Expander to implant exchange post single mastectomy. Implant going to be larger than fill. Advice?

Question

My expander is currently filled to 580cc, my surgeon ordered a high profile 700 cc implant for the exchange. I don’t understand bc they said to overfill bigger than implant so why would she order 120 cc larger, also worried 700cc is way to big for me. I’m 5’2” and 120 lbs. I only learned of the size she orerded when I met with the scheduler so I’m trying to decide if I should make an appointment to discuss my fears or just trust her.

Samir S. Rao, MD · Answer

I routinely use implants that are 100-150cc larger than the expander fill.   There are several reasons
1) the empty expander is about 50cc which needs to be account for
2) many of us use medium or short height expanders, which means all that volume is in a smaller space than the implant will fill, so you need a larger implant to fill the extra space created during the exchange of expander to implant
3)I also believe that using a larger implant can help decrease rippling, particularly in pre-pectoral reconstructions

Ritu Chopra, MD · Answer

It all depends on what size your breasts were before mastectomies and how happy you are with your current size. At times I do like to make the pocket smaller than the implant. In my opinion it gives a snugger fit which may decrease the possibility of rippling. You should for sure have a discussion with your surgeon if you have any concerns preoperatively. I hope this helps!!

Allen Gabriel, MD, FACS · Answer

Thank you for your question. Please discuss size with your surgeon.   Size is such a subjective measure that its difficult for us to understand the desire of each patient's size.   Therefore it is important for a dialogue with your surgeon so some limitations can also be explained.   I generally use larger implants than the final fill.  Hope this helps and best of luck.

Christine Fisher, MD, FACS · Answer

Many patients have questions about the transition from tissue expanders to final implants, so thank you for asking this question. When in doubt, my advice is to always consult with your surgeon. Hearing that you are 5’2” and 120 lbs, a 700cc implant sounds quite large; however, this depends on the "footprint" of your original breasts. It is common to fill the tissue expanders to a greater volume than your final implants will be. This gives the surgeon more skin to work with during the final implant placement surgery. I always tell my patients I can do away with excess skin in the OR, but I cannot create it. This is why I air on the caution of expanding to a larger volume than the final implant will be.
I encourage you to meet once again with your surgeon to get your questions answered. It's important for you and your surgeon to be on the same page.

Kelly Killeen, MD, FACS · Answer

It sounds like you should absolutely discuss this with your plastic surgeon.  How do you feel about the current size of your breasts?  If you are ok with it and do not want to be larger, a 700 cc implant is the wrong choice as it will increase your size about a full cup size with your small frame.  If you have loose skin that your surgeon believes should be "filled" with a bigger implant, you can instead have a smaller implant with a lift.

John M. Weeter, MD (retired) · Answer

Factors that  plastic surgeons consider for the implant in post-mastectomy reconstruction include the size to match the opposite breast, desire for a woman to be smaller, similar, or larger after the reconstruction, weight of the mastectomy surgical specimen, body dimensions (height, weight, base width of the breast, sternal notch to nipple distance), and other factors. I also like to ask the patient as she is going through the expansion process, when we have reached the desire fill contour. After that point I may temporarily over expand about 50-100 cc. for a few months.  Then I bring the volume back to the desired volume fill which is then less tight and is softer and hopefully more natural of a feel. I would discuss this with your surgeon and arrange for a follow-up office visit to discuss this so that all are in agreement.  Put your mind at ease by this discussion.

Expander to implant exchange post single mastectomy. Implant going to be larger than fill. Advice?

Answers (6)

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