Michael A. Fallucco, MD, FACS

Thank you for sharing your experience, this is a common and understandable concern after implant reconstruction. That persistent heavy, sagging feeling you describe in the left breast, especially noticeable without a bra can sometimes be due to pocket laxity, asymmetry in implant positioning, or weakened support from the surrounding tissue. After a mastectomy and implant placement, particularly over time, the skin and internal support structures (like the capsule or muscle) on one side can stretch more than the other, leading to a "bottomed-out" or lower-positioned implant. Even after implant replacement, if the underlying pocket wasn’t revised or tightened during surgery, the same issue can recur. Another possibility is capsular stretch or thinning of the soft tissue envelope on that side. This can happen after implant rupture, as the body responds differently to leaked silicone and may lead to changes in tissue integrity over time. If your surgeon didn’t note any complications during the replacement surgery but you still feel and see a difference, you might consider a second opinion from a plastic surgeon who specializes in complex breast revision. Imaging (like ultrasound or MRI) and a clinical exam can help determine whether the implant has dropped, rotated, or if the pocket needs surgical adjustment (e.g., capsulorrhaphy or internal mesh support). In short, what you're experiencing is not uncommon, and while your implants are new, the surrounding tissue and pocket dynamics may need to be addressed to restore symmetry and comfort. You deserve to feel balanced and at ease, don’t hesitate to explore your options.

Yes, you can absolutely get round implants at your exchange surgery even if your surgeon placed teardrop (anatomical) expanders initially. The expanders are just temporary devices designed to stretch the skin and muscle; the final implant shape can be different based on your aesthetic goals. Many patients start with teardrop expanders because they mimic a more natural breast shape during expansion but then choose round implants later for fuller upper pole volume or a different look. Regarding the issue with one expander sitting higher and migrating toward your armpit, it’s important to address this with your surgeon. Asymmetry in expander position can cause visible differences in breast shape and size, which you’re already noticing. In many cases, some degree of adjustment can be made during the exchange surgery itself, especially if the pocket needs revision to center the implant better. However, if the expander is significantly malpositioned or causing discomfort, your surgeon might recommend intervention sooner. It’s best to discuss this concern promptly with your surgeon. Sometimes minor adjustments can wait until exchange, but if the position is causing problems or risks tissue issues, earlier correction may be necessary. Open communication will help ensure you get the best possible outcome at exchange.

Great question! Breast tissue expanders are most commonly filled with saline because saline is safe, easily adjustable, and well-tolerated by the body. Saline expanders allow gradual filling through a valve, which helps stretch the skin and muscle gently over time in preparation for the permanent implant. That said, there are air-filled tissue expanders available, but they are much less commonly used. Air expanders can be lighter and may provide some advantages in specific clinical scenarios, but they are not as widely adopted because air can be more difficult to control and may have risks related to air embolism or leakage. Overall, saline remains the standard choice for tissue expansion due to its safety profile, ease of monitoring, and surgeon familiarity.

Thank you for your question and for sharing your concerns. Using a castor oil pack over silicone breast implants is generally considered safe and should not cause any damage or breakdown of the implants themselves. Silicone implants are designed to be very durable and resistant to external substances, including oils applied topically. Castor oil penetrates the skin’s surface but does not reach or affect the implant material beneath. That said, your increasing chest muscle neuropathy and discomfort warrant careful evaluation. Neuropathy after mastectomy and reconstruction can result from nerve irritation or injury during surgery, and while it is not typically a sign of capsular contracture, the two conditions can sometimes overlap symptomatically. Capsular contracture usually presents with firmness, tightness, or visible distortion of the breast rather than nerve pain or neuropathy. I recommend that you follow up promptly with your plastic surgeon to assess your symptoms thoroughly. They can perform a physical exam, and if needed, imaging studies such as ultrasound or MRI to evaluate for capsular contracture or other complications. Managing neuropathy may require specific treatments such as physical therapy, medications, or nerve blocks, depending on severity. Using castor oil topically is unlikely to harm your implants, but your new symptoms should be evaluated by your surgeon to rule out capsular contracture or other issues and to guide appropriate treatment.

Thank you for your thoughtful question, this is a concern I hear often from patients facing unilateral mastectomy with smaller breast sizes. The good news is that it is possible to maintain a small breast size after mastectomy, including using implants in the range of 75–80cc if that matches your natural breast volume. Advances in implant technology mean there are very small, low-volume implants available that can help achieve good symmetry without drastically increasing size. However, achieving perfect symmetry can be challenging when one breast is reconstructed and the other remains natural, especially if the natural breast is quite small. Often, the reconstructed side may require a slightly larger implant to match the shape and projection of the natural breast, which is why some surgeons suggest larger sizes on the mastectomy side paired with volume adjustments (or reductions) on the natural side. But this doesn’t mean you have to go “dramatically” bigger if your goal is to stay small, it really depends on your individual anatomy and what your surgeon can achieve through pocket placement, implant selection, and possibly minor adjustments on the opposite breast. If you’re comfortable with your natural breast size and prefer to stay within that range or even smaller, it’s important to communicate that clearly with your surgeon. Some patients choose to undergo procedures on the opposite breast, like a lift, reduction, or even a small implant, to achieve better symmetry without increasing overall size. Ultimately, the goal is to tailor the reconstruction to your preferences, not societal expectations. So, yes, an implant around 75–80cc could very well “do the trick” depending on your chest dimensions and soft tissue, and there are options to maintain a small, natural profile after mastectomy. It’s absolutely possible to stay small, and your surgical team should work with you to respect that priority.