What is the proper size of implants (reconstruction) due to breast cancer? (Photo)

I'm currently a TNBC at stage 3, had a double bilateral mastectomy with plans of future reconstruction, currently have tissue expanders in. After healing went thru 25 sessions of radiation on my left side, now started the expansion process currently at 390cc of saline, but my left side is having issues. I'm 5'3" and 138 pounds, before surgery was a 38/40 C, but will like to be a B cup now due to back issues (3 surgeries and fusions) . Is a 400cc silicone implants correct for my frame?

Doctor Answers 4

Proper implant size for implant based reconstruction.

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Thank you for your question.

This is a difficult question to answer via this format but I can offer my general approach I use to determine size.  The first information that we need is your base width "how wide the breast is in cm" (this should be the width of the expander you have in place).  We also will want to know the height of the breast if we are contemplating anatomic "shaped" implants.  We then can look at implants with the same base width and these will come in 3 or 4 different profiles or projections depending on the implant manufacturer.  This will then give the sizes that should fit your chest dimensions.  This will of course be tailored according to patient desire on size and the quality of the tissues present.  Also helpful is knowing the mastectomy resection weight to estimate the volume required to replace the breast tissue.  With radiation the chest wall, muscles, fat, and skin will also shrink and this will need to be accounted for as well when looking at volume to replace.  If you feel like you are a good size, many surgeons will try to over expand by 10-20% to generate a little more tissue to work with at the time of exchange.

With radiation implant reconstruction can be difficult and unpredictable.  Frequently I will add tissue with a latissimus flap to get the results we desire.  Fat grafting can be done as well to improve the soft tissue envelope.  I recommend speaking with your surgeon about their process for determining size.  I am sure they have a well developed algorithm to help with the sometimes challenging determination.

Best Dr. L

Austin Plastic Surgeon

Better ot have radiated expanded skin...

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I think you may have a hard time expanding that radiated side.  As the saying in reconstructive surgery goes, "It's better to radiate expanded skin than to expand radiated skin".  If things don't progress, you will require your own tissue to be brought in to reconstruct that breast (either alone of with an implant, as well).  Options are plentiful, but there is ALWAYS a best option for each individual patient.  I hope this helps.  You will be able to choose the implant size by determining what you like with the expander in place.  If you have 600 cc in the expander, your final implant gets chosen off of that number.


Breast Reconstruction

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Please talk further with your plastic surgeon about implant based reconstruction given your radiation. If the L breast is already having difficulty with the expansion process, you will be plagued buy issues with an implant for the reconstruction. You are far better served in the long run to have your own tissue used for reconstruction. There are both options using tummy tissue or your back skin. I know it is more surgery, but better to do it right the first time than go through too many surgeries and have a painful reconstruction. Please consider your own tissue, at least for the left side. Best wishes. 

Erica Anderson, MD
Reston Plastic Surgeon
5.0 out of 5 stars 5 reviews

Proper implant size

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Thank you for your question, and I hope your recovery is going well.  This is a difficult question, and somewhat subjective.  By performing a physical exam and taking measurements, one can get some idea of implant sizing.  You can also get a sense of implant volume by wearing a non-padded bra or camisole and looking in the mirror.  The shape will likely be different with the permanent implant, but you will be able to get a sense for volume.  If you are unsatisfied with the volume and are unable to proceed with any further expansion, you and your surgeon may need to discuss alternate plans for reconstruction.  Hope that helps!

Soumo Banerji, MD
Houston Physician

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.