Surgery and Reconstruction for small breasts

Hi everyone,

I was diagnosed with triple negative breast cancer in June and so I’m currently undergoing 21 weeks of chemo. My oncologist has suggested I start thinking about what I’d like to do for surgery but with 34aa boobs I’m not clear what the realistic options are and I’m concerned that surgeons are not fully sympathetic or understanding about how some women feel about their small breasts. 

I have always hated my breasts, not being able to wear pretty bras and not feeling a ‘normal’ woman. I’m really worried I’ll end up with something much worse than I have now. 

My chemo has actually shrunk the lump so much that I can’t feel it, but because my breasts are so small they may decide a mastectomy may give better results than a lumpectomy. I’d really like the whole thing done as quickly as possible but I have to have radiotherapy too which I believe means they prefer to wait for that to be done before doing reconstruction. 

Ive searched the forums and there are have hardly been any posts about surgery and small breasts. I’m hoping there might be someone around now who is or has gone through something similar. 

Thanks, Emma x

hi Emma,

Have you been offered skin sparing mastectomy? that might work while you have radiation therapy. It preserves your own skin envelope - you just have a temp implant that gets swapped later - it gives you more time to think.

While I was researching my options I came across a small breasted woman like me. Her surgeon offered her the option of going up a size - this is possible with implants; she had an immediate mastx filled with implant and then the other boob augmented with another implant slightly later. In the meantime she used a small silicone pad to even them up. She was really happy with her boobs afterwards, they were better than before in her view. You might ask the surgeon how to achieve this.

I was happy with my breast size despite being a ‘aa’ and didn’t want the healthy boob reshaped and lifted (which would have been needed for symmetry) plus didn’t want the issues that come with implants (needing them changed & worries about contracture etc) so I opted for a simple mastx; really hard decision, took ages. I nearly went for the diep flap op (own tissue flap) but was put off by the long recovery and additional abdominal surgery - I have already had 2 c sections and have had other ops - I am not good at recovery and hospital stays.

The thing is you might just need more time to think - in which you could have a simple mastx and recon afterwards. Sometimes it’s presented as a black and white decision where there is no going back and it need not be. I guess the advantage of having the whole thing done at the same time is that you are a priority and don’t have to go on a long waiting list for an op like diep which is relatively specialist and you might have more or less painful implant options.

Equally being small breasted means that simple mastx is relatively easy to live with - I am very new to it but it does seem the case. Might be a bit of a pain swimming and strappy tops are a bit of a challenge. I realised that so much of my body image was tied up with these boobs, as if my femininity depended on it. But you can still look good - there are those lovely tatoos though you have to wait a few years for them.

I did find a whole journal article on the problems small breasted women have in making these decisions - most of it is because they don’t want the other healthy breast tampered with. However small boobs are rather fashionable these days so I wouldn’t feel guilty to reconstruct them or worried that they are not sexy, they are uniquely you. But it’s a **bleep** situation you are going through so if you want bigger boobs, why not ask the surgeon if it is possible to go up a size or more and with your physique how? 

I hope that helps! I am sorry you are having to go through all this during Covid -  I feel it has been so much more difficult to make informed decisions. 

If you are interested in diep - make sure you talk to a plastic surgeon; and you might want to talk to a few women who have had a few of the options you are considering via the ‘Someone like me’ service that Breast cancer now provides - you can be matched by age etc. It’s fairly swift. Some surgeons offer show and tell events where women talk about their experiences following recon surgery - which should be coming back in September.

I hope that helps.x

hi Emma I have small breasts and was so conflicted for ages, it’s not easy.

I had multicentric cancer so didn’t need chemo or radio but needed a mastx and was a candidate for immediate recon. While I was researching what to do, I came across a woman similar to you - she had a skin sparing mastectomy while radiotherapy was being done to preserve her skin envelope and then diep recon (own tissue afterwards). 10 years on she felt it was the right decision, she even got a flat stomach out of it - but it does depend on you having ample fat around your abdomen.

If you want to increase your breast size though, I think that is also possible - you could ask your surgeon how best to achieve this. You might have to be upfront with the surgeon and have a conversation about making both bigger as you might be happier with going through the whole process if there is a chance of better boob shape at the end!  It’s quite something to go through if you don’t like your boob volume.

I spoke to one woman who said that she might as well get something good out of a crap situation and asked for bigger boobs, & her surgeon offered that option using implants. I didn’t want to modify my one healthy one, I quite like it, but was worried that if I didn’t modify both - as I got older the healthy one would droop further and the new one would sit proud and high on chest so I didn’t go for that.

The option I chose was simple mastx as recovery shorter, less invasive op and actually with small boobs very feasible to look symmetrical with a pad or small prosthetic. There are some funky things you can wear nowadays, you can have your own bespoke underwear made. It’s ok, I was devastated before the op just contemplating my changed body, I thought it was so unfair, but now am ok with it. You can’t notice it when I have my clothes on.

Good luck with deciding - I would be really clear with the surgeon about what you want out of it.

take care, 


Hi Emma

I was in a similar position to you. I am 34AA. I had a left side mastectomy in February 2019. I was offered the Diep flap op a month after the mastectomy. I took sometime to think about it and eventually decided that I didn’t want a major operation with a long recovery time, or an additional scar from hip to hip. I was advised by the plastic surgeon that an implant would not give a good result.

I did some research  and found that in France surgeons have been reconstructing new breasts using lipomodelling (fat grafting) for some years with good results. I asked my onco surgeon if this was a possibility for me and she had no hesitation in agreeing to do it. I had it done in February this year. The advantages are a minor op. It is done under general anaesthetic but as a day case. I was under about an hour. Minimal scarring. I have 2 tiny scars at the top of each thigh about 1cm long. No additional scarring on the chest. The mastectomy scar is used. The recovery time was short. I was back home by 3.30 on the day and was driving within a week. I had to wear Spanx type shorts for 6 weeks to prevent any unevenness in the thighs. I wore an ordinary bra. I now have a cleavage again. When wearing a bra or swimsuit you wouldn’t know I had a mastectomy. I no longer use the silicone prosthesis but just a little extra padding on the left side. It doesn’t look like the other boob but it is much better than before the procedure.

It is possible to repeat the procedure as some of the fat is reabsorbed by the body naturally over the first few months. It does settle down though  I have retained most of the volume. If I want to have more volume the surgeon is happy to give it another go using fat from my buttocks.

I am happy with the outcome. It might be worth asking your surgeon if lipomodelling is something your team would offer.

Good luck with everything.

Hi Emma!  I don’t have big breasts but average I guess 36B.  My sonologist (specializes in breasts, who knew???) suggested oncoplastic surgery but then as far as is known, the lesion is small, HER-2 negative and only Ki-67 so fairly non aggressive.  He tells me they will do this at the time of removal of the lesion (right breast only) and hopefully only 2-3 sentinal nodes .  I agreed to do this over a lumpectomy as it will all be done at the same time and I needed to decide prior to the surgery.  My doctor seems to believe that our breasts are important to a woman’s self image.  Not sure if that is a good or bad thing as I had never looked at it in that way and am 65 so less so in my opinion.  I just wanted the girls to fit in a bra.  I have not had chemo but regardless of the outcome, I will be having radiotherapy also when recovered from the surgery.  I do not know if any of this helps you but just to let you know you are not alone in trying to decide.  My surgery is October 5th.