also beneficial for transgender women who are taller or who have larger frames. In fact, smaller breasts can look unnatural in this case. Your surgeon will advise you on the best cup size for your needs. Furthermore, the nipple is often placed more laterally. Therefor the width of the implant should reach lateral enough to project the nipple on the top of the breast.

5 differences breasts of transgender vs cisgender women

Larger sizes are often required with an MtF breast augmentation

2-HRT (Hormone Replacement Therapy) has an influence on breast formation

Many trans women have developed some of their own natural breast tissue thanks to MtF hormone therapy. It generally takes two years before breast growth in transgender women reaches its maximum size. However, breast development varies significantly from person to person. Typically, the breasts of trans women are (much) smaller than a cisgender woman’s. While the volume growth of the gland itself is often disappointing, the skin and the nipple undergo most valuable changes, making even larger implants look more natural after surgery. Dr Maarten Doornaert advises to wait at least 18 months before getting a breast enlargement after starting with HRT.

3-Difference in musculature can make a MtF breast augmentation more challenging

Cisgender women often have thinner chest muscles, and the skin surrounding the breast tissue is relatively loose as it has had time to adjust along with the natural growth of the breast. Transgender women often have thicker chest muscles and very tight skin that has not had the opportunity to adapt to naturally-growing tissue. This makes it more challenging to insert larger implants, but these techniques may make it easier:

  • Start with smaller implants, allow the skin to stretch, and then insert larger implants later down the line.
  • A tissue expander is seldom required. It is much like an implant, but it can be increased in size with salt water injections over time. However, since it often has folds in the beginning, the rate of complications is higher than with a silicone implant.
  • Finally, it may also be possible to utilise the patient’s own fat tissue. Following a liposuction procedure, the fat is reinserted into the breast area in a series of treatments to stretch the skin.

4-Trans women’s nipples are differently positioned than those of cisgender women

Trans women generally tend to have slightly lower nipples than cisgender women. This has an impact on the positioning of the breast during surgery. What this means, is that the natural breast crease may be lowered during the breast augmentation. This way the nipple can be properly centered on the implant.

5-MtF breast augmentation natural look needs more patience

It is especially important for trans women to follow specific after-care measures. The reason for that is that trans women typically have a larger pec muscle than cisgender women do. Due to this muscle, the implant may be held higher on the chest wall. With breast massage and compression however, the implant will “drop” into a more natural position. Equally, the skin needs adaptation to the new volume, and may appear stretched and unnatural. Skin however always “gives”, so the softer look will develop in time.


I am interested in a surgery, in which country do you perform FFS and BFS?

Dr Bart van de Ven (FFS) travels to different European cities for consultations twice every month, but surgery is only performed in Antwerp, Belgium. Dr Maarten Doornaert (BFS) on occasion also travels for consultations, but also only performs surgery in Antwerp.

What if there are post-op complications?

It doesn’t happen often, but should there be a complication during your stay, you can notify Petra (our permanent resident) or one of the night nurses and they will get in contact with the surgeon if they can’t help you themselves. There will always be someone by your side.

When you leave our clinic, you will receive the phone number of the surgeon in case a complication were to arise later on.

How long should I wait when I am on HRT before I get a breast augmentation?

Body Feminization surgeon Dr Maarten Doornaert would recommend to wait about 16 months. To know why , read more here.

When should I stop my HRT treatment?


You can continue your HRT treatment before, during and after your FFS. You will receive an anti-thrombotic injection the day before surgery to prevent blood clotting. We prefer you to continue taking your hormones because FFS is emotionally already perturbing enough without messing with your hormone balance.


Only for implant surgery of the buttock and hips we ask to stop one week before the surgery. The day after surgery you can continue your HRT treatment. This because this type of surgery implies some immobilisation (obliged) after the surgery. In this case the risk for blood clots is higher.

You still have another question? Feel free to ask! We will answer your question and if generally applicable add it to the FAQ of this page.

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