In this guide13 sections
- Key Points
- Does MTF Top Surgery Leave Scars?
- Where Are MTF Top Surgery Scars?
- What Do MTF Top Surgery Scars Look Like Over Time?
- How Do You Minimise Scars After MTF Top Surgery?
- What Do Fat Transfer Breast Augmentation Scars Look Like?
- MTF Top Surgery Keloid and Hypertrophic Scars: Who Is at Risk?
- Is Capsular Contracture the Same as a Scar?
- MTF Top Surgery Scar Treatment: What Can Help?
- When Should I Contact the Clinic About My Scars?
- Frequently Asked Questions
- MTF Top Surgery in London
- References
Key Points
- MTF top surgery leaves a small, well-hidden scar. At Centre for Surgery the incision is around 5 cm long and sits in the fold beneath each breast, so it is not usually visible from the front.
- Scars change a lot over the first 18 months. They usually start pink and slightly raised, are often at their reddest at two to six months, then flatten and fade to pale lines over 12 to 18 months.
- Tension control matters most early on. Wearing your surgical bra for six weeks, sleeping on your back for at least eight weeks and avoiding heavy lifting all protect the scar while it is weak.
- Silicone and sun protection have the best evidence. Silicone gel or tape once the wound has fully healed and your surgeon agrees, and SPF 50 or clothing over the scars for at least three months.
- Fat transfer scars are tiny. Fat is placed through a few cannula marks only a few millimetres long, which usually fade to small dots.
- Raised scars can be treated. Hypertrophic and keloid scars are more likely in darker skin and in people who have had them before, and steroid injections, laser and scar revision can all help.
Yes, MTF top surgery leaves scars, but they are usually small and well hidden. With implants, the scar is a short line of around 5 cm in the fold beneath each breast, which is covered by the breast itself when you stand and by most bras and bikini tops. It is usually pink and firm for the first few months, then softens and fades to a pale line over 12 to 18 months. How it ends up depends on how your skin tends to heal, how well the scar is protected from tension, sun and smoking while it matures, and whether you have a tendency to raised or keloid scars.
This guide explains where MTF top surgery scars sit, how they change month by month, the scar care with good evidence behind it, who is more likely to get raised scars, and which treatments can help. For the wider picture, our MTF top surgery recovery guide covers the full week-by-week timeline.
Does MTF Top Surgery Leave Scars?
Every operation that cuts through the full thickness of the skin leaves a scar, and MTF top surgery (gender-affirming breast augmentation) is no exception. What sets it apart is how small and well placed that scar usually is: an implant needs only a short opening, placed in a natural crease where it is shaded by the breast. Most trans women who have implants end up with two short, pale lines in the fold beneath the breasts, and fat transfer leaves only a handful of tiny dots.
Where Are MTF Top Surgery Scars?
The fold incision: the standard at Centre for Surgery
At Centre for Surgery, implants for MTF top surgery are placed through an incision of around 5 cm in the inframammary fold, the crease where the underside of the breast meets the chest wall. The incision is closed in layers with dissolvable stitches, so there are no stitches to remove at your wound check.
This is also the approach most surgeons use worldwide. A 2026 narrative review of 37 studies on breast augmentation in transgender women ↗ found that the fold incision was used in more than 80% of recent cohorts, valued for the clear view it gives the surgeon, precise creation of the implant pocket and the ease of setting a new breast fold[1]. In a 2024 series of 46 transfeminine patients, 91% had their implants placed through a fold incision[2].
That matters in MTF surgery. A masculine chest often has a shorter distance from the nipple to the fold and a wider chest wall, so the fold usually needs to be lowered to suit the implant. Your surgeon plans the incision to sit in the new crease once the implant has settled, so it may look slightly low for the first few weeks.
Other incision options
Two other approaches are used for breast implants, though they are less common in MTF surgery:
- Periareolar: a curved incision along the lower edge of the areola. The scar can blend into the colour change, but the areola is often small before MTF surgery, which limits the size of implant that can pass through it, and the 2026 review noted higher rates of the wound opening with this approach[1].
- Transaxillary: an incision in the armpit, which avoids a scar on the breast itself. It is technically demanding, gives less control over the pocket and the new fold, and the scar can show when you raise your arms.
Our guide to breast augmentation incisions compares all three in more detail. Your surgeon will explain which approach suits your chest, and where your scar will sit, at your consultation.
What Do MTF Top Surgery Scars Look Like Over Time?
The wound itself seals within about two weeks, but the scar underneath keeps remodelling for much longer. A typical pattern looks like this:
- Weeks 0 to 2: the incision is covered with tape or a dressing and supported by your surgical bra. Your first wound check is at day 7 to 10.
- Weeks 2 to 6: the wound has closed. The scar is a thin pink line that may feel tight, numb or itchy.
- Months 2 to 6: scars are often at their reddest, firmest and most noticeable, as new collagen is laid down. This stage worries people most, but it is normal.
- Months 6 to 12: the scar softens, flattens and lightens.
- Months 12 to 18: most scars have matured into flat, pale lines close to your skin colour.
Fold scars tend to settle well over this period. In a 2019 prospective cohort study in Aesthetic Plastic Surgery ↗ of 163 breast augmentation patients, scars in the breast fold scored better than armpit scars at one and six months, mainly on redness and height; by 12 months both had faded to the same low score, and patients rated their satisfaction with the scar at a median of 9 out of 10[3]. So judge your scar at around a year, not at three months. On darker skin, scars often stay darker (hyperpigmented) for longer before they fade, and sun exposure makes this worse.
How Do You Minimise Scars After MTF Top Surgery?
No product guarantees a fine scar, but a few simple measures have good evidence behind them. Always follow your surgeon’s plan.
Weeks 0 to 2: wound care
Keep the dressings clean and dry until your wound check unless told otherwise. Do not pick at the tape or scabs, and keep creams and oils off the wound while it is open. Avoid swimming and baths until it has fully healed. If you remove chest hair, avoid shaving, waxing or epilating directly over the incision until it has healed.
Wear your surgical bra for six weeks
Your post-surgical bra supports the implants as they settle and reduces the tension pulling on the incision every time you move. Wear it day and night for six weeks, taking it off only to wash. Avoid underwired bras in early recovery, as the wire sits right along the fold scar; your surgeon will tell you when you can wear them again, usually at your six-week review. Our article on wearing a bra after breast augmentation explains what to look for.
Sleep on your back and avoid strain
Sleep on your back for at least eight weeks after MTF top surgery, with your upper body raised for the first two weeks. Lying on your side or front puts pressure on the implants and pulls on the fold while the scar is at its weakest. Avoid heavy lifting, pushing and reaching above your shoulders in the early weeks, and leave chest exercises, running and the gym until your surgeon clears full exercise at around six weeks.
Taping to reduce tension
Tension across a healing incision is one of the main triggers for scars that widen or thicken, and supporting the scar with tape reduces that pull. In a 2005 randomised controlled trial in Plastic and Reconstructive Surgery ↗, 41% of people whose caesarean section scars were left untaped developed a hypertrophic scar by 12 weeks, compared with none of those who applied paper tape to their scars for 12 weeks[4]. A 2026 systematic review of 14 studies also found that taping surgical incisions improved how scars looked compared with no treatment, and that low-cost paper tape may give results similar to silicone sheets[5]. Your surgeon will tell you whether to use paper tape, silicone tape or gel, and when to start.
Silicone gel and silicone tape
Silicone is the most widely recommended first-line treatment for preventing raised scars. It is thought to work by keeping the outer layer of the scar hydrated, which calms the overactive scar-forming cells underneath. A 2022 systematic review and meta-analysis of randomised trials found that silicone gels had both a preventive and a treatment effect on hypertrophic scars, although many of the trials were at risk of bias[6].
- When to start: only once the incision is fully closed with no scabs and your surgeon agrees, usually from around six weeks after MTF top surgery.
- Gel or tape: silicone tape or strips suit a short, straight fold scar and add a little tension support; gel is easier to use under a bra.
- How long: wear strips for 12 hours or more a day, or apply gel twice daily, for at least three months, and longer if the scar is still red or raised.
Our article on whether silicone strips help scars heal explains how to apply them correctly.
Sun protection for three months
Ultraviolet light can darken a young scar permanently, particularly on darker skin. The fold scar is mostly hidden, but it is exposed in a bikini, when sunbathing or on a sunbed. Keep your scars covered with clothing, or use a broad-spectrum SPF 50 sunscreen on them, for at least the first three months, including on holiday. Sunscreen should not go under silicone strips, so use one or the other at a time.
Scar massage
Once the wound has fully healed and your surgeon is happy, a few minutes of gentle massage a day can help a firm scar soften and stop it sticking to the tissue underneath. Use slow circles along the scar with a fragrance-free moisturiser or your silicone gel, without pressing deep into the implant. It can also ease the itchy, over-sensitive feeling that is common as nerves recover.
Stop smoking and nicotine
Nicotine narrows the small blood vessels that heal the wound, raising the risk of the incision opening, infection and poorer scars, as well as capsular contracture around the implant. We ask everyone to stop smoking, vaping and all nicotine products for four weeks before and four weeks after surgery.
What Do Fat Transfer Breast Augmentation Scars Look Like?
If you have MTF breast augmentation with fat transfer, there is no implant incision at all. Fat is removed by liposuction from areas such as the tummy, flanks or thighs, purified, then injected into the breasts in small amounts through a cannula. Both steps are done through tiny entry points only a few millimetres long.
These cannula marks usually heal as small dots that fade to near-invisible over the following year, and they are often placed in natural creases or the bikini line. On darker skin they can stay darker for some months, so the same sun protection advice applies. The trade-off is a softer, more modest increase in size than implants. A hybrid approach, combining an implant with fat transfer, leaves the short fold scar as well as the cannula marks. Our guide to choosing the right implant size for MTF top surgery explains how your surgeon balances size against your chest and skin.
MTF Top Surgery Keloid and Hypertrophic Scars: Who Is at Risk?
Most scars that look thick at three months are simply immature and will settle. A small number become abnormal raised scars:
- Hypertrophic scars are raised, red, firm and sometimes itchy, but stay within the line of the incision. They often improve over a year or two and respond well to treatment.
- Keloid scars grow beyond the edges of the incision into the surrounding skin, rarely improve without treatment and can come back after removal.
The chest is one of the areas of the body most prone to raised scars. The risk is higher if you or close family members have had keloids before, including from piercings or acne, if the wound becomes infected or opens, and in darker skin. A 2025 review noted a higher burden of hypertrophic and keloid scarring in people with skin of colour, usually described as Fitzpatrick skin types IV to VI[7].
If any of these apply to you, tell your surgeon at consultation, so your scars can be watched closely and any thickening treated early. Our article on whether hypertrophic scars go away explains how these scars behave over time.
Is Capsular Contracture the Same as a Scar?
No. Your body forms a thin layer of scar tissue, called a capsule, around every implant, and this is normal. In capsular contracture, that internal capsule thickens and tightens, making the breast feel firm, look higher or ache. It is unrelated to how your skin scar looks. Our guide to capsular contracture covers the symptoms and treatment.
MTF Top Surgery Scar Treatment: What Can Help?
No treatment can remove a scar completely, but several can make a raised, red, wide or uneven scar much less noticeable. At Centre for Surgery, scar revision covers steroid injections, laser scar treatment and scar revision surgery, used alone or together depending on your scar and skin type.
Steroid injections for raised scars
Injecting a corticosteroid directly into a hypertrophic scar or keloid reduces inflammation and slows the overproduction of collagen, so the scar flattens and softens. Injections are usually repeated every four to six weeks over a few sessions. In a 2025 systematic review comparing treatments for hypertrophic and keloid scars, triamcinolone, the corticosteroid most commonly used, gave the greatest reduction in scar scores of the treatments compared[8]. Injections do not need to wait for the scar to mature and can start as soon as a scar looks like it is becoming abnormally raised.
Laser scar treatment
Laser treatment can improve a scar’s redness, texture and thickness, and can be combined with injections. International consensus recommendations from 26 dermatologists and plastic surgeons describe lasers as a first-line therapy for scars after injury, with special considerations for treating darker skin types[9]. A course usually involves a few sessions several weeks apart.
Scar revision surgery
A fold scar that is still wide, stretched or puckered once it has matured can be cut out and closed again with careful attention to tension, replacing a noticeable scar with a finer one. Surgical revision is usually considered once the scar has matured, at around 12 to 18 months, and small revisions are short day-case procedures, usually under local anaesthetic.
When Should I Contact the Clinic About My Scars?
Contact us if the wound opens or oozes, if redness, heat, a high temperature or discharge suggest infection, if one breast becomes suddenly swollen, tight or painful, or if a scar starts growing beyond its original line or becoming more raised and itchy after the first few months. In the first 24 hours after surgery you have your surgeon’s direct number; after that you can call us on 020 7993 4849, 9am to 6pm, Monday to Saturday. Out of hours, call NHS 111, or 999 in an emergency.
Frequently Asked Questions
Do trans women have top surgery scars?
Yes, but they are usually small. Trans women who have implants have a short scar of around 5 cm in the fold beneath each breast, which is hidden by the breast when standing and by most bras and swimwear. Trans women who have fat transfer have only a few tiny cannula marks that fade to small dots.
Where are the scars for MTF top surgery?
At Centre for Surgery the scar sits in the inframammary fold, the crease beneath each breast. Other approaches place the scar along the lower edge of the areola or in the armpit, but the fold incision is the most widely used for MTF breast augmentation, as it gives the surgeon good control over the implant pocket and the new breast fold.
Do top surgery scars stay forever?
Yes, the scars are permanent, but they change a great deal. Most start pink and slightly raised and, over 12 to 18 months, become flat, soft and pale lines. Silicone, tension support from your surgical bra and sun protection while they heal give them the best chance of settling well.
How long do MTF top surgery scars take to fade?
Most MTF top surgery scars are at their reddest and firmest between two and six months, then fade gradually. By 12 to 18 months most have matured into flat, pale lines. Scars on darker skin can stay darker for longer before they fade, so judge your result at around a year rather than at three months.
What speeds up scar healing?
You cannot rush a scar, but you can help it heal well. Keep the wound clean and dry for the first two weeks, wear your surgical bra for six weeks, avoid heavy lifting, do not smoke or vape for four weeks before and after surgery, and start silicone gel or tape once the wound has healed and your surgeon agrees.
Do scar creams really work?
Silicone gel has the best evidence of any scar product, with randomised trials showing it can help prevent and treat raised scars. Most other creams, including vitamin E and onion extract, have weak evidence. Plain moisturiser is useful for scar massage, but it does not replace silicone, taping and sun protection.
Will my scars show in a bikini or low-cut top?
Usually not. The fold scar sits beneath the breast, so it is hidden by most bikini tops, bras and low-cut tops when you are standing. It may be visible when you lie on your back or raise your arms in a very small bikini, and protecting it from the sun for at least three months stops it darkening.
MTF Top Surgery in London
MTF top surgery at Centre for Surgery is performed by GMC-registered surgeons at our CQC-regulated Baker Street hospital, rated Good overall by the CQC, under TIVA as a day case. We offer breast augmentation with Silimed silicone implants, fat transfer or a combination of the two, and your surgeon will show you where your scar will sit and how to care for it before you decide. Our implants come with a ten-year warranty covering grade III and IV capsular contracture and implant rupture. No diagnosis, GP referral or WPATH letter is needed, and the consultant who assesses you is the consultant who performs your surgery. You can also read about nipple sensitivity after MTF top surgery. Your initial consultation is £100, redeemable against the cost of surgery if you go ahead. Finance is available, subject to status.
Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation
References
- Cordary M, Cristofari S. Surgical approaches for prosthesis placement in transgender patients: a narrative review. Annales de Chirurgie Plastique Esthétique 2026;71(4):410–418. doi:10.1016/j.anplas.2026.01.004 ↗
- Sanchez Figueroa N, Kuruoglu D, Fahradyan V, Tran N, Sharaf B, Martínez-Jorge J. Feminizing gender affirming breast surgery: procedural outcomes at a single academic institution. Aesthetic Surgery Journal Open Forum 2024;6:ojae032. doi:10.1093/asjof/ojae032 ↗
- Sun J, Mu D, Liu C, et al. The comparison of scars in breast implantation surgery with inframammary fold incision versus axillary incision: a prospective cohort study in Chinese patients. Aesthetic Plastic Surgery 2019;43(2):328–335. doi:10.1007/s00266-018-1299-3 ↗
- Atkinson JA, McKenna KT, Barnett AG, McGrath DJ, Rudd M. A randomized, controlled trial to determine the efficacy of paper tape in preventing hypertrophic scar formation in surgical incisions that traverse Langer’s skin tension lines. Plastic and Reconstructive Surgery 2005;116(6):1648–1656. doi:10.1097/01.prs.0000187147.73963.a5 ↗
- Lee DKR, Duru DO, Nicolet G, Kiew CYK, Abood A, Wong KY. Cosmetic outcomes of postoperative scar taping after surgical incisions: a systematic review. JPRAS Open 2026;51:374–386. doi:10.1016/j.jpra.2026.07.002 ↗
- De Decker I, Hoeksema H, Verbelen J, et al. The use of fluid silicone gels in the prevention and treatment of hypertrophic scars: a systematic review and meta-analysis. Burns 2022;48(3):491–509. doi:10.1016/j.burns.2022.03.004 ↗
- Kazemeini S, Nadeem-Tariq A, Hajian P, et al. Hypertrophic and keloid scar management: advances in diagnosis, perioperative care, and anesthetic modulation. Cureus 2025;17(7):e88810. doi:10.7759/cureus.88810 ↗
- Jackson K, Lee A, Ahmad N, Nguyen HP. Analysis of therapeutic interventions for hypertrophic and keloid scarring: a systematic review. Journal of Drugs in Dermatology 2025;24(8):770–776. doi:10.36849/JDD.8895 ↗
- Seago M, Shumaker PR, Spring LK, et al. Laser treatment of traumatic scars and contractures: 2020 international consensus recommendations. Lasers in Surgery and Medicine 2019;52(2):96–116. doi:10.1002/lsm.23201 ↗
Related Articles
- MTF Top Surgery Recovery and Aftercare
- Choosing the Right Implant Size for MTF Top Surgery
- Does MTF Top Surgery Affect Nipple Sensitivity?
- Do Hypertrophic Scars Go Away?
