MTF Top Surgery in Beverly Hills, CA

WHAT IS MTF TOP SURGERY?

MTF top surgery is a surgical procedure that uses breast implants (and sometimes fat transfer) to create a feminine chest contour.

In other words, it’s a breast augmentation performed as part of a gender transition. The goal is to provide transgender women with fuller breasts that are proportionate to their body and aligned with their gender identity. This procedure not only enhances your physical shape but can also have a profound positive impact on emotional well-being.

Top surgery is typically performed as an outpatient procedure under general anesthesia. It usually takes about one to two hours to complete. During the surgery, Dr. Schwartz will make carefully planned incisions to insert the breast implants and sculpt your new bustline. Common incision sites include along the inframammary fold (the crease under the breast), around the lower edge of the areola (peri-areolar), or occasionally in the armpit.

The incision approach is personalized to each patient, aiming for minimal visible scarring. Dr. Schwartz will discuss which incision and placement are best for you based on your anatomy and desired outcome.

Understanding the surgical procedure

After making the incision, a pocket is created for the implant either beneath the chest muscle or above it, depending on what will yield the most natural-looking results for your body.

Many trans women have minimal native breast tissue, so placing implants under the pectoral muscle can help provide a smooth upper breast slope and additional soft tissue coverage. In some cases, if enough breast tissue is present or a particular implant type is used, the implant might be placed above the muscle to achieve the desired shape.

Dr. Schwartz will carefully choose the approach that best suits your body and implants. If you have very tight chest skin or desire a significantly larger breast size, he may recommend a staged plan, such as using a temporary tissue expander or opting for a moderate size initially, to ensure your skin can safely accommodate your new breasts without excessive tension. However, in most cases the skin will stretch beautifully to create your feminine curves without the need for additional procedures.

Once the implants are positioned and symmetry is checked, the incisions are closed with fine sutures. A small drain may be placed temporarily if needed to prevent fluid build-up, though this is often not required for routine augmentations. Finally, you’ll be placed in a supportive surgical bra. You will wake up in the recovery area and, after a short monitoring period, be able to go home the same day.

Before you leave, we will review all your post-operative instructions to ensure you feel prepared to take care of your new bust during healing.

CANDIDATES & REQUIREMENTS

MTF top surgery is an incredibly personal procedure, and Dr. Schwartz will ensure you are a good candidate and fully ready before moving forward.

Ideal candidates are transgender women or transfeminine nonbinary individuals who are seeking a breast augmentation to achieve a more feminine appearance. You should be in good overall health and able to undergo a surgical procedure. It’s important that any significant medical or mental health concerns are well-managed, as your safety and well-being come first.

There are a few special requirements and considerations for transgender patients pursuing top surgery.

In line with widely accepted standards of care, Dr. Schwartz requires that you undergo hormone therapy (estrogen, and possibly androgen blockers) for at least 18 months prior to breast augmentation. This period of hormone therapy often induces some natural breast tissue development and other body changes; by waiting at least a year and a half, we can better assess how your body responds and what implant size might be appropriate to achieve your goals.

Additionally, patients must provide a letter of recommendation from a therapist or licensed mental health professional affirming that top surgery is a suitable and positive step for you. This letter is a standard step to ensure you have psychological support and are ready for surgery as part of your transition. Dr. Schwartz also asks that you have been living as your identified gender for at least two years. Living as a woman full-time for a significant period helps confirm that breast augmentation aligns with your long-term gender identity and goals.

Other candidacy factors include age and lifestyle habits. For example, you should avoid smoking or vaping before and after surgery, as nicotine can impair healing.

BREAST AUGMENTATION OPTIONS

One size does not fit all when it comes to top surgery. There are multiple techniques and implant types that can be used to create your new breasts. During your consultation, Dr. Schwartz will work with you to design a surgical plan that best suits your body type and goals.

Saline implants

Saline breast implants consist of a silicone outer shell that is filled with a sterile saltwater solution.

These implants are placed into the chest empty and then filled during surgery to the desired volume. Because they are filled in situ, saline implants allow a bit of fine-tuning of size and typically require a slightly smaller incision. They are also generally less expensive than silicone implants.

However, Dr. Schwartz usually does not recommend saline implants for most MTF transgender clients. Saline implants tend to feel firmer and can be prone to visible rippling or wrinkling, especially in patients with very little existing breast tissue or thinner skin.

Many trans women have a slender build or minimal chest fat, which means a saline implant might show its edges or texture more obviously. While saline implants are safe and the body can easily absorb the saltwater if an implant leaks, their aesthetic drawbacks make them a less popular choice.

Silicone implants

Silicone implants are a very popular choice for MTF top surgery. Like saline, they have a soft silicone shell, but they come pre-filled with silicone gel: a cohesive, gelatin-like substance that closely mimics the consistency of real breast tissue.

Standard silicone implants are known for their natural feel and appearance; they tend to have less rippling compared to saline and create a pleasantly soft yet realistic breast.

Many transgender women prefer silicone implants because they provide a convincing natural breast tissue effect, which is key to achieving a feminine look and feel.

The implants are available in a wide range of sizes and projections, so Dr. Schwartz can help you choose dimensions that will give you the silhouette you desire, whether that’s a subtle enhancement or a boldly feminine bust.

Silicone implants have an excellent safety profile and are FDA-approved. You may eventually need an MRI or ultrasound to check implant integrity over the years, but they generally last many years before any maintenance is needed.

Cohesive gel (gummy bear) implants

“Gummy bear” implants refer to a type of highly cohesive silicone gel implant that is form-stable and often shaped to create an extremely natural breast contour.

These implants get their nickname because the gel inside is thick and firm enough that if you cut the implant, it retains its shape, like a gummy bear candy. Cohesive gel implants are often teardrop-shaped, meaning they are thinner at the top and fuller at the bottom, closely mirroring the shape of a natural breast.

This can be especially beneficial for transgender patients who desire a very natural slope to the upper breast and a nicely rounded lower breast.

Dr. Schwartz is highly experienced with gummy bear implants. In fact, he has been one of the highest-volume users of gummy bear implants in the U.S. This high level of experience means you’re in exceptional hands if this implant type is chosen for you.

Do note that because many gummy bear implants are anatomically shaped, they may require precise positioning and a slightly larger incision. Rest assured, Dr. Schwartz’s advanced surgical techniques keep incisions as small and hidden as possible.

Fat grafting

Fat grafting can be a fantastic adjunct to implants or, in select cases, an alternative for a modest breast enhancement.

In fat grafting, Dr. Schwartz gently liposuctions fat from one area of your body (common donor sites include the abdomen, flanks, or thighs) and then purifies and injects that fat into the breasts. For MTF top surgery, fat grafting is often used in addition to implants to fine-tune the results.

For example, Dr. Schwartz may place implants to provide most of the volume and then layer a thin blanket of your own fat over the implant edges or in the upper breast to soften the transition and enhance cleavage. This technique can “camouflage” the implant, making the breast feel and look even more natural.

In some cases, a patient who wants only a small increase in breast size and prefers not to have implants can opt for fat transfer alone. However, fat grafting alone has limits on how much volume it can add in one procedure. Only a certain amount of fat can reliably “take” and survive in the new location.

Combining procedures

MTF top surgery can be done as a standalone procedure or as part of a more comprehensive surgical plan.

Dr. Schwartz often sees patients who choose to combine their top surgery with other body feminization or facial feminization procedures for a full transformation.

If you have additional aesthetic goals, for example, contouring your waist and hips for an hourglass shape, or softening facial features with facial feminization surgery, be sure to discuss these during your consultation.

Depending on the specifics, some procedures can be safely performed in the same surgical session as your breast augmentation, while others might be staged separately.

THE MTF TOP SURGERY PROCEDURE

Every top surgery with Dr. Schwartz is approached with meticulous care, surgical expertise, and an understanding of the unique considerations for transgender anatomy. On the day of your surgery, you will arrive at our fully accredited surgical facility in Beverly Hills.

You’ll meet the anesthesia team and Dr. Schwartz will make his pre-operative markings on your chest, reviewing the plan one more time to ensure we’re all on the same page about your desired outcome.

Once in the operating room, you’ll be gently put under general anesthesia so that you are completely asleep and comfortable throughout the procedure. Dr. Schwartz uses an advanced form of anesthesia called TIVA (Total Intravenous Anesthesia) for his breast augmentation patients. TIVA is a gentler technique that uses IV medications only, which leads to a smoother wake-up and less nausea after surgery.

The surgery itself generally takes around 1–2 hours, though it can vary if we are doing additional procedures or very extensive adjustments.

The procedure is done on an outpatient basis, meaning you get to go home the same day. You will need someone to drive you and stay with you initially, since you’ll still be recovering from the anesthesia.

Before you leave, we will ensure you have all the supplies you need and clear instructions for the evening and next few days. We’ll also schedule your follow-up visit and make sure you know how to reach us at any time with questions or concerns.

RECOVERY AND AFTERCARE

Recovery after MTF top surgery is generally very tolerable, especially with the advanced techniques used by Dr. Schwartz.

Most patients find that the first 1–2 days involve some soreness and tightness in the chest, but significant pain is uncommon. You will be sent home with detailed post-operative instructions on how to care for your incisions, medications to take, and activity restrictions to follow.

We will also provide a special post-surgery bra that you should wear as directed, usually full-time for a few weeks. This bra helps support your new breasts, minimize swelling, and protect the healing tissues. In general, you’ll want to take it easy for the first week: get plenty of rest, stay hydrated, and avoid any strenuous activity.

Light walking around the house is encouraged to promote circulation, but avoid lifting anything over a few pounds or any vigorous exercise.

After one week

Many of our patients are pleasantly surprised at how good they feel just 24–48 hours after surgery. Some even feel well enough to go out for a gentle dinner the very next day.

Showering is generally fine after the first couple of days, with care to keep water pressure off the incision sites.

By the end of the first week, discomfort is usually minimal, and you’ll be off any prescription pain medication, if you even needed any at all. Dr. Schwartz’s patients often manage with just Tylenol and other over-the-counter remedies. Bruising is typically mild. Swelling will be present but starts to subside significantly after the first 10-14 days. We’ll see you for follow-ups to monitor your healing and remove any drains or stitches if needed (most sutures are internal and dissolve on their own).

Weeks 2–4

By around two weeks post-op, many patients resume driving and very light exercise like walking longer distances.

Raising your arms overhead may feel tight at first, so stretching should be gentle. We also advise avoiding submerging your chest in baths, pools, or hot tubs until your incisions are completely healed, which usually comes around 3–4 weeks.

After week 4

During recovery, you should plan to sleep on your back with your upper body slightly elevated (propped up with pillows) for at least a couple of weeks. This helps reduce swelling and protects your incisions.

You’ll notice that initially your new breasts sit a bit high and feel firm. This is normal. Over the first few months, implants “settle” as swelling resolves and tissues relax, resulting in a softer, more natural look and feel.

By about 6 weeks you’ll see a pretty good preview of your results, but the final outcome (in terms of shape and scar fading) continues to improve up to 6-12 months after surgery.

Schwartz Rapid Recovery™: A better recovery experience

One of the reasons patients travel to our Beverly Hills office for top surgery is Dr. Schwartz’s innovative Schwartz Rapid Recovery™ protocol. This is our signature combination of surgical techniques and recovery care that helps you heal faster and get back to life with minimal downtime.

It starts with the anesthesia method (the TIVA anesthesia mentioned earlier), which avoids the grogginess and nausea often associated with traditional general anesthesia.

Another key component of Schwartz Rapid Recovery™ is proactive pain management. Rather than relying on heavy painkillers after surgery, Dr. Schwartz uses advanced techniques to prevent pain before it even starts. For example, he may inject BOTOX® into the pectoral muscles during surgery. This relaxes the chest muscles and prevents the tight muscle spasms that can cause discomfort after implant placement.

He also often uses EXPAREL®, which is a long-acting local anesthetic, by placing it into the chest muscle layers during the operation. EXPAREL® slowly releases numbing medication over about 72 hours, providing pain relief in those critical first days.

Thanks to these methods, most of our top surgery patients experience far less pain than they expect.

Interested in finding out more?

SCHEDULE YOUR PERSONALIZED CONSULTATION

Embarking on male-to-female top surgery is a significant milestone in your journey, and choosing the right surgical team is paramount.

With Dr. Jaime Schwartz’s experience in transgender health and our office’s warm, inclusive environment, you can feel confident that you’ll receive outstanding, empathetic care from start to finish.

Ready to learn more? Our clinic is conveniently located off Wilshire and San Vicente in Beverly Hills.

240 S La Cienega Blvd #200
Beverly Hills, CA 90211

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