CONCAVITY
Hi all, I'm posting on both the reconstruction and reconstruction alternative forums cause I'm curious about concavity. I had a bilateral mastectomy with expander placement three weeks ago. I chose this option despite my PS saying an expander was not good in previously radiated breast tissue because I didn't want to use other body tissue (like my latissimus) and I felt if I at least tried reconstruction, whether it worked or not, I will have at least tried. (I'm the type that would always wonder... 
) Anyway, as predicted, one of my breasts was radiated in 2006 and it is NOT happy with the expander. If this fails, I will go flat. I am able to wrap my brain around the issue of being flat, and in fact would get a big beautiful tattoo to adorn myself with. What I struggle with is the idea of CONCAVITY. Do we know why that happens? Anyone? Does it have to do with expander or implant placement pushing on the chest wall?
Thanks for any experiences you can share.
Peace,
Geena in Providence
Comments
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Geena,
If by concavity, you mean the way my left side looks after a bliat mast, so that instead of being flat (as I had expected), it is concave, I can assure you it is not the result of a recon job, because I didn't have (or want) recon. It's just the way my rib cage is shaped, I guess. I'm almost flat on the right, so I don't know why the left isn't. I just know it has nothing to do with recon!
Dawn
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Dawn is definitely right that concavity can occur without previous reconstruction. However, I've read posts by women who had an implant removed and experienced concavity, whose plastic surgeons said that implants can definitely compress the rib cage. So I think it's possible that sometimes reconstruction with implants can cause more concavity than would have occurred otherwise.
Dawn, that's surprising in your case that one side is more concave than the other, since if I recall correctly, you didn't have radiation, so you would think both sides would be the same.
Another thing I've learned on this journey is that there are three kinds of rib/sternum configurations (I learned this on the recon board): one in which the sternum forms a level area with the ribs; one in which the sternum protrudes slightly; and one in which the sternum is slightly concave relative to the ribcage. Turns out I have the configuration where my sternum protrudes slightly. When I had my own breasts, though they were a large B/small C, they always fell away from the center of my chest. I now realize this is because of my bone structure. And it explains why, despite having large enough breasts for cleavage, I didn't have a natural cleavage. It also explains why now, post bilateral mastectomy, even though my ribs aren't concave, it appears somewhat that way since the ribs aren't quite even with my sternum.
Sorry for TMI, but I found this info very interesting and thought others might, too.
Geena, many women don't have any issues with concavity even if they had an implant removed. Hopefully, you would be one of them. You might want to look at some of the photos on my non-profit website, BreastFree.org. You'll see that some women have very nice results when choosing to go flat.
Barbara
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Barbara,
You are right, and I expected to be identical, only my surgeon, who did a lousy job on my chest left no spare material on the left except a hideous triple tuck on the side, and a lot of spare material, which I hope and pray was just fatty tissue, on the right. I would have been concave there too. I have what I have begun to describe as 2/3 of a flat-ish bagel with a concave hole in the middle on the right. His scars run from inner lower to outer upper. The scars are quite unattractive, as much as a 1/2 inch wide in places, but they don't stand out the way I understand keloid scars do. He glued me shut instead of using stitches, staples, or steri-strips on the outside (heavy knots on the inside which worked their way out through holes in my skin over the next 4 months or so). Pardon me. I keep telling myself I won't rant about him any more, but every time I get started it all comes back to me, and there I go! Anyhow, you are right, that I would be concave on both sides, if he had removed everything. And like you, I have the more pronounced sternum. I had no idea why I never had cleavage, in spite of being a 36 B or C for the last few years I had breasts. I just keep learning!
Geena, I hope you don't have to worry about concavity, but if you do, there are several types of forms designed to even out such issues. My original TruLife silicone forms had a Plus (a creamy filling encased on the back) on the left one to fill in, and I'm currently wearing the Silique Comfort-Lite, which I love! The beads do the same job in these forms.
Dawn
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Geena-
I didn't do recon and I have 2 beautiful tattoos over my scars. I hate not having breasts but the tattoos help me when I see my image in the mirror. I am not concave, just flat.
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Geena, I talked to you on a different thread about my decision to deconstruct. After 3 years, my muscles were constricting like Charly-Horse spasms around my implants. I figured it was the beginning of capsular contracture. Since I don't have enough excess tissue (or money!) to consider a GAP procedure, even if I wanted to, I am now going flat ala natural.
My ps told me that he had to leave part of the implant inside of me. I tried to find info about it, but he said it is a circular base piece that molds itself onto the ribs, and would be quite difficult to impossible to remove it. I'm not sure if that adds to the terrain of my chest, but I do have concavity.
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Thank you for the feedback, all. Erica - the info on the sternum's relationship to the ribs was fascinating.
Baywatcher - I love that you have tattoos!!!! If this doesn't work out or I cry "uncle", I'm doing the same. I'm with you on the lack of excess tissue and excess money - and frankly - I kind of want to keep my other parts where they are, thank you! I know those options work well for others, but it would not be the direction I would go in.
SLH - Thanks for sharing that with me - again! It sounds like you had a difficult go of it with the spasms and subsequent surgery. I asked my PS today about all of this and she said the longer expanders or implants are left in, the more chance of concavity because the ribs are being pushed on. Hmmmmm. Dunno. More will be revealed!
I so appreciate the feedback!
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I had bilateral surgery 3 years ago and my chest is still concave. Maybe they take the muscles out too? I opted to not have any implants figuring that I'd just use the "falsies". Unfortunately, there is nothing holding the bra down in front, so it slowly slides up and I look like a guy in drag. I have found NOTHING that looks even vaguely natural. Had I known about this concave chest issue, I may have reconsodered the various options.
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ShariPDX,
Thank you for sharing that. I do know if I go "flat" or "concave" I won't wear a prosthesis. The idea to my mind would be to try and move beyond all this to the best of my ability. Dealing with prosthesis adventures might put me over the edge. Maybe thick yoga tops or cami's under things? We'll see. I get a sense that what happens with this expander - whether it improves or doesn't - is out of my control and ultimately I'll just have to let go to whatever the result is. Right now me and the expander in my radiated breast are playing tug of war...... and so far it's a draw...
Thanks for all the feedback!!!
Geena
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I have the prosthesis and 2 very pricey bras tucked away unused in my closet in their cute little boxes. I just wear looser t-shirts, blouses, etc. If I wear patterns or t-shirts with some design, saying, or cartoon on the front, I like to think the boobie thing is not an issue. It's very comfortable and liberating to not wear bras and such.
I didn't want any implants because I didn't want to worry about some nasty little cell who might be growing behind or underneath them, never to be detected. I had my my left breast removed as a precaution when the right one needed removal. I've never been a gambler.
Of course, at 63 they were no longer needed for babies, and not much of a sex toy any more after 30+ years of marriage. It's a harder decision for a younger person, I'm sure.
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Geena-
I just posted a photo of my tattoo on the photo site. That way you can see what it would look like if you went flat with a tattoo.
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I just had a bilateral and am slowly realizing my sternum sticks out severely and so I have two round concave places in my chest. I never had implants...and I too was expecting a flat chest. I guess some tattoos will have to fix this...I see no alternatives.
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Hi WireRabbit-
Welcome to BCO! This is an older thread, but there is lots of discussion about living without reconstruction on many of these helpful links: https://community.breastcancer.org/forum/82/topics...
We hope this can be a place of support for you!
The Mods
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I think it has to do with the shape of your ribcage and also with how much non-breast tissue you have on your chest. I have a large and prominent ribcage and virtually no tissue covering it (light musculature, no fat). As a result, I am not concave at all. On the other hand, my ribs are clearly visible, which is not a great look, but hey!
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This is a good thread, even if it's been inactive. I am concave on the right side now. They had to take all the skin and fat in my last surgery, and essentially just replace it with a skin graft. It's a very thin skin covering my ribs, and that's about it.
Does anyone know if it's feasible to do a little fat grafting into the concave area? Don't know if I'd even want to, but I'm just brainstorming.
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I'm also concave in my mastectomy area, up to my collarbone and under my arm. I had a mastectomy for DCIS in 2000. It wasn't too bad, just a flat area where my breast used to be and the line of my scar.I didn't have chemo or rads, because it was only DCIS.
Then my BF found a lump under my scar in 2009. On biopsy, it turned out to be some of my original tumor cells, now turned invasive and growing into my chest wall. They did scans on me to detect distant mets, which they did not find. That made me stage III and not stage IV.
They had to take my pectoral muscles, as the tumor had started to invade them. I'm down to the bone where my breast used to be. I call it my upgrade surgery, upgrading me to a full radical mastectomy. The muscle doesn't grow back. It's sometimes hard for me to find a prosthesis that fits well, as not many ladies today need or get surgery this extensive. But we do what we must to get cancer-free.
The surgeon also took out 10 of my axillary nodes, of which three were positive. I had CMF chemo, followed by taxol. It wasn't fun, but it wasn't horrible either. They wanted to give me AC, but I'd already had my lifetime max of adriamycin when I had my bone cancer in my leg as a teen. I also had radiation to my chest wall.
My treatment took about a year. It pushed me into menopause at age 42. The node removal and radiation made my lymphedema worse. But I'm still here, NED. As my BF says to me when he kisses my concave mastectomy scars, or hands me my crutches as I hop out of the shower: "you may not be all there, but you're still here." Usually followed by, "and now, how about ..."
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My chest is also concave. I really wasn't expecting that at all. I had Goldilocks reconstruction which was supposed to give me small breasts, sort of a reconstruction compromise. It didn't turn out well and I lost all of it. What's left is thin skin adhered to my rib cage. I am careful not to wear open neck tops because when I bend forward you can see clear to my belly button. My upper chest looks weird as heck.
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It was nice to read through these posts. I didn't reconstruct the right, and worried about concavity, but I think it looks okay.
I'd agree... my very expensive prosthetic likes to take a walk! I'm donating it away next week. Pretending I am German and going braless all the time. Maybe someone else can enjoy that little pink boobie.
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Hi y'all!!
I had a double mastectomy in January of this year and an axillary dissection in February and chose no recon. I'm going to have a fat grafting this coming Tuesday due to the fact that on the right side I was left with a large concave hole. (PS said it might take 2-3 sessions but he might try to do it in 1. I hope)
My cancer was on the left side and that side is not that bad but now after 3 months it's starting to "sink" a little. I asked my BS why my "good" side looks so bad and she only answered that it was because there was a lot of muscle, tissue and nerves that had to be taken out (I was a 44 DD). Hopefully this procedure will help with the pain and discomfort, I can't sleep on my side.
Insurance gave me 2 camisoles and 1 bra with prosthesis but I chose to buy A-shirts because of the cotton and they feel better (tighter) on my chest.
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Amy - thanks for sharing that story! I am glad your BF has been so supportive. That is encouraging to me, because I struggle to adjust to how my body has changed.
I used to be comfortable in my body, and now I just don't feel attractive anymore. I'm only in my 30's so maybe it doesn't help that I compare myself to other young women who still have their breasts. I don't know if reconstruction would help, because I will never get my real/original breast back. Also, my only option is flap reconstruction, which is scary for many reasons. My doctors don't want me to reconstruct anytime soon regardless, so I have plenty to time for the dust to settle. Maybe my feelings on it will normalize in time, but right now it's a hard adjustment.
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Mylosmom - please keep us posted on how the fat grafting turns out! I hope it alleviates some of your symptoms. :-)
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Hi....I had a BMX on May 1st. I was just wondering when you had your surgery and if you feel you looked concave righr away or gradually because I think I m gradually starting to go that way and I dont know if it can happen as you heal. It doesnt bother me. I m just curious.
Thank you
Paisley222
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I think I started to notice it several weeks after my BMX. I had a lot of swelling and tissue necrosis afterward, so maybe I wasn't paying attention to my shape too much. I was too horrified by what was left!
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Hi everyone,
I had my fat grafting done and 2 small "fat necrosis" on my right side taken out on May 15th. As I had thought, we didn't get the results I was hoping for in 1 session. My PS suggested I go do another procedure In July, but I told him that I was going to hold on on having another surgery so soon. I've gone thru 3 surgeries in 5 months and my body needs a break.
The hollow spot on my right side was only filled a little, and he tried to even out both sides at my chest, which that is healing ok. The next procedure would be to continue with the fat grafting and get the "dog ears" under both of my armpits. Hopefully that will alleviate the pain I still have when I lay down on my side. No date set for that yet, will come back and update.
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ha lol
Back in closet. Thanks
For
The laugh
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After 2 years of many problems of reconstruction, I had them take it all out. I am concave, with a sternum that protrudes a bit. My PS left small skin flaps in the middle to help with my bra not riding totally up. I also wear home-made suspenders sometimes. I have found it best when I purchase sports shirts that have bra molds in them. I take out the molds, fill with micro mini beads (on line), insert them back in and tack them in place with a few stitches. I have bought the top loose enough to be comfortable ( I wear a medium, but buy large for comfort). I also shorten up the straps to bring the shirt up high enough to not notice concavity. This works well with camisoles too. I have expensive silicone implants, but love my idea better. This is an old thread, but you might still be having issues.
bilateral mastectomy 2017, 5 reconstruction surgeries, reconstruction removal 4/2019
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