About MTF “Top” Surgery (Feminizing Augmentation Mammoplasty, Fat grafting):
Dr. Esther Kim performs this procedure in the Division of Plastic Surgery at UCSF. We will give your chest a female appearance by placing implants underneath your natural breast tissue and muscle. Dr. Kim will discuss selection of implant type (silicone or saline) as well as size and shape to match your body and your desires during your consultation. A small incision will be made in the crease underneath each breast or around the nipple. A pocket is made underneath the skin and muscle of the breast to give each breast a natural teardrop shape.
Some patients can benefit from fat grafting from the belly, hips, or thighs in conjunction with implant surgery to achieve additional fullness in specific areas of the breast. This procedure is not currently covered by insurance.
Due to privacy and ethical considerations, we do not publish photos of our patients on our website. During your consultation, you will have the opportunity to view pre-operative and postoperative result photographs.
Documents required for clearance for surgery:
- Your insurance card and identification
- A completed Medication List and Plastic Surgery Intake Packet
- A completed UCSF Transgender Care Intake Form faxed or mailed to the Transgender Care Navigator
- A completed Chest Surgery Patient Checklist
- A Clearance Letter from your medical provider indicating that you are medically cleared and prepared for surgery, and capable of providing consent for surgery. The letter should include a discussion of any relevant medical history or substance use, and specify your body mass index (BMI). It is acceptable for the statement of capacity to provide consent to come from a mental health provider.
- Documentation by your medical provider of current and consistent estrogen therapy for a minimum of 12 months (Required as surgical results are superior after a minimum of 12 months of hormone therapy)
- In some cases, a formal Referral Letter from a licensed mental health professional maybe required.
How to prepare for the operation:
- Meet all necessary criteria for surgical treatment (see ‘Getting clearance from your doctor and/or therapist for Chest Surgery’ link).
- You may be asked to obtain additional medical or mental health clearance letters, which must be faxed to the office before your operation can be scheduled.
- A pharmacy and pharmacy plan in order to obtain postoperative medications.
- Schedule an appointment or phone appointment with the anesthesia PREPARE preoperative evaluation clinic. They will tell you what time to check in on the day of surgery.
- Two weeks before the operation:
- Make sure you eat a healthy balanced diet, get plenty of rest, and stay active.
- If you are a smoker, you should absolutely quit smoking two weeks before and six weeks after surgery to avoid poor wound healing and complications (or better yet, use this opportunity to quit forever!)
- PREPARE clinic will tell you which medications to stop taking and which to take.
- Make sure you have transportation to and from UCSF for your operation (most patients go home the same day)
- The night before surgery:
- Shower with antibacterial soap and hibiclens (chlorhexidine) scrub – this is available at most drugstores
- Make sure your home is well stocked with light food, beverages, and items that you will need are within reach without needing to lift your hands above your head or bending over.
- Plan for postoperative appointments, usually at 2 weeks and 6 weeks from your operation.
- Supplies for after surgery:
- Comfortable, loose clothing to wear after surgery
- Comfortable surgical bra or sports bra with closure in the front
- Silicone sheets or scar gel for after surgery
What to expect for your recovery:
- Your incisions will be covered in surgical glue. Most patients will have no bandages or dressings to change.
- The skin glue will begin to fall off a few days after surgery as your skin heals.
- As your incisions heal, you can expect some itching and shooting pains. This is normal.
- Plan to sleep on your back with several pillows to elevate the head of your bed. This is to lessen the amount of swelling and bruising you experience, which may get worse the first few days after surgery before getting better.
- Showering is okay one day after surgery. Don’t soak or swim in a tub or swimming pool for at least three weeks after surgery.
- You will be sore and will need to rest for 2-3 days after surgery. During this time, you may need someone to help you at home. We do want you to walk around the evening after surgery to prevent blood clots form forming in your legs.
- Avoid strenuous activity or lifting more than 10 pounds for two weeks after surgery.
- Scar Care:
- You can improve the appearance of your scars by using silicone sheets or scar gel on your incision, beginning two weeks after surgery. Your surgeon can advise you on which brands and size to purchase.
- Scars can be made more noticeable by sun exposure for up to one year after surgery. Make sure the scars are either covered, or apply a strong sunscreen to your scars.
Getting Clearance from your doctor
and/or therapist for Chest Surgery:
At UCSF, we want you to have the best possible result from your surgery with the greatest satisfaction. UCSF criteria for chest surgery are based on the World Professional Association for Transgender Health SOC (Standards of Care) 7th Edition. One Medical Clearance Letter from a licensed physician, psychologist, or licensed mental health professional is required, documenting the following:
- Persistent, well-documented gender dysphoria
- Capacity to make a fully informed decision and to consent for treatment
- Age of consent (18) or meeting the WPATH SOC 7th Edition criteria for adolescents
- Any significant medical or mental health concerns are reasonably well-controlled.
- Documentation of at least one year of current and consistent estrogen hormone therapy
Specific insurance plans may have additional requirements. In some cases, a Referral Letter from a licensed mental health provider meeting the following specific requirements will be required to schedule a consultation:
- Your identifying characteristics
- Their psychosocial assessment of you, including diagnoses
- Duration of their relationship with you, including the type of evaluation, counseling, and therapy provided to date.
- An explanation that criteria for surgery are met, and the clinical rationale for supporting your request for surgery.
- A statement that you have given informed consent for chest surgery.
- A statement that your mental health provider is available to contact for care coordination, including their telephone number or email.
We require that your primary medical doctor provides a Medical Clearance Letter before scheduling your consultation. In addition, we ask that your BMI (body mass index) is less than 37 before scheduling your consultation. The reasons for this are twofold – to reduce the risk of general anesthesia and to give a better appearing final result. In some cases, you may be asked to have a consultation at UCSF with Dr. Deutsch prior to scheduling your consult with Dr. Kim.
Referral letters and documentation can be e-mailed, faxed or mailed to:
UCSF Transgender Care Navigator
2356 Sutter St, 4th Floor
San Francisco, CA 94143
Please include your legal name, preferred name (if different), and date of birth with all communication.