BREAST IMPLANT SIZING 101
Comments
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Whippetmom - I go to PS tomorrow to discuss potential E-day and size preferences. I am currently 5'3" 145lbs with a 33" ribcage. I have Mentor style 7200 550 TEs filled to 600. I was a 34C before BMX and am fine with that size. I am mostly concerned about the sever divots and the big time step off. Any recommendations ? ooops, 32 ribcage
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While we're talking about 410 Allergen "Gummies," just thought I'd also comment that I am very happy with mine. No rippling unless I bend over and then just a little where skin is very thin. Good projection. Nice slope and cleavage. Look very natural, only more full than before. Would prefer them to be a little softer, but they are fine. Actually look quite good!
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My implants "jiggle." But I have had fat graft transfer times two and it softens everything up.
Lilah, the implants I told you about are Sientra cohesive gel "gummies" but they are rounds, not anatomicals. I am hoping I can hold out for Sientra implants - who knows when they will be FDA approved though....
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Shannon: I have a question for you first. What do you think about the size you are currently? Are they just right or do they feel too large?
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whippetmom: I could use your input with regards to appropriate implant sizing for my body type. I have Allergan 133SX-14 TE's, 500cc's filled to 550. Fills are done, exchange is set for 9/28.
I am 5'3½", 142 lbs, 34" ribcage. I am short waisted, smaller shoulders, wider hips (41" . . . . I know, ugh~). Anyway, my pre-BMX bra size was 36DD. I told my PS I did not want to be that size again and that I would be happy with a full C cup, although I am more concerned with being proportioned to the rest of my body than with cup size.
My concerns: Looking at my now full TE's, I feel like they are small for my body. Perhaps I just got so used to seeing my full chest that now my size seems small in comparison.
My husband thinks currently they are a decent size for me. My PS says if we go any larger, that they will begin to go towards my underarms, and that I will have the "coconut" effect. My PS asked me if I was happy with the size, and I really am not sure if I am or not. I told him that I could live with the size I am, but that I wanted more projection with the implants. He noted that info.
My question to you: Based on my measurements, do you think I am at the right size now for my body type? I have been losing weight for the last 5 months and still have 12 more pounds to go to reach my desired weight.
Your input would be greatly appreciated. Thanks!
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whippetmom & lilah: No she's not having radiation. There were no nodes involved.
The rationale for the LD flaps is that the implant coverage will be poor otherwise. To be clear, I mean the LD muscle being used for coverage - my wife is having nipple and skin sparing MXs, so she doesn't need skin.
Two of the three PSs were willing to do implant-only, but they still recommended LD flaps as being preferable. They all say, that without LD flaps, the implants will be palpable and that it could even be possible to see the bottom edge of the pectorals (and showed us photos to that effect). Particularly since my wife is so thin. (45kg/100pounds at 160cm/5'3".) They also say that, without the LD flaps, rippling and capsular contracture will be greater risks, and hence revision surgery will come much sooner than if LD flaps are used.
It's hard to argue when three different guys agree like this. I'm not enamoured by the grand plan though. I don't like the idea of chopping up functional muscles to make non-functional boobs. I am also finding it hard to accept that a lump the size of a mosquito bite will end up requiring 6 different incisions (SNB, lumpectomy, 2xMX and 2xLD). Anyway, we booked one guy to make sure my wife has a slot before Xmas, but we are still investigating.
Chemo is going pretty well, thanks. (Easy for me to say.)
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Merovingian -- it's just not what I've ever heard before. Here in the US they usually only recommend LD Flap (using the muscle from the back, yes?) if the woman has had radiation, due to poor integrity of the skin. All I can think is that there is a reason that all three doctors see an issue with your wife's skin (her thinness?).... I agree it seems extreme to make so many cuts to a body for such a small, low stage cancer (though Her2+ -- which I am as well -- is highly recurrent, so they tend to be aggressive when treating that -- and triple positive is also worthy of attention... with that said, I see your wife is receiving Herceptin as part of her treatment, which is great). I did chemo and it was (surprisingly) easier to do than I would have thought. I hope your wife is also having an easy (relatively) time of it. The hardest part for me was losing my hair, which has grown back.
Whippetmom -- interesting about the fat grafting and the jiggle!
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Wippetmom, I think I would like to be smaller than I am currently with these TEs.
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Merovingian: That was the surgery they recommended for me first-What I ended up having was an Alloderm Sling which supports the breast and helps with the thin skin issue. Are there any dr's there that do this procedure because this is what should be done and it's much less invasive.
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Shannon: Here is what I would recommend, and I will use Mentor products since your PS used Mentor TEs....
I think to address your step-off deformities it might be best to use a moderate plus profile implant. I would recommend 500 ccs in Mentor's moderate plus profile implant. It will be smaller than what you have currently. 550 ccs in this style would work also and still give you a nice result for your frame. You have considerable projection with your TEs, which you will not have with the implants. The moderate plus profile gives more of an athletic appearance to the chest wall than the high profile implants, if you know what I mean. Let's say you wanted to have the appearance you have now with your TEs, you would need at least 650 ccs in a high profile implant to approximate what you have currently. So you can see that 500 ccs is quite a bit less.
The other option is the high profile style implant, and you would need 550 ccs in this style of implant. I would ask your PS to bring the two sizer styles into the OR and see which one addresses the step-off best and gives you the most natural appearance.
Deborah
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HeftyLefty: You have a couple of options. Your short height TEs are designed in such a way that the PS can use a considerably larger implant at the time of the exchange. Your TEs are strange looking devices, because they expand in the lower pole and so they have the appearance of being rather "shelf-like". This makes it difficult to appreciate what the implants will look like eventually, but it is a very good style of TE - don't get me wrong. So with this TE, you have the following dimensions:
TE: 14.0 cm width and 7.1 cm projection.
I think that your PS could easily exchange you out to 650 ccs and even 700 ccs in Allergan Style 20 - a high profile smooth round silicone implant. You could easily handle an implant with a width of 14.0 to 15.0 cm.
Style 20 650 ccs - 14.2 cm wide and 5.9 cm proj./ 700 ccs 14.5 cm wide and 6.2 cm proj.
Now you might be a candidate for the Allergan Style 45, which is the ultra full projection style implant. What is good about this, is that it does not add height to the chest wall - and since you describe having a short torso - it might work in this regard, as well as offering the greatest projection to balance out the lower half of your bodacious body!
Do you get my drift? But in Style 45, you would need 800 ccs to match the width of your TEs. Here are those numbers:Style 45: 800 ccs - 14.2 cm wide and 6.7 cm proj.
So this is why I feel safer recommending Style 20. I think that 700 ccs is the volume I would recommend in that style, as you are getting a little extra width and the projection is still good.
So run these numbers by your PS and let me know what you come up with!
Deborah
EDITED TO ADD: You do NOT need to overfill any further in order to exchange out to the implants aforementioned. These short height TEs are not designed for aggressive overfill...
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Thanks, Deborah. You're an angel to help so many of us on this part of the journey. I will not be meeting with my PS prior to surgery date, only the nurse one week prior; but I will discuss this with her at that time. Again, thanks!
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whippetmom: BTW, you are SOOOO right about my TE's being "strange looking devices". They definitely have that shelf-like appearance. Additionally, my left TE somehow rotated a quarter turn, making it look like I have a football on the left side of my chest! PS says he will have some extra pocket work to do on me since the TE's had a mind of their own. Overall, though, I am not that disappointed in how they look under clothing: I have been able to get through the summer wearing most of my tanks, sundresses, and swimsuits without anyone being the wiser. - Sans clothes is another thing!
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merovingian: I was going to also ask if they are using Alloderm or some other dermal grafting material in Australia. We have had very diminutive gals your wife's size pass through here and they did just fine with implants only, but they have all had Alloderm slings.
How about using fat from the "love handles" area? It is far less invasive than a lat flap in such a thin patient. They are doing it in the UK also....so why not Australia?
Ask about this area instead. Seems like a much lower risk of compromise than one might have with the latissimus dorsi flap procedure in a woman with a very bony habitus. I am concerned about the lat flap for her. If they can take the love handles - great. If not, implant only.
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Heftylefty: Yep, and that is why the suture tab TEs work best - especially with the low height TEs, which seem to be at a higher risk for rotation/malpositioning. But I suppose the increased cost is why many docs do not order them or use them. Allergan and Mentor both have them, so why not use them??? Grrrr.
You could email your nurse the information - or at least call or email her and ask her which implants have been ordered. It might be too late one week before the surgery.
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I have a bit of a dilema. I'm having a mast on Tuesday and the PS is putting in a TE in my left side. The thing is, the boob left behind is a double D. Can the TE reach that size, or do I have to go through another surgery to reduce the other one?
I'm 5'2" 115lbs. Definatly TOO big. I welcome a more appropirate size. A second surgery is a bit scary. I've spent my whole adult life carrying around these oversized breasts and they kind of became a part of me, not who I am. Smaller boobs will be more attractive. Has anyone had a breast reduction after cancer? Am I being vain? I guess I should worry about the CANCER and not my clevage.
Any comments would be appreciated.
HALF a DD, Maureen
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I have a bit of a dilema. I'm having a mast on Tuesday and the PS is putting in a TE in my left side. The thing is, the boob left behind is a double D. Can the TE reach that size, or do I have to go through another surgery to reduce the other one?
I'm 5'2" 115lbs. Definatly TOO big. I welcome a more appropirate size. A second surgery is a bit scary. I've spent my whole adult life carrying around these oversized breasts and they kind of became a part of me, not who I am. Smaller boobs will be more attractive. Has anyone had a breast reduction after cancer? Am I being vain? I guess I should worry about the CANCER and not my clevage.
Any comments would be appreciated.
HALF a DD, Maureen
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Chef -- I am a uni and my native breast was a DDD! I did have a reduction and lift (and I LOVE the results). While the TE on the MX side was being expanded I obtained (from a shop at the Breast Center at my hospital) a fiber filled insert that I could remove stuffing from as the TE got bigger... which I inserted into my bra to even myself out during fills. By the time I was done with the fills I was able to go without the insert (my TE was filled to 850 ccs and was a close enough match at that point without the insert). My final implant is 685 cc's and I desperately needed the lift anyway (and the reduction made a good match)... now both sides are pretty perky!
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Whippitmom, You have obviously provided such a service here for women that need information about what size, what implants etc. Everyone is clearly very happy with what you tell them. I'm curious, did you get information off the internet and compile it? Was it your own experience that drove you to do this for others? You clearly understand the system better than most of us here and going through it, and I'd love to know where you got the knowledge-Thank you for all the assistance you've provided to so many of us. Pat
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LILAH
THANX for putting a positive spin on this. PERKY is good. I've heard that the reduction was painful. I just would like to be a large C but my PS says a B would be more appropiate for my frame and height. I've carried around the DD and cannot imagine a B cup. Do I have a choice? I just don't know which way to go. May I ask your new perky cup size? THANX
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Pat: I was a medical paralegal and then a medical malpractice claims and research investigator for twenty five years. As an independent consultant, I was asked to join a team of investigators working on the silicone breast implant controversy leading to massive individual and class action lawsuits in the 1990s. A great deal of information I impart does come from continued research on the internet, as well as through medical books by Kenneth Shestak, MD and Scott Spear, MD. I am an interior and landscape designer now [since 1997] and so I suppose I have this artistic bent, coupled with an understanding of medical terminology and a passion for research. My own experience with breast reconstruction was the impetus for me to help other women, but a very important reason for being here is that I consider this a "ministry", as I had wanted to use any gifts God has given me to help other women going through this sometimes confusing and challenging journey.
EDITED TO STATE: My design work is only part-time and for years I just dallied in it for myself and for friends - even while working in the medical-legal field. Now I do have select interior design clients but primarily perform landscape design [pro bono], designing the medians and other landscaping needs in east Long Beach, as part of my role on the board of the garden club in my community. This is why I am able to spend so much time here!
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Hi Deborah!
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chef: Coupled with Lilah's stellar information, I would suggest you talk to your PS this week and discuss the need for a reduction/lift, because this will have bearing on the style and volume of tissue expander he uses next Tuesday. I think it will be almost imperative that you have a reduction, as with your small frame, it is going to be difficult to get sufficient expansion on the MX side to get ptosis [droop] to match your native breast. I think you absolutely need that native breast to be smaller and lifted, so that the nipple/areola ends up in the right place on the mound.
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Hi Laura: I have to warn you that I have been having major insomnia. I might need to set up a rollaway bed in the bathroom! Hope we have a big bathroom again!
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Hi Laura
You are so cute.
Chef -- my new "size" is a D but I look like a C (anyway I'm a small D). That is because implants are wider than natural breasts, so I need the D (sometimes a DD still actually) for the width. My natural breast is very accommodating LOL. It hangs a little lower than the implant side but not enough to bother me much and in a bra they are perfectly matched. A reduction does take longer to heal from than an implant, I won't lie, but really I can't tell you how good it feels to be rid of all that boob. Moving up the nipple/areola for the lift part resulted in increased sensitivity (a nice counter for the complete absence of feeling on MX side). At first the increased sensitivity was TOO MUCH. But that did relax after a few months (thank goodness).
My PS did what's called a lollipop incision (imagine a circle around the areola and a line straight down to chest from the bottom of areola and that is the incision -- some doctors do an inverted T but mine did not, which was better for healing). My PS actually did not attempt anything so drastic as a B cup -- yikes! I would say that you should tell your PS not to go overboard if you do go with the reduction/lift. You should post the info Whippetmom needs to get a suggestion for an implant size that would be good for your frame and then match from there. My PS did the reduction/lift at the same time as the exchange. I think recovery varies on the reduction (and on the exchange for that matter) but by and large reduction will take more time to heal than exchange.
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chef: Call the office tomorrow and find out what style and volume of tissue expander your PS ordered. It will be in your chart.
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Hi Lilah !
Dear Deborah... do not worry about keeping anyone awake.... have you really LOOKED again WHO is in our room....LOL LOL.... I doubt we will ever get in before 1 am.... lol.... I was worried about YOU... but now I know.... you can take it! XOXOXO !!
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Laura -- (and Deborah) -- all I can say about that is: Uh-oh!
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Hi girls! Long time, no "talk"
I had a full capsulotomy and Alloderm placement yesterday in my right foob (the radiated one). My PS said that the capsule was not hardened. It was just tight. and nothing looked "funny" - no lumps! Thank God. I don't need to go through that again!!! Hopefully this surgery fixes my capsular contracture.
I hope you are all doing well!
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kittycat: That's great newsx!!!
Deborah, Laura and Lilah: Are you all in Vegas already??? I won't be able to make it-I am booked solid through October but I will be there in spirit!!!
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