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Breast augmentation 

Transgender breast augmentation is a surgical procedure that involves enhancing the size and shape of the breasts in individuals who identify as transgender. The dual plane technique is one of the commonly used approaches for this procedure. Here is some information about transgender breast augmentation using the dual plane technique:


1. Dual Plane Technique: The dual plane technique is a surgical method that involves placing the breast implant partially under the pectoralis major muscle (submuscular) and partially under the breast tissue (subglandular). This technique allows for better coverage of the upper pole of the implant while maintaining a natural appearance.  This is the best option for transgender breast enlargement or augmentation since it produces a feminine natural-looking breast.


2. Customized Approach: Each individual's anatomy and desired outcome may vary, so the dual plane technique can be customized to meet specific needs. The surgeon will assess the patient's chest wall, breast tissue, and skin elasticity to determine the appropriate placement of the implant.


3. Incision Placement: There are different incision options for transgender breast augmentation using the dual plane technique. The most common incision sites include inframammary (in the fold underneath the breast) and periareolar (around the areola). The choice of incision depends on the patient's preference, breast anatomy, and surgeon's recommendation.


4. Implant Selection: Transgender breast augmentation involves the use of breast implants to achieve the desired size and shape. The type of implant, such as saline or silicone, will be discussed during the consultation. The surgeon will help the patient choose the appropriate implant size and profile based on their goals and anatomical considerations.


5. Recovery and Results: After the surgery, patients can expect some swelling, bruising, and discomfort, which usually subsides within a few weeks. It is important to follow the surgeon's post-operative instructions for optimal healing and to minimize complications. The final results of transgender breast augmentation using the dual plane technique can be seen after the initial swelling has resolved, typically within a few months.


6. Potential Risks and Complications: As with any surgical procedure, there are potential risks and complications associated with transgender breast augmentation. These may include infection, bleeding, poor scarring, implant displacement, capsular contracture (scar tissue formation around the implant), changes in nipple sensation, and asymmetry. It is crucial to discuss these risks with the surgeon beforehand and follow their guidelines to minimize the likelihood of complications.


7. Psychological Considerations: Transgender breast augmentation can have significant psychological and emotional benefits for individuals who desire a more feminine chest appearance. It can help improve self-confidence, body image, and overall well-being. Before undergoing the procedure, it is essential for patients to have realistic expectations and undergo thorough counseling to ensure they are mentally prepared for the changes.


It is important to consult with a qualified and experienced plastic surgeon specializing in transgender breast augmentation to discuss the best approach, technique, and expected outcomes based on individual needs and goals.

Figure1:  Before & After Photos of Dual-plane breast augmentation performed by Dr. De La Cruz

Complimentary Procedures


Breast augmentation can achieve dramatic and beautiful results on its own as well as in conjunction with other cosmetic surgery or non-invasive procedures. We sometimes recommend combining breast augmentation with other procedures such as a breast lift for more satisfying results.

Saline and Silicone Gel Breast Implants


Breast implants are silicone shells filled with either saline (salt water) or silicone gel. Both implant types are very safe, and each offers its own advantages. We will help you decide which kind is right for you. During surgery, we will place the implants behind each breast, underneath either breast tissue or the chest wall muscle.

After many years, the U.S. Food and Drug Administration (FDA) has approved silicone breast implants for breast augmentation surgery. We are proud to offer patients the option of silicone gel-filled breast implants, since they are much softer and feel more natural than saline-filled breast implants

Breast Augmentation Surgery Incision Techniques


The breast augmentation procedure lasts one to two hours and is typically performed with general anesthesia. Incisions are made in inconspicuous places on the breast to minimize scar visibility. These may be located:

  • In the armpit (transaxillary),

  • In the crease on the underside of the breast (inframammary), or

  • Around the areola, the dark skin around the nipple (periareolar).

The breast is then lifted, creating a pocket into which the implant is inserted.

Saline implants may also be placed endoscopically through an incision in the navel. This minimally invasive breast enhancement technique is known as a transumbilical breast augmentation or TUBA approach.

With regards to the incision, Dr. De La Cruz typically makes the smallest incision one can achieve (~2.5 cm to 3.5 cm incision) along the underside of the breast (inframammary incision).  He also performs incisions through the armpit (transaxillary) or around the areola (periareolar incision) as well.

Figure 2:  Before & After Photos of Dual-plane breast augmentation performed by Dr. De La Cruz

Breast Augmentation Surgery Placement Options


One of the most important decisions prior to a breast augmentation is the selection of the breast implant pocket.  The clinical manifestations of this may not be apparent for several years.  Sagging of the breast may inexorably worsen, especially after giving birth or with aging.  There are several breast implant placement options:  subglandular (above the muscle), partial subpectoral (below the muscle), and dual-plane technique (partially subpectoral and partially subglandular.)

Implant placement beneath the muscle of the chest offers a few advantages over placement beneath the breast tissue only. These include reduced risk of capsular contracture (post-operative tightening around the implant) and less interference with mammogram examinations. Possible disadvantages include need for drainage tubes and elevated pain in the first few days following surgery. We will discuss which option may be best for you.

Dr. De La Cruz’ preference for the breast implant placement is the dual-plane technique.  Although the surgical technique may be more complicated and may potentially take longer, the dual-plane technique has the advantages of both the subglandular (more natural result) and submuscular approaches (less capsular contracture.)  Dr. De La Cruz performs all the different implant placement options and he will decide with you your best option to achieve a natural and longer-lasting result without compromising the excellent outcome that one would want to achieve.


After the implants have been inserted and positioned beneath the nipples, the incisions are stitched closed, then taped and bandaged. A surgical bra will then be subsequently placed in the operating room.



Most patients feel tired and sore after breast augmentation surgery, but this usually passes in a day or two. Many patients return to work within the week.

The stitches that are placed during your breast augmentation will dissolve.  Typically, there will be no stitches that will need to be removed after your surgery. Any post-operative pain, swelling and sensitivity will diminish over the first few weeks.

Scars from breast augmentation incisions will begin to fade in a few months and will continue to fade for months or years.



Complications following breast augmentation surgery are uncommon and usually minimal. They may include capsular contracture, swelling and pain, infection around the implant, a change in nipple sensation, milk production if you nursed a baby within a year before the procedure, and breakage or leakage of the implant (implant rupture) as a result of injury or the normal compression and movement of your breast.

If a saline implant ruptures, the implant will simply deflate in a few hours and your body will absorb the salt water. If a silicone implant leaks, you will need to see your plastic surgeon immediately. Regular monitoring of breast implants after breast augmentation is recommended to ensure continuing breast and implant health.

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