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

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).

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.

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.

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.

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

Unfortunately, asymmetry following radiation is an extremely common and challenging issue. The irradiated breast tends to be higher and to have tighter skin. While at the exchange for implants, your surgeon will almost certainly improve your symmetry, this is likely to become a recurrent and worsening issue. Note the you have significantly less skin from the nipple to the fold on the left when compared to the right (unless I'm mixing up sides in the pic). This means that breast will never have quite as natural a "hang" as the non-irradiated breast. For my patients, I recommend converting to a diep flap reconstruction. I understand that this may be daunting for some patients, but will over the long run result in a much better outcome.

Hello,As far I can see with only one photo of your breast (I highly recommend you get an in-person consultation with a Board-certified Plastic surgeon and breast reconstructor).
It all goes to the position of the implant, if you still have a pectoralis muscle in your right breast, I think you could be a good candidate for a dual plane Breast implant plus Fat transfer to the cleavage for camouflage (this technique will make your breast look closer as the gap between is fill). One again you need to talk with a Board-certified Plastic surgeon that has experience in Breast Reconstruction.
I hope this information has help you.