BREAST IMPLANT SIZING 101
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Dear Whippetmom
Thank you from the bottom of my heart. I am 5 foot 4 inchines and weigh 128 pounds. I have a ribcage of 32 to 34 inches. I have 133-mv-14-T 500 ccallergan tissue expanders. I am expanded to 500 cc and I am pleased with my current size. My PS wants to put in another 50ccs and exchange to 550cc implants. I am worried that this will be too big for my frame. I want to look the way I do now after exchange what do you think? My TE are not tight all the way around there is a little bit of softness in some corners. Is this why my PS wants to overexpand? Please help me. What type of implants to you recommend for me and why? thanks a million
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Whippetmom - Thanks so much! I will talk with my PS this week and I'll let you know. Thank you!
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rubalou: do not stress... we have time to sort this out. Okay, so I know that you have a 12 cm wide TE, but I need the style to know the volume. Do you see the letters 133 SV or SX, MV or MX, FV or FX?
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Saradoheny: Allergan Style 20 - 550 to 600 ccs. This is what you need. It matches the width of your TEs and, as Cindy states, you need this much to approximate what you have with the TEs. I prefer 600 ccs, But if your PS feels you are pretty tight, 550 ccs will be fine. A very nice size for you.
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Whippetmom: Whew! Thank you for your help. All I have is the LPPFH 12 and what he said he was filling them to. From what I have read on this forum it sounds like he is possibly over filling(?) I can tell you that until this last fill to 320cc I could feel some wrinkling in them as though they were not fully expanded. I will have to get the info from my PS office. Thank You, Thank You. Thank You!
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Dear Hillick and Whippetmom. You have no idea how you my mind at rest at such a stressful time. The speed of your responses is amazing!
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SpecialK: Cindy PM'd you with some information to take back to your PS. I agree that if he could continue with fills on the smaller side - and allow it to catch up in terms of projection - he could very likely use the very same volume implant bilaterally. I think there are not that many circumstances when varying sizes of implants - 50 ccs or more - would be necessary. In most cases, there is an anatomical issue - a ribcage deformity or spinal deformity - or some assymetry caused by a lat flap plus implant - in order to really need different volume implants. In my own case, my right breast from puberty was always smaller than the left, and although the envelope left after BMX on that side was smaller, the PS used the same volume implant bilaterally. It worked out just fine.
So let's try to bring the fill volume up to that of the opposing side.
I will stick with my original recommendations regarding size.
Deborah
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rubalou: You see, the problem is, there is no Allergan TE which has a volume "between 310 and 370 ccs". There is no specific limit in Allergan literature regarding overfilling of TEs, and it is left up to the judgement and discretion of the plastic surgeon. So you could have a 200 cc TE, a 250 cc TE, a 300 cc TE or a 350 cc TE. [Actually, you could also have a 400 cc and a 450 cc TE with a 12.0 cm width, but I cannot fathom why your PS would tell you it could only fill to 370 ccs, if so.] More specifically, you could have one of myriad of styles. The key for me would be if you have a SX style of Allergan TE, because this would enable your PS to get you into a larger implant than he would with the MX or FX style of implant.
No matter what the style though, if you are hoping for a high profile implant, you need at least 425 ccs - Allergan Style 20. You would need at least 339 ccs in Style 15 - Allergan. I would not recommend anything but a high profile or midrange/moderate PLUS profile style implant. But let's get the rest of the puzzle put together and we can refine the numbers accordingly.
But referable to the saline issue, you have a right to tell the PS that you do not want saline implants. With your bony torso, this is a recipe for rippling. Just tell him you want silicone - smooth, round silicone - NOT textured implants. Tell him you want to get as much right as possible the first time and you know and I know you will not be happy with saline.
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I am sooo glad I only did one breast. Taking the one off was tramatic enough. It is good to look down and see one normal breast. Plus the pain level of one is huge. I can't imagine my whole chest hurting. I am also able to lift myself with my left arm. I picked up mastectomies bra's at Northoms. I only paid 10% for them. So when I go to work later this week, I have a soft fill on the masectomy side to even me out. It's a cotton fill so you can take stuffing out as you need it. I just hope I feel strong and well enough by Thursday to work. Right now, I'm dealing with the pain and being tired 24/7. After surgery I was glad to see something there, but wasn't for sure if it was normal as the pics I've seen didn't quite look like mine. Thanks Deborah for assuring me I'm normal.
I'm sleeping a lot. Today I feel nausia, like throwing up. I don't think I'm taking this whole thing well.
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Hi and happy New Year dear Whippetmom! Just popping in to send you good wishes.
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whippetmom - Thank you so much for the reply. I did get some info from hillck. Here's the deal - I do have even projection on both sides now, even with less in the left side. Aside from the left side being slightly lower, and NAC slightly higher (which he says will be corrected at exchange), they look the same. I do have a PS appt tomorrow, so I will re-ask these questions and see what he says. I do think that size-wise I will end up where you originally thought. I will get back to you on what transpires tomorrow!
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Thanks Cindy! Sending you good wishes as well
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All - came back from PS. He says two different sized implants due to a combo of scar tissue and chest wall, which I was unaware of before. I was never expanded after BMX because I struggled with necrosis and the left expander was removed, so the chest wall part never came up. In any event, even with two different amounts of saline they are symmetrical and even so this seems to be ok.
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hillck - Yes, it is looking like I will end up with what I wanted, which will be slightly larger than what I had - should be a solid C cup. I am at that point in fills where I look a bit "stripper-ish" though! Based on what I originally talked to whippetmom about back in Aug. I am exactly where she predicted I would be - pretty amazing! I am also very relieved that the skin held up so well - low and slow was the name of the game with fills.
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Whippetom- Back from PS today and I am very happy to say he said he would be using the exact same ones you recommended. He will be bringing in several sizes and will use the largest one possible as per my request. Thank you for your help. I was much more knowledgable today and could listen & retain info so much better. I did ask about post-op care and he recommended no underwire for about a month, just to wear the same type of sports bra with closure in the front. Any comments on that?
Janet
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I saw Cindy's answer SpecialK, referable to the chest wall issues, and it was my own, so ditto to what she said. So glad you are where you need to be and this should be pretty exciting - waking up to the new girls. Cannot wait to hear all about them!
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Janet: I like it, I like it! It all sounds good to me. After one month, wired bras are okay and I like that also!
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Whoa, Nellie!!!
First fills today: I got 180 ccs in the OR. Today I asked how much I'd receive, thinking somewhere in the neighborhood of 50ccs, as that's kind of average here, isn't it?
His response was "Let's just see how it goes. I don't have any preconceived amounts that I use."
Of course, I was thinking he'll just inflate me til I scream, or they pop.....
I never felt a thing on the left. He asked how I was doing, and I told him it felt a bit heavy...and he stopped. However, on the right, I did feel the sting when the needle went in. He said this was because the needle went through the muscle, and next time, it may feel different, or I may not feel it at all. Again, he asked how I was doing, and when I said "full" he stopped. I really couldn't see any visible "rise in the mounds"...
They're tighter, but no real pain.I did take half a muscle relaxer before I went in...) Even tonight...no pain, just tightness and discomfort.
He filled me with 100 ccs today!!!
Of course, I was big to begin with, had lots of loose skin, and very lax pec muscles. And he used the Amazon sized TEs on me, so 100 ccs has to diffuse over a wide area. This may have meant it was easier for flabby me to get a large fill instead of a much more slender lady with a tiny chest.
It also means that instead of ten fills, I may have fewer, which means I start my 3 month waiting period earlier, and get my exchange surgery earlier! (We'll see if I'm this enthusiastic the next time he wants to inject 100 ccs....
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blessings: You are moving right along! I think you will be fine with this fill protocol. Congratulations on your first authentic fill!
Deborah
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Good Morning blessings2011,
I too had 100cc fills, came out of surgery with 200 and 300 cc. I also had feeling on the right side. That is one large needle and I didn't like it much, was very sore for a few hours after the fill. On my 2nd and 3rd visits, I asked for lidocaine, I would rather feel the little needle! That made fills much easier. I'm done now with fills and now just waiting out my time. Good luck to you
)Keely
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Hi Whippetmom:
Got my last fill yesterday and the information on what TE's I have and also what my PS has ordered for my exchange. I had a lot of mis-information. Moral of the story - don't listen to what the receptionist tells you!
My TE's are Dermaspan Low Pole Plus by Specialty Surgical Products. They have a fill cpacity from 310-370cc and are 12.0 wide, 9.8 in length with a 5.2-6.0 projection. I am very happy with my current size which is 350cc. PS wanted 350-370cc and we were both hoping for the 370cc but more than 30cc would not go in this time after 2 weeks so I am done.
He has ordered a saline 'sizer' which the nurse said they put in and do a test close with to see what will fit. He has ordered 3 sizes of silicone implants. Allergan Naturelle biocell textured silicone round, style 120. He has oredered the 120-300, 120-340 and 120-400. What's your size recommendation?
I know he told me when we first started that he prefered smooth for reconstruction. I have emailed the surgical co-ordinator to ask that i be changed to smooth but am curious why he is requestin textured. I've read some things that say textured may be better for reducing capsular contraction but it seems pretty inconclusive. Do you have an opinion on that?
He is planning to do fat grafting and told me that about 30% of it usually takes. He plans to do this at the begining of the exchange surgery and then again if needed when he does my nipples. It's unclear to me if my insurance will cover this or not. The wording is confusing. It looks like it may be covered if done at the same time with another proceedure and coded correctly as a adjunctive to the exchange proceedure. They have it mixed in with proceedures to completely replace the breast with only fat tissue which they don't cover because it's 'experimental' so it's hard to tell. I have a pronounced shelf with my TE's and am very boney - especially now with no breast tissue. My question on the FG is - do you have an opinion on it? would you or have you done it?
Deborah - Thanks so much for all you do for all of us. You are a Godsend and make so many of us feel so much better about what we are going through. God Bless you!
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rubalouI did have fat transfer done twice. I too am very thin/bony on top. I'm glad I did it. It makes for a much more natural look and reduces ripples. My PS is out of network so they didn't pay great but they did cover (part) of the fat transfer. You can get the codes from your PS office. Call the insurance and see how much the pay/cover. I would think that your PS's office already did that though.0
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Thanks Lago! What kind of implants did you get - smooth or textured? Silicone? I had a lull of felling calm about this whole thing and find now that a date is set that I am really nervous again. I appreciate your response. Talking to others with similar experiences is sooooo calming. :-)
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Rubalou I have:
cohesive gummies/Allergen/Natrelle/smooth/mid profile/style 15/397cc
My stats: 5'6"/130 lbs/31" ribcage(Whippetmom will need this info from you too)Most people get higher profiles than style 15. (like style 20) but I don't feel like hamburger buns at all. I would not have wanted to be any bigger. I think because I have no fat on my upper body that these worked well.
I did ask my PS about textured when I first met him because I too read that they reduced capsular contraction. He said he didn't find a difference. I have also read just the opposite too. So far I have had no issues with capsular contraction. My boobie prizes are nice and soft. They don't know what causes it. They think infection can but still not sure. Some women just get it. I do massage like I'm supposed to.
Need to get ready for work. Only a 1/2 day for me today.
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Thanks Lago! We are very close in size. All the same except I'm an inch taller so VERY helpful! Have a great day!
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rubalou: You need to change his mind about textured implants. You will not like them. *I don't think there are but two or three women on these forums who have had textured rounds and at least two of them immediately switched them out to smooth silcone rounds. You will have traction rippling with textured implants. There is, as you state, no conclusive evidence that textured implants reduce the risk of capsular contracture enough to outweigh the negatives they produce. So please insist on smooth.
You will be happy with 425 ccs in Allergan Style 20 - smooth round silicone implants. You will not be happy with anything less than 400 ccs - Allergan Style 20. You could use the Style 15, as Lago stated, but I think you would want at least 371 ccs as a minimum volume. You would be a bit smaller than you are now, but it is a nice width for your frame. It is a good option, if your PS feels he needs better implant coverage - has less projection than Style 20.
*The Mayo Clinic in Scottsdale, Az uses textured silicone rounds with their one-step with Allo-bra patients and this seems to work, because the entire breast pocket is lined with Alloderm and traction rippling is not an issue. But for any other application, it just is a recipe for disappointment.
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Oh...rubalou....referable to fat graft transfer - yes - I have had it done twice. I think it is very helpful in filling in some minor contour defects and perhaps some rippling [not traction rippling - nothing resolves that except removal of the textured implant!] and having it done at the same time as the exchange is great. You have my vote there.
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Whippetmom - you are the best! My PS has changed me to style 20 and has ordered 400,450,475 and 500cc to have in the OR so I guess he agrees with your assesment!
I wouldn't have known to even ask if not for you.
GOD BLESS YOU!!!!!!!!!!!! I feel so much better I am crying tears of joy!
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rubalou: Wow....ask and it shall be given unto you!!! What a great surgeon! He has your desires and best interest at heart! If he can use 450 ccs or 475 ccs - that would be fabulous! I am so glad he is willing to do this for you!
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I am not doing so well with this whole mastectomy trip. I am not doing well on pain meds. My bs said today suggested to just do tylenol & ibprofin. My ps used botox on the pec muscels which allowed him to put in 300 cc's of saline at the time of mastectomy? I woke up from the mastectomy with square breast. His nurse put in 60 cc today and 40 next week. After that I'll wait for 6 weeks to heal and then implants and a little fat grafting. The nurse said the nore saline the more it will fill out the implant and less it will hurt. I hope so. Is it wrong to miss your real breast?
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