BREAST IMPLANT SIZING 101
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I have never posted before although I have been reading through many threads over these last months.Thank you all for providing more help than you can know. I had a nipple-sparing BMX in Feb and am scheduled for exchange surgery on June 2. I love my PS and will see him for pre-op on May 21 but I am starting to obsess and worry about the final (hopefully final) outcome. Can you help me with the implant sizing? I am 5'9" about 130 lbs, 29" ribcage. I have Allergen 133MX expanders with a 400cc capacity. I am filled to about 420 (on the last fill I was just happy to leave and didn't pay attention to the exact fill amount). I will have fat grafting during the transfer surgery to deal with the significant step-off between my breast and ribcage. My PS is likely using smooth round silicone and will use an implant larger than the expander but we have not resolved yet the exact size. I really don't want to be any smaller than I am now with the expanders and I am worried that I will be disappointed. I'd appreciate any suggestions.
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Ok a little late as I am fully expanded and a month or so away from exchange just wanted to check if I am close to what "the breast whisperer" would recommend
I am 5'3" approx 150 lbs a rather athletic build flat tummy and I carry all that weight rather evenly but alittle bit more in the thighs since chemo. Ribcage is 32.5 inches I was a 36C or 38 depending on bra style prior to bilateral skin sparing. I wanted to get close to that size not talking cup size as I know you don't like that Deb and maybe even a bit more perkiness foob greedy lady that I am. Before mx my left was a bit larger I mean 120 grams larger according to the pathlogy and the right sat a bit lower in the IMF - left was 700 grams and right was 580 grams.
My expanders are Allergen 133FV - 13 (500cc) yes my PS overexpands 20% so I am over expanded to 780cc . I got to the 650cc point and figured this was a good size my PS is very conservative. I was figuring allergen style 20 650cc is this a reasonable suggestion to the PS in a few weeks? I know he will be doing some pocket work as he is a bit unhappy with how far apart they are and a bit of rippling on the inside of each in the cleavage area. The skin has held up well I do have stretch marks but they were there prior to any expansions and I have one little pucker at the end of the left incision that he said he will clean up during exchange.
Thanks for any help
I have read these boards for well over a year from my time in the waiting room for biopsy results and thru chemo and surgery. One year anniversary of dx coming up in a few days what better way to top that off but with new squisy foobs!!!!
K
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ref: I think you would be happy with Allergan Style 20, smooth round silicone implants with a volume of at least 500 ccs. If you could sneak in another 50 ccs and exchange to implants with a volume of 550 ccs, that would be a plus. So inform your PS of your preferred volume at the time of your pre-op or even earlier. We almost have to let them know they might as well put us back under unless they do everything within their power to ensure we wake up with the volume we desire....as long as this desired volume is within reason. The 500 ccs volume is assuredly within reason. For some, 550 ccs might be pushing it, but if your skin expansion allows it...it might work. For the most part, this is an unknown until you are in the OR and the PS has the sizers in hand. We do not want to test the limits our skin will allow, as it is important to maintain skin integrity. Keep in touch and let us know how everything goes for you!
Deborah
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Thanks Deborah. That's about what I thought. I wanted to see how far I could go and still be reasonable. I will ask for 550s. Is there any reason to consider the Allergen 45's? My PS keeps saying that the issue is going to be projection.
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Well, projection is always going to be an issue with breast reconstruction. You have the ribcage for Style 45's and I certainly think you could be a candidate. It is just that so few plastic surgeons seem to remember that this style exists and most do not stock this style of implant so it is rarely used.
On second thought....I just went back to your original post and saw that you have the MX - not the MV! So you have a 12.0 cm width rather than a 13.0 cm width TE. So indeed yes, the Style 45 would work for you. But I would venture to state that only if you could get the Style 45 in 550 ccs. This would put you at 12.4 cm width. I just think any narower and with the lower volume range, the implants could sort of look like bullets on the chest wall. Do you see what I mean? Typically, I see the Style 45 being used more with implant volume 600 ccs and greater. So I think 550 ccs is as low as I would want to go with that style. We tend to focus on projection, but width is very important also, because essentially the width helps us fill out a bra and width is necessary to give the appearance of fullness of the breast mound. Also, you need to have a nice healthy distance between the sternal notch [that hollow area just below your neck] and your nipple or imaginary nipple - 21 plus centimeters - I think, in order to pull off this taller style of implant. It will sit taller on the chest wall. Have you been to the pictures forum? Sandysunshine has her photos there. She has your height and weight and ribcage and she has 550 ccs in Style 20. You could get a good idea of what this would do for you.
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K - Ohh...I think I want to send you to the top of the class! You are a very good student! LOL! Yes, I think that 650 ccs in Style 20 would be just about ideal for you. You know your skin integrity and I feel quite confident that indeed you could exchange out to this volume of implant, especially based on your 20% overfill status. I think you have to put this number in your PS' head and let him know your convictions about size and volume. If he is "conservative" as you state, he might not be movable to this volume of implant. You need to see where his mind is with this number. I have had some women come to me just this week, disappointed with getting implants with significantly less volume than they had "agreed" upon with their plastic surgeons. I think that he has to feel confident about that 650 number, and this is something you should know prior to going in for the exchange, so that you can know whether you need to manage your expectations. You need to know what number he feels confident with....prior to the exchange.
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Deborah, thank you for this great information. I see what you mean about the width being important too. I have not been on the picture forum. I'm not sure how to get to it or if I can get approval yet since I only just started posting today.
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Deborah...ha ha
I think I have read the whole exchange thread and did all my measurments SN-N , rib cage prior to mx. So when we were doing expansions and the PS said "well so are we there or almost there when I was expanded to 600?" I said nope 50cc more to go I am looking at style 20 650cc and his response was "and where did you come up with that" when I told him rib cage measurment, and my SN-N measurment - his nurse giggled and said trust her she knows more than me he shakes his head writes something down and walks out of the room. I had quite a bit of skin to work with seeing how much breast tissue they removed so the fills went smoothly and I did them weekly at first 120cc's and when I hit the 540 mark we backed off to 60 so my skin handled it all very well. See some of your students pay attention.
He is conservative in the aspect of being very anal about everything .. talking with some of the nurses who have scrubbed in with him they say you wouldn't believe the amount of antiesptic he uses if he could hose down the whole OR and make the whole staff bathe in it prior I think he would..lol . My breast surgeon had a fight with him the day of my mx as I had thrush and the PS was ready to call everything off till my onc and breast surgeon got a hold of him. I had 4 tumors all T2 bilateral and they were not going to let him hold out any longer. He stated he wouldn't let me go overboard with the fills and I did try on some old bras at 650 point in the fills and they filled up the best they could still with the empty nipple syndrome. Ok maybe conservative isn't the right word he is a perfectionist if it's wasn't for the tiny spider veins around my incision and lack of nipple you would never even know I had surgery and it looked that like 2 months out with no scar treatments. I guess I will have to try to get into his head next Wed... wish me luck !! Our inital consult I told him I wanted to keep my approx size and I know I will lose some projection but some nice cleavage and whatever projection I could get this 38 year old would appreciate .. so hopefully he paid attention to my wishes he didn't scoff at the 650cc so let's hope
thanks Deborah I am glad you are able to help so many of us understand the differences and arm us with the info we need when we meet with our doctors... big kudos to you !!
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kw - Oh, you are too, too much! If this were a job, I would hire you!!! So it is sounding to me like he is on board as much as we could hope for him to be at this juncture. So I will be praying for you...come here and remind me before your exchange surgery please...but do let me know what transpires during your pre-op.
I think you have mapped this all out excellently. Kudos right back to you girlfriend!
Deborah
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Hi Deborah, I know you will be missed and I'm wishing you a good trip if you are traveling. My PS agreed to the Allergan 20's along with a bilateral lollipop lift. He said an adamant NO the the 45's and I didn't question him. I am expanded without any fills to 250 and feel like a full C small D- which I find unbelievable. My goal is less big and more perky, As you were able to see from my pictures I emailed you, I had many years of big and droopy double D's. I still want projection and want to have some boobage with the coveted cleavage and high headlights while maintaining the integrity of my thin skin. I think with my LD reconstruction, I can meet that goal. Can you give me an idea of what size the biggest implant I can suggest to the PS to make sure he and I are on the same page? I aspire to be a star pupil too
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Waldo: I need to calculate the dimensions of your TEs. While I am packing for my trip, could you get your TE information for me and give me the dimensions? I know you told me you have low profile Mentors, but I do not recall if you ever told me exactly which volume you have. Are they 250 volume or 350 volume TEs? You will find the links for Mentor at the top of this thread. I think that once you get dimensions of your TEs, you are going to find it will take at least 350 ccs in a Style 20 to match what you have now in volume with your TEs. I do not know how much your PS is willing to push the envelope with size. He might even balk at going from 250 to 350, that is, unless your TEs ARE 350 cc recommended volume.
This is something you really need to reinforce and discuss with him and be in agreement regarding prior to surgery. How much will he do? You need to find this out....
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Waldo....Scratch what I just said....I just went through my emails and found that you do have 350 ccs....let me recalculate this...
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Okay, Waldo...
I think at least 400 ccs in Allergan Style 20 - if he is using Allergan - would be the minimum volume. I am basing this on the width and projection of your TEs. You have sufficient width and projection with your TEs at the current volume for a 400 ccs high profile implant. You have sufficient width and projection for a 450 cc implant - but I doubt he will agree to this. Maybe I'm wrong...you can see what he says. It is all going to depend on how much he can safely place in the pockets after your lift procedure, because this will minimize the pocket somewhat. This is pretty tricky, as you know, because you have the flaps and it is not as easy to calculate how much they add to the volume at this point. Unfortunately, this will only be evident to your PS during surgery, and you will not know until after the exchange. So discuss these thoughts with your PS....
Your TEs....12.7 cm wide by 6.5 cm projection. With 250 ccs fill, you maintain the same width, but you do not have full projection. So if projection is diminished to 5.5 cm, you have with your TEs:
TEs: 12.7 cm wide by 5.5 cm projection
Allergan Style 20
400 ccs: 11.9 cm wide by 5.0 cm projection
450 ccs: 12.4 cm wide by 5.2 cm projection
475 ccs: 12.6 cm wide by 5.5 cm projection
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Maybe I will push for 475 first and compromise with him on 450. I wonder if I can handle the 450- well lets see if he agrees.
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Thanks Deborah, I am in 350 cc recommended volume but filled to 250.
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Whippetmom wrote...about "reinforcing" something with your plastic surgeon...just like I did. On the cart as I was going in for my exchange surgery today I saw Mentor 500 moderate. NOPE!!
No mentor high profile 550's anywhere to be found as I requested. If he said my skin couldnt handle etc..ok. But at least try!! I REFUSED to go under until they sent the nurse to the office for what I requested.
I woke up...all the nurses were standing around beaming!!! Mentor High Profile 550's were in and voted on as looking most suited to my frame. I am so happy!! Thanks to Deborah, who performs a ministry to us all here...and thanks to all of you ladies for your knowledge and support. As soon as bandages come off I will somehow wrangle photos into this contraption!!!
Stand up for what you believe ladies...you have all earned that right in this process and deserve it!!!!!!!!
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geewhiz: You are kidding me, no way, no way, no way!!!! I cannot believe you did that! You are just blowing me away with your moxie! What a story. I just love it! I am just so thrilled for you and so proud of you! Thank you for coming here and sharing and indeed I want to see photos when you have the unveiling! Congratulations!
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Geewhiz, I am blown away too! Good for you- not sure I would have the guts especially then, to piss off my PS! But it worked for you and I bet they look spectacular. Have you posted your pics yet?
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Deborah, I am dizzy catching up on reading your responses! You are the best! Enjoy your time off!! One thing, I have style 45's at 460 and LOVE how they look, so much better than my past implants, just a little self conscious of being a bit vavoom after years of being rather flat (but that's just me)! Think I can get used to it;) I know, I need to post on photosite.
Geewhiz, Good going!!! We're also beaming for you!
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Hi Deborah, I know you are away, so no rush in getting back to me. I was just wondering if you could help me with implant sizing. I had BC 9 years ago, with a lumpectomy and 33 rounds of radiation. At Xmas time last year, another lump was found in the same breast. So on March 5th I had a bmx with Allergan 133V series tissue expander matrix put in at the same time. The catalog # is 133SV, short height, dimensions are 13 x 9.1 x 5.7. I am 5' tall, 105lbs, with a 32" ribcage. The TE 's are 300cc's, and my PS hopes to fill to 400cc's. I have had 3 fills so far, the left is now at 260cc's, and the right, previously radiated side, is now at 220cc's. Its a very slow process as the right side is very tight, only allowing 40cc's at a time. I am in Canada....don't know if that matters...lol! Hope to hear from you soon!
Cindy
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Cindy....
Of course I can help you Canadian gals! But it is good you mentioned this, as I need to know if your PS is focusing on anatomical 410s or CPGs or if he will use standard silicone rounds.0 -
Katey...Darlin,. I stand corrected! Could you post photos on the pic forum?
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Deborah,
I am not sure, so I will have to ask at my next fill. Which one of those would be better? My local PS is doing my fills only, as my PS who put in the TE's, and will be doing the exchange is a 4 hr. drive....so I haven't seen him for awhile. I asked at the beginning about saline vs silicone, and he said I could have whichever I wanted. Thanks for your help!
Cindy
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LOL Deborah! I didn't think I was ready to join Austin Powers fembots!!
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Torpedos Katey. I was picturing torpedos! LOL! No, but honestly, it would be great to see Style 45's represented in under 500 ccs....
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Cindy: I personally think you would want around 425 ccs in a high profile silicone round implant, but that would require some pocket revisions quite possibly, as the 425cc high profile implant is narrower than your TEs - not by much though. You will have sufficient expansion for this size of implant. Many, if not most, plastic surgeons in Canada seem to be inclined to use the anatomical shaped "gummy bear" true cohesive gel implant which is not yet widely available here in the States. It is very important that you research the anatomical implant and know whether you want this type of implant, as sizing is much different for this implant than for the standard silicone rounds. Plastic surgeons are SUPPOSED to select the tissue expander, not only based on the chest wall of the patient, but also with an eye and a vision towards what style implant they intend to use at the time of exchange. So asking your PS these questions, even if by email or phone call, would be helpful. I happen to personally prefer the smooth silicone rounds for someone with your petite stature, but that is just my preference. So please talk to your PS and do a little research and let me know which way you decide to go.
Deborah
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I just got a second opinion yesterday, over 6 weeks after I was DXed with a recurrence of DCIS, and the good news is my new BS at Memorial Sloan Kettering does not think I need a MX, therefore no recon!
I will have another excision, and I don't know what else as follow up, I wasn't able to ask, as I was still reeling from the news! I will email the nurse with followup questions.Thanks to whippetmom and all of you for sharing your experiences and special thanks to those who responded to private messages, and for the support on this site.
Lil
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whippemom- I'm 3 weeks out from BI nipple sparing masc. with tissue 400cc allergen TE and I'm already worried about final implants. I know the Dr. is going to use the new gummie bear implants. I think they only come in a tear drop shape. I want to have a natural shape but I want projection and fullness too. I also don't want them to be too far apart. My friend had the GB and showed me and her breasts looked really far apart. Does this have to do with your natural body or the was the PS places the implants? Is there anything I need to know while getting fills and what should I ask him about future implants so I get the results I want?
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Sweetie: I just bumped up the "All About Gummies" thread in the Breast Reconstruction forum. Go to the Active Topics and look for it and read through it. If you read my thread notes above, you will see what I state about plastic surgeons placing the tissue expander with the anatomical implant of choice in mind when they do so. Talk to your PS about his plans in this regard. The 410s are sized much differently than standard silicone rounds. Also, I would need to know which Allergan TEs - which style - you have and your height, weight, ribcage circumference to help you further as well.
Deborah
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Deborah..
I have a question, when you have the time.
I talked to my PS a little about what we do here on BCO, and your role.. the TE and Implant info. He thought, over all, it is a good thing. He did add, that it is really important that " the skin" of the woman is also taken into the entire equation, not just the size for TE vs Implant... and size of woman. He said this plays a role in the future of the results.
Your take on this?
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