I had a bilateral mastectomy with one-step reconstruction. Prior to the surgery I was a 36DD and wanted to go smaller with the surgery - that did not happen. I know I need to give this time (6 mo), but is it possible to go smaller with the one-step surgery and exchange the implants? If so, what are some of the challenges of doing this such as puckering? I don't want another surgery but I'm not happy with my size. Thank you!
Size Revision to One-step Breast Reconstruction?
Doctor Answers 2
Breast revision surgery
It is maybe possible to perform a breast revision for you in one step, but without an exam it is difficult to say.
Size Revision for Single-Stage Breast Reconstruction
Single-stage breast reconstruction can be challenging especially when it comes to obtaining the desired shape and size. For larger breasted patients, it can be difficult for the surgeon to address all the excess skin following mastectomy with just the implant. It sounds as if your surgeon needed to fill up the skin envelope with an implant that was larger than your desired preference. Simply replacing the implant with a smaller one will not address the excess skin.
In order to create a smaller size and maintain a very aesthetic shape I would advise a skin reduction procedure along with a smaller implant. This procedure involves removing the excess skin -- often using the same "inverted T" incisions used in breast reductions. This approach will allow your surgeon to place a smaller implant and still sculpt the breast skin into a more pleasing contour. This technique does have additional healing risks -- especially at the point where the skin flaps meet at the "T" junction. Due to your mastectomy, your breast skin is very thin and is more prone to healing problems -- especially when cuts are made along the bottom of the breast and vertically to remove excess skin. I have, however, performed this technique with success many times but you must understand the additional healing risks. Small wound healing problems can often be managed with local wound care. There is a remote possibility of having healing problems that could lead to the exposure of the implant. This is rare but it can happen.