Gender-Affirming Breast Surgery

The Gender Confirmation Center of San Francisco performs the full range of gender-affirming breast and chest surgery for transgender and non-binary patients. MTF and non-binary patients may undergo breast augmentation using implants placed submuscularly or subglandularly to create a feminine chest contour. FTM and non-binary patients seeking chest masculinisation undergo chest reconstruction — commonly called top surgery — which removes breast tissue, reshapes and repositions the nipple-areola complex, and contours the chest wall to a flat or masculine profile. Dr. Mosser's team operates under an Informed Consent model and works with patients' insurance providers to secure coverage where applicable.

Breast and chest surgery at the Gender Confirmation Center of San Francisco is one of the core surgical offerings of Dr. Scott W. Mosser MD FACS, a board-certified plastic surgeon with 29 years of operative experience who has dedicated his practice exclusively to gender-affirming care since 2013. For MTF (male-to-female) and non-binary patients seeking breast augmentation, the procedure follows principles established in cosmetic breast surgery but is planned with attention to the specific anatomical starting point of patients who have developed under the influence of exogenous oestrogen therapy — including considerations of existing breast tissue volume, chest wall width, and the desired degree of augmentation. Implants are selected in collaboration with the patient based on size, profile, and material preference, and are placed either in a submuscular pocket beneath the pectoralis major or in a subglandular position depending on the patient's tissue coverage and aesthetic goals. The procedure is performed under general anaesthesia, typically as an outpatient at one of the practice's affiliated hospitals. For FTM (female-to-male) and non-binary patients, chest reconstruction aims to create a chest contour consistent with the patient's gender identity. The surgical technique is selected based on the volume and elasticity of the patient's breast tissue and the size and position of the nipple-areola complex. Patients with smaller breast volumes and good skin elasticity may be candidates for a periareolar or keyhole approach, which uses an incision around the areola margin and removes breast tissue through this access while simultaneously reducing the nipple-areola complex size. Patients with larger volumes or greater skin laxity typically undergo a double incision mastectomy with free nipple grafting — the most common FTM chest reconstruction technique — in which bilateral horizontal incisions allow complete removal of breast tissue and skin, with the nipple-areola complex excised, sized, and reapplied as a free graft at a masculinised position on the chest wall. The practice's insurance advocacy team actively pursues coverage for chest surgery under gender dysphoria diagnosis codes and has achieved approximately 90 percent insurance coverage rates for qualifying patients. Patients traveling from outside the San Francisco Bay Area are accommodated with telehealth consultations and coordination support.