I had a double mastectomy and expanders. The expanders were filled to 850cc. I had them replaced with 750cc high profile silicone implants a few days ago. My chest looks really small. My chest is about 37", I am 5'7" 155lbs (gained about 15lbs during chemo). I also had fat grafting done. The implants don't look high or low, just not there. What does this mean/ Should I get a revision, or is this normal for 3 days post-op?
Why Do I Look Flat Chested with a 750cc Implant?
Doctor Answers (8)
Why Do I Look Flat Chested with a 750cc Implant?
It is very earl in your post operative period to determine the shape and projection of the implants due to swelling. You should have a good idea on how they are going to appear at about 6 weeks after surgery! According to your height and weight in general 750 cc high profile implants should give a good projection.
A picture of your self would be helpful as well to determine the width of your chest!
As described before use of a acellular dermal matrix may help as an internal bra to increase projection!
Flat appearance to breast reconstruction.
There are many factors which contribute to the shape of a reconstructed breast.. 750cc High Profile silicone implants typically give good projection, however, the surrounding soft tissue can mask this projection if not properly shaped. In your situation you state your expanders had 850cc. The volume and shape of those expanders would definitely give a different look than the 750cc HP implants. Expanders always appear more projecting because they are essentially fixed devices. They are firm and do not change shape with position. In contrast, the implants are soft and deform to the weight of the soft tissue envelope and change their shape based on your body position. This leads to a different shape of the breasts following exchange. I often tell patients that the expanders give the look of implants in a supportive bra. One option for improved projection would be a change to Natrelle Style 45 implants as these have significantly more projection.
Many women have excess skin and fat underneath the arm which is not removed after a mastectomy. This soft tissue can create the illusion of a wider, less defined breast in a reconstruction. Liposuction and skin contouring will improve this appearance and give lateral breast definition. In addition, the actual mastectomy skin flaps themselves need time to contract around an implant. Particularly when the expander is overfilled in comparison to implant size, the mastectomy flaps can take several weeks before they form fit around the implant. Finally, a loss of the inframammary fold (the sharply defined crease under the breast where the breast meets the chest) can occur during the mastectomy and lead to poor definition of the bottom of the breast. There are several techniques that can improve this fold definition and improve the overall contour of the reconstructed breast.
Even with all of these issues addressed, some patients simply look small with the large implants. In these cases, autologous tissue (TRAMs, DIEP flaps) may be a better option.
# days post-op Wait
It is very common poat op to see a globular shape to the breast. It will take time for the swelling to resolve and the implants to achieve their final shape. I am curious if you had an acellular matrix such as alloderm at the time of the expansion. Very often this helps give more projection. If you are unhappy in the end you may want to wait until the shaped implants become available. Good luck.
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Breast reconstruction revision
Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final time consists of combining any of the above techniques.
If you are interested in being seen in Austin please give us a call. I know this is a difficult time for you. The majority of my practice is devoted to reconstruction for women with breast cancer or who are BRCA+
3 days post op
First of all, 3 days post op is way to soon to discuss adjustment. I will not even consider it for 6-8 weeks. Projection can be affected by the with of the pocket . If the pocket is wider than the replacement implant then the implant will fall into the wider implant and projection will be lost. I would recommend giving your procedure time to settle and discuss your concern with your PS . Give him a chance to help you reach your goal. But remember this is not cosmetic surgery. Reconstruction is trying to return you to a normal appearance but they will never be like your original breast. Good Luck and congrats for not having cancer anymore.
750 cc implants for breast reconstruction
750 cc implants are almost the max. You should give it a few months to settle down before being overly concerned about the shape and size.
High profile silicone gel expanders
Will project further than moderate profile ones, but they will tend to be softer and flatter than saline ones. The first weeks/months after implants will see definition of the breast implants into softer more natural looking and separate breast mounds. Do not be in a hurry to start changing things until you are through healing and your skin has had time to conform to the new implants.