BREAST IMPLANT SIZING 101
Comments
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Yes, this may be the sutures holding the Allograft in place. But, won't that still be an issue after the exchange? Doesn't the Allograft remain to the support the implant? I think at this point I am obsessing about everything that can go wrong. While I am excited to get to the exchange, I am nervous because I really want this to be the last surgery and I'd like to be happy with the result and not settle. I don't think I'll be happy with lines running across my breasts!
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ref: The Alloderm is not supposed to be sutured under tension, and so when done appropriately, the Alloderm should be nice and relaxed in the lower pole. It is my understanding that the sutures should be absorbed after time. I frankly have not heard of this complaint previously....this sensation of feeling and/or seeing the outline of the Alloderm graft under the skin, and so hopefully your PS will be able to tell you what is going on. Please let us know what he tells you. This question might come up again down the road.....
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I will come back after my appt tomorrow and let you know what he says. So far he has brushed it off as a non-issue which is fine with me if it is not evident after the exchange. I am certainly going to make it clear that this is my expectation.
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ref- I don't know if we are experiencing the same thing or not but I have a trail of sutures that are coming to the surface along the lower curve of the breast. My PS said those sutures usually dissolve but, for some reason, they are instead working their way to the surface. My PS said sometimes it takes as long as 6 months for them to dissolve but that she will remove them during my exchange surgery next month.
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MBJ - I posted a photo on the other website. I'm now filled to 440 on one side and 420 on the other. Definitely getting projection after today's fill. One more fill to go!! Yeah! My name on the other forum is Fore.
We don't have Alloderm in Ontario . . only available on a study basis.
Deborah, if you recall my photo from the last surgeon (the TE was practically growing in my underarm, you'll see the difference the new PS made. What a difference! Thanks
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Kate - yes, this sounds similar... coming to the surface is a good way to explain it. Since my last fill more of these lines began to appear. My PS and his assistant both made comments how this will be corrected during exchange though they didn't explain how. That's something I'll discuss further when I see him tomorrow.
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Kate: Thank you for sharing that with ref....and for anyone else who might experience this!!!
Mantra: So that was YOU! I commented on it but I want you to watch that medial migration....after the exchange wear a sports bra which separates and defines the implants...
Moving Comfort makes several...take a look at the Cara, Fiona or Maia:
http://www.barenecessities.com/Moving-Comfort-Bras_catalog_nxs,31,vendor,789.htm
I gave some additional recommendations on the pics forum. But you look fabulous and the size is really just perfect for you....
Deborah
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OK, Whippetmom! I will give you all the dimensions of my body and TE's and if you could give me ANY advice about implants,i will owe you big time!! LOL
Height: 5' 10
Weight: 145.2lb
Waist: 31 1/2 "
Shoulder width: 16" (measured across the front)
Ribcage: 32"
Width of TE: 5" (straight line) 7" (going over from one side to the other in an arc)
Height of TE: 7" (going from top to bottom from chest wall,over the top,down to ribcage in an arc)
Projection: 2 1/4" (measured from centre of chest wall to furthest point) 3 1/4 " (measured from the outer edge under my arm to the furthest point).
Hips: 37"
Thighs:22.5" (gained over an inch since being off work with the surgery!!!)I am quite long in the torso also.
So there you have it! Layed bare for all to see! (kinda!)
Now you know my PS is recommending teardrop cohesive gel. Im happy to go with cohesive gel but if i stuck with teardrop,what size/dimensions do you think would suit my body size/shape?
And the same question for if i chose round ones?? Baring in mind i am currently at 330ml with another expansion in 2 weeks and HOPEFULLY one more after that. I will total either 390ml or 450ml at the end.
The overall look id LIKE is to have some kind of cleavage and projection.This is my dilemma as i'll get more cleavage with rounds but more projection with teardrop.My PS mentioned about not going too wide with my implants as she says i am too slim! But i'm not actually that slim as i am quite broad.
HELPKay
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Kay: I need the data on your TEs. Mentor or Allergan? Which style? What is the total "recommended" volume of your TEs? I MUST have this information for the anatomical cohesive gels, as they must fit the pocket created as closely as possible...
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oh no! i have no idea on the make/style! I do know the recommended fill volume is 300ml. I will try and ask the breast nurse when i'm at the hospital this Monday,but i don't think she will know. If she doesn't know,i will ask if she can get the make,style etc and email it to me.
My PS says i will be getting a smaller implant that what i look now with the TE's in to allow for shrinkage.Thats why they are over filling me. Will this matter if they are supposed to fit the pocket as closely as possible???If i have just 1 fill left, i'll be 390ml at the end,but i'm hoping for 2 more to take me to 450ml.
I took a look at the link to the Allergen implants you put on the first post here. I would love to be able to have the 410 FX or MX. But it looks like they may be too wide as again,my (female) PS said she wont put an implant in thats too wide as it wont suit my shape! =(
How much can you over fill a 300ml expander to safely? Or does that depend on the make/style also?
Feeling disheartened as each day goes by.......... I feel like i'm going to be really disappointed with my finished result,as i seem to want one thing and my PS seems to want to do another.0 -
Kay: Measuring the circumference under your TEs - you are 32 inches, correct? You can easily handle a 13.0 cm wide implant. Not that you are going to come close to that dimension, but just throwing this out there. Here is the issue: You don't want the pocket too large for the anatomical, as it can rotate and if the pocket is significantly smaller than the TE, it is going to possibly feel very restricted and rigid and tight in that pocket. We do not KNOW the width of your TE...which is why you need this info! It is a registered medical device and you SHOULD have been given a card - one is sent with the TE to be given to the patient by the MD. If they threw away the card, they MUST have the TE data recorded in your medical chart...
Mentor and Allergan do have "disclaimers" regarding overfilling....they know the PS is going to do it - well some of them do - yet they still need to mention this for liability purposes. I would say 50% overfill is more than sufficient.
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Hi Whippetmom-
Hoping you can help me as well. I'm over 3 months out after a bilateral NSM. I met with my PS this week and she gave me a date for my exchange-June 29th. I requested all the info you said I needed, and why, and my PS kind of gave me some attitude about it which surprised me because she has never been like that. I almost felt like she thought I was questioning her judgement. Anyway, I'm not sure if I was able to get all the info you need so whatever guidance you can give me is appreciated.
Height- 5'4", Weight- 115 lbs, Ribcage Measurement-28", Waist- 29"
(I'm in the same boat as M-star- gained 2" in my waist since this all began! Yikes!)
I'm pretty short waisted as well.
TE's- Mentor CPX3 Low Ht Contour Profile Xpndr
Ref-354-7111 Lot 5960291 Sn 596029
Width- 11.4 cm Height- 8.1 cm Projection- 6.1 cm
I'm not sure what the recommended fill volume is because my PS wouldn't tell me. She said it wasn't important because they can be filled as much as you want. The only thing I could find was on the Mentor web site for this TE it said volume 250 cc's, but I don't know if that is what is recommended. I am currently at 365 cc's. My PS said I am right in between 2 sizes of implants. She said she would be using Mentor Smooth Round High Profile. She said if I want to go smaller she would use 350 and if I wanted to go a little bigger she would use 375. (She said if I go bigger she wants me to do one more fill of just 25 cc's per breast.) She kept referring to cup sizes which I know you don't really go by that. (She even had me put on different bras they had there.) I told her I was an A cup to start and wanted to be a full B. The web site said the 350's have a diameter of 10.5 cms with a 5.9 cm projection and the 375's are 10.7 cms with a projection of 6.0 cms.
I told her I didn't like the large space between my breasts (2") and could she move the implants closer together. She said how close they can be is determined by the location of my pec muscles but that she would do the best she could.
Like everyone else my TE's are practically in my arm pits and I don't want my implants there. I would like to go a little bigger to the 375 but they are a little wider, too. My PS said the difference wouldn't be noticeable.
Also, right now I feel like I have kind of a "linebacker" shape when my arms are down. I asked about the pooches of skin between the breast and the arm. (Not sure if this is the "dog ears" I've heard mentioned.) She said she could lipo it but wanted to wait a few months after surgery which means going under again and extra costs. Not sure what everyone else does.
Well, didn't mean to write a novel here. Like a lot of women I am more nervous about this surgery than my MX. Just want to make sure my PS and I are on the same page as far as size. Thanks!
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Kate: Do you mean Style 354-6111?
So you probably have implants with a recommended fill volume of 250 ccs. As long as your PS feels your skin integrity is good, I think you want to continue with fills, because I recommend Mentor high profile smooth silicone round implants with a volume of 400 ccs. The minimum would be 375 ccs....
Go take a look at Val61's breast reconstruction journey on the pictures forum. She had the same TEs you have and she has 425 ccs, high profile silicone rounds. She is a bit taller than you and has a longer torso...but the HPs you still need because of your small ribcage circumference.
Deborah
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Oh...Kate...yes, I would prefer to wait and see if the "mud flaps" or dog-ears resolve after the exchange. They can be liposuctioned later. But I had some worrisome pooching also and it all resolved on its own within four months after the exchange.
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Kate - we seem to be on a similar schedule. I had a bilateral NSM in Feb and am scheduled for exchange in two weeks.
Deborah & Kate - I saw my PS today and he said that there is scar tissue that will need to be removed during the exhange. It seems that how much revision of the pocket is necessary he can only tell in the OR. I am fairly encouraged that the lines showing through will be corrected in this process. I am tall and thin so there isn't a lot of fat coverage so he is doing fat grafting during the exchange. My PS said he will also liposuction the extra skin flaps under the arms. Seems like lots to do and almost more of an art than a science.I guess at this point I am cautiously optimistic.
Oh, Deborah... my PS said he prefers Mentor silicone rounds. He said he will bring in sizers for 500cc through 700cc and go with what fits best after the work he needs to do in the OR. I'm happy we are on the same page with trying to get as much volume as possible.
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whippetmom- The 354-7111 number is what the PS gave me. I requested a letter stating that I had TE's because I'm going out of town and I was worried I'd set off the security alarms at the airport. She gave me a letter with two stickers on it that had all the numbers I gave you.
Good to know the "flaps" can go away on their own!
Thanks for getting back to me so soon!
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ref- Have you checked out the thread "Nipple Saving Mastectomy with immediate reconstruction"? Lots of good info on there, too.
My PS didn't say anything about fat grafting but she did say she may use more Alloderm on me. She said she'll have it on hand but won't know if she needs it until she gets in there. I'm hoping she is as much of a perfectionist as she was when she placed the TE. She said one of my nipples was just slightly angled so she straightened it out.
I guess at some point we just have to trust that our PS's know what they are doing but it is nerve wracking all the same.
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Deborah,
I discussed my exhcange with you a few weeks ago and you suggested Allergan implants. I spoke with my PS and he uses Mentor and assures me they are both equally good. Would you agree? I am not sure if I should insist that he give me a better more detailed reason. He seems to just use the Mentor implants. Any thoughts?
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Kate - Thanks for the suggestion. I have been reading the NSM thread but haven't posted there. It's taken me a while to jump in. I agree that we need to get to a point where we trust the judgment of our PS since so much has to be decided during surgery. The best we can do is let them know what we want and work with someone who is on board with those wishes. My PS is very reassuring and does beautiful work so now I just hope all goes well. But, yes, it is very nerve-racking!
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Thanks Deborah
i will try and get some more info on my TE's if i can.....though its gonna be like trying to get blood out of a stone! They will prob just say "why do you need to know?"
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tamgam: Mentor implants are just fine!
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Hi Tamgam, My PS seems to use Mentor, primarily as well. My TE is a mentor. But I told him I want Allergan 20's and he agreed to bring a few of them into the OR. I worked for a pharma complany that makes medications but IMHO, I believe that the implant manufacturer's sales rep /physician relationship has a lot to do with the PS's preference. When I mentioned I want allergan- my PS said the 20's have a bigger projection. He also said they have a nice warranty. As far as I see the warranties are the same, but I think if you insist- he cannot refuse to give you what you want. Right now I am having more of a problem with him ordering the larger size I want. Bit I have decided (with Whippetmom's help) to remind him about my outcome preference and then to trust him and relax.
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Kay.....Just respond, "I am asking because I know that these tissue expanders are registered medical devices and I have read that the manufacturer provides a card with the medical device information which is to be given to the patient implanted with these devices."0
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Ahhh...good thinking! sorry for being such a pain in the A$$ with all this! I will write that down and quote it word for word if they question me as to why i want to know
.Not sure why we don't get given these cards. Maybe its cus we're not paying privatley so unlikely to go off somewhere else for revision surgery or other procedures. I'm sure the card will be in my notes. Failing that i'll tell them i'd like to have it as a souvenir to go with my video's and photo's!
hey,i can now post unlimited!
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Kay....you wrote:
"hey,i can now post unlimited!
"Let the fun begin!
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Waldo's comment about the PS' relationship with the implant mfr's sales rep is spot on...It reminds me of what Dr. Steven Wallach [a famous NY PS] stated in response to someone's question re: whether Mentor or Allergan implants were preferred:
"I think they are all about the same. I use Mentor only because I like the sales rep." __________________
Steven Wallach, MD, FACS
www.stevenwallachmd.com0 -
whippetmom- I am kind of concerned that my PS is not having me do very many fills before my exchange. I am currently only at 365 cc's. She only wants me to do 25 cc's more per breast before the surgery where she is going to place a 375 cc implant. Everyone else seems to expand much bigger past their desired size.
She did say she might use more Alloderm for this surgery. Would that make a difference?
I'm worried there is going to be too much stretching of my skin.
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So much going on--I haven't posted in a couple days and I need to catch up!
Mantra: I will go check out your pics on the other site, thanks! I have two or three more fills to catch up to you!
M-Star: wow, we really are very close in size! My expanders are 13 cm wide and so my volume right now is mostly width (footballs lol) not height or projection. Keeping my fingers crosses.
Deborah: How long do you recommend waiting for the exchange after the last fill? I found that if I massage the expander and take a muscle relaxer it's more bearable when I get the fill.
Val66: I am so jealous. I looked at your pics on timtam's site and your breast are perfect! You started out smaller then me so it makes me not feel that I am being overly ambitious trying to get to the size I want. My PS keeps asking me, so, how big do you want to go? nervous laugh. How long after your last fill until your exchange?
Thanks everyone for your wonderful help and feedback!
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mantra: You are looking great! Do you know what size your PS is exchanging you out to? If you already posted this and I have forgotten, blame the late hour and chemo brain, lol. Even though I have only one side expanded, it feels to wide, but it looks just like yours, just less fill. Are they recommending a 3 month wait?
thanks!
Mary
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Kate: It is entirely appropriate to not overfill....entirely appropriate to exchange you out to implants larger than the volume of the tissue expanders. I was expanded to 425 ccs and exchanged to implants with a volume of 550 ccs. You are just fine.
Mary: Waiting two to three months after the last fill - the longer the better - is what is recommended.
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