I'm not sure whether I ought to have a BA with Surgeon #1, who has no Realself reviews, and with whom I would pay only about 11.5% of the cost of breast augmentation (includes deductible and coinsurance), or if I ought to have it with Surgeon #2 or #3, who have many good Realself reviews, but for whom I would pay 100% of the cost.

Tomorrow I'm going to have a consultation with Surgeon #2, after already having a consultation with Surgeon #1 2.5 weeks ago.  Surgeon #1 has no Realself reviews, but is board certified with the American Board of Plastic Surgery and American Board of Surgery, and was listed in local magazines in my major metropolitan area numerous times as a top doctor.  Surgeons #2 and #3 have roughly the same amount of board certifications and were likewise listed in magazines in my local area, but also have many Realself reviews, dozens of which are dealing with breast augmentation, and have answered over 100 questions on Realself about breast augmentation.

Details as follows:

Surgeon #1 (who is covered by Kaiser Permanente insurance with a small copay):
MD
Has a board certification in Surgery, with the American Board of Plastic Surgery
Has a board certification in Plastic Surgery, with the American Board of Surgery
Was rated Top Doctor in a local magazine in my major metropolitan area in 2010, 2014, 2015, and 2016, and Top Doctor in a different local magazine in 2011 and 2014
Has no Realself reviews.

Surgeon #2 (who is not covered by insurance, I pay full price):
MD, PhD, FACS
Has a board certification with the American Board of Plastic Surgery
Fellow of the American College of Surgeons (FACS)
member of the American Society of Plastic Surgeons (ASPS), American Society for Aesthetic Plastic Surgery (ASAPS), Southeastern Society of Plastic Surgeons, holds the Certificate of Added Qualification in Cosmetic Surgery from the ASAPS
Was selected by 3 local magazines in my major metro area as a top surgeon, listed as one of America's top surgeons by the Consumer Research Council of America.
Has 94 reviews on Realself, with a 4.9/5.0 rating, Realself "Core", 55 reviews deal with breast implants, has answered 138 questions on Realself that deal with breast implants.

Surgeon #3 (who is not covered by insurance, I pay full price):
MD
Has a board certification with the American Board of Plastic Surgery
Has a board certification with the American Board of Surgery
Member of the American Society of Plastic Surgeons (ASPS), American Society for Aesthetic Plastic Surgery (ASAPS)
Was selected by a local magazine in my major metro area as a top surgeon several times, listed as one of America's top surgeons by the Consumer Research Council of America.
Has 108 reviews on Realself, with a 5.0/5.0 rating, Realself "Top Doctor", "Core", 35 reviews deal with breast implants, has answered 532 questions on Realself that deal with breast implants.

Hey Dear!  That's a really tough spot.   I had to pay for all of my surgeries myself and I know choosing a surgeon can be nerve wracking.

I am originally from a town where theres maybe 5 plastic surgeons (and only one other town in the state tha has other plastic surgeons).  I had my first BA with a surgeon who had actually done 2 of the 3 other TS girls in my town who both had phenomenal boobs!  He also gave me like a thousand dollar discount so for my first BA I think I only paid like 4500 or something around there.  I ended up with my left boob being too high (it never dropped) and my right boob being too far to the side of my body - I hated it.  He made me wait and wait and wait to see if they would improve and they didn't.  I probably went to 6 or 7 post op appts with him over the course of a year after my surgery. Of course they didn't improve so he offered to fix them where I would only have to pay for anesthesia and OR time (I wouldn't have to pay him again)   Ultimately I chose not to do this because I personally just did not trust him.  I wanted the incision in my armpit because I had hardly any breast tissue and I didn't want to risk anything with my nipples (due to enjoying nipple stimulation so much)  But it was never even a discussion. He never once tried to talk me out of it, nor did he educate me on the fact that so many BA through the armpit result in malposition of implants and thus I felt like he failed to do his job of educating me.  He did educate me on many other things (I went up in size per his suggestion & went under the muscle per his suggestion as well)  Also I had a lot of difficulties healing after (if you want to PM me about that)

I ended up having them redone this year and it's only been 2 months so they're not fully healed but I am happy so far.  I had them redone with Dr Hoch stein in Miami.  He's known as the boob god and has thousands of BA on his site and also has a history of doing TS girls.  I feel like anytime you consider surgery if youre choosing to go to a surgeon who basically specializes in something (like does thousands and thousands of BA) that you're placing a pretty safe bet.

You could do the one that's almost free & if youre unhappy you could always have a revision w the other one.   You may also want to check and see if you go with one that you pay 100% (will your insurance cover for you to have a revision? I doubt it).  Keep in mind also that a revision is often times a lot more than an initial BA if you go to a totally different surgeon.  Now plenty of people go to a doctor and need a revision and just have the same surgeon redo it. 

However if I could go back in time, I would never have went to the first surgeon even if it was a savings of about 1000.  When you look at the fact that I had to pay 6800 for my revision I actually didn't save anything at all!  Meet with all of them. Ask how many trans girls they've done and how many BA they've done, and also look at their actual photos.

Dr H wasn't the most convenient for me at all, but all of the surgeons in Beverly Hills whom had done TS girls wanted 10-15K for a revision.   On the east coast, some were as much as 10k, but all of the ones I looked at whom had done TS girls, I thought the results were not good, like pics I wouldn't have ever considered posting!  Dr H was the cheapest revision combined with best results.

Hi Sfbarbie, I went to Surgeon #2 today, and he really impressed me.  His patient coordinator said that he had done breast augmentation for more than 100 trans women patients (Jackpot!), and that one trans woman was getting a BA with him this Friday, in fact, whereas Surgeon #1 had done BAs on two.  I'm really psyched now and would like to get it done with Surgeon #2.

The surgeon proposed to use Mentor-brand Silicone implants, Smooth Round, Moderate Plus Profile, 550cc right, 600cc left.

He measured my chest wall and found that I'm 22cm left, 23cm right, 26cm nipple to nipple.

He wants to place them under the muscle, because there's not enough breast tissue to place them over the muscle (said you needed 2cm or more in the upper breast for over-the-muscle).

The patient coordinator told me that there are 3 days available to get the surgery done in August, and another 3 days available in September.

I'm going to email the patient coordinator a few more questions.

Yay!  So exciting.  Are you going to check with surgeon 3?    What incision will you be using?  Originally I had Mod Plus Profile, 360cc saline implants overfilled to 400cc & when I got them redone I changed to smooth silicone mod plus profile implants at 435cc.  I am D cup (I had hardly any boobs at all like probably not even a AA cup!)

I don't think I'll need to get a consult with Surgeon #3 because I feel like I really hit the jackpot with Surgeon #2, who's done 100+ BAs on trans women and has been doing BAs one or more times a day for the last 30 years.  I feel really psyched still after meeting with him yesterday, and am thinking really hard about whether I can pull the trigger on the earliest available appointment with him, in a month, or if there's some reason for me to slow down and wait till possibly September or October (the sooner the better, I'm thinking).

They'll be going sub-muscular.  I'm 5'8" and have wide spaced breasts and nipples, and if you do a google search for "realself My breasts are wide set and my nipples point outward, will an augmentation exaggerate this?", then you'll find an example of a woman who has almost exactly the same issue that I have.

I feel like I have phantom breasts or something.  Like my brain is wired in a way that it expects me to have adult female breasts, but I don't, so consequently, I have virtually no sensation from my natural breasts, but if I wear breast forms (I'm wearing them now to kind of prepare for post-op BA), strangely enough, I actually feel like I have much more sensation from them, even though they're not a part of my body, they're just breast forms that are sitting against my natural breasts.  Weird.

Anna,
I found it very helpful during my BA consultation to use Vectra 3-D imaging to help visualize the effect that the choice of implant (type, shape, size) and their placement (subglandular, submuscular, pocket position) will have on the final result.  Having widely spaced breasts and nipples is often a problem for trans women.  You'll want to compensate for this as much as possible, depending on what's most important to you.  For example, if you like to wear camisoles/tanks without a bra, breast symmetry will be more important than nipple position.  If you like to wear low neckline tops that will show off some cleavage, then you'll want implants that can easily be pushed up and together with an appropriate bra.  Your surgeon should help you achieve an optimal appearance given your particular anatomy.  I would stay away from a surgeon who is biased toward one surgical procedure and implant type or another.  You want someone who can do what's going to give you the best possible outcome in your unique situation. 

BTW, Renee Reyes' website has a lot of good information for trans women including breast augmentation.  It's not completely up to date, for example, she doesn't talk about the newest highly cohesive silicone (gummy bear) implants, but nevertheless, provides lots of useful information.