Breast Construction

Breast construction (breast augmentation) is a gender-affirming, upper body surgery that creates, enlarges or shapes one's breasts.

This surgery is performed when the breast growth from hormone therapy is insufficient. The goal is to have breasts and nipples with sensation, a larger cup size and minimal scarring. This surgery is done by a plastic surgeon. This can also be performed on clients who are not on hormones because it is contraindicative and/or not aligned with gender goals.

Referral & consult

Referral & consultation process

1Complete surgical care planning

To get started, you will need one surgical recommendation, which is made after surgical care planning . This can be done by a clinician who meets the qualifications and competencies outlined in the WPATH Standards of Care 8 - this can include your primary care provider or a counsellor. Part of the surgical care planning process includes assessing whether you meet the WPATH criteria required for this surgery and whether you are ready for surgery. After you have completed your care planning and have received a surgical recommendation, your primary care provider will refer you either to the Trans Care BC central waitlist for upper surgery or to a plastic surgeon of your choice. Additional information or consultation with specialists may be required at the discretion of the surgeon.

2Review referral options

Visit the surgery referral page for steps required in the referral options for breast construction (or breast augmentation).

3Speak to your surgeon

Once you are referred to a surgeon, the surgeon must submit a funding request to MSP (using this form, Provincial Coverage of Breast Construction Surgery). Funding requests are reviewed by MSP on a case-by-case basis and publicly funded in certain circumstances. 

The criteria for breast construction (breast augmentation) are:

  • You have been on hormones for at least 18 months (unless hormones are not clinically indicated for you); and
  • You have had little to no breast growth; and/or
  • Significant asymmetric growth as determined by plastic surgeon

You may want to ask your surgeon about:

  • The different surgical techniques available
  • The advantages and disadvantages of each technique
  • What your options are if you are not satisfied with the appearance of your breasts
  • Whether they have before-and-after photographs of their own patients, including those of both successful and unsuccessful outcomes
  • The risks and possible complications of the various techniques
  • The surgeon's own complication rates for each procedure

The procedure

The basic steps in breast construction (breast augmentation) are:
  • An incision is made under the breast or around the areola.
  • A temporary breast-tissue expander is inserted to make room for the implant.
  • A few months later, the tissue expander is replaced, usually with permanent saline-filled implants.
  • The nipple and areola are then reconstructed to a typical feminine shape.
  • You will probably be admitted to hospital and sent home on the same day.

Preparing for surgery

While you wait for your referral and approval for funding to be processed, you should keep your personal information updated with all of your health care providers, including any change of name or contact information. This will ensure your health care professionals can reach you to schedule consultation and surgery appointments.

Visit the Preparing for Surgery page to help you create a plan for after surgery.


All surgical procedures involve some risks. Risks include negative reactions to anesthesia, blood loss, blood clots and artery blockages. These complications can, in extreme cases, result in death. It’s important to discuss these risks in detail with your surgeon. 

Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise and respond to them appropriately. They will also inform you about what you can do to minimize your risks.

Some complications are particularly associated with breast construction (breast augmentation). Below are a list of some possible complications of this surgery. Please note - this list is not comprehensive and you should have a detailed discussion of risks with your surgeon

Can occur when bacteria enters the wound. Small infections can be treated with antibiotics. Infections can lead to the formation of an abscess (a collection of pus). An abscess can be treated with antibiotics or drained by the surgeon. Infection of the breast implant pocket requires implant removal and replacement at a later time.

When blood collects in the surgical site, causing pain, swelling and redness. Smaller hematomas can be drained, but larger ones require removal through surgery.

When clear fluid accumulates in the surgical site, causing swelling. Seromas may resolve on their own or they may need to be aspirated (sucked out) once or more by the surgeon.

Something does not look the same on both sides. The breasts, nipples or areolas could be asymmetrical in size, shape or position. Significant asymmetry may require further surgery.

When the scar tissue that naturally forms around the breast implant thickens and contracts. This causes the breasts to become extremely firm with a shape that may be unsatisfactory. Requires surgical removal of the thickened capsule and implant replacement or removal.


May be correctable with various treatments, including additional surgery. Your surgeon will give you advice on what you can do to minimize scars.


Partial or permanent loss of nipple or skin sensation.


The implant could rupture, causing a sudden change in breast shape, or become exposed as a result of wound-healing problems or infection. Sometimes the implant feels or looks wrinkly. These problems would require implant removal or replacement.

After surgery

Post-operative care

You will likely be prescribed painkillers and antibiotics after to reduce the chance of infection.

Your surgeon may recommend a certain type of bra to wear after surgery to promote healing. You’ll also have surgical dressings for the first few days and Steri-strips along the incision lines. Your surgeon will give you instructions about when to remove the dressings and when it is okay to shower. The Steri-strips are usually left in place and will fall off on their own.

As a normal part of the healing process, you should expect:

  • Your upper body to feel stiff and sore for the first 2 to 5 days following surgery
  • Your breasts to feel tight and sensitive to the touch
  • Your skin to feel warm or itchy
  • The skin 1 to 2 cm around your incisions to be red (if it spreads beyond this, seek medical attention)
  • To see or feel the knot from your stitches at the end of the incision
  • Bruising and swelling (this will mostly resolve within a month)
  • Feelings of sharp shooting pain, burning sensations and general discomfort
  • Your  scars to fade over time


The number of check-ups needed following surgery varies from person to person. You’ll likely have one or two check-ups with your surgeon. You can also see your primary care provider about any concerns in the post-operative period. 

When you visit your surgeon or primary care provider, they should check your surgical sites to make sure there are no infections or wound-healing problems. They will ask questions about pain, bleeding and fever, and how you are feeling physically and emotionally.

Recovery time

Recovery time (the time it will take you to get back to your usual activities) varies from person to person, so always follow the advice of your own surgeon. 

Many people feel comfortable within a week following the surgery, but you’ll need to get plenty of rest in that first week. It is common to return to your daily activities gradually over the next 3 to 4 weeks. Some activities, such as driving, heavy lifting and exercise, may be restricted in the post-operative period. Your surgeon will give you advice about when it is okay to resume these activities.

Surgical revision

In some cases, due to healing complications, a surgical revision of a breast construction (breast augmentation) may be needed. You can speak with your surgeon about whether a surgical revision is appropriate. If your surgeon determines a revision is medically necessary, they will apply for funding. MSP will typically only fund revisions that are related to pain or function. Only revisions related to appearance are generally not covered.

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