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Questions and any advice for straight to implant reconstruction?

Looking for advice and suggestions on how to be best prepared for my surgery and any other questions I should consider for my PS.

Two weeks ago I had a lumpectomy bilateral reduction. Love my new breasts. Sadly, the left reduction tissue was chock full of DCIS. The more you know… right?

I get to heal for a couple of months and look forward to a uni-left mastectomy and straight to implant reconstruction.

I decided not to consider any of the flap surgeries. I’ve had three back surgeries and altering my core muscles in any way is a bad idea.

I have an excellent PS and breast surgeon. They both feel that they can scoop everything out and get me a nipple sparing mastectomy with immediate implant insertion.

The PS is aiming for a 650ish ML implant. I’m now a C+ or D down from DDD - thank god for the reduction!!! She’s going to place over the muscle and use Alloderm.

The only reason I’d have an expander is if they don’t get good circulation/profusion. Won’t know until day of. So I’d sign off on the immediate reconstruction but could wake up without a nipple and possibly an expander.

She wants to go back in about 6-12 months and do lipo/fat graft from my tummy to hide the shelf and smooth out the dips yes please! That gives me time to settle in, work out and reduce my own belly before she shapes the bulge I hate. Lemons to lemonade!

Am I missing anything here?

I just haven’t seen anyone go straight to an implant that large. It could be they are comfortable as they have been in my chest once and know what to expect. Plus my breast surgeon is phenomenal.

Thoughts?

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Comments

  • moderators
    moderators Posts: 7,884

    Hi @skyefall,

    Here are some questions to ask your plastic surgeon before reconstruction surgery.

    We hope this helps!

    —The Mods

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,726

    My experience may be less relevant as it was 12 years ago. Generally referred to as one step implants, they seem to be less common than the expander route. When I had my surgery, there seemed to be an upper limit on cc’s but I honestly don’t remember. I am quite petite and liked my natural breasts so my goal was to get as close to that as possible. I believe I’m at slightly under 500 cc’s . I am a 36 C which is a tad bigger but not noticeable. I’ve had no fat grafting as I am stage IV and have had more than enough medical procedures. I also have Alloderm but my implants are under the muscle as over the muscle was almost unheard of 12 years ago. I’m sorry that this info is not more current but over my years on bco there haven’t been too many women who’ve had a one step implant procedure. Take care

  • skyefall
    skyefall Member Posts: 18

    @exbrnxgrl thanks for commenting. Yeah - there haven’t been a ton of like cases that I’ve found on here.

    I think part of my deal is just having had surgery two weeks ago, the surgeons were just in there and have a plan. Which, luckily I like!

  • muska
    muska Member Posts: 224

    My experience is from ten years ago, double mastectomy with implants reconstruction, implants under the pectoral muscle.

    i was hoping for direct to implant but ended up with expanders. They said the damage to tissues from mastectomy didn’t allow to do direct to implant. I don’t remember the exact wording but my cancer was very close to the chest wall and they had to remove a lot.

    Everything turned out well and I had an exchange to implants procedure six months later after chemo.

    I was 36D before surgeries. My implants are 500 ml and I am 36C with implants. Looks good proportionately. I am 5’4”and weigh 141lb.

    Good luck to you!

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,726
    edited September 2023

    muska,

    The op is asking about large cc implants for one step reconstruction, not using te’s. When mine were done there was a limit on cc’s, which I think was at the 500 mark. Her doctor is aiming for over 600 cc’s and asking if anyone had gone that big during a one step procedure.

  • skyefall
    skyefall Member Posts: 18

    It’s all good. The comment tracks with the what if scenarios. It was helpful. Both your input has been helpful.

  • skyefall
    skyefall Member Posts: 18

    Hi all.

    I just had my uniMX and straight to implant. I’m day 3 from surgery and so happy with everything.

    My surgeons were amazing. They landed the nipple sparing MX. I got a 590cc implant. It feels secure. Although super strange at the edges.

    Pain is minimal. Just using Tylenol. Drains are annoying but manageable.

    I’m so happy with my decisions on all this and my faith in my surgeons.

  • moderators
    moderators Posts: 7,884

    That's wonderful to hear, @skyefall! We're so glad to know that your surgery went well, and that you're feeling happy with the results. Thanks for the update! Wishing you a smooth and speedy recovery!

    The Mods

  • nns121317
    nns121317 Member Posts: 110

    My BMX was straight to implant and each is 535cc, which was the largest my PS offered. I'm a big girl, 6'1" and 180 lbs, so he felt the largest option would look most proportionate. Recovery was not a huge deal (it was tough because I only had one good leg at the time due to an injury, but otherwise would've been simple). I had fat grafting earlier this year, and aside from developing a super uncommon infection, it was fine too.

    I'm scheduled for DIEP in April, though. I don't like how the implants feel, I'm not convinced my body loves them, and my radiated side is super tight. I definitely don't recommend radiation with implants, especially larger implants, but that's how my path went. My implants were better before radiation for sure.