When the necessary criteria for carrying out the surgery are met (see above), the person concerned must:

• identify a specialized clinical center
• schedule a medical consultation with the specialist to decide:
  • where to place the prosthesis (behind the pectoralis major muscle, under the mammary gland or partly behind the muscle and partly under the gland, the latter called dual plane breast augmentation)
  • the type of prosthesis and its dimensions
  • the location of the scar (around the breast areola, in the armpit or under the breast)

It is not necessary to stop oestrogen hormone therapy. However, interruption of hormonal treatment may be suggested, in some cases, as this therapy increases the risk of thrombosis associated with the operation. The interruption can vary from 2-4 weeks before surgery to 2-4 weeks after. In general, if you are taking any prescription medication, you should discuss it with your specialist. It may be necessary to stop taking it even several days before the surgery. Drug therapy may be resumed at the doctor's discretion.

Breast augmentation is a cosmetic surgery that allows you to increase the breasts by inserting silicone implants.
There are several techniques for performing breast augmentation which vary on:

• the place where the prosthesis is placed (behind the pectoralis major muscle, under the mammary gland or partly behind the muscle and partly under the gland, the latter called dual plane breast augmentation)
• the type of prosthesis
• the location of the scar (around the breast areola, in the armpit or under the breast)

The technique used for this surgery is chosen on the basis of the characteristics of the person (height and size of the chest) and his expectations. The operation lasts 60-90 minutes and takes place under general anesthesia.

The surgical procedure is performed on a day-hospital basis or short hospital stay, depending on the characteristics of the person and post-operative recovery.

• Pain and / or discomfort in the hours and days following the surgery are normal
• A surgical bra must be worn for four weeks after the operation
• In the first few days it is recommended to avoid raising your arms, making efforts with them and lifting loads
• Walking without getting tired is recommended to prevent the risk of deep vein thrombosis
• The first check-up visit with the surgeon is usually scheduled within the first week after the surgical procedure
• After 4 weeks from the operation, it is generally possible to return to the usual activities.

Like any surgery, there is a risk of bleeding, infections and adverse reactions to anesthesia.
Other specific risks and complications of this surgery are: capsular contracture (the formation of a sort of scar around the prosthesis that can compress it causing deformity, pain or a hard texture of the breast), seroma (accumulation of fluid), displacement of the implants, rupture of the prosthesis, loss of sensation, prolonged pain after surgery, asymmetry between the two breasts, dissatisfaction with the aesthetic result obtained.
Correction of these complications may require further surgery.

National Health Service (NHS): it is possible to carry out this intervention at the expense of the NHS in a public facility (only in some regions).
Private care: at the discretion of the health provider.

Coleman E, Bockting W, Botzer M, et al. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Int J Transgend. 2012; 13(4): 165-232.
Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869-3903. Erratum in: J Clin Endocrinol Metab. 2018; 103(2): 699. J Clin Endocrinol Metab. 2018; 103(7): 2758-2759.