BREAST IMPLANT SIZING 101
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I went to see the plastic surgeon today and they did another fill of 40cc's .. completely filled. I fill a little tight right now, new breast, looks better fuller. In 6 to 8 weeks they will do the implant. Next week I'll talk with the p.s. Now that I'm feeling about back to normal, I feel more positive about it all.
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Whippetmom- last when you advised me you had said natrelle 20 700-750 cc. My PS said that because of pocket work he had to do he used the 600cc because they fit better. In your opinion do you think they will be too small? And if they are, is fat grafting an option?
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Hi whippetmom - I have been reading a lot of the discussion on this topic. This is my first public post. I had a BMX on Nov 14, 2011 with TE - Natrelle 133 MX -11, 300cc's. I was filled to 180 cc's each at surgery and have had 2-60 cc fills and 1-30 cc fill leaving me at 330 right now, which seems to be my original size (32C) - which is what I want. My PS likes to overfill 10%, so I will be getting an overfill next - after that, the exchange. I am 5'1", 110 lbs. My below TE measurement is 29". My husband thinks that the saline implants are safer, but I keep seeing that the silicone implants are mostly recommended on this site. My PS has done a great job with the reconstruction and she does not have a preference of saline vs. silicone. I am very happy with what the TE's look like right now and they don't bother me at all. Please give me your recommendation for the implants and why or why not it is better to go with saline or silicone. My PS let us feel samples of both and we did not have a preference and it was also mentioned from my PS that the saline gets to room temperature faster than the silicone - they conduct heat better. Thanks sooo much for all the help you have given and are giving to us breast cancer survivors.
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tenaj: When he did "pocket work" did he narrow the pockets? If so, this is why he used 600 ccs. If he wanted narrower pockets, why didn't he start out with narrower TEs? This is always so perplexing to me....
So what do you think of the size? Take it easy with any upper body movements - as you need to protect the internal suturing.0 -
whippetmom- he said "narrowing" today of the pockets. Pre-op he just mentioned more cleavage, moving them together. I was dissappointed immediately as I felt uninformed. As far as the size, they seem to be changing everyday. A bit bigger today. I guess I was expecting much bigger. Thanks for the taking it easy as not much on the way of instructions/ limitations was said. He did say to keep wearing the sports bra. See him again in 1 week - possible instructions on massaging.
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Sis: You know, your TEs have quite a bit of projection - and honestly, if you really like the look of your TEs, you could use a Style 45 in 400 ccs. It is an option for you - would have the most projection of any other style of implant. Otherwise, I would recommend around 325 ccs to 400 ccs in Style 20. In order to approximate what you have now with the TEs, you need to be closer to the 400 cc mark - so 350 ccs or 375 ccs. As long as your skin integrity is good and your skin has responded well to expansion, and it sounds as though it has, based on your post, I think this size range should be perfectly within reason. I am referring to smooth, round silicone implants - which is why I specify the Style number above.
As far as the preference for silicone over saline, it is just what I personally prefer. I think that for thin women who have or tend to have a bony ribcage, saline just is too troublesome - with rippling being almost guaranteed. We face the risk of rippling to some degree with silicone also, but it could be minor and acceptable with silicone, whereas with saline, the rippling is usually a deal-breaker. Please click on my name and read my bio - I feel the current generation of silicone is perfectly safe - and I know the history of silicone.
I have to say that saline implants serve their purpose, but for thin women who have undergone breast reconstruction, it rarely renders a satisfactory result.
Deborah
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tenaj: I think you may end up quite happy with the size, if he narrowed the pockets and brought them in more medially. Do you want to send me photos? PM me for my email address if so!
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Whippetmom, I'm filled to 500 and am ok with this size. Just ok. My ps always overfills but doesn't wait too long for the exchange. She is going to do 100ccs more next Tuesday which will bring me to 600cc. If I like that, she will fill once more for the overfill. She agrees that 500 and above is fine for my frame. So I'm excited to see what 600cc will look like. Thanks for suggesting it. My 2 friends agree I should go bigger than I am. My original post that had te info and height weight ribcage is on page 171.
Kori0 -
Hillck, thank God you brought that up!! I remember reading something about that. Whippettmom, how do I make sure I get what I want. The smallest I'd want to be is right now@
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Kori: If you are sort of yawning about the size at 500 ccs, I think you are going to likely need implants with around 650 ccs. Now an option would be, and you need to talk with your PS about this, the Allergan Style 45 implant. It is an extra full projection implant. You would need 650 ccs in this style, but it would give you the most projection of any round silicone implant out there. But talk to your PS because it is important to ensure you have good skin to implant coverage with this style. A 600 cc HP implant would have approximately the same appearance you have now with your TEs, which is why I feel you need this additional volume.
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Kori: I went back and looked at your stats [AND BLESS YOU FOR GIVING ME THE PAGE NUMBER] and I just have to say that I feel you could use the width of the Style 20s. My ribcage is narrower than yours at 30 inches, and my implants are 13.6 centimeters. I feel you could use at least 14.0 centimeters in width. Width is important to us for cleavage and also to achieve a balanced appearance on the chest wall. If you had a 30 inch ribcage, I could easily see you with the 650 ccs Style 45s - but I don't want the implants to look like torpedos on you....which is why 650 ccs in Style 20 would be a good choice, if your PS can do it - otherwise, I am sure you will look very nice with 600 ccs as well.
Fills serve the purpose of ensuring that the PS has good skin coverage over the implant at the time of the exchange. The overfilling only increases the projection and the height of the TE, in the area where coverage over the implant will be required. Overfilling of the TE also serves to give a bit more stretch to the skin so that you have a nicely defined IM fold, or in order to get some ptosis/droop - especially if the patient is a unilateral and the PS is trying to gain symmetry with a native breast. Not everyone needs overfilling to get a nicely defined IM fold and I would say that some would not benefit at all by overfilling, especially if you already have quite a bit of excess skin after the BMX. Not every PS feels that overfilling is necessary. Some overfill because they always overfill, and some rarely overfill. It's a mixed bag out there.
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I'm positive she will do 650cc in the hp 20. It was the style 45 I didn't think she would do. I'm so glad it will work out as I'm definitely asking for 650 cc in style 20. I agree that considering my excess skin she shouldnt overfill, however. It will only be for 2 weeks. I am still going to ask her if she will do a lift also. Thank you so much for re-reading my stats!!
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whippetmom...I think I sent you a PM :-)
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Dixiemine - I responded!
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Kori: Cool!
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whippetmom: can you tell me the purpose of a baseline mammogram before a lift/reduction? If you have really dense breasts that show nothing on mammogram, are they still good, or should I have a baseline MRI?
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Mammalou: I would personally opt for a baseline MRI if you are contemplating cosmetic surgery on a breast if you: A. Have extremely dense breasts which hinder mammograhic interpretation, and B. If you already have a history of breast cancer in the other breast, not detected via mammography. The clincher is- will insurance cover this?
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Rubalou, PREACH! absolutely, I totally feel like I deserve to be happy!
Whippetmom, I sent her an e-mail with all the dimensions of the proposed implants, plus my current expanders. Looking forward to hearing what she says. I really like her; she's an amazing surgeon and super nice. Just hope we can agree on size!
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mammalou I believe they always do a mammo before augmentation to be sure you don't have breast cancer. In your case I agree with whippetmom. I had very dense tissue and the tumor was in the posterior region. I had a scare 4 years prior (with ultra sound) but everyone said it was nothing. 4 years later I had a 6.5 cm tumor with a blood nipple! I'm sure if I had an MRI it would have been spotted much sooner.0
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mammalou - Please press for an MRI if you have dense breast tissue! I had years of "normal" mammograms with the additional comment "no masses seen, but lesions could be obscured by dense breast tissue". I finally fought for a "screening" MRI, which was tough and took 6 months because I had no family history, nothing palpable, no current symptoms. What I did have were 5 masses, two of which were small cancers. As opposed to lago, I was diagnosed quite early because I had the MRI before I was symptomatic. Sorry, don't mean to worry you, I just can't recommend MRI strongly enough for dense breast tissue...
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Well that applied to me. I was peri. My mom & sister (older) both have dense tissue but neither have issues. They both had kids… so I had an added risk factor even though my sister had her kids in her 30's.
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OK, i heard back from my PS - basically, she feels that based on the way my ribs curve and where my breasts are located, I shouldn't go bigger than 375. She thinks it might look unnatural on my body. She's also concerned about stretching my radiated skin, which is understandable to me. She has ordered 375, 350, and 325. I asked if we could try for the 375's - I think I will be happy with that. Whippetmom, what do you think? (I can't thank you enough for your guidance.)
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Whippetmom- thanks for your encouraging & intelligent words. If I can figure out how to get a picture to you I will PM you. Thanks again :-)
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Thanks for your recommendations Deborah. I printed the information you posted and took it to my PS appt. today. My PS was in agreement with your recommendations. She added another 30 cc's, making a total size at this time = 360 cc's (feeling very "big" right now). I think I have decided to go with the Style 45, with either 360 or 400 cc's. When my PS fills me, does she need to meet this volume or is the exapander volume different than the utltimate implant volume. Since you based your recommendation on the fact that I liked the expander size at 330 cc's (TE 133MX-11, 300cc), do I really need to be filled to the 360/400 cc + 10% overfill? Also, thank you for your guidance on silicone vs. saline. My PS agreed with you about saline "rippling" and that is why she always fills the saline implants to the max size or more when her clients chooses the saline alternative. I am going with silicone based on your vast knowledge and the other great women on this site's experence. Also - I have not received a response from the gatekeepters (I have PM'd two of them) to get access to the photo site so that I could see the results from other women and post my pics for your review and recommendation. Any suggestion on getting access to this site? Maybe I have to post a minimum number of discussions to be eligible?
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hillck - thanks for your input on slicone. I have decided to use silcone base on your guidance and on whippetmom's expertise. I also discussed it with my PS today and she confirmed what you said about the safety of silicone. Thanks!
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Sis49 be patient. It can take time. One of the gatekeeper is on an entirely different time zone. Also this is all volunteer so they also have day jobs that pay. I know it took a few days when I tried to sign on.0
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Whippetmom- I would love to know what your opinion is regarding my final implant size. I have had a double mast. (no skinsparing or unusual chestwall shapes) in 2010 with chemo and no rads. I've just received my tissue expanders last Friday. My first skin/pec expansion seems to be going really well, pain went away after 3 days. I'm 48, 5'-6", 145lbs with a ribcage size of 29 1/2". My PS put in Allergan 133KV 300cc tissue expanders and they are filled with 150cc so far. I don't want to be large or small just around what I used to be, a full B, my PS is supportive in my desire to be a moderate size. PS does not believe in creating a larger pocket and then downsizing implants, but in placing the expander precisely and going from there.
Thanks so much for your advice, what a great resource!
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sweetbean: No matter what your PS uses in this size range, the size will be perfect for your frame. I agree with her about your radiated skin. It is better to get good skin coverage and maintain tissue viability than it is to have the largest implants in that range. So know that your PS is going to do her best to give you what you desire - but implants without complications is the goal.
Deborah
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Whippetmom, you are amazing! Thank you so much for all of your help - I'm beyond grateful. I was so stressed out about this, but you have helped me understand the process and now I feel really good about my upcoming exchange. You are a blessing!
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Sis: Your PS knows what she needs to do to get you to the 400 cc Style 45, and I feel it needs to be 400 ccs - not 360 ccs. You just need that little width boost at 11.2 cm. Your PS can see how well your skin is responding to expansion and she will determine if you need to continue with fills. She will want to expand enough so that she can get good skin coverage [especially with the ultra full projection style implant] and also so that she can get a nicely defined IM fold for you at the time of exchange.
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