Breast augmentation for trans women in Thessaloniki and Athens, Greece

It is a gender-affirming operation that enlarges the breasts with a silicone implant placed behind the breast tissue that has grown on hormones. A chest shaped by testosterone has a different anatomy from a cisgender woman’s, so the choice of implant, pocket and incision is adapted to it rather than copied from standard augmentation.

Oestrogen therapy develops the breasts, mainly in the first 6 months, and the growth often stays small. If you want breasts in proportion to your height and shoulders, an implant is usually needed.

A chest that developed under testosterone is wider, with a smaller areola that sits further to the side, a stronger pectoral muscle and a shorter distance from the nipple to the fold under the breast. That is why I adapt the implant, the pocket and the incision. For general information on implants, see my breast augmentation page.

It suits adult trans women and transfeminine non-binary people with sustained gender incongruence who want larger breasts than hormones have given them. I follow the WPATH Standards of Care, Version 8 (SOC8), which recommend at least 6 months of hormone therapy first, unless you do not want hormones or they are medically unsuitable for you.

Who is it typically for?

• Trans women with little breast development after at least 6 months of hormone therapy.
• Transfeminine non-binary people who want breasts.
• People who cannot take hormones or do not want to, after we have discussed it at the consultation.
• Asymmetry in breast size after hormone therapy.
• A wide gap between the breasts, with nipples that sit further to the side.

When do I not recommend it?

• Under the age of 18.
• When hormone therapy has only just started or is not yet stable, unless hormones are not wanted or are medically unsuitable.
• When the assessment set out in WPATH SOC8 has not taken place.
• When a physical or mental health condition is not under control and could affect safety or the result.
• When there is an active infection or an untreated breast condition.
• When free (liquid) silicone has been injected into the breasts in the past, until it has been checked with specialist imaging.

At the consultation we discuss what you would like to change and how long you have been on hormones. I measure your chest and we try sizers together, and you leave with a written plan. Before surgery you need blood tests, an anaesthetic check, a breast ultrasound, a plan for your oestrogen and, if you smoke, time off cigarettes.

What happens at the consultation?

We talk about what you want to change and how long you have been taking hormones. I measure the width of your chest, the position and size of the nipple, the thickness of the tissues (with a pinch test), the distance from the nipple to the fold and the gap between the breasts. From these I set the range of implants that suit you, and we try sizers together in a special bra. I ask for an assessment by a health professional experienced in gender identity, as WPATH SOC8 sets out. You receive a written plan.

What tests and instructions apply before surgery?

You need blood tests, a pre-anaesthetic check and a breast ultrasound. Oestrogen raises the risk of blood clots; whether you continue it is decided individually with your endocrinologist. It is usually continued, with thrombosis prevention according to your individual risk. Stop smoking 4 weeks before surgery and for 4 weeks after. If you take anticoagulants or antiplatelet medicines, stop them only on the advice of the doctor who prescribes them.

The operation is done under general anaesthesia and takes about an hour. The implant usually goes in through an incision in the fold under the breast, which I often lower. The pocket depends on tissue thickness: dual plane when the tissues are thin, above the muscle when the breast gland allows it or when a larger implant is chosen.

I infiltrate the area with a long-acting local anaesthetic, so that pain in the first few days is minimal. No drains are used.

Above or below the pectoral muscle?

I use the same criteria as in standard breast augmentation, but this chest has two particular features. The tissue covering the implant is often thin, and then placing the implant partly under the muscle (dual plane) hides its edges better. On the other hand, the pectoralis major muscle is stronger, and an implant under it can move or change shape when the muscle contracts. So when hormone therapy has produced enough breast gland and the pinch test allows it, I prefer to place the implant above the muscle or under its fascia (subfascial).

Which implant suits a wider chest?

Because the chest is wider and the nipples sit further to the side, an implant with a wider base is usually needed, to fill the breast and narrow the gap between the breasts. The implant is centred behind the nipple, but it does not move the nipple and cannot create cleavage on every chest. I usually use round, smooth-surface implants. Implants that are very large for your tissues increase complications.

Incisions and stitches

My preferred incision is in the fold under the breast (inframammary fold). Because the distance from the nipple to the fold is short, the new fold is usually drawn lower than the original one, so that the implant sits under the nipple and the scar hides in the fold. An incision around the areola is less suitable, because the areola is small and the fold cannot be lowered enough through it. An armpit incision leaves no scar on the breast but gives less control over the new fold. The stitches are internal and do not need removing.

Combining it with fat transfer or liposuction

Fat transfer can be added to the augmentation for a small correction of volume, better cover over the edges of the implant or a narrower gap between the breasts. On its own it rarely gives the volume most trans women ask for, and how much fat survives is not predictable. The operation can also be combined with liposuction and fat transfer to the buttocks and hips.

Do I need to stay in hospital?

No. The operation is a day case: you go home the same day with someone accompanying you, wearing the special support bra. You must not drive after a general anaesthetic.

The first 1–2 days are almost pain-free thanks to the long-acting local anaesthetic. You can return to desk work in 3–5 days and to exercise at 6 weeks, but training the chest muscles waits until 6 months. Discomfort fades over 4–6 weeks and the breasts settle into their final shape at 3–4 months.

You do not stay in hospital: you go home the same day, accompanied, so the time in Greece is set by your check-up and by when it is safe to fly. Plan to stay 5 to 10 days; you can fly from day 5, after your final check the day before the flight. The stitches are internal and do not need removing, so there is no stitch appointment to wait for.

Before you fly. Oestrogen raises the risk of blood clots, and so does a long journey. We agree a plan for your oestrogen with your endocrinologist before surgery, and you walk from the day of the operation. I see you for a final check the day before your flight. On the journey, walk in the aisle and keep your legs moving; depending on your risk, I may also prescribe blood-thinning protection.

Follow-up from home. Follow-up is by video call at 10 days, 1 month, 6 months and 1 year. If anything worries you, for example if one side swells, message the practice on WhatsApp and you receive a reply the same day; in an emergency, call us, and for an acute problem go to the nearest hospital emergency department.

What to arrange at home. You will be wearing the special support bra and should avoid sudden arm movements and lifting for the first days. Most people go back to desk work in 3–5 days and light physical work at 1 week; heavy physical work waits a month and chest training 6 months. If you will need help at home with lifting, arrange it before you travel.

The breasts take their final shape in 3–4 months and the scar fades during the first year. Implants are durable but not lifelong, and if you continue hormone therapy the breasts may still change a little. Nipple sensation usually stays normal, and studies show satisfaction and less gender dysphoria in most trans women.

Implants are replaced when a problem appears, confirmed by MRI, or when you want a different size. After 15–20 years we discuss replacing them as a precaution.

The main risks are the same as in standard breast augmentation: capsular contracture, haematoma (a collection of blood), infection and implant displacement. Because of the anatomy of the chest, I pay particular attention to where the implant sits and how it moves with the muscle. The table shows how common each risk is and how I prevent or treat it.

Smoking. Stop at least 4 weeks before and 4 weeks after the operation. Smoking increases healing complications and, together with oestrogen, the risk of blood clots.

Blood thinners. Tell me if you take anticoagulants or antiplatelet medicines. They are always stopped in agreement with the doctor who prescribes them.

I do not publish prices, because the cost depends on the implant, the technique and any procedures combined in the same operation. You receive a written quote after the consultation, once I have examined you and we have agreed on a plan. These are the factors that make the difference:

• The type and size of the implant.
• The pocket and the complexity of the operation.
• Combining it with fat transfer or liposuction.
• Combining it with other gender-affirming surgery in the same operation.
• The hospital and the anaesthesia.