BREAST IMPLANT SIZING 101
Comments
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Mantra,
I have the same size expander as you, and I also look flat except when I am not wearing clothes. This is not my ultimate goal. My dr. plans to overexpand mine to get to a C and I imagine he would fill yours to 400 at least before doing the exchange.
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Jerusha I just had exchange (at MSKCC) to gummy after unilateral MX in December... I was worried after reading that some women were unhappy but so far (one week post exchange) the implant is very nice! Not too firm, though firmer certainly than liquid silicone. I like the tear drop shape for the natural slope in the upper quadrant. Did they offer you a trip to one of their free breast reconstruction seminars? You can actually feel a sample of each kind of implant -- saline, liquid silicone, and gummy (or cohesive gel)... if you want to compare. They also go into a lot of detail about the various autologous choices. To me the disadvantage of the gummy is that the largest size I could get (and got) was the Allergan 410 MX 685cc (full height would have been too high)... but you are smaller than I am and so I think there would be plenty of size choice for you. Anyway, I'll let Whippetmom answer your questions but thought I'd add at least one positive two cents worth about the gummy.
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KKT: The tissue expander is a registered medical device and so there would be a paper trail if the PS sent it back to Mentor for safekeeping. TE failure is not common but it can occur. It is one of the risks inherent with medical device implantation and is one of the risks we "sign off on" with our signature on a medical consent form. The limited warranties for tissue expanders would likely be similar to those of saline implants - and Mentor's website does specify what is covered in the event of failure of one of their "implant devices." Apart from that, if you believe you have indeed been adversely impacted as a result of medical negligence, you would want to present your case to a medical malpractice attorney in your area, so that they might evaluate your case and determine if it warrants pursuit via litigation.
I am so sorry you are plagued with so many complications and I hope you find some answers and some relief accordingly.
Deborah
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Dear Lilah, Thank you SO much for your "two cents" which is, actually, quite valuable to me!!! So good to hear that you are liking your gummy. It is a huge relief to finally hear something good. I know that the size of implant can look different from woman to woman, but if you dont mind my asking, what bra size does the 685 put you at? Were you surprised by your size after surgery? They keep telling me that I will look/be "much smaller" after the exchange. BTW, how has your recovery been? Did you come home with a drain? Dressing of some kind or special bra? I'm trying to decide how long to plan to be home from work and from driving. (It took about a month for me to get back to myself after the bilat mxs). I didnt, unfortunately, attend the seminar at MSKCC as I live kind of far away. I wish I had. I think I would have chosen DIEP. I'm so not liking this TE deal, and wish I were done, done. Thanks again!
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Jerusha: I am always fascinated to hear about the journey we all take to get to this place. I am glad you made the decisions which turned out to be the best. Thank you for sharing this for all of us - for women who come after you who need to make decisons regarding their breast cancer options.
The gummy bear implants are more "pocket specific" than the standard round saline or silicone implants. The pocket needs to be created with the style and volume of gummy bear in mind. The 445 gm MX looks more appealing to me just for the added volume, as well as the additional width. If your PS overfills as much as you mentioned, he is trying to increase projection with the TEs, as the width remains the same. If you opted instead for standard silicone rounds, I would recommend high profile implants with a volume of 500 ccs.
I think that it would be good to investigate further your implant options, as there are numerous threads in the Breast Reconstruction forums which discuss the true cohesive gel "gummy bear" implants vs. standard silicone round implants. There is one thread entitled "All About Gummy Bears" which you might want to find by scrolling down through the Breast Recon forum threads.
Please let me know if you have any further questions, and welcome to breastcancer.org. We hope you will also visit and join our happy little family over on Exchange City....
Deborah
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I am about to go offline again and I might not be back on again until Wednesday. I am in Yosemite with no web service on my Blackberry and I did not bring my computer. So I am borrowing one for a couple of hours tonight. We head home on Wednesday.
Will one of you veterans tell Jerusha about the pictures forum and about posting here and on other threads over the next week so that we can get her on as early as possible? Jerusha, there are several gals on the pictures forum who have the gummy bears and you can read about their thoughts regarding same once you gain entrance to that protected website.
Deborah
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Whippetmom -- have fun!!!
Jerusha -- I don't know yet what size bra I will be wearing as I JUST had my exchange surgery last week and am still healing, wearing a post-surgical bra, which does not have a cup size. I am sure much smaller than I was, which was DD... the 685 is the largest possible MX gummy made... and I would have liked something larger to be honest but I'll be fine with this. I think the advantage of regular silicone is that they go MUCH larger but I found the notion of the teardrop shape (much thinner in upper pole) more appealing. I'm not disappointed by that either... and think all in all I'm happier with smaller but teardrop shaped. I'm probably a C cup now, might even be a D (but I'm guessing).
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If you want to get to the picture forum... you will need to PM a lady here on BCO named: Timtam
She is the only one who can give you all that you need to join this picture forum. She is the owner, and she keeps it very safe for everyone.
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Hello, I was reading this forum for long time, but finally I need to make the decision. I have the Mentor style 2500 TE on one side and I was expended up to 440cc. I am going to have an exchange surgery in 2 weeks. We (my doctor and I) decided on Style 45 375 or 400 on reconstruction side and a Style 40 280 on other good side (it is so small now). However I am starting to worry because TE has 12 in width, but those implants are around 11 inches only. Would not they be too narrow for me? Thank you for all your help and great useful information.
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Hi,
I have a question regarding alloderm. I have DCIS I am going to have sentinel node bx. next week. I am waiting to hear when my bmx and reconst. is scheduled it will be sometime in June. My ps has been out of town. I had a pre-op interview/history and physical today by a PA and then teaching by an RN that works with my ps in the office. She said she is not sure if he will use alloderm on me. I can not wait to talk to him regarding this because I thought this was state of the art. He is a well known reconstruction ps and only does breast surgery. I had a 2nd opinion and selected him because of recommendations and his experience and the vast amt of research he has done. He works out of the University of Michigan. The other ps that I saw had only done 30 breast reconstr. surgeries but explained how she uses alloderm. I guess I am anxious regarding this issue. Please let me know what the standards are.
Thanks so much this is a wonderful site.
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Any implant done today is made with an Alloderm sling. It holds the breast in place after the implant replaces the expander and it gives your remaining breast skin some thickness that you would be otherwise lacking. Without it, the implant would move and you would see it through the skin and there would be a higher incidence of failure. Do find someone who is very experience in order to get the best cosmetic results. Good Luck!
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MBJ -- actually my PS does not use alloderm.. so there are implants that don't use it.
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Galya:
I will have access to a computer tonight and can give you further info then. Typing from my Blackberry no. IIn the interim, I need your height, weight and ribcage circumference.0 -
Pamcycle:...Alloderm iis not always necessary and not used by every PS. There are some pretty renowned plastic surgeons out there I greatly respect and they do not use Alloderm in their practice. The patient,s body habitus dictates the need in many respects. If you have nice, substantial skin flaps you might not need Alloderm. If you want to go over you vital stats we can discuss it further.
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Thank you, Whippetmom. I am 5'4'', around 130 lbs and 34'' ribcage.
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Galya...The Style 45 in the volume you mentioned would, I agree, be too narrow for you. Also, using the 45 for a uni might be risky, unless you can achieve the same height and projection with an implant on the native breast. I also fell you could use at least 450ccs...a Style 20 migh be more appropriate. Your PS is not going to know how much he truly needs for the other breast to gain symmetry until you are in the OR.
Sorry for any typos...I can barely see the BB screen ...0 -
Aw Deborah you are too much! I am picturing you in the middle of Yellowstone surrounded by nature's bounty and tapping away at your blackberry
Bless you.0 -
Whippetmom, I am so sorry, but I just measured myself more accurate and I am only 30.5'' ribcage. Does it make any difference? Thank you
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No, not all Plastics use Alloderm. If you are in need of radiation, or have had it prior, then AlloDerm is almost ALWAYS used. If a PS was not going to use it in a radiation situation, I would find another PS. In regular implant recon., it is not always needed.
Personally, if I had not needed radiation, I believe I would not have needed the AlloDerm. I have very good skin and it is thicker than a lot of girls. ( I only know this because my rads. onco. and my ps told me so.
Hi Deborah.. welcome back! Is it raining there?? Lord have mercy on us... it is STILL raining...
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Galya: I still feel the Style 20 is better. You do want 12.0 cm width implants - at the minimum. I am still on the road and it is too difficult to access the implant mfr websites w/o my computer, but you would need much more volume to achieve sufficient width, and my chief concern would be achieving symmetry with the 45. When I get home in the next hour I can look at the numbers.
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Okay, I'm HOME!!! What a relief to see my nice, expansive computer screen, rather than that teesny, weensy Blackberry screen all week!
Gayla: Why don't you email me photos so I can see if perhaps you could use the Style 45. I just feel that it might be more difficult to match the opposing breast with that style of implant. But let me see photos. You would need a minimum of 460 ccs with some minor pocket revisions with the Style 45 and it would take 500 ccs in Style 45 to match the width of your TE.
Style 45 - 500 ccs: 11.9 cm width by 5.7 cm projection.
Your PS knows if your skin has expanded sufficiently to handle this volume of implant. I presume your PS based the width of your TE on the base width of your native/natural breast, which is typically what is done with unilateral MX's, which is why I feel that staying in the 12.0 cm width range is important. So I will PM you with my email info.
Deborah
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Laura: Thank you for helping me out while I was away and temporarily without internet access. We came home to beautiful weather. I am so sorry you are under gloomy skies right now!!! Hope you will be wearing these
soon!Deborah
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Lilah,
I had heard (from a friend who did her reconstruction 15 years ago) that implants that were done before without alloderm tended to be problamatic. I have heard that the implants with Alloderm are more "natural" looking and more supportive with less movement due to the sling. Since I am pretty thin, I am grateful to have the Alloderm, but I know it's not all that common yet. There are still many surgeons that don't do the procedure yet.
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Lilah: I will explain over on Exchange City.....
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HI everyone, I am having my PBM on July 1st and am very confident that my PS has my best interest in mind. He said not to worry yet about what implant I want until after my initial surgery is over and we begin fills. I would like to see what the difference of look is with different surgeries, TE, and implants. I PMed Timtam to view results and so I have an idea of what to expect, but no response. I thought maybe she is no longer in charge of this or maybe I did something wrong due to being a newbie here : ) Anyone that can help would be awesome.
Also, just reading through I have to say "Whippetmom" you are truly talented and such a wonderful person to devote so much time to helping others : ) I'm sure I will be asking you lots of questions when I figure out where to start!! This is all so overwhelming....
Thanks~
Jen
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Deborah -
I'm in awe of your knowledge! I've been reading on EC for a while, mostly to try to make up my mind about whether I want to do reconstruction or not, and I'm going to start reading here now. I'm scheduled for a 2nd mastectomy and TE placement July 21, and while this is not something my PS mentioned, I'm curious about the Mentor product that's a combo TE & implant. How come no one talks about that? Is it a bad idea?
Tory
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Tory: There are a few plastic surgeons who use the Mentor Spectrum expandable for single stage breast reconstruction, although we see this mentioned infrequently here on the breast reconstruction forums. You would need to have substantial skin flaps and/or desire minimal mound expansion after MX....small breasts. There is one plastic surgery group in San Francisco nearly exclusively using this implant after MX....
For those of you wondering what Tory is talking about....here is the link:
http://www.mentorcorp.com/breastsurgery/reconstruction/adjustable-breast-implants.htm
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Jen: Welcome....and I am happy to help you when you are ready!!0
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Deborah - With all this conversation about Alloderm, I was hoping you could help me with a question I have. My PS used Allograft during my BMX with TE placement. Over these months of fills, I have developed a line running across one breast and bumps on the other where the edge of the Allograft is showing through. I was told that this would all be corrected during the exchange but I'm not sure how that is possible since my skin will still be thin. How do you conceal the line between the Allograft and the implant? I am seeing my PS tomorrow for my pre-op meeting and will discuss this again along with what seems to be a hundred other questions! Exchange just a couple of weeks away.
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ref: You might be seeing/feeling the marionette sutures - where the Allograft is sutured into place. As long as there are no complications, I think you will be just fine. You also have the unfilled edges of the tissue expander which might be contributing to this "defect." Give it time but yes, do point this out to your PS. Incisional dehiscence would be rare but it has been reported.
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