I'm not sure whether to get silicone or saline implants and what size I could use

Breast cancer diagnosis Nov 2005, Bilateral mastectomy Dec 2005, Chemo then Breast Reconstruction with expanders and saline impants completed Oct 2006; 2nd dianosis Dec 2011 followed by chemo and radiation. One implant has moved outward, the other shifted up and seems harder, there's no pliability to it. I'd like both implants replaced but not sure saline again or silicone. I have approx 790cc now, would like least 100 cc more if possible. I am obese and need larger for better appearance

Doctor Answers 2

Breast reconstruction revision

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I you BMI is over 34 then I don't recommend implants.  Use your own tissue in the form of lower abdomen tissue.  Whether you have cancer of one of the genetic mutations I find the DIEP flap to be the best alternative in these cases.

Revision After Radiation

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Thank you for you question. There are several things going on from your description: (1) implant lateralization on the non radiated side (2) capsular contracture on the radiated side and (3) dermal fibrosis (hardening of the skin). If you were my patient I would suggest the following: (1) Wait 9-12mo from your last radiation treatment before considering revision. The radiated skin has to stabilize and that takes time. Second, the radiated skin is hard and the implant is hard and displaced...this is a capsular contracture. Radiated skin is a bad environment for an implant. Even if the capsule if removed I doubt it stretch enough to safely place another implant AND you would likely develop another hard capsule. You need to replace the bad skin with soft skin that will stretch and accommodate and implant. 

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