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veggal Member Posts: 261
edited July 2022 in Breast Reconstruction

Hi everyone,

After a stressful few days of possible “Bia-ALCL vs something else” it has been determined that the pain and swelling in Lefty is likely due to a rupture in the lower part of the implant. An MRI has been ordered to confirm. Even without the MRI, my PS is ready to schedule an implant exchange, and said on the phone yesterday that she didn’t even need to see me again before surgery. She proposed a quick replacement of both implants

I am in favor of the exchange, as Lefty is so uncomfortable. However, in May when I had my annual appointment, we had discussed “an eventual downsizing” of implants as I did not particularly want to be 80 with these big implants. At that time she told me that we could go down a cup size or two without affecting nipple placement (I had NSM) and the skin would “spring back” and be fine She also has moved the nipple in other women and of course there is always a risk, but so far all have made it

I also have had fat grafting and there are a couple of defects on my donor sites that could use some smoothing and a small divot in Righty that could use a bit of fat I feel this is a good time to address ALL of these issues since she is going to be in there anyway

I plan to bring this up once the MRI is done. My questions for you all are: 1. Has anyone with a history of NSM and implants downsized without affecting or revising the nipple placement? How do you like it? 2. Has anyone with NSM downsized and had to surgically change/move the nipple placement? How did that go?

Finally, I am frustrated that this has happened. Theimplants aren’t even 5 years old, I am pushing 60, and I have no idea what caused the rupture. A part of me wonders if some kind of flap surgery would even be possible as I have had grafting using abdomen and thighs and I have also had an appendectomy with an open incision decades ago I am also pretty thin. Sigh I wish we had a few more options

Thanks in advance!



  • specialk
    specialk Member Posts: 9,221
    edited July 2022

    I had a NSM in 2010, when I was 54, but lost my left expander shortly afterward due to some skin issues. I went through chemo, then had the expander placed again and filled bi-laterally slowly, and exchanged successfully. At a later point I downsized by about 150ccs as I was still having skin issues on the non-cancer side, and there was no nipple location problem as a result of that downsize. I will say that even though I downsized by 150ccs, the cup size was only nominally smaller. I only went smaller on one side and there was very little difference between both sides. In order to lose two full cup sizes I am not sure you would have correct nipple placement, but your PS should be able to advise based on your current size, desired new size, and your individual situation and body habitus. I later downsized again bi-laterally and elected to have traditional mastectomy incisions that removed both nipples, as that was the only way to downsize further, match the sides, and remove the excess skin to achieve good aesthetics without pretty drastic asymmetry. I needed to do the additional downsize to maintain the health of the skin on the left which has had pretty intensive intervention. I have the unfortunate combo of thin skin, very thin pectoral muscles, VERY thorough mastectomies, and poor vascularization as a result of all three of those things - but this is not the experience of most. I don't feel I am a candidate for tattoos because of the skin issues I have had, I don't want to risk more problems. I had a surprise silent rupture diagnosed last year by routine MRI on the right (cancer side) and had both implants replaced since they were textured and had been recalled due to BIA-ALCL risk - the thought being I was under anesthesia, so do both - and downsized slightly again. I was 64 at the time of this surgery, and am now pretty much the original breast size I was, which is great. I asked my PS why she thought the rupture happened, and her response was that sometimes there is a defect in the implant, but sometimes with patients who are slightly built or have a bony chest the implant is chafed in the pocket and develops a thin spot. She said there was no obvious reason when she examined the removed implant. The surgery went well and the aesthetics are good. Sorry this has happened, hope this info is helpful, and wishing you the best.

  • veggal
    veggal Member Posts: 261
    edited July 2022

    Thanks Special K! Your info is very helpful.

    Yep, I am a thin-skinned, bony-chested person. On ultrasound, the bottom edge of the implantappears hazy, and the MRI will likely show more detail. It was also VERY tender when the ultrasound wand pressed on that area. I am quite swollen, but improving.

    I am doing a lot of thinking today.

    Thanks again.