Breast Reconstruction: What size and type of implant would you recommend for my shape/size? (photo)

Question

I will have a bilateral mastectomy soon and want immediate implant reconstruction. I am 5'6" 130 pounds. I am considering nipple/skin sparing because I dont want a tattoo nipple nor no nipple. I like the teardrop/natural and was thinking medium profile or low profile as I don't like the round and high "fake boob" looking shape. I was thinking 350cc or so. I have a B cup breast size now. The left breast is the one with cancer but I am having both breasts removed.

Ritu Chopra, MD · Answer

Depending on how the mastectomy flaps look after removal of the breast tissue will dictate if you are a candidate for direct to implant reconstruction. Assuming in surgery the flaps look great the size will depend on how much skin laxity you have and how much breast tissue is taken out. Direct to implant is a great operation in patients with small to medium breasts that do not want to be significantly bigger. In your case from the pictures it appears 350 would be an adequate size to fill out the skin. I always have enough sizes in the operating room just in case you need to be bigger and or smaller. Good luck hope this helps!

David Parizh, DO · Answer

1. Fight the cancer2. The breast surgeon will advise if you are a candidate for a nipple sparring mastectomy. This goes in line with number one. 3. Find a plastic surgeon that will guide you appropriately. No one can promise you a direct to implant. That can be the plan. That can be the goal. However, a good surgeon will need to make that safety assessment after mastectomy depending on the quality of your skin flaps. If you dictate what reconstruction. You want and the skin flaps aren’t healthy this will put you at risk for skin necrosis and death, delay of cancer treatment potentially. Having said that, I advise patients to chose implants based on a few factors. Their aesthetic goals, going to same size or smaller is safest. If you go bigger it shouldn’t be by much. The choice of implant depends on the availability of skin envelope to receive the implant. An expander may need to be placed to create a skin envelope if needed. The breast width is another limiting factor. If you have a small frame you can’t receive certain implants. The low profile for same volume have to be wider. The medium or high profile for same volume have to have smaller diameter. A good surgeon can help you in this process. Once they lay out options you can give them guidelines for surgical reconstruction. The above range you made isn’t far off. Just depends on many factors I’m trying to mention. 
Lastly, nipple position. Are your nipples where they need to be? Do you need a lift and repositioning of the nipples? Do you want the additional scar burden? 
I hope that give you something to think about. I like to layer these conversations with my patients. It’s a difficult time in your life and you shouldn’t be rushed to make a decision. Trust and expectations are key! 
Best of luck to you.

Gary M. Horndeski, MD · Answer

Unfortunately,
you have not told us your age or bra size, just your cup size.  The traditional skin sparing mastectomy is
based on the premise that reconstructing the breast to its original state will
give you optimal aesthetic results. 
However, if you look carefully at your breasts, you will see that they
have descended and are asymmetrical.  You
would benefit from a lift and I recommend a mastectomy using The Bellesoma
Method.  By lifting the breast higher,
you will require a small implant that will be almost totally sub-muscular.  This location provides long term stability
and minimizes capsular contracture.    Best Wishes,Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear durgama1008,Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Robert Whitfield, MD · Answer

Aesthetic breast reconstruction begins with analysis of the current breast size and shape.  Measurements and 3D imaging are used to provide information about the current size of the breast because cup size is not accurate.  Depending on the type of reconstruction desired, using your own tissue, implant or a combination a plan can be formed.  It sounds like you have decided you want an implant based reconstruction.  The implant can be placed above or below the muscle.  Depending on the procedure performed the implant or expander can be placed that day.  If an expander is placed then it is filled over a series of office visits until the desired volume is reached.  Exchange to a permanent implant is performed as an outpatient at 3months after the procedure.  A direct to implant procedure is performed with placement behind the muscle if several factors are acceptable related to the skin and perfusion of the nipple complex.

Priti P. Patel, MD · Answer

You ask a great question and I tell all of my patients that you should meet with the surgeon a few times before breast reconstruction so that he or she understands your goals.  Generally with a direct to implant patients can achieve a nice appearance if they are pleased with the current size or somewhat smaller.  A moderate plus or high profile may give you better projection and is based on your body frame and desired appearance.  A shaped implant is often used in patient's who are looking for a more natural appearance.  Sizing will largely depend on the quality of your skin flaps and tissue health at the time of the mastectomy.  Your surgeon will discuss these things with you during a consultation as well as potentially discuss the option of a tissue expander placement and two stage reconstruction.  Good luck on your journey!

Nicholas A. Flugstad, MD · Answer

Sorry about your diagnosis. It can be quite difficult to accept needing your breasts removed. Your reconstruction starts with a correctly selected tissue expander that will help restore your breast skin and maintain the volume. Then you will be changed to a permanent implant about 3 months later. Usually moderate or high profile is needed, because mastectomy removes all the breast tissue. You need that projection to give you normal shape. Have 2 consults with American Board of Plastic Surgery certified surgeons in your area that perform this surgery regularly. Best wishes.

Breast Reconstruction: What size and type of implant would you recommend for my shape/size? (photo)

Answers (7)

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