Breast enlargement, or top surgery, is a surgery done for people assigned male at birth (AMAB) as part of the gender transition process.
Top surgery is done in several different techniques, depending on the patient’s preferences and the surgeon’s capabilities.
Top surgery can be gotten in several ways: privately, through the Gender Reassignment Committee (fully subsidized), and sometimes through the Kupat Holim / HMO (partially subsidized or through supplementary health insurance).
Usually the purpose of the surgery is to create a ‘feminine’ looking chest, that is, larger breasts.
It’s important to know that sometimes, especially for nonbinary people, the desired result isn’t a ‘feminine’ looking chest.
Top surgery can be done as a part of gender affirmation for trans women, nonbinary people, and cis women.
The purpose of the surgery is to reduce the dysphoria the person experiences and align their external appearance with the gender they identify as.
There is no need to have any other medical procedures done to get top surgery, but many trans women get it after starting HRT, to get to a sufficient level of breast growth through hormones that the final result of the surgery may look more natural.
In addition, keep in mind that the requirement to stop HRT before the surgery, because of a higher risk of blood clots, is outdated. That said, you should follow the surgeon’s instruction in any event.
If you smoke, you need to stop smoking about a month before the surgery and at least a month after it, to avoid complications.
The existing types of surgery
There are different kinds of top surgery done with different techniques. Not every person can get every kind of surgery, since there are factors that affect your options such as the size and shape of the chest. Therefore, you should consult with a surgeon to get the type of surgery that fits you.
You can look for surgery results on community facebook groups, on reddit, or on the website Transbucket.
Keep in mind that the goal of the surgery is to achieve a result that’s good for you, not necessarily a result that looks like a cis woman’s chest.
Implants
Most top surgeries are done using implants. There are different kinds of implants that contain various materials, and you can choose the type that fits you with your surgeon:
- Material – you can choose implants made of silicon, or implants filled with saline (salt water). Silicon implants are filled with a silicon gel of a fixed size, and already have the gel inside them when they’re implanted (implants filled with liquid silicon are no longer used due to the health risk of the implant potentially ripping). Saline implants are implanted empty and filled during the surgery, and can be filled or emptied after the implantation as well.
- Size – implants come in different sizes, usually from 200cc to 500cc. It’s best to pick the size that fits your body proportions.
- Shape – implants come in different shapes. Usually round implants are used since they’re symmetrical and there’s no risk of them getting turned around and creating an asymmetrical breast shape, but you can also use anatomical (teardrop-shaped) implants.
The chosen implants can be inserted into the body through a cut made under the breast or under the nipple. The cut is usually made under the breast.
The implants can be placed above or below the chest muscles. You should consult with the surgeon about this, but in general, implantation above the muscle requires less recovery time. If there’s not a lot of breast tissue and fat in the chest, the implant will be placed under the muscle. If there’s enough fat it can also be placed above the muscle. The size and shape of the chest muscles can also affect the decision.
Compared to fat transfers, implants have the following advantages and disadvantages:
- Advantages – implants keep their shape for longer and are lighter.
- Disadvantages – some scarring.
Fat transfer
Another method of breast enlargement is fat transfer. Fat is taken from some other part of the body and injected into the breasts. Fat transfer is less effective when there is a large amount of fat being injected and the skin of the injection area is greatly stretched.
Compared to silicon or saline implants, fat transfer has the following advantages and disadvantages:
- Advantages – minimal scarring, a more “natural and soft” feeling
- Disadvantages – you need a sufficient amount of fat to use this method. In addition, there’s a possibility the fat will get absorbed into the body or move around since it doesn’t have a set structure. This method may also cause the development of fat cysts in the breasts.
Recovery and the visibility of scars
Recovering from top surgery depends on the type of surgery you had. Usually, returning to an office routine will take between two weeks and two months, and returning to a physically active routine will take between two months and half a year.
After the cuts have recovered, we recommend you use cream or silicon tape to prevent noticeable scarring and improve the appearance of the scars.
Your surgeon will advise you on medication and scar care during your recovery.
Top surgery and rehabilitation
You should go to a lymphatic physical therapist, as this is the recommended type of physical therapy after top surgery (both breast enlargement and breast removal). This physical therapy can help to reduce pain, reduce fluid retention and swelling, manage scarring, and return the shoulders’ and torso’s range of movement.
Post-operation physical therapy is a service you’re eligible for from your Kupat Holim. Anyone who has top surgery should consult with one of the therapists in the attached list about this, and they can help you coordinate treatment through your Kupat Holim even if they don’t work with it themselves.
A list of trans friendly lymphatic physical therapists, updated at the beginning of 2023.. updated at the beginning of 2023.
Surgeons and funding for surgery in Israel
Top surgery can be done privately (either paying for it yourself or using private health insurance; for more details on private insurance), through your Kupat Holim without the Gender Reassignment Committee (you can get partial or full funding if it’s included in supplementary health insurance), or in the public healthcare system with full funding by your Kupat Holim if you have an approval from the Gender Reassignment Committee.
We recommend you consult with several doctors. Private consultation will usually cost a few hundred shekels, and you can use private insurance if you have any to get reimbursed for this. Some private doctors can be met at a discount if they have an arrangement with your Kupat Holim. You can consult with doctors in the public healthcare system with coverage (Tofes 17) from your Kupat Holim.
A list of doctors who perform the surgery (this is not a full list, it’s best to do more research):
- Dr. Alon Liran
- Through the Gender Reassignment Committee, funded by your Kupat Holim
- Performs the surgery at Sheba hospital
- Through private healthcare
- Through the Gender Reassignment Committee, funded by your Kupat Holim
- Dr. Udi Arad
- Covered by your Kupat Holim with an approval from the Gender Reassignment Committee
- Performs the surgery at Ichilov hospital
- Part of Mabat – Transgender Healthcare Center, 03-6974000
- 03-6974000
- Through private healthcare
- https://udiarad.com/
- Covered by your Kupat Holim with an approval from the Gender Reassignment Committee
- Dr. Yaakov Frend and Dr. Rivi Chayat
- Covered by your Kupat Holim with an approval from the Gender Reassignment Committee
- Perform the surgery at Wolfson hospital (Keshet clinic)
- Through private healthcare
- Covered by your Kupat Holim with an approval from the Gender Reassignment Committee
- Dr. Yoram Wolf
- Covered by your Kupat Holim with an approval from the Gender Reassignment Committee
- Performs the surgery at Hillel Yaffe hospital
- Through private healthcare
- https://www.dr-wolf.co.il/
- Covered by your Kupat Holim with an approval from the Gender Reassignment Committee
- Dr. Biader Bilal
- Covered by your Kupat Holim with an approval from the Gender Reassignment Committee
- Performs the surgery at Meir hospital
- Facebook – LGBTQ Healthcare at Meir
- For appointments – 09-7471555
- Through private healthcare
- https://www.dr-biader.co.il/
- Clinic address – Winkler clinic, Brazil 17, Tel Aviv
- Phone – 03-5278128
- Email – biader.bilal@gmail.com
- Covered by your Kupat Holim with an approval from the Gender Reassignment Committee
- דר. קרן כהן
- מומחית בכירורגיה פלסטית עם התמחות בניתוחי התאמה מגדרית
- בית החולים בלינסון בפתח תקווה
- Phone – Yael, 03-9376366, Sunday-Thursday 08:00-11:00
- Email – bl200159@clalit.org.il
- Dr. Avri Raveh
- Through Maccabi Kupat Holim
- Through private healthcare
- https://drraveh.com/
- Dr. Ran Talisman
- Only available through private healthcare
- https://dr-t.co.il/
- Address – Zeitlin 1 Tel Aviv
- Phone – 03-6090660
- Only available through private healthcare
- דר. גבריאל תמיר
- Only available through private healthcare
- גורדון 71 ת”א, טלפון: 03-5278448
- ברודצקי 43, ת”א, טלפון: 03-5278448
- קניון גירון אשקלון, טלפון: 054-6804144
- Only available through private healthcare
- Dr. Ram Silfen
- מנתח פלסטי בעל ניסיון בהגדלת חזה לנשים טרנסיות.
- Address – Einstein 40, Tel Aviv
- Phone – 1-700-50-10-35
- מנתח פלסטי בעל ניסיון בהגדלת חזה לנשים טרנסיות.