Background: To achieve long-term improvement in health care of transgender women it is necessary to analyze all aspects of gender-confirming surgery, especially the relation of risks and benefits occuring in these procedures. Whilst there are many studies presenting data on the urologic part of the surgery, there is just few data about complications and satisfaction with breast augmentation. Methods: This is a retrospective study using parts of the BREAST-Q Augmentation Questionnaire and

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... nal questions for symptoms of capsular contracture and re-operations and analysing archived patient records of all transwomen which were operated at University Hospital Essen from 2007-2020. Results: 99 of these 159 patients (62%) completed the questionnaire after a median time of 4 years after surgery. Breast augmentation led to re-operations due to complications in 5%. The rate of capsular contracture (Baker Grad III-IV) in this population was 3%. Most patients (75%) rated high scores of satisfaction with outcome (more than 70 points) and denied to have restricitions due to their implants in their everyday life. All patients reported an improvement in their quality of life owing to breast augmentation. Conclusion: Breast augmentation by inserting silicon implants is a safe surgical procedure which takes an important part in reducing gender dysphoria.