How Do I Choose the Best Size Implants After Mastectomy? Going from 425cc to 650cc

It’s virtually impossible to answer this question
without a consultation and physical examination for a variety of reasons.When choosing breast implants for breast reconstruction,
we’re not interested in implant size, but instead, we’re interested in the
appropriate implant fit.We want to
achieve harmony, balance and proportion with the surrounding anatomic
structures.It’s
probable that 650 cc implants would improve your overall aesthetics.Unfortunately, without an exam or pictures
it’s hard to say with certainty how these implants will fit on your body.The
best approach to resolve this issue is a consultation with a board certified
plastic surgeon.This surgeon can use
external silicone sizers to understand the patients’ aesthetic goals.This approach minimizes the anxiety that many
patients experience regarding breast implant size.

Thanks for your question.With regard to the selection of size, I would defer to your doctor.Implant size is highly dependent on your
actual chest measurements.These
measurements can then be compared to the measurements of the different implants
to match you with the right size based on what you are looking for.Best of luck!

Dear db4758 in Flagler Beach, FL:

Determining the size of implant needed for breast augmentation is subjective, so there is no single correct answer. One simple trick is to buy a bra the size you would like to be and fill in the needed volume using rice and a zip-lock bag. The amount of rice in the zip-lock can be varied until you are comfortable with the fill volume. Bring the bags to your surgeon at your pre-op appointment to give them an idea of how much additional you would like.

After a mastectomy, the breast tissue is removed. Some skin is removed too, so the skin may be tight. If radiation is performed there is additional skin shrinkage. All these lead to the need for larger volumes to get average sized results. If the skin is too tight, sometimes a tissue expander needs to be placed first to expand the skin, then an implant is placed. By placing the expander after the mastectomy, it is possible to actually see what the volume looks like before the final result is set. Sometimes the skin will not expand well and a smaller volume must be used.

If you currently have 425cc and do not have enough projection, then going to a 650cc HP does not at all sound unreasonable.  You have to remember that post mastectomy, you have NO breast tissue, so it is not at all the same as someone having 650cc for augmentation purposes because they are starting out with some tissue.  You will not look like a stripper!  Feel comfortable and confident in you and your surgeons decision!

Communication  with your surgeon is the key.

The more breast surgery I do the more I realize that there is no correlation between the size or model (profile) of implant used and resulting cup size.  This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saline/silicone  and low/moderate/high profile), bra  manufacturer variance  in cup sizes, the  degree  of filling of the cup  with breast tissue,  and the subjective differences in patients perceptions of cup size. 
Much of the final “look” achieved after breast augmentation surgery  depends on several factors:


1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.

2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.

3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.

4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.

I hope this helps.

db4758: Sorry to hear about your predicament.  My answer is predicated on a lot of assumptions, so ultimately, you will have to confide in your Surgical Oncologist and PS.  Assumptions: 1) Your SO plans a skin sparing/nipple sparing mastectomy.  If your case will require removal of a lot of breast skin, your PS will be limited in the size of the tissue expander, which can be safely buried under the mastectomy flaps. 2) Your breast cancer doesn't require additional radiation therapy. Often this isn't clear until after the status of your axillary lymph node sampling is cleared by pathology.  Again, you & your PS may have to settle for a more modest TE/implant.  3) Your mastectomy flaps heal by primary intention. Remember there are 2 surgeons in the OR, the SO and PS and occasionally mastectomy flaps don't heal well and require returns to the OR.  That's some of the "bad" news but here's how I counsel women who request mastectomy reconstruction with TE/Implants.  The width of your bony chest wall doesn't change, so there is a range of TE (tissue expanders) and implants, which it can accomodate. The priorities in breast cancer reconstruction are patience, innovation, communication, and humility, both for the patient and surgeon.  Ultimately you may have to agree to multiple stages to produce your aesthetic ideal but you can facilitate this by letting your PS know what you like.  Good luck.

The choice of implant size and shape in a breast reconstruction depend upon your pre-mastectomy breast width, desired breast volume, and your overall body type. 650cc may look very large in one women and small in another. The staging of your reconstruction following your mastectomy and whether a dermal matrix (such as Alloderm) was used will impact the decision to use larger, more projecting implants. Higher profiles (particularly with larger implants) makes more sense in breast reconstruction because of the lack of overlying breast tissue. Also, the higher profile allows for fuller volume without the implant width violating the normal dimensions of the breast. Without an exam, it is impossible to state whether you would have a "stripper" look, but given that you state you had a "B" cup breast in a pushup bra at 425cc, I doubt these implants will be too large. Initially following revision, the skin may look very tight and should soften over time. Good luck with your surgery!

Implants greater than 500cc are not uncommon in breast reconstruction.   A woman will need a much larger implant after a mastectomy to achieve the desired profile because there isn't any breast tissue present over the implants.  Adequate tissue expansion is also important to prevent the skin from limiting projection and allow the implant to give a good natural appearance.  

650 cc implants are quite large and may give you the "stripper" look.  However, an exam would be essential to evaluate what would be good for you. This can not just be surmised from this brief correspondence.

I would think that 650 cc would be too big based on the before surgery breast size. You have thin layer of skin  and going too big has the risk on thinning the skin even more.