Size of Implants. Had Chemo and Bilateral Mastectomy and Radiation?

I had Chemo, a bilateral mastectomy in Feb 2012 (and radiation). After my surgery, Dr said that I could only be a B cup from a 38 C. When i was hoping to maybe a little bigger (since going through all this). He said it is not ethical to go bigger or be the same size. And if I wanted to I would have to go to California. Do not really understand why he did not tell me this before hand. Just wondering if this is true. I think it is because he is not getting paid cash (insurance is covering).

Doctor Answers 3

Breast size in reconstruction

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I'm a bit baffled by the response you describe from your PS.  You likely have some options to achieve your goals.  If you have undergone radiation therapy, I would suggest you consider autologous (using your own tissue) reconstruction such as a DIEP Flap.   Implants after reconstruction have an increased risk of scar tissue formation (capsular contracture).   Please visit with a board certified PS to learn more about your options.  And remember, you insurance will likely cover  a consultation out of state if there is not a DIEP flap specialist in your area.  Best wishes.

Dr. Basu

Houston, TX

Increase in size for breast reconstruction

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It is common to increase patient's breast size after mastectomy, as many breast cancer patients have had some volume loss with breast feeding or weight change and get a nice result from the upsize. If you have had radiation, sometimes the expansion process can be more difficult in the radiated field, especially if there has been a boost (area of chest wall was treated with increased radiation). For the usual 3500 cGy treatment the chest wall is usually just somewhat tighter but it is do-able.

Most surgeons are very willing to give patients the results they want, increased tissue expander fills are the only work involved - C or B implants are not that different to place. Ask him if he has any concerns about your ability to expand physically, as accusing you of being unethical that you want C boobs sounds way off. Of course, I am from California!

Lisa Cassileth, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 16 reviews

Radiation therapy changes everything

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Often after radiation therapy we are unable to safely expand the tissue and get the size breast reconstruction that we would like.  The complication rate after radiation therapy is much higher.  It might be possible for you to have a fat transfer procedure at this time in order to get a slight increase in volume.  Consider asking your surgeon about this option.  If it is too risky, they will tell you.  Good luck.

Michael Novia, MD (retired)
Olympia Plastic Surgeon

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