Too slim to have reconstruction after a partial mastectomy: Options?

Is your IDC lesion so large that he really needs to take out that large a wedge? I was a 34 DD. The surgery I had was called a segmental mastectomy and oncoplastic reconstruction as well as mastopexy on other breast for symmetry. The oncology surgeon removed the cancer in one breast then the plastic surgeon stepped in and did the reconstruction and mastoplexy. Entire procedure was 3 1/2 hours, outpatient.
I am now 34C, although personally I would have been okay if I was smaller. I was tired of dealing with the overlarge breasts- but that’s just me.
There are different types of surgical cuts, my doctor did the “wise” protocol. It’s like cutting an upside down W, removing two triangles of breast. He did not use any other fat or skin to form the new breasts, just a reduction of what was there. My cancer was at 9:00 in the lower outer quadrant. The surgeon explained that when he needs to remove more tissue from one side, he just shifts all the tissue over. So the W shape on that side wasn’t symmetrical- but the finished breast is equally rounded.
I had an “anchor” surgical scar, the nipple was moved up, and I have a suture line straight down from the nipple to the inframammary fold, and a suture line the full length of that fold.

It seems like your surgeon could add an insert on the one side to increase the breast from an A cup to a C? Then do a mastoplexy on the other breast to reduce it from DD to C. Although that may not be a satisfactory size.
My sister did get an insert that was a D cup after BC surgery - needed to use an expander to stretch the skin enough to cover it. But maybe there isn’t a DD size?

Love the above answer- very thorough. All of our specific situations are so different- and future treatments/radiation etc. A second opinion is not a bad idea especially if you’re just not getting data that makes sense to you. It might be that your current surgeon isn’t explaining things well or it might be that they just are not well educated in breast surgery and options. I’d work with a very very reputable plastic and reconstructive surgeon in conjunction with your current (or future) breast oncology surgeon to get the best results. It might not be reasonable to immediately (or ever) return to a 32DD on your cancer side- even with mastectomy (skin and nipple sparing if possible?) and tissue expander reconstruction. But a segmental mastectomy on cancer side with opposite side reduction for symmetry is often done. Best to you- keep reaching out to your team for answers.

If this were me, I would get a second opinion. If the second doctor gives you the same answer, then you know that is just the answer to what might be available, for your cancer. If your second doctor has different options for you then you might want to swap surgeons.
I would be sure to ask about long term expectations from whatever my choices are. I looked at what I needed to do to buy a few years and didn’t think about what my choices would look like 20 years out. I have been sorry I took what they offered and didn’t push for the flat bi-lateral mastectomy that I wanted.
You know the old saying about “if I knew I would live this long, I would have made better choices” hahaha.
Is there a breast specialty clinic close to you where you might get a second opinion (outside of your current medical group)?
Have you identified some options you could accept in terms of surgery?

It was suggested that I have a simple mastectomy after my diagnosis. I was a 32A at that time and the tumor was the 9-12 quadrant. There was no way to do a lumpectomy. After discussing my options with my surgical oncologist and a plastic surgeon, I opted to do a bilateral mastectomy with immediate reconstruction. I went with expanders which included the addition of a mesh "pocket" for the implant which I could expand to the necessary size (which now has me at about a 34 C/D. Maybe have a conversation with a plastic surgeon for their opinion?

@brightside21, I hope you saw the helpful responses from @auntieoakley @triciaot @bunnymoon and others. Have you discussed options with the plastic surgeon?

JMHO, I had a right mastectomy, large breasts and opted for no reconstruction. I was late 60s at the time. I had a VLNT surgery 2 years later and opted for a DIEP flap as they had to open my abdomen (Amazon smile scar from hip bone to hip bone) and had lots of fat to use. Procedure failed sadly so am still one sided but the insert into my bra balances visually. What I found necessary was Balance, not size. Any opportunity to have balance is worthy. The size doesn’t matter imho. If you come away with balance and don’t have to mess with inserts to achieve balance well, that is GOOD outcome!

I agree that's exactly what I want balance & symmetry is mentally & physically needed.
Sadly I've been given no options to achieve this without a 2nd op to my non cancer breast to do another reduction.
It would be far better to have a small reconstrution to the pre tumor breast after the wide excision. But as I've no spare tissue I'm NOT a candidate fir any flap proceedure. So have no options for reconstrution.