I had a bilateral mastectomy with immediate reconstrution using expander implants. my right side went considerably lower hence, no fold at the bottom. My surgeon said to fix this he would have to stitch to my ribcage. I had surgery done 3 wks ago and have woken this morning to find that the fold has gone and the implant is once again going southwards. Is there anything that can be done for me. Before the mastectomy I was a 34c cup. I am now a 32E cup. has the surgeon made me too big?
Reconstrution Implant Bottomed out After Mastetomy
Doctor Answers (4)
Use a tissue expander with suture tabs like Sientra
Bottoming Out of Reconstructed Implants
What you are describing is a bottoming out of an implant. This likely occured because of an absence of support to the implant. This absence could be due to many reasons which include but are not limited to: poor mastectomy skin quality and violation of the inframammary fold during the mastectomy, and the technique used to place the tissue expander implant. If your reconstructive surgeon already attempted to reconstruct the inframammary fold with sutures, but this failed, you still have some options. Although this problem can be challenging, this problem can definitively be corrected/improved. I have found that utilizing Alloderm or Strattice as an internal "bra" helps to definitively correct this problem. Please visit with an American Society of Plastic Surgeons member surgeon to learn more about your options.
Reconstruction bottoming out
It is unclear from your history. Did you have it repaired already once before and it is occurring again? Sometimes alloderm is used to reinforce the fold.
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Breast Reconstruction Bottoming Out
Any sudden change in the position of your implant should be evaluated by your reconstructive surgeon. It appears that the inframammary fold has been disrupted. This most probably occurred during the initial mastectomy. It is a challenging problem to correct in the mastectomy patient, but can be done with careful planning.
As far as your size concern, this should be carefully evaluated with your surgeon. It is unusual to see such a large size discrepency when changing the tissue expander out for a permanent implant. I like to involve the patient in the sizing process and help determine the endpoint of expansion.
Breast Cancer Reconstruction is a process. Depending on your goals and expectations, revision surgery may be indicated to achieve the best size, shape, and symmetry.
All the best in a safe recovery,
Paul S. Gill, M.D.
Gill Plastic Surgery
Houston Double Board Certified Plastic Surgeon