My plastic surgeon is hesitant to expand me to a C after mastectomy. Is going from a 34A to 34C cup reasonable?

I'm 28 and about to have a mastectomy, no radiation. I am a 34A right now, hoping to get to small C cup after expansion. 5'6, 140 pounds, no BRCA involvement. My plastic surgeon seems intent on me staying an A cup, doesn't want to go to a C due to 'skin stretching' even though I've heard many women go from an A to C after mastectomy. This was literally the only thing I was looking forward to. Should I go see a different plastic surgeon? I don't see why this isn't possible.

Doctor Answers 5

Breast reconstruction

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Different expanders are somewhat limiting if you have a very narrow chest.  There are new Mentor expanders that are more narrow that provide the expansion you are suggesting.  The Menor, Artoura expanders I placed recently are providing this level of expansion for a very petite patient of mine.

C cup sounds reasonable

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I'm not sure why your surgeon can't get you to a C-cup if you desire.  In the absence of radiation, a tissue expander could be placed at the time of your mastectomy and used to stretch the pocket for the final implant (skin and muscle) up to a C-cup range.  When the expander is removed and the final implant placed on the mastectomy side an implant will need to be placed on the opposite side for symmetry.  These procedures should be covered by your insurance.
If your current surgeon is uncomfortable with making you larger, you might consider another opinion.

Scott Thellman, MD
Lawrence Plastic Surgeon

Upsizing during breast reconstruction

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Thank you for your question. There are so many factors that affect breast reconstruction (including size and location of the tumor, type of mastectomy planned, quality and thickness of mastectomy flaps) that it is impossible to say with certainty. That said, if you feel like your plastic surgeon is not on the same page you are, get a second opinion! Surgeons are like shoes- you may wear a size 7, but not every size 7 shoe fits your foot comfortably. The reconstructive process is a journey, not an event- choose your travel companion with care.

You may also consider having a second meeting with your initial plastic surgeon to talk specifically about size. Often there are so many topics to discuss in the initial consultation that some topics may not have been discussed in the detail you would have liked. Now that you've had some time to digest the information you may have more specific questions. 

The only downside to a second opinion is that it may not be covered by your insurance- call and check your benefits beforehand. If your insurance is not going to cover a second opinion mention this when making your appointment and ask the consultation fee so that you are not unpleasantly surprised.

You should put equal thought into the decision of your mastectomy surgeon- are you a candidate for nipple sparing mastectomy, for instance? Some techniques limit the skin excised, which allows for greater expansion during your reconstruction and thus a bigger implant. However, not all techniques are appropriate for every tumor. 

It can also be helpful to speak with other women who have already gone through the process. This is an important decision and a difficult journey no matter what you ultimately choose. I wish you the best.

Meghan Nadeau, MD
Seattle Plastic Surgeon

Breast Reconstruction

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What type of mastectomy? skin sparing? nipple sparing? or do they need to take skin?
In any way the ultimate size depends on your desire. An expander is put equal or slightly bigger than the size you want and over inflate to gain as much skin then exchange for the implant.
If you are thinking of doing Immediate To Implant reconstruction, that may limit the size of the implant.

Samir Shureih, MD
Baltimore Plastic Surgeon

My plastic surgeon is hesitant to expand me to a C after mastectomy. Is going from a 34A to 34C cup reasonable?

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Thanks for your question.  Your goals for breast volume are reasonable, especially since you're not getting radiation.  The whole point of tissue expanders is to expand the skin!  Not sure why a larger cup size is not being considered for you?  Photos would be helpful.  It never hurts to get a second opinion by an experienced plastic surgeon certified by the American Board of Plastic Surgery.  Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 23 reviews

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