Reconstruction options for small breasted, petite woman?

famousthecat

I'll be meeting with the plastic surgeon soon to discuss breast reconstruction options after preventative BMX, and I'm trying to do as much research as possible in advance. There are so many reconstruction options out there, my head is spinning! Can anyone shed some light on where I should be focusing, given that I'm small breasted and not wanting to go bigger, but I also don't have much extra fat or skin on me? Would implants be my primary option, or are there other options I should look into before my meeting with the surgeon?

Moderators

Hi famousthecat!

We're sure others will be by shortly to weigh in with their thoughts and advice. In the meantime (at the risk of further overwhelming you!), we'd suggest checking out the main Breastcancer.org site's pages on Types of Breast Reconstruction, for some information on each available option and details about which option might work best for you.

We hope this helps!

--The Mods

VegGal

If I were starting over I would push for a nipple and skin sparing mastectomy and any kind of flap surgery that could give me natural tissue replacements. I would likely first check with the breast recon center in New Orleans, as they seem to have the best track record for that kind of stuff.

Good luck

Shelligirl

I met with a PS right away and that was a mistake because I was overwhelmed and didn’t have any questions ready. You are doing great by doing your research first.

There is a Facebook page called, flat and fabulous that has a lot of good info for people considering their options. Seeing photos has helped me understand the options too.

I’m still deciding and researching so appreciate new posts here

famousthecat

Shelligirl, I totally joined that Facebook group! It's wonderful, and I'm really appreciating it. A big part of me really does not want to go through the surgeries and extra physical toll of reconstruction, but then I'm also not entirely sure how I'll feel flat. I *think* I'd be totally okay with it - not great, but okay and thankful as heck that I don't have to go through the rest of my life monitoring and waiting to get more invasive cancer. There are so many different reconstruction options, it's overwhelming, isn't it?!

Veggal, I wish I had all the money needed to make these decisions and consult with the best. As it is, I learned the only plastic surgeons who take my insurance at the hospital I'll be at are the residents clinic - meaning, residents would be doing my reconstruction. I'm trying to keep an open mind because there's no way I can afford out of network for reconstruction, but... I guess them not taking my insurance might make the decision for me in the end. There's a great PS here who I'm still going to have a consult with, but I can't afford her out of network. 🙁

VegGal

I have heard that New Orleans will work with patients that don’t have in network practitioners available. I would at least call and talk to them and they might be able to refer you to a similar practice near you who would also work with you.

I would be very hesitant to let residents do a complicated recon on me. Explore all options. Measure twice,cut once!

famousthecat

Yeah, I am SUPER hesitant about the residents clinic. The only bright side is my husband may be getting a new job in the next week or two, and if they offer different insurance coverage, I may have more options. I really love my breast surgeon, I'm just so nervous about the reconstruction process anyway that I really want someone who is solid working on me.

hapa

famous - I am also petite and was small breasted. I guess I still am. My first recon was done by a well regarded PS at a fairly high volume, well known cancer center, but she used moderate plus profile implants on me in a direct to implant surgery. They were too narrow and projected too much and just looked weird. I had her swap them out with low plus profile implants and they are much better. I would have preferred low profile implants, but alas I think at this point the original set had stretched my skin too much for that. I had about 170g of tissue removed from each breast and am now sporting 210cc implants. So slightly bigger. So if you decide on implants and want to stay small, definitely talk to your PS about special ordering low profile implants. Even large cancer centers don't tend to keep these on hand. I think this is why the first set were such a poor fit; that was the closest they could get to my original size with what they kept on hand, and my PS doesn't prepare far enough ahead to have special ordered anything, and I didn't know enough to ask. Most women get high or very high profile implants for reconstruction. And most women also get gummy bear (cohesive) implants. My first ones were cohesive but the second set is "responsive", so they are softer and feel much less like foreign objects wedged in my chest. I am pleased with the responsives, and they don't have any more rippling than the first set.

Even with these low profile implants, I still am more comfortable wearing a bra all the time. Implants are just not the same as natural tissue. I didn't have a choice as I was not a candidate for diep due to being so thin. Still, I would not do a diep reconstruction due to the additional down time. Plus, I feel like that's just messing up one part of your body to "fix" another part, and neither of them will come out looking that great. I will try to get some fat grafting to my existing implants to smooth out the edges and match the sides a little better (my cancer side had radiation and the skin has thinned, making that side look a little smaller).

One thing I might have looked into if I had known at the time is a pure fat grafting reconstruction, where they leave the skin and nipple intact, and instead of cutting a free flap from your abdomen, they just lipo out some fat and deposit it where your breast used to be. You probably won't get much projection doing this but if you're already pretty small, you might just end up a little smaller; nearly flat but still with a little bit of shape there. I have no idea how small you are when you say "small breasted". I have not seen anyone else on here with implants as small as mine, and I think mine are still too big.

Good luck with your decision.

Scrafgal

"ditto" on the residents...

famousthecat

Update: husband got the new job! We'll find out tomorrow what insurance it offers and whether any plastic surgeons in the city take it. Oh, private health care is just the BEST, isn't it?

I'm leaning more and more towards going flat. I personally don't think I'll care much one way or the other. Sure, it would be fun to have nice boobs on the other side of all of this - but only if it doesn't require a whole lot of pain and work, and that seems far from a given in the reconstruction process. So... I've got consults with two different offices at the end of this month and will go from there. Now to make sure my husband would be okay with none-boob me...

Dovely

Hapa, your situation sounds similar to mine. I am thin and have almost no fat on my chest and have 240cc implants (I'm actually not sure what profile). Until yours I thought I was the smallest on here! I used to be a 30c, so in clothes they look similar to my younger, pre-breastfeeding boobs. Nude, I do have a serious step off and they look like foobs. I don't have enough fat on me for fat grafting so I've decided to just accept them the way they are.

Famousthecat, I was flat for two weeks in between my surgeries. They had planned to do direct to implant but my tissue wasn't happy so I had to wait two weeks. I'll just say... it was intense. I'm not trying to discourage that choice, because it works for many, just point out that it's a huge decision. If you decide on implants, there definitely are options for petite women. They won't ever look perfect in the nude, but at least there's no cancer! That's how I have learned to accept mine.