Increase Breast Size Through Reconstruction After Mastectomy?

Question

Is it possible to increase breast size with reconstruction following a mastectomy? Will it increase both breasts, even though only one will be removed? I will have enough tissue left after mastectomy and will be using expander and saline breast implants. My current size is full B/Small C; want to go to full D to DD.

James N. Romanelli, MD, FACS · Answer

In many cases, it is possible to increase your final breast size while undergoing mastectomy and reconstruction. Your surgeon needs to evaluate your skin characteristics to determine how much fullness can be achieved. However, it is possible to increase your breast size by one or two cups by adding an implant on the side opposite the mastectomy.

Christopher V. Pelletiere, MD · Answer

If there is one nice thing about having to undergo breast reconstruction after a mastectomy, it is that you can really change your breasts if you want to. some women have always wanted to be larger or smaller, have their breasts higher or lower, etc. A surgeon should really work with you to figure out the best way to not only reconstruct the breast, but to alsoget it to the size you desire. This also includes any surgery on the opposite breast for symmetry purposes ( yes, insurance will actually cover a breast augmentation on the other side for symmetry purposes).

Farbod Esmailian, MD · Answer

You will be undergoing tissue expander reconstruction and will have to see how things go.  It is not always possible to go larger than you were before.  It all depends on the quality of the skin you have left behind and see how the expanders do.  If you do go larger, the insurance company generally do not cover implants to the other breast.  The will cover breast reduction and breast lift performed on the opposite breast for symmetry purposes, but not an implant. 
Another recommendation I would make is to look into the silicone implant for placement after your tissue expander.  Saline does not do well after mastectomy reconstructions.  You will have lots of rippling and feel is not the best either.  I generally recommend silicone implants after mastectomy for all those reasons.  After explained the risks and benefits of silicone implants most patient desire to have the silicone placed.
Good luck.

David Greenspun, MD, MSc · Answer

You shoud discuss your desire for breast size with your plastic surgeon as "going larger" can be an option. The shape and size of your chest, and the quality of your skin after mastectomy, will help determine just how large you can safely go. If you other breast is smaller, you will need to augment that beast. Just be aware that breast augmentation surgery can affect the appearance of mammograms.

C. Bob Basu, MD, MPH, FACS · Answer

The good news is yes - Often your plastic surgeon can strive to tailor your reconstruction to achieve your goals. This is true for both implant based and autologous tissue only reconstruction. Please talk with your board certified plastic surgeon to learn more about your options and what can reasonably be achieved.

Steven Wallach, MD · Answer

If you are having tissue exapnsion and then exchange with an implant, you certainly can be larger than with what you started with. My preference is using autologous ( your own) tissue as opposed to an implant.

Robin T.W. Yuan, MD · Answer

My philosophy is to afford the patient going through mastectomy for breast cancer all the benefits of a patient going through cosmetic augmentation so that her quality of life can be actually enhanced following cancer treatment. This means trying to understand and listen to what a particular patient desires. If you want to be larger, the treatment of your cancer and the reconstructive options might need to be altered to achieve your goal.  There is rarely only one way to treat breast cancer. If you are wanting to become larger, then that obviously means  using implants on the nomral, unaffected side. This would mean an even larger implant on the mastectomy side so the goals would be to allow treatment of that side and still allow an opportunity for a larger implant.
This goal might preclude lumpectomy and radiation due to the potential limiting side effects of implants in a field of radiated tissue. A mastectomy that preserves maximum skin would be appropriate. A size increase to D might suggest use of silicone rather than saline implants due to the rather unnateral feel of large saline implants, oterwise a flap plus an implant might be better. This is of course assuming that you do not plan or need a prohpylactic mastectomy on the unaffected breast. Review al your options and potential side effects and risks with your plastic surgeonand oncologic team.

George J. Beraka, MD (retired) · Answer

Hi.
1)  You can certainly have a larger breast recostructed after mastectomy.  Many of our patients in Manhatan do this.
2)  We do a breast augmentation on your other breast.
3)  But I advise against very big breasts, because smaller reconstructed breasts look more natural.

Theodore Katz, MD, FACS (retired) · Answer

With what you describe, your surgeon should be able to expand the tissues enough to get you to a D cup - I would be concerned about going larger than that. As skin is expanded there are potential problems in healing and subsequent skin contraction, thickness, capsular contractions, etc. Just make sure that your plastic surgeon is experienced with tissue expansion and don't be afraid to ask questions. Ask about the potential risks and complications and what he/she can do if they occur; ask about how close in symmetry he can get and don't expect perfect symmetry (including size, shape, nipple/areolar appearance, etc). Ask to look at photos of women who have had this procedure by him or even talk with a patient or two. Although your insurance company may not pay for the implant, you will be covered for the hospitalization and/or facility fees as well as anesthesia and the physician charges for the tight side and this is quite a cost saving. Discuss the fees with the doctor or back office. Also ask if there are any additional charges for the tissue expansions in the office (usually not) and ask about what charges would be incurred for subsequent procedures, if needed, to achieve better symmetry. It is not unusual to need a second relatively minor procedure to get the breasts closer to symmetry in size and shape.

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