Unhappy with Reconstruction After Mastectomy?

Question

I had a bilateral mastectomy last year, with tissue expanders and silicone implants. My breasts don't match and one side hurts. The implant moves differently (like it's loose) on the painful side, is below the crease, and an inch lower than the other side. Everytime I bring up the pain and that one side is lower and below the crease, my doc says she is happy with the result. I want them to come close to matching! Am I being unreasonable? If not, how do I get her to address my concerns?

Shitel Patel, MD · Answer

I recommend getting a second opinion. It is difficult to know your options without an in-person consultation. My best guess is there are options to correct your complaints. Good luck!

Larry S. Nichter, MD, MS, FACS · Answer

Without an exam or even photos, it is impossible to render an opinion. However, given the fact that you have concerns and don't feel your plastic surgeon is listening to you, I would advise a second opinion.

Robert Whitfield, MD · Answer

You can use your own tissue!Three
basic forms of breast reconstruction exist. You can use your own tissue,
implants or a combination of the previous two techniques. Your own tissue can
be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting.
Implants can be done in one stage or two stage. Two stage reconstructions are
started by placing expanders at the time of mastectomy. Once they expanders are
placed they are able to be inflated as determined by wound healing. The final
time consists of combining any of the above techniques.

If
you are interested in being seen in Austin please give us a call.  I know
this is a difficult time for you.  The majority of my practice is devoted
to reconstruction for women with breast cancer or who are BRCA+

Sugene Kim, MD, FACS · Answer

If you feel that your plastic surgeon is not listening to your concern/needs, you can get a second opinion from another plastic surgeon. It is not unreasonable to get the second opinion when you are unhappy and having asymmetry and pain.

Steven Wallach, MD · Answer

As for the appearance, I can not comment because I do not know how they look.  Bare in  mind, no two breasts are exactly the same, so asymmetry to some degree is normal.

Darryl J. Blinski, MD · Answer

Reasonable = yes but possibility is another matter. Best to obtain a few in person opinions. Remember "realistic expectations" are paramount in any reconstruction. Best of luck.

David L. Abramson, MD · Answer

It is reasonable for you to want to be as symmetric as possible. However there will always be some slight differences. Pain is a concern as well as your statement that one breast is below the inframammary fold.

Kamran Khoobehi, MD · Answer

Breast reconstruction with implants are very challenging. There is minimal soft tissue coverage. The other concern is the quality of the skin due to the radiation . Fat grafting post reconstruction is a promising new technique and you may want second opinion if your surgeon disagrees with you about the results. Please be realistic.

Robin T.W. Yuan, MD · Answer

There are two aspects to this question/issue. One is a patient's dissatisfaction with a result. The other is the potential of the procedure itself. Certainly the only reason to undergo plastic surgery is to improve your face or body to the degree that it has a positive effect of you. if you are dissatisfied, that is a shortcoming of your result. The other part of the question is whether your expectations can ever be met by your surgeries. Some surgeries are inherently imperfect. Breast reconstruction and even breast augmentation with implants are inherently imperfect operations. The problem is to reconcile these two issues. i think all reconstructions should have the expectation of some asymmetry. Whether or not that asymmetry can be improved to the degree that you are satisfied can only be resolved with a detailed exam and review of your past surgery. You can always request a referral for a second opinion.

	Robin T. W. Yuan, M.D.

Edward J. Domanskis, MD (in memoriam) · Answer

I would recommend getting another opinion. It is far easier to get symmetry usually in someone after a doublke mastectomy rather than a single. Different things can be done to achieve this.

Unhappy with Reconstruction After Mastectomy?

Answers (12)