Topic: The Itty Bitty Titty Committee

Forum: Breast Reconstruction — Talk with others facing decisions about whether or not to have breast reconstruction, and if so, what type and when.

Posted on: Dec 31, 2019 03:17PM

Posted on: Dec 31, 2019 03:17PM

hapa wrote:

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.

Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2- Targeted Therapy 3/28/2018 Herceptin (trastuzumab) Targeted Therapy 3/28/2018 Perjeta (pertuzumab) Chemotherapy 3/28/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 8/22/2018 Lymph node removal; Lymph node removal (Right): Underarm/Axillary; Mastectomy; Mastectomy (Right); Prophylactic mastectomy; Prophylactic mastectomy (Left); Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Radiation Therapy 10/22/2018 Whole breast: Lymph nodes, Chest wall Hormonal Therapy 12/21/2018 Arimidex (anastrozole), Zoladex (goserelin) Targeted Therapy Nerlynx
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Dec 31, 2019 10:04PM minustwo wrote:

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.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Jan 1, 2020 11:18AM veggal wrote:

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.

Dx 1/12/2016, DCIS, Left, <1cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR-, HER2- Surgery 3/11/2016 Mastectomy; Mastectomy (Left); Prophylactic mastectomy; Prophylactic mastectomy (Right); Reconstruction (Left): Tissue Expander; Reconstruction (Right): Tissue Expander Surgery 6/10/2016 Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Surgery 9/8/2017 Reconstruction (Left): Fat grafting, Silicone implant; Reconstruction (Right): Fat grafting, Silicone implant
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Jan 1, 2020 03:04PM Cpeachymom wrote:

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.

39 at Dx. Fate whispers to the warrior, 'You can not withstand the storm.' The warrior whispers back, 'I am the storm.' Dx 6/21/2017, IDC, Right, 4cm, Stage IIB, Grade 1, 1/3 nodes, ER+/PR+, HER2- Surgery 7/5/2017 Lymph node removal: Sentinel; Mastectomy: Right Hormonal Therapy 9/11/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 9/18/2017 Lymph nodes, Chest wall Surgery 10/10/2018 Reconstruction (right): Tissue expander placement Surgery 3/24/2019 Reconstruction (right): Saline implant Hormonal Therapy Zoladex (goserelin)
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Jan 1, 2020 04:33PM hapa wrote:

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.

Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2- Targeted Therapy 3/28/2018 Herceptin (trastuzumab) Targeted Therapy 3/28/2018 Perjeta (pertuzumab) Chemotherapy 3/28/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 8/22/2018 Lymph node removal; Lymph node removal (Right): Underarm/Axillary; Mastectomy; Mastectomy (Right); Prophylactic mastectomy; Prophylactic mastectomy (Left); Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Radiation Therapy 10/22/2018 Whole breast: Lymph nodes, Chest wall Hormonal Therapy 12/21/2018 Arimidex (anastrozole), Zoladex (goserelin) Targeted Therapy Nerlynx
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Jan 1, 2020 08:38PM - edited Jan 1, 2020 08:45PM by Cpeachymom

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.

39 at Dx. Fate whispers to the warrior, 'You can not withstand the storm.' The warrior whispers back, 'I am the storm.' Dx 6/21/2017, IDC, Right, 4cm, Stage IIB, Grade 1, 1/3 nodes, ER+/PR+, HER2- Surgery 7/5/2017 Lymph node removal: Sentinel; Mastectomy: Right Hormonal Therapy 9/11/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 9/18/2017 Lymph nodes, Chest wall Surgery 10/10/2018 Reconstruction (right): Tissue expander placement Surgery 3/24/2019 Reconstruction (right): Saline implant Hormonal Therapy Zoladex (goserelin)
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Jan 2, 2020 10:36AM - edited Jan 2, 2020 10:38AM by veggal

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.

Dx 1/12/2016, DCIS, Left, <1cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR-, HER2- Surgery 3/11/2016 Mastectomy; Mastectomy (Left); Prophylactic mastectomy; Prophylactic mastectomy (Right); Reconstruction (Left): Tissue Expander; Reconstruction (Right): Tissue Expander Surgery 6/10/2016 Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Surgery 9/8/2017 Reconstruction (Left): Fat grafting, Silicone implant; Reconstruction (Right): Fat grafting, Silicone implant
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Jan 2, 2020 05:35PM beach2beach wrote:

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.

Dx 7/28/2017, LCIS/DCIS/ILC, Right, <1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 8/8/2017 Mastectomy; Mastectomy (Left); Mastectomy (Right); Reconstruction (Left); Reconstruction (Right) Hormonal Therapy 9/12/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jan 3, 2020 06:33PM DesertPup wrote:

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.

Dx 9/2018, ILC, Left, 6cm+, 1/8 nodes, ER+, HER2+ Surgery 1/15/2019 Radiation Therapy 2/28/2019 Whole breast: Breast, Lymph nodes
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Jan 3, 2020 07:50PM hapa wrote:

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.

Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2- Targeted Therapy 3/28/2018 Herceptin (trastuzumab) Targeted Therapy 3/28/2018 Perjeta (pertuzumab) Chemotherapy 3/28/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 8/22/2018 Lymph node removal; Lymph node removal (Right): Underarm/Axillary; Mastectomy; Mastectomy (Right); Prophylactic mastectomy; Prophylactic mastectomy (Left); Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Radiation Therapy 10/22/2018 Whole breast: Lymph nodes, Chest wall Hormonal Therapy 12/21/2018 Arimidex (anastrozole), Zoladex (goserelin) Targeted Therapy Nerlynx
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Jan 11, 2020 07:15PM ali52 wrote:

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?

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