sizing down after NSBMX with implants possible???

I have a complicated surgical history, so this is not a straightforward story. I also did not downsize because of aesthetics - it was a rather involuntary situation, but I am glad I have the implants I have now. From beginning to end this was over 6 years. I originally had NSBMX with sub-pec expanders. My sentinel node biopsy was clear in the OR during that surgery, but in the lab during the more thorough pathology cancer cells were found and I required ALND - mainly due to being Her2+. That surgery was scheduled for five weeks after the BMX. Within two weeks of the ALND I had extensive necrosis and my non-cancer side expander ruptured through my skin - not on the IMF incision, but on the front of the breast just under the nipple. That repair didn't hold, another was attempted, then my left expander was removed so I could start chemo. Six weeks post chemo, my left expander was replaced, I was filled slowly, and exchanged using smooth, round, high profile Mentors. I had fairly extensive fat-grafting a year later because I have a bony chest, had pretty big implants (650ccs), and a pretty severe step off, so the fat was to soften it and make things look more natural. I only had upper pole grafting as I did not need any additional size added to the implants themselves. That fat graft was very successful and things looked good aesthetically but those implants were quite large, and I did have side boob. Two years later I required repair to the cancer side dermal matrix - mine perforated, more in the right than left - and the perforation is unusual to have. During that bi-lateral repair surgery the previously necrotic area on the left tore open in three places, but was repaired at that time. The repair didn't hold, was attempted again swapping out the left implant with a 500cc so as to stress the skin less, but that didn't work either and the implant was later removed. I will say that dropping 150ccs in implant size did not displace the nipple like I assumed it would, nor did that side look appreciably different from the other side with a 650cc implant. The 500cc was a smooth, round, high profile Mentor also. Over the next 18 months I had two fat grafts to flat side to help with skin integrity and thickness, and another expander was then placed, filled, and I had exchange surgery to round Inspira implants 450ccs, bi-laterally. I can wear the same bras I wore with the larger implants, but I am a different shape - more natural looking. In order to downsize during that surgery on the cancer side I had a horizontal traditional mastectomy incision, and the right nipple was removed. This was not necessarily mandatory, but after this many surgeries I lacked nipple symmetry anyway. About 6 months later I had a fat graft to the left side, and the left nipple was removed as well.

If you have teardrop implants I am surprised you have as much upper pole fullness, but I am wondering if some of that is swelling. They generally don’t drop as much as rounds due to their internal firmness but they will still change over the next several months enough that you shouldn’t make any decisions without knowing their final look. Most plastic surgeons would advise you to wait for this reason. Something else I would say as well is that every surgery you have can have an affect on nipple symmetry and location so you want to be sure you want to make a change if that is good now, and that if you do make a change your doc isproviding reasonable assurance that symmetry can be maintained.

wow SpecialK, your story is insane. You must be glad you're done with all that.

Ugh. I too, am allegic to the tape adhesives. I really understood the extrnt when they tried to remove the rubber-foam type adhesive wrapping that enveloped my new foobs. Layers of skin peeled right off with it.