Expert in Transgender Breast Augmentation

Dr. Steven Teitelbaum is an internationally renowned breast augmentation surgeon in Los Angeles, and for over two decades has been helping transgender women in both first-time and revision breast enlargement. His goal with any gender affirming breast augmentation is to provide natural, feminine, and beautiful breasts.

Dr. Teitelbaum lectures at major plastic surgery meetings about the challenges unique to transgender breast enlargement, sometimes incorrectly referred to as “Los Angeles mtf top surgery”, and teaches other plastic surgeons his technique to manage them. Both cis and transgender women from around the world travel to Los Angeles to consult with Dr. Teitelbaum for breast augmentation. While he has been performing breast augmentation in transgender patients for over twenty years, he has seen an explosion of transgender patient over the past five years. He has operated on prominent and influential transgender women, including authors, activists, counselors, and celebrities. He and his office staff have the expertise and experience to help you in your journey.


Eager to Help Transgender Women

It is professionally satisfying to perform breast augmentation surgery in all women because they are typically thrilled with their results. He has seen the increase of self-esteem and confidence in breast augmentation patients from teenagers who had correction of congenital deformities, to women who simply needed “a refill” after having babies. But in few instances is this increase in self-esteem as profound as when he creates beautiful and feminine breasts for a transgender woman.

For trans patients, this is a major step beyond self-esteem per se: for many, breast enlargement is the defining moment in their transition. Perhaps this because it is the secondary sexual characteristic most associated with femininity and it opens up the possibility of wearing any type of clothing and having naturally feminine curves without the need for padded bras. Gender identity may be on the inside, but it is undeniable that what we see on the outside affects both how we feel and how other people perceive us.


Cisgender v. Transgender Augmentation

At one level, the operations of a cisgender and transgender breast augmentation, often falsely referred to as “mtf breast augmentation”, are the same: an implant is being placed into a breast consisting of a nipple, skin, breast tissue, and muscle. The surgical instruments and fundamental anatomy are the same. However, there are profound differences in tissue dimensions and tissue characteristics that require attention to very particular details. Both groups of patients describe equally diverse goals. There is a myth that transgender patients typically seek unnatural breasts; in reality, their requests are as varied as those of cisgender women, ranging from a subtle and natural change to a look that is disproportionate and obviously surgical. While Dr. Teitelbaum can make people look eye-catching and fake, his niche is in the beautiful, graceful, and feminine. His patients most commonly ask for breasts that look natural, balanced, and proportionate; they usually specifically state that they do not want breasts that are overly large, round, bulging on top or fake.

There are at least seven important anatomic differences between cis and transgender augmentations that are too often unrecognized by patients and surgeons:

  1. The rib cage and breasts of a trans woman are usually wider than that of a cis woman of similar height and weight. To create an ideal breast shape and to have that breast fit on the thorax means that the surgeon must take multiple, precise measurements, and select from a wide range of implants. While surgeons may just think of “volume” with a cisgender augmentation, looking independently at volume, height, width and projection is important to creating beautiful breasts for the transgender patient.
  2. A trans woman’s nipples are usually situated more to the outside of the breast mound. This affects where the implant should be placed so that the nipple ends up relatively centered (from left to right) on the breast mound.
  3. A trans woman’s nipples are often situated low on the breast mound. The ideal breast has about 55% of the breast volume below the plane of the nipple and 45% above. While sometimes the implant needs to be placed below the natural crease of the breast in a cisgender woman to achieve that balance, it is necessary far more often in the transgender patient. That position is critical to the result and must be planned exactly. Failure to properly determine where to situate the bottom of the breast and to keep the implant in that position are the two factors that account for most of the suboptimal results in transgender breast augmentation. Dr. Teitelbaum teaches other surgeons a specific technique to manage this issue.
  4. All breasts are made up of a combination of fat (soft) and gland (firm.) Breast in transgender patients are firmer and denser because, unless they are significantly overweight, their breasts are predominately made up of glands that are enlarged from the hormone therapy. They are often akin to the breasts of a cisgender woman during puberty, typically lacking the fatty component to their breasts that gives breast their natural sway and squishiness. Since most patients want to have youthful and perky breasts this is typically not a problem. But it is important for surgeons to take the reduced degree of breast tissue malleability into account because this affects the implant sizing and it is important that prospective patients understand what this might mean about their result.
  5. Cisgender patients usually have thicker and tighter skin. Years of fluctuating breast size from monthly periods, weight changes, gravity, genetically thinner skin, and of course the substantial stretch with pregnancy can all thin skin further. A transgender patient usually has their augmentation sooner after the beginning of their hormone-induced female “puberty” than a cisgender woman might, so the skin has been more recently stretched and it has not had the chance to relax and soften.
  6. The combination of the denser tissue and less compliant skin yields a breast that is thicker, tighter, and higher than that of the typical cisgender patient. This is important to understand because it means that the breasts usually end up very high, perky full, firm and tight – something that many cisgender women aspire to but cannot achieve– yet at the same time many prefer breasts that are a little lower, less full, and with more “bounce.” Dr. Teitelbaum carefully explains to each patient what range of possibilities are available so she can choose.
  7. The pectoralis major muscle is often (but not always) thicker in an transgender woman. Rarely is it thick enough to create a problem; it just requires a greater level of attention to anesthetic and technical considerations during surgery. There may be a greater tendency for the muscle to push the implants slightly down and out over time, though this is also an issue for cisgender patients.

Dr. Teitelbaum’s Unique Approach

The goal of gender affirming breast surgery (mtf top surgery is a common misnomer) is to create beautiful, natural-looking breasts. Dr. Teitelbaum employs an innovative surgical technique that makes such breast augmentations more beautiful and predictable. It takes into consideration the concerns mentioned above and aims to avoid the pitfalls. These improvements are:

  1. Meticulous and detailed assessment of anatomy.
  2. Understanding exactly what each patient wants rather than allowing his own aesthetic to determine the result.
  3. Suggesting an implant size and dimensions that best changes your shape into the one you want.
  4. Using computer simulation to demonstrate what to expect.
  5. Using absorbable mesh during surgery to “fix” the inframammary fold – the bottom of the breast – into an exact position on the chest wall in order to create a crisp and accurate bottom of the breasts.
  6. Often use anatomically shaped implants to better control the balance of fill of the breast.
  7. Using the same meticulous surgical technique, nerve blocks, and rapid recovery he has used with thousands of cisgender patients.

This approach creates a most natural and beautiful breast appearance, with an ideal amount of volume above versus below the nipple, nice expansion and fill of the lower pole, and an upper pole that feathers out and transitions gradually into the upper chest.

Dr. Teitelbaum has presented this technique to many plastic surgery organizations, including the 2018 Atlanta Breast Symposium – the largest plastic surgery meeting in the world focused strictly upon breast surgeries. He has been invited to write a book chapter on transgender breast augmentation for an upcoming major textbook of breast surgery.


A Kind and Respectful Office

Dr. Teitelbaum and his staff take great pride in assisting trans women achieve their authentic bodies. He and his staff are pleased to help patients who are transitioning, and are sensitive to their unique fears, concerns, hopes, and dreams. Some patients seek a very natural and feminine augmentation – as if they had naturally moved through female puberty. Others desire breasts that garner attention. Whichever you prefer, Dr. Teitelbaum can make them beautiful. You will find everyone you speak to on the phone and in person to be dedicated to your personalized care and comfortable recovery.


Fat Injection for Transgender Breast Augmentation

Many trans patients ask for liposuction of their love handles to enhance a feminine, hourglass figure. Sometimes this fat is transferred into the buttocks or outer thigh. This fat can also be used for the breast. Fat alone does not produce a breast of adequate size, but it can help widen a breast that responded very well to hormones. It also can be used in conjunction with an implant to conceal the implant edges and make the breast look more natural than it might with an implant alone.


Why Choose Dr. Teitelbaum for Transgender Breast Augmentation?

Trained in surgery at Harvard, Dr. Teitelbaum is one of the most respected plastic surgeons in the world. He is one of the most sought after lecturers on breast augmentation in the world and his contributions to the field of breast augmentation and breast implant technology are significant. Though is office is located in the Los Angeles area his patients come from around the world. He has achieved a reputation for surgical excellence, based upon his outstanding skills – including when performing gender affirming breast augmentation. As reported in Allure, “he produces astonishingly natural results.” He is an Associate Clinical Professor of Plastic Surgery at UCLA School of Medicine, (Advanced Level Resident Instructor), and a widely- sought speaker, educator, patient advocate and innovator. His interest in transgender breast augmentation spans two decades, and he is responsible for developing a superior, cutting-edge surgical technique.


Selecting Your Plastic Surgeon

The first step in determining whether Dr. Teitelbaum should perform this crucial surgery is to carefully read through this website several times. Is this procedure right for you? Do you like Dr. Teitelbaum’s philosophy, training, and results? If so you can schedule a consultation over the phone or an in-person private consultation. After discussing your medical, surgical, and hormonal history, Dr. Teitelbaum will work with you to determine the exact process for your gender affirming breast augmentation surgery in Los Angeles.


A Private Consultation

Your aesthetic goals are of primary importance in breast augmentation. You have an aesthetic vision, and concept of your body that is unique to you. You will find Dr. Teitelbaum easy to talk to, a warm, compassionate human being, and able to answer all of your question and concerns simply and thoroughly. You will find him to be brilliant, detail-oriented, and very focused on your body and your wishes. He is known as a straight-talker and will help you to understand the options that suit your body and your wishes.


True Artistry in Transgender Breast Augmentation

Dr. Teitelbaum has an innate ability to achieve aesthetic balance. He has studied classical painters and sculptors to gain insight on the perfect balance in the human form. His focus on the artistic aspects of the human body has proven to be of beneficial to his trans patients. Your body will be in the hands of an artist – and one of the most sought after plastic surgeons in Los Angeles and beyond.


FAQ’s

Is gender affirming breast augmentation surgery tax-deductible?

Political issues around breast augmentation are constantly changing these days, usually for the better, but certainly not always so, nor on the pace women should reasonably expect. So this is something always to ask your accountant. And certainly Dr. Teitelbaum Is not a tax expert, so don’t take his advice. What he wants you to know is that some recent patients have told them that their accountant said it was okay. Click here to view a 2016 article from the Huffington Post.

How old do you have to be to have a breast augmentation?

Saline implants are FDA approved for women 18 and over, and silicone are approved for women 22 and over. They can only be used in younger women when it is a reconstructive surgery. In fact the younger a woman transitions, the shorter the period of time of male hormones, the better the result. In these situations Dr. Teitelbaum will confer with your therapist and general physician.

Is hormone therapy required?

You should be on hormones for a minimum of one-year and your breast development should have stabilized. He has performed breast augmentation on people who have been on hormones for less than a year, but in those cases has spoken with their personal physician.

Is a note from a therapist or a certain amount of counseling required?

Breast augmentation does not require a note from a therapist or special counseling; all that is required is hormonal therapy and a commitment by the patient. What is important is that a patient understand the risks and benefits of surgery, has a support system, and has thoroughly considered all of the issues.

Will insurance cover gender affirming breast augmentation?

This is still in a state of flux and varies by state. Dr. Teitelbaum is not an insurance provider and is not on any network. So his fee remains the same and is paid by each patient. If there is an opportunity for insurance reimbursement the patient is responsible for filing the claim, but Dr. Teitelbaum’s office will assist you in any way it can.

Should breast augmentation occur before FFS or GRS?

While breast augmentation surgery usually occurs before facial feminization surgery and gender reassignment surgery, there are times it occurs after. This is a personal choice for each patient. It is affected by the degree of breast development on hormones and the priorities of an individual patient.

How much pain is there after surgery?

Dr. Teitelbaum has been teaching a 24 hour recovery after breast augmentation for many years, and is as successful at doing this in both trans and cis women. It is the result of complete preoperative planning, a detailed understanding of anatomy, gentle and precise surgical technique, and an excellent anesthesiologist.

Does a person have to identify as a female to receive a breast augmentation, or can non-binary individuals receive a breast augmentation?

There are no rules or laws governing this. Dr. Teitelbaum assesses each patient individually. Usually he does not need to speak with a patient’s therapist, but on a case by cases basis he may feel that it is best.

Is there a limit to how large a person’s breasts can be enlarged?

If the patient wants to look natural then there is a limit. If a breast has too small of an implant it will be empty. If the implant is too big the breast will look stuffed. His measurement system and computer simulation will help you to see this.

What is the role of fat grafting?

Fat grafting can widen and slightly enlarge a breasts that have had adequate growth from hormones, but it does not make a significant size difference. However, when tissue coverage is thin, fat grafting to the breast smooths out the edges of the breasts and helps conceal the presence of the implants.

Which incision does Dr. Teitelbaum suggest?

The inframammary (IMF) or under the breast incisions is today’s most often used approach for both cis and transgender augmentation. The scar is the most concealed; but most important of all is that study after study has shown a reduced incidence of a large number of complications after breast augmentation, and an overall reduced rate of a revision surgery.

Are implants best placed in front or behind the muscle?

For both cisgender and transgender women the implant is typically placed behind the muscle. This is because the more tissues there is over the implant the more the edges are obscured and the more natural it appears. It also has a lower rate of capsular contracture, which is the build-up of thick scar tissue around the implant. However when behind the muscle there can be movement of the implant with motion of the pectoralis muscle, and perhaps there is an increased tendency for outward migration over time. So while Dr. Teitelbaum and most plastic surgeons place the implant behind the muscle in most cases, there can be circumstances in which it is appropriate to place it in front of the muscle.

What is the unique thing that Dr. Teitelbaum does differently than most other surgeons with transgender breast augmentations?

The key difference is the firm fixation of the bottom of the breast against the chest wall. This should be highly defined. He does it with an absorbable mesh and it makes a big difference. It is not a requirement that you do it this way, and in some trans patients the crease is already at the right place and is well defined. But if you look at transgender photographs on the internet you will often see a soft or vague crease under the breasts.

What type of implant does he use?

Dr. Teitelbaum has used and continues to use every type of implant that is available in the United States, including saline and silicone, gummy bear, round and teardrop, smooth and textured. There is a reason for each of them and he will explain them to you. There is a particular role for teardrop implants in transgender patients and he will explain those to you at your consultation, along with the tradeoffs of using them. If one implant were always the best then only one implant would be made.

What can be done to enlarge nipples?

Nipples in transgender women are usually narrower and shorter than cisgender women. While some trans women wished that their nipples were larger, it is ironic because so many cis women wish that theirs were smaller! While there are reconstructive techniques to make nipples that have been lost from a mastectomy, these are not finessed enough to be used simply to enlarge a nipple. Some patients have had luck making their nipples larger with suction cups. But the best news is that trans women usually – but not always – end up with very erotically sensitive nipples.

Can my areola be made larger?

The darkly pigmented areola skin cannot literally be made larger. But tattooing can be done to make them larger or darker. However most trans women are very happy with their areolas and it is very unusual for someone to want to do it, but it is of course an individual decision.

Are there risks that are more common with transgender breast augmentation?

Historically it was thought that trans women had more capsular contracture – scar tissue buildup – than cis women. But that was probably due to older techniques and Dr. Teitelbaum has not noticed a difference. The only problem that seems to be more common with breast augmentation in trans women is implant malposition, specifically meaning that the implant slides down and is too low in the body. This can require a revision. That is why Dr. Teitelbaum emphasizes the benefits of his use of an absorbable mesh to secure the implant into position.

What happens to nipple sensation?

There is always a risk of partial or complete loss of nipple sensation from a breast augmentation, in both trans and cis women. That risk is less than 10% but that is of course very significant to those who want to maintain it.

How does HRT affect breast cancer risk?

This is a great question. Dr. Teitelbaum has spoken with endocrinologists and breast cancer surgeons and no one seems to have a good answer to this question. As more and more women lives out the rest of their lives after decades of hormones we will know better. While mastectomy is usually not recommended for patients with the BRCA 1 and BRCA 2 breast cancer genes, including male breast cancer, it is important to understand how hormonal therapy will affect these patients’ breast cancer risk. When Dr. Teitelbaum sees a woman on hormones for a breast augmentation with a significant family history of breast cancer he always refers them to a breast cancer specialist or geneticist.

Should transgender women with breast implants get mammograms?

This has not generally been recommended in the past. It is also problematic because the breasts of trans women are typically so dense that the mammogram would look very cloudy, with little visualization of the breast. Beyond that it has not been recommended. However women with particular family histories or genetic predispositions may be told to consider it on a specific basis.

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