Breast Augmentation

Surgeries are an option for anyone who wants to align their body with their gender, including non-binary people. There’s no one way to be trans, and you can choose whatever journey feels authentic to you.

This might include hormone therapy and transition-related surgeries, or it might include surgeries without hormones. It might not include medical treatments at all. Not every trans, non-binary or gender diverse person has surgery – it’s a decision that’s yours to make.

What is breast augmentation?

Breast augmentation is sometimes known as “BA” or “top surgery”. It’s a surgery for people who would like to change the size and shape of their breasts. This shapes the chest in a way that’s often perceived as “feminine”. You can choose between different surgery and implant types, depending on your surgeon, anatomy, insurance coverage or personal preference. 

Why do people get breast augmentation? 

There are many reasons someone might get breast augmentation. The most common is that it can help ease feelings of dysphoria, which improves your wellbeing. It can give you more options for clothes to wear, and some people might also choose surgery to feel more comfortable in environments like the pool, gym or beach.

Breast augmentation can also correct aesthetic issues like asymmetry, lack of growth or conical breasts, if you’ve been taking hormone therapy.

Alternative treatment options

If you’re not ready for surgery or are still exploring your options, there are other ways you can change the shape of your chest. Hormone therapy with estrogen is one way to build breast tissue without surgery.

In some people, estrogen can give an amount of breast growth they’re happy with. However, the amount of growth you can have with hormone therapy will vary depending on factors like age, genetics and body fat. Some people will have more noticeable results than others, so remember to be kind to yourself!

Breast forms are another way to increase the shape of your chest. These are made of silicone, gel or foam, and can be inserted into a bra or attached to your skin with adhesive.

If you have some breast growth but want to increase size, then padded or push-up bras could also be an option for you.

Surgical techniques

You have a few choices when it comes to surgery. You can decide between different sized and shaped implants, along with different surgical techniques. This will come down to your surgeon, your current anatomy and your goals. In your pre-surgery consultation you’ll have a chance to discuss all of these options and find what works best for you. 

Surgical technique

• Implants can be placed under your chest muscle (submuscular) or over the chest muscle, just under your breast tissue (subglandular)

• To insert the implant, your surgeon can make an incision in your armpit, around your nipple, or underneath your breast

Implant type

• All breast implants have a silicone outer shell. You then can choose between implants filled with silicone (a gel) or saline (a liquid).

• There are different shapes you can choose (round or teardrop) depending on your anatomy and goals

• Implants also come in different volumes (measured in cubic centimetres or “cc”s)

In some cases, surgeons can perform a breast augmentation without implants. This type of surgery is less common, and involves transferring fat to the breasts from another part of your body.

Side effects and risks

As with all surgery, breast augmentation comes with side effects and risks. These are:

Aesthetic complications

• Asymmetry of breasts and/or nipples

• Permanent skin changes (e.g. wrinkling or stretching) if implants are removed

• Wrinkling or rippling of skin

• Scarring (most visible with incisions under breasts)

Implant complications

• Implant failure (e.g. breakage, leaks, deflation)

• Implant migration or extrusion (where the implant comes through the skin)

• Capsular contracture (scar tissue forms around the implant, often requiring surgery to correct)

Other risks

• Breast cancer screening being less effective

• Numbness or loss of sensation in the area

• Necrosis (where the skin dies)

• Anaplastic Large Cell Lymphoma (ALCL), a cancer of the immune system in the tissue next to the implant. This risk is higher with textured silicone implants (from 1 in 2,800 people to 1 in 30,000 people with such implants).

• Mondor disease (an inflammation of blood vessels below scars), which affects less than 1% of people

Breast implants have a limited lifespan (estimated at 10-15 years). This means that you may need to replace them in the future. The timeline of this will vary depending on the type of implant and/or any complications you have.

Some aesthetic problems can be addressed with revision surgery. Your surgeon should walk you through all of the potential complications with breast augmentation, and some may include revisions free of charge. You can ask them about this in your consultation appointment.

General surgery risks

There are some general risks that come with most surgeries. They are:

• Bleeding

• Blood clots in your legs or lungs

• Injury to surrounding organs, nerves or blood vessels

• Hematoma (a collection of blood) or seroma (a collection of fluid)

• Infection or abscess

• Wound opening or delayed healing

• Chronic pain

• Scarring

• Feeling dissatisfied with the outcome

• Feelings of regret about surgery

These risks can be higher with certain medications and health conditions, like immune or clotting disorders, or if you smoke. Tell your doctor about any medications and supplements you take, along with any health conditions you have (even if they don’t seem relevant!). 

Anesthetic risks

Breast augmentation usually requires going under general anesthetic. General anesthetic has the following risks (most of which are very rare):

• Nausea/vomiting

• Damaged teeth

• Aspiration pneumonia (pneumonia from inhaling liquid like saliva or vomit)

• Respiratory failure (i.e. stopping breathing)

• Heart attack

• Coma

• Death

Ready for surgery?

If you'd like to get breast augmentation, your surgeon will require an assessment to confirm you're ready for surgery. If you'd like to apply for funding to cover your surgery then you also need to submit an application to the Ministry of Health in Ontario or Alberta Health in Alberta. To have surgery covered in these provinces, you must have been on 12 months of continuous hormone therapy with little to no breast growth at the time of your assessment.

In Ontario, the clinician who does your assessment will submit this application. In Alberta, your surgeon will submit this application. They’ll do this after you’ve been referred to them - whether they accept your referral is at their discretion. 

If you are in Ontario, Foria can provide your assessment and we can also submit and track your funding application for you. See our Surgical Referrals in Ontario article for more information.

Foria does not currently offer assessments in Alberta, but these services will be available soon. See our Surgical Referrals in Alberta article for more information.

This content has been reviewed by Foria’s Medical Director, Dr. Kate Greenaway and our community advisory team. Medical sources include Rainbow Health Ontario’s TRS Surgical Summary Sheets.

by Foria Clinical Team

Oct 4, 2023・ minute read

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