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The Itty Bitty Titty Committee

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hapa
hapa Member Posts: 613
edited January 2022 in Breast Reconstruction

I really should have started this thread two years ago, but I didn't, so I'm starting it today. If you are wanting to stay small-breasted or are just generally thin and want advice on reconstruction from other women in the same boat, this is the place to ask. Hopefully other small-breasted/thin women will chime in to offer their experiences and advice as well.

Personally, I was a 41 year old trail runner, BMI was a very solid 19-21, 5'3" with an A/B cup and wanted to stay about the same size. I never considered myself to be particularly thin or athletic, or even small-breasted, but I don't think my PSs had a lot of experience reconstructing women my size. I had direct to implant reconstruction plus two revisions: one because my first set of implants were horribly mis-sized by my PS, and the second more recently was fat grafting, which only yielded 30ccs of fat (which is about 2 tablespoons - not worth the down time IMO). I currently have Allergan Inspira Responsive Low-Plus profile 215cc implants. If I had to do it again, I would have gotten TEs at my BMX instead of going direct to implant, and I probably wouldn't have bothered with fat grafting.

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Comments

  • minustwo
    minustwo Member Posts: 13,077
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    Hapa - I hope this thread succeeds. Back in 2008 there was a thread with women who chose to stay small. It was a great support to many people - including me. Seems like many docs just assume women want to be bigger. Or maybe men just want bigger. Anyway, it seems hard for many plastic surgeons to LISTEN.

    Good luck & happy new year.

  • veggal
    veggal Member Posts: 261
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    Hapa, sorry your fat grafting experience was a let down. The surgeon DOES matter. My BMI was 19.2 and my PS easily got two rounds of grafting with great results. From my reading, anyone but those who are emaciated are good candidates, but an experienced surgeon is the key.

    I hope your current implants are trouble free and the fat that was grafted thrives.

  • Cpeachymom
    Cpeachymom Member Posts: 249
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    Love the title!

    I have prepectoral saline, Ideal implant 210 and 270cc, BMI <20, fat grafting on my radiated side at time of exchange, also about 30 cc, gives me a B cup. They don’t match, but they’re not uncomfortable and they look ok with a bra. The fat grafting left my upper pole too full and lumpy, which is probably my only complaint, and I don’t think it can be fixed. I did delayed recon, had TEs placed about a year after finishing rads.

  • hapa
    hapa Member Posts: 613
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    VegGal, when you had fat grafting, where did your PS harvest from? Did you have obvious pockets of fat or did they just harvest a thin layer over a large area. I saw a website of a place in Miami that uses some advanced technique to harvest larger amounts of fat off of thin women by harvesting off large areas that normally would never get liposuction.

    Cpeachy - you are the only person I know of with saline, do you have a lot of rippling?

    I am grateful that my implants aren't uncomfortable. I'd rather they look bad and feel ok than vice versa. But OTOH I feel like a bad looking reconstruction kind of misses the point.

  • Cpeachymom
    Cpeachymom Member Posts: 249
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    hapa- I do not have ripples. My radiated side is too darn tight to move, and my good side has enough tissue to hide any. It's more like a very small augmentation on that side to make them match. I went with the smallest possible for that brand on my good side, and I think he also under-filled it. I'll have to double check that.

    It does FEEL weird though. Like a baggie of water on the good side if you put your hand on it, but I don’t notice it at all throughout the day.

    I agree, comfort and mobility were prime concerns for me. But i knew I wanted recon.

  • veggal
    veggal Member Posts: 261
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    Hapa, the first round she used inner and outer thighs. The second round she again shaved some from outer thighs, hips and also took from my abdomen. She skimmed large areas. In the second round the surgery was actually delayed as the special cannula she uses wasn't in the OR and someone had to find it as I snoozed away. 😳

    The bruising was impressive! She also mixed the fat with something that helped it “take" and it worked well. Two years and it's holding.

  • beach2beach
    beach2beach Member Posts: 245
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    I was at best a full A at diagnosis, I opted for a bilateral mastectomy. Was not a candidate for deep..not enough fat. So I went direct to implants. Even with that my PS told me I would not get much more out of it than a small B due to the fact of skin being tight. I'm two years out. /they are not bad though can see some side ripping in certain angles. Last time I went to PS he said I could have a revision and go a little bigger, Not sure if I want the downtime with it and if I did I still probably would only get to a mid B size

    Guess all in all I'm ok with it. Maybe I will do something somewhere down the line.

  • desertpup
    desertpup Member Posts: 18
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    Yes! Yay for the smalls!!! I asked to have b cups, small C MAXIMUM and he gave me D's!! LOLOL They're ridiculous and too big and now way too far apart and clearly too heavy for my skin/pockets. Definitely having these redone and getting my super sport-ish smalls. I tried talking to the PS that did it and he was actually snarky and not at all interested in being helpful. You really put your trust in these people and they have the nerve to take it so personal when you're not happy. Good Lord!! It's so silly. I'm still swollen on the left side from radiation but will be shopping around soon for a new, more aligned PS.

  • hapa
    hapa Member Posts: 613
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    Hi DesertPup, I see you're in Scottsdale. I had mine done at Mayo in Phoenix both times. When I met with my PS for revision, I took in a page from the Allergan brochure and circled the ones I wanted ordered for my revision. I had them order five sets plus sizers. They did it. I remember when I met with my original PS at Mayo (who quit before my BMX), he said he ONLY places high or very high profile implants. That meant nothing to me at the time. My first set were moderate plus profile and even those were too much projection. Are yours pre-pec or sub pec?

    VegGal - I'm glad you were able to get a good result. I wouldn't allow the PS to take fat from my thighs because my calves are very chunky and I am worried my legs would look upside down if we took any fat off my thighs. But I might allow it if I do any more fat grafting. He thinks he can get ~30ccs off each thigh.

    I met with my PS on Thursday and he said he also cut a lot of scar tissue out of my armpit and injected some fat there. He said he was actually able to cover quite a bit with the fat he took out (probably because my implants are so small) and he thought it was still worth while. I'm still swollen, and he also said the skin might get more elastic over time and that it will be 2-3 months before it all settles. Fingers crossed that this right boob relaxes a bit to match the left.

  • ali52
    ali52 Member Posts: 1
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    Hi Ladies, Yes! Itty Bitty is what I would like. My original PS gave me 495 cc Silicone gel 11 years ago. I am 5’7” very small frame and very athletic. Implants have been so uncomfortable, I am going to have them out soon, but cannot decide whether to get implants again or do FT, so doing lots of reading. I like the idea of the Ideal implant, anyone have experience with them?

  • hapa
    hapa Member Posts: 613
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    I've not heard of Ideal Implants until now. They look interesting. One thing to consider: the silicone implants that are used today are cohesive, so they do not leak if they rupture. They are also "overfilled" so they have a profile much like the Ideal implant, they don't look deflated and they don't deform as much when held vertically. The Ideal marketing info appears to be comparing their implant to older silicone implants. So not that much of a difference IMO, though I haven't felt the two side by side or seen any implanted.

    With the swelling down, I can now see where the fat grafting evened out the top of the breasts on both sides. The divot near my armpit was also filled on both sides, though it looks like the fat took on the prophy side but not the cancer side. The cancer breast still sits higher than the other. I am hoping it relaxes and droops a little over the next couple months. The scar tissue that was removed from my armpit does not seem to have made much difference in terms of how tight that area is or the nerve issues it was causing, though I will wait and see how that plays out as well.

  • Cpeachymom
    Cpeachymom Member Posts: 249
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    ali52- I have Ideal, I liked the idea of saline, prepectoral with alloderm.

  • hapa
    hapa Member Posts: 613
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    Cpeachymom - can you tell us more about your Ideal implants? How do they look/feel? Any ripples? Did you have fat grafting with them?

    My revision is settling and I'd say there is slight improvement over where I started. The scar tissue in my armpit is looser than before; a lot of the tightness I still had after surgery was just swelling. I could feel a long, hard ridge under there after surgery if I dug in, but that isn't quite so hard anymore, though it is thick. I don't know if that was a muscle or tendon or just the scar tissue. The cancer side looks a little more like the prophy side but is still smaller. It is a bit more droopy than before but still kind of hard and perky compared to the left. Maybe it's just me but I like them to look a little bit droopy without a bra as it seems more natural. Otherwise they look like barbie boobs to me. Still hoping for more improvement. I am a little over three weeks out from surgery at this point.

  • nola70115
    nola70115 Member Posts: 61
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    My natural breasts were very large, droopy, and asymmetrical. I HATED them and had basically been ashamed of my body since I was 11 years old. I was glad to have an excuse to get rid of them, although I'd have rather not had cancer though LOL. I had to argue with the PS about wanting to go down in size. It was like they'd never heard of somebody wanting smaller breasts before. Since I had plenty of skin I went direct to implant.

    What I didn't plan on was gaining weight during chemo and from tamoxifen. Before, my breasts were where I carried most of my weight, so when I gained, they just got bigger. Without breasts to absorb weight gain, it went to mid-section. My proportions are all screwed up now because my waist measurement is the same as my bust. I'm basically barrel-shaped. I don't miss having large boobs but I miss being able to buy clothes that fit. Work clothes, like suits, are just about impossible to wear anymore.

    I really don't want more surgeries but I feel like I need to get a revision and lipo around my waist. The implants still feel exactly like silicone bags shoved under my muscles, even five years later. My body is just something I live with rather than feel good about. I won't let them give me huge breasts again though. I can only imagine how much that much of an implant would weigh. Even the relatively small ones I have feel cumbersome.

  • hapa
    hapa Member Posts: 613
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    Nola, are you a candidate for a DIEP? It's more scars, but women who get them seem to love it. I guess it feels a lot like normal breasts, which you will never get from implants.

  • minustwo
    minustwo Member Posts: 13,077
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    hapa - one thing with implants, it takes from 6 weeks up to 6 months to tell how they will look. You said you are only 3 weeks out, so although it is hard - try to step back from the mirror for awhile. You can read about the changes everyone goes through on the "exchange" thread.

  • hapa
    hapa Member Posts: 613
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    MinusTwo - I'm aware of that, just giving an update. I don't expect any major changes though, these are not going to "drop and fluff" like sub-pec implants do. Hopefully the fat grafting causes some of the scar tissue to remodel and the skin on the cancer side will get more elastic. It is definitely not going to get any bigger than it is now, so if it's smaller than the prophy side it will always be unless I get more work done.

  • nola70115
    nola70115 Member Posts: 61
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    Hapa, a DIEP is what I am considering. I've definitely got the fat for it. I didn't get it the first time around because I didn't want the really long surgery and recovery time. The idea of having my entire torso cut up like a patchwork quilt does not appeal, and there's the risk of complications. It would be really distressing for me to have one or both sides "fail" and wind up looking worse than I do now. I chose implants because I wanted the fastest surgery and recovery, but it seems like the only way to avoid future surgeries to to skip reconstruction altogether.

  • beeline
    beeline Member Posts: 193
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    Cpeachy - were you able to do implant recon after rads? I am waiting for my official consult but have been told informally I'll need to use autologous tissue on the radiated side. I am also about a year out.
    Like others here, I am/was a member of the itty bitty titty committee and hoping to stay that way!


  • legomaster225
    legomaster225 Member Posts: 356
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    Count me in the committee. I've been small all my life. My PS was wonderful about making me look pretty much exactly the size I was before. I went immediately to implants 235cc. I'm 5'5" and have been about 110 lbs my entire adult life. Big boobs would look ridiculous on me. Maybe if I was younger I might have gone bigger but not now. I'm happy with my results.

  • Cpeachymom
    Cpeachymom Member Posts: 249
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    beeline- yes, I have prepectoral saline. I did TE surgery almost a year after finishing rads. Then exchange about 5mos later. Expansion was no picnic though, radiated skin doesn’t stretch the way normal skin does. My PS was on board from the beginning and used alloderm to secure the implant on that side. I had no complications, other than a drain pushing on a nerve bundle. I guess you have to find a good PS who has experience with radiated skin.


  • Cpeachymom
    Cpeachymom Member Posts: 249
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    hapa- I did reply a while ago... no ripples, I had fat grafting on my radiated side, but my ps was only able to get very little, so a second round isn’t an option. I realized about a month ago that I can feel the port that is on the front side of the implant, that was unsettling, and prompted a call to the PS to make sure that’s what it was. My radiated side is high and tight and hard, my good side is squishy. I think it feels weird, but my hubby says he doesn’t notice...not sure if he’s just being nice.


  • SuBeez88
    SuBeez88 Member Posts: 5
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    This is a great thread! Its refreshing to hear from other itty bitty people.My doctors kept referring to me as "petite" but I know they were just saying "flat chested." LOL. I'm 5'2", 118 lbs and like a 34A. The size of my DCIS relative to size of my breast made mastectomy a good choice (along with family hx). My plan is to be maybe just be a tad bigger than what I was before (recoop the post nursing droop) and like maybe a B but nothing more.

    I was so fixated on the mastectomy itself that I realize I didn't really tell him what I was envisioning w/ PS at my first visit. We talked about the process and he said we fill the expanders until you are happy, but I didn't think that it might change anything. Well I found out in post op visit, they he put in high-profile expanders. I was wondering if they were contributing to the pain I am having. I told him at my first fill vist this week that I'm not hoping to be that big and it sounds like the implants don't have to be high profile.

    It sounds like with petite people they often use high profile because we're narrow diameter and they look better? Anybody have insight into this? I feel like they should have a catalog of implants besides just the pre/post boob mug shots.

    For people who have already done theirs, did you get a choice of brands/type? Did you have to push your PS for options or did they offer? And did you all do a lot of research before? IF it wasn't for this forum, I wouldn't even know about all these brands and types of implants!!

    Tx! Su

  • hapa
    hapa Member Posts: 613
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    I got direct to implant reconstruction and didn't know much about implants. My whole case was kind of a cluster b/c I decided on pre-pec with one PS, that PS abruptly "left" the clinic before my MX, and the next PS didn't do pre-pec but didn't realize that's what I wanted until a WEEK BEFORE MY SURGERY when she told me she "doesn't really do that surgery". I did ask about implant sizing and she said she'd try a couple different sizes, taking into account how much tissue was removed in my MX, and pick the ones that looked the best. Long story short, she did the pre-pec surgery anyway, the implants she put in were the lowest profile ones they had, and to get the pockets to close she wound up using moderate plus profile Mentor implants that were too narrow for my chest. They looked ridiculous. Do you remember that cone bra that Madonna wore? It looked like I was wearing one of those under my clothes all the time. Without clothes, they roughly looked like two oranges nailed to a telephone pole - completely unnatural and bolted on, and you could see the sides of my chest sticking out past the sides of my implants, ribs and everything. They also got capsular contracture after rads, so I had revision with implants that I picked out myself from the Allergan catalog. Mentor doesn't make anything lower than a moderate plus profile in their overfilled line of gummy implants, which is what is typically used for reconstruction. They special ordered the implants for my revision, but they ordered responsive implants instead of cohesives. I was worried they'd have terrible rippling once the swelling came down but they don't and I like the softer feel of the responsives.

  • beesy_the_other_one
    beesy_the_other_one Member Posts: 170
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    You can make me laugh every time, hapa--

    "Without clothes, they roughly looked like two oranges nailed to a telephone pole - completely unnatural and bolted on . . . "

    Now that's a visual.

  • Ohthatcat
    Ohthatcat Member Posts: 16
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    I just wanted to say I was a 34-36DDD before reconstruction and I am so happy with just having TISSUE EXPANDERS in because my overly large, saggy baggies plagued me forever. I plan on going to a large B, which my PS knows is tough because of bra sizing but he will keep me small. I’m 5’3 and had ginormous boobs since I was a teen. I’m hoping this keeps the fills to implant time shorter, too, although I think I need rads now. But I’m okay with itty bitties now

  • magari
    magari Member Posts: 335
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    I too had direct to implant reconstruction. My first implants were shaped/textured and I developed adhesions and was having other issues with them, so I had them switched to smooth rounds. My body doesn't seem much happier with these, so I am considering having them removed and trying either just fat grafting or possibly DIEP reconstruction.

    Although I am not super skinny, my surgeon told me at my initial consult that she didn't think I had enough tissue for a bilateral DIEP procedure. So whatever is doable without implants is going to yield very small breast mounds. I was only about a 34 B pre-surgically, and my current implants are slightly larger than I'd envisioned - probably because my rib cage is somewhat broad for my 5'4" frame. I'd be completely satisfied with an A, or even a AA cup at this point.

  • Sanzabar13
    Sanzabar13 Member Posts: 1
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    i'm considering having my implants removed and using fat grafting only. I'm a B-C cup 255cc but want to go much smaller. I spoke with my PS and he said he could do it in two surgeries. I was just wondering if anyone else out there has had this done?
    It scares me with all the excess skin. I want to make sure that that's removed. I just want these implants out of me. I can't work out comfortably, can't do anything with out the constant reminder, I just feel uncomfortable in them.

    I want to run without worries

  • magari
    magari Member Posts: 335
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    I was completely okay with going to a smaller size.

    But I currently have excellent sensation, and my surgeon said that I'd need both skin removal and nipple repositioning if she were to remove my implants and go with fat grafting only. Which she said would almost certainly result in the loss of sensation.

    That's a significant loss, and a more involved surgery than I was hoping for. So I bought myself some pretty bras and am planning to keep my implants.

  • desertpup
    desertpup Member Posts: 18
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    Sorry Just now seeing This!!!! Hows things?