BREAST IMPLANT SIZING 101
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(forgot to include the 12. 133FV-12)
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GreenMonkey sometimes my PS did my expansions and sometimes the nurse. If I didn't want the nurse to do it I would have to find a time when my PS was there.
As far as him being late. Remember MDs are people too. Good chance he had an emergency. Sometimes we forget we aren't their only patints. If he is the top guy I'm sure he gets more challenging cases.
Not sure why he didn't have your records. He should have been able to see how much he expanded you by those records. If you still want to stay with him then find a work around. Ask to speak to his nurse. She should be able to answer all your questions… and what she doesn't answer she can check with the PS.
Not all good doctors have great bedside manners but it's up to you to decide if you want to deal with it.You will have a long relationship with this PS. If you can't communicate you can change now.
BTW expanders are weird on most of us.
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thank you lago! I know my bad attitude isn't helping and I know what you said is right. I just found out I'm cancer free and I should be bouncing around, happy, happy, happy. But all weekend I felt cranky and it doesn't make sense. I'm annoyed with my TE, my skin hurts, I want to sleep on my side.... I'm starting to focus on all the noncancer stuff (husband out of work, dad dead) all the stuff I didn't get to do before....
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hale: I think that 500 ccs or 550 ccs in a high profile smooth round silicone implant would be perfectly fine for your frame. I am 5'3" and 122 pounds with a 30 inch ribcage and my implants are 550 ccs HP silicone rounds. However, hate to frighten you, but I am a DD cup. You must trust when I tell you though, that it takes more implant to give the appearance of volume after reconstruction - so I look like a "C" cup in clothing. This is why I do not like to predict or discuss "cup" size. It is more important to match the width of your TEs -[ presuming the PS has not gone billy-wonkers and has given you a TE too wide for your chest wall] - and to choose a volume and projection which is suitable for your chest wall and your body habitus. So I think you should definitely forego any additional fills. By no means, no more fills. You have already had one complication with one TE and so do NOT push the envelope, literally and figuratively! You have plenty of expansion for 500 ccs or 550 ccs in a HP implant.
Deborah
[Oh....BTW...your PS has not gone billy-wonkers. Your TEs are just right for your frame.]
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janice: The key with unilaterals, is that symmetry is the primary goal and achieving that goal might mean lifting the native breast. If you have significant maternal droop [aka "ptosis"] with the native breast, it is going to take a lot of expansion to really stretch out that skin, so that the PS can use an implant large enough for symmetry but on the other hand, small enough to allow for a comparable degree of ptosis to match the contralateral breast.
If you were to have a high profile smooth round silicone implant, the smallest size which would work would be 600 ccs. The Allergan LV - low height, variable projection - TE does allow the PS to utilize an implant with considerably greater volume than the TE - typically twice the volume of the TE. So conceivably, around 700 ccs. So it all depends on the size of your post-MX skin flaps and how much the PS is able to stretch the skin during expansion. Go slowly and do not try to fill too quickly. Also, you need to ask your PS if a lift on the native side would be beneficial in order to get the best symmetry.
Deborah
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Shannon: I am going to PM you....
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GreenMonkey
You are not alone, I am also feeling really crabby when I should feel like the weight of the world has been lifted since my pathology came out good. I have a TE that is just starting the filling process and haven't had enough time to know if it is going to get better or worse before it is to the max fill or how long it might take. It is uncomfortable sometimes more than others. I wasn't quite sure if wearing an underwire bra made it hurt more. I see the PS tomorrow for a fill so I will hopefully get some answers. I am also anticipating the OK to go back to work, I would like give it a shot, maybe 4-6 hrs at first and then next week full time.
Like you said now that we are cancer free we seem to be finding the other things that make us feel negative and down. I know it will be helpful when other things in our lives start to turn around. I hope & pray that your husband finds work soon (I've had that with my husband too but now he has a job). It is very hard not to feel the way you do. So give your self some time and hopefully your mood will improve.
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Whippetmom
Thanks for the info. I wasn't sure at first if I wanted to do a lift on the native breast side (the PS said most of this patients don't choose to because they are wary of having any unwarranted surgery on the healthy breast). However, he did suggest that I have a lift to the native breast to achieve better symmetry. Perhaps I should go that route and take his suggestion.
You are truly amazing to have such knowledge and to be so helpful to all of us.
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Whippetmom -- so did Sientra get approval for an anatomical shaped cohesive gel implant? That would be cool. (Basically having the appeal of the teardrop shape of the gummy but with the softer feel of less firm silicone).
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Whippetmom:
Thank you so much for the information! I love my PS and he is good - he does primarily reconstruction - not just but that is his specialty! (Unfortunately he never has a shortage of patients.)
As with most docs I've noticed through this - he has a plan (but they don't always share the details), not that it isn't a good one but maybe it should be tweaked and he did give me an out "When your done let me know.." So I will have this discussion on Wednesday!
I truly appreciate your knowledge and willingness to share it with those of us following in your footsteps - a godsend to many no doubt!
Thank you to all who post here - wish we'd never needed BCO but glad it is here to learn from!
-Michelle
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That is what I hear Lilah.
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Janice - You wear a underwire with your TE? Be careful! I personally couldn't get my Te's to fit in an underwire and it HURT. Underwires are great for post-exchange support but for now a soft-cup, exercise bra or camisole would feel a lot better.
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Hmmm.... interesting! I may ask my PS about it. She has been wanting to exchange me for a smaller gummy (which I am against, because this one is a good match to my native breast) due to the fact that this one may be a little more than my back muscle can take... as I have some continuing pain in my shoulder blade that I assume is from the constant pull on the stretched muscle. I will tell you more after I see her in June.
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Lilah....
Your implants: 15.5 width and 13.9 height and 7.1 projection
In Sientra - if the implant dimensions I have are CURRENT and correct, the closest we could come would be:
Sientra Moderate Profile Nuance - 550 ccs - 15.2 cm width x 13.1 cm height x 5.4 cm projection. [So look at that difference in projection.]
According to my chart - and I HOPE they add more options - the high profile Nuance only goes up to 550 ccs, with dimensions: 14.5 cm x 12.4 cm x 5.8 cm. This might be an option, but I worry that it would mean too much pocket work to narrow the pockets.
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Thank you whippetmom. I will ask my PS on Thursday when I go formy third filling. From the start, my left breast would not accept as much saline as the right. The doc said that during surgery he put 60 cc in each. I had surgery on feb 14 and the first filling on March 8 when the doc managed to put 90 cc in the R one but only 70 cc in the L. Then, on March 15, he started with the L and I couldn't even take a full syringe of 60 cc. It was painful, the pressure was killing me. So, to even sides out, he could only put 30 cc on the right. So they are both now at 180 and I am dreading the fill-up. But I know I have to keep going, there is no way to stop. I just don't know how to make my body more tolerant of the injections. And definitely the left is much harder to inject, because the pressure builds up rapidly. And the doc says that he overinflates by 50%. So then to have 300 cc implants, he would have to fillme up to 450 which, at least now, does not seem doable. Like somebody else mentioned somewhere, I might have to have tiny tiny fillings of 25 cc and again, I was hoping to do this process quickly so that I could have the operation and get rid of this strait jacket which is torturing me day and night almost to the point that I feel I cannot breathe at ease. I am so depressed that I've been crying every day. And I am on anti-depressants.
. Ok, i just found out from a piece of paper I got upon my discharge that what I got is 133FV-11
I do have my original nipples and on the left the nipple is being pulled downward by the oddly shaped expansion. I cannot look in the mirror without having desperation creep over me.0 -
SMG1954 - the fill process is not a race. I had 50cc fills, one 60cc fill that about killed me and then waited four weeks until my next fill which was my last at 25ccs. Space the fills further apart if necessary and ask for less saline. They can also take saline OUT if necessary.
I don't understand why your P.S. overfills so much, but whippetmom can answer better than I can.
Your expanders don't tell you what the final reconstruction is going to look like. You've been through so much ... There is hope and what they look like now ... Don't focus on that. Focus on communicating with your P.S. what you want. Whippetmom can help you! (((((((hugs))))))))0 -
Also ... SMG1954 - Ask for muscle relaxers! Flexeril, Valium ... They really can and will help with the pain. I took one Advil (anti-inflammatory) and one Tylenol prior to my fills, and then took each one again every six hours for the first twenty four hours after a fill. I took a Flexeril (muscle relaxer) if I was still hurting and I also used a heating pad the night after my fills. The heat really helped.
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How much filling did you take in all Dawne?
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I took Aleve for the pain at the last 4 expansions. My PS filled only 60cc at a time.
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310ccs. I exchanged to 325cc implants.
I do not understand at all why your P.S. wants to overfill you that much ... I understand some do so there is some natural droop (ptosis) but with your tiny body ... It doesn't make sense to me.0 -
okay.... I took a vicodin prior to the fill and it was a breeze. Then I got home and the vicodin wore off. NOW, I'm uncomfortable, but only the "low" side. 60 cc's per fill. I feel like if the "low" side was in the same place as the other side, I'd be in great shape!
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I had my fills two weeks apart until the last one ... Which was four weeks.
I never needed narcotics for pain, but my last two fills, I took the muscle relaxers which helped a great deal.0 -
I have a muscle relaxer but I don't use it because it makes me dizzy and groggy - maybe I'll try half. I was told I couldn't use heat of any kind. They are all so different.
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Thank you so much fir this wonderful resource. Ok, a few more questions:
What is everyone's experience with overfilling/underfilling? It seems that many of you report TE of a certian volume exchanged for implants of a higher volume. While my PS wants a 50% overfill.
What is everyone's experience with volume of fillings and frequency? Is it better to go with less saline at more frequent intervals, such as 1 week or more filling less often?
What is your experience with gummy bear/anatomical implants or for others, the round ones? My PS recommends the round ones saying that anatomical ones may shift and give you the lopsided appearance i have now due to, probably, having the left TE shifted.0 -
SMG: Here is something I posted last year in answer to the question about "overfilling" of the TEs. But I will preface by stating it is quite ridiculous for plastic surgeons to state that they always overfill by 50% or any percentage. It is not a one-size-fits-all approach which should be taken with breast reconstruction. What if the patient already has ample skin flaps? Overfilling by 50% would be unnecessary and could be detrimental to the cosmetic outcome. That said....
Jul 6, 2011 12:01 amwhippetmom wrote:
Posted this before, most recently last month....
Overfilling: Some do and some do not overfill. Overfilling is sometimes needed in order to stretch out taut skin so that a bit larger implant can be used, when the PS wants to insure he is going to have good skin coverage over the future implant, in order to get a little natural droop or ptosis. The skin does retract when the TEs are removed and so this is just a little extra assurance in some cases.
But primarily, a PS will overfill in order to create ptosis - a natural droop. Overfilling for ptosis is not needed in every case. It was not needed in my case.
Hope this answers some questions....
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SMG: Also, read the header to this thread.....more answers to be found there.....including this:
1. TISSUE EXPANDER - OVERFILLING AND REASONS FOR DOING SO:
Overfill is sometimes performed and it can be done so for a myriad of reasons. It can be done because a PS always does it in his practice [which makes no sense to me]; it can be done for assurance of good implant coverage with the skin flap; expanding out the skin a bit more so that a larger implant can be used, or in order to achieve ptosis [droop], especially in unilateral recon. It is not necessary in all cases to overfill and some docs never overfill, some rarely ever and some always do. But for those who are small-breasted prior to MX, it often is necessary, so that there is good skin closure, if a larger volume of implant is needed or if symmetry with the contralateral breast is required for ptosis and symmetry.
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Deborah -- thanks so much for that info about the Sientra Nuance. Wow -- 550 ccs (and 5.4 vs.7.1 projection) is a huge difference! SO I won't be going that route any time soon.
Re: Overfilling... my PS likes to overfill. My TE was filled to 850 cc's and my implant is 685 cc's. I don't have much ptosis, though, so I'm not really sure what the point of the overfill was. Maybe without the overfill she would have put in a smaller implant (and as posted earlier the size I have now is a good match in both projection and shape to my remaining native breast).
As for the pain -- yeah I found the last three or four fills to be quite painful (and I also filled a little at a time... maybe 50 cc's a visit at the end). I found advil helped as well as frequent massage of my shoulder blade.0 -
SMG my PS overfills. I never got the exact amount but my nurse said I was filled with 60cc each time. I had 10 expansions (+ what ever he filled me with at surgery). My implants are only 397cc. So I don't know if I was really expanded that much but if I do that math that's a lot of over expanding. I was small to begin with (wore a 34 A/B bra). I currently wear a 34D. I went a bit bigger and my PS likes to achieve ptosis… and he did.
My first 3 expansions were done before chemo, starting 2 weeks after BMX. The expansions resumed after chemo, again weekly. My PS prefers to go slowly.
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Thx for the info Blessings,wow dunno how you will survive the Optifast. I could stand to lose a few lb. I didnt think i was swollen either until one morning suddenly my bra was huge! Ok I guess the swelling went down and then I just wore my pre surg bra which was comfy since I was back to pre surg around the torso but my TE were a little red from the underwire so I went back to the mx bra but I just dont find it comfy. Like "lago" I hope to go a little larger but I am not in a hurry, I would rather have 12 50cc fills its my PS who is convinced that I will get infected if they do more fills,she wants to do more cc with less fill appts so its her idea to rush and I am not one bit happy with it! I can alway call and cancel and spread these out but I dont think I will have control over the 100 cc fill. She crosses her arms when I talk to her.
What do we do when going thru airport security? Has anyone flown with the TE? Did you get any special swimsuit? Do I need a medical card to fly? I had surg 4 wk ago and I am just dumb on the subject.
So Blessings,you gotta let the cement dry b4 you go in for the exchange I guess? Good luck.
I am about 5"4 so about your height and weight 150 lb, I used to keep it off with exercise but the PS wont let me do anything but walk and I have so much anxiety with the Arimidex I eat too many times a day and most at night after work,gotta stop my bad habits someday..lol
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Layla that is bullsh*t. There is no reason for you to suffer. I would demand she try 60cc instead of 100cc… unless you have a history of infection then maybe that's another story.
I flew last summer. I did bring my card. I ended up with a full pat down but not because of my TEs. (Note to self. Do not wear a long skirt when flying. They think you are hiding a bomb down there).
BTW I wore camis or nothing with my TEs. Ask your PS if you need to wear a bra.
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