BREAST IMPLANT SIZING 101
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I thought i posted but maybe not. I am 5' 3" and 110 lbs. Does anyone hear a sloshing sound inside their chest after the implant surgery?
Lago, what size bra do you wear now? I know you said you are happy with the result.0 -
robo47: I may be wrong but a friend of mine has the gummy bear implants and she was covered either by insurance or by whoever is doing the trials. She just had to sign a paper enrolling in the study for the gummy bears and agreed to have an MRI at a certain time. They also told her they would pay her $150.00 for participating in the trial.
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SMG I currently wear a 34D (measure 30"+ ribcage). I'm 5'6" and 129lbs-136lbs depending on the time of year.0
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Robo: I'm a bit older than some of you, but yes my gummies were covered by insurance - in my case Medicare & AARP. There are ongoing payments to you for participating in the trial. Can't remember all the details offhand, but you get the first $100.00 after post op appointment. There are sporadic payments like that starting every 6 mos & increasing to a year or more through out the 10 year research period.
And yes, I like the shape & feel of my gummies. They're bigger than I wanted, but otherwise I'm pleased with the product.
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Exchange surgery today! Got 800cc hp ..hope they end up looking bigger than my 600cc tissue expanders!
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I had the sloshing sounds right after exchange. That goes away. I think it is mostly air caught in the pocket that will dissapate and the implant is moving around in that, but also some fluid that will be absorbed.
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marial, congrats on your exchange! I hope you're feeling well today, how do they look?
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I am wrapped in an ace bandage until monday so not sure how they look yet..and one drain due yo some extra work needed on the left side..but I am glad he was able yo get in the 800cc..as I was afraid I would wake up with less..and these 600 tissue expanders are too flat
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I bet you will look great. I also was concerned when I had my exchange surgery that my PS would go to small. He told my husband that the last thing I said before going to sleep was "error big", so he went with the largest implants possible for me, 600 cc high profile. I am now a c/d cup and love them. Just had some fat grafting and now has even more fullness at the top of the implants. Definitely better than my original parts as far as how they look.
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Ya, when he marked me he said, he will try to get the 800cc in..and i guess they fit I said if you are between two sizes, err on the large..I hope to be a full c/d
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Exchange done! I did take a peak but know that things change. There's a lot of swelling and bruising, fat grafting done as well. Feel so much better this time around and anxious to see the results as the weeks go by! Thanks to all of you who post on this board, it truly is so helpful through this journey
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Congratulations beachymom!
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I have not been here in awhile, just cruisng along with fills. Last week I got what may be my final fill.
My only 'concern' is that my PS, when I asked for the card re: my TEs, indicated he usually sends it home me the patient at the time of surgery, and that he didn't have it in my file. I cannot find it in my paperwork so...I let it drop.
So, I am 5'7", 165 lbs, 38" ribcage, wide and flat rib cage/body habitus. PS recommends nothing smaller than an estimated C cup. Initially said he would fill these TE to 700-800. At 780 he now sayd maybe one or two more fills, but if I want to stop, he can agree to that and will insert approx. 750 moderate plus profile silicone implants, which he estimates (only because I pushed him) to be a large B, small C. He stresses that this is only an estimate, that he cannot guarantee.
My TE's are almost in my armpits, with a grand canyon in the middle of my chest. He assures me that the final implant surgery will pull them closer together, and lower profile (I look like a frickin' Madonna cone bra). I have had no complications and am quite happy with my results, so far.
My next appt is 3 wks after my last. He said at that time I could have one more fill or he will see how my scars are and schedule exchange in about 2 months.
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Hi whippetmom, I am newly diagnosed and planning (unless I talk myself out of it reading the PMPS thread) to have unilateral MX with "delayed immediate" reconstruction using a TE for skin saving . If the path report comes back clear after mastectomy I would be having reconstruction a few days later, on the same hospital stay. If not, it would be delayed until after whatever additional treatment would be indicated. My preference would be a flap reconstruction, but the PS I consulted with says I am too thin. I have a 2nd opinion on May 1 with another PS but it would not surprise me if he says the same. I guess I just want to hear it from someone who has done microsurgical flap reconstructions—I don't think the first PS has. If the 2nd PS says I'm only a little under the necessary weight I'd be very tempted to see if I couldn't gain a few pounds to make it possible to go directly to a flap reconstruction. I'd really rather not have an implant at all, unless it's the only type of reconstruction open to me. If implants are my only option I think I'd rather have a saline than silicon, I'd worry less about the consequences of a leak.
I'm 56 and my breasts are quite droopy. They are slightly different in size anyway, but it's not noticeable with clothes on. As long as they're no more different afterwards than they were before, that's fine, and OK if what was the smaller of the two ends up the larger. However, I would like the reconstruction to match the existing breast as closely as possible in shape/droopiness. I definitely don't want to have surgery on the unaffected side. My measurements are:
height: 5'7", weight:125 lbs (I usually weigh more like 130), fine-boned. I don't think I am either very long or very short in the torso, and have no rib cage oddities that I've ever noticed or anyone has ever pointed out to me
Rib cage circumference: didn't know if you meant exhaled (29") or after a deep breath (31-3/4")
Measurement around fullest part of breasts: exhaled 34" inhaled 35-1/4"
Distance from inside end of collarbone to nipple L (affected) 10-1/4" R 10" (measured "as the crow flies", not along the skin surface). For about the first 6-1/2" of that distance there is not much overlying the chest wall but skin. I suppose there must be some pectoral muscles there too, but I am not athletic and they appear pretty minimal to me.
Estimated projection (laid a ruler across both nipples and measured from ruler to sternum):1-1/4"
diameter of breasts about 13 cm (both sides)
Distance between inner edges of breasts is about an inch.
Estimate of actual breast volume R <240 cc L slightly larger (don't ask me how I measured this, but I think it's a pretty good guesstimate)
What's your size advice for a short term TE and for an implant? I asked PS about areola sparing, which I would like to do if possible. If I understood his answer correctly there is no medical reason I should not do this but (he said) additional skin would need to be removed so areola sparing wouldn't work out for cosmetic reasons. I assume the areola would end up off to the side somewhere. But how can the skin of the existing breast be too large for a reconstructed breast the same size as the natural one that was removed? And how will I end up with the same droop on the reconstructed side as natural, if skin is removed from one side only?
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curveball: I think that if you are hoping for a microvascular procedure sans implant, you have options other than a traditional flap - but you need to see someone who is qualified to assess whether you are truly a candidate for same. As far as a tissue expander is concerned, it all depends on the size and degree of ptosis/droop of the breast you will preserve. You say it is quite droopy, which means the PS will select a TE on the MX side to match the width of the native breast. He will choose a TE larger than the implant he intends to use and likely overfill that TE so that he can get sufficient skin flaps to allow for ptosis to match that native breast. So perhaps that would be a moderate height TE with a width of 13.0 cm and a volume of 400 ccs or a full height with a volume of 500 ccs - same width. And thereafter, perhaps use a moderate plus profile implant with a volume of around 371 ccs. This is only a guess - it is what I might recommend if you had a bilateral, but you see, achieving the droop to match the native breast is what is rather difficult to achieve, when there is significant droop. Many women have the native breast "lifted" at the time of the exchange in order to gain better symmetry. So keep me posted and let me know what you decide to do.
Deborah
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I am hoping for a flap procedure of some variety, not necessarily microvascular, but it may not be possible at this time. I have an appointment with 2nd opinion PS who is experienced at those techinques, but the earliest appointment I was able to get was May 1. Maybe I really am too thin. If so, I will have to get the implant now, and hope by the time it needs to be replaced, I have enough donor tissue to make it work. I absolutely don't want to have surgery on the unaffected breast. If that means I have one breast higher than the other until I can replace the implant with a flap, so be it.
I really don't understand the function of the tissue expander for skin saving. Is it placed under the muscle or on top of the muscle but under the skin? I don't understand the need to "get" skin flaps when the entire existing skin except nipple/areola will be preserved. Isn't that all the skin that's necessary? If not, why not? In fact, he first PS I talked to spoke of removing some of the existing skin. Why remove existing skin and then use a TE to stretch out what's left—why not just leave the skin that was already there? And a 371 cc implant sounds just huge to me. That's more than half again the volume of my natural breast! Does the volume of the implant bear any relation at all to that of the natural breast it is replacing?
I think I have no clear picture in my mind of how reconstruction surgery is done, and maybe that's why this is so confusing to me. Is there a step by step explanation anywhere? I have just seen an outline of the surgery in a book but it doesn't go into much detail or explain why things are done the way they are.
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Curveball -- there's a BCO member who has a blog that includes links to videos of her entire reconstruction. Maybe this will help you to see what happens? Here's a link to her webpage (which she posts in her profile, so she is open about sharing this). The videos are posted on You Tube and linked via her website. She had bilateral implant reconstruction with Allergan 410s (aka the gummy) and is thin.
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curveball I know my BS doesn't support nipple sparing. He also removes the skin and entire biopsy tract. His stance on nipple sparing is debatable but you really do want them to removed the biopsy tract. Whippetmom can talk in detail about the expansion process. There are some women that don't need to go through this process but they typically are larger to start and want to go smaller.
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I have a feeling it may be too soon to answer my questions, but I am really struggling with my reconstruction options. I had a BMX on March 12 with immediate DIEP reconstruction. Through a series of unfortunate events, I lost both flaps and am now left with just the BMX. I start chemo next week, and I am tentatively scheduled for reconstruction on July 25, which will be a month after my last chemo.
My PS is telling me I will get the most natural look with a latissimus dorsi flap with a TE followed by a small implant. Or I can choose to just have the TE/implant. Frankly, after all the difficulty with the DIEP the thought of another flap just doesn't excite me. The PS really gives me the impression that the implant alone will leave me unhappy, though.
I am 5'4", weigh 170 and rib circumference is 35". Since I don't have te's yet, any idea what I should expect from implants as far as style and size would go? I was previously about a 40C, but I'm sure I was wearing the wrong size bra. I lost 70 pounds last year, still have another 30-ish to lose.
I just want to go back to looking as close to the me I worked so hard to be, and not sure if I should suck it up and do the flap or if implants alone will work for me. Any advice????
And yes, I am obsessing about reconstruction to get my mind off chemo next week.
It scares me to death, and at least with reconstruction I feel I have some input and control. 0 -
Dianne: I have seen very successful lat flap plus implant procedures. But I too am perplexed about your dual flap failure. I would certainly want this investigated further before undergoing any further surgeries. Would you think about getting a second opinion? I can help you find someone, if you want to PM me.
Deborah0 -
Dianne,
I have very similar stats to you, and just had my exchange surgery on Friday..I think I am about a 36d..and have 800cc ..I known still haven't seen the final outcome..need the whole drop and fluff..but if you want to see my size, I can email you a pic if you'd like of just implants..0 -
@ lago, I am only investigating areola sparing. The cancer is way over in my armpit and the MRI report says "no additional findings elsewhere in the breast". Since I have ductal carcinoma I'm not even investigating retaining the nipple. What is the biopsy tract?
@ kayb, mine is right under the skin too, and maybe that is why the PS talked about removing skin, but if so, I misunderstood him. It seemed to me he said that there was excess skin, not that skin would be removed in case it had cancer cells in it.
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Curveball My tumor was in the upper out corner in the posterior region. I suppose I could have done a areola sparing if I found a different BS. I don't think mine does them but probably wouldn't be right for me anyway. Biopsy tract is the scar and the entire path the needle took when removing tissue during your biopsy.0
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@lago—I am pretty sure the biopsy tract is nowhere near the nipple/areola. If upper outer corner in the posterior region is way around the side nearly in the armpit, that's where mine is too. My brother (a doctor) says this is a pretty typical location.
@TinaT—there's no info about stage or grade because I won't have a full diagnosis until after surgery when the status of my lymph nodes has been determined. The pathology report from my needle biopsy says Nottingham grade 2, positive for both hormone receptors and negative for HER2.
Why am I writing off the nipple? Basically the same reason I am writing off the rest of the breast when the lump is smaller than a marble and way over to one side, namely peace of mind. I have ductal carcinoma, the nipple is where all the ducts converge, so how could I be sure in my own mind that the entire cancer has been removed if I retain the nipple? Maybe are some specks of cancer there, too small to detect on a mammogram or MRI. As I understand it (but I'm open to correction) there aren't any ducts in the areola, so leaving it intact would be a way to have a more natural-looking reconstruction, without increased danger of retaining cancerous cells.
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Since my PS suggested nipple sparing surgery I have done a little research and find that stats are reassuring as long as lesion is not near nipple. No increase in reoccurrence with NS. PS told me that she will do a frozen section during surgery to assure nipple is "clean". She takes the interipr of the nipple and leaves the nipple skin so how would that be different than the rest of the breast skin? Good enough for me. I will try it despite my BS reservations.
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curveball - Each of us has to make decisions that are most comfortable in our own minds after doing our research and talking to our doctors. Seems there are no rights or wrongs. I am by no means trying to talk you into nipple sparing surgery. However, since you state you are just starting on your journey I do want to point out that many women with ductal CA have nipple-sparing surgery.
Standard procedure during nipple sparing surgery is for the breast surgeon to core out the tissue behind the nipple and send it as a separate specimen to the pathologist. The pathologist examines the specimen during the surgery. If it initially looks clear the nipple can be left. Each patient is warned, however, that more extensive study of the tissue will take place and if the final path report finds any abnormalities in that tissue the nipple must then be removed after the fact.
Again, not trying to sway you, I just wanted you to know that the tissue is kept separate and undergoes close scrutiny by the pathologist.
Best wishes!
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TinaT, I am planning on "delayed immediate" reconstruction, and the method of nipple sparing you describe would fit in well with that. The nipple could be left on until after the path exam and if necessary removed during the second surgery, assuming that takes place immediately. I will have to think about what the possible outcomes might be. I also don't know if nipple sparing is available through my health care plan. It may only cover more-or-less standard varieties of mastectomy & reconstruction; nipple sparing surgery may not have had enough studies done yet for it to be an option. Now I come to think of it the same could apply to areola sparing too.
I just found this thread in the archives and talked myself out of nipple-sparing http://community.breastcancer.org/forum/44/topic/7836910 -
curveball - There are women who have expanders as well as those who go immediately to implants on the following thread. I don't want to hijack this thread when there are others devoted to nipple-sparing surgery:
http://community.breastcancer.org/forum/44/topic/745796?page=108#idx_3236
As I mentioned, each of us has a slightly different story and you will find that there can be some wide differences of opinion with breast and plastic surgeons. The best we as patients can do is to gather as much info as possible and go with what our heart and gut tell us!
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