Michael Cohen, MD

Kai2017,

without knowing your fully history, it is difficult to know the reasoning behind surgeon A's plan.  Here are some potential reasons surgeon A might be thinking the way he or she does: 1) a DIEP is a much bigger operation with a much longer recovery.  Perhaps surgeon A is giving your the option of the expander first in case you decide that you are okay with implant-based reconstruction and change your mind on the DIEP once the expander is in.  2) If there is a chance of radiation (if that's still unknown), it is better to radiate the expander than a flap, and then do the DIEP at least 6 months after radiation.  Based on your tumor size, hopefully this will not be necessary.  3) Surgeon A might be of the opinion that doing the expander first will provide a better final cosmetic result, because modern expanders create a nicely shaped breast skin envelope during the expansion process - something that would be more challenging to achieve with a flap alone.  Regardless of which surgeon you go with, make sure you are comfortable with the surgeon's plan and understand his or her reasons for the plan.  There are many skilled microsurgeons in Seattle; make sure you have a surgeon who has extensive experience in microsurgical breast reconstruction and not someone who just finished their fellowship.  Make sure you speak with other women who have gone through the DIEP flap themselves.  Do your homework, and do not hesitate to come back to either (or both) of the surgeons for a re-consultation if you are not clear on something.  Best of luck with your reconstruction journey.  

Sorry about your complication.  The best starting point is to ask your primary care doctor, who can also get expert help by referring you to a hematologist.  Good luck.

It is quite normal for women over age 60 to be concerned whether they are candidates for elective breast surgery.  I have performed multiple breast surgeries on women in their 60's and 70's with no complications, provided proper patient selection.  Ultimately age is just a number, and the much more important question is your overall health and tissue quality.  I have had patients come in for consultations who were in their early 40's, in poor health, and whose bodies looked and behaved like they were elderly.  Those patients are poor candidates for elective surgery.  I have also had patients in their mid-70's who were completely healthy and whose tissues looked like they were 20 years younger.  Those patients are usually quite safe for elective surgery.  When someone your age who is relatively healthy has encapsulated implants that are starting to feel uncomfortable, I do not hesitate to take them to surgery, provided adequate general medical clearance has been granted by the patient's primary care doctor.  The consultation includes informing you on the safety of not pursuing any surgery as far as keeping the capsule and the old implants is concerned, as well as providing you with your surgical options, which include: (1) implant and capsule removal and nothing else; (2) implant and capsule removal with a breast lift (not everyone is a candidate for a simultaneous breast lift); (3) implant and capsule removal with placement of new, better implants (there is nothing wrong with that at age 65 as long as you are healthy).  Make sure you see a board-certified plastic surgeon for your consultation.  It would be helpful if you get a full physical with labs and tests with your primary care doctor first, in order to give your plastic surgeon an idea of your overall health.  Best of luck.

Your concern is quite normal.  Only you can ultimately judge whether you want to go bigger.  Without photos, nobody on this website can give you that advice.  If you are content with your current size, then do not go fixing what's not broken, because every surgery has a small risk of making things worse than before.  Also, if your surgeon is fixing a bottoming-out situation, then a larger implant is going to increase the risk of recurrent bottoming out, so keep that in mind.  Good luck.

Your concern is very common and quite normal.  Keep in mind a couple of things that could potentially alleviate your anxiety about your choice.  First, a difference of 25 cc (which is less than an ounce) is very small; therefore there is no "wrong" choice in your situation.  Second, when it comes to that small of a difference, the decision is often made intraoperatively by the surgeon based on your anatomy and what looks best on the table when they sit you up while you are asleep.  Going into the surgery with a choice of two close sizes of implants (such as your case) is very normal (I would say almost universal).  You will need to trust your surgeon to rely on his or her judgment during the surgery.  Hopefully you have had a chance to "try on" these sizes at the office with a bra, in order to estimate which size you prefer, and hopefully the implant sizes were selected based on careful anatomic measurements of your breasts made by the surgeon during your consultation.  If you still have any pressing concerns, make sure you contact your surgeon's office before the surgery and have a chance to speak with someone to address them.   Congratulations on your upcoming surgery.  Good luck!

It is very natural to be concerned about postoperative infection whenever breast implants are involved.  The most common signs of breast implant infection are increasing pain in one or both breasts, increasing rapid swelling in one or both breasts, or new-onset redness in one or both breasts.  Fever without any of the above three symptoms, is very rarely a sign of a new-onset breast implant infection.  The vast majority of patients with breast implant infections do not develop a fever until the infection has progressed to a severe stage.  Based on what you are saying, it does not appear that in your case any of the classic symptoms of breast implant infection are present (if they are present, then that is very concerning, and you should call your doctor and start antibiotics as soon as possible).  Other symptoms for which some plastic surgeons would recommend antibiotics are symptoms of bacterial infections elsewhere in your body, such as sinus infection, tooth abscess, bronchitis, or urinary tract infection.  If all you are having is a cold, then that's a viral infection that does not respond to antibiotics and is not a known risk to your implants.  The fact that you forgot to take your prescribed postoperative antibiotics does not necessarily increase your risk for breast implant infection, because many plastic surgeons today do not give antibiotics to their patients after breast augmentations, and their patients do just fine.  Make sure you speak with your plastic surgeon at some point as soon as possible.  Wishing you a speedy recovery.

Sorry about your postoperative course.  Your concerns are valid and understandable.  If you are six weeks postop, you are still in the healing stages with a lot of swelling, making it difficult to judge the final result.   Implant removal, when done without a lift or without another implant placement, can sometimes result in distortion of the breasts due to internal scarring, history of previous breast surgeries, etc.  Without having your preop and postop photos, and without having the detailed history on your implant surgeries, it is nearly impossible to say more than that.  Your best course of action would be to continue to allow the tissues to heal, the swelling to subside, and to have your plastic surgeon re-evaluate your breasts at approximately 6 to 12 months postoperatively.  There is not much you can do in the meantime. Good luck.

I am sorry about your complication.  Capsular contracture is a known potential complication of breast implant placement.  A hematoma does increase your risk of developing capsular contracture.  A hematoma is also a known potential complication, of any surgery.  It is not clear from the photos whether you had a hematoma versus bruising with swelling.  As far as the "held liable" question: this board should not be used for legal advice, and plastic surgeons on this board are not here to act as expert witnesses on potential legal cases.  We are here to give expert plastic surgery advice.  If you want legal advice, you should be asking an attorney, not plastic surgeons.  In my opinion, your best and least costly course of action would be to seek another qualified plastic surgeon in your area, not an attorney.  Best of luck.

You do not have tuberous breasts.  If you are dissatisfied with the appearance of your breasts, you would benefit from a breast lift (a mastopexy) which would address the ptosis (or sag) of your breasts as well as raise the nipple to a higher position.  You could have an augmentation at the same time; however you say you are already a D cup, so you probably do not need an augmentation.  The only disadvantage to a mastopexy is the scar.  Make sure you see a board certified plastic surgeon who has an extensive breast surgery experience.  

I recommend waiting until you are 6 months postop to see what final size you end up being, because at this point there is still some swelling present.  However, it is doubtful that you will go down to a B cup from your current DD.  If you have another appointment with your surgeon (e.g. a 3 month postop), you should bring up this concern to him or her.  As an aside, although your reduction surgery did leave you on the larger side, the shape of your breasts turned out excellent, so you must be in good hands.

Michael Cohen, MD

Bayview Plastic Surgery, Gig Harbor, WA