It is desirable for a plastic surgeon to discuss breast cup sizing at the time of initial consultation in preparation for mastectomy and breast reconstruction. Although skin quality is a factor in many aspects of the postoperative course, except in patients with irradiated skin, most patients do not have limitations on cup size during the reconstructive process.
With expander reconstruction, patients have complete control over the ultimate size of the breast and may request increase or decrease in expansion to get a “preview” of the final result. During this process, the surgeon adds or subtracts sterile saline to the expander and the patient has an opportunity to see the appearance of the volume/size during the expansion process.
Choosing Breast Size in a Natural Reconstruction
With regards to autologous tissue reconstruction (tissue taken from another part of the body and used to replace the natural breast after mastectomy) to some extent the patient is limited in size to the amount of tissue that is present from the donor site. If the available tissue is in excess of the patient’s desire then the surgeon can reduce the amount of tissue that is transferred, but if there is not enough available tissue then the patient will have a smaller breast. This too can be changed postoperatively with a small implant if desired. This can be placed under the natural tissue reconstruction to add additional size. This is generally done six months following the initial reconstruction to allow time for healing and subsequent selection of appropriate implant sizes.
For example, if a patient undergoes a double mastectomy and has a limited amount of tissue that is going to be taken from the belly as part of a TRAM-flap, there may not be enough belly tissue to accomplish the desired breast size following mastectomy. In this case, six months following the belly flap, a patient may choose to use a small implant to accomplish a desired fuller size. In my 25 years of practice, this has only been requested in a few patients and most of the breast reconstructions using autologous tissue are sufficient alone to accomplish a satisfactory size for patients following mastectomy.
In closing, it is likely that the reconstructive surgeon can determine the breast size following mastectomy reconstruction and achieve the patient’s desired cup size postoperatively. Comprehensive discussions with your plastic surgeon during each preoperative consultation will provide ample information, as well as allow your surgeon to discuss your expectations at great length. Meeting the patient’s expectations is the most important measure of success with any form of plastic surgery.