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Topic: question about my implant replacement

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: May 16, 2021 07:18PM

RCBoothe wrote:

I was diagnosed with triple positive breast cancer in my right breast in November 2014. It was borderline stage 1/stage 2. I had a mastectomy of my right breast, 15 months of chemo, and reconstruction surgery (2016 - 2017). During reconstruction I opted to have my left breast removed so that I would not sit around worrying about getting breast cancer in it. My plastic surgeon used textured implants. It turned out that I went from a B cup to a D cup, which I was extremely happy with. I had always wanted larger breasts, but would not put out the money for a look I could achieve with an add a cup bra. There were small issues in that the right one was much rounder than the left one due to skin loss and it having to be stretched. Also, on the left side I have an indention above the breast that my plastic surgeon said I needed fat grafting to fix. I couldn't have it because my insurance would not pay for it. However, it was only noticeable when I flexed while exercising. Also, the left breast was slightly smaller than my right breast. I know that breasts are sisters, not twins, but mine were more like 2nd cousins. However, I was so thankful to have gotten them back and to have the added bonus of larger breasts that I didn't let these small imperfections bother me. My plastic surgeon retired and when I went see my new one, he told me that research in the past year had shown that the implants I had could cause lymphoma. I had received a letter from the company that made the implants about this issue about 1.5 years ago. I talked to my oncologist about it at the time and the general feeling at the time was that it was false information and the company was taking the implants off the market to avoid lawsuits. However, my plastic surgeon told me that was true at the time, but further research had confirmed the link to lymphoma. He suggested replacing them with smooth, round implants, which would give me the rounded look I wanted to begin with. My original plastic surgeon never asked me what I wanted, but that is a different story for another time. He asked me about size and I told him that I wanted to be the same size and definitely not any smaller. He said he would use the same volume on the implants except for a slightly larger one on the left so that my breasts would be the same size. I had surgery this past Wednesday. Once I got over the anesthesia and strong pain meds, I gave them a good look. They are so pretty, look the same size, and are round and full at the top like I wanted. I no longer have the indention above the left breast. However, I am no longer a D cup. They looked a little smaller to me than the ones I had, but I figured I was just imagining things. It was bothering me so badly that the next day I decided that I would try on one of my D cup bras (without underwire) for just a few seconds to be sure. And sure enough, I don't fill out the cups anymore. I am probably more like a C cup. He used the same volume implants he said he would use, because I have the paperwork, so I don't know what happened. I know this is a 1st world problem, but I have been so tearful and upset about this. I know it is silly, but I cannot stop crying about it. I tried to talk to my best friend about it, but she told me I should just be happy to be alive, which made me cry even more. I have no one to talk to about this issue except on this forum, which I just found. I know some of it is probably after surgery depression, but I am so disappointed, especially when he indicated that I would be the same size. I see him on Monday to get my stitches out on May 24th. Should I talk to him about this? Should I tell him I am disappointed in the size? If so, I don't know if I can do it without crying. I don't know why this has upset me so much, except that I have been so happy with the D cups, that I feel a loss. Before I went home he mentioned something about having difficulties on the right side because of it being "so tight " but I was so out of it from anesthesia, that I don't remember exactly what he was talking about. Does anyone know why I am a smaller cup size with the same size implants as the previous ones? Do different implant styles behave differently? I am wondering if what he meant by "so tight" will mean that I can't get larger implants. If that is the reason, then I am fine with it. However, If he offers to replace them with larger implants, I don't know if I want to go through surgery again but I am afraid I will regret it if I don't. Please don't judge me on this, but If you can answer my questions or have any encouraging advice, I would appreciate it.

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May 16, 2021 08:54PM saltmarsh wrote:

Ugh. Sympathy! It kind of makes me crazy that doctors sometimes talk with us when the anesthesia hasn't worn off yet. That's a real problem at times when we can't have anyone else with us to absorb, record, or retain the information! They really should know better and unfortunately, I think it's up to us to remind them.

If I were you, I'd call or email and explain that you know you spoke with him post-op but that you were still hazy from the meds and you want to make sure you understand the details of your surgery now, and ask him (or if he has a right-hand assistant, him or her) for clarification. If you're worried about crying, maybe opt for email. That way, you may get your answer in writing, which is nice to have.

Dx 3/8/2021. LCIS, ILC. Surgery 4/19/2021 mastectomy, right
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May 17, 2021 05:53AM Rah2464 wrote:

RC - I think how you fit into the bra is not just the volume of the implant but also the shape. I had a redo last year because I was struggling with a neuroma and scar tissue. My PS put in a different shape implant from my first set and actually went up in CC a bit. But becasue of the shape and how they sit in the pocket, I don't project outward as much as I did so they "feel" a little smaller (my diff is less because we are speaking about full B size here for me). And yes, they don't fit in my old bras the same way either so I went out and purchased new ones. They look pretty and match pretty much and they fit my frame better so it is a give and take.

I hope you do have a discussion with your PS about your concern and that you are able to feel better about your result. But I am sorry for the feeling of disappointment.

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)
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May 17, 2021 11:58AM RCBoothe wrote:

Thank you. I called and talked to the nurse and she said to not worry about size until 3 months out and said that is what my plastic surgeon would tell me. I am still going to bring it up when I go for my Monday appt. However, I do feel better. I wonder why 3 months would make a difference. Would they shift or settle during that time? I did not pursue that question because I could tell she was busy.

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May 17, 2021 03:10PM typhoon wrote:

Just want to echo what Rah said. About a week after my BMX (skin/nipple-sparing, direct-to-implant reconstruction, C-cup before to C-cup after), I made the mistake of trying on one of my regular bras to see if it would be more comfortable than the surgical bra, and was devastated to see that it didn't fit! I saw my PS soon after, and mentioned the issue. She pointed out (as did Rah) that my new foobs are shaped differently than the old originals, and that bras do get stretched and shaped a bit with regular wearing; she also noted that it would take about 3 months for things (internal inflammation, etc.) to settle down after surgery. For me, things did shift as I healed - right after surgery I had a couple of small dents (not ripples, but dents), one side was higher and tighter than the other, and the headlights were slightly askew. Now, almost six months out from surgery, the dents are gone, both sides are even, the headlights are facing straight ahead, and the only hints that I had a mastectomy are the thin scar lines (and those are fading nicely). So, I waited the prescribed 3 months or so (wearing sports bras all the time) before I went out bra shopping. Yes, I'm still a C, and my new bras fit just fine.

Please don't be reluctant to raise your concerns with your PS - if s/he is anything like my PS, they would much rather talk through your concerns with you, than to have you upset and worried! Hope your continued healing is easy and quick!

Dx 10/23/2020, DCIS/IDC, Both breasts, <1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 12/9/2020 Lymph node removal: Left, Right, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 1/14/2021 Arimidex (anastrozole)
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May 17, 2021 03:25PM Snowflake888 wrote:

Dear RC,

I can’t specifically speak to implant replacement, but when my surgeon switched out my tissue expanders for the implants, the next day I was so disappointed. I looked like an A cup and I wondered why I went through all that expansion. In fact, my chest muscles were so tight, I couldn’t take a deep breath. No one told me the muscles relax and things settle. I was so much bigger within the first month, and even bigger by three months. Now I wish they were smaller. I would recommend that you take photos and keep checking each couple of weeks.

I hope it works out for you. (I cried after the surgery, too, so no judgements from me).

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May 17, 2021 05:14PM RCBoothe wrote:

Thank you so much. This makes me feel better. I will just talk with him on Monday. I am happy things it worked out for you.

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May 17, 2021 05:15PM RCBoothe wrote:

Thank you. This makes me feel so much better. I have been worrying that the opposite would happen and that they would be even smaller after swelling went down.

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May 21, 2021 11:40AM Ctrunningmom wrote:

hi ladies - this is super helpful, I had my exchange surgery on Tuesday (May 18) and remove bandages/showered this morning and could not stop crying, so disappointed. Yes I’m grateful to be alive and cancer free I know that is huge but after this year the one hope I had was that I would graduate from the itty bitty club into something more. When I removed the bandages I look exactly the same - besides the radiated leftie being smaller and tighter than the right and super bruised (fat grafting?)? Anyway I’m glad to know it’s normal to be disappointed and only hope they appear larger as swelling decreases????? I was an A in a good day and had hoped to be a C, but look like an A right now.

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May 22, 2021 04:34PM RCBoothe wrote:

Ctrunningmom, I am happy this has been helpful. I can tell you from the first time that I went through reconstruction that there is some tweaking that plastic surgeons do afterward. Some do fat grafting, but my insurance would not pay for it. I am trying to remind myself of this but I am still crying. I did well from about Monday through Wednesday, but I started crying again yesterday and have not been able to stop all day today. I have even considered looking for an add-a-cup bra if mine don't go back to D-cups. I just know those are usually push-up bras and I don't know if push-up-bras can be worn with implants. I wore an add-a cup bra for years before I was diagnosed with breast cancer and went through reconstruction. I am like you in that I am so thankful to be cancer free and alive. I am so happy that the researchers discovered that the implants I had did have a good change of causing lymphoma and that I was able to get them replaced. However, I am a perfectionist by nature and the way I handled the imperfections of my previous reconstruction was my comfort in that I had come out two cup sizes larger. It was like getting augmentation without having to pay for it. Now, these are smaller so my attitude is that if they can't be larger, then I want them to look perfect. In the past couple of days I have noticed a flat spot develop on one of them. I am in such an emotional state that I know when I open my mouth to talk to my plastic surgeon on Monday that I will burst into tears.

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May 25, 2021 10:39PM OnTarget wrote:

Ctrunningmom- The implants can look flat when you first get them, and they "drop and fluff" a bit, but they aren't going to look 2 sizes larger regrettably even after the swelling goes down.

Diagnosed at 42, Oncotype score 16, ITC in one node- considered node negative. Lost right implant to infection March 2020. Waiting to start reconstruction all over again. Dx 4/8/2019, ILC, Left, 3cm, Stage IB, Grade 2, 0/3 nodes, ER+/PR+, HER2- Dx 4/23/2019, ILC, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 5/15/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 6/14/2019 Zoladex (goserelin) Chemotherapy 8/6/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 11/6/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 2/15/2020 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting, Silicone implant Surgery 3/30/2020 Reconstruction (right) Surgery 11/6/2020 Reconstruction (right): Tissue expander placement Surgery 6/1/2021 Reconstruction (right): Tissue expander placement
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May 26, 2021 09:57AM - edited May 26, 2021 09:59AM by RCBoothe

I saw my doctor a couple of days ago and he said that the reason for the flat area on the front of my right breast is because that is where my scar tissue is from my mastectomy. I didn't have the flat area previously because the textured implants were tear dropped shaped and protruded at that area. The replacement implants are smooth and round so the fullness is evenly distributed. The nurse told me that they would continue to settle and the flatness would appear slightly less. I am trying to keep in mind that bra cups are shaped so it won't show through my tops. Also, she showed me before and after pictures of me with my previous implants compared to these, and I am definitely larger. That is so strange since I did not fill out my D cups bras. Anyway, I hope to go for a bra fitting in about a month to see.

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