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MTF "Top" Edition

Updated: Oct 26, 2020

Your Daily Google Search and Self-Education

By Bren Bartol

Image via The Center.

MTF: Male to Female

FTM: Female to Male

Being trans is not an easy experience, and when other people don’t know much about the trans experience, it makes it even harder. What can others do to help make this easier? Learn. “Passing” is a concern of many trans people, and there are several different ways to do it. For MTF people, or trans womxn, they have several options to have breasts, or give the illusion of it.

Non-surgical Options

Follow the drag queens. If they can make fake boobs, so can you! You can buy silicone breasts, or a bodysuit with rigid breast cavities to stick pads in. Another option is to get a push-up bra, or a bra that pulls your chest muscles together. This can be combined with boob contouring! Boob contouring is a recent invention that takes makeup and makes it look like you have breasts.

Medical/Surgical Options

HRT, or hormone replacement therapy. While hormones will not give you full breasts or breasts that are proportionate to your body, HRT will give you small breasts.

Breast augmentation is the other option (that my research revealed). The surgery takes about two hours, and because it is a major surgery it comes with concerns. Many surgeons suggest waiting until adulthood to undergo this surgery. Breast Augmentation is harder to obtain than HRT, as it is expensive, and depending on where you are in the world, it won’t be covered by insurance. In the US, where my research is centered, we do not have universal healthcare. Lots of insurances in the US will cover the surgery, but they require a letter from a trans competent mental health professional.


There are two types of breast implants, though a select few facilities offer a third. These options are saline implants, silicone implants, and Sientra Gummy Bear implants. Implants come in a teardrop shape and a round shape. Some surgeons prefer the round implant, as they are more flexible and a teardrop implant requires a larger incision, often leaving a larger scar. You should work with your surgeon to decide which implant and size would work best and be the most proportionate to your body.

Saline implants are filled with a salt water solution, which make them more prone to rippling and wrinkling. They can be placed behind the chest muscle instead of behind tissue, which can hide the edges of the implant. Though there is a concern that a saline implant can move, leak, or deflate, silicone implants resemble fat the best, and give the most natural look. They are less prone to rippling, and are good for a lesser amount of tissue in the chest (trans womxn often have less tissue in volume in their chest). It is important to remember that in some cases, silicone implants can move, rupture, or lead to numbness in the nipple. Finally, there are Sientra Gummy Bear implants, which are much more rare, with much fewer surgeons offering them. They are filled with a silicone-like gel, and look and feel the most natural. They keep their shape in any position, even if the outside ruptures. Keep in mind, implants do not last a lifetime. They often last 10-20 years, and while they could last longer, it is unlikely that they will last life long. It is not uncommon to need a revision later in life.

There is always a possibility that the womxn may not have enough tissue to cover the implant, and the surgeon will perform a tissue expander, which will add skin to cover the implant.

There are different types of scars and incisions, which can be decided by your body. Periareolar, which is a scar that borders the areola, Inframammary, which is below the fold of the chest muscle, and Transaxillary, which is through the armpit and natural folds of the skin. If you wish to have your areolas resized, you can have it done surgically, but it will leave additional scars. Scars will fade two to three months post op, and the final scar will show by eighteen months, if not sooner.

For post operation, it is made abundantly clear you must not drive home, and instead have someone drive you home and stay the night with you. Some private facilities have an offsite place patients can stay after the surgery. Surgeons ban tobacco and drugs (talk to your surgeon about prescription medication) for 21 days post op, ban alcohol until you receive their prescribed medication, and ban driving for two days post op. They ask you not to go back to work or normal activities for 7-10 days after the surgery. Post op, you must wear a chest compressor to reduce the swelling. You can also use ice to reduce the swelling and the pain.

Surgeons require you keep your dressings clean and do not remove them unless you are told too. They ask you to sponge bathe until you are told you can shower. They advise to start your diet with liquids and light food, and progress it moderately.

Because this is a serious surgery, there are some risks. Asymmetry, seromas, hematoma, and scars changing your breast shape are legitimate concerns. Seromas are when a watery, yellow colored liquid pocket forms under the skin. Small ones go away by themselves, but larger ones need to be drained by a doctor. Hematomas are a small pool of blood that accumulates under the skin, which have a 2% risk of occurring. Some need surgical intervention, but some don’t.

Passing, while desired by most, is the cisgender normative idea that a trans person needs to look cisgender, and has pushed some passing desires to a point that is detrimental. What is most important is what feels best for you, not what society says is.

Written by writer Bren Bartol


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