Implant swap, 2 different sizes- big deal to change smaller implant to next size up? (photos)

My implant swap ( bilateral m, semi skin sparing, rads to r, expanders/alloderm) I have 620 on left and 555 on right. It looks awful! Other than being smaller Its not wide enough and the pocket seems tighter than the left. I do not want a lat flap. The skin is thin, I had dehissance and corrective surgery. Id liketo know opinions on putting a 620 in the small side. Implant Projection is almost the same. Also, can an incision be made in the breast fold so the scar doesn't have to be opened?

Doctor Answers 1

Breast implant exchange in a Reconstructed radiated breast

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While I am now longer actively doing reconstruction, I can still tell you that to ask for a larger implant in a radiated breast pocket that has had a dehiscence before is asking even begging for trouble.  I would advise you to speak with your surgeon regarding possible fat grafting to that right side.  It can increase the size as well as improve the quality of the overlying skin. Another option to make them match is to go smaller on the left with or without fat grafting to the right. Or you can get the recommended latissimus flap which is the best most reliable option for thin irradiated skin. With out an exam, it is impossible to say for sure but my recommendation is DO NOT under any circumstances try and stretch a irradiated thin skin pocket. You could end up losing the reconstruction all together and have to start all over with a flap for sure.  Talk again with your surgeon. Best of luck. Your reconstruction actually looks quite good except for the asymmetry. 

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