Really Need Help with Choosing Final Size and Placement of Implants After Reconstruction, Help?

Doctors,I had a Bilateral(skin and nipple-sparing) mastectomy 11/2011. I'm 5'7", 130-5 lbs. My bra size pre-surgery was a full 36B to 36C. My expanders (Natrelle 300cc)have been filled to 380cc as of 1/20/12. The nurse said I will probably only have another 120ccs maximum, and I'm concerned. Expanders are very far from my sternum extending under my arms. My best attempts to fit bras make me a B cup. I'd like a FULL C with more centered/natural placement. This is stressful. Thanks for any help!

Doctor Answers 5

Sizing of Implants in Reconstruction

When choosing expanders and implants for breast reconstruction, it is first important to respect your breast footprint. Based on your height, weight, and bra size, I assume you had somewhat wide, but not greatly projected breasts. Without a photo, i cannot guess whether or not you had widely spaced breasts to begin with. When expanders are placed under the muscle, they may tend to move laterally, especially if the lateral mammary fold has not been well reinforced.

300 cc expanders seem a bit small for your chest (assuming they are medium height expanders).. When overfilled to 380 cc's, they tend to round up, reducing their diameter, and filling the breast footprint even less.

Please ask your surgeon if the diameter of your expander ,matches your breast base diameter. If not, they should probably be replaced and placed more medially to avoid riding under your arms.

If you cannot receive a satisfactory answer, consider seeking a secondary opinion.

Kennewick Plastic Surgeon
5.0 out of 5 stars 37 reviews

Mastectomy Reconstruction with expanders, serial expansion, and change for implants

Thank you for your question. I understand your concern.  First, let me say that there is ample opportunity for adjustment of the pocket at the next surgery. Usually the implant pockets can be brought closer together at that time.

Also, bear in mind that the expanders are narrow and harsh around the edges. That is why they are so uncomfortable. Their job is to expand and stretch your tissue, giving you projection and space for future implants. Because of this, they usually look bigger than the implants that you will get.  For example, if you have 500cc in an expander and put in a 500cc breast implant, the implant looks slightly smaller even though the volume is the same.  Most women will elect to be expanded about 10-15% more so that the final result ends up being the size that they want to be.

Discuss these specific details and all of your questions in detail with your plastic surgeon. Make sure that you and your surgeon are on the same page.

 I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 182 reviews

Implants for breast reconstruction

The way the bresat look after expanders is different than with implants. Usually the pocket is adjusted after the expander is removed so that the implant sits appropriately in the pcoket. If the expanders look a bit lateral, then the pocket can be closed down on the side as the implant is placed.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Implants after expanders

You need to talk with your plastic surgeon. He/she should be able to understand your concerns and explain how they can be addressed. What you describe is not uncommon and much of that can be markedly improved with the implant placement, so don't let this bother you too much.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 34 reviews

Implant Reconstruction

It is important that you communicate your concerns to your plastic surgeon.   During the 2nd stage procedure of implant-based reconstruction (the "implant exchange procedure"), your surgeon will do his/her best to medialize your implants and fine tune your result.   Your surgeon will review what is possible and should also highlight any limitations of what can be achieved.  Best of luck.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 210 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.