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Topic: BREAST IMPLANT SIZING 101

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

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Posted on: Jan 7, 2010 11:01 PM, edited Feb 6, 2013 08:06 PM by whippetmom

whippetmom wrote:

BREAST IMPLANT-BASED RECONSTRUCTION AFTER MASTECTOMY:

Please scroll to the bottom and find your tissue expander information and dimensions and/or breast implant information so that you can be well-informed about your optionsllll

PLEASE READ THE FOLLOWING INFORMATION IF YOU HAVE QUESTIONS REGARDING BREAST IMPLANTS.

It is very important and even crucial that you discuss all of your concerns, hopes, desires and plans for your breast reconstruction outcome with your doctor.  You have every right and every reason to want to get it right the first time and to know what your options are in this regard.  Please let your doctor know that you are very interested in being a partner in the decisions he or she will make regarding your breast reconstruction journey. 

This thread is essentially an informational link for those who are preparing to undergo mastectomy [unilateral or bilateral] with immediate reconstruction with two-stage tissue expander placement or have already undergone reconstruction and you are in the tissue expander fill phase of this process.  

1.  TISSUE EXPANDER - OVERFILLING AND REASONS FOR DOING SO:

Overfill is sometimes performed and it can be done so for a myriad of reasons.  It can be done because a PS always does it in his practice [which makes no sense to me]; it can be done for assurance of good implant coverage with the skin flap; expanding out the skin a bit more so that a larger implant can be used, or in order to achieve ptosis [droop], especially in unilateral recon.  It is not necessary in all cases to overfill and some docs never overfill, some rarely ever and some always do.  But for those who are small-breasted prior to MX, it often is necessary, so that there is good skin closure, if a larger volume of implant is needed or if symmetry with the contralateral breast is required for ptosis and symmetry. 


2.  SILICONE VS. SALINE?

Please note that the question of whether you should have silicone vs. saline implants at the time of exchange is one which you can research on your own, and you can find various threads discussing the differences on bc.org.  However, the overwhelming number of women on these forums now have silicone breast implants - most specifically - silicone smooth round breast implants. 

If you live in Canada and/or your PS has access to true cohesive gel implants, aka, "gummy bear implants" - the Mentor CPGs or Allergan 410s, there are numerous threads here on bc.org which discuss the merits of these implants versus the standard silicone rounds.  [We are happy to help with sizing in this regard as well, although please note that breast reconstruction experts state that the tissue expander should be chosen specifically for expanding and creating the breast pocket for the corresponding cohesive gel/gummy bear implant.  Therefore, it is probably more uniquely important that you discuss with your PS where he/she intends to go in terms of implant size/projection at the time of exchange.]  

3.  IMPLANT SIZING INFORMATION:

If you are interested in discussing implant sizes,  make sure you compile and provide us with the following information:
 
Height, weight, ribcage measurement [measuring the circumference of your ribcage under your tissue expander(s) or under your bra line].  Also, if you have TEs [tissue expanders] - we need to know about them.  The style - Mentor or Allergan most likely - and whether they are short height, moderate height, full height if Mentor and style number if Allergan.  We also need the recommended fill volume of the TEs - the number of cc's.  (NOTE:  If you have PMT Corporation tissue expanders or any other unlisted manufacturer, please see if your PS will provide you with the dimensions of such devices.]

4.  "WHAT CUP SIZE WILL I BE?" OR "WHAT SIZE IMPLANT DO I NEED FOR A "C" CUP?"

I CANNOT PREDICT CUP SIZE.  PLASTIC SURGEONS ADMIT THAT THEY CANNOT PREDICT CUP SIZE WITH ACCURACY! 

It is very difficult to determine cup size with breast reconstruction patients, as volume does not easily translate to a specific bra size. There are so many factors which determine how implants will look on any one individual, e.g., your ribcage circumference, whether your chest wall is bony or if you have a fair amount of adipose tissue surrounding the chest wall.... if you have any ribcage deformities or other structural issues which might impact implant placement.  We can sort of "project" where you might want to be...or estimate the implant volume which you could "aim" for - so that you can sort of look at the prize ahead of you.  Most of us have found though, that it is better to continue with tissue expansion until you have reached a desired volume and appearance, and then compare these dimensions with the breast implant dimensions found on the links at the top of the Exchange City thread in the Breast Reconstruction forum. 

BREAST IMPLANT SIZING IS SPECIFIC TO YOUR VITAL STATISTICS

Implants of a specific volume will look different on A 5'10" 176 pound woman with a 35 inch ribcage, than they will  someone who is 5'3" tall, weighs 110 pounds and has a 29 inch ribcage.  So height, weight, ribcage circumference, body habitus - all of these things come into play when determining what style and volume of implant will best fit someone's frame.

QUESTIONS FOR YOUR PLASTIC SURGEON:
 
In the interim, here are very important questions to pose to your plastic surgeon.  Ask your PS if he/she tends to place you in an implant with a volume larger than the TEs, or if he/she prefers to place you in an implant smaller than the TEs.  If your PS likes to overexpand - overfill - ask about this.  It is important to know what is in your PS' mind about where he intends to go with your reconstruction, because this will assist us in calculating to what extent you require expansion in order to exchange to the desired implant size and dimensions.
 
Based on everything I have read in my four years of researching breast reconstruction, the tissue expanders SHOULD be placed by the PS with the foreknowledge of the approximate size and style of implant he/she intends to use for you down the road.  It should not be "let's just throw this tissue expander on her and see where it takes us." The WIDTH of the tissue expander is a very important consideration.  Proper placement of the tissue expanders is a very important consideration.  Please discuss these issues with your PS.  

TE and Breast Implant Data:  We should be given a little plastic credit card with information regarding our TEs and our breast implants after surgery.  ASK FOR YOUR CARD!  These are registered medical devices and the manufacturer intends that patients have access to this information.  Make sure that you ask your physician's office for this information and retain it in your medical files.   

It should be stated that a great deal of other criteria goes into implant selection.  Also of importance: Your torso [short or long], any potential ribcage or chest wall deformities or issues [e.g. pectus excavatum, pectus carinatum], and how much tissue you have overlying the chest wall.  Also, if you are a unilateral, symmetry issues come into play and this determines the style and volume of implant selected. 
 
We all want the best possible cosmetic outcome from this reconstruction journey. There are other women throughout the bc.org family who also have important information to share and we hope they add their thoughts to this thread so that your breast reconstruction journey is made easier and also so that you feel empowered about this aspect of your breast cancer recovery!

TISSUE EXPANDER AND BREAST IMPLANT CATALOGUE LINKS:

ALLERGAN:

breastimplantadvice.com/wp-con... 

MENTOR - CLICK ON IMPLANTS OR TISSUE EXPANDERS

www.mentorwwllc.com/global-us/...

SIENTRA:

www.sientra.com/Content/pdfs/P...

SSP - Specialty Surgical Products/DERMASPAN TES:

www.ssp-inc.com/Products/Breas...

QUICK LINKS - IMPLANTS ONLY

MENTOR:

www.justbreastimplants.com/bre...

ALLERGAN:

www.justbreastimplants.com/bre...

I knew you before I formed you in your mother’s womb. Jeremiah 1:5.
Diagnosis: 10/15/2008, IDC, 1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Apr 14, 2012 06:31 PM beachymom wrote:

Exchange done! I did take  a peak but know that things change. There's a lot of swelling and bruising, fat grafting done as well. Feel so much better this time around and anxious to see the results as the weeks go by! Thanks to all of you who post on this board, it truly is so helpful through this journey Smile

Diagnosis: 9/13/2011, ILC, 3cm, Stage II, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Apr 15, 2012 01:28 AM whippetmom wrote:

Congratulations beachymom!

I knew you before I formed you in your mother’s womb. Jeremiah 1:5.
Diagnosis: 10/15/2008, IDC, 1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Apr 15, 2012 05:08 AM SheChirple wrote:

I have not been here in awhile, just cruisng along with fills.  Last week I got what may be my final fill.

My only 'concern' is that my PS, when I asked for the card re: my TEs, indicated he usually sends it home me the patient at the time of surgery, and that he didn't have it in my file.  I cannot find it in my paperwork so...I let it drop.

So, I am 5'7", 165 lbs, 38" ribcage, wide and flat rib cage/body habitus.  PS recommends nothing smaller than an estimated C cup.  Initially said he would fill these TE to 700-800.  At 780 he now sayd maybe one or two more fills, but if I want to stop, he can agree to that and will insert approx. 750 moderate plus profile silicone implants, which he estimates (only because I pushed him) to be a large B, small C.  He stresses that this is only an estimate, that he cannot guarantee.

My TE's are almost in my armpits, with a grand canyon in the middle of my chest.  He assures me that the final implant surgery will pull them closer together, and lower profile (I look like a frickin' Madonna cone bra).  I have had no complications and am quite happy with my results, so far.

My next appt is 3 wks after my last.  He said at that time I could have one more fill or he will see how my scars are and schedule exchange in about 2 months.  

A smile is the most beautiful curve on a woman's body.
Diagnosis: 10/14/2011, IDC, 1cm, Stage I, Grade 1, 0/6 nodes, ER+/PR+, HER2-
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Apr 15, 2012 09:10 PM curveball wrote:

Hi whippetmom, I am newly diagnosed and planning (unless I talk myself out of it reading the PMPS thread) to have unilateral MX with "delayed immediate" reconstruction using a TE for skin saving . If the path report comes back clear after mastectomy I would be having reconstruction a few days later, on the same hospital stay. If not, it would be delayed until after whatever additional treatment would be indicated. My preference would be a flap reconstruction, but the PS I consulted with says I am too thin. I have a 2nd opinion on May 1 with another PS but it would not surprise me if he says the same. I guess I just want to hear it from someone who has done microsurgical flap reconstructions—I don't think the first PS has. If the 2nd PS says I'm only a little under the necessary weight I'd be very tempted to see if I couldn't gain a few pounds to make it possible to go directly to a flap reconstruction. I'd really rather not have an implant at all, unless it's the only type of reconstruction open to me. If implants are my only option I think I'd rather have a saline than silicon, I'd worry less about the consequences of a leak.

I'm 56 and my breasts are quite droopy. They are slightly different in size anyway, but it's not noticeable with clothes on. As long as they're no more different afterwards than they were before, that's fine, and OK if what was the smaller of the two ends up the larger. However, I would like the reconstruction to match the existing breast as closely as possible in shape/droopiness. I definitely don't want to have surgery on the unaffected side. My measurements are:

height: 5'7", weight:125 lbs (I usually weigh more like 130), fine-boned. I don't think I am either very long or very short in the torso, and have no rib cage oddities that I've ever noticed or anyone has ever pointed out to me 

Rib cage circumference: didn't know if you meant exhaled (29") or after a deep breath (31-3/4")

Measurement around fullest part of breasts: exhaled 34" inhaled 35-1/4" 

Distance from inside end of collarbone to nipple L (affected) 10-1/4"  R 10" (measured "as the crow flies", not along the skin surface). For about the first 6-1/2" of that distance there is not much overlying  the chest wall but skin. I suppose there must be some pectoral muscles there too, but I am not athletic and they appear pretty minimal to me. 

Estimated projection (laid a ruler across both nipples and measured from ruler to sternum):1-1/4"

diameter of breasts about 13 cm (both sides)

Distance between inner edges of breasts is about an inch. 

Estimate of actual breast volume R <240 cc L slightly larger (don't ask me how I measured this, but I think it's a pretty good guesstimate) Tongue out

What's your size advice for a short term TE and for an implant?  I asked PS about areola sparing, which I would like to do if possible. If I understood his answer correctly there is no medical reason I should not do this but (he said) additional skin would need to be removed so areola sparing wouldn't work out for cosmetic reasons. I assume the areola would end up off to the side somewhere. But how can the skin of the existing breast be too large for a reconstructed breast the same size as the natural one that was removed? And how will I end up with the same droop on the reconstructed side as natural, if skin is removed from one side only? 

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Apr 16, 2012 09:56 PM whippetmom wrote:

curveball: I think that if you are hoping for a microvascular procedure sans implant, you have options other than a traditional flap - but you need to see someone who is qualified to assess whether you are truly a candidate for same.  As far as a tissue expander is concerned, it all depends on the size and degree of ptosis/droop of the breast you will preserve.  You say it is quite droopy, which means the PS will select a TE on the MX side to match the width of the native breast.  He will choose a TE larger than the implant he intends to use and likely overfill that TE so that he can get sufficient skin flaps to allow for ptosis to match that native breast.  So perhaps that would be a moderate height TE with a width of 13.0 cm and a volume of 400 ccs or a full height with a volume of 500 ccs - same width.  And thereafter, perhaps use a moderate plus profile implant with a volume of around 371 ccs.  This is only a guess - it is what I might recommend if you had a bilateral, but you see, achieving the droop to match the native breast is what is rather difficult to achieve, when there is significant droop.  Many women have the native breast "lifted" at the time of the exchange in order to gain better symmetry.  So keep me posted and let me know what you decide to do.

Deborah 

I knew you before I formed you in your mother’s womb. Jeremiah 1:5.
Diagnosis: 10/15/2008, IDC, 1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Apr 17, 2012 03:32 AM curveball wrote:

I am hoping for a flap procedure of some variety, not necessarily microvascular, but it may not be possible at this time. I have an appointment with 2nd opinion PS who is experienced at those techinques, but the earliest appointment I was able to get was May 1. Maybe I really am too thin. If so, I will have to get the implant now, and hope by the time it needs to be replaced, I have enough donor tissue to make it work. I absolutely don't want to have surgery on the unaffected breast. If that means I have one breast higher than the other until I can replace the implant with a flap, so be it.

I really don't understand the function of the tissue expander for skin saving. Is it placed under the muscle or on top of the muscle but under the skin? I don't understand the need to "get" skin flaps when the entire existing skin except nipple/areola will be preserved. Isn't that all the skin that's necessary? If not, why not? In fact, he first PS I talked to spoke of removing some of the existing skin. Why remove existing skin and then use a TE to stretch out what's left—why not just leave the skin that was already there? And a 371 cc implant sounds just huge to me. That's more than half again the volume of my natural breast! Does the volume of the implant bear any relation at all to that of the natural breast it is replacing? 

I think I have no clear picture in my mind of how reconstruction surgery is done, and maybe that's why this is so confusing to me. Is there a step by step explanation anywhere? I have just seen an outline of the surgery in a book but it doesn't go into much detail or explain why things are done the way they are. 

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Apr 17, 2012 06:51 AM, edited Apr 17, 2012 06:52 AM by Lilah

Curveball -- there's a BCO member who has a blog that includes links to videos of her entire reconstruction.  Maybe this will help you to see what happens?  Here's a link to her webpage (which she posts in her profile, so she is open about sharing this).  The videos are posted on You Tube and linked via her website.  She had bilateral implant reconstruction with Allergan 410s (aka the gummy) and is thin. 

www.courageismystrength.com/


Diagnosis: 6/2/2009, IDC, Stage IIa, Grade 3, 1/17 nodes, ER-/PR-, HER2+
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Apr 17, 2012 08:31 AM lago wrote:

curveball I know my BS doesn't support nipple sparing. He also removes the skin and entire biopsy tract. His stance on nipple sparing is debatable but you really do want them to removed the biopsy tract. Whippetmom can talk in detail about the expansion process. There are some women that don't need to go through this process but they typically are larger to start and want to go smaller.

DONE!! alturl.com/enjth • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX done 8.31.2010
Diagnosis: 7/13/2010, IDC, 5cm, Stage IIb, Grade 3, 0/14 nodes, ER+/PR+, HER2+
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Apr 17, 2012 01:13 PM kayb wrote:

curveball - I know that in my case my surgeon removed extra skin because my tumor was near the surface. That increased the chance of there being unseen cancer cells in the skin, so extra was taken just in case.

TEs are placed under the pectoral muscle because it provides more support for the implant. Skin with no tissue underneath isn't supportive enough on its own, or even with some Alloderm added. So the TE stretches not only the remaining skin, but helps create a pocket under the pec for the future implant.

Diagnosed: May 20, 2010 Diagnosis: Diagnosis: 5/20/2010, IDC Right, 2cm, Stage I, Grade 2; DCIS Left; 0/5 nodes, ER+/PR+, HER2+
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Apr 17, 2012 07:45 PM DianneNC wrote:

I have a feeling it may be too soon to answer my questions, but I am really struggling with my reconstruction options. I had a BMX on March 12 with immediate DIEP reconstruction. Through a series of unfortunate events, I lost both flaps and am now left with just the BMX. I start chemo next week, and I am tentatively scheduled for reconstruction on July 25, which will be a month after my last chemo.
My PS is telling me I will get the most natural look with a latissimus dorsi flap with a TE followed by a small implant. Or I can choose to just have the TE/implant. Frankly, after all the difficulty with the DIEP the thought of another flap just doesn't excite me. The PS really gives me the impression that the implant alone will leave me unhappy, though.
I am 5'4", weigh 170 and rib circumference is 35". Since I don't have te's yet, any idea what I should expect from implants as far as style and size would go? I was previously about a 40C, but I'm sure I was wearing the wrong size bra. I lost 70 pounds last year, still have another 30-ish to lose.
I just want to go back to looking as close to the me I worked so hard to be, and not sure if I should suck it up and do the flap or if implants alone will work for me. Any advice????
And yes, I am obsessing about reconstruction to get my mind off chemo next week. :) It scares me to death, and at least with reconstruction I feel I have some input and control.


Diagnosis: 2/13/2012, ILC, 3cm, Stage IIa, Grade 3, 0/4 nodes, ER+/PR+, HER2-
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Apr 18, 2012 01:03 AM whippetmom wrote:

Dianne: I have seen very successful lat flap plus implant procedures. But I too am perplexed about your dual flap failure. I would certainly want this investigated further before undergoing any further surgeries. Would you think about getting a second opinion? I can help you find someone, if you want to PM me.

Deborah

I knew you before I formed you in your mother’s womb. Jeremiah 1:5.
Diagnosis: 10/15/2008, IDC, 1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Apr 18, 2012 01:35 AM marial wrote:

Dianne,

I have very similar stats to you, and just had my exchange surgery on Friday..I think I am about a 36d..and have 800cc ..I known still haven't seen the final outcome..need the whole drop and fluff..but if you want to see my size, I can email you a pic if you'd like of just implants..

Diagnosis 12/15/2010 IDC 3cm 0/6 nodes stage IIa,grade 3' Triple Negative
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Apr 18, 2012 02:41 AM curveball wrote:

@ lago, I am only investigating areola sparing. The cancer is way over in my armpit and the MRI report says "no additional findings elsewhere in the breast". Since I have ductal carcinoma I'm not even investigating retaining the nipple. What is the biopsy tract?

@ kayb, mine is right under the skin too, and maybe that is why the PS talked about removing skin, but if so, I misunderstood him. It seemed to me he said that there was excess skin, not that skin would be removed in case it had cancer cells in it.

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Apr 18, 2012 08:16 AM lago wrote:

Curveball My tumor was in the upper out corner in the posterior region. I suppose I could have done a areola sparing if I found a different BS. I don't think mine does them but probably wouldn't be right for me anyway. Biopsy tract is the scar and the entire path the needle took when removing tissue during your biopsy.
DONE!! alturl.com/3o9ni • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010
Diagnosis: 7/13/2010, IDC, 5cm, Stage IIb, Grade 3, 0/14 nodes, ER+/PR+, HER2+
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Apr 18, 2012 12:19 PM TinaT wrote:

curveball - There's no info about stage or grade at the bottom of your post.  Just curious why you've written off saving the nipple if the cancer is in the axilla? 
Surgery: NSBMX Feb 2011 for ILC and DCIS - More lobular neoplasia and multiple foci ADH in same breast found at surgery - Oncotype DX = 18 (No Chemo!) - Anastrazole April 2011 - Exchanged TEs to silicone implants Aug 2011
Diagnosis: 12/8/2010, ILC, <1cm, Stage Ib, Grade 1, 0/1 nodes, ER+/PR+, HER2-
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Apr 18, 2012 09:03 PM curveball wrote:

@lago—I am pretty sure the biopsy tract is nowhere near the nipple/areola. If upper outer corner in the posterior region is way around the side nearly in the armpit, that's where mine is too. My brother (a doctor) says this is a pretty typical location.

@TinaT—there's no info about stage or grade because I won't have a full diagnosis until after surgery when the status of my lymph nodes has been determined. The pathology report from my needle biopsy says Nottingham grade 2, positive for both hormone receptors and negative for HER2.

Why am I writing off the nipple? Basically the same reason I am writing off the rest of the breast when the lump is smaller than a marble and way over to one side, namely peace of mind. I have ductal carcinoma, the nipple is where all the ducts converge, so how could I be sure in my own mind that the entire cancer has been removed if I retain the nipple? Maybe are some specks of cancer there, too small to detect on a mammogram or MRI. As I understand it (but I'm open to correction) there aren't any ducts in the areola, so leaving it intact would be a way to have a more natural-looking reconstruction, without increased danger of retaining cancerous cells. 

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Apr 18, 2012 09:19 PM, edited Apr 18, 2012 09:27 PM by dobie

Since my PS suggested nipple sparing surgery I have done a little research and find that stats are reassuring as long as lesion is not near nipple. No increase in reoccurrence with NS. PS told me that she will do a frozen section during surgery to assure nipple is "clean". She takes the interipr of the nipple and leaves the nipple skin so how would that be different than the rest of the breast skin? Good enough for me. I will try it despite my BS reservations. </ep>

Dobie
Diagnosis: 7/2007, ILC, <1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Apr 18, 2012 09:24 PM TinaT wrote:

curveball - Each of us has to make decisions that are most comfortable in our own minds after doing our research and talking to our doctors.  Seems there are no rights or wrongs.  I am by no means trying to talk you into nipple sparing surgery.  However, since you state you are just starting on your journey I do want to point out that many women with ductal CA have nipple-sparing surgery. 

Standard procedure during nipple sparing surgery is for the breast surgeon to core out the tissue behind the nipple and send it as a separate specimen to the pathologist.  The pathologist examines the specimen during the surgery.  If it initially looks clear the nipple can be left.  Each patient is warned, however, that more extensive study of the tissue will take place and if the final path report finds any abnormalities in that tissue the nipple must then be removed after the fact. 

Again, not trying to sway you, I just wanted you to know that the tissue is kept separate and undergoes close scrutiny by the pathologist.

Best wishes!

Surgery: NSBMX Feb 2011 for ILC and DCIS - More lobular neoplasia and multiple foci ADH in same breast found at surgery - Oncotype DX = 18 (No Chemo!) - Anastrazole April 2011 - Exchanged TEs to silicone implants Aug 2011
Diagnosis: 12/8/2010, ILC, <1cm, Stage Ib, Grade 1, 0/1 nodes, ER+/PR+, HER2-
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Apr 18, 2012 11:20 PM, edited Apr 19, 2012 12:09 AM by curveball

TinaT, I am planning on "delayed immediate" reconstruction, and the method of nipple sparing you describe would fit in well with that. The nipple could be left on until after the path exam and if necessary removed during the second surgery, assuming that takes place immediately. I will have to think about what the possible outcomes might be. I also don't know if nipple sparing is available through my health care plan. It may only cover more-or-less standard varieties of mastectomy & reconstruction; nipple sparing surgery may not have had enough studies done yet for it to be an option. Now I come to think of it the same could apply to areola sparing too.

I just found this thread in the archives and talked myself out of nipple-sparing community.breastcancer.org/for...

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Apr 19, 2012 01:23 AM TinaT wrote:

curveball - There are women who have expanders as well as those who go immediately to implants on the following thread.  I don't want to hijack this thread when there are others devoted to nipple-sparing surgery:

community.breastcancer.org/for...

As I mentioned, each of us has a slightly different story and you will find that there can be some wide differences of opinion with breast and plastic surgeons.  The best we as patients can do is to gather as much info as possible and go with what our heart and gut tell us!

Surgery: NSBMX Feb 2011 for ILC and DCIS - More lobular neoplasia and multiple foci ADH in same breast found at surgery - Oncotype DX = 18 (No Chemo!) - Anastrazole April 2011 - Exchanged TEs to silicone implants Aug 2011
Diagnosis: 12/8/2010, ILC, <1cm, Stage Ib, Grade 1, 0/1 nodes, ER+/PR+, HER2-
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Apr 21, 2012 12:26 PM t43179 wrote:

Whippetmom - I was told to email my questions to you for help........my original post is below.  Also, I cannot figure out how to get to the "pic forum".

I have exchange surgery on 4/30/12.  Currently have 380cc expanders and going to 350cc Allergen Natural style 20 high profile silicone.  I am 5'5 1/2" and weigh 123lbs with narrow chest.  I would love to see some pictures of similar size as I'm starting to panic that I am going too small even though it is surgeons recommendation.  I had skin sparing bilateral mastectomies.  Doctor thinks 350 will be signifcant on me. With 380cc filled expander I am full B or small C but would like to stay that way.  How much smaller will I be?

Also, has anyone had permanent sutures poke through skin from Alloderm?  Guess these have to be removed with exchange surgery.

Thanks


Diagnosis: 1/30/2012, IDC, 1cm, Stage I, Grade 1, 0/2 nodes, ER+/PR+, HER2-
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Apr 21, 2012 12:30 PM SMG1954 wrote:

Hi everybody:

It is 10 days now after my implant surgery and I am quite pleased with how they look.   The PS will see me again on the 26th and he told me to massage my breasts down and in and out (sides).   They are still a little bit high but I look better than I looked before surgery.   I don't have to wear a bra.  Hooray for that!   I don't like them unless I really have to (under something a little too thin or transparent.  The doc said I should let gravity move the implants a little lower.   I am also massaging my scars with calendula cream.   A lot of friends recommended that for scars.   It is working already.   Good luck to everyone! 

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Apr 21, 2012 10:40 PM Maxine53 wrote:

Hi all!   Whippetmom:   I had a BMX on February 14, and am in TE's right now.  My PS says he plans to expand me to 400 or 425, but I'm concerned that may be too big.  My expanders hold 400ml, and my paperwork says they are 133MV.   I'm 5'5", weigh 122, and my ribcage is 28 inches. 

I'm up tp 300cc so far, and i think what bothers me is the diameter of the expanders; they extend way out to the sides, and just look like huge, flat disks!  I don't want to be huge and flat, just medium and as close to normal as I can get.   Will this appearance change with the implants?  Do they come in smaller diameters for small people?  Do you have any suggestions for implant sizing? 

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Apr 22, 2012 12:22 AM kayb wrote:

t43179 - the pic forum is a private site not associated with BCO. You have to request access as the gatekeepers are very careful about protecting the privacy of those on the site. PM Lilah, nowheregirl or Dawnehope and ask for access. They may require you to make more posts here on BCO before they give you access. They check our posts to be sure we're legit. You'll find it very helpful when you get there!

Diagnosed: May 20, 2010 Diagnosis: Diagnosis: 5/20/2010, IDC Right, 2cm, Stage I, Grade 2; DCIS Left; 0/5 nodes, ER+/PR+, HER2+
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Apr 22, 2012 02:54 AM, edited Apr 22, 2012 03:03 AM by whippetmom

t43179: Well, 350 ccs sounds a tad bit small, but I need to know about your TEs. What style and volume? Is 380 ccs overfill or underfill? It all depends on your TE dimensions. Also, what is your ribcage circumference?

I knew you before I formed you in your mother’s womb. Jeremiah 1:5.
Diagnosis: 10/15/2008, IDC, 1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Apr 22, 2012 03:09 AM whippetmom wrote:

Maxine: they are displacing laterally, which can happen. They should not be flat, at 300 ccs fill. Perhaps you should send me photos. Your PS must be planning on either 500ccs HPs or around 400 ccs in a midrange profile implant. You can PM me for my email address...

I knew you before I formed you in your mother’s womb. Jeremiah 1:5.
Diagnosis: 10/15/2008, IDC, 1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Apr 22, 2012 03:15 AM, edited Apr 22, 2012 03:44 AM by Fearlessfoot

Hi, I am newly diagnosed 2April and although small, early stage, and no nodes affected, because it is lobular and multifocal and I have some family history, I will have BMX probably in 2 weeks.  No radiation or chemo recommended, just anti-hormonal afterwards.  I am freaking out.  I live in Switzerland.  My breast oncologist said I cannot have the autologous type with my own body tissue because of the cancer being lobular, sneaky, and very hard to see if recurrence.  So now I am "stuck" with implants (which actually makes my decision-making easier).  Here they usually do mastectomy and implants in one-step process, so where can I go to get info and connect with others who have done that?  It seems like everyone on the forum is with TEs.  I really need help with size because I have aways wanted smaller breasts.  I am 5'7" 130lbs with 34DD.  I am scared about putting the implants under the pectoral muscle and failure rates etc. I am having trouble finding threads on the forum for my particular case, info on how to do the measurements, photos, etc.  I am meeting with PS tomorrow for first time.  Thank you for any guidance you can provide. 


Diagnosis: 4/2/2012, ILC, <1cm, Grade 1, 0/6 nodes, ER+/PR+, HER2-
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Apr 22, 2012 04:26 AM whippetmom wrote:

Fearlessfoot: Look for the "One-Step" threads. Here in the U.S, it is a one- step with Alloderm, which is the standard. I think that the fact that you will have ample skin flaps and will want to be smaller, makes you a good candidate for this procedure, but some things need to be discussed. Implants with a volume around 425 ccs to 475 ccs in a HP style would be nice for your frame, but it all depends on the skin envelopes - how much remains after the BMX. Because you are large breasted, you might have some droop? If so, where will your nipples end up on the mound when the implants are placed. This is a good question for your PS. Your current breast size and degree of ptosis is a factor to discuss. Where will the suture be..e.g., what is the surgical approach? Find out if your PS will use anatomical implants - like the Allergan 410 or Mentor CPG, or silicone or saline rounds. Let us know after your appt and we can discuss further.

I knew you before I formed you in your mother’s womb. Jeremiah 1:5.
Diagnosis: 10/15/2008, IDC, 1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Apr 22, 2012 06:09 AM Fearlessfoot wrote:

Oh, thank you so much, whippetmom! This is so very helpful to go with these kind of specific questions!  What a wonderful resource we have in you and others on this forum! 

Diagnosis: 4/2/2012, ILC, <1cm, Grade 1, 0/6 nodes, ER+/PR+, HER2-
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Apr 22, 2012 08:33 AM t43179 wrote:

Whippitmom, my TE's are Allergan Naturalle style 133FX-11-T 350cc so I am 30cc overfill.  I measured just under fram fold and am 28 inches there.  Dr says I will be 1 shot glass smaller going from 380 TE to 350 silicone but what about the extra plastic in the expander?  I would love to see pics of other 350cc's. 


Diagnosis: 1/30/2012, IDC, 1cm, Stage I, Grade 1, 0/2 nodes, ER+/PR+, HER2-

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