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Photo Credit: Echinacia – Cone flower by aussiegall licensed under CC BY 2.0

 

This is a big week for me. Tomorrow morning (Tuesday), I will have my tissue expanders replaced with silicone implants. The plastic surgeon says it’s an easier surgery than the bilateral mastectomy I had in April. One hour versus four hours, and the recovery is supposedly easier too. This is a relief, but I always get nervous before any surgery–no matter how small.

It’s ironic that I am going through this. I considered getting a breast lift after I finished breastfeeding my second child, but I chickened out because I don’t like going under the knife. The thought of getting cut open suddenly made the droopy boobs, wet sock look seem quite alright. I could live with that. But I’m not okay with the no boob look, so here I am getting a breast reconstruction. This is just another way in which breast cancer has forced me into unwelcome situations.

Part of me is glad to get this surgery over with because, if all goes well, this will be the last of my surgeries. I’m crossing my fingers for no hematomas this time! A week after my mastectomy, I had to go back to surgery to evacuate fluid and blood that was not draining from my right breast. That’s the breast where I had the cancer. The surgeon said that had nothing to do with it, but I’m convinced that’s my problem side. So I hope my right breast, or whatever is left of it, behaves tomorrow.

The other part of me is a little sad to see my tissue expanders go. I know that a lot of women who’ve had the expanders don’t like them, and they are happy to get rid of them. Expanders are rock hard. They need to be in order to stretch the muscle and create a pocket for the implant. This means that sleeping on your stomach can be uncomfortable because they push against you. Actually, they will push forcefully against anything. Since I have no sensation on my breasts, I don’t have a clue when my robo-boobies are pushing on something. My husband claims they’ve pushed him around a couple of times.

Tissue expanders also do not conform to any bra except a sports bra. Forget underwires. The expanders just pushed my underwire bras out of the way and in no time, I was wearing the bra around my waist. The flip side of this, which is what I like about the expanders, is that your breasts stay put. They simply do not move. You can lie on your back, on your side, stand on your head, whatever.  They don’t budge. Maybe it’s a little weird to have constantly perky breasts, but I love it because it means I don’t have to wear a bra. Ever. I can even go running without a bra!

Okay, fine. Technically, I didn’t have to wear a bra before the expanders either, but I wasn’t trying to give gravity a hand. And forget running without any support when there is even a hint of movement. Expanders, on the other hand, come with built in support. Gravity will not bring them down.

Unfortunately, the doc says they have to go. They aren’t meant to stay in there for years.

Saline vs. Silicone

For this surgery, I had to decide whether to use silicone or saline implants. All implants have a solid silicone shell, but they are filled with saline water or silicone gel. At first, I was pretty sure I wanted saline implants. If they rupture, you notice right away because your breast deflates. Your body absorbs the saline water, and then it’s just a matter of getting it replaced. Silicone implants, on the other hand, can rupture silently. Since your body does not absorb the silicone gel, the ruptured implant just sits there and it is harder to notice a leak.

I tend to be risk averse when it comes to my health, so I was leaning heavily toward saline implants. When I told my plastic surgeon about this, he encouraged me to consider silicone implants. He claimed that they are safe, and they would provide better aesthetic results. Since he also encouraged me to have a nipple-sparing mastectomy after another surgeon had said that I was better off having nipple reconstruction — and I am very happy that I spared my nipples — I took his advice seriously. I have always felt that he has my best interest in mind, so I trusted him and did some research on saline versus silicone breast implants.

There is definitely a lot of controversy surrounding silicone implants. The FDA removed them from the market for breast augmentations (but not breast reconstructions) in 1992 due to concerns that ruptured implants could cause autoimmune diseases. After studies found no association between the two, they were once again allowed for augmentations in 2006. I’m not quite sure why the silicone implant moratorium applied only to augmentations. If there were health concerns, why didn’t they stop using the implants for breast reconstruction patients as well?

During that time, silicone implants were still allowed in other countries, and they evolved into modern implants that are made of a cohesive gel that is less likely to migrate if the implant ruptures. I couldn’t find definitive numbers for the rupture rate of silicone or saline implants, but it appears that the likelihood of having an implant rupture increases over time. My surgeon recommends replacing the implant at 10 years, even if it is intact. Ruptures may also be spotted with an MRI, but this is an expensive procedure that health insurance plans may not cover.

From an aesthetic perspective, silicone implants are a good option for breast reconstruction because they feel more natural, and they ripple less. These are both important issues when you have none of your own breast tissue to mask the implant. Silicone implants are also lighter and less likely to sag. Of course, if the implants are large, they will sag no matter what type they are. I’m not going double DD, so this was not a big concern for me. However, I would prefer lighter implants in general.

Oh, how I wish I could try them on before choosing one!

If they looked and felt the same, I would pick saline. Even though my surgeon and every other plastic surgeon on the web claims they are both safe, I think most people would agree that saline implants are probably safer. However, I do want to be happy with the aesthetic results. It’s bad enough that I have a long scar from my areola to my armpit reminding me of all I’ve been through. If silicone is going to help me achieve a more natural look with a lighter feel to it, then I want to give it a shot. I do intend to get them replaced in ten years, even if they haven’t ruptured. I just hope this is the right choice for me!

Size & Shape

Prior to this surgery, I also had to select an implant size. The expanders helped with this. After the mastectomy, I saw the plastic surgeon every two weeks and each time, he would fill each expander with 50 cc’s of saline water. We did this until I reached a size that I was happy with. We stopped at 400 cc’s which gave me a profile similar to what I had before having children. He wanted to overfill them a little bit because the muscle will flatten out the implant, but we weren’t able to do that. Both of my expanders had rotated, and since they are tear-drop shaped, they were expanding the wrong area of the breast. Instead, he is going to try using larger implants (480 cc), and if they don’t fit, then he will just use the smaller ones. At this point, I don’t really care too much about the size. I just want to be done with all of this.

I also chose high profile implants, meaning they protrude more and have a narrower base. Since my chest is not very wide, this will avoid having a side boob. At first, I was concerned that I would have a “shelf” look if they protrude too much, but when they place the implant under the muscle, it gets flattened out, and you lose projection. I opted for round implants versus the ones that are tear-drop shaped due to my experience with the expanders. Those rotated and made my breasts look lopsided. That’s not how I want to look for the next ten years.

It’s hard to know whether you are making the right choices when it comes to breast reconstruction. Especially if, like me, you have no prior experience with breast implants. You really don’t know what to expect. This is why it’s important to do some of your own research but also trust your plastic surgeon. I’m pretty confident I will be happy with my results. If nothing else, I will be happy to be done with surgeries.

 

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