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.
ALLERGAN 410 - "GUMMY BEAR" IMPLANTS:
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.
AFTER THE EXCHANGE:
Just remember that just after the exchange, the implants can look misshapen and flattened out and sometimes downright bizarre! You need to give it two weeks - sometimes much longer. DON'T OBSESS ABOUT THE SIZE OR SHAPE RIGHT AFTER THE EXCHANGE! STEP AWAY FROM THE MIRROR!
EMOTIONAL ISSUES AFTER THE EXCHANGE:
Many of us and I mean MANY of us go through a period of sadness and depression after the exchange. It is an emotional journey we have been on since diagnosis and we suddenly seem to start experiencing all of the emotions we have placed on hold throughout the mastectomy and TE expansion process. So just rest in knowing that we have been there and we know what you are going through right now. Try to avoid obsessing over the appearance of your new breasts. Feel free to ask any questions or voice your concerns, but it is quite normal as this point in your 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:
CATALOGUE FOR CANADIAN AND EUROPEAN PATIENTS
MENTOR - CLICK ON IMPLANTS OR TISSUE EXPANDERS
SSP - Specialty Surgical Products/DERMASPAN TES:
QUICK LINKS - IMPLANTS ONLY
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