BREAST IMPLANT SIZING 101
Comments
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SweetCaroline: Would you please PM me and let me know where you are in California? I want to make sure you have all of your options presented and that you are on track for the best result. I have another thread which discusses this very topic of radiation and breast implants. So please go visit this thread as well. But PM me with your height, weight and ribcage....
http://community.breastcancer.org/forum/70/topic/744891?page=1
Deborah
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GreenMonkey: Cannot wait to hear about your appointment!
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Green Monkey -- Dr. Pusic is my PS at MSK and I think she is great. She's a straight shooter as far as what she can/can't do... but I'm sure she can help. The only thing that surprises me, though, is that you are able to see her. I've heard from others that once you see one of the MSK doctors you can't see another (in same discipline). I hope that is wrong!
Deborah -- you know you can always have people PM me about that
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Lilah, I am so excited to speak to someone who has Dr. Pusic! you just elevated my mood by 59%
I heard the same, you can't switch. I'll pm you on my strategy 0 -
LOL GreenMonkey -- bravo to you for having a strategy! (And it seems to work). I LOVE Dr. Pusic
Does that elevate your mood more than 59%? LOL I love that number tho... so funny. She is a perfectionist.
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whippetmom: I had a question for you. The kind or tissue expanders I have which are allergan 133sx and and 133 fx will accomodate a larger implant. If the TE is exchanged for a larger implant, does the breast looks rounded or does the implant drop eventually and the breast looks more natural, like in the shape of a teardrop? Thank you for your help.
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mkw1: Are you saying that you have two different styles of tissue expanders? A short height on one side and a full height TE on the other?
After breast reconstruction, there is no breast that takes on an actual "tear drop" shape. The shape will be more rounded, but any breast which is augmented, takes on a more rounded appearance. An anatomically shaped implant will sometimes give more of a natural shape - more so than a silicone round - but there are women for whom the anatomical shape looks indistinguishable from a round implant, once inside the pocket. I think if one is a unilateral and does not intend to augment the native breast, the use of an anatomically shaped implant would be more inclined to take on the natural shape for better symmetry with the native breast.
Deborah
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whippetmom: I thought that after the implants were placed, they eventually drop some. Am I mistaken?
Yes, I have two different kind of tissue expanders. I originally had both tissue expanders to be short height, but after I lost the left one because of an infection and I lost some more skin to scar tissue, the PS decided to place a full height on that side with more volume.
Thanks a lot for your help and blessings.
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mkw1: In some women, yes, the implants can settle and sometimes "drop" but not in all cases do they do so or need to do so. We all can respond differently to the expansion process..
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Ihi ladies
I wish I had found this site and forum a lot sooner. I had BMX in December and having my exchange in april. I was a 36b before surgery and measure 38 with the TEs. I told my Ps I wanted to go bigger with surgery but he is telling me he can not do anymore fills because my BS cut aggressively on my cancer side. I have only had 2 fills and think I'm at 450cc I'm not sure. I guess I should of been keeping better track.. My plastic surgeon doesn't seem to be forthcoming with a lot of information. He told me he will be taking 3 sizes of implants in with him to surgery and see what fits. Is there any questions I should be asking? Thanks so much0 -
Cyn0619: Go easy on yourself. Many of us learn about this by going through it. If we've never done it before, we may not know the questions to ask in advance.
You could ask your plastic surgeon if you are/aren't at 450cc now. You could ask how many ccs of saline he is giving you w/ each fill. You could ask if you could actually see examples/samples of the implants he plans to use.
Also -- emphasize whether you'd like to be bigger/smaller than what you are now (with the tissue expanders).
Re-read whippetmom's initial post on this forum (lots of good info).
Ask him about profiles/style/volume (see link): low/high profile -- means how much the implant protrudes from your body.
Ask him about Alloderm. Does he plan to use it?
Tell him how you'd like your cleavage to look -- close together / far apart.
Ask him about breast placement -- does he place them high and expect them to naturally drop/droop?
Talk to him about intended results: what if you aren't happy. what if you do want to go larger after the surgery. could you re-operate? is there something he can do to address this now.
Good luck. And remember -- it's your body. So you are not "putting the PS out" by asking him detailed questions. You're actually helping all involved. You have every right to get exactly and/or as close to the results you desire.
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Cyn0619: I am not an expert on breast reconstruction but my PS had also told me my surgeon had radically removed skin on the cancer side, which was my right side. However, he has already filled the expander on that side to almost 600cc. The expansion process has been much slower for me, giving my skin a chance to stretch. I had the tissue expander inserted on October 2011 and still will keep it for a while until achieving desired volume.
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I am a newbie and this is my first post, however, I have enjoyed reading all of the topics and have learned so much. I do not know all the abbreviated terms yet, but this is my story. I had a double Mastectomy Feb. 27th due to cancer and have been back for 2 fills. I am 5'8" and weigh 168. I suure hope to lose a few pounds though. I wore a size 38 DD bra but, have no idea what size my TE's are but I know I told my PS that I wanted to be as close to normal as possible. He recommends the round silicone implants for the larger breasted patients. I need to know what size implants I would need and am thinking 800 CC's and know that is the largest for Silicone. Do you think this is adequate for me to be as close to normal as I was before the surgery or should I go with the Saline so more can be added. If not, can you help me with the questions I need to ask my PS?
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Caro4: I know that 800 ccs in a high profile smooth round silicone implant would be sufficient for you. You might have received a little plastic card at the hospital with your tissue expander information. If not, call and ask your doctor's office staff, as the style and volume of TE will be documented in the chart. There is another implant mfr called Sientra and they have siicone implants up to over 950 ccs. They just became available two weeks ago when the company was granted FDA approval to start marketing their product. They have been widely used in Europe for years. But I personally think that 800 ccs should be quite sufficient.
Deborah
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because I am unhappy with me TE's I recently went for two additional opinions and I can't get over how different they are.
do you recommend round or teardrop implants?
should you use the TE tabs?
where does the nipple skin come from?
can you wear a tampon during your BMX?
can I have blood drawn from my arm now that I had a SNB?
what about dropping below the natural fold?
are these (my current TE's) too low?
are faux SYMMETRICAL boobs too much to ask for? and if so, why?
does having a 1 and a half inch difference in the placement of your TE's mean it will be more difficult to fix during the exchange?
I get really upset with myself for "picking" a dick for a PS but hell, I was focused on the cancer. In my never ending quest for perfection, I was doing research last night and came across New Yorkers TOP DOCTORS - I used to think this was the bible but there he was, my PS from hell, listed year after year after year ...excellence for this and that and yet, you messed up on me.
okay... enough about my bitching, time for wine. again, thanks for listening!
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Hi to all,
Due to LCIS, I am pursuing a pbmx. I have consults lined up for next week. I am hoping to do nipple sparing direct to implant.
i am meeting with two BS next week. Do the surgeons usually select the implant for you? I am a 38D now and am willing to go down to a large C or small D. My BS said I need to be lifted too. Since he is doing a lift, would a D look larger than normal? I had two kids and am quite droopy. I do not want to look larger but it seems logical that they will seem larger if lifted.
Just wondering what to expect at these consults. Any questions I should ask? How do I convey the "look" I want?
Thanks.
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Thanks for the info, Deborah, I will call them tomorrow... I go back on Thursday for another fill and will speak with my PS...I so appreciate this. I have a friend that was DD but shorter and a larger lady, and she was so unhappy with her 800 CC's but hers were Saline. I am also going to ask him about the profile (Protrusion) because the round ones he showed me didn't look like anything protruding...hope that makes sense. I just want to be return as normal as possible. Thanks again and I love to read all the questions and great information given. Thanks and God Bless!!
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shabby6485 - OK, I'm a little confused (but, that's nothing new). Typically the BS (breast surgeon) performs the mastectomies and possible lymph node biopsies/dissection THEN the PS (plastic surgeon) steps in to do the reconstruction. I have implants, but I went through the tissue expander process.
So.....in the direct-to-implant procedure the BS does the entire surgery - no PS involved????
You are having bilateral surgery, but they mention a lift? Does that simply mean he/she will be removing some excess skin before the implants go in?
The selection of implants is ultimately up to the surgeon at the time of surgery. Typically he/she will order several styles/sizes of implants. They don't always know until you're in surgery which implants will work and look best. HOWEVER, there should be plenty of good communication between you and your surgeon before that day about what your hopes and expectations are!
Well, all I did was ask more questions.....I didn't help at all did I?
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Hi Tina
Sorry for the confusion. My mind is completely fried after the past two weeks. You are correct. I meant to say PS. I believe the lift will be supported with the alloderm. (?) and than removal of some skin?
I need to figure out what my expectations are. I am very concerned that the new boobs will look fake and be uncomfortable. Did you kind of know the "look" you were after? I guess I better formulate some intelligent questions for the PS!
Thanks for the replies and for pointing out how utterly clueless I am at this point. Ha! This is so new to me...just two weeks now. Hope all is well with you!
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Whippetmom, what if I want to swap out larger implants for smaller - won't there be like "empty space" so to speak ....or will it just have a natural droop?
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Green Monkey:
do you recommend round or teardrop implants?
Okay, in all honesty, I think that round silicone implants work best for women who have had bilateral mastectomies, are thin, have rather bony chests and are extremely uncomfortable with their tissue expanders. If you have the princess-and-the-pea syndrome going on, you probably will find that the rounds will be softer and more to your liking.
should you use the TE tabs?
I like them. I think that they can help reduce the potential for or degree of superior and lateral migration during expansion.
where does the nipple skin come from?
It is created from the skin on your breast mound. There are YouTube videos available which demonstrate how this is done, but here is a good written description.
http://www.breastreconstruction.org/SecondaryProcedures/NippleAreolaReconstruction.html
what about dropping below the natural fold?
That most certainly needs to be corrected either by removing and replacing the tissue expanders [which I recommend in the extreme cases of IM fold malposition] or at the time of exchange. The IM fold is one of the most important factors to consider in breast reconstruction
are these (my current TE's) too low?
I do not know. Do you want to send me a photo privately? Why don't you get on the picture's forum and post some photos for us....
are faux SYMMETRICAL boobs too much to ask for? and if so, why?
No.
does having a 1 and a half inch difference in the placement of your TE's mean it will be more difficult to fix during the exchange?
That does not sound like an extreme degree of malpositioning to me. It can be rectified by the right plastic surgeon who KNOWS how to correct such defects.
I get really upset with myself...I was focused on the cancer....
There are many before you who have been unhappy during the first stage of reconstruction and have opted to go elsewhere. We all have been in that position of being more focused on the cancer than the cosmetic outcome. It is what comes natural to us all - that fight or flight focus. So do not beat yourself up about this. You are NOW involved and in charge of what goes on with your reconstruction, so just know it gets better from this point forward.
Deborah
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Caro4: I do not know that you even need 800 ccs. You might only need 700 ccs. So it will all depend on your skin flaps and your tissue expanders. Update me when you have that info.
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shabby6485 - I suppose one of the benefits of the TE/expansion process is that many PSs use the "tell me when you like the size" approach to fills (as mine did). Even though the expanders often are't shaped exactly as the implants are you have the chance to live with them at different sizes and think (or agonize) about it for some months before deciding. There are, of course, limitations for some who have had radiation, etc.
I wanted to look as much like "me" as possible, but a little fuller. I have a bony chest and a fairly prominent sternum. I had numerous discussions with my PS and his PA and they knew that I did not want the implants to look cone-like or to project a lot so I ended up with "moderate plus profile" implants rather then the more often used "high profile" implants. They are perfect for me, very natural looking. I should add that I have smooth round silicone implants, Natrelle Style 15.
If you don't have access to the picture forum you might find it helpful to check out some photos to help you decide what you do and don't like about implants. Send a PM to Lilah or firni or Dawne-Hope to check about getting access.
Best wishes!
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shabby: In addition to what Tina shared above, I will have to say that you will not be larger than you are currently with one-step/Alloderm breast reconstruction. You will be smaller. How much smaller depends on the amount of skin retration, the skill of the surgeon and the viability of the flaps after mastectomies are performed. The one-step procedure has a high failure rate, which is to state that many women are not happy with the results after a one-step procedure. Many plastic surgeons feel that there are actually very few women who are good candidates for a one-step reconstruction. What represents a "good candidate" is unclear. This is why I would get a second opinion and maybe even a third. Essentially, it also has very much to do with the plastic surgeon performing the procedure and it would be crucial to have a PS who has performed a one-step many times with good success and can show you the photos supporting his success rate with the procedure.
Deborah
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Green: I think I missed two of your questions:
can you wear a tampon during your BMX?
I don't know why not.
can I have blood drawn from my arm now that I had a SNB?
Have it drawn from the opposite arm instead - just as a precautionary measure.
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What is a TE tab?
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Fearless: You need to stay close to the same width as what you have currently or you will need the pockets narrowed - typically a procedure called a lateral capsulorrhaphy. Refresh my failing memory about your current implants - style and volume.
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Oops...never mind Fearless. I just saw that you messaged me...
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Again, thank you Deborah. Always direct and informative. If you want to run for public office you have my vote.
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Deborah, I heard today from a PS that wearing a tampon during surgery puts you at risk for toxic shock syndrome - it was part of the pre-op instructions.
and, regarding blood, what if you had nodes taken from both sides?
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