Can I go larger after reconstruction following mastectomy?

Question

I had invasive ductal carcinoma and had bilateral mastectomy radiation to right breast, reconstruction 2 years later. Tissue expanders, don't know size- I have high profile 400cc implants, they look flat and sagging now, especially radiated side. I would love to go bigger and feel better, or is it too late. My skin is soft and pliable. I am 5ft. 5 in weight 132 llbs. Praying this is possible. Is the procedure to revise size the same as initial placement? What is recovery time?

Ram Kalus, MD, FACS · Answer

From your description and photos it appears you can most likely have a significant improvement with revision reconstructions and upsizing your implants. This is fairly straight forward surgery. Consult with your plastic surgeon or another board certified plastic surgeon with experience in all aspects of aesthetic and reconstructive breast surgery. Best of luck to you. There is indeed hope.

Adrian Sjarif, MD · Answer

Hi and thanks for your question,
Your breast reconstruction appearance is not an uncommon one following radiotherapy to one side - the radiation always causes a tighter, smaller reconstruction and the skin is usually a little more resistant to being stretched by the expander.
I do not think that going bigger is going to be a straightforward undertaking. One option would be several series of fat grafting sessions to try and increase the size and improve the shape of the right breast reconstruction to more closely match the left side.
If you want to increase the size of both breasts, then I'm afraid you would need to consider removing the implants, replacing them with tissue expanders and expanding the skin up to a point where they could then accomodate larger silicone implants.
Another option to consider would be to replace your implants with abdominal tissue in the form of TRAM/ DIEP flaps - these usually provide a good amount of tissue for reasonably sized breasts as long as you have enough abdomen to consider as an option.
Best thing to do going forward is to discuss these options with your PS and in particular what you want to achieve with your breast reconstruction.

Jeffrey G. Copeland, MD · Answer

When you have that much history of breast surgery and radiation, there are lots of opportunities for problems. If your skin is soft and mobile, that is better, and if you breasts seem empty, there may be room for more volume. As always, a visit to a board certified plastic surgeon who has enthusiasm for breast reconstruction will be necessary to determine your best course. I hope it goes well for you.

Tanya Judge, MD · Answer

It certainly looks like you might be able to get a bigger implant.  It does depend on how soft your tissues are and how much give they have, especially on the radiated side. How much bigger you can go will depend on what your tissues are like.  Radiated tissue generally doesn't allow for much stretch. See what you're Plastic Surgeon says, it certainly does look like your tissues could handle a little bit more volume. Good Luck!

Steven Wallach, MD · Answer

It might be possible to go larger. you would have to be seen in person to see how supple your tissues are. Good luck.

Erica Anderson, MD · Answer

It will be difficult to revise, but possible. With the radiation effect, implant based reconstructions typically have complications. You could get a better result if you would consider a latissimus flap to help with blood supply to the area in addition to the implant. Shaped implants or even more highly cohesive implants could also help the result. Best wishes.

Can I go larger after reconstruction following mastectomy?

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