Dr Macadam's goal is to reconstruct a breast that is very similar to your pre-surgery breast. This will allow you to feel comfortable in clothing and restore your sense of body image following your mastectomy. It is very important to be realistic about the expected outcomes. A reconstructed breast will not be identical to your original breast. In addition, in most patients the sensation will be much less than in the native breast.
In unilateral reconstructions it may be difficult to match a reconstructed breast to the contra-lateral non-reconstructed breast. Consequently, most women that have a unilateral reconstruction require some form of surgery to the other breast in order to improve symmetry. This will leave scars on the non-cancer breast.
Implant and flap reconstruction are very different. Implant reconstruction will create a breast that is round and 'implant-like', as there is very little camouflaging tissue present. One common misconception is that implant reconstruction is analogous to breast augmentation. After breast reconstruction the only tissue covering the implant is the patient's muscle and skin (absent breast), therefore the shape of the breast is dictated by the implant shape. In thin women there is almost always some degree of rippling evident after an implant reconstruction.
Many patients have a size in mind when presenting for breast reconstruction. The size of the reconstructed breast(s) depends on many factors including whether the patient has had radiation, how wide the patient's chest is and how much tissue is available if a flap reconstruction is being performed.
Flap surgery creates a breast that is shaped by your own tissue. Consequently the breast will increase and decrease in size depending on weight gain and weight loss. The size of the reconstructed breast(s) will be dependent upon how much tissue is available on your body.
Dr Macadam is extremely dedicated to her patients and to optimizing outcomes. She will do her best to create the best reconstruction possible. It is important to realize, however that there are limits to the aesthetic result that can be achieved in breast reconstruction surgery.