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Breast Surgery
Gender-affirming breast augmentation, often called transfeminine top surgery, uses breast implants, sometimes with fat grafting, to build a fuller, feminine chest. At his La Jolla office near Westfield UTC, double board-certified plastic surgeon Tim Sayed MD plans each part of the surgery, from implant size to incision, around your body and your goals.
20+
Years in practice
Double
Board-certified
1:1
Surgeon-led care
At a glance
What it is
Breast surgery with implants that adds volume and shape to a transfeminine chest, usually once estrogen therapy has been underway for a while.
Who it suits
Healthy trans women and transfeminine people whose breast growth on hormones has fallen short of what they want.
La Jolla cost
About $9,000 to $15,000 in total for the surgeon, anesthesia, facility, and implants, and less if fat grafting is used alone. Financing is available, and your written quote sets the exact price.
Procedure time
Roughly 1.5 to 2 hours under general anesthesia, and you go home the same day.
Recovery
Back to desk work in about a week, and to most activity by four to six weeks.
Provider
Tim Sayed MD, MBA, FACS. Double board-certified plastic surgeon in practice for more than 20 years.
Most trans women who choose this surgery have been on estrogen for some time and find that natural growth has leveled off short of the size they want. Implants, sometimes combined with fat grafting, make up the difference, and Dr. Sayed sizes and places them to suit your chest and proportions.
The procedure
MTF breast augmentation is a gender-affirming procedure for trans women and transfeminine people. You may also see it called transfeminine top surgery or transgender breast augmentation. Breast implants create the added volume, and fat grafting is sometimes used alongside them to refine the shape.
Estrogen starts breast development for many trans women, but growth often levels off after about two years, frequently at a smaller size than hoped. Surgery adds the fullness and projection that hormones can't, with the size and shape chosen together at your consultation. The aim is a chest that looks proportionate and feels like yours, dressed or not.
This surgery focuses on the chest. Facial feminization and genital surgery are separate procedures with different goals. If you'd like to understand how implants are placed, our pages on breast augmentation and subfascial breast augmentation explain the technique in more depth.
Candidacy
You're likely a good fit if you're healthy, want more breast volume than estrogen has given you, and have realistic expectations. Most surgeons suggest some time on estrogen first so natural growth can level off and the implant can be chosen around your own tissue, although hormone therapy isn't strictly required. At your La Jolla consultation, Dr. Sayed reviews your health, your goals, and any documentation your situation calls for.
would like a fuller, more feminine chest than hormones alone have given you
have been taking estrogen long enough for breast growth to level off
are healthy overall and your weight is steady
don't smoke, or can give up all nicotine before surgery and while you heal
know what recovery involves and have goals you've talked through with your surgeon
started estrogen recently and may still see more breast growth
have a health condition to get under control first, or your weight is still changing
smoke and can't yet stop nicotine for the healing period
are mostly focused on facial or genital gender-affirming surgery, which are separate operations
expect implants to last a lifetime with no upkeep, since they can need revision surgery over time
Results are most predictable once estrogen has done its work, because Dr. Sayed builds the implant plan around the breast tissue you already have. This surgery doesn't change the face or genitals.
Your options
The right plan depends on your chest, how much breast growth estrogen has produced, and the size and shape you're after. Many patients pair implants with a small amount of fat grafting, and areola or nipple refinement is often done during the same operation.
Implants do most of the work in MTF breast augmentation, adding volume and projection reliably. Most patients choose silicone gel implants for their natural feel, and saline implants are also available. Because a transfeminine chest is often wider, with tighter skin, Dr. Sayed chooses the implant's size, profile, and position carefully so the breasts look feminine rather than too wide-set or overly projected.
With fat grafting, a small amount of your own fat is removed by liposuction from another area and used to soften the edges of the implant and shape the upper breast and cleavage. On its own it rarely adds enough volume to a chest with limited breast tissue, so it's usually paired with implants. It can also make the transition from chest to implant look more natural.
Hormones and the added volume can change the size or position of the areola and nipple. Areola reduction, nipple reduction, or repositioning can be planned with your augmentation so both sit in proportion on the new breast, often in the same operation through concealed incisions. Our nipple and areola surgery page has more detail.
Some patients also combine this surgery with chest or body contouring. When the skin is very tight, a staged approach with a tissue expander is occasionally used. Dr. Sayed will explain which option, or combination, suits your anatomy and goals.
In short: implants for volume, fat grafting for refinement, and areola or nipple work for proportion. Doing them together in one operation means one recovery.
How it works
Plan on about 1.5 to 2 hours in surgery under general anesthesia at an accredited surgery center, and you go home the same day. First, Dr. Sayed marks the plan on your chest while you sit upright. Through the incision you've chosen together, he creates a pocket above or below the chest muscle, places the implant, refines the areola if that's in your plan, and closes the incision in layers. Someone will need to drive you home.
General anesthesia. You sleep through the procedure at an accredited outpatient surgery center.
About 1.5 to 2 hours. The length depends on implant placement, the incision, and whether fat grafting or areola work is included.
Outpatient. A companion drives you home the same day, and you leave with written recovery instructions.
Implant type. Silicone gel has a natural feel, and saline is also available. Cohesive gel implants hold their shape well on a transfeminine chest.
Placement. The implant can go above or below the chest muscle. A dual-plane position is often used because it balances a natural look with good coverage.
Incision. Under the breast fold, along the edge of the areola, or in the armpit, wherever the scar will be best hidden for you.
Implant size and profile. Matched to your chest width and skin so the result looks proportionate and feminine, without too wide a gap between the breasts.
Scar placement. Incisions are positioned and closed with care to help scars stay discreet as they fade.
Nipple sensation. Dr. Sayed takes care to protect the nerves to the nipple while creating the implant pocket, which helps preserve sensation in most patients.
The implant techniques are the same ones used in cosmetic breast augmentation. For the technical detail, see breast augmentation and subfascial breast augmentation, or browse all of our breast surgery options.
Cost
In La Jolla, MTF breast augmentation typically costs about $9,000 to $15,000 in total. That figure includes the surgeon's fee, anesthesia, the surgical facility, and your implants. Where you land in the range depends on implant type, whether fat grafting or areola work is added, and the details of your surgical plan.
These figures are estimates. The written quote you receive after meeting Dr. Sayed is the exact price to plan around.
Implant type. Silicone gel implants cost more than saline, and cohesive gel pricing varies.
Additional procedures. Adding fat grafting, areola or nipple refinement, or a lift with implants increases the total.
Anesthesia and facility. General anesthesia at an accredited surgery center is included in the quoted price.
Surgeon experience. Part of the fee reflects the training and experience of a double board-certified plastic surgeon.
Gender-affirming breast augmentation is increasingly recognized as medically necessary, and more health plans now cover it. Tim Sayed MD is an out-of-network surgeon and doesn't bill insurance directly. His team gives you the detailed operative documentation needed to file an out-of-network or reimbursement claim. Financing can spread the cost over time, and you can ask for a written estimate on our pricing page.
Recovery
Recovery is much like recovery from cosmetic breast augmentation. Most people are back at a desk in about a week, ease into light activity after two to three weeks, and return to most activity, chest workouts included, by four to six weeks. You go home in a supportive surgical bra with a written plan. If you live in North County, plan the ride home ahead of time: Encinitas and Carlsbad are about 25 to 35 minutes from the office.
Day of surgery
Same-day outpatient surgery under general anesthesia. A companion takes you home in a surgical bra, and soreness and tightness across the chest are expected.
First week
Soreness, swelling, and tightness are normal. Many people stop prescription pain medication within a few days and return to desk work in about a week.
Weeks 2 to 4
Swelling starts to ease and light activity comes back. Keep wearing the supportive bra; your surgeon will tell you when to add gentle movement.
Weeks 4 to 6
Most everyday activity and lower-body exercise resume. Chest and upper-body workouts come back once your surgeon clears you.
3 to 6 months
The implants soften and settle into a more natural position, and scars keep fading. Your final shape becomes clear over these months.
Sleeping. For the first few weeks, sleep on your back with your upper body slightly raised.
Driving. Most people can drive within a few days to a week, once they no longer need prescription pain medication.
Exercise. Walk from the start, add light activity at two to three weeks, and return to chest exercise around four to six weeks, once your surgeon clears you.
Bras and garments. Wear a supportive surgical bra without underwire day and night at first, to support the implants while they settle.
Sensation and scars. Any temporary change in nipple or skin sensation usually settles over weeks to months, and scars fade over the first year.
The surgeon
Planning implants for a transfeminine chest, which is built differently from a cisgender woman's, takes experience. Tim Sayed MD has been in practice for more than 20 years, trained at UCSF, Harvard, and Massachusetts General Hospital, and is board-certified by both the American Board of Plastic Surgery and the American Board of Surgery.
His focus on breast implant revision and removal gives him detailed knowledge of implants and the chest wall, which he uses to plan implant size, placement, and incision for a natural, feminine result. You meet with Dr. Sayed himself, and he plans and performs your surgery. You can review his credentials and training before your visit.
American Board of Plastic Surgery
American Board of Surgery
Fellow, American College of Surgeons
20+ years in practice
The area
Tim Sayed MD's La Jolla office is in the University City (UTC) area off Genesee Avenue and welcomes trans women and transfeminine patients from across San Diego for MTF breast augmentation, including La Jolla Village, Pacific Beach, Torrey Pines, Del Mar, Carmel Valley, and Sorrento Valley. Orange County patients can also see Dr. Sayed at the Newport Beach office, and our Southern California MTF breast augmentation page covers both locations.
San Diego's beaches and outdoor life, from La Jolla Cove to Pacific Beach, mean many patients want a chest that looks right in a swimsuit. Incisions are planned to be discreet, and because the coastal sun is strong, it's worth following your scar care plan closely while you heal.
4510 Executive Drive, Suite 210
San Diego, CA 92121
Get directions to the La Jolla office on Google Maps
Drive times to the office
La Jolla Village
5 min
University City / UTC
4 min
Del Mar
12 min
Carmel Valley
13 min
Carlsbad
35 min
Encinitas
25 min
Sit down one-on-one with Tim Sayed MD at the Executive Drive office to discuss your goals, your options, and the implant plan that suits your chest. You'll leave with a clear recommendation, realistic expectations, and a written quote.
Questions
In La Jolla, expect a total of about $9,000 to $15,000 for the surgeon, anesthesia, facility, and implants. Health plans increasingly cover gender-affirming breast augmentation. Dr. Sayed is out-of-network, and his office provides documentation so you can file for reimbursement. Financing is also available, and your written quote at consultation gives the exact cost.
It isn't strictly required. Most surgeons do recommend some time on estrogen first, often around 12 months, so natural breast growth can plateau and the implant can be planned around your own tissue. Starting with more developed tissue may allow a smaller implant and a more natural result. Dr. Sayed and the clinician who prescribes your hormones will help you decide on timing.
A growing number of plans do, as gender-affirming breast augmentation is increasingly recognized as medically necessary, but coverage and requirements vary from plan to plan. Dr. Sayed is an out-of-network surgeon, so he doesn't bill insurance directly. Instead, his office gives you the operative documentation to submit an out-of-network or reimbursement claim and can walk you through what to expect at your consultation.
Gender-affirming breast augmentation generally follows the WPATH Standards of Care. Many surgeons, and most insurers that cover the surgery, ask for a referral letter from a qualified health professional confirming you're ready. What you need depends on your plan and situation, and Dr. Sayed will tell you exactly which documents apply at your consultation.
Transfeminine chests are often wider, with a tighter skin envelope and less breast tissue to start, so Dr. Sayed sizes the implant to your chest width and skin rather than to a cup size alone. A larger implant is possible, sometimes in stages, but the most natural results come from matching the implant to your frame. Trying sizers and comparing profiles at your consultation helps keep your goal realistic for your anatomy.
Most patients choose silicone gel implants because they feel more natural, but saline is also an option. Placement is often dual-plane, with the implant partly under the chest muscle, which gives good coverage and a natural upper-breast transition when there's little breast tissue. Dr. Sayed recommends the implant and plane that suit your chest and goals.
There are three options: the inframammary fold under the breast, the lower edge of the areola, or the armpit. The fold is a common choice because the scar sits in a natural crease and the incision allows precise control of implant position. Dr. Sayed places and closes the incision carefully to help the scar stay discreet, and most scars fade over the first year.
Yes, and many patients choose to. Hormones and added volume can change how the areola and nipple sit, so areola reduction, nipple reduction, or repositioning can be done in the same operation, through concealed incisions, to keep everything in proportion. See nipple and areola surgery for details.
Most patients keep nipple sensation, and Dr. Sayed takes care to protect the nerves during surgery. Numbness or heightened sensitivity while you heal is common and tends to settle over weeks to a few months. Lasting change is uncommon, with a slightly higher chance after larger implants or certain incisions, and Dr. Sayed will go over your own risk with you.
That's a personal decision based on your priorities, your health, and how much recovery time you want between operations. Many patients have breast augmentation on its own so the chest can heal and settle, and it can come either before or after facial feminization or other gender-affirming surgery. At your consultation, Dr. Sayed can help you work out a sequence that makes sense.
Your screening schedule depends on your age, how long you've been on estrogen, and your personal and family history, so follow the advice of your primary care clinician. Implants don't rule out mammograms; just let the imaging center know you have them so it can use the right technique.
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