BREAST IMPLANT SIZING 101
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Three17 my PS grabbed and jiggled/grabbed my fat (love handles) very aggressively the first time he was checking for fat for fat transfer… and I'm thin. Yes it is a bit weird to have someone jiggle/grab your fat when your not expecting it and I had been seeing him for a year at that point since initial visit and all my expansions were done. Surgeons can be very quirky. The smarter they are the quirkier they are. I'm lucky mine has a great personality but he is quirky. I actually get a kick out of it.0
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Three17
Welcome to a group we never wanted to join but glad that you found us. Looks like you are local to me. I too was very confused about all the possibilities of reconstruction. I too was considering a DIEP or TRAM before deciding on implants. I went to U of P for the DIEP evaluation and to be honest with you was the only time I had cried during the beginning of the journey. They do come highly recommended by my BS but the doc i saw had no bedside manner and grab my belly fat just the same. If they would only explain what they were doing and why it would be so must easier for the patients. I subsequently went with implants for a variety of reasons however I would suggest you continue to do some more research. Much of your decisions will have to be made based on your cancer treatment (if you will need radiation) for that may effect your choices and you need to be informed. You may want to join the picture forum to see exactly what to expect with reconstruction). Also I recommend you check out a few more message boards(NOLA these doc do some incredible recon and micro fat graphing). Not sure of your insurance or financial situation but traveling for a great result maybe worth it). I did not have to have any chemotherapy or radiation and chose immediate reconstruction (which just means tissue expanders placed at time of BMX, I recently just had my exchange surgery for implants) however if the decisions are many you can always wait for recon deal with the cancer treatment first then decide. If you would like to talk please PM me I would be happy to help in anyway I can. I am sure whippetmom will be along shortly to offer some excellent advice. In the meantime take a deep breath try to relax and don't panic. I know there are so many decisions but you need to take one step at a time and take care of yourself
Liz0 -
Three17
For access to the picture forum (totally different site outside of BCO) please PM either MJB, Timtam or I think also lilah. There is a process to follow to protect everyone's privacy and it may take a little bit to get on but well worth it for you. The selfless women who photo journal their stories and recoveries (the good the bad and the ugly) are wonderful and have helped countless women through this journey. I will forever be indebted to them for they have gotten me through a many bad night
Liz0 -
LOL well I sit corrected re: Botox! Thank goodness for you Whippetmom and all your incredible knowledge.
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Hi Everyone...I wanted to reply on the use of botox as my PS did use botox on me when he placed the TE. I truly believe it made my expansion process easy. I had a hard time finding anyone who had even heard of this so I dedicated a post to it on my blog to help spread the word on the use of botox in breast reconstruction in the hopes that it would help other women. I was able to have 100ccs a fill with little to no discomfort and I attribute that to the botox. I would really encourage anyone to explore it with their surgeon. Just my 2 cents!
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Three17:
I am also a full-figured woman (my pre BMX bra size was 44D or 44DD depending on the bra). I am in the process of recon using implants. There are actually many options for us full figured types. Now you may not end up as large as you are now, but you can still get a very good result. I will be getting Mentor, cohesive gel smooth round silicon implants filled to between 700 to 800 ccs. I thought I would end up much smaller, but I now believe based on what I am seeing that I will end up with a C or D cup. If you want to go larger, you can go with the much larger saline filled impants to. If you want to take a look at my progress to date on the picture forum, my topic is BMX and Recon Journey of a Bodacious Gal. If you want to PM me with questions, that is ok also.
Phyllis
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Do we put all our stats here, or Deborah, do you take those privately. Oh, whoever asked, I have the Mentor Spectrums and am filled to 450 on the left and 480 on the right. I don't like the Spectrums one bit. I SO wanted the Spectrums to be one step but yes, they are hard and hurt. I told the PS I wanted "rocking tits" and he thought I meant big, but really I just want perky. I believe I'm getting the Mentor cohesive gel implants...not the smooth ones...I forgot what the other ones were called...I need a nap! I'm 31" around the rib cage, almost 5"1 and petite, but was 34 DD before my BMX. If I were a C when all was said and done I wouldn't complain...
This is going to be the second surgery in three weeks! I need a vacation!
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Eema:
The mentor cohesive gel implants come in smooth and textured. Are you getting the textured ones? Mine will be smooth, round high profile.
Maybe the PS thought you said "rock hard tits" not "rocking tits"!
That is what you get with the Spectrums!Here is a link to the Mentor website if you want to see all of the choices and there particulars. http://www.mentorwwllc.com/global-us/Breast.aspx
Phyllis
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Sorry....going out of order here with answers, but it is easier....
EEMA: I need to know which Mentor Spectrum style/volume you have...
http://www.mentorwwllc.com/global-us/Breast.aspx
As Phyllis mentioned, the memory gel rounds come in smooth and textured versions. Very few of us have textured implants - they just do not bode well for breast reconstruction. So this is something to discuss with your PS. If you are going to the Mayo in Scottsdale, however, textureds are fine - and I mention this because of your comment in your profile "a couple of Alloderm bras."
So let me know which Spectrum style/volume - as I essentially need to know the width of the devices.
Deborah
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three17: It is quite true that many plastic surgeons feel that women who have a good deal of adipose tissue - women who are "overweight" - but I prefer to call you BODACIOUS - are not optimum candidates for implant-based reconstruction. The problem is that the implants tend to be "swallowed up" by the volume of adipose tissue http://en.wikipedia.org/wiki/Adipose_tissue and therefore, even sometimes with the largest available implants, the appearance of volume on the chest wall is diminished. So this is why autologous/microvascular procedures are often recommended. I honestly agree with Faulkh, if you are willing to do so and have the insurance to cover it, NOLA is the place to go for a DIEP or etc. That in New Orleans, Louisiana. You will have the most natural appearing reconstruction with this method and you will essentially get a body re-contouring in the process. However, this is not for everyone - and so if you are sold on implant based recon, then let's get you there and get you to a happy place accordingly. I would go to Kenneth Shestak, MD or one of his colleagues in Pittsburgh. Dr. Shestak wrote the book on how to address and achieve volume with "bodacious" patients. He is world-renowned - everyone who has been around for a long time here knows how often I quote him and revere his work in breast reconstruction. If you opt for implants only - I heartily recommend you obtain a consultation with him as well.
http://www.upmc.com/MediaRelations/Experts/Pages/expertspage.aspx?expertid=217
Deborah
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Phyllis: I believe that those Mentor Spectrums soften up and relax in the pockets over time. But you know, frankly, no one who has had the Spectrum used as a TE has retained it - all have been swapped out for silicone after expansion is complete. So I just cannot say how they ultimately respond if left permanently. When used AFTER expansion with a TE - they respond just fine - as they should.....
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354-2513, textured. My PS says the are better against capsular contraction. And I do have Alloderm slings, does that make a difference?
Do you need any other info? Will the new ones hurt so much?0 -
whippetmom I have a question for you. I had my exchange 8 days ago. I am healing nicely nicely. My PS seemed to have to do a lot of pocket work and lipo on my porphy side because that side the expander was very low and there was a lot more tissue left there after the bmx than the side with where the cancer was removed. I had 2 drains the first one taken out 3 days after the surgery and the second one came out 5 days after the surgery. I have no oozing of any fluid and the incisiions appera to be healing up well in my opinion. He now has is using three things to try to keep things in place. One is this tape that is wrapped around both sides and up the middle, then a fairly tight surgical bra, and then a strap around the top of my chest.
My next appointment with him is tomorrow. I am concerned because the bottom of the prophy side has this extra skin that is folded over under the implant. Do you think that is normal after lipo sometimes? WIll this flatten out on its own or will the PS have to do another procedure to remove that? I told him i noticed that side looked weird and he just agreed with me and said it was from the lipo but I don't know why I did not ask him what he will do about it.
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Eema:
No, if it is just a "sling" or "hammock", you will still have issues with a textured round silicone implant. 95% of women here on bc.org who have round silicone implants, have smooth vs. textured implants. There is no conclusive evidence that textured implants reduce the risk of capsular contracture over smooth, when placed submuscularly. Additionally, since textured implants tend to deflate earlier or need replacement sooner than smooth rounds, any benefit further diminishes when you think about needing a repeat surgery sooner with textureds than with rounds.
This is Brian Gawley, MD's, assessment of textured vs. smooth - and he echoes what others have said. I can send you a slew of links but you can research this on your own...
SMOOTH VS. TEXTURED ROUND SILICONE IMPLANTS:
Some advantages of smooth implants include:
- Longer lasting than textured implants
- More affordable than textured implantsReduced risk of rippling
Textured implants have a rough outer surface which feels similar to
sandpaper. This creates cohesion between the implant and surrounding breast
tissue, enabling it to more easily maintain its proper placement in the breast
pocket. This is particularly important in teardrop shaped breast implants.
Textured implants were initially created to reduce the risk of capsular
contracture, a complication which occurs when excessive scar tissue develops
around the breast implant, causing the breast to harden. However, there has not
been any conclusive evidence that textured implants in fact reduce the risk of
capsular contracture.Textured implants have been associated with several complications,
including:- Higher rate of leaking
- Rippling [you can get terrible traction rippling with textured implants]
Additionally, textured implants are more expensive than smooth implants. For
these reasons, smooth implants have become the preferred option for the majority
of breast augmentation procedures.
Unfortunately, the same characteristics of a textured surface that may cause the scar tissue to form erratically around the textured implant (an intended benefit) may also cause the implant to appear rippled in appearance. Furthermore, textured implants often have thicker shells and may be firmer in appearance and palpability.
Something to discuss with your PS!Deborah
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Carrol: Could you post a picture on the pic forum? It sounds a bit odd. But there is a great deal of tissue swelling after liposuction, so perhaps this is what you are seeing? Otherwise, I am not envisioning what you are describing. Let me know when you post a photo.
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Arizona gals...
There is someone on the Surgery- Before, During, After forum, looking for a breast surgeon in Arizona. I don't know where she lives in Az, but could you find the thread and post if you were happy with yours and if you cannot find the thread, PM me and I will post it on the thread.
Thanks!
D
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Whippetmom- sorry I haven't had time to read all the posts, but noticed some on being a Larger woman. I had exchange in June with 800 cc's mentor silicone gel. The largest implant made at this time. I have also been told by my PS that I swallowed my implants. My PS says that they are coming out with a larger implant , 1000cc's. I was just wondering if you have heard this or would know where I could get more information. I have searched the internet and can't find anything. He says I need the 1000 with some fat grafting. He does not do DIEP and not sure that NOLA would be an option to just give up on the implants and go with other options. TRAm is out of the question according to my PS because I had a BMX and I would lose abd. strength with the TRAM?
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Mammachick:
My PS told me the same thing regarding a Tram Flap as I also have a BMX. I am also a larger woman (Bodacious is what we are calling us on this forum
) I also feel I could not go to NOLA as I couldn't handle the multiple trips as I am a single parent. I did not check into it, but it appears to me that more surgeries are required. Oh, and I live in Michigan and only one surgeon here does the DIEP flap and she doesn't take my insurance. According to my PS, 800 is still the largest they make in silicon gel. There are larger ones in saline implants and there is a woman on the picture forum who has 960cc saline implants. I am not sure what the largest is that they make in silicon. I don't know your particulars, but if you want to PM me, I would be willing to share more info privately. I am on the picture forum. Currently, I still have my TE's and am not scheduled for exchange until January. Phyllis
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I am certainly not the expert on implants, but I thought my PS told me you could get "custom implants" in larger sizes.
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I haven't been on here in awhile because I did radiation and then had to wait 2 months to starts fills again. I think I'm almost done with the fill process, but I'm a little uncertain. I had a left MX so I'm going to be doing a lift/reduction on the right breast. I am a DD and want to go smaller and have been told that they probably couldn't get my left side back to that size anyway. I'm not sure how much to fill, so I'm wanted to get some more info. I'm 5'3", rib cage 33 inch, wieght 138 lbs. I have an Alergan Style 133 MV - 500cc TE. Right now my fills are at 525 cc and I was aiming for a large B or C cup. They plan on overfilling. I'm not sure if I should go saline or silicone. Can you tell me what you think?
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Hi again,
I will certainly talk to my PS about smooth implants--so you recommend smooth round?
Thanks,
Eema
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Hi Whippetmom, thank you so much for your help. I think many of us would be lost without this thread.
My height is just little under 5' 4", weight is 132, rib cage = 31.5 (which surprised me!). I have a long torso, look much taller than my height, carry weight in legs, workout, have always seemed proportioned. My chest is pretty boney looking.
My bra size was 34c for most of my years, then blew up to 36dd from pregnancy & weight gain. After 10 years of carrying extra weight, lost 50 pounds. I'm 36b or c now. Breasts are pretty saggy so PS needs to do a lift. His incisions will be across the middle of both breasts and over the nipple. I plan to fight him on that. I have pics of the incisions drawn on me if needed.
I really don't want flat circles, though I pretty much have that now. I do want some projection but also want (need) to sleep on my stomach again someday. I lift weights (not too heavy). The girls are very dense.
Thank you again
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Three17, I can't answer your question, but I wanted to say I'm sorry you were treated that way. PS's can be so gruff treating us like cattle. I feel like I'm working in a brothel sitting up there on a table with my shirt wide open while we try to talk normally. Next week when I go in for another consult, I feel like bringing a red light with me.
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For the ladies wanting larger implants... I believe there have been some women (I can think of a few) who chose to go with saline because you can go up to 1200 cc's in saline and thus get a larger size. The ones I'm thinking of (sorry I can't remember names at the moment, maybe Whippetmom can chime in if she remembers) switched out from 800 cc silicone to 1000 cc or larger saline and were MUCH happier with the larger size. So that is definitely an option to discuss with your PS if you are "bodacious"
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Phyllis and Christine ans Lilah- I already have the 800cc mentor silicone the largest made at this time. When discussing with my PS he said we could go with saline and get bigger, but that they would be much harder. Even the silicone seem harder to me than I thought because my muscle is very thick and distorts them when I move. They aren't as soft as I expected. So for me I think saline is out too. He also said that they could be custom made, but that Mentor was talking 6 months ago about making a larger one. I just can't find any info on it. NOLA is out due to me being a stay at home mom and homeschool on top of that. We couldn't swing the money for all the travel and hotels and multiple trips that I am sure would have to be taken. I see the PS on the 15th and he was suppose to be researching the new implants for me. Hopefully if we can get the larger implant soon and fat grafting, which he said he would do at the same time as changing out the implants, I will be able to get to a comfortable size. I don't mind being smaller, they just have no shape right now.
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mamachick: I have not heard about Mentor coming out with a silicone round larger than 800 ccs. So this is good news, if true. I know that Sientra Corp. is in clinical trials with a 1000 cc "gummy bear" silicone round and some plastic surgeons have access to it, but very few of them apparently. When this will be FDA approved for widespread use is anyone's guess. I know Grant Stevens, MD in Los Angeles has access to it and perhaps your PS could call him and see if he could wrangle one. It would be pretty firm though - firmer than what you have currently. As Christine mentioned above, custom silicone implants with volumes 1000 ccs and above can be ordered, but your PS would need to have the ability to order them. Kenneth Shestak, MD, in his "Reoperative Plastic Surgery of the Breast", discusses methods he employes with bodacious gals to increase the appearance of volume on the chest wall, with documented success.
So this is all I have at this point. Some gals, as Lilah states, have switched from 800 cc silicone rounds to saline rounds, which go up to 960 ccs and they have been happy with the results. Keep us posted on what your PS is able to find out about the Mentor implants.
Deborah
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mamachick: Do you want to privately email me your photos so that I can see what is going on? PM me and let me know and I will give you my email addy. Now fat graft transfer could add some volume, and I know that it is possible to liposuction around the IM fold area, to get a bit more definition. But some liposuction of the abdomen would also improve the appearance of volume on the chest wall. It certainly improved things for me after liposuction in that region when I had FGT to address rippling and a step-off defect. So there are things which can be done in other ways to improve the appearance....and it does not require opening up the breast pocket to do so.
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mammalou: I would definitely go with smooth silicone round implants. Nearly all of us have silicone here on bc.org. Your TEs have a width of 14.0 cm so if you were to exchange out to a high profile implant, you would need implants with a minimum volume of 600 ccs - high profile. If your PS wants to use a smaller implant because of the rads side and needing some ptosis, you would need 533 ccs in Allergan Style 15 and I think this would be a nice size for you as well. You have significantly more projection with the TEs, which should allow for good skin closure and some ptosis after the exchange.
Deborah
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Crescent: I'll PM you my email address - so that you can send me photos.
Deborah
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Whippetmom- I will be honest I haven't taken any pictures except for right after my exchange when I was very unhappy and still very swollen and din't realize it. I will try to take some more and I will PM you when I have them. I was really uneducated about all of this when we started. Didn't find the website till after my exchange. Now trying to back pedal and fix things that maybe could have been avoided. I see what you mean about lipo of the abd. improving the look. I have a belly and now that my breasts aren't what they use to be I notice the belly even more. My PS has talked about too going in and stitching the pocket since mine seems to be fairly large and fat grafting into the cleavage area. My implants sit to the side too much. All I know is I won't give up till I am happy!
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