Reconstruction After Mastactomy with Full 500cc?

Question

I had one breast removed and am going through the reconstruction process. My current size is a small B, appx 340 cc in volume in the good breast. I am considering going to a full 500cc. So a full 500cc silicone gel implant to the removed breast and augmenting the the other to match with a smaller implant (150). I think that will give me a full size C but don't know for sure. I am 5'11 and 155 lb, long torso. I am still very active so want to keep it comfortable but be a little fuller.

Darrick E. Antell, MD, FACS · Answer

I believe that you need to be examined in person to better answer your question. What you have described seems reasonable for someone of your frame, but there is a whole lot more information needed, in order to give you a more specific answer.
Discuss your particular concerns with your surgeon.

Farbod Esmailian, MD · Answer

Breast reconstruction is an art and can not be answered fully without examining you and know much more history. There is A LOT that goes into determing the sizing and so forth. I would discuss this with your plastic surgeon.

	These are the discussions that I have with my patients on a weekly basis when they are coming in for their expansions. So it is very common to ask but difficult to answer without seeing you and talking to you extensively.

	Good luck.

Steven Wallach, MD · Answer

To adequately match the opposite side you woudl need a thorough exam and consultation. Just by the description it is very difficul tto say what would be best.

Susan E. Downey, MD · Answer

One of the techniques I have used is to have a patient try on a bra with an implant in the bra to get an ides of the size they would like to acheive. For example If you are a 36B and want to fill a 36C bra -  try on a 36C bra and put implants in the bra to see approximately what size implant is needed to give you the desired volume. This will give you the size implant needed for the augmentation of the "normal" breast. The implant needed for the side that had the mastectomy can be estimated by the weight of the mastectomy specimen and the same volume added to that volume as will be added with the augmentation. 
So for example, if the mastectomy specimen weighed  340 grams and you want to add 150 cc to augment the remaining breast , the reconstructed breast should have an implant volume of approximately 490 cc. Of course you need to discuss your particular situation with your plastic surgeon. Radiation can make reconstruction more difficult and you may want to consider a lift also on the augmented breast.

Peter A. Aldea, MD · Answer

Dear JMK,
Entire books were written about the options and pitfalls of breast reconstruction. Without your photographs and an examination, our discussion must be considered as purely conjectural as it may not even be applicable to you.
The first questions we would need answered are:
1. Opposite breast - Is there a possibility of biopsy or prophylactic mastectomy?
2. Were you radiated after the mastectomy? That will significantly influence the choice of reconstruction and lead you more to chose reconstruction with your own tissues.
As you know, breast reconstruction can EITHER be done with your OWN tissues or with implants.
When implants are used, the plastic surgeon either puts an expander at the time of surgery (to be replaced after expansion with an implant) or a permanent implant (with an Alloderm sling) . The latter is usually done as guided by  the intraoperative use of temporary sizing implants that guide us in the choice of the best looking implant.
Personally, I would not augment the normal breast until I knew FOR SURE that it does not have breast cancer. With some breast cancers, there is a high likelihood of bilaterality. It makes no sense to potentially obscure early detection with the use of an implant IF this is the case. A breast lift on that side though, should not fall in this category.
Each person is an individual and needs to be treated as such. I would make a list of concerns and wishes and discuss it with your surgeon. After you agree on what your reconstructive goals are, only then I would proceed.
Good Luck.

George J. Beraka, MD (retired) · Answer

Hi!
Your plan sounds reasonable. Here are 2 specific suggestions:
1)  It is often necessary to do a little breast lift as well as augmentation in your normal breast, because the reconstructed breast will not sag at all, and you want the best possible symmetry.
2)  In NYC, we use disposable implant sizers during surgery to see exactly which  breast implants will give you a full C cup and make you symmetrical.  Then we open the correct permanent implants.  This way there is no guess work!

Richard P. Rand, MD, FACS (retired) · Answer

The question you ask really cannot be answered by any of us on line. These kinds of inquiries need to be directed to plastic surgeons in person who can examine you. If you had radiation treatments on the mastectomy side, you will probably not get a good implant reconstruction because of the excessive risk of capsular contracture after radiation.

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