Silicone Implants After a Bilateral Mastectomy? (photo)

My plastic surgeon expanded my tissue expanders to 750 ccs, then replaced them with 700ccs cohesive gel silicone implants. Before the exchange surgery, I was wearing a 36 D sport bra. Although I can still wear the same size bra, they do not appear to be what I thought.They certainly appear much larger in a photo.....little projection, but full.Is this natural?

Doctor Answers 8

Silicone Gel Implants after Reconstruction

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The photos appear to be very early in the post-op period and pretty normal at this point.  Unfortunately, almost all breast reconstruction patients exhibit less projection than ideal.  It is the nature of the mastectomy and the inherent softness of the gel implant.  There are high profile and newer ultra-high profiles that can help.  In addition the true cohesive gel, form stable implants can maintain better projection in some patients.  At this point, I would not do anything.  Let them settle and heal.  In 3-6 months if you were still unhappy, an implant exchange to change volume, type, shape, and projection should be an straightforward 30 minute operation with little downtime.

Implants after Mastectomy #breastreconstruction

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Brest cancer reconstruction can be very difficult surgery. Silicone implants never have the projection that a saline implant or tissue expander will have. I battle this every single day. I always tell my patients that their final implants will not be as projected as the expanders. I do use the highest projecting implants made. If I know a patient will not be happy with the biggest silicone implant's projection then saline implants may be a good choice. You will sacrifice soft feel for projection.

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 54 reviews

Reconstructed breasts often do not fit traditional bras

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One of the difficult thing about expander reconstruction is that the implants do not have the same projection outward as the expander itself. The expander is engineered to maintain continuous outward pressure to establish the pocket and prevent collapse. The downside is that the expanders become more firm when volume is added. This however goes away when the implants are placed.With regard to bras, the lack of outward projection means that most cups don't get filled completely. There are some bras, like Tshirt bras, that don't have as conical a shape. Many people wear camisoles with the shelf built in since you don't often need as much support. Hope this helps. 

M. Scott Haydon, MD
Austin Plastic Surgeon
4.8 out of 5 stars 93 reviews

Cohesive gel implants

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Allergan now makes a smooth round cohesive gel implant that will give you more projection and be a little softer the the textured anatomically shaped implants.

Francis X. Fleming, MD
Kennewick Plastic Surgeon
4.5 out of 5 stars 18 reviews

Final cohesive gel implants does not fit the same as tissue expander

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In implant base breast reconstruction, tissue expanders often have higher projection than the actual implants. Since your tissue expanders were filled to 750cc, the actual final volume is >800cc. The tissue expander has a volume of 75cc due to its thick shell and a metal port. Therefore, to get the same projection and size, you need implants in 800cc range. I normally underfilled my tissue expanders and then place larger implants at the second stage. Good luck on your reconstruction. 

Mytien Goldberg, MD, FACS
Los Angeles Plastic Surgeon

Breast reconstruction with implants

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It is common to overexpand your tissue expanders prior to your second stage breast reconstruction.  This amount of overexpansion is typical, along with accounting for the size of the port within the expander in that volume.  Depending on which projection expander was used and which implant projection was used will also determine the amount of projection that you have during and after your reconstructive procedure, respectively.  It is common to have a little less projection with the implant than with a tissue expander, since the expander is doing just that - expanding your tissue.  Once your final implant has been placed, it will have a softer, lighter, and more natural feel and appearance.  

Looking at your photo, it appears that you are recently postoperative.  This flattening is usual, especially since your previous atop the breast was used.  Allow the swelling to subside and the implants to settle for several months before your final results will be seen.  Thank you for your question!  Hope this helps!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Implants after breast reconstruction

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You just had surgery and your breasts look exactly how they should. As the implants settle and the tissues adjust you should be pleased with the  shape of your breasts. They will be less tight, round and "boxy".

Remember you had breast reconstruction. Even though we came a long way we cannot mimic exactly the shape of "real" breasts. As Dr. Haydon mentions operated breasts are "rounder" and do not have a lot of projection. To find a bra is sometimes tricky. Victoria Secret and certain brands in high end shops such as Nordstrom, Nieman Marcus have now bras specific for "operated breasts".

Keep up the faith and follow your surgeons directions and advice.

Guido P. Gutter, MD
Evansville Plastic Surgeon
4.9 out of 5 stars 18 reviews

Breast reconstruction and implants

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It looks like you just had surgery. I would give it time to settle and for the swelling to go away.   Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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