Jiggle Physics

Everything you need to know if you want to breast boobily

Foreword: This article discusses surgical techniques and procedures for breast augmentation, as well as the recovery process for breast augmentation. As a result, it talks about breasts frequently, but no surgical images or images of naked breasts appear anywhere in the article.

Slowly, with more effort than it usually takes, I force my eyelids open. I feel groggy, heavy, buried in thick tar.

Not a surprise. I’ve been through quite a few surgeries so far. Anesthesia isn’t new to me.

What is new is that I’m in motion, the hospital bed I’m lying in still in jostling a little as a nurse wheels me back to the recovery room. Anesthesia usually hits me hard, and it’s rare to get an anesthesiologist who gets the doses right enough for me to be awake and alert within a half hour of the end of surgery, much less as I’m being wheeled back to the recovery room.

I crane my head a bit, to look down, heart fluttering already. I know what’ll be there. Well, since this is the second time in for me, what more will be there. But some part of me, thirty-eight years in the making, whispers that it will never be, can never be.

But there they are. Bulky, flat-fronted in the way they are right after surgery, riding high and too-tight, painful in the compression between my stretching pectoral muscles and my ribcage.

“Boobies!” I crow with a foggy, muzzy glee, seeing just how much bigger they are than they were after my first surgery. I raise my hands slowly, in a joyful echo of the way I throw my hands up when I ride a roller coaster, only for my tender pectoral muscles to sharply remind me of just how much pressure they’re under right now. I moan a little in pain, and my hands drop back to the hospital bed.

The nurse pushing me sounds like he’s about to choke with how hard he’s fighting to stifle his laughter at my nonsense.

“Feeling all right?” he asks in a rich tenor. I completely ignore his question. I’ve got more pressing interests.

“How much did he get in?” I ask, peering up at the nurse as I’m wheeled into the recovery room bay where my wife is already waiting. The nurse takes a bit to answer, wheeling me around and pushing me back into the bay proper.

“Two thousand cc’s per implant,” he says, where both my wife and I can hear. “He gotcha where you wanted to go.” I feel like I’m about to explode with excitement and disbelief. I’ve got no idea why that number felt so significant to me, but it had, for months leading up to this, my final gender-affirming surgery, been a clear beacon I’d hoped for more than I’d dared to admit.

“I’ve got a gallon of boobies!” I say, as gleefully as the recent anesthesia will allow, and this time the nurse cannot contain his laughter.

Store-bought is just fine freaking amazing

In retrospect, I can see that I needed to be busty my whole life. It was the first real longing that broke through the haze of puberty, even if I didn’t understand it for what it was. My flat chest, largely unaided by HRT given some unfortunate family genetics, had been a source of terrible dysphoria for me ever since I hatched. I’d tried to bargain with myself to want—to need—less than I ended up getting. I was so terrified that people, especially other women, would reject me over them.

Turns out those fears couldn’t have been farther from the truth.

One of the things I learned early on in transition was that cis women especially loved the bold makeup styles I favored—rich, bold red lipstick and sparkling, multihued eyeshadow. It was a surprise to me, to be complimented so regularly on my makeup by women who favored much more subdued styles, and even moreso when, a year and a half after I came out, a trans man who was a friend of mine asked me to do his wife’s makeup for their wedding photos because the two of them loved my look so much.

What I was shocked to learn after my second breast augmentation, with the four total liters of implant that I now carry beneath my pectoral muscles, was that the vast majority of the cis women I ran into after the operation reacted in the exact same way to my very large and noticeably-augmented-by-design breasts in the exact same way. Yes, the picture in the header of this article is me, and yes, I wanted people to be able to tell that my boobs had been augmented. I love the look, and I really believe that there’s way too much shame floating around over getting your boobs done.

To hell with “homemade is best, but store-bought is fine.” Store-bought is freaking amazing!

I’ve lost track of the number of compliments I’ve received from cis women in the year I’ve had them too. Hell, this very morning a longtime cis friend of mine who I’ve been quite open with about my implants—a woman who is herself far from flatchested—bashfully admitted to me that she was sorely tempted to get her breasts done like I had. She just likes mine that much, and I think there’s a degree of “oh, I’m allowed to do that?” that’s a lot like what I felt when I saw Zeni for the first time that sort of bubbled up for her, hanging around with me.

The world is very good at training women, cis and trans alike, that being bold, feminine, and unabashedly, gleefully the way we want to be is bad, and will result in our punishment. Tone down that makeup, drop that hemline, cover up that cleavage… but feminine people are drawn to rebel against those commandments not because of patriarchy or to catch the attention of men, but because we rejoice in femininity itself, whatever signifies it. That’s the whole premise of Serano’s Whipping Girl, Sexed Up, and a lot of her other work.

Turns out that women generally like being feminine. Who’d’ve thought, huh?

And boobs, especially big ones, are pretty damn feminine.

First, lets unburden a few myths

Breast augmentation is one of the most straightforward gender-affirming surgeries out there, but there are a lot of choices to make along the way that have meaningful tradeoffs. More importantly, there are also a good number of very common mistakes that folks make and myths that people believe that it’s best to lay to rest at the outset.

Myth 1: you need to replace your implants every decade

This one’s understandable, but it is by far the most common myth I hear about. To make a long story short, when breast implants first hit the market, manufacturers recommended that they should be changed out every decade or so, and that kept up through the late ‘90’s to the early ‘00’s. It makes sense—implants are a medical device, and all medical devices wear out over time, even ones made of titanium, like knee replacements.

A lot has happened since then, and one of the perkiest things is that implant manufacturers responded to early worries about implant leakage and failure by redesigning the shell—that’s the outside part of the implant, that holds everything together—to be way, way, way more heavy-duty than it really needs to be. They’re so overbuilt now that the major manufacturers offer lifetime warranties with all of their implants, and recommend that you don’t even start checking on how they’re doing until a decade has passed. Even then, you only go for a swap-out when there’s significant wear.

Myth 2: Anything about breast implant illness

If you’ve done much searching about breast augmentation, you’ve probably heard of breast implant illness. If you haven’t, it’s a diagnosis of exclusion, which means that it gets diagnosed when someone has symptoms, but no clear cause for them. When you get a boob job, you’ll even have to sign a disclaimer acknowledging that it’s a risk.

Except… well, it probably doesn’t exist. Every test or study that we’ve attempted to capture what it is or how it works has failed. And only about 400 cases of it in total have ever been documented by medical professionals. Worldwide.

For a sense of scale, about 300,000 breast implant surgeries and about 100,000 breast reconstruction surgeries were performed in 2022. Just one year.

And that sagged from 2021’s record of about 360,000.

Myth 3: Fake boobs don’t feel like natural boobs

I can’t link studies here, because it’s all about feel, but seriously—breast implants feel pretty much just like a natural boob. That’s the whole point. If you want to see for yourself, ask a local plastic surgery clinic if you could touch one of their samplers. They’ll have a whole selection lying around for that exact purpose.

Fake boobs can be firmer and perkier than natural boobs if your surgeon isn’t very good or if you want that sort of look. Or if, like me, you go really big, and that main reason for that is that they have to put more into the implant than the manufacturer originally intended. I’ve got 2,000cc implants, but they’re in implant shells originally designed to hold 800cc’s, because 800cc shells are the largest size cleared for use in America by the FDA. It’s a lot like filling up a water balloon—the more you put in it, the firmer it gets, unless you get a bigger balloon.

Anyway, the most common reason that a fake boob looks fake is that the surgeon didn’t make as big a breast implant pocket—we’ll get to that in a minute—as they really ought to have. So, if natural-looking boobs are important to you, find a really good specialist.

Myth 4: Big breast implants cause back pain

I’ve had a gallon of boob for a solid year now. Zero back pain from them. I know a number of other big breast implant-havers, both trans and cis, who went even bigger than I did. Same story.

Here’s the real deal: about 80% of boob-havers wear a bra that’s the wrong size, and almost all of them wear a bra that’s significantly too small for their breasts. There are a lot of reasons for this, but one of the main ones is the idea that anything larger than a D-cup is super big, so people go “I can’t be that big” and sister size down. For reference? I’m an M-cup in US sizing, or a HH in UK. And yes, I can still buy my bras off the rack, albeit at stores with expanded sizes.

Shockingly, improperly-sized bras cause a lot of back pain. Good ones don’t.

So, seriously: go get professionally-fitted for a bra, and not at Victoria’s Secret or any other chain place either. Go to a local specialty boutique that stocks a wide range of sizes. At the very least, use the A Bra That Fits Calculator. A really good bra will perk you right up.

Mistake 1: Didn’t go big enough

I’m going to be frank: the most common regret among people who get a boob job is that they wish they’d gone bigger.

Yep.

A lot of surgeons steer people away from larger implants subtly, and patients are often afraid, as I was, that going as busty as they really want to be will make people treat you poorly. Turns out? Making comments about someone’s boobs or treating them differently because of them is sexual harassment, and people are really keen to avoid that, even in America.

So, seriously: when you’re deciding on what size you want for implants, go for the biggest size you think you’re going to like. Odds are that that’s what you actually want. Trial sizers as big as your heart desires are only a bag of rice, a pair of scissors, and some pantyhose away.

Mistake 2: Going cheap

Getting your boobs done is expensive—ten grand, and going up from there the more expert your surgeon is—in the US. It makes sense to try to save money where you can. Even with insurance covering breast augmentation for transfeminine people more and more frequently, there’s often a deductible or coverage gap, so there’s a lot of incentive to save what money you can. Thing is, the cheap guy at the local clinic? He’s cheap for a reason. You absolutely get what you pay for.

Do your research and be willing to do a little traveling, especially if you’ve got a specific look or feel that you really want. The really skilled surgeons will absolutely put a bounce in your chest in the best possible way. It’s way less expensive to save up and go with the best than have to get your boob job revised.

How to get a boob job

Frankly, it’s pretty easy to get a breast augmentation, if you’ve got the money or insurance coverage. It’s a well-understood, straightforward surgery, and there are a lot of people who can do a great job. In many ways, the hardest part is choosing between all your options.

Step 1: Find the right surgeon

Finding the right surgeon for you is incredibly important. Take your time. The best resource you’ve got available to you is RealSelf, a website filled with non-retouched, patient-provided images of their surgery results, surgeon-by-surgeon, with written reviews to go along with them. If you’re trans, and/or if you’re taller than about 5’4”, I’d strongly recommend that you look for a doctor with lots of experience working with trans women and XL breast implants, which is just any implant larger than 600cc’s. Doctors without that experience are much more likely to make implant capsules, which are just the spaces in your body where your implants will sit, that’re too small for a taller woman's chest. It’s not a competence thing. It’s just that they’re used to working on smaller breasts.

Also, if a look that’s as natural as possible is high on your list, consider a doc with that same expertise, because making properly large implant capsules is the most important part of making them feel and look properly natural. Remember the balloon analogy from a moment ago? Imagine you tried to fill up a big balloon that you’d put inside a small one. It wouldn’t really matter how big the big balloon is, would it?

Anyway, when a person is taller, they’re also, on average, broader across the ribcage, and that means you have a larger area that’s the base of your breast. That’s important, because doubling the volume of an implant only increases how far it’ll stick out from your chest by about 20-30%, because of something called the square-cube ratio. If you’re tall or broad—and I’m 5’11”, with German and Irish heritage that gives me a broad, 40” ribcage, for reference—you’re going to need a much larger implant to look the same, proportionally, as a smaller woman with typically-sized implants. I’ve got a friend with a more slender ribcage who recently had her second breast aug. Her implants are smaller than mine are by a fair margin, but they look significantly larger on her than mine do on me.

Above all else: make sure your doctor specializes in breast augmentation. The last thing you want is the best tummy tuck doc on the East coast doing your boobs just because he’s got an opening in his schedule.

Step 2: Consultation time!

Once you pick a couple of docs who seem like they’ll work for you, book a free consultation with them. Either go to their offices or, online, talk to them about what you want. Be direct. Tell them specifically what you want, and do not talk about cup sizes. Cup sizes are a ratio, not an absolute number, so a D-cup on two women will usually look wildly different. Explore The Irish Bra Lady’s Instagram to get a feel for what this looks like in the real world. Asking for a cup size is a fantastic way to get let down.

Instead, give your surgeon pictures of some women’s breasts that look the way you want yours to look. Ideally, pull them from the doctor’s own RealSelf results, but anything that isn’t in a bra and actually shows a fair bit of breast—bikini shots are really good here—will get the job done. They should have sample implants that you can try on right there in the consult, so bring a sports bra with some extra stretch to your appointment!

A good surgeon is an artist. If you tell them what you want your boobs to look and feel like, and show them the size you’re hoping for, they’ll be able to pick the implants that’ll meet your needs much better than you will. It’s scary giving away that much control, but everyone I know who has has been glad they did it.

Step 3: Decision time

When you’re deciding who to book with, you’re going to be given a few choices, beyond the docs themselves. Really, there are five choices you’re going to need to make:

Choice 1: Where the implant sits

There are three ways an implant can be put into you: over your pectoral muscle and beneath your existing breast, under the pectoral muscle in a cavity the surgeon will create, or inside your pectoral muscle, a procedure usually called dual plane.

Never go with a placement that isn’t your doctor’s preferred placement. If you love a doctor’s results but want a different placement, go with a different doctor.

Over the muscle placements (OTM) are kind of the old school approach, and usually work best if you’re going for a smaller implant. The recovery is the easiest of all placements, and the big advantage is that your pectoral muscles aren’t affected by the surgery—more on this later. If you’re a really athletic person who uses their upper body a lot, like a rock climber, over the muscle is absolutely the way to go. The downside is that over the muscle placements have the highest rate of complications after you’ve healed from the surgery, and sometimes they can make mammograms trickier.

Under the muscle implants (UTM) are exactly what they sound like, and go into a pocket that the surgeon creates underneath your pectoral muscle and above your ribcage. As you might guess from this, early recovery from this placement hurts like an absolute bitch, because you’re putting constant pressure on areas that are freshly-cut by your surgeon. The advantages, however, are plenty: most people say they look quite a bit more natural than over the muscle implants, there’s a much lower risk of post-surgical complications like capsular contracture and, for my money, the very best one: your pectoral muscle supports the implant for you, which makes it much easier to go without a bra when you want to. Honestly? I really don’t need to wear one if I don’t want to. The major downside is that UTM placement distorts your pectoral muscle, which reduces the maximum amount of upper-body strength you can have, so this is not the route for upper-body athletes.

Also, if you’re thinking about going really big, like I did? Under the muscle is unquestionably the way to go. You’re going to want the support.

Also, you can flex your pecs and make your boobs dance. It’s a neat party trick. 🤭

Dual plane (DP) implants are a midpoint between under the muscle implants and over the muscle implants, where the bottom of the breast implant capsule isn’t the closed-up-and-healed pectoral muscle. The idea of it is to try to balance both types of implant placement, mitigating the disadvantages of each… but I think that the result is the worst of both worlds: the hard recovery and strength decrease of UTM placements with the lack of support and increased complication rate of OTM placements. It’s the newest approach, and doesn’t have the lengthier long-term recovery statistics that the other placements have. Some docs really swear by it, though.

Choice 2: Incision placement

Where your surgical scar is going to be—where the surgeon cuts you open to do their thing—is the second choice you need to make. You can either go in through the crease at the bottom of your breast or through your nipple. This is a pretty simple decision to make: if you’re worried about scarring, or frequently get keliod scarring, a nipple incision is probably better, because the scar gets hidden in your aureole. The risk higher for a loss of sensation in your nipples, but a good doctor knows how to avoid it. If you’re not worried about the scarring, or preserving sensation is your top priority, going in through the crease is the best bet.

If you’re going above 1500cc’s, you don’t actually get to make this choice—you’re going to need to do a nipple incision. The explanation is kind of technical and the sort of thing that can creep people out, so if you’re interested in the details, send me a message and I’ll be happy to break it down for you.

Choice 3: Silicone or saline

Next you’re going to have to pick what you want inside of your implants. Silicone “gummy bear” implants are a gel, while saline is just sterile salt water. In general, people say that silicone implants feel a little more like natural breast tissue. On the flipside, saline implants are a little bit safer—implant shells are really tough, but if you get in a bad car crash or something, there’s a chance an implant will burst. If you’ve got silicone implants, they won’t seep out into your body, but the silicone will still be exposed to the insides of your body, which means that you’ll need to get them out right away. If a saline implant bursts? You’ll just pee more that day. It’s still important to get the burst implants out, but it’s not an emergency procedure.

And if you’re going really big, you’re going with saline, period. Silicone maxes out at 800ccs in the US, and 1200 in the EU. Only saline implants can be overfilled to go larger.

Choice 4: The implant profile

This bit’s gonna be slightly technical, and mostly outside of your control—your doctor is going to recommend a profile that fits the look you’re going for, and maybe you’ll need to make a this-or-that choice.

Implants come in a variety of profiles, which is just a way of describing how far out they project from your chest, given a constant base diameter. In a nutshell? The higher profile you go, the more artificial they’re going to look.

It’s not quite as simple as “same implant shell, changing volume,” though, because a low profile shell—not pictured in this diagram—has a little less surface area than a moderate profile or a high profile implant. Your doctor will probably recommend a profile for you based on what you’ve told them you want, but if you’re given a choice, remember that higher profile is a perkier look, while lower profile is a more natural one.

Choice 5: Want an internal bra?

Ever wanted to cheat at life? Wish your boobs looked as good when you’re naked as they do when they’re in your favorite bra? Have an implant go wrong, and things got super droopy, or asymmetrical? An internal bra can solve all sorts of breast-related problems, give your boobs extra support, and make them look fabulous. If you go for this, though, make sure that you make it extra-clear to your surgeon exactly what you want your boobs to look like once you’re done healing. These can be customized to almost any level of support you might want, but the standard approach is, erm, rather perky.

If you’re going big

If you want boobs like mine—and, again, I’ve been really surprised at just how many people have talked to me about how to get their own set in the last year—you’re going to need more than one operation. The most that a specialist in XL breast implants can go with your first surgery is probably going to be between 700 and 900cc’s, though there’ll be some outliers depending on how big your ribcage is. My surgeon, Dr. Revis, is one of the best in the world at going super big safely, and even he can’t go bigger quicker than that.

Your second operation will have a far, far easier recovery, and they can usually boost you more the second time around than the first, because your implant capsule is healed up and just needs to stretch to accommodate the new volume—but remember that the square-cube ratio is a harsh mistress. The most dramatic increase, cc for cc, will be in your first augmentation. Dr. Revis boosted me by 1,100ccs in my second surgery, and that was a real stretch made possible mostly because I have really elastic skin and weak pectoral muscles due to a birth deformity.

If you’re looking to go really big, there’s also one other option that I should at least mention: expander implants. Originally designed to help cis women who’d had cancer-related mastectomies get to a larger size safely, some surgeons are willing to use expander implents, which are breast implants with a special valve implanted in your armpit under the skin, allow you to add additional saline bit by bit without having extra surgeries. A few people—my friend, Zeni, amongst them—use them, connected to large implant shells, to go in for some very, very large breasts.

Frankly? I don’t like expander implants very much. They come with a lot of risks that regular implants don’t have, the worst of which is that the breast impant is more likely to get infected. The complication rate is relatively low—just a fair bit higher than conventional implants.

Once you’ve made your choices, all that remains is to put a deposit down and wait for your surgical date.

Surgery day

Surgery day will be a lot like any other surgery you’ve ever had—no eating for eight hours before, clear your schedule for recovery—except you might be surprised to learn that it’ll only be 45-60 minutes between the time you’re wheeled into the operating room to the time you wake up in the recovery room. Boob jobs are quick.

You’ll need someone to drive you home, or to your recovery location if you’re traveling, and you’ll absolutely need someone to help you for a while.

Recovery time

Especially if you’re going UTM or DP, you will need regular help for very basic things, like opening doors if they stick, for the first week or two of your recovery. You’ll be surprised at how weak you are. Have someone handy to help you out. You’re going to need it. And yes, you’ll get your strength back as your body adapts to its new reality, but that’s going to take time.

You’ll probably be sent home with strong painkillers and muscle relaxers. If you went UTM, the muscle relaxers will do more to keep the pain down than the painkillers. Do not miss a dose or you’ll regret it. A lot.

You’ll be wearing a special postsurgical bra for the first 6-8 weeks, and you’ll need to sleep on your back and at about a thirty-degree upward angle. A lot of doctors will also have you start wearing a big elastic band to help push the implants down into their dropped position. It’s all irritating, but it’s really worth following those orders.

In the first week, rest as much as you can. Get up and walk a little every hour or so, but mostly rest. Things will get easier the second week, and the pain will be mostly gone by the end of the third.

The physical pain, anyway.

The dysphoria monster

So, I’m going to be frank here: your boobs are going to look really weird for the first month or two after your surgery. That’s because they need to be placed higher than you eventually want them to sit, or when they heal they’ll look really droopy. This is a process called dropping and fluffing, and it takes about 3 months to mostly finish. But… well, this means that you’re going to look like you’ve got some roided-out bodybuilder pecs for about a month after surgery.

Whether you’re cis or trans, you’re probably going to feel some dysphoria for a little while after your breast augmentation because of that. It’s a very common part of recovery.

I felt some pretty awful post-surgical regret right after my first breast augmentation, like I’d made a terrible mistake, because of how they looked. It took about a month and a half for me to feel really all right with them, and a solid three before I genuinely liked how they looked. This is a normal part of the process. If you go looking, you’ll see cis woman after cis woman telling the same story.

Bear with it. It’s part of the process, and it will pass.

The longer recovery

Technically, it can take as much as 18 months for your implants to really settle into their final position. I’m just about a year, and they’re still moving, bit by bit, into more and more the exact look and position I asked Dr. Revis for, but the month-by-month differences aren’t noticeable anymore. Keep in mind, if you’re looking for a really natural look, that that’s the biggest effect of the long recovery: that they’ll get softer and softer as time goes by.

Your second round (if that’s your thing)

So… if you’re coming to me for advice on getting a boob job, there’s a real chance it’s because I’ve got the boobs I have, and you’re at least curious about getting your own set like mine. After all, my boobs look like this:

If you’re planning on going really big, go to one of the best doctors you can find, and accept no substitutes. There’s a reason I linked Dr. Revis. He’s fantastic with trans folks, doesn’t require WPATH letters, and treats us exactly like he does his cis clients. He’s also a virtuoso at making really big boobs. Literally the one and only downside of working with him, in my opinion, is that he’s based in Florida… but a lot of the other best breast surgeons in the nation are too.

The good news is that your second—or, if you’re really going for it, your third—breast augmentation will be vastly easier than your first in every way: pain, dysphoria, upper body strength, the whole shebang. You’ll still be needing help for a week or so, and you’ll still need to be pretty gentle with yourself for a while after the surgery, but once you’ve done this once? A second time is an absolute breeze by comparison.

And honestly? Boobs are wonderful, for those who want them.

The world’s gone mad, in many ways. Live your dreams.

Author's note: this article doesn't talk about fat graft breast augmentation because it's an entirely different procedure, with entirely different risks, than conventional breast augmentation. It has more in common with Brazilian Butt Lifts than anything I've written here, and would honestly require it's own, separate article to cover in detail.