I’d really appreciate some advice. I’m due to have a prophylactic mastectomy and implant-only breast reconstruction using tissue expansion in a couple of months. I’m 5ft 6. I'm 11 stone, which means that I am a D cup. I'm going to exercise to get fit but I’d quite like to diet as well and go to 9 and a half stone, but if I do that I will drop to a B cup. Will being thinner with a smaller cup size mean I will have to have smaller implants ultimately?
Does Current Cup Size Determine Size of Implant for Breast Reconstruction?
Doctor Answers 7
Breast Reconstruction and Implant Size
To an extent, yes the current breast size does determine how big an implant can be placed. Also how much skin is left behind after the mastectomy determines the final size of the breast as well.
Hope that helps.
Implant size following tissue expansion for breast reconstruction
One advantage of using tissue expanders for reconstruction following prophylactic mastectomy is that to a large extent you will be able to determine the size you will like based on the amount of fluid placed in the expanders. Even if you loose weight, you should be able to tell how much volume in the expanders (and later in the implants) will look good on you. Just be sure that you loose the weight before yo have the expanders exchanged for permanent implants.
Prophylactic Mastectomy Breast Reconstruction
Entrenched views about what is OR is not proper "breast cancer surgery" have radically changed over the years. When a prophylactic mastectomy is done, it is NOT done to remove a cancer but rather to remove tissue with a high likelihood of becoming a cancer. Since no cancer exists in the breast or touches the breast skin THERE IS NO NEED to remove all the breast skin with the underlying breast. The breast skin may be peeled off the breast and the important under breast fold - inframammary fold can be preserved while only the breast tissue is removed. NO EXPANDER IS THEREFORE NEEDED. Instead, the breast is immediately reconstructed with an implant and the underside of the breast can be built with a hammock of either AlloDerm or Strattice to hold the implant up and provide further thickness under the breast skin.
The IDEAL size of the implant will be determined by the current breast width and will depend on the surgeon's vision of the ideal implant that can be covered by your pectoralis major muscle and still stay on the front part of your chest without falling sideways.
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Breast Reconstruction and Breast size
You should have no problem being whatever size you want since you are going to have tissue expanders placed. One can inflate these to achieve whatever size you desire. Even if you were not having expanders placed, you should have no problem of staying your current size, since your skin will probably not shrink with the weight loss. Your current size will also look larger on a smaller frame. I would, therefore, highly recommend the weight loss, as you will feel much better without the 21 lb. that you plan to lose. I would not, however, go any smaller, as this weight loss will bring you to a BMI of 21.
Meet your Plastic Surgeon before the mastectomy and discuss all your options, and the desired breast size. A skin sparing mastectomy will leave almost all the skin envelope. This will allow the Plastic surgeon to put a good size implant without the expansion. Do not worry about loosing the weight. The breast skin envelope will not shrink that much. how much subcutaneous fat the general surgeon leaves makes a big difference in the reconstruction.
Breast recosntruction and size
If you lose weight, and your bresat gets smaller, you can always have larger implants placed to increase your size.
Current cup size determine size.
It is a guideline for us to use in determining the correct sized implant or expender to use in your planed reconstruction. Remember it is just a guide not a final determining factor. Your operating PS can discuss in more detail.
From MIAMI Dr. B
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