Not Happy With Size of Breasts After Mastectomy

I Am 46 and Weigh 260. Had Prophylactic Bil. Mast. Done. PS Inserted MX410685. Look Like A's Was DD Prior. Options?  I am feeling dismayed/depressed to say the least. Surgeon said he put in the largest. Can that be? I was a 44DD. He said he would check with colleagues and I was to check also. Don't care how we got here, just want to find a solution? I am doing the study, but don't want to walk around with A breasts (or close) the rest of my life. Suggestions?

Doctor Answers 6

Breast Size After Reconstruction

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This is not an uncommon problem. In women who are overweight, reconstruction with even the largest implants available may leave an inadequate result with breasts that are small and out of proportion with the rest of the body. In these cases, additional procedures involving autologous tissue reconstruction may be indicated. These would include TRAM flaps and latissimus dorsi flaps. At your weight, bilateral reconstruction with TRAM flaps would involve high risk of complications of fat necrosis within the flaps and of healing problems at the abdominal donor site. Reconstruction with bilateral latissimus dorsi myocutaneous flaps may be a better option to provide more volume to the reconstructed breasts and likely a more natural shape.

Miami Plastic Surgeon
4.9 out of 5 stars 41 reviews

Implant choices

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It is difficult to size all patients adequately to what they once were before mastectomy because we are limited to the largest implants being 800 cc.  In an overweight patient this becomes more evident.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast implant reconstruction

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The problem is that there are only so many implants, and none as big as a DD breast in a 260 pound person. The larger the patient the more they swallow up the volume of an implant.  Your best bet would be to lose weight, which would be good for your health, and the breasts will look bigger and bigger as the pounds come off.

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Size of Breast after Implant Reconstruction

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I am sorry to hear of your dissatisfaction regarding your implant breast reconstruction.    With the high level of projection on your gel implant, it is not going to be possible to reconstruct a larger breast by implant alone.  

Depending on your height and weight, your surgeon can calculate a Body Mass Index (BMI).  They can utilize this number to determine the safety in performing a tissue based reconstruction.    If your BMI is too high, your plastic surgeon will recommend medical or surgical weight loss to minimize your chance of complications and ensure a safe long lasting result.   If your BMI is within normal limits, you may be a candidate for tissue reconstruction from the abdomen (DIEP or TRAM), buttocks (S-GAP or I-GAP), back (Latissimus Dorsi), or inner thigh (TUG).

I believe one of these solutions will give you a long lasting result that is aesthetically pleasing to you.   I wish you a safe recovery.

Paul S. Gill, M.D.

Gill Plastic Surgery

Houston Double Board Certified Plastic Surgeon

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Size of Breast after Mastectomy & Implant Reconstruction

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I am sadden by your dissatisfaction with your breast reconstruction. Most women are very satisfied with their reconstruction. However, there are few women in your situation. It is really hard to give you a specific advice without doing a proper exam. There are other options available to you. These may include changing the implant capsule shape, changing implant type, shape, and size, adding autologous tissue (your own body) such as Latissimus muscle flap or even TRAM. I would suggest discussing these with your surgeon and/or getting another opinion from a board certified Plastic Surgeon.  Good Luck

Dr Stan Okoro

Stanley Okoro, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 168 reviews

Breast size after mastectomy and reconstruction

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I completely understand how going from a DD to an A cup can be upsetting.  You currently have the Style 410 Allergan cohesive gel implants with a base width of 15 cm and projection of 7.1 cm.  There is not another gel implant (round or anatomic) with more projection than the one you have.  The anatomic implants are shaped such that the most projection is at the base (bottom) of the breast.  You might consider changing to a round implant, which could give you more overall projection (upper and lower part of the breast), but you would lose a bit of your current lower projection.  You might also need more tissue expansion to accommodate an implant of a different size, as the anatomic implants are placed in precisely-sized pockets.

This is a tough problem, as your body type seems to indicate that you aren't a great candidate for other kinds of breast reconstruction, like TRAM (using tummy tissue to make a new breast) or lat dorsi.  However, this might be something to discuss with your surgeon, as he has actually examined you and could give you more insight into your appropriateness for these other options.  Best wishes!

Carmen Kavali, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 46 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.