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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 12:17PM

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+ (FISH) 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: Right, Underarm/Axillary; Mastectomy: Right; 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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Apr 7, 2020 03:46PM hapa wrote:

Eh, my fat grafting didn't seem to give good cosmetic results. I asked the PS why and he said to get the cancer side to match the other side he would have had to do a capsulectomy. SO WHY DIDN'T WE DO A FREAKING CAPSULECTOMY???? I don't know that I want to bother anymore. I will say that the tightness improved significantly from removing the scar tissue from my underarm and so did the numbness and tingling. So at least there's that.

Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2+ (FISH) 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: Right, Underarm/Axillary; Mastectomy: Right; 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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Apr 14, 2020 05:49PM - edited Apr 14, 2020 05:58PM by sunshyne95

Hi hapa, I've just been reading through the thread, love the Itty bitty idea! I'm a lot further down the road than most of the ladies on here, my dx and lumpectomy/radiation were in 2008! I breastfed 3 kids (dx was at age 41) and had droopy As with a chunk out of the right and scar tissue from lumpectomy that slowly had adhered to pec muscle. 5 years later my surgeon referred me to a plastic surgeon who placed 255g sub-glandular Allergan Natrelle textured surface implants which made me a 34C - I ended up hating being that big, I'm very athletic and they made it very difficult to run/work out comfortably! They also progressively got more painful and I began having symptoms of BII (breast implant illness) about 2 years ago. I also received the Allergan recall letter from my local hospital. So I found another PS (my original one said I didn't have symptoms of BIA-ALCL and my implants looked fine so I should leave them) and explanted with an en-bloc total capsulectomy and mastopexy with U-flap 6 weeks ago today. I am SO happy to be back to Itty bitty and have been feeling so much better! I had capsular contracture to bi-lat breasts and a double capsule on the left. My radiated side (right) is looking pretty freaky - much smaller than left, nipple higher, and very hard (I call it my Franken-boob lol!). When I saw the PS 3 weeks ago he said he could do scar revision and fat transfer at a later date - after reading about your experience with the FT I honestly don't know if I want to bother with it... Plus the tissue is really very weird/tight/hard so I really don't know how they could possibly jam anything else under there! I think I'm also older than most of the ladies on this thread (55) so I think I just don't really care as much about esthetics as I used to, I've had decent looking larger breasts with implants and I found them to be a pain (literally!) and am ecstatic to be back to a small, athletic size (maybe an A?) even though they are uneven etc! Best of luck to all the ladies undergoing reconstruction currently, if I was to pass on any insight I would maybe say try to gather as much information about implants as possible. Not all women have problems with the silicone but at the very least they will need to be replaced every 10 years (more surgeries) and they can have issues such as ruptures, silicone gel bleed, capsular contracture etc and like I mentioned before can cause issues with your health sometimes (I won't go into details about my BII issues because this is already an excessively long post!!!) My implanting PS definitely never passed on any of that information 7 years ago, and BIA-ALCL had been around for years (since 1997 I believe). If I knew then what I know now I would likely not have done any reconstruction... Lol hindsight is always 20-20 though isn't it!

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Jun 16, 2020 02:36AM mikichi wrote:

Hi Ladies,

So happy to find this post, I only wish I had found you all sooner. I too ended up with implants that are bigger than I wanted.

I am 5'7' 124lbs, small frame, athletic. Before BMX I was 34AA.

When researching implant sizing on this site months ago I found so little information for 'smaller' women. I only wanted to be a B and from reading all the forums I thought I needed to get 350cc implants. Several PS websites said 250cc was a 'very small' implant.

My PS recommended direct to implant with 240cc since he estimated I had 190cc breast tissue. He never showed me sizes so I went off information I found online and I asked him to put in the biggest size possible - 300cc, which he said would be a B. Well, after the surgery I discovered my actual tissue was only 80ccs and that the 300cc moderate plus profile mentor smooth rounds looked completely ridiculous - I felt like a porn star. Even my husband cried for how completely out of proportion they looked on my body.

So I had the implants replaced. Again the surgeon wanted to go 235cc (narrower base, mentor smooth moderate profile - lower profile looks more natural PS said). I said lets do the smallest size available - 195cc, but we ended up agreeing to meet in the middle with 215cc moderate profile.

Two months post surgery and I went bra shopping. I am now a 32D. Both my husband and I think that the implants are still too big. The PS did a good job - they are symmetrical, and there is light/ moderate rippling as expected. But the foobs are bigger than I ever wanted. For many women they would be ideal, but personally they still feel huge.

It's a relief to hear that I am not the only one on this forum who feels this way, but also really frustrating. I don't want to go through another exchange and then end up with a worse result/ scarring/ contracture so I will just leave them alone for now. Maybe when they need to be replaced I can finally down size to some nice itty bitties again.

Just today I had what might be my final consult with the PS and asked about fat grafting. My chest was bony before, but now you can really see my ribs, including in between the implants, and a significant depression and line above the implant. In a bra or bathing suit my husband says you can obviously see that I have implants and the concave areas above the implant are noticeable. The PS said he could do fat grafting using fat on my thighs, but he would not recommend it. 'It will make a little improvement, but not what you are hoping for.' He told me the best option would be to gain weight. For someone who has been the same size since they were a teen and is very active, that is not a helpful suggestion.

So now I am wondering if it is worth it to do fat transfer. The experiences of ladies on the breastcancer forum, as well as recommendations on PS sites are really mixed. Is it worth it to go through another surgery? Do I want to use up my fat reserves on a procedure that might work? The big incentive to do it now is that I will lose my insurance coverage in three months so any future fat grafting will be out of pocket.

What do the other itty bitty ladies think? Was fat grafting worth it for you?

When I went in for direct to implant BMX, I naively thought it was going to be one and done. Now I see from this forum that it starts with the first one and then continues on with a lifetime of surgeries.

Advice to small women out there - make sure you have a really clear idea of what size you want to be after surgery. Ask the PS for photos of different sizes on women with similar frames. I went in with no clear idea and just trusted the PS to do what they thought was best. Ask to try sizers so you can get a feel of how new bigger implants will look and feel. The goal is to feel comfortable in your own body, not fit into the stereotype of what 'most women want.' If that means special ordering a smaller size implant than the PS usually caries, then be prepared to wait to get the right size.

Surgery 3/19/2020 Prophylactic mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Jun 17, 2020 07:12AM hapa wrote:

at 5'7" and 124 lbs, it is doubtful you have enough fat to make much difference. I had one round of fat grafting where they removed from my abdomen and flanks and they only were able to harvest 30ccs of fat. That is two tablespoons of fat. The PS put it near my armpits where the edges of the implant looked really unnatural and could be seen if I was wearing a bathing suit or tank top, or though a tight top. It looks better but that wasn't enough fat for it to look completely normal. And you can still see the edges of the implants on the sides, plus a few ripples. I am 5' 4" and about 118lbs. Of course numbers don't tell the whole story, you can be "skinny fat" and maybe you do have more fat than your stats would suggest. I seriously thought they'd get 100-200ccs of fat of my abs no problem because I had a little pooch there, but that was not the case. My PS said that taking more would have risked leaving indentations on my midsection where they took the fat from. After the surgery I was annoyed that he wasn't more aggressive with the liposuctioning, but having seen pictures of a thin woman whose PS took too much fat off and left her with a lumpy stomach, I'm now glad he held back. My stomach does look great now though, so at least I've got that going for me.

Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2+ (FISH) 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: Right, Underarm/Axillary; Mastectomy: Right; 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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Jun 18, 2020 04:44AM beach2beach wrote:

Hi,

I was always very small chested. Barely filled an A. After finding out I had BC i decided to do a bilateral mastectomy. Both boobs had taken biopsies over the years and doing a lumpectomy really would have left that sucker deflated. Because I was thin I did not have any fat to use for DIEP so the PS suggested direct to implants. My skin was tight..so couldn't say how big he could go. End result, I came out with a 140cc..more than I had before but still small but I have shape to it. Before I don't even think I had anything you would call cleavage. :) I can pass in a 32B now, not completely filling it. You can see ripples but unless they lob fat off of my butt and stuff it around it, I'm ok with it. I would not have looked right with anything big. I'm 5'10 and at the time I was 137.

I now and forever shall be one in the itty bitty titty group.

Dx 7/28/2017, LCIS/DCIS/ILC, Right, <1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 8/8/2017 Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Hormonal Therapy 9/12/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jun 18, 2020 09:30AM MinusTwo wrote:

10+ years ago, there used to be an active thread here for ladies who preferred small. I found that most docs 'assume' that all women want to be big/bigger/biggest. Interesting that many plastic surgeons are men. I always thought they were imposing their values. Just wanted to register as a member of the group. I was so glad to get rid of large breasts. Blouses always gaped if I chose one with buttons. I wanted implants, but only big enough so that I could pull on my clothes & look good with no hassle. My implants are medium size and acceptable, but I would have been happy with smaller too.

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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Jun 18, 2020 09:52AM MinusTwo wrote:

Just for grins & giggles, I found the old thread from 2014. But even just look at the header, the picture is startling.

https://community.breastcancer.org/forum/44/topics...


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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Jun 18, 2020 10:18AM hapa wrote:

Thank you for digging that up, MinusTwo!

Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2+ (FISH) 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: Right, Underarm/Axillary; Mastectomy: Right; 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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Oct 27, 2020 02:29PM beeline wrote:

Hi, for those itty bitties who have implants and are satisfied with their outcome, can you tell me what size they are? I've re-read the thread and see just a couple mentioned. I am currently mid-delayed recon with a tissue expander filled to 140 and trying to get a sense of how much farther to go. I'm about 5'3" 19-20 bmi. Always been an A/B cup. I know it's different for everyone, but would still love more data points from others on the smaller side.

hapa, I see you're at 215 now. What size were your "oranges bolted to a telephone pole" implants?

Thanks!

American in NZ. Dx’d at 42. Had to stop Taxol after #6 due to neuropathy. Randomised to control group in MonarcheE trial 😩 Started delayed recon with FT and implants in 2020. Dx 7/17/2018, IDC, Right, <1cm, Stage IA, Grade 2, ER+/PR+, HER2- (IHC) Surgery 8/2/2018 Lymph node removal: Right, Sentinel, Underarm/Axillary; Mastectomy: Right Dx 8/21/2018, DCIS/IDC/Paget's, Right, 2cm, Stage IIIC, Grade 2, 10/22 nodes, ER+/PR+, HER2- (IHC) Chemotherapy 9/18/2018 AC + T (Taxol) Hormonal Therapy 2/12/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 2/25/2019 Whole-breast: Lymph nodes, Chest wall Hormonal Therapy 1/22/2020 Arimidex (anastrozole), Femara (letrozole)
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Oct 27, 2020 05:32PM MinusTwo wrote:

Beeline: Whippetmom doesn't check every day anymore, but she really is the 'breast whisperer'. If you read the header of the thread link below and provide all of the information she discusses, she will likely get back to you in a week or so. Her recommendations are "gold".

https://community.breastcancer.org/forum/44/topics...

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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Oct 27, 2020 09:17PM hapa wrote:

beekine, I think the oranges were 195 on one side and 220 on the other. The current ones are wider (bigger base) and lower profile

Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2+ (FISH) 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: Right, Underarm/Axillary; Mastectomy: Right; 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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Oct 30, 2020 02:19PM beeline wrote:

Ah, so it’s about the profile than specifically size — thanks Hapa!

American in NZ. Dx’d at 42. Had to stop Taxol after #6 due to neuropathy. Randomised to control group in MonarcheE trial 😩 Started delayed recon with FT and implants in 2020. Dx 7/17/2018, IDC, Right, <1cm, Stage IA, Grade 2, ER+/PR+, HER2- (IHC) Surgery 8/2/2018 Lymph node removal: Right, Sentinel, Underarm/Axillary; Mastectomy: Right Dx 8/21/2018, DCIS/IDC/Paget's, Right, 2cm, Stage IIIC, Grade 2, 10/22 nodes, ER+/PR+, HER2- (IHC) Chemotherapy 9/18/2018 AC + T (Taxol) Hormonal Therapy 2/12/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 2/25/2019 Whole-breast: Lymph nodes, Chest wall Hormonal Therapy 1/22/2020 Arimidex (anastrozole), Femara (letrozole)
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Aug 13, 2021 12:23AM ChrisJack1 wrote:

Oh my you are my peeps! I am teeny, maybe a 32 AA at best and I'm 5.9 and 122 so can't get a diep etc (too bad they can't use my cellulite laden saddle bags. My upper body is disproportionately smaller and bonier than my lower body so yeah, I'm a pear. I am getting a mastectomy w recon on September 16 instead of BS recommended lumpectomy w radiation because removal of my tumor will require losing my lower breast pole. Despite the fact that the BS admitted that I could have a significant defect from a lumpectomy w rads, she thought it "likely wouldn't look too bad". The first BS I consulted said it would "disfigure me" but still she recommended a lumpectomy w rads too. Honestly, I believe they assume it wouldn't be that big of a deal because I have such small breasts. The PS thought that most likely was the issue, and although he conceded that there could be an over hang/droop & puckering effect after rads (tumor is about a half an inch down from the nipple) he warned me that he would have to make me a large b or small C because the footprint of the smaller implants would be too small. I wanted to be a full A and at most a small B. Has anyone had this issue?? Anyone told they have to go bigger even thou they are narrow? This is a reputable PS from a prestigious hosp in a large east coast city saying this.

ALSO, I told the PS that maybe I should just consider going flat on that side because he said that implants (sub-pec he recommended) would look "pretty darn fake" on me bc I have thin skin and I'm boney. He warned me that I will have extensive rippling, be able to see the outline of the silicone implant in places, and it will sit high up. He said that may be something to consider since I don't want the fake look and I really "didn't have much breast tissue to begin with". Basically, he said, a mastectomy wouldn't be so drastic bc I'm pretty darn flat already. TO ME it feels like my concerns re loss of my breast and issues re reconstruction matter less bc I didn't have breasts (read, bigger breasts) to begin with. My own mother said going flat wouldn't be such a big deal bc I'm so small and so many women athletes are small and "didn't I watch the Olympics". Ahhhh

Anyone feel dismissed - like it didn't matter? I have always been so embarrassed about the size of my breasts and my body - not feeling feminine and no, therapy hasn't worked. Knowing recon w implants will put the left breast up high and the natural breast not too great is a bummer. Maybe I should just go flat. If I just could be smaller. Don't know what to do. I'm very lost. I am also trapped caring for my 91 yr old dad who fell at Easter and is now handicapped, incontinent, and he has dementia. No one helps. I haven't been home but 5 times in all these months. Any opinions or input is welcome!


Biopsy 6/2021: Lft breast - Invasive carcinoma w/ ductal & lobular features. Foci suspicious for lympthovascular invasion, grade 2. Estrogen R pos. at 99%. HER2 neg. Unilateral MX w/ TE sub-pec scheduled for 9/16/21 Dx 6/17/2021, ILC/IDC, Left, Grade 2, ER+/PR-, HER2- (IHC) Surgery 9/16/2021 Lymph node removal: Left, Sentinel; Mastectomy: Left; Reconstruction (left): Tissue expander placement Hormonal Therapy Surgery Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery
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Aug 13, 2021 02:20AM Rah2464 wrote:

ChrisJack1 I was always a little girl as well, but I went for the implants. I am thin and thin skinned so yes I do have some rippling. Doesn't bother me too much. You should reach out to whippet mom on this site who responds to the breast sizing 101 forum. She is very good with implant sizes based on your body type. Does your PS have photos you can review to determine what you want to do? What about having the implant reconstruction then removing them if you just hate it?

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 6/26/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 7/26/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 11/19/2020 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Aug 13, 2021 12:20PM hapa wrote:

ChrisJack - most PSs have no idea what to do with thin small breasted women. Doctors have a bad habit of trying to either minimize or blame the patient for problems that they don't understand or can't fix. Unfortunately you are likely to get a poor outcome if you do a BMX with reconstruction. Have you asked about getting a lumpectomy and having the remaining tissue rearranged to make a small, somewhat normal looking breast? Will the dent be small enough for them to fill it via a few rounds of fat grafting? You might have to get creative and shop through a lot of plastic surgeons to find someone who is confident about working on someone your size.

The other option is to get low profile implants. You will have to get them from Allergan, as I don't think Mentor makes anything less than a "moderate plus" profile implant. You can find their table of implant sizes online -- print it out and take it to your PS and ask them which implants they are recommending. IIRC mine are low-plus profile responsive implants from Allergan. The responsives sag a little more than the cohesives, which IMO makes them look and feel a little more natural. The downside of that is that they supposedly have more rippling, but the rippling on mine isn't bad and it's less than I had with the higher profile cohesive implants. I wish there were more science involved in implant sizing but most surgeons just wing it and you have no idea what you're getting until you wake up.

I'm seeing a PS at MD Anderson about a capsulectomy and they definitely don't make me feel like my problems don't matter. The original PS I had did, and everyone at that cancer center would always tell me how great my recon looked when I looked like a cartoon. I felt like they were all trying to gaslight me into just accepting the shitty job they did the first time around so they wouldn't have to fix it. When I mentioned that the implant was painful all the way around the edges on one side but not the other they were like "well that's just how it's going to be". Okay, thanks! I say keep shopping plastic surgeons until you find one that has put in low profile implants. A lot only want to do high or very high profile implants, I don't understand why.

Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2+ (FISH) 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: Right, Underarm/Axillary; Mastectomy: Right; 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 27, 2021 01:09PM - edited Dec 27, 2021 01:10PM by Jewelweed

I definitely want to watch this thread!

I was a D-cup, then had an oncoplastic lumpectomy. I am now a small B-cup and couldn't be happier. I'd be pleased even to be an A-cup. The idea of being able to wear bralettes while I run just makes me giddy!

The breasts are a little uneven though-- the non-BC breast is slightly larger and a little lower than the one where I had the lumpectomy, and now, post radiation, I am worried that this discrepancy is going to get worse.

I do *not* want larger breasts, just symmetrical ones. My current PS though seems to think it is just not worth it to make minor tweaks. I would think we could at least do a slight reduction and lift on the non-BC side. Anyone else face something like this?

Dx 7/15/2021, IDC, Left, <1cm, Stage IA, Grade 2, 0/5 nodes, ER+/PR+, HER2-
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Jan 8, 2022 11:41AM PandaPoo wrote:

Hi everyone, I'm new to all these. Got my biopsy result on Tue. I'm very flat (like cup AAA flat) and I'm hoping for mastectomy with reconstruction so that I can finally have boobs. From the initial reading, DIEP sounds fabulous if done right (tummy tuck as a bonus after giving birth to twins). But it looks like most you gals chose to have silicone implants instead of flap. I'm very curious as of why. Sorry if this is a very dumb question. I'm still reading and there's just so much to read...

Dx 1/4/2022, IDC, Right, 2cm, Stage IB, Grade 2, ER+/PR+, HER2-
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Jan 8, 2022 12:10PM Moderators wrote:

Hi, PandaPoo! We just wanted to drop a line to say welcome and thanks for participating in our Community! You have come to the right place for support and shared experiences with others, and we're sure our members and their responses will help you make the best decision along with your medical team. We hope you get answers and advice soon. Please let us know if there's anything at all we can do to help!

Best wishes,

From the Mods


To send a Private Message to the Mods: community.breastcancer.org/mem...
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Jan 8, 2022 12:20PM - edited Jan 8, 2022 02:38PM by ParakeetsRule

PandaPoo, thin, small women often don't have enough spare flesh for a flap reconstruction. I ended up going flat because I didn't want to deal with an implant and that was my only option for reconstruction. I didn't have enough extra fat to create a boob. (and still don't)

I'm 5'2" and 112-118 pounds. I don't know my cup size because I don't wear regular bras, but I'd guess it's some variety of A cup. I kept my healthy right breast and now wear a small knitted knocker prosthetic on the flat left side. I requested their smallest size and still had to pull out half the stuffing so it would match my other boob. 😆

Dx at 36 and again at 41. So dumb. Dx 3/21/2017, IDC, Left, Grade 2, ER+/PR-, HER2- Chemotherapy 5/15/2017 AC + T (Taxol) Surgery 9/13/2017 Lymph node removal: Underarm/Axillary; Mastectomy: Left Radiation Therapy 11/1/2017 External: Lymph nodes, Chest wall Hormonal Therapy 1/15/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Dx 11/2021, Stage IV, metastasized to bone/lungs/other, ER+, HER2- Hormonal Therapy 12/8/2021 Zoladex (goserelin) Hormonal Therapy 12/8/2021 Faslodex (fulvestrant) Targeted Therapy 12/13/2021 Piqray (alpelisib)
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Jan 8, 2022 01:58PM MinusTwo wrote:

My PS said not enough natural fat to make anything w/o silicone implants

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 9, 2022 02:49AM Rah2464 wrote:

Yes, same here. Nothing to work with. 5'8" and 120 lbs. I had always had tiny boobies, now I have moderately sized implants that are way bigger than my natural ones were.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 6/26/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 7/26/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 11/19/2020 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Jan 10, 2022 04:25PM hapa wrote:

Not enough fat for a flap. My PS did a fat transfer and only got 30ccs off my abs and flanks, so yes, a flap was out of the question.

Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2+ (FISH) 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: Right, Underarm/Axillary; Mastectomy: Right; 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 13, 2022 04:08PM NayaBean wrote:

I hope this is the right place to post my concerns and questions about my recent reconstruction surgery. If not -- if I should do a separate post in the Breast Reconstruction parent forum, for example -- please let me know!

The problem that prompts me to post here is that my implant, which was put in two weeks ago today, looks much bigger than I thought it would. I had a total of 300 cc of silicone injected into the tissue expander, but the implant size is 770 cc. Does this mean that my implant is more than twice as large as I thought it would be? Or is it possible, somehow, that a 770 cc implant is similar in size to a tissue expander that had only 300 cc of silicone injected, because of some correlation metric that I don't understand? And that my perception of the size, now that I have lived with it for two weeks, is somehow off?

Details: I had a mastectomy in the left breast only, with a tissue expander. Pre-cancer, both breasts were way too big, in my opinion, for my 5'0" height. The one silver lining of the whole cancer journey for me was looking forward to having two normal-sized breasts, with an implant on the left and a reduction on the right. During the expansion process, I said that I wanted only 300 cc. My plastic surgeon thought I should have one more fill of 100 cc, for a total of 400 cc. But I knew I wanted only 300 cc, so that's what we did. (Three fills, 100 cc each.)

So as I said, the reconstruction surgery involved an implant on the left and a reduction on the right. After the surgery, I was disappointed to see that the implant on the left, to my eye, was noticeably bigger than the reduction on the right. (I am very happy with the size and look of the reduction.) So I checked the Device Identification Card that I was given after the reconstruction surgery, and I see that the implant size is 770 cc.

Clearly, there was a failure of communication between my plastic surgeon and myself. Or else, I just don't understand how this all works. I had assumed that the implant size would be 300 cc or thereabouts -- not 770 cc. But maybe I am totally confused about how the tissue expander fill correlates with the implant size.

I will talk to my plastic surgeon about this when I see him for the post-op appointment this coming Tuesday. But in the meantime, I am wondering if anyone here can tell me if I am right in thinking that my 770 cc implant is way too large, given that it was clear that I wanted (and got) only 300 cc of silicone during the fill process.

Note: According to the Device Identification Card that I was given after the surgery, I have an Allergan Natrelle Inspira Cohesive Breast Implant, Style SCF, 770cc.

___________________________

P.S. I also failed to confirm with my plastic surgeon what shape my implant would be. We just never talked about that -- he never brought it up, and I never asked (that part is clearly my bad). I assumed it would be teardrop-shaped, to match the shape of the right side. (After the reduction, the right side is definitely teardrop shape, which I like because it looks natural.) But the implant I got is the kind that is very rounded on top. So that's another assumption that I should have confirmed, and another way the two sides don't match. Sigh!!!

Dx 5/27/2021, IDC, Left, Stage IIA, Grade 3, 1/38 nodes, ER+/PR+, HER2- Surgery 6/25/2021 Lymph node removal: Left; Mastectomy: Left; Reconstruction (left): Tissue expander placement Hormonal Therapy 8/3/2021 Arimidex (anastrozole)
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Jan 13, 2022 04:31PM hapa wrote:

Your surgeon didn't communicate with you very well if you guys didn't discuss implant shapes and how your breasts would look post-surgery. Obviously the reduction was done to match the two sides so there's no good reason why he should have put a large implant in and then reduced the second breast to a smaller size. He probably wrote in a note long ago that you would get a 770cc implant and so that's what his PA ordered and that's all he had on hand the day of your surgery, so that's what he put in, but who knows why he chose such a large implant, ask him. Or just find a different surgeon and tell him/her that you're unhappy with this outcome and you'd like a revision. Granted I haven't seen your breasts and I wasn't in that room when you had your consult, but it sounds like your reconstructed breasts are very much not symmetrical, and I have no idea why anyone would want a reduction on the non-cancer side but not the cancer side, so unless you explicitly asked for that, from my reading of your post your PS sounds like an idiot.

Few surgeons are using teardrop implants anymore due to risk of some rare cancer, but he should have told you that or at least told you that your breast would not have a natural shape and would not match the non-cancer side. If you want the breasts to match you may need to have a further reduction with a small round implant added on the non-cancer side, or just have a complete MX of that breast and get two matching implants. If you are moving on to have radiation, keep in mind that radiation may result in capsular contracture (it did for me) and so you may want to start with a bigger implant on that side.

If I were you I'd ask some pointed questions at your next follow up and unless he has some REALLY convincing answers, start looking for a new PS to do the revision.

Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2+ (FISH) 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: Right, Underarm/Axillary; Mastectomy: Right; 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 13, 2022 04:55PM NayaBean wrote:

Thanks, hapa.

I didn't actually know that few surgeons use teardrop implants. But as you say, you would think my plastic surgeon would have made all of this clear to me. I will definitely talk to him about all this when we meet on Tuesday. It might make sense to have a revision, although I don't know if insurance would cover it.

For whatever it's worth, I realize that my post makes it sound as if my plastic surgeon messed up. But he was recommended by my breast surgeon, who was recommended by my primary care physician, whom I think is awesome. I had a very good impression of him when we first met, and just in general -- he is very kind, for one thing. But also: once I had met with him the first time, it occurred to me to do a search on him in these breastcancer.org forums. He comes up several times, and everyone here who mentions him talks about him very highly. Which makes me wonder if all this is mostly my fault? Like maybe he *did* discuss all this with me, and in some brain fog it didn't sink in? But having said that, I can't really imagine that I would have missed the kind of discussion that I now wish we had had!

P.S. I am not having radiation, so that's not an issue.

Dx 5/27/2021, IDC, Left, Stage IIA, Grade 3, 1/38 nodes, ER+/PR+, HER2- Surgery 6/25/2021 Lymph node removal: Left; Mastectomy: Left; Reconstruction (left): Tissue expander placement Hormonal Therapy 8/3/2021 Arimidex (anastrozole)
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Jan 14, 2022 02:16AM Rah2464 wrote:

NayaBean, not sure how much difference in size you are seeing but I do know that your reconstructed breast will be swollen for a while and will reduce in size just a bit over a few months or so. But I as well am not sure how the implants are sized. Volume is volume and is not impacted by material (silicone or saline). I am not sure if TEs have a certain "volume" pre fill that is counted towards a total? Hope you get some answers and get things resolved to your satisfaction.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 6/26/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 7/26/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 11/19/2020 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Jan 14, 2022 08:54AM NayaBean wrote:

Hi, Rah2462.

It's hard to convey the difference in size that I am seeing, without photos! But it's not freaky -- for example, I doubt that a stranger would necessarily notice it if I were out in public, walking down the street wearing a bra and a shirt. In fact, when I first saw my adult daughter after the surgery, I was wearing my compression bra and a polo shirt, and she said I looked great. But then when I pointed out the specific concern I have -- I can best describe it as a fairly large mound on the top half of my left implant side, which is not mirrored at all on the right reduction side -- she definitely noticed it, and even said if it were she, she would request a revision surgery.

That is a good question, about whether there is any pre-fill in the TE. I seem to recall reading somewhere online that a TE can start with something like 60cc before being put in. But I don't really know if that's true in general, and I definitely don't know if that was the case with my TE. So I will add that to the list of questions to ask my surgeon on Tuesday!

I'll also ask about what you brought up regarding what I can expect as time goes on and any swelling is reduced.

Thank you!

Dx 5/27/2021, IDC, Left, Stage IIA, Grade 3, 1/38 nodes, ER+/PR+, HER2- Surgery 6/25/2021 Lymph node removal: Left; Mastectomy: Left; Reconstruction (left): Tissue expander placement Hormonal Therapy 8/3/2021 Arimidex (anastrozole)
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Jan 14, 2022 09:22AM ParakeetsRule wrote:

It sounds like you have some shape issues too but if there's a size difference other people wouldn't notice, I wouldn't necessarily think that's a bad thing. It's pretty common for natural breasts to be different sizes! Mine definitely were but nobody but me could tell.

Dx at 36 and again at 41. So dumb. Dx 3/21/2017, IDC, Left, Grade 2, ER+/PR-, HER2- Chemotherapy 5/15/2017 AC + T (Taxol) Surgery 9/13/2017 Lymph node removal: Underarm/Axillary; Mastectomy: Left Radiation Therapy 11/1/2017 External: Lymph nodes, Chest wall Hormonal Therapy 1/15/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Dx 11/2021, Stage IV, metastasized to bone/lungs/other, ER+, HER2- Hormonal Therapy 12/8/2021 Zoladex (goserelin) Hormonal Therapy 12/8/2021 Faslodex (fulvestrant) Targeted Therapy 12/13/2021 Piqray (alpelisib)
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Jan 15, 2022 07:17AM - edited Jan 15, 2022 07:18AM by Ava55

Hi all,

I am getting a bilateral mastectomy and a reconstruction using Mesh ADM (accelular dermal matrix) implants on my right breast with a sentinel node biopsy.

I have DCIS 8cm intermediate and worried about whether they will find evidence of it being invasive or worse in the nodes.

Has anyone been through this with similar journey?

Also concerned that the implant will be larger than my natural breast and that it will feel strange and not symmetrical (I didn't have enough fat for DIEP).

Any advice on things to talk to the surgeon about or what to expect?

Thanks

Ava

DCIS, intermediate, ER positive, mastectomy plus ADM reconstruction with implant plus sentinel node biopsy ,
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Jan 15, 2022 08:33AM NayaBean wrote:

Thanks, ParakeetsRule.

You're right, I have both size and shape issues.

Thank you for the reminder that it's common for women to have different size natural breasts!

I'm beginning to think this will all work out, once my plastic surgeon and I really talk. Thanks everyone for letting me go on about this, and for your helpful comments.

Dx 5/27/2021, IDC, Left, Stage IIA, Grade 3, 1/38 nodes, ER+/PR+, HER2- Surgery 6/25/2021 Lymph node removal: Left; Mastectomy: Left; Reconstruction (left): Tissue expander placement Hormonal Therapy 8/3/2021 Arimidex (anastrozole)

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