BREAST IMPLANT SIZING 101
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Slainte, MBJ or Lilah can get you info on access to the picture forum, I think!
Send one of them a PM... 0 -
undercoverrebel: I have sent you a private message!
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whippetmom: Hi, I just had my last fill on oct. 14. Next time I see my PS (in Nov.) it will be to discuss sizes and I would like your help and advice on what size and style you think I should be looking at. - My PS will be using either Allergan or Mentor and he can bring 3 into the operating room. I will be having my exchange surgery in early Dec.- just waiting to confirm date.
My TE's are Mentor - Siltex Medium Height Style 6200 (550cc) - (#354.6214) right now they are filled to- left/810 and right/910 (that really sounds like alot) but for my body shape they do not look too big. My ribcage measures at 34 1/2 and I am 5'1" at about 155lbs (trying to loose a few more before surgery) my waist is around 35 1/2. The TE's are wide and do not project alot. My left side is higher (mx in 2005) the right mx was done in may 2011 with TE's.
If you could please let me know what size or style options you think I should be looking at - it would help me a lot. I don't want to end up too small or have them too high up for my body shape.If needed I could send photos. Please let me know if you need more information.
Thanks - Silvana
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Hi Whippetmom..
Saw the PS today and was told I have VF 500 TE's. Full height..... I am 5'1, 125 lbs and wore a 34C or D before my bmx. Just hoping to be back in the same ballpark post reconstruction.
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Silvana: I am going to send you a private message...
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odie: That would be FV500's - full height, variable projection. So I think that you should be happy with around 500 ccs - high profile saline implants - if saline is your preference. I think that 550 ccs would be fine also. But most definitely you want high profile implants.
Deborah
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Whippetmom, my ideal recon would be a natural looking, small AA-ish. Do you think this is possible with implants? What is the smallest size that you think would work for me? I guess you could say I like the waif look
4 years ago I consulted with 3 different PS and they all recommended larger than my preference. I ended up doing nothing and go flat. I am 45, 5'9", 125 lbs, ribcage 29" I had bmx, and while there is not much scar tissue, the skin is very thin, especially on the right side.
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lalisa: I have a couple of thoughts for you. My first would be that the anatomical Allergan 410 implant might give you the best bang for the buck - in terms of the appearance you want to achieve. I would say the low profile style anatomical - LM - 250 grams, LF - 270 grams. Or, in silicone rounds - Allergan for example - Style 15 - 304 ccs. Perhaps a Style 40 - 320 ccs. I feel you need close to a 12.0 cm width for your frame....between 11.5 cm and 12.0 cm width. It is the projection you want to reduce - to get the waifish appearance you seek. However, it just simply takes more implant for breast reconstruction to create the mound - remembering that you will look smaller in clothing and you probably can just go braless with implants in this much smaller range. Or wear pretty little Freyas and Chantelles which act like minimizers.
For the TEs - I would think that the short height - SV or SX - 250 ccs or 300 ccs...would be a good option - for expanding out the lower pole and leaving the upper pole essentially alone. You would need to go to someone who has the Allergan 410s in clinical trials though, if you went in that direction.
Would you please PM me and let me know who you have consulted with thus far? I might be able to help you.
Deborah
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Just wanted to say "thank you" Whippetmom. Appreciate your input..
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It's been a few weeks since I posted . I saw my PS on 9/29/11. We went over everything again. we had a great conversation . I had stated I wasn't happy with my results. I had been advised I should get a second opinion and my PS even stated perhaps I should and he wouldn't be offended. I left with a lot to think about. I put my faith in front, where it should be! took out my emotions and went over pros and cons. Took a good long look in the mirror figuratively and literally. I decided after all he went over that, sure I could get a second opinion and if I had more done, chance that it could be worse. I do trust my PS, i believe I was getting in my own way and don't think I am settling. I'm going to Nordstroms this weekend for a bra fitting and I know with the right fit all will be well. My size has improved so I really don't need flap or diep to add volumn. I am scheduled for Nip reconstruction 10/28/11 and I can't tell you how peaceful I feel. I appreciate the support and info I've received.
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I had my consultation with my PS today to discuss revision surgery. We both agreed that the implant I have (Natrelle style 10, 270cc) needs to be replaced with a smaller one. No specifics were mentioned as to which style or volume, but since this wasn't the pre-op appointment, just a consultation, I figured it was OK not to have those details yet.
We also discussed about putting in more Alloderm as a firmer shelf underneath, since the implant has bottomed out. The PS believes that I have a neuroma situation in the scar tissue, and coupled with the extra weight of the implant bottoming out, that's why I've been having nerve pain down my arm.
And finally, we talked about filling in the rippling area that's on top by my armpit, though it was unclear whether he'd use fat grafting or more Alloderm. I suppose that's a game-day decision? I felt I couldn't get a definitive answer from him as to which he would use, which was better, and why. Guess that's why I'm going for other opinions.
The soonest date for surgery would be November 14, based on both his schedule and mine. I have two more appointments next week with different PS's. Though I think if I hear the same exact thing from the first one, I'll just go with my regular guy and get it done already.
I'm still troubled as to why the bottoming out occurred in the first place. I saw the picture of me a couple days post-op, and I looked completely level and balanced. And I didn't stop wearing the sportsbra any sooner than I was told, in the initial weeks following the exchange. I guess sometimes these things just happen??
Anyway, just wanted to touch base here and thank you, whippetmom, for helping me arm myself with information for this meeting. Will keep you posted as to how the other appointments go.
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Lynda: You are in a good place. Go to Nordstroms, find some fabulous bras and enjoy!! So happy for you!!
Deborah
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Bottoming out is often due to overdissection of the pocket. But it can also occur with a large implant. Women with thin skin would have a greater likelihood of this occurring, but it is one of the most common reasons for revision after augmentation or breast reconstruction.
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Pardon my ignorance here, but what exactly is overdissection?
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Deborah, thank you so much, this is the first advice about sizing implants that I really have confidence in. I think part of the reason that I stopped pursuing recon 4 years ago is that I just lost confidence in ANY of the doctors I saw. And I saw LA PS who came highly reccomended. It would have helped so much if they had explained anatomy and how different sizes can look very different depending on the particulars of the woman. I'll pm you the Drs I consulted. And thank you again for sharing all that you know about this subject- it is a LOT!
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BOTTOMING OUT OF IMPLANTS
When Implants Bottom Out: How it Happens and How it's Fixed
In some cases tissue support at the bottom of the breast can weaken, allowing the breast implant to move downward forcing the bottom crease lower on the chest.
Factors that can contribute to bottoming out include:
- Over dissection of implant pocket (when this is the cause, bottoming out usually occurs within weeks or months)
- The implant is too heavy for the amount of skin and underlying breast tissue (under this circumstance bottoming out occurs gradually over time)
- Placement of implant (complete sub-muscular placement has a dramatically lower occurrence of bottoming out than placement above muscle or partially below muscle, although this may result in a less natural look)
Correction of Bottoming Out
To correct this complication additional surgery is necessary:
- An incision is made (usually along the breast crease)
- The tissue surrounding the implant is cut and rolled upward to the desired position of the new crease and held in place with internal sutures
- The incision site is closed
Note: If the implant is too heavy for the amount of tissue it may need to be replaced with a smaller implant or temporarily removed while the tissue heals.
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This article explains how proper dissection of the inframmary fold is achieved....
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wealth of info, as always. Thanks whippetmom!
Such a delicate surgery. Also understand a bit better why we wake up in recovery after our DMX and TE placement feeling like an elephant is standing on the chest.
Thanks.
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OK yet another thing to worry about going wrong when I get my exchange on tuesday to my big D cup 650cc implants. I keep telling mu doctor I want them high. I am going to be really bummed out if they are too droopy.
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Whippetmom, I sent you a PM...I know the PM function wasn't notifying of new messages for a while, so just wanted to let you know... Thanks!
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Carrol2,
My 600cc implants, high profile are nice and high, not much droop. I know you will do well. I am not on the picture forum, but can send you and email picture if you would like. Just private message me with your email. You volunteered along time ago to help me get on the picture forum, but I never did it. Taking pictures along the way and may at some point. Sweet dreams tonight for you. Only positive thoughts!
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Carol
Good luck tomorrow. I am sure you will be very pleased. Just take things one day at a time. Best wishes
Liz0 -
Thanks everyone tomorrow is the big "E" day. 615am. I look forward to sharing how great they look with you all.
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Good luck, Carrol!!!! I'm sure they'll be "exsquishees!" 0
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Yamaha (Natalie) -- it's me who doesn't get notification anymore (sigh). I think Whippetmom is good with those.
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Best of luck Carrol!
I'm back with an update from the PS second opinion appointment. Still have one more appointment later this week; not sure if I'll keep it or not.
Anyway, so this other PS said that he would've liked to see me keep the TE longer than just the six weeks I had it, so perhaps that's the reason I've bottomed out a bit? He didn't say that specifically, but it gave me a new perspective as to the whys and hows of what's turned out for me. And while he suggested the same exact revision procedure (including switching to a smaller implant), he strongly recommended that I wait another three months at least before having the surgery. In his words, I have nothing to lose and everything to gain by waiting. So now I'm going to go ahead with training for and running my January marathon after all!
And as for the referred pain, he also said something different than my original PS which helped a lot. He said that the area from the side ribs, up into the armpit and down the inside of the arm is always a difficult for mastectomy patients, and so the discomfort I've been feeling is to be expected. He recommended lots and lots of self-massage ("rub it like you love it"), and honestly, I've found that when I do that, it does ease things. Yeah, the pain stinks but it's not horrible, given this perspective that it's "normal"... and certainly it beats having cancer in my body.
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Whippetmom: Your recommendation for me (5'2", 145lb 32 inch rib cage Mentor medium height 550TE filled to 600 w/ severe divots) was for 500cc moderate plus profile implants or 550 moderate plus profile implants. My PS is refusing to even talk about high profile because of the divots, he is planning on doing fat grafting too ! I am afraid I am going to have the hamburger bun look. He said he needs the width from the moderate profile or moderate plus profile to help with the divots. It seems like almost everyone gets HP. My question is : Will the moderate plus look hamburger bunish ?
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Shannon: Definitely not moderate profile implants! Moderate PLUS profile are fine. Tell your PS that you would be very unhappy with moderate profile style implants. I prefer 550 ccs in midrange or moderate plus profile. In Allergan, it is Style 15. In Mentor, they call it "moderate plus". So make sure you clear this up. I don't know about HPs for you. You might want to get a consultation with someone else just to verify what is going on and to find out why the step-off defects are so severe. I would like to know myself. It is true the the moderate plus profile would be better for someone with step-off deformities, but there are ways to address the step-off issues - using fat graft transfer or Alloderm. So if you are feeling that you would prefer HPs and your PS will not budge, give yourself some solace by at least consulting with another PS to see what he or she has to say about such matters. Then I believe you can go into the exchange with peace of mind....
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shannon....are you on the pictures forum?
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orangemat: I like that plastic surgeon!!! I agree wholeheartedly about the rush from last fill to implants being too short. WOMEN....THE LONGER YOU WAIT BETWEEN THE LAST FILL TO THE EXCHANGE THE BETTER!
I also very much like his premise about waiting three months. I hope you go with him next time!
Run your marathon, love your body and get on with life! Keep us posted on how you are doing!
Deborah
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