Nipple and skin saving Bilateral Mastectomy with tissue expanders

The implants should look slightly better than the expanders, but don't expect anything more than an A cup . Most surgeons fill the expanders to a larger volume than the implant size they plan to use, wait at least 30'days for things to settle down, and then use the extra space tot week how the implant sits. I would gues your surgeon is aiming for 325 ml implants but surgeons will never commit to exact size...they usually take "sizes" to the OR and then decide what they think looks best. Before you sign for your exchange sit down with your surgeon and be very specific about what you want. Your expanders can usually be filled to at least double the volume listed. ( that is a 350 ml expander can be filled to 700 ml or more) . Your surgeon might be worried that your ski will not hold up to more expansion ( particularly if you had radiation). Or they might think you want smaller breast or less cleavage. You can always wait and get another opinion while your expanders are still in. I cannot emphasize enough making surgeon that your surgeon understands and can deliver what you want. I was a 38D and said I was ok with being a little bit smaller. What I ended up with was less than a double A...if I still had my nipples they would have doubled my end result. Fortunately I found a second surgeon whose sense of reasonable is in line with my own. You have been through so much, hang in there and don't settle for less than what you know is right for you.

When I wanted to expand larger, my surgeon was concerned about stretching the skin too much. His best quote is "the enemy of good, is better." When he did the exchange to regular implants, he was able to remove some scar tissue and create a larger pocket. And put larger implants in. Remember that you can always have them replaced. And the fat grafting should be part of your reconstruction - if you have insurance, they will pay for that.

If your mastectomy was done because you have Cancer, then by law reconstruction including fat grafting must be covered. However, if this was prophylactic because of family history or because you carry the BRCA gene it is considered cosmetic and is not covered. Implants usually look significantly smaller than the expanders. I would continue to expand until you are happy with the size then add another 10 - 20 % overfill to stretch out the pocket. Unless you are very petite the 240 ml will give you almost no projection. By now you are probably already done, hope this helps someone else with the same ? And that you were satisfied with your final result. Best wishes

I am closer to your age than 59 (I'm 51) but I can not imagine not caring about ripples in my breast in 10 years. I have had a mastectomy and looking at a prophylactic one on the other side. I have a mentor spectrum implant that is highly adjustable until I'm happy with it and I never have pain when I go for a "fill" which is different from an expansion