Expanders or Direct to Implants?

mysunshine48 · March 2015

Which is better to do? I have implants now and my PS wants to do direct to implants, but, I have heard that expanders are better to have first. I don't know? Can anyone share experiences and recommend one over the other? Anyone go direct and this is was the way to go.....or not? I may have to have expanders in for several months as I need chemo and, then, possibly radiation. I would assume exchange would have to take place after all that, which could be up to 6 months. I just don't know.

And, anyone have implants and radiation and need new implants? I sure need some answers cause I need to make a decision on this before surgery in a couple of weeks.

Moderators · March 2015

Hi Mysunshine,

Others should be along soon to offer their advice and experiences with Implants and Expanders.

You might like to take a look at this page on our site while you wait for responses.

Implant Reconstruction: What to Expect

There's lots of information on the whole process and your final decision will be the one that is right for you.

Best of luck! Sending our kind wishes and healing thoughts to you,

The mods.

muska · March 2015

Hi Sunshine, I am a bit confused. You say you have implants now, are you scheduled for a bilateral mastectomy that would remove the implants you have now?

mysunshine48 · March 2015

Hi muska, I do have implants now, but the implants now, but they were put in 10 years ago and my breast tissue is covering them. So, I will need new implants as my PS says since they are older and with no breast tissue of my own, to have a similar size, I will have new ones. They will be taken out at surgery and my PS will follow the surgeon. But, I have heard conflicting stories about going direct to implants (large size to account for tissue loss) or having expanders. I guess I already have stretched muscles, so it makes sense to go direct. It was just recommended by a PS nurse to have expanders anyway. I don't know.....that is why the question.

Anyone out there gone direct to implants that can comment?

SpecialK · March 2015

Generally with direct to implants you are limited to what will fit behind the pectoral muscle. Since you already had implants the muscle is stretched but not to the size you would need to create breasts as large as what you will lose with BMX. The question is the muscle laxity and what size implant will fit into the space you currently have, and what size you would like to be. You may want to ask your PS whether both implants and TE can be brought into the OR and the decision made when the PS sees what size implant will fit into your existing pocket. What size implants do you currently have? What size are you now? Have you looked at the direct to implant threads on this site?

mysunshine48 · March 2015

Hi,

I sent you private message because I was not sure you would see my post. I have 450's now and he was talking 650 cc, but I am not sure he meant with expanders or direct. I would like to go bigger since I will have no breast tissue. I wonder if it is possible to go to 650 direct?

SpecialK · March 2015

Since you already have a fairly large implant from augmentation it is conceivable that you could do 650ccs with direct to implant recon. PS often use sizers in the OR, which are a disposable implant measuring device - your PS could see if he could fit a 650cc implant in. My assumption on the 650cc mentioned by your PS is that it would offer you comparable size to what you currently have with augmentation. If not, you could have TE for a short period since you already have a large pocket created by the 450cc implants you have now.

muska · March 2015

I would go with what your PS recommends if you have trust in him/her. Expanders are usually a temporary solution for those of us who need the muscle stretched before the implant can be put in. That being said, 650ccs is a rather large implant - of course, depending on your size and body image.

As for radiation, they can radiate with implants in but the cosmetic result suffers a bit. If they put expander first and radiate on expander, it might take a while before they can exchange it for implant and healing problems are frequent. I recommend you discuss this with your RO too.

I opted to have exchange surgery before radiation. I am 10 months post-rads. The radiated side is slightly smaller and slightly higher than the non-radiated one. This is not noticeable when I am dressed and I can wear tight fitting tops if I wear a bra with light padding. Such outcome is very typical.

SpecialK · March 2015

mysunshine - is there is specific reason you are thinking you need radiation with BMX and a 1cm mass, or are you considering all possibilities?

mysunshine48 · March 2015

I am just considering all possibilities. My surgeon had a Mammoprint test done on the tissue from the core biopsy and I am high risk. He already said I will need chemo. So, the way things are going, I am more than likely going to have radiation. I really don't know. But, I am so worried. I actually felt the lump the first of January. Then, I broke my leg and could not walk. Then, my mother had a major stroke - in Oregon - and I had to go there in a wheelchair. She passed away. I was there 3 weeks, which made my tests drag out. Then, everything has taken sooooo long, and, now my surgeon and PS are going on vacation and I could not be fit in for surgery until April 10. I am so worried that the time from DX to surgery is allowing the cancer to spread. My surgeon says he does not think so, but he does not really know. And, my KI67 test was 23%. I think that is high too, but really do not know. I live alone and have no family here. My son and family are coming to visit before surgery and my sister is coming for surgery and will stay a couple of weeks. But, it is so difficult going through this alone. I start crying in the middle of the grocery store.

mysunshine48 · March 2015

Sorry to vent, but I have had so much to deal with in the past 3 months and now have this to look forward to. I was retiring this year from teaching and was looking forward to doing fun things for a change. Now, breast cancer. I had to leave school early because I work (ed) with special needs young children and just could not do it anymore. It is an exhausting job and I could not concentrate on that and all the planning, etc. And, there started to be too many appts. and phone calls during the day, so I just took FMLA until the end of the year so I can have insurance. I guess I am just a mess tonight and am really scared about all of this.

SpecialK · March 2015

I understand your anxiety, and you have had a lot to deal with recently with your broken leg and the loss of your mom - I am so sorry. Try not to worry too much - I know that is easier said than done. I would think radiation is unlikely unless you have positive nodes, or your mass is close to the chest wall or skin. Those are the usual scenarios for needing radiation - it is more about location of your mass than something like Mammaprint, or Ki percentage. You are just over the borderline on your Ki67% - it is a high low test result, with anything over 20 being high, I have seen many here on BCO with a higher percentage. I also had delays getting to surgery - diagnosed in September, surgery in November - then delays to get to chemo - not until February, but it all turned out ok. I am hoping you get through with treatment and then can get back to doing fun things and enjoying your retirement - I know it is hard to imagine that right now - but you will get there.

Expanders or Direct to Implants?

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