I encourage large breast patients to use there own tissue and if it is not large enough afterwards I use there own fat removed from the hip and thighs to improve the size and shape of the result!Please find an experienced Board Certified Plastic Surgeon and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all aspects of facial surgery, breast augmentation and body procedures including tummy tucks or mommy makeovers!
Thank you for your question. The implant size to choose following a mastectomy is a tough decision, absolutely. The largest silicone implant is 800cc and should offer you a good result, but it is hard to tell without better photos. In the office here we use something called the Vectra system which takes a 3-D image of your breasts, estimates their weight and simulates what you may look like post-operatively. I would suggest consulting with a physician that uses some type of 3-D imager, if possible, to feel more comfortable about your procedure. Good luck!
You ask a very great and valid question. I struggle with my patients daily about this issue. The biggest silicone implant made is 800cc's. You can get over 1,000 cc's if you have a saline implant. They do not feel as good as silicone and I almost never use them in reconstruction. You need to get your mind into a place where you can deal with the fact that once the old breasts are gone, the new ones are only placeholders. They will not look nor feel like your native breasts. They are purely there to restore shape to the body and look good in clothing. It is sooooo hard to get good projection and size in a patient like what you are describing because your body will swallow that volume pretty quick. My advice is pick a surgeon that you feel very comfortable with and that will do the very best job they can, but realize what you want and what they can deliver may be two totally different things. I try so hard to have my patients understand the limitations of reconstructive breast surgery before we even start. As much as I preach it to my patients, they still don't get it a lot of the time until it is done. So just prepare yourself that your new breasts will not be what your native breasts are. They may be great, but just not the same.
In clothing posted photos does not allow any of us to speculate on your size of breasts! Therefore best to seek more in person opinions...
Given your weight loss history, I am assuming you have laxity in your tummy area? If you felt you could benefit from a tummy tuck, why not consider using your excess skin and fat (the tissue that would be normally thrown away in a cosmetic tummy tuck), and use that tissue for your mastectomy breast reconstruction? I would recommend you consider the DIEP flap procedure for your breast reconstruction. You are correct, there are volume limitations with implants. If you have enough tissue, the DIEP flap procedure might be a good option for you. Please visit with a board certified PS who is experienced with DIEP Flap procedures to learn more about your options.
First of all, congratulations on your success with your weight loss. You are correct that even the biggest implants can get swallowed up and become poorly defined in a woman with a broad chest. Your surgeon likely has a technique to improve things in this setting. What I have found to be successful in this setting is using large implants in a very high profile (Style 45 by Allergan) and then making the chest more narrow by a combination of aggressive liposuction of the lateral chest wall (that tissue beneath your armpit) and excision of the extra skin that results. I came about this technique after struggling with exactly what you describe. The results have been really good to this point.
I would urge you, however, to either trust the plastic surgeon that you work with or find another that you trust. He or she may have a very different plan than I described that may well work as well or better.
I wish you the best of luck,
In the US, a 800cc implant is the largest silicone implant available. Sometimes a custom saline implant can be made but this may not be available at this time. The key to sizing is what will fit in the base width of your chest wall and give you adequate projection. I will use ultra high profile implants in this situation which usually gives reasonable projection. Consult with your surgeon to make sure you have reasonable expectations.