Skin expansion, how much is at all possible?

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duvan
duvan Member Posts: 24
edited November 2014 in Breast Reconstruction

I've had my permanent implants for 3,5 months, but I'm not happy with either the size or shape of the reconstructed breasts. I think that maybe I should have had another type of expanders, in order to stretch the skin more so that it would have been possible to get a more "ptotic" breast. My right breast is pretty ok, I'd like a flatter and less pointy implant, but that is probably the easy part. My left breast though, doesn't look good at all, and doesn't feel really good either. I think that the skin hasn't been stretched enough, and the breast just looks like a small peak, kind of pointy in my opinion. Not round like the other one. The expanders I had were wide and low height. I believe that I should have had expanders that stretched the "whole" breast, not just the lower pole. Maybe it would have looked better then. The thing is also that I have the scar UNDER my breasts, which is because I had scars from previous breast reductions already, and they used those scars to not make new ones. BUT the scars are now a bit up on the breast, which feels odd. I'd like to pull it down, to have it IN the crease, not above it. But I don't know if it is possible to stretch the skin more. But doesn't it really just depend on the size of the expanders and how long you have it in?

Also I wonder why the expanders aren't directly under the skin, since it is the skin that is to be stretched?


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  • SpecialK
    SpecialK Member Posts: 16,486
    edited November 2014

    Do you know what the maximum volume of your original expander(s) was?  Were you filled to that volume, or beyond it?  Did you have a skin sparing procedure?  Most who have expander to implant do not have much in the way of ptosis after their exchange surgery,  as implants do not behave like natural breast tissue and stay in mostly the shape they are. The shaping of the pocket behind the pectoral muscle will usually determine the eventual shape of the reconstructed breast. I also have IMF incisions (under the breast) and if your scars are up on the front of the breast it sounds as if maybe you have "bottoming out", where the implant has dropped below the IMF. Do you have alloderm slings? The purpose of expanders is not only to stretch the skin, but the pectoral muscle underneath.  The implant is placed behind that muscle so a place must be created for it.

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  • angelia50
    angelia50 Member Posts: 381
    edited November 2014

    Special K. I am new to all of this. I noticed you asked someone if they had Alloderm. Do most people have the Alloderm slings or do most not? I do and guess I thought everybody did but I've notice some people get them at time of exchange and mine were put in at the same time as the expanders.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited November 2014

    angelia - I do think most people have alloderm, but some people don't and have experienced the bottoming out - that is why I asked that question of the OP. I also had the alloderm at the time of expander placement.

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  • angelia50
    angelia50 Member Posts: 381
    edited November 2014

    special K. Thanks. It seems doctors all over do things so different and then I read things on here and begin to question if my doctor knows what he's doing or not. I'm almost afraid to say it, but so far, I haven't had any of the terrible things happen I've read about. I didn't have radiation, or chemo, so I'm sure that has been a plus. I have mine all filled up and my doctor won't do the exchange until 3 months after the final fill. That seems different than most too but apparently, its to be sure everything has settled and to be sure the muscle is not going to snap back during the exchange. I'm supposed to have some minor fat grafting and unfortunately for me I'm not at any loss for fat to choose from. I think he plans to take some from upper side, like where your bra would come around. At time of the mastectomy, plastic surgeon came in, drew all over the place and I said to my husband, do you think he's going to be able to put this all back together and he said I don't know but I think he thinks he can, and thats what matters and I guess thats true. He seems confident that he knows what he's doing. Hope so.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited November 2014

    angelia - it is interesting that there is not one standard way that plastic surgeons handle reconstruction, and the many factors involved in decision making about how to approach it.  The important thing is that you are confident that your doctor is doing the best job for, and with, you.  A number of plastic surgeons like to wait for a while after the final fill, that is not that unusual, but you will see all kinds of time frames - don't let that worry you.

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  • angelia50
    angelia50 Member Posts: 381
    edited November 2014

    special K, thanks for the encouragement. I have all my doctors at a breast center and I feel like even though he has a private practice and can do all kinds of surgeries, he has devoted a lot of time and study to reconstruction which is totally different than augmentations and things of that nature. So, I hope he's up on all the latest and best.

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