Need tissue expanders a 2nd time?

I had a bilateral mastectomy last September with tissue expanders with the exchange surgery in April.  I expanded to 650cc silicon implants and am not satisfied with the size and would like to go up to the 800cc model.  I am trying to figure out if I will need to have the tissue expanders put back in again before I can move to the bigger size implant.  I have had the nipple reconstruction and will be having the nipple tattoo in a few months.  Will going up in size affect these things as well?  I have had no problems with the surgeries or the current implants that I have now.

Doctor Answers 4

Increasing size after breast reconstruction

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Thank you for the question!  I'm sorry to hear that you are not completely satisfies with your breast reconstruction results thus far.  It sounds as if you are pleased overall with the implant-based reconstruction.  An increase in size from 650cc to 800cc is close, however, may be difficult to achieve with simple exchange of implants alone.  It is difficult to accurately answer your question without photographs or an examination.  If you do have some laxity now, it may be possible to exchange these with simple pocket revision at that time.  Otherwise, it may be necessary to re-expand with tissue expanders if size alone is the issue.  This may change the position of your reconstructed nipple.

Another option may be fat grafting of your reconstructed breasts which would provide contouring of the breast along with increasing the size as well.  Harvesting of fat via liposuction from areas where you have excess, which is then reinjected into the areas where it is needed may be enough to ameliorate your concerns.  Large volumes of fat, depending on your body habitus may be utilized.  A combination of the two is reasonable as well.  Fat grafting would likely do little to change the position of your nipple reconstruction.   Certainly an evaluation and examination by your surgeon would help you in deciding which procedure(s) may be the right one(s) for you.   I hope that this helps!  Best of luck!

Second round of tissue Expansion

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It is difficult to answer your question without pictures and an in-person examination of your tissues, but in general switching from a 650cc to an 800cc implant won't likely require a second round of tissue expansion. This will be true especially if the skin over your current implants is soft or loose. A good compromise would be to increase the implants somewhat, but to also employ use of fat grafting. This is a procedure where several cc's of your own fat is harvested via liposuction and transferred back into your breasts. This is a nice solution if the volume you are missing is at the top part of your chest. 
Another alternative if even an upgrade with bigger devices and fat grafting is still not adequate for your desired volume is to consider flap surgery such as a TRAM or a DIEP flap which uses your own abdominal tissue to reconstruct the breasts.

Mark Gaon, MD - Account Suspended
Newport Beach Plastic Surgeon

800 cc implants

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Without pictures or the ability to examine you this is very difficult to answer. Clearly your expectations have not been met. The size you are describing is reachin the limits of devices. If the size and shape are not to your liking maybe you should investigate some of the flaps being performed like DIEP flaps. Fat grafting with or without BRAVA could be used. 

Implant size increase

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It is likely that you will not need re-expansion to go up to 800 cc's.  As for impacting your nipple areola complex, an exam in person is important.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.