My breast reconstruction revision, part 1

I was attempting to juggle sample breast implants when the plastic surgeon finally came in the room for my revision consultation. I had waited weeks for this introductory appointment with Dr. L. He was running late.

Trying out round breast implants for my reconstruction revision surgery.

I’ve been thinking about doing a breast reconstruction revision surgery almost since I had the initial reconstruction in the first place. My original PS in San Diego, the one who was in the room for my mastectomy, said it’s normal and common for breast reconstruction patients to do a revision or three.

Before I got the chance, I moved to Boston. The first PS I consulted with out here left me livid. I don’t usually dislike people, but we really didn’t click. It’s so important to trust and connect with your doctor! This meeting with Dr. L was my second stab at finding a revision surgeon who was a good fit.

He showed up wearing a bow tie, just like in his photo on the website. He winked at me. Good sign. At ease, I started rattling off my questions and concerns.

Why I’m considering a revision

My concerns are cosmetic. I’m very fortunate in that I have a good reconstructive result to start with. When you get breast cancer, you end up looking at a lot of boobs. I know how mine compare. They’re pretty good. But they’re not as good as real.

I weathered the trauma and the terror of having cancer, the disgrace of being constantly prodded at and the debilitating side effects of my meds, and now I’m “healthy” and tasked with living my life as best I can in this alien body. My boobs will always be fake and weird, and I’m at peace with that. With the revision, I’m just shooting for a little less weird, that’s all.

A ripple runs through it

Breast reconstruction after a mastectomy isn’t like a boob job. In my mastectomy, I was able to keep my skin and my nipples. Many women don’t. But when you’re only working with skin and none of the fat and other tissue that boobs usually contain, little is left to the imagination. Every implant ripple shows through your skin like a pair of cheap leggings.

The effect is compounded when you’re fairly thin, which I am, and choose pre-pectoral (above the muscle) placement, which I did. Of course, I knew what I was getting into. I still feel like I made the right choice there.

I currently have Natrelle 485cc anatomical implants. They’re teardrop-shaped, cohesive gel (gummy bear), and textured. I liked them at first, but I think they’ve rotated a little, and they seem sort of off-center now.

Textured breast implants and the risk of lymphoma

I am aware that by choosing textured implants, I increased my very small risk of contracting anaplastic large cell lymphoma (ALCL), a type of non-Hodgkin’s lymphoma (cancer of the immune system) that has been linked specifically to breast implants with textured surfaces. As I understand it, my chances of getting it are somewhere between one in 3,817 and one in 30,000.

If the teardrops were working for me, I would probably take those odds. But now that they’re not, why risk it? In the revision, I’m considering switching to smooth round implants to solve the rotation (round is round, no matter which direction the implant moves) and slash that risk of ALCL.

Trying out round breast implants for my reconstruction revision surgery.

The revision surgery plan

To work on the rippling, I’m thinking another round of fat grafting is in order. Dr. L is concerned I might not have enough fat to work with, but he clearly hasn’t spent enough time scrutinizing my body in the three-way-mirror under the fluorescent dressing room lights at Target.

He says that patients frequently have to undergo a few rounds of fat grafting to get the optimal result. This is because there’s only a thin area to inject the fat into–basically between the Alloderm (acellular dermal matrix) and the thinned skin–and there’s not a lot of vascularity. The fat has to get a blood supply from somewhere in order to survive. Real breasts have blood vessels throughout. Reconstructed breasts only have them in the skin. As you do more rounds of grafting and some of that fat takes hold, that area gets a little thicker.

While we’re swapping the implants anyway, I’d like to tinker with the size and shape a bit. No, not bigger! At 485cc, I’m a comfortable 34D. I like the size, but I think the high-profile implants stick out a little too much. They get in the way.

We discussed choosing an implant with a wider footprint but less projection. I’m 5’10” and have broad shoulders, so my frame can handle a little more diameter.

Trying out round breast implants for my reconstruction revision surgery.

It’s weird to shop for body parts like I’m looking for the perfect gift on Amazon. It’s also hard to wrestle with the survivors’ guilt and the thought that I should be content with what I have and get on with my life. But at the same time, I know I also deserve the opportunity to feel as normal as possible, and part of that is being comfortable with my alien body.

I like this new surgeon and am leaning toward setting up a revision plastic surgery date with his office. I’ll think on it over the long weekend and see where I’m at next week.

Have you done a revision surgery? What are your thoughts?

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