Is Labiaplasty Right for You? A Guide to Costs, Benefits, and Realistic Expectations
You have a clear goal: a feminine chest that looks right in a tee, a dress, and in everyday movement. MTF top surgery (gender-affirming breast augmentation) builds breast shape with implants, fat grafting, or a blend of both. On this page, you’ll see how the operation works from consult to recovery, who it suits, what influences top surgery cost, and how we approach care in Los Angeles and Beverly Hills.
Meticulous Planning. Natural Lines.
A natural-looking result isn’t about size alone. It’s breast footprint, fold position, implant projection, nipple-areola balance, and a slope that reads feminine on your frame. At our Beverly Hills office, board-certified plastic surgeon Sheila Nazarian, MD, MMedSc, plans each case around your chest width, soft-tissue support, and goals. Cases run in an accredited OR with modern anesthesia and strict pocket control. You get straight planning, measured recommendations, and a finish that looks like you—only more aligned with your gender identity.
We work with transgender patients, trans women, and nonbinary patients across a wide range of starting points: minimal breast tissue, chest tightness from training, or previous procedures that affect incision placement or pocket stability. The focus is a feminine chest contour that fits your build and lifestyle.
How We Shape Feminine Lines
MTF top surgery builds a female breast where limited breast tissue exists. It is a form of gender affirmation surgery and, in many policies, a reconstructive surgical procedure. The operation has three pillars: implant selection, pocket creation, and, when needed, fat grafting for refinement.
Implant choice. Size and projection are set by chest width, skin stretch, and your target shape. Round silicone implants are the workhorse; the profile is chosen to meet your goal without stressing thin tissue. We use sizers during the case to confirm volume in real time.
Pocket creation. The implant pocket can sit behind the pectoral muscles (submuscular), in a dual-plane position (upper portion behind muscle, lower portion in front), or, in rare settings with strong soft-tissue cover, in front of the muscle. A dual plane is common for a soft slope and stable fold.
Fat transfer. Small volumes of body fat can be moved from the waist, flanks, or thighs, then placed in fine threads along the upper pole or inner breast to hide borders and enhance cleavage.
This is breast surgery in the service of alignment, not a copy-and-paste breast augmentation from cis-female templates. The plan respects your frame and how you move.
Who Thrives and When to Wait
Good candidates for Gender Affirming Surgery in Beverly Hills are adults in solid health, with stable weight and clear goals for size, cleavage, and nipple position. If you’re on hormone therapy, time on estrogen can add a modest base of gland and skin stretch. Waiting for that soft-tissue change can improve pocket cover and long-term shape. Nicotine must stop on the timeline we give; blood flow, scars, and surgery results depend on it. If chest skin feels tight, staged fat grafting can set the table for implants. If your goals include a very full look on a narrow chest, we’ll map what is safe for your skin and fold so the outcome holds.
We care for transgender women, male-to-female patients, and nonbinary patients seeking a feminine appearance. We also counsel patients exploring other paths—breast reduction or bilateral mastectomy—when the aim is a more masculine chest. Every plan centers on the person, not a label.
How We Shape Feminine Lines
A measured plan brings the chest into balance with your frame. Implant selection, pocket control, and optional fat grafting work together so the shape reads feminine in stillness and in motion—without pushing your tissues past what they can support.
Measure. Fit. Tailor.
The initial consultation maps your chest in standing and seated positions. We measure width, sternal notch to nipple, nipple-to-fold distance, and skin stretch. We review photos to track symmetry and landmarks. You try sizers in clothing to feel proportion, then we review surgical technique, incision placement, and pocket options. Bring prior notes if you have a chest surgery. If hair removal is part of your plan, we time it around wound care so the skin stays calm.
We talk about lifestyle: gym work, swimwear, work attire, and any binding history that might influence loose skin or fold position. The plan moves at your pace. We set a pre op appointment for final questions, garment sizing, and consent.
Implants, Fat, or Hybrid
Implants are the foundation when you want reliable volume and projection. We match implant width and profile to your chest, then place it—most often in a dual-plane pocket through a short inframammary incision—for a soft slope and stable fold. On narrower chests, low or moderate profiles create shape without widening the footprint. On broader frames, a touch more projection can balance the rib cage without dropping the fold.
Fat is the fine brush. We harvest a small amount with micro-lipo, refine it, then place it in thin threads along the upper pole or inner breast to soften borders and improve cleavage. Fat grafting can polish a result or make a subtle size change; it’s not meant to replace implants for significant volume.
Hybrid augmentation pairs a correctly sized implant with targeted fat grafting. The implant sets projection; fat blends edges and enhances cleavage where skin is tight. This approach shines on narrow chests, athletic builds with firm soft tissue, or any case where you want smooth borders without oversizing the implant.
If you have excess skin from a weight change or prior plastic surgery, we adjust the pocket strategy and fold support so the implant sits steady. A history of gynecomastia surgery or pectoral implants can change dissection planes—bring operative notes. Dense breast tissue from extended hormone therapy is mapped to reduce side roll and pocket stretch. Some patients add limited body contouring from the harvest sites (waist or flanks) for proportion without overreach.
| Feature | Implants (Silicone) | Fat Grafting Only | Hybrid (Implants + Fat) |
|---|---|---|---|
| Best for | Predictable size/projection; lasting footprint | Subtle volume; border softening; cleavage tweak | Natural look with real volume; narrow or athletic chests |
| Volume change | Moderate to large, set by implant | Small to modest; limited by skin and supply | Moderate to large with refined edges |
| Cleavage/upper pole | Good; may look edged if tissues are tight | Improves inner fullness; limited lift | Strong cleavage with soft transition |
| Incisions | Short inframammary fold | 2–3 tiny harvest/placement entry points | Fold incision + tiny harvest/placement entries |
| Anesthesia & time | General; ~1–2 hours | Local or general; typically shorter | General; add time for fat harvest/placement |
| Recovery | Desk work 3–5 days; gym 4–6 weeks when cleared | Often faster; activity ramps sooner | Similar to implants; mild extra soreness at harvest sites |
| Pros | Reliable size; stable shape; broad size range | Uses your own tissue; no device; blends edges | Natural feel/appearance; best balance of volume and softness |
| Considerations | Device maintenance over the long term | Unpredictable take rate; may need sessions | Longer OR time; cost reflects dual steps |
| When to skip | Very thin cover without fat option | Desire for significant size change | Not ideal if harvest fat is very limited |
If you’re unsure where you fit, we’ll size in clothing, review measurements, and map a plan that gives you the shape you want without pushing your tissues beyond what they can support.
Smart staging, calendar-safe
Your chest is part of a broader picture. Many patients stage facial feminization surgery or facial feminization procedures at a different time, so healing is more comfortable. Others plan modest body contouring once weight is steady. Staging matters; your energy is a resource. We build a calendar that respects work, support at home, and your timeline.
From check-in to set-and-prop
You’ll check in at our Beverly Hills facility, meet the anesthesiologist, and review markings with your surgeon. Under general anesthesia, a short incision is made in the inframammary fold. We create a dual-plane pocket so the upper implant sits under the pectoral muscles for a soft slope while the lower breast drapes naturally. Sterile sizers go in first; we sit you up to confirm symmetry, projection, and fold position in real time.
Finally, breast implants are placed with a no-touch method, and then the incision is closed in layers. When planned, fat grafting follows—small-volume harvest, refinement, and micro-thread placement along the inner breast or upper pole to soften borders and improve cleavage. Implants alone take about one to two hours; add time for fat transfer. This is an outpatient surgical procedure.
You leave in a soft support bra with clear instructions. Most patients return to desk work in three to five days, start easy walking day one, add light cardio around week two, and wait for overhead lifting and heavy training until cleared at weeks four to six. Follow-ups cover pocket settling and scar care; once sealed, start silicone and strict sun protection. If you’re also planning facial or body work, we’ll stage it for a smooth recovery.
Six Weeks to Settled Shape
Plan for a quiet first weekend. Most patients return to desk work in three to five days. Short walks start day one. Light cardio returns near week two. Overhead lifting, pushups, and heavy training pause until cleared around weeks four to six. Sleep on your back at first. Keep incisions dry until cleared, then begin scar care with silicone and sun protection. The early look runs high and full; implants settle as the pocket relaxes. The final slope is judged around three to six months.
Nipple sensation varies. Some patients feel increased sensitivity as swelling fades; others note little change. If your job is physical, we stage time off to protect the repair. If you bind or tape for performance, we set hard lines to safeguard the pocket.
Safety, Minus the Drama
Every surgical procedure carries risk. For augmentation, the main concerns are bleeding, infection, fluid pockets, fold instability, asymmetry, capsular contracture, and implant issues over time. Careful pocket control and scar care reduce many of these risks. We watch for rare problems early so the fix is simple. If you heal with thicker scars, we add silicone, massage, and, when needed, a steroid for stubborn spots. Clear instructions and reachable staff make a real difference.
What to Expect and When
You’ll see a change right away, though early swelling and a high position are normal. As weeks pass, the fold sets, the inner borders meet with less tension, and the upper pole softens. Clothing fit improves first; swimwear and low necklines follow as the shape settles. The aim is a feminine chest contour that holds through movement and reads balanced with your hips and waist. When implant choice tracks with chest width and soft-tissue support, the change looks intentional, not oversized.
Numbers: Clear and Candid
Pricing reflects implant type, time in the OR, anesthesia, facility, and any fat grafting. Your written quote includes surgeon fee, anesthesia, facility, garments, and routine follow-ups. Fees in Los Angeles/Beverly Hills can differ from those in smaller markets due to staffing and accreditation requirements.
We’re a self-pay practice and do not bill insurance. If you’d like to pursue out-of-network reimbursement on your own, we’ll provide an itemized statement with CPT/diagnosis codes. Your insurer determines whether approval or payment will be granted.
For out-of-pocket costs, we partner with medical financing providers so you can choose monthly payments that fit your budget. You’ll see clear numbers up front so you can plan with confidence.
Care that respects your story
Gender affirming care is medical care. We respect the role of your mental health professional in documenting gender dysphoria and helping set a timeline that protects your headspace. We align with your HRT prescriber on medication timing and any adjustments near surgery. Questions about transgender health—from skin care on estradiol to gym pacing—get straightforward answers.
Meet in Beverly Hills to map a plan that fits your frame, schedule, and goals. We’ll review measurements, sizing, pocket options, and recovery in clear terms, then set a timeline that respects your life.
Call (310) 263-8239 • Nazarian Plastic Surgery • 120 S. Spalding Dr., Suite 315, Beverly Hills, CA
Plan three to five days off desk work. Walk the day after surgery. Start light cardio around week 2. Hold overhead lifting, pushups, and heavy training until clearance at weeks 4–6. Sleep on your back and wear the support bra as directed.
Some plans cover gender affirmation surgery when the criteria are met. Insurers may request letters, a gender dysphoria diagnosis, and treatment history. We provide itemized codes and estimates. For uncovered portions, medical financing is available.
Implants create reliable volume and projection. Fat grafting refines borders, softens the upper pole, and can improve cleavage. On most builds, fat alone doesn’t produce enough size. Many patients choose implants with small-volume fat transfer for polish.
Estrogen can add modest breast tissue and skin stretch, which improves implant cover. Adding a few months on HRT can help. We coordinate with your prescriber and plan any medication pauses around the operation.
The incision sits in the inframammary fold under the breast. It hides in the crease once the fold sets. Scar care includes silicone, gentle massage when cleared, and sun protection. Fading continues for many months.
Measurements guide the range: chest width, nipple-to-fold distance, and skin stretch. You’ll test sizers in clothing to sense proportion. Profile and volume are picked to fit your chest without stressing the fold. Your surgeon confirms with intra-op sizers.
It’s possible, but staging often feels safer and more comfortable. Combining lengthens anesthesia and recovery. Many patients schedule chest first, then facial feminization procedures or body contouring later. We’ll map a timeline that fits work and support at home.
