Can my coming permanent implants be positioned closer to the center? (photos)

Question

I had bilateral mastectomy with breast expanders reconstruction in June 2022. After this I had radiation treatment to my left breast. My implant replacement surgery is scheduled for March 2023. My breasts now are asymmetrical and too far appart. During my last doctors appointment my plastic surgeon told me that vertical asymmetry will fixed by lifting right non-radiated breast but horisontal position can not be changed. I’m very disappointed and would like to hear other’s doctors opinion.

Ryan Rebowe, MD · Answer

Unfortunately, your surgeon is most likely correct. Your right implant can likely be repositioned higher and closer toward the midline. However, the radiation to your opposite breast will make it difficult to permanently reposition this implant. Utilizing autologous tissue, such as a latissimus flap, may help to give soft tissue support for implant repositioning, but this is very patient dependent. I would say that your reconstruction overall is a good result, however some implant repositioning will certainly enhance this outcome (as is true with most first stage reconstructions).

Chul Hwan Seul, MD, PhD · Answer

If we decide to lift only the right breast, we will have to raise the right nipple only in the vertical direction.If periareolar mastopexy is performed on both sides, it is possible to move both nipples upward and move them to the medial side, but there is a disadvantage of scarring on both sides. In fact, the left side is in a situation where lifting is not necessary.In my opinion, do not try to move the nipple position to the medial side, and if you do not do both of the lifting, do only the right side. When removing the expander and inserting the implant, widen the pocket to the medial side and fat grafting to the cleavage side to increase the intermammary span. It would be nice to reduce it.

David Parizh, DO · Answer

It looks like you had a nipple sparing mastectomy. Radiation is not very kind to skin as you know and are experiencing. If your breasts were initially wide apart prior to the mastectomy that is something that can be marginally improved. If the implant shifted laterally it is a difficult problem but a solvable one by tightening that breast capsule (resultant scar tissue) to place the implant medially. Lastly, fat grafting is a great adjunct to use to add volume where one desires to help achieve a more superior aesthetic result! Hope that helps. Here if you have any further questions.

Derek Fletcher, MD · Answer

I depends on what position your tissue expanders and future implants are in. If they are under the pectoralis muscle, then your surgeon will be limited in how much he/she can move the implants towards the center line by your muscle anatomy. The attachment of your pec muscles to your sternum (breast bone) cannot be completely cut because that will cause significant permanent damage to your breast reconstruction and pec muscle function. Typically, the most you can move implants towards the center line to increase cleavage when the implants are under the muscle is about a half inch. 
If your implants are above the muscle, there is a lot more capacity for moving them towards the center to achieve increased cleavage because your surgeon does not have to worry about injuring the muscle.

Daniel Barrett, MD · Answer

Dear Reliable549522,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Can my coming permanent implants be positioned closer to the center? (photos)

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Answer: Implant positioning

Answer: Implant positioning

Answer: Implant placement

Answer: Implant placement

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Everything you need to know about Breast Reconstruction

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Can my coming permanent implants be positioned closer to the center? (photos)

Answers (7)

Answer: Implant positioning

Answer: Implant positioning

Answer: Implant placement

Answer: Implant placement

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Recommended reading

Everything you need to know about Breast Reconstruction

Our mission is to create a world where every investment in modern beauty is Worth It.