Surgery and Reconstruction for small breasts

[greenfairy]

Hi,

Ive been looking at recent results from a hospital in Paris and didn’t know if anywhere in the U.K. had reconstructed with just lipofilling. Could I ask which hospital or surgeon this was at all?

Many thanks

Greenfairy

[stefi]

Hi there really hope swelling goes and you heal up well. just to say I am one year on from mastx with no recon, 36AA. I feel fine now (after a lot of physio at the beginning) and barely think about it. I just spotted this in my inbox. I don’t wear a bra and prosthetic while exercising (too sweaty!) just a close fitting vest top from M&S though I do wear a foam prosthetic when swimming with a Nicola Jane swim crop top. I have found Sloggi’s seamless bra with back fastening and moulded cups to be super comfy with a softie or you can wear without; Nicola Jane does a few AAs in their range, which is what I mostly wear now as their bras have integral pockets for the softie which is less hassle and doesn’t slip around. It’s trial and error getting the right size softie/prosthetic. Lots of tooing and froing to the post office last year! That’s just in case you ever need a feeling of balance in your clothing, but fab of course if you do without. I never used to wear a bra much prior to BC but the ones I have found are v comfortable and I don’t mind at all. I cannot feel any difference in my chest if I wear one now.  I don’t think anyone notices either way. But your body confidence will return, so good luck x. 

[Vivi]

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.

[jbojo]

Hi,  thank you so much for replying.  You are right, I had to go back to Llantrisent Royal Glamorgan hospital to have the swelling drained as it was a seroma.  I wore a zip up bra with a softie in, which far too big even when took stuffing out but nurse advised to wear to try get swelling down.  I really can’t see me wearing in the future even though i have purchased quite a few… i will just go without.  I dont have a problem with being lopsided so why should anyone else.  

I was really pleased to hear that you have gone without and no-one noticed.  Well done.

we should be proud and grateful we have overcome another hurdle of life.

take care 

[Shi]

❤️Jbojo, please do ring your team and get checked just to be sure all ok, post op everyone has different experience and as scientistmafia has mentioned it possibly could be seroma. They can happen and lots on here have had them. Always best to get everything checked with your team though each step of the way. They are there to help and guide you safely through and you help them do this by being vigilant and ringing them with any concerns about anything ❤️❤️💕💕✨✨Shi xx

[scientistamafier]

Jbojo, I wonder if you need to speak to someone about the swelling in case it is a seroma. It might not be, but if you feel it is increasing in size then please contact your hospital.

It took a few months for my body to settle into its final shape after my mastectomy in August 2020. I didn’t have any reconstruction, nor have I bothered with a prosthesis. I usually wear a soft stretchy bra, but didn’t bother for a few days recently. No one noticed as far as I know, certainly colleagues didn’t say anything.

[jbojo]

I found your post very interesting.  This is the first time i have posted so bit nervous.  I had a left sided mastectomy last Monday, 13th September without any reconstruction as surgeon said i dont have a lot of skin and would look odd so chose not to have and not to be in hospital for long due to COVID.

I had the drain removed after 5 days which is good but now i have an awful lot of swelling all over chest wall under arm and round back, its very uncomfortable but i assume it will go down eventually.  I dont wear bras normally as only small busted but am worried now what to do when the soreness goes.  Should i wear a post op bra with zip down front to ease the swelling.  

Do you go without a bra and how do people react.  You should as that’s you are coping very well.  Kind regards

[Lucky1]

Hi Steffi

Yes my scar was flat. The fat sits just under the skin. 

The procedure is usually used to even out scar tissue or dips in a reconstructed breast. A friend of mine with large boobs had a successful reconstruction a few years back with lipomodelling when her implant failed due to infection. She couldn’t have the Diep flap op  but was offered lipomodelling. It did take a few attempts to get an acceptable size for her but she is happy with the result.

Hope this helps.

[Emma_B]

Hi Susie,

Sorry to hear about your diagnosis and hope you’re Still recovering well.

Thanks for sharing your experience and thoughts. I am certainly getting the impression that it’s a long road, whatever happens, especially with Covid. 

emma x

[stefi]

hi Lucky1

Interested to know more about this lipofilling solution, I have never heard of it to create a whole breast but it sounds much less invasive than diep which is great if it works. When you say the mastectomy scar is used - was your scar flat? where does the fat that creates the mound actually sit? 

Thanks

stefi

[susie95]

Hi Emma

I'm a 36A in one boob and a 36B in the other, always been a bit lop-sided but I am classed as having small boobs - saw it in black & white on a letter from my consultant to my GP!!

My larger boob is the problem - had an invasive lobular tumour diagnosed in February this year. I was put on Letrozole (i'm 62 and post-menopausal) and on hold until Covid eased. I was also told straight away and following an MRI scan that I would need a mastectomy on that boob, primarily because the size and irregular shape of the tumour and the need to get clear margins would essentially take the whole of the boob anyway. 

I was always keen to have an immediate reconstruction if possible and by the time my follow-up appointment came in June, this was an option. I had looked at the various reconstruction options and decided I wanted an implant because it's a simpler surgery and a faster recovery time. Essentially, though, I would have gone with the recommendation of my surgeon who is, after all, the expert. He was very clear that reconstruction is a journey and there can sometimes be additional, smaller surgeries and interventions to achieve the optimum result. I very much felt that he wants to achieve what is right for me and I definitely think I could have asked for a larger boob and to have the other one matched up later.

Like you, I was very lucky that the Letrozole shrank my tumour during the waiting period, or at least changed the shape of it. So, when it came down to finalising the surgery, I was told that I could have a skin-sparing and nipple-sparing mastectomy. This meant one wound which is underneath my (new) boob and they were able to access the sentinel lymph node from there as well.

I am 4 weeks post surgery now and I've been told it could take months for swelling/bruising to go down and for me to know the final size of my new boob. However, I've had no bruising at all and, although it does feel swollen, I fit into the same bra as before the op and my boobs are a good match - still lop-sided but I've been like that most of my life. I'm sure I could opt to have an implant in the other one but personally, for me, I don't think I can be bothered. I read somewhere on here that it's a much shorter op to just have an implant in and quicker recovery.

I would discuss your options with your surgeon. If part of the reconstruction process is to offer an "evening-up" at a later stage then why not go for the size you want and get some benefit for having to go through this horrible period? A key question during these Covid times would be how long you'd have to wait to be evened up.

[Emma_B]

Thanks Stefi for your response, it really helps to hear other people’s experiences. 
There is a bit inside my head that would like to ask for augmentation but it’s a lot of extra to put myself through but like your friend said, it could be a well deserved “silver lining.”

To be honest, the idea of any surgery is really frightening me.

Thanks again x

[Emma_B]

Hi Lucky1,

Thanks so much for getting back to me and all the detail. I was wondering if lipomodelling would be the best approach. I hope the radiotherapy allows that. 
Best wishes for your continued recovery x

[Lucky1]

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.

[stefi]

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, 

x

[stefi]

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

[Emma_B]

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