Good advice from MinusTwo. Since each PS has their own way of doing things, you really need to work with your own PS to get the answers. I will say that I think it's more common for PS's to say "no" to underwire rather than insist on it. What's more common, I think, is a requirement to wear, at least for a short time, a compression bra. But that's not a hard and fast rule either. Some women never wear a bra after reconstruction; others always wear a bra. My preference is a low impact seamless sports bra - super comfortable.

In terms of reconstruction, since you want to go small, ask about direct-to-implant. That could be a good option for you.

As everyone has commented, there are different recommendations made by plastic surgeons. Ultimately, when you're well healed you just end up wearing or not wearing what makes you comfortable. It's been 9 years for me and i have long forgotten about what my ps said 🤷🏻. I have bilateral implants equivalent to a large B or small C cup and I can comfortably go without a bra. I do wear one to work (teaching students over Zoom from my empty classroom) but it is a very soft stretchy, wire free bra. Have you ever had a professional bra fitting? After my surgery and recon had healed, I went to a fitter who specialized in post mastectomy bras even for those with reconstruction. It really helped me find well fitting, comfortable bras. This could address your back problems too, perhaps.

Susan,

I have one step implants and am a rare one and done person. I was lucky and had a ps with a lot of experience in the procedure. He was also very honest and said he would bring te’s into the OR in case he didn’t think the one steps would yield an aesthetically pleasing result

I have rather large implants, giving me a D cup, and the only bras I ever wear are Coobie, just a simple cloth bra that's super comfortable. I've had no problem with my implants sagging.