How can I increase my breast size?

Breast Size Enhancement Options

For individuals seeking breast enlargement, surgical breast augmentation with implants remains the most effective and evidence-based method, though hormone therapy (for transgender women) and external tissue expansion systems represent alternative approaches with varying degrees of effectiveness.

Surgical Breast Augmentation

Breast augmentation with implants is the most established and reliable method for increasing breast size 1, 2:

• Implant options include saline-filled or silicone gel-filled breast implants, both contained within a solid silicone envelope 3
• Effectiveness is immediate and predictable, with controlled size outcomes based on implant selection 1
• Long-term monitoring requires initial imaging at 5-6 years post-surgery, then every 2-3 years thereafter to screen for rupture 3, 4
• Complications include rupture (saline ruptures are clinically obvious with breast size/shape changes; silicone ruptures may be asymptomatic), capsular contracture, and rare breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), particularly with textured implants 3, 4
• Patient selection is critical and should involve comprehensive education about risks, realistic expectations, and long-term commitment to monitoring 2

Important Surgical Considerations

• Silicone gel implants are safe and acceptable for breast augmentation 3
• The outdated notion that implants must be replaced every 10-15 years is a myth; replacement is only needed if complications occur 4
• Reoperation rates range from 14-24% after 3 years, emphasizing the importance of proper patient selection and surgical technique 2

Hormone Therapy (Gender-Affirming Care)

For transgender women seeking feminization, estrogen-based hormone therapy produces breast development 3:

• Regimen typically includes estrogen plus an antiandrogen (such as spironolactone) to achieve testosterone levels <50 ng/dL 3
• Breast development is sustained during the first 3 years of treatment, with some studies showing continued growth beyond the initial timeframes 3
• Expected outcomes: In one study, 1% achieved less than A cup, 9% achieved A cup, 16% achieved B cup, and 1% achieved E cup 3
• Limitations: Results are variable and unpredictable; many transgender women ultimately pursue surgical augmentation for desired size 3
• Risks include thromboembolism (particularly with ethinyl estradiol), cardiovascular effects, and decreased fertility 3

Critical caveat: Progestins are often sought for breast development but are NOT recommended by the Endocrine Society due to increased cardiovascular and breast cancer risks 3

External Tissue Expansion Systems

Non-surgical vacuum-based breast enlargement devices have limited evidence 5, 6:

• Mechanism: Applies controlled vacuum distraction force (approximately 20 mmHg) to stimulate tissue growth 5, 6
• Protocol: Requires wearing device 10-12 hours daily for 10 weeks 5, 6
• Reported results: One study showed average 55% stable long-term increase in breast size (range 15-115%), though only 12 of 17 participants completed the protocol 5
• Side effects: Irritant contact dermatitis and folliculitis 6
• Major limitations: High dropout rates due to compliance issues, limited long-term data, and results far less predictable than surgical augmentation 5

Topical Hormone Therapy

Topical estradiol application has extremely limited and low-quality evidence 7:

• One small pilot study (45 women) showed breast size increase in only 46.7% of participants, with response correlated to IGF-I levels 7
• This approach is NOT recommended due to insufficient evidence, unpredictable results, and potential systemic hormone effects 7

Clinical Decision Algorithm

1. First consideration: Is this for gender-affirming care in a transgender woman?

   • If yes: Refer to endocrinology for hormone therapy evaluation; counsel that surgical augmentation may still be needed 3
   • If no: Proceed to step 2

2. Assess motivation and expectations: Is the patient seeking significant, predictable size increase?

   • If yes: Surgical consultation is most appropriate 1, 2
   • If no: Consider conservative observation

3. For surgical candidates: Comprehensive preoperative education about implant types, risks (including BIA-ALCL, rupture, reoperation rates), and lifelong monitoring requirements 3, 2

4. Avoid: Topical hormone therapies and external expansion devices as primary recommendations due to poor evidence, high failure rates, and unpredictable outcomes 5, 7, 6