How can breast symmetry be corrected when tissue expander pockets have formed at different heights?

jugglingjellyfish

I had a bilateral mastectomy with immediate above-the-muscle tissue expander reconstruction a few months ago, and I’m trying to figure out how to achieve the best possible symmetry with the implant exchange.

My breasts were naturally symmetrical before surgery, so I’m struggling with the possibility of ending up with noticeably asymmetrical breasts after reconstruction. After everything I’ve been through, it would be incredibly upsetting to have a result that is visibly uneven.

The issue is that my tissue expanders appear to be sitting at different heights, and I’m concerned that the “pockets” have already formed around them in those positions. My understanding is that scar tissue has developed around the expanders, which may make it more difficult to change their position during the expander-to-implant exchange.

I’m trying to understand what options are available to correct this.

A few questions for anyone with experience in implant-based reconstruction:

● Can an implant pocket be lowered if it has already healed around a tissue expander sitting too high? How successful is this, particularly if substantial scar tissue has already formed?

● Can the existing pocket be revised to create a more symmetrical position, or does the scar tissue make this significantly more difficult?

● If the original mastectomy caused a need for internal sutures to prevent the expanders from migrating toward the armpits, can cutting those sutures create enough additional room for the implants to sit lower?

● Can capsulotomy or capsulorrhaphy techniques help correct differences in implant height and pocket position?

● If one breast sits higher than the other, would lowering that breast generally be preferable to lifting the lower breast to match it?

● Has anyone achieved good symmetry after reconstruction when their expanders were initially sitting at different heights? What ultimately made the biggest difference?

I’m particularly interested in hearing from people who have dealt with this specific problem, as well as plastic surgeons experienced in revision surgery after implant-based breast reconstruction.

I understand that perfect symmetry isn’t always possible after a mastectomy, but I’m hoping to get as close to my natural anatomy as reasonably possible. I don’t want to assume that I’m stuck with the current positioning simply because the pockets have already formed.

I’d really appreciate hearing what worked, what didn’t, and what questions I should be asking my plastic surgeon before proceeding with the exchange.

moderators

Hi @jugglingjellyfish, we're sorry for the worries that have led you here. The short answer to your questions is that yes, your reconstructive surgeon should be able to correct the asymmetry at the time of your implant exchange, but it's important to consult with your reconstructive surgeon to discuss which corrective approach would be best for your case.

The following webinar discusses what can be done to ensure that you get the reconstruction results that you want:
https://www.breastcancer.org/videos/corrective-breast-reconstruction-getting-the-results-you-want

Our community discussion thread on implant exchange experiences may also be helpful for you to browse through. Although it is an older discussion, it contains over a thousand pages of comments so that you can get a good idea of others' experiences.