BREAST IMPLANT SIZING 101
Comments
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Merilee: Okay...so this is delayed recon...got it! Well, I think the same formula still applies - it all depends on your skin flaps - and what size and style TE the PS feels they will accomodate. So once you have your appt. with him, come back here and we will chat about his plans. But please share what you want out of this...so that he can plan how to get you as closely to that point as possible...
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Thanks, It sure is nice to have a place to talk this through. I really only want a little bit of shape and I am concerned that he will want me to have more.
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Merilee: It sounds like he knows where he is going with your reconstruction....the TE sounds right to me...
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Bump
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Just trying to get things straight in my mind:
Choices of type of implants are Saline, Silicone, Cohesive Gel (Gummies)?
There are two type: Textured and smooth
Shape - round, teardrop?
High, mid & low profile?
Am I missing anything else? My final presurgical appointment is on Friday and I guess I have to make some decisions. Or does the PS make the decision for me? I'm assuming this is not a "one style fit all" type of thing. Does age, life style fit into the equation?
I'm 57 (58 in May). 5' 2". Weight range is 112-116 (depending on how good the chocolate is!!). I wore a 34 B and would like to stay that size if possible. I lead an active lifestyle and enjoy playing sports.
I honestly thought I had it all straight and worked out in my mind thanks to Deborah's PM;s, but months have gone by and now that I'm at the 11th hour, I feel like I'm about to take the most important exam in my life and I haven't studied enough!
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Mantra: You should have some input, if you want some control in the outcome. I think you can certainly ask your PS what he is recommending by way of implant, and for you, I would say either a high profile silicone smooth round or a true cohesive gel gummy in perhaps a moderate profile. I think around 400/425 ccs in either Mentor or Allergan high profile [grams, instead of ccs in gummys] would be the range you want to look for at the time of exchange.
ADDENDUM: Of course, the above recommendation also hinges on the width of your TEs. I do not recall the width of your TEs. If you needed something wider than could be afforded by a high profile implant, a moderate plus profile would also work for you - just a little less projection.
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Hello Whippetmom, and all others:
1/11/10 I had a TRAM flap which is filled with fat necrosis. Prior to the TRAM I had a TE (threw the card away never thinking I'd be neededing it again), this was over the muscle to expand the skin. The hard, necrotic tissue will be removed, PS will save any viable soft tissue.
I am 54 yr old, 135 lbs, band width 34.5, current bra size 40 C (38 B when I am 10 lbs lighter like I would prefer to be).
What else do I need to tell you to know what I need to ask for. I want to be an informed implant consumer. I
Thanks you for providing this assistance to myself and others,
Robin
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Robin: I think I need to clarify your ribcage measurement. I am confused by the 34.5 circumference in light of your current 40 band size. Either you have been wearing the wrong band size all of these years or something else is going on. Did you take the tape measure and wind it around the ribcage under the bra line - under the inframammary fold? Confirm for me please.
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whippetmom: I just remeasured. New numbers - 36" around the ribcage, 40 over the breasts.
My chest is broad even though I am a relatively small woman.
Robin
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Thanks Robin. That makes more sense. So when you say "breasts", do you currently have a mound from the flap? Also, I forgot to clarify...are you a bilateral MX or one side only? If you are a UNI...tell me more about the remaining native breast. Is it going to be lifted and augmented with an implant?
I think you need an implant with a width of at least 14.5 cm....so it really depends on whether you have some mound already which will add dimension along with the implant. You might need to email me photos..
In order to obtain over 14.5 cm in width, you are looking at a 650 cc high profile implant, or 550 ccs in a moderate plus profile implant. I am concerned that since the TE was placed over the muscle, you might be limited in implant volume.
Find out from your PS if he uses Mentor or Allergan implants. Will he use silicone smooth round implants [preferably]?
Deborah
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Whippetmom - My current TE is a Mentor 354-6213.
Siltex® Medium Height Contour Profile®
Volume 450
Width - 12.7
height - 10.8
Projection - 7.0I only have a 100 CC in it. When I changed to a new (much more knowledgeable) plastic surgeon, she said it is positioned incorrectly. She is removing it this month and replacing it . . . starting all over again. Original TE was done in September. I can't help but wonder if removing it and starting all over again is going to cause additional problems.
During the same surgery, on my "healthy side", I am having a mastectomy. I will either have a tissue expander put on that side as well, or I may have immediate implant with alloderm. I'm in a study and won't find out until Friday which route I will be going. Regardless, my left breast is not eligible for the study so it will have a tissue expander.
If these questions have been answered previously, feel free to just point me in the direction of where to find the link.
1. What is the advantage/disadvantage of smooth vs textured?
2. What is the advantage/disadvantage of silicone vs gummy.
3. Is there a reason why you suggested high profile for silicone but moderate profile for gummy.
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Deborah - here is my history:
left lumpectomy, bilateral reductions - margins not clear= left mastectomy, delayed TE over the pectoral muscle, TRAM reconstruction 1/11. Yes, I have a mound there but it never softened, never developed the inframammary fold. The expanded skin on the left is filled to capacity with the TRAM. It looks a little smaller to me than the right breast. Since the natural breast has already been reduced, I don't know how much more can be done to it.
I am consulting with my original PS and another in Denver,
Tomorrow I will take a few pics and attempt to send it in a PM.
Silicone implants were discussed, brand never mentioned.
Robin
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Mantra:
1. What is the advantage/disadvantage of smooth vs textured?
If it is the anatomical gummy - the true cohesive gel implant - it is going to have a textured surface. It needs a textured shell to help prevent it from rotating. A round implant does not need a textured shell to keep it positioned within the pocket But textured rounds and tear drops are used by some plastic surgeons who feel that they reduce the risk of capsular contracture [but studies have shown the reduced risk to be so minimal as to be useless] but they also have a shorter lifespan. Textured round implants are known for causing traction rippling - and in breast reconstruction patients, unless you have a recurrent problem with CC, I would never advise using textured rounds or tear drops. When it comes to the "standard" silicone implants currently widely available today, smooth silicone round is always the preferred implant choice.
2. What is the advantage/disadvantage of silicone vs gummy.
You will have to perform a search for the many threads re: the "gummy bear" implant. It is much firmer than standard silicone rounds. You are probably more limited by the style and volume of the gummy bear, because the pocket needs to be created specifically for the shape of the gummy bear, in order that it fits correctly in the pocket. Some women just love their gummy implants and some wish they had gone with smooth silicone rounds. You need to perform more research in this regard. I cannot advise you one way or another. You might start another thread to discuss the merits of the gummy vs. standard silicone round.
3. Is there a reason why you suggested high profile for silicone but moderate profile for gummy.
The high profile or moderate PLUS - don't forget the PLUS - were recommendations for the smooth silicone round. The recommendations for the gummy differ somewhat, because if you look at the Allergan Natrelle website, the "profiles" for the gummy are numerous. Again, the gummy needs to fit the pocket created by the TE. And it sounds as though you are getting a new TE - perhaps a new size - so gummy sizing would need to be discussed with your new PS.
If you want the best symmetry possible, I would go with a TE in the opposite breast after MX - a one-step is not likely going to do it for you. Perhaps your PS knows something I do not know though - I am doing this blindfolded and she has examined you. So that one-step issue needs to have further affirmation regarding symmetry.
Deborah
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Robin: I am PM'ing you my email address. You will need to email me photos.
Deborah
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Mantra: Use the "Search" feature on bc.org - in the upper right hand corner - and then in the "keywords" box, type in "gummy bear" [without the quotes] and you will come up with a number of threads on this topic.
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Mantra:
This is an excerpt from Dr. Teitlebaum's website. He is one of the cohesive gel clinical trial plastic surgeons in California:
"Anatomical or teardrop-shaped implants must be placed in exactly the right position and leave less room for error. If an anatomically-shaped implant moves around, it will cause a very unnatural profile. The only form-stable implants that are under consideration by the FDA have an anatomical shape. In order to prevent rotation, a pocket that precisely fits the implant must be developed." He goes on to say that "the surgeon must ensure that the pocket is made to fit the implant, which is a very different approach than most surgeons use with a round smooth implant...in which [they] make an overly large pocket to allow the implant to move around. One must be cautious in patients with loose, empty, or floppy types of breasts, as loose tissue may allow the implant to move around." [Obviously, this last reference pertains to augmentation patients, but if the skin flap is overexpanded or if large skin flaps remain after MX, the same might apply..]
Dr. Teitelbaum states:
"Another concern would be patients requiring "revisions in which there is already a pocket that either may be too big for the new implant, or is already lined with smooth tissue, thereby preventing the textured surface in the teardrop implant from adhering and preventing rotation."
This excerpt seems to speak to any thought someone might have of replacing a round implant at some point with a "gummy bear" once approved....inferring that you will need to increase the volume and dimensions of the pocket in order for this to be possible...
"If a patient is getting old implants replaced and the pocket is just too loose, a round gummy bear implant may be used. However, the round ones [he refers to the round cohesive gel implants - Sientra currently has this style in clinical trials] are not available in the United States at the moment. You will definitely need a skilled plastic surgeon to insert your cohesive gel implants."
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Thank you so much. This is very helpful in helping me to make my decisions.
I've narrowed things down a bit and just have a few more questions. I have decided not to go with the gummy. Too restrictivewhen it comes to the types of implants. Worried about the firmness too.
I called my PS office and found out she uses Allergan.
From the link you sent to the Allergan site, Their expanders are Natrelle® Style 133V Series.
Is the high profile you suggested equal to their Full Height Variable Projection? And is the or moderate PLUS equal to their STYLE 133MX Extra-Projection Range?
Am I also correct in assuming that at this point, I just select the tissue expander but whether it is textured or smooth, is irrelevant at this point until the exchange surgery. Yet these are the best tissue expander for round implants but also leave the door open a bit to some other options during exchange surgery?
Thanks again for all your help.
Diagnosis: 7/10/2009, DCIS, <1cm, Stage 0, Grade 3, 0/3 nodes, ER-/PR-
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Ooops . . . somehow my post got a bit screwed up. Also wanted to add the following.
My first surgeon would not use round implants on me. She said they won't look right. Her exact words were " they will look like a half a grapefruit sitting on my chest." When I see my new surgeon tomorrow to finalize things, if she says the same thing, what should I say?
Will round look weird on me because of my age (58 in May)? When I first met the new surgeon in November, I vaguely remember her using the term teardrop. However, at that time she was only looking at doing one breast and perhaps teardrop is the best match to my real breast? But now that I'm having a prophylactic mastectomy, she'll be starting with a blank canvas, so to speak.
I really like the idea of not having to worry about it shifting and looking weird. And if smooth will give me a fighting chance at not having ripples, I'm all for it.
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Well, I scheduled expander surgery for the 7th of June. The PS will use a mentor450 and fill it until I get a small b look. He will be using AlloDerm slings to give me a more natural look. He wants to use smooth round silicone.
He agreed to give me perky, rather than 50 year old boobs LOL, I made him write it down.
Comments, advise and thoughts please.
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Mantra: Your new PS is going to have more to say about the selection of the new TEs, but I think that the most logical choice would be to stay with the moderate height TE and so this would be the 133 MV or MX. I like the short height also, but you need a TE with at least 400 ccs to get you where you want to be. The thing I like about the MX, if the projection will work for you, is that you can get a narrower based width with a little more volume. So perhaps a 133 MX 400 cc would be nice and that keeps you at 12.0 cm in width. But I think that a 13.0 cm width would be fine on your frame, so your PS has the option of going with either 400 ccs or 500 ccs. Let her decide. I just advise against the FX or FV, because I think it over-taxes and over-stretches the pectorals and we want to try to avoid that. Thin women especially are predisposed to having a step-off defect in the upper pole,, where the bony chest meets the implant, and I think that the least amount of disruption in that area might be best for us...
Referable to your question about the appearance of the rounds...what a buffoon that PS was to say that to you! Harumph! Well, I am 59, going on 60 this July, and I have the high profile silicone rounds and I am happy with my round perky breasts! Your PS can expand you sufficiently to get enough stretch to exchange you out to an implant which will give you some natural droop.
Let me know if I can help further!
Deborah
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Merilee: I like the way he thinks! It all sounds good to me! Once you have expansion underway we can revisit the "numbers" for you. Congratulations!0
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Hi Whippetmom,
Thank you so much for doing all of this. I have found myself anxious at different times throughout this process, and I always seem to find my answers on this site. I was diagnosed with DCIS on Nov. 19, 2009. It was Grade 3. The plan was to do a lumpectomy and rads. First surgery on Dec. 9 with no clear margins. Reexcision on Dec. 21 with still no clear margins. I had bilatteral masectomy on Jan. 22 with expanders. I do not have to have any other treatment. I am supposed to have my exchange on April 23 and I'm nervous about the size. After all of this, I want to end up with great boobs. I love my PS and trust him but wanted your input. Here's my info:
Height - 5'7"
Weight - 130
Ribcage - 30 inches
TE's - Mentor moderate height with recommended fill volume of 350 cc's
I am expanded to 480cc's right now and go back one more time next week. He said he wasn't sure if he would do the 60cc's he has been doing or less. He does do overfill. I met with the nurse today for preop stuff and she said my chart had implant size of 450 or 475. Final decision next Friday. I think I would rather be too big than too small. I was always on the small size. It is just so hard to tell with these hard turtle shells in my chest right now. I appreciate any help you can give.
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Deborah I have tried and tried to get them on the pic fourm but can't get them the right size!! thank you so much.
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boromom:
If your PS wrote down "475" ccs, he must be using Allergan implants, instead of Mentor? Mentor does not have a 475 cc implant - at least in silicone. lAllergan Natrelle Style 20 has a 475 cc implant. I trust he is not talking saline? I do not know saline sizes off the top of my head like I do silicone. 475 ccs is the absolute LOWEST volume I would recommend for you. Allergan Natrelle Style 20 high profile silicone smooth round - 475 ccs. However, I prefer 500 ccs for you. Actually, you might be the a very good candidate for the ultra full projection style implant - Allergan Natrelle Style 45 in 500 ccs... Since your TEs are 11.7 cm wide, these might work for you. Write all of this down and present to your PS and hold firm on "nothing smaller than 475 ccs"
Support your request by comparing the dimensions of your current expansion with your TE:
Mentor TE: 11.7 cm width by 6.6 cm projection [actually, the height and projection is now greater due to your over-filling of the TE]
Allergan Style 45: 11.9 cm width by 5.7 cm projection
Deborah
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mom2Bnegative..
Are you using www.drpic.com? Upload a photo, resize down to 50%, save to your pictures folder and then upload that resized photo on the pictures forum. If you want to send them to me I can resize them for you and send them back to you and then you can post them on the forum. PM me for my email address.
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Hi Deborah,
Thank you so much for your reply. He is using Allergan silicone because the nurse gave me a big book on them yesterday. I go in a week for my last fill and will take all of your info with me. I wonder if I go with 500cc's if I'll have to delay the surgery for more fills. If he did a full fill next visit, I would be at 540cc's. Not sure if that leaves enough extra skin. Anyway, thank you again. I truly appreciate your taking the time to do this.
Melissa
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I think you have sufficient skin now. I do not see why you need any further fills. The majority of us have implants which have more volume than the tissue expanders. For instance, my TEs were filled to 425 ccs and I have 550 cc implants bilaterally. We are looking at dimensions - not volume. TE volume does not translate to implant volume. At least hold firm on the 475 ccs...and 500 ccs is only another 25 ccs...
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hi whippetmom
Again many thanks for all your advice up to this point. Had exchg on thurs. (I had mentor 350cc moderate ht TEs filled to 340cc; PS put in 500 cc mentor round) (I am 5'7" 140 lbs 32 inch ribcage) I am kind of unhappy as it does not look good as they are very flat in front! The TEs projected out more in clothes although now it is much smoother and does not have weird shape that TE's had. We did discuss before surgery that I wanted more fullness on top as I was very small before (barely 36A) so it now has better "slope" if that's the proper word but if you look at me from side angle does not look like I have much. Also left one is very swollen in upper part (PS said he did more work on that side) It is definately bigger than what I started this whole thing with but I don't feel that I have cleavage, just more like flattened pancakes. I tried on halter dress that I bought with TE's and it does not look as good as they do not project out as much?? to give you a picture looks to me like male bodybuilder w/large pecs
Is this normal?
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winter: You say you have Mentor "round", but WHICH rounds? Get a catalog number - we want to know if they are high profile, moderate plus, or just "moderates"....
While you are getting this info, please note that you will see quite a few changes over the next few months - sometimes the most dramatic after the first week or two post-exchange. But let's see what style your PS used...
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I will have to get that info next time I see him (I do have in file somewhere cards which have style no etc.of tissue expanders, would that be the same style no as final implant or no?)
thank you
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