Breast implants

On this page:
Standards of care
What happens during breast implant surgery
Supporting your trans client through surgery
Downloads

This page provides a brief summary on gender affirming breast implants and offers guidance to help you support your trans clients if they undergo this surgical intervention.

Breast implants (also known as breast augmentation or mammoplasty) are typically sought by trans and gender diverse people who were presumed male at birth (PMAB), including trans women and non-binary people, to increase their breast size. Not all trans people want, seek or can have surgery, and being trans doesn’t necessitate surgery either. Find out more about that on our ‘Am I trans enough?’ page.

Information for community members about breast implants is available here.

WPATH Standards of Care

The Standards of Care – 8th edition (SOC8) are published by the World Professional Association for Transgender Health (WPATH) and offer guidance to clinicians working with trans people all over the world, including criteria and recommended referral pathways for those seeking particular medical and surgical interventions.

The SOC8 do not specify an order by which surgeries should occur, if sought at all, and are guidelines, not legislated requirements.

Criteria for breast augmentation (implants/lipofilling) in trans and gender diverse patients

Capacity to make a fully informed decision and to consent for treatment
Being assessed for risk factors associated with breast cancer prior to mastectomy
Being informed about aftercare requirements, travel and accommodations, and the importance of postoperative follow-up

Although not an explicit criterion, it is recommended that trans and gender diverse people undergo feminising hormone therapy (minimum 12 months, but ideally two to three years) prior to breast augmentation surgery. The purpose is to maximise breast growth in order to obtain better surgical (aesthetic) results.

Breast/chest surgery techniques and complications

The performance of breast/chest operations for treatment of gender dysphoria should be considered with the same care as beginning hormone therapy, as both produce relatively irreversible changes to the body.

For the trans and gender diverse person assigned male at birth, a breast augmentation (sometimes called ‘chest reconstruction’) is not vastly different from the procedure in a natal female patient. It is usually performed through implantation of breast prostheses and occasionally with the lipofilling technique. Infections and capsular fibrosis are rare complications of augmentation mammoplasty.

For the trans and gender diverse people assigned female at birth, a mastectomy, or ‘male chest contouring’ procedure is available. For more information, read our Top Surgery page.

What happens during breast implant surgery

A surgeon places implants made of a silicone shell and filled with either silicone gel or saline (salt water) under either the breasts or the breast muscles on the chest. Breast implants will often need to be replaced after a period of time, sometimes between 10 and 20 years, and it’s best to check with a client’s specific surgeon what this timeframe might be.

Supporting your trans client through surgery

Before surgery

At appointments in the lead up to surgery, your client might like to discuss their expectations and concerns, as well as their hopes and fears. It will be important to have an open conversation about what surgery can and cannot do. They may have been waiting many years for this particular surgery and feel that they have a lot riding on it. They may not be part of a supportive network or could be the centre of a thriving friendship circle. They might be clear about what they need from you, or really unsure. 

Although the SOC8 don’t mention it in their guidelines, some surgeons request that their clients be referred to a mental health professional for assessment to confirm readiness for surgery.

Finding comprehensive, evidence-based information about gender affirming surgical processes can be a challenge, and so your client might benefit from your additional research, including contacting a specific surgeon, if requested, or connecting with other health professionals to better understand and explain the process, possible complications, risk factors and outcomes. 

It’s also likely that a person’s GP will be the first point of contact for any post-surgical care and complications, so having a sense of what might be happening, and being able to engage with additional clinician peer networks could prove advantageous. 

Surgery location

If your client is contemplating surgery in Australia, it is prudent to encourage them to obtain private health insurance when and if they can afford it. This may help cover some of the costs such as the hospital stay. Their surgeon will be able to provide the applicable MBS Item Numbers that can be checked with the health insurer. 

If a patient is considering having surgery overseas, they will very likely appreciate a discussion about the benefits and risks of travelling overseas for surgery. This can be complex, especially if the surgery they’re seeking is not performed, or widely available, in Australia. 

For some patients, benefits can include cost saving, particularly if they’re not able to access private health insurance or Medicare in Australia, having greater choice of surgeons and being connected to a global community of trans people (we do a great job of offering comprehensive surgical reviews to the community).

Risks tend to arise from a lack of access to post-surgical care, including being able to effectively, and efficiently treat complications. Additional complications can arise if the person is not being able to take the requisite time off work or study and inadvertently damaging the surgical site. 

Around surgery

Around the point of surgery, the surgeon and their staff will typically be supporting the trans or gender diverse person through any fears and complications.

Some surgeons require patients to decrease hormones, particularly oestrogen, for a period of time in the lead up to, and immediately following, surgery. Your patient may want to discuss timeframes, expectations, and potential side effects from this. 

After surgery

As well as providing regular post-surgical care for your client, you might find yourself supporting them through learning how their body now functions and feels.

Even if a surgical outcome is affirming for people, it can still be confronting. Discuss with your client that it is normal to feel excited, but also very normal to feel overwhelmed or uncomfortable, to grieve, and to take time to become used to their body again. This isn’t an indication that they have made a mistake, or regret their decision, but a normal part of reconnecting with how their body appears and functions.

It can also be valuable to discuss how sensation may change, and what this might feel like. Having an honest conversation about how your patient will need to learn this for themselves over time can be helpful too. Refer to peer networks or a mental health professional, as needed.