My reconstructed breasts do not match at all. Can alloderm be used to make one breast that is much smaller and differently shaped look more like the other?

I had a bilateral mastectomy with expander placement. This was followed by latissimus flap reconstruction on both sides (one side was radiated). My first surgeon did the latissimus flap procedure on the left (un-radiated side). She later was going to do the same procedure on the radiated side. However, I was overexpanded on the radiated side and the expander broke through my skin. I ended up with an infection, necrosis and lost a large area of skin on the radiated side. I switched surgeons and had the latissimus procedure (this time using a large piece of skin from my back to replace the lost skin on my front). The second surgeon was clearly a lot more skilled. The shape of the radiated side reconstruction is more natural and feels more natural. However, the shape is so different from the other breast that it is obvious all of the time, I have to dress to cover my chest and it is very uncomfortable for me. The main difference between the two breasts is that the unradiated side has a much higher profile. It also extends out more. It is far less natural looking than the radiated side. But, I simply want there to be at least some resemblance to the other. I am due to have nipple reconstruction. My new surgeon said that he can do something to try to build up or raise up the radiated side so that it more closely resembles the other. (Incidentally, the radiated side is not tight, it is quite elastic and feels very natural, the skin healed well from the radiation). Is aloderm something that could be used to try to get the profile of the radiated side to match the other side? Is there something else that could work? I am very slender and do not have fat that can be used. Thank you in advance for you answer/suggestions.

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Expert Answers

drchrysopoulo (Physician - Surgery - Plastic (Verified) ) - 10 / 27 / 2011

Alloderm can be used to help improve projection and shape but based on your description of the degree of asymmetry, I dont know that Alloderm will get you to where you want to be.

It sounds as though you quite like the way the irradiated side has turned out and you are unhappy wth the appearance of the non-irradiated side (left). I would consider leaving the irradiated breast alone and adjusting the left breast. The risk of complications is always higher when operating on irradiated tissue.

Since you had a tissue expander and latissimus reconstruction, I presume the expander was replaced by an implant. It certainly sounds that way considering how "projecting" the left breast is. One option would be to downsize the implant on the left side. Using a smaller implant on that side (perhaps one with a slightly lower profile) would also help decrease the "over projection" you described. Any other adjustments that are needed in terms of shaping can be performed at the same time.

It is very difficult to say which is the best way forward for you, especially without examining you or knowing the exact details of your situation. Oftentimes there is more than one way to get the best result. I really encourage you to discuss all your options with your plastic surgeon to ensure you are as comfortable as possible with the plan moving forward.

I hope that helps.

Dr C
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member5155 (Survivor (1 year)) - 10 / 28 / 2011

Thank you, that really does help. It never occurred to me to consider adjusting the unradiated side, but, that makes a lot of sense. It is the side that looks fake, feels fake too. I am considerably smaller than before reconstruction, which is fine. But, I really hope that I can end up with something that is not so obviously different on both sides.

I really like the surgeon I have now and I will do as you suggest and discuss all options with him. I think your suggestion of perhaps making the adjustments to the un-radiated side may really be a solution.

You are correct in assuming that the tissue expander was replaced with an implant. I was told I was simply not a candidate to use my own tissue for reconstruction. I asked if I could gain weight to do that, but, nobody seemed to think that was a good idea :) (Darn).

Thank you again for your answer. It was very helpful.

Lisa (aka Cancerfree2b)

Anyway, I will
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