Dr. Medalie performs Breast Augmentation and Tracheal Shave for his MtF patients. Please scroll to the bottom of this page to see information about Tracheal Shave

Breast Augmentation Surgery with Dr. Medalie

For MtF trans patients who desire more visible breasts, the first treatment that can be of benefit is the female hormone, estrogen. The results are extremely variable, but almost all patients have some growth of breast tissues. The more definitive and predictable way to achieve female breasts is through breast augmentation surgery with implants. This surgery is not very different for cis or trans patients and is well tolerated. The only difference is that the cis male chest tends to be wider with bulkier pectoralis major muscles and based on the individual patient Dr. Medalie may choose to go above the muscle as opposed to partially underneath it. Dr. Medalie encourages readers to see his breast augmentation section for additional information.

*Plastic surgery results can vary from patient to patient and are not guaranteed.

What people are saying about Dr. Medalie on Google:

I'm a physician that specializes in the care of transgender people. I have seen hundreds of top surgery results over the years. Maybe even 1,000.

Dr. Medalie routinely produces the best results I see on any of my patients that get top surgery done. The worst outcome top surgery I have ever seen done by him was a 9/10. The best I've seen done locally in michigan I'd call an 8/10. Literally, the worst results I've seen on anyone done by this guy are better than the best results done by everyone else. Some of these patients come back and you can't even tell that they ever had top surgery done. I don't even know how he does the micro suturing or whatever it is that he does to not leave the telltale 1/2cm thick double incision scar lines but the results are amazing.

I have never talked to Dr. Medalie personally. I don't know him personally in any capacity or have any vested interest in his clinic or his success. This is my real honest opinion after eight years of treating transgender patients and seeing the results of the work of many surgeons.

Unequivocally he is my top recommendation for top surgery. It's not even close.

Will P

*Feb 17, 2021

Before MtF Breast Augment

Before Image of Male to Female Surgery Cleveland OH

After MtF Breast Augment

After Image of Male to Female Surgery Cleveland OH

MtF breast augmentatin before and after 2

Directly above: Breast Augmentation and simultaneous Tummy Tuck Surgery

The Consultation at Cleveland Plastic Surgery

When you schedule a breast augmentation consultation with Dr. Medalie, he will go over the procedure in depth, show you numerous patient pictures and let you feel the different types of implants to get an idea of what is the best fit for your body.
This will gives you an opportunity to see if you can communicate well with Dr. Medalie.
Dr. Medalie can assess you for any issues that may complicate or prevent breast augmentation.
You can learn how different choices may impact your result.
You can learn about different types of breast implants (saline vs. silicone, moderate vs. high profile)
Together, you and Dr. Medalie will come up with a plan for surgery (above or below the muscle, implant size and profile). You will review the "Rice Test" which is a good way to evaluate implant size in the comfort of your own home.
You can ask what to expect during your recovery from breast augmentation

A breast augmentation procedure includes the following steps:

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. Dr. Medalie prefers light general anesthesia with the patient breathing fully on her own.

Step 2 – The incision

Incisions are made in inconspicuous areas to minimize visible scarring.We will discuss which incision options are appropriate for your desired outcome. Incision options include: along the areolar edge (peri-areolar incision), the fold under the breast (inframammary fold) and in the armpit (axillary incision). I prefer the IM fold approach because recent literature suggests that it is associated with a lower incidence of capsular contracture. Ths incision for a silicone implant is by necessity larger than one for a saline implant because the silicone implant is pre-filled and the saline implant starts empty.

Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.

Step 3 – Inserting and placing the breast implant

After the incision is made, a breast implant is inserted into a pocket either:

A. Under the pectoral muscle (a complete submuscular placement). This is almost never used by Dr. Medalie in MtF patients.

B. Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement). This is about 30% of Dr. Medalie's breast augmentation procedure for his trans patients. It actually is in what is called the "sub-fascial' plane where the gland of the breast is elevated in conjunction with a very thin layer of fascia which coats the pectoralis muscle.

C. Dual-plane which is partly under the muscle (in the upper pole) and partly under the breast (lower pole). This procedure is the most frequent procedure used by Dr. Medalie for his MtF breast augmentation patients.

The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and Dr. Medalie's recommendations.

Step 4 – Closing the incisions

Incisions are closed with layered sutures (that dissolve) in the breast tissue and with sutures, skin adhesive and surgical tape to close the skin.

Over time the incision lines will fade. The quality of scar depends on many things, including your genetics, exposure of your body to nicotine and infection.

Step 5 – See the results

The results of breast augmentation are immediately visible. Typically they start high and then over time settle to a lower and more natural appearance. I usually tell patients that what they see is not what they get until 3 months after the surgery.

View Frequently Asked Questions about Breast Augmentation Surgery

Do I Need General Anesthesia?

Yes-Breast Implant surgery needs to be performed with the patient asleep.

How long does it take?

Typical surgery time is around 1 hour.

What is the chance of infection?

I typically give my patients antibiotics for 5 days around surgery. I have never had a post-op infection or an implant extrusion.

Are there bleeding risks?

During the surgery, local anesthetic is injected into the tissue-this blocks the sensation and also constricts blood vessels. As a result, there is very little bleeding during the surgery. I have NEVER had a patient have a severe bleeding complication post-op, but it is not impossible and a return trip to the OR may be necessary. No one has ever needed a blood transfusion for this procedure.

What is the recovery?

This is a fairly small operation and requires a short recovery. Pain that may require narcotic pain medicine typically lasts 3-4 days. After that, ibuprofen (Motrin and Advil) is sufficient. I recommend that patients take at least 1 week off from work. The post-op care involves support bras for several weeks and scar massage after that. Most of the swelling and all of the buried stitches have disappeared by 3-4 months.

When can I resume my normal activity?

I recommend that patients refrain from exercise for at least 2 weeks after surgery. Even after 3 weeks, the incisions may be sensitive and patients need to use caution (focus on leg work more than arm work). Full activity can resume by 6 weeks post-op.

When will I be completely healed?

Some of the deep sutures under the skin can take up to three months to completely dissolve. For this reason, some patients may report sensitivity issues such as itching for up to three months post-op. Breast and nipple sensation can take longer to normalize. Typically my patients have resumed full activity by 3 months and have the appearance that will be with them for many years to follow.

Saline vs. Silicone?

When choosing between saline and silicone breast implants for breast augmentation surgery, it’s important to understand the advantages and disadvantages of each option. Saline breast implants are filled with a sterile saltwater solution, offering the benefit of smaller incisions and easy detection if a rupture occurs, since the implant deflates naturally. They are typically less expensive, but some women feel they look and feel less natural compared to silicone. My ideal saline implant candidate is someone who has a full B or C cup of breast tissue. Silicone breast implants, on the other hand, are filled with cohesive silicone gel that closely mimics the look and feel of natural breast tissue, making them the most popular choice today. However, they usually require a slightly larger incision, are more expensive, and ruptures can be harder to detect without imaging. The best choice depends on your body type, cosmetic goals, and personal preferences, which is why a consultation with Dr. Medalie is essential to determine the right implant for you. Almost always I recommend silicone breast implants for my MtF patients. They tend not to have much native breast tissue and also need larger implants (which may show rippling when filled with saline)

Saline vs. Silicone Breast Implants: Pros and Cons

Feature	Saline Breast Implants	Silicone Breast Implants
Filling Material	Sterile saltwater solution	Cohesive silicone gel
Look & Feel	Less natural, may ripple	Very natural, soft, and smooth
Incision Size	Smaller (implant filled after insertion)	Larger (pre-filled implant)
Rupture Detection	Immediate (implant deflates)	Harder to detect, may require MRI or ultrasound
Cost	Generally lower	Typically higher
Safety	Saline is safely absorbed by the body if ruptured	Silicone is safe but requires monitoring for “silent ruptures”
Popularity	Less commonly chosen today, but still a good choice for smaller implants	Most popular option worldwide
Ideal For	Women wanting lower cost or smaller incisions	Women prioritizing natural look and feel

Can other procedures be performed at the same time as breast augmentation?

Yes – I frequently perform multiple procedures on breast surgery patients. Frequently, I perform liposuction or tummy tuck. Sometimes, I also perform breast procedures such as breast lift. Many of my patients ask for vaginoplasty or labiaplasty as well.

What does it cost?

A breast augmentation with silicone implants costs around $8500 (saline is around $7500) at Dr. Medalie’s outpatient surgery location. All procedures are less expensive when combined with other procedures such as labiaplasty or liposuction.

What if I am from out of town?

I frequently perform breast surgery on patients who live out of town and are unable to easily to see me in consultation prior to the procedure. I have several requirements for these patients: I must see pictures of them prior to scheduling surgery. They need to contact my office and have my patient care manager email them a medical history form to be filled out and sent back. Typically, the patient will come into town 1 day prior to the procedure, and I will see them the day of surgery. I will perform a phone consultation about 3 weeks prior to surgery. I will then perform the operation and patients can usually return home the day after surgery. Your post-op visit will be a virtual visit with my nurse, Michelle, about 10-14 days after surgery. I will then follow the progress of the patient via e-mailed pictures. My patient care manager has information about hotels in the area as well as financing. You may contact her at valerie@clevelandplasticsurgery.com.

Tracheal Shave (Chondrolaryngoplasty): An In-Depth Guide for Patients

A tracheal shave, also known as chondrolaryngoplasty, is a gender-affirming facial surgery that reduces the prominence of the Adam’s apple. This procedure is especially popular among transgender women and non-binary individuals seeking a more feminine neck contour, but it can also be performed on cisgender patients who feel self-conscious about a visible Adam’s apple.

What Is a Tracheal Shave?

The tracheal shave is a cosmetic surgical procedure that involves carefully reducing the size of the thyroid cartilage at the front of the neck. By contouring this cartilage, Dr. Medalie creates a smoother, more feminine neckline without compromising the function of the vocal cords.

Tracheal shave before and after (2) — Tracheal Shave Before and After Surgery

Tracheal shave before and after (3) — Tracheal Shave Before and After Surgery

Tracheal Shave Cartilage — Pieces of cartilage removed from the tracheal prominence

tracheal shave 5 — Before Tracheal Shave

tracheal shave 5 after — After Tracheal Shave

Ideal Candidates

Patients who may benefit from a tracheal shave include:

Trans women who want a less masculine neck profile.
Non-binary individuals who want a less masculine neck profile.
Cisgender men or women bothered by a prominent Adam’s apple.

Ideal candidates should be in good overall health, have realistic expectations, and consult with a board-certified plastic or facial surgeon experienced in this very specific Surgical Technique. Dr. Medalie meets these criteria.

During the procedure, a small incision is typically made under the chin or in a natural skin crease on the neck to keep scarring minimal. Dr. Medalie then carefully reduces the thyroid cartilage with a scalpel and rongeur while making sure that the vocal cords are not affected. Surgery usually takes 1–2 hours and is performed under local anesthesia with mild sedation.

Recovery Timeline

First few days: Mild swelling, soreness, and tightness in the throat are common. Patients can also have a horse voice for a week or two.
1–2 weeks: Most patients return to work and social activities.
4–6 weeks: Full healing with reduced swelling; incision lines fade over time.Final scar appearance can take up to 9 months.

Patients are often advised to avoid heavy lifting, strenuous activity, or excessive talking immediately after surgery to protect the vocal area.

Risks and Considerations

While tracheal shave is generally safe, potential risks include:

Temporary or permanent hoarseness.
Scarring at the incision site.
Infection or delayed healing.This has never happened in my practice.
Rarely, changes in vocal pitch if cartilage reduction is too aggressive.

Choosing a qualified surgeon such as Dr. Medalie with expertise in voice-preservation techniques is critical to minimizing these risks.

Benefits of Tracheal Shave Surgery

Creates a smoother, more feminine neck contour.
Reduces gender dysphoria for transgender women.
Improves overall confidence in social and professional settings.
Can be combined with other facial feminization procedures for a comprehensive result.

Long-Term Results

Results of a tracheal shave are permanent. Once the thyroid cartilage is reduced, it does not grow back. Scars are usually small and fade over time, leaving patients with a natural-looking, feminine neckline.