BREAST IMPLANT SIZING 101
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Lago - Wasn't sure what the youtube video would show. I was concerned it might have something to do with massaging. Very funny!
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HeftyLefty:
How many times have you met with your PS during this process? I have honestly never heard of a pre-op NOT including the PS. It is the last time before your surgery for answers and reasurrance and clarifying of what will be done for you during the surgery. To have to present these questions to a nurse who will not have answers and will say, "I don't know, I will have to get back to you"....I just think if I had been told I would be meeting with the nurse for my preop - well, that just would not have happened. When was the last time your PS saw you? Examined your TEs?
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Issymom you'll get used to my surprise videos.
BTW I am happy with my silicon but I have a few ripples. My PS plans on doing some more fat grafting to fix that at nipple reconstruction… if he can find some. He had issues finding enough at the exchange. Hopefully I can point him in the direction of my thighs this time. Plenty there. 0 -
Thanks Whippetmom, I will talk to my oncologist. I saw her just before my expander surgery and am due to see her but didn't have time before the surgery. Yes, my PS does mostly breast reconstruction and was highly recommended by my breast surgeon (one of the best in Washington). He also fixes a lot of other PS's bad reconstruction. I trust him. They said that over the muscle, the recovery is easier and there is less movement when flexing the pec muscle.
I will make some phone calls tomorrow and will let you know what I hear.
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Issymom -- is he using alloderm to hold the implants in place? Also I think Saline is preferable if you are going very large (like 800 ccs or higher)... but other than that most women prefer silicone.
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Lilah - No Alloderm. My only concern is making sure they don't shift to the side (under my arms) the way the expanders do. I asked about it and they said that they will make a pocket to ensure it stays in place. Didn't ask how, maybe I should have.
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Can anyone tell me what I need to do to get access to the reconstruction picture forum?
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survivor11 - The picture forum is a privately moderated site (separate from BCO). Try sending Lilah, MBJ, or firni a PM (private message) here to find out about getting access.0
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Issymom - I'm totally shocked that your PS is going over the muscle with the expanders and exchange implants. Usually they're put over the muscle if you have a lot of breast tissue.
When I had an augmentation (pre BC), I had saline implants over the muscle. This was mainly because I have pectus excavatum and slight ptosis. When I had a mammogram, they did NOT pick up the small BC lump because the SALINE implant blocked the full view of my breast tissue. I had an ultrasound and this is where they discovered the lump. When I had my BMX, my first set of implants from the aug were removed and I had expanders put under the muscle. For the exchange implants, my PS uses silicone, unless the patient insists on using saline.
Since I've had saline, TE's and silicone, I will say that the silicone are much softer. I'm really happy with them.
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Issymom - another point about going under vs over the muscle... I am also BRCA1+ (so is my sister, who is a bc survivor). I had a bc recurrence 8 months after my bmx. It's not typical, but being BRCA+, made it more likely for this to happen. I found 3 small lumps. It had developed near the original site and had grown into the scar capsule toward my chest wall. It stopped at my implants (which are under the muscle). Anyway, the point I'm trying to make is that had an implant been over the muscle, I probably wouldn't have felt this.
I also had D+ cups from my augmentation and lots of skin. My PS went under the muscle and stretched the muscle to what the skin could handle. I have 550 cc's and am again a D+ cup. Being that your implants will be even larger, I would be afraid if the skin could handle that weight and if you would experience droopiness (especially since he's not using Alloderm). Another thought, why are you keeping your nipples? I was told by my PS and BS that the nipples should not be kept, especially being a BRCA1+.
Please ask your PS about this decision. Sorry if I'm being a little strong on this, but I want what is best for you. Good Luck!!!
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Issymom- Also the risk of capsular contracture down the road is less with submuscular placement. I agree you should get a 2nd opinon. As long as you have a good surgeon who leaves as much of the pec muscle intact as possible, you will have minimal distortion of the pec muscle when flexing. While the sugery may be a bit easier subglandular, Neither of these exchange surgeries are anywhere near as tough as the original mastectomy. I've heard lots of stories about how easy the transfer surgery was submuscular. Also I think in the long term, the subglandular silicone implants will look better several years down the road.
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whippetmom i told my PS about you but I think all the questions i gave him made him nervous. He wanted to know why we needed all this info specifically the volume recommendation for the TE and the width of my TE. I think he got nervous about being checked up on like this. Fine with me though hopefully it will keep him on his toes. He knows i like lots of info, i grill him with questions almost every time i see him. I have 650cc TEs filled to 700cc and will be getting 650cc round gel implants. My PS says that is as big as I can go and it should be a large C small D. I weigh 154 right now expecting to get back down to 140 asap, 5'7", and my rib cage is 32 in i think. I am very short waisted so he understood that I wanted the implants high. Also that I like projection so high profile. If you recall my pics one implant was higher than the other and i liked the higher one better. he said that one will a little lower and the low one will be higher.
I am getting really excited and nervous about the actual surgery and recovery and that this is it now. I really hope i get good results. I hope my expecations are not inflated and that I will be happy in the end.
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Carrol one thing I can tell you is they will change a lot in the next few months after exchange surgery. Don't panic when the bandages come off. I'm 11 weeks out and they look so much better shaped now. I swear they seem bigger/fuller too.
BTW one is still lower than the other. I saw my PS yesterday and he agrees it's a bit lower. He's going to fix that when I do nipples. Also do a bit more fat grafting (if he can find some
). Will call today to make that nipple appointment. We both like the higher one better since it has ptosis and is more natural looking. I never had ptosis before. Mine old ones were too little and firm for gravity to have any effect on them.
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Carrol: Lilah mentioned on the pic forum that implants with the same volume will have a smaller appearance than what you see now with the TEs. I think that if you are 5'7" and 140, this size would be ideal for you....
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I spoke with the PS' nurse today over the phone about upcoming surgery. In addition to general pre-op questions, I asked her what implant brand, sizes, and profiles my PS was ordering for my exchange. Although I have Allergan 133SX-14 TE's, he will use Mentor implants, bringing in Moderate + Profile, and High Profile, range 500cc - 650ccs.
whippetmom, you had suggested Allergan style 20 - 650ccs (your pref) or style 45 - 700ccs. I know you based your recommendations on the TE's being Allergan, so how will these possible Mentor implants work for me, (to remind you of my specs: 5'3½", 140 lbs, 34" ribcage, short waisted, small shoulders, 41" hips)
Thanks for your help.
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I don't know what to do! I met with my ps today thinking it was to discuss sizing and general questions about my 09/29 e-day. but she said she had cancelled the surgery and wanted me to meet with 2 other ps to get 2nd opinions. On our last visit I asked what size implants she was planning to bring into the OR with her, and I said that I was told a 550cc implant may work good for me based on my measurments and what I was hoping to achieve, I also asked if she was able to use Allergan implants,(she did ask who told you this I said there was a site that I visited that gave advice.) My husband has been with me at every visit and he agrees nothing was aked that any other person wouldn't ask. I think I scared her by saying cc's and names of implants. I asked her if any other women came in with these types of questions, saying that they wanted a decent projection with not to wide of a diam. She said NO. So im sitting with expanders in and I feel like I'm going to have to live with them forever. I feel like she is trying to teach me a lesson. I never ever questined her I only mentioned the 550cc sound like a good size. I can't believe this happened. I don't know what to do I feel folish, I keep on asking my self why, because I asked questions? So now I need to find a couple more ps ( do they even want to meet with you if you allready have ex in?) what should I say when making these apointments?
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bcs2011 what kind of PS were you going to who is ready to shuffle you off to some other PS because she doesn't like your questions? Did she say why she wasn't going to do your surgery or why she cancelled without checking with you first?
If I were you I would find someone else unless your PS is cancelling for some personal reason that has nothing to do with you.
Maybe she is ill and can't do the surgery. Maybe she has surgery schedule for herself for all we know. I would find out why she wants to meet with new PS when you are already 1/2 through the process with her. Something just doesn't sound right.
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[[[bcs2011]]] - Seriously, if she is that threatened by those questions, you need to get another PS. I'm sorry you're going to have to wait.
This is only my opinion ... but next time ... let the doctor talk ... ask what they're thinking and if the implant hasn't been mentioned that has been suggested ... say something like, "What about a 550cc implant?"
I'm sorry this has happened to you. Talking to other PS's can only be a good thing ... no harm is going to come of that .... and other women on here have had one PS do their TE's and another do their exchange surgery.
The last thing we all need is a passive agressive PS.
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She said she cancelled because she feels I need to talk to another ps about my expectations. She said she dosn't think I will be happy with what she does. I don't know why except for me mentioning my little knowledge of what I learned, like my te size and implant sizes. I truly think this scared her. No other reason I can possibly think of.
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bcs2011 if that's what she said then get rid of her. It should have been your decision to cancel and see other PS not hers. She should have told you her plan and why what you wanted can't be done.
Good riddance. Yes is sucks you have to wait but these things happen. Initially I had to wait a few extra weeks for my exchange because there wasn't an opening… and then I had to wait an additional month because I got shingles. It's always something but you'll get it done. Best to find a PS that doesn't cancel surgeries based on what she thinks you are feeling. I hate when doctors tell you how you feel.
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bcs2011: My first BS didn't like me asking questions either and he also had me crying at every visit. I ended up with a much better surgeon who let me ask questions and ask for what I wanted. You are hiring them to do a job and if they don't like questions you are better off, believe me. I told my PS exactly what I wanted and everytime he disagreed I kept bringing it up until I got what I wanted. Yes, I am demanding and yes I got what I wanted. Out of everything we have been through this is one small area where we should have some control if at all possible. Don't beat yourself up about it and interview a couple of PS's based on their ability to not only do the job but their ability to listen. Hugs!!!
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I should add: maybe you dodged a bullet and will end up getting much better results. It shouldn't be too long a wait. Sorry you have to go through this.
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My PS also does not like me asking questions, and he usually does not give very definitive answers. I did end up going to another one for a second opinion under the sage advice of whippetmom. I find it incredulous that these "professionals" take it upon themselves to determine how best to reconstruct the bodies that we live in, with no thought as to what we might think or feel about the matter, then seem offended when we try to give some input.
Bcs2011, after what she pulled, you are much better off getting that second opinion, and if I were you, I'd kiss that one good-bye. Maybe it's fate, and if she doesn't think she can deliver on your expectations (what? To feel good about the way you look? Unimaginable!), then you are better off with someone who's at least willing to try. Excuse my sarcastic tone, I just can't believe some of the stuff we have to put up with after all we've been through!
Just remind yourself, "this too shall pass."
Deborah (whippet mom) is a very good resource if you need help finding another PS.0 -
Just wanted to chime in with my 2 cents about surgeon/gods. I'm up for exchange Tuesday and while I know my PS is great - he knows he's great too. Even the doc I saw for a second opinion said he's the best so I'm still there. But I sure wish he had been able to answer questions without becoming defensive. Like pinkbutterfly said - we should have some say about our own bodies and sure should be able work as a partner in our health care. I'd be crazy if I didn't have wonderful feedback from my BS, MO and GYN. Good luck to Bcs2011.0
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I agree with MBJ, you are hiring them - they are being paid for the work they perform. My first PS sort of waffled with his answers at the end - I took it upon myself to find another PS. It was the best decision I made. I often wonder if I would have had better results if I went to the second PS to begin with. Live and learn.
I forgot to add, when I met with the second PS, I knew immediately that he had alot of experience with breast cancer patients - he answered all my questions and agreed with me when I made suggestions. I felt like I was in good, experienced hands.
Hopefully, this is a blessing in disguise for you.
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Slinky, I feel like my PS is starting to waffle on me, too, now that I'm at the end... Going to get a second opinion before I go back under the knife...
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YamahaMama, it was hard for me to call around because I felt like I was cheating on my first PS. He is such a nice guy that I didn't want to hurt his feelings by shopping around. But my gut was telling me that in his round-about way, he was trying to tell me he wasn't experienced enough. I could tell because he started to waffle when I asked about fat grafting. I just got the nagging feeling that he was still green around the ears. Well, I had to have a revision within two months of my exchange, so my gut was right.
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Some PS's don't do fat grafting -- either from lack of experience or because they have reasons they don't like to (my BS told me she's not a fan because of the risk of getting fat lumps that are confused for cancer, for example)... but I have to say the PS who cancels a surgery because she doesn't like being asked a simple question is just not a good doctor. I am not a fan of the "I am god" type of doctor and so thank goodness you are out of it. Better to wait for the right surgery than to have the surgery just to get it done.
Many doctors are mistrustful of information obtained on the internet and, for the most part, they are right. There is a lot of misinformation out there. But with that said, it is absolutely fair to ask for information -- to say: what size and style of implant will you be using? I know I asked my PS many questions prompted by advice from Whippetmom and she very patiently answered me. I even used the Allergan list of implants to read up on what my options were (I have a gummy so I knew I would have an Allergan 410) in terms of size. Then when I saw my PS I asked her what she was thinking of using and when she told me specifics I knew exactly what she was talking about and was able to say to her: bigger is better
Most PSs take a variety of sizes in (some also will take in different styles) and use their eyes and trial and error to make a final decision. Any PS who is not willing to admit that or who isn't open to discussing what you want is certanly not one I would want to see.
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HeftyLefty: The Allergan Style 20 is nearly identical to Mentor's high profile style implant. So that works fine. I think that the Mentor moderate plus profile is a workable style also - and I would just trust that your PS will use the implant volume and style which looks best on your frame. It all sounds good to me. Talk to your PS before the surgery and tell him what you hope to achieve in size and appearance.
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bcs: I am sending you a private message....
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