Male to Female Surgery

Chest Surgery

For 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 no different for cis or trans patients and is well tolerated. I encourage readers to see my breast augmentation section as well as examine the information at the American Society of Plastic Surgery at

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




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.

breast augmentation incisions

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:

submuscular and subglandular breast implant placement

A. Under the pectoral muscle (a submuscular placement)

B. Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)

C. Dual-plane which is partly under the muscle (in the upper pole) and partly under the breast (lower pole). This procedure is more frequently used in women who have had children and have some droop to their breasts.

The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and your surgeon’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.

breast augmentation incision locations

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.

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

» 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 1.0 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 issue 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.
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 $7000 (saline is around $6100)  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 or fax them a history and physical form to be filled out and sent back. Typically the patient will come in to 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 see them back in my clinic in several days to check the surgical site and answer any questions. This means that the patient will spend around 4-7 days in the Cleveland area. Patients who live far away, but can drive to Cleveland (2-6 hrs.), can go home the next day and drive back to see me for their first post-operative appointment. I will then follow the progress of the patient via e-mailed pictures on a weekly basis. My patient care manager has information about hotels in the area as well as financing. You may contact her at [email protected].
Where can I get more information?
Please call Dr. Medalie at 216-393-9924. You can also e-mail his patient care manager, Valerie, at [email protected].