BREAST IMPLANT SIZING 101
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Bump
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Whippetmom- Just when you had me calmed down about getting too busty, I read your post about upper pole fullness in TE's causing damage to the pectorals! I'm ALL upper pole fulness, that's what has been freaking me out - all of my summer clothes are completely unwearable. Also I'm very bony in both the sternum and ribcage areas. What kind of damage? I was hoping to be able to do pushups again someday!
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Lee: Don't freak out! My comment stated that some plastic surgeons - Dr. Kenneth Shestak, in particular, feels that it is better to use a lower height tissue expander, in order to AVOID damaging the pectoral muscles and to not over-expand and put undue pressure on the pectoral muscles during tissue expansion. He has seen evidence of pectoral damage, but I think he was inferring that this can occur...it is a risk...but he does not suggest it is a problem he sees regularly - he just wants to take precaution to avoid it in his own patients. I had full height tissue expanders. Tissue expanders can migrate and they do tend to ride upward towards the collarbone or laterally towards the armpits. It can be corrected at surgery. You have a highly experienced plastic surgeon. He knows what he is doing.
Referable to pushups: It is a very uncomfortable maneuver for nearly all breast reconstruction patients with partial-submuscular placement, e.g., under the pectorals. You will be able to do them, but you will hate the feeling when doing so. After breast reconstruction, and once you exchange to implants, the implants are controlled by the pectoral muscles and when performing certain upper body exercises, there is animation of the implants and it is not a pleasant sensation. You will see when you have the exchange. You just learn to find upper body exercises which do not trigger this implant animation.
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Deborah - that's a really interesting explanation of the shorter height expander. Mine is a lower height expander and I have a crater above the expander to where it meets the bony ribcage. My PS says it will be filled in with the implant at exchange. I hope so. It makes it impossible to wear most necklines. We are also do fat grafting to fill in where necessary. One week to my exchange. Not going to lie, I'm nervous.
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ref- I have that same crater. It's definitely made dressing in Arizona a challenge! My exchange is a month out and my PS said the implant will fill it in as well. We'll have to compare notes afterwards!
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Kate - I never thought I was a provocative dresser until I realized that all of my v-necks and tank tops were completely not workable! My BMX was in Feb (and I'm in NJ) so I didn't notice how difficult it would be to find something to wear until it got warm. I'm one week out to my exchange and I'm hoping for the best but aI little worried I'll be disappointed. I'll let you know how it goes.
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ref and kate:
Some women have a very difficult time "style-wise" with their TEs. They can take on an absolutely terrifying shape on the chest wall! You are not the first to complain of this making the apparel search difficult during the TE stage of reconstruction. But this has no bearing on the outcome, if you are in the hands of a skilled reconstructive surgeon. It really is sort of unpredictable, to some extent, what direction and shape these TEs will assume under expansion.
Hang in there girls! It will be over soon!!!
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whippetmom- I'm not sure if you can answer this or not. I'm a month out from my exchange and am going to stay kind of small with implants of 450-475 cc's. (I gave you my info in an earlier post and you thought 475 at the smallest and suggested I see Val61's photos which I did.) Anyway, my concern is the gap between my breasts. I am very small boned (5'4", 115 lbs, 28" around). The gap is about 2 1/2". I spoke to my PS about this and she said she would try to put the implants as close together as possible but that it was based on where your pec muscles are. I was just wondering if this is considered a large gap and do you know of other women who had large gaps with TE's where the PS was able to bring the implants closer together? I've heard women referring to "pocket work" but my PS didn't say anything about that.
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Kate: Did you look at Val's TEs? Hers were at least 2.5 inches apart. I have seen many this widely and laterally displaced and, at the time of exchange, the PS opens up the pocket a bit and brings the implants in closer to the sternum. You may need some lateral [side] suture/support to keep the implants from migrating towards the armpits again. Discuss this with your PS before the exchange and make sure she feels she is able to do this.
If you look at Val's photos, do you feel you have the same approximate width between implants? I do know that the structure of the ribcage has very much to do with the placement of the pockets, but I think that the skilled surgeon can overcome some of these structural hurdles. Ask Val if you can print out her photos to take into your PS....
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Whippetmom: After seeing Kate33 post that 475 is small with a 28" ribcage I am starting to panic and think that maybe I'm going too small! My PS said that I will not get the kind of projection with the implants as I do with the expander, yet I'm not getting a huge amount of projection now!
Am I getting ahead of myself? Can my 32" ribcage can support a larger implant then you originally advised even though I have a bony chest? I know that when I started posting I said I wanted a more "natural" look but if natural requires a padded, push-up bra then I know I won't be happy. You have been so patient with my questions and I believe I only have one more fill to around 450 before scheduling for the exchange and my dr. wants to know what the goal is.Thank you in advance and I hope you are having a lovely weekend with all of this great, sunny weather we are having!
Mary
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MBJ- I shouldn't post when you are going on no sleep. My implants will be 350-375 cc's not 450-475! Sorry if I freaked you out that yours are too small! I guess I need to proofread before sending! OOOOOOPPPPSSSS! I'm sure yours are fine!
whippetmom- I will ask my PS about the lateral suture support. Thanks!
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Kate - I also have a gap of about 2 1/2" between my breasts. I'm quite a bit taller than you but also thin (59", 130 lbs, 29" around) and my PS says that he will move them closer together at the exchange. How close? I don't know. He is quite the artist and seems to have a great aesthetic sense so I'm trusting that those adjustments will be just right.
MBJ - I'm filled to about 450cc and I don't have huge projection either. I'm a bit concerned about the final results with the implants. My PS keeps telling me that it's completely different with the implants than the expanders in terms of shape. He is bringing sizers from 500cc and up to the exchange and wants to see what works best then based on what scar tissue, etc he finds. I think the goal is 550cc.
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Kate33: Thank you! I was really freaking out! What's good to know is that my PS originally wanted to put in 350-375 cc's and after speaking with Whippetmom, I told him I wanted 500 cc's. I didn't sleep at all last night add my chemo brain and lord knows what I post sometimes LOL. Thanks again for clearing that up for me.
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MBJ- Sorry again for freaking you out! I can't even blame it on chemo brain!
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MBJ: I noted that over on EC you stated you and your PS were considering the moderate plus profile implant. Is that the style you and I discussed? Just want to confirm all of this before your exchange.
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Hi Ladies,
This site has been so helpful. I originally didn't want reconstruction, but my breast surgeon insisted that I at least talk to a plastic surgeon and I changed my mind at the last minute. So, here I am and I realize the further I get along in the process and the more I read this site, that I am pretty clueless!
I'm still undecided on whether I want saline or silicone and my PS and I have talked about this; and he's left it up to me. I also didn't know that I had much of a say re what type of either I should get. I just thought that he would pick what's best for me. I was just curious on what you would recommend.
Here my info: 5'5" 109lbs, 28 1/2 inch ribcage.
I have an McGhan 133MV-11 (250cc) Tissue Expander.
I'm expanded to 290cc's and the last fill about killed me. It was so bad I cancelled my last fill b/c I needed a break. The left side always hurts more after fills and that particular one I had pain all the way up and down my ribcage for several days. I too have a wide gap between my expanders and I feel like my left one has migrated over to my armpit. I was a 32C (small C) before my dmx in February. I wanted to get there again, but I'm not sure I'm going to make it. I fear my body may be telling me I'm done. I like the size that I am now. But my PS likes to over-fill before the exchange. I'm not sure I'm going to make it.
Thank you for your thoughts. You all are so helpful, encouraging and knowledgeable. Thanks!
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Dawne-Hope: Nearly all of us choose silicone implants. Currently, most of the women who have come through here who opt for saline, have done so because they need the largest implants available and saline has the largest volume currently available.
Based on where you are with your TEs, I think that you would probably be just fine with around 325 ccs to 350 ccs in a high profile implant. If Allergan, this would be the Style 20, smooth round silicone high profile implant. It would be an appropriate size for your frame. Aim for the 350 ccs if you are able....
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Dawn-Hope- Our measurements are very similar and I had almost the exact same experience that you are having now. I got to about 250 cc's and the fills became extremely painful for me. I thought I was going to have to stop right there. My PS had me take a break for about 3 weeks to let everything settle down. In the meantime, I read several posts on here from women saying their PS prescribed the muscle relaxant, Flexeril, for their fills and that it helped immensely. I asked my PS if we could try it and she agreed.
I take it 3x a day and it has made a huge difference. I was able to continue my fills painlessly and am now at 400 cc's. I'm a month out from my exchange and am going small with an implant of 350 cc's. (Whippetmom recommended 350-375.) If you want to stop at the size you are now I say go for it. But if you wanted to go bigger just wanted to let you know what worked for me. Good luck!
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whippetmom - thank you for taking the time to respond. I lost my mom to BC last Sept. and I've felt kind of lost going through this experience without her. Thank you for your advice. 350 is about one more fill. I can handle at least one more!
Thanks again!Kate33 - Thank you for your response. I've felt kind of whimpy when I read about other ladies and their experiences. Helps to know that I'm not alone. I'll try the Flexeril. That's what I used primarily after the BMX and it helped me far more than any pain meds. I have some now and I don't really know why, but I haven't taken it as liberally as I did after my surgery. I'm having to work now and I think I'm afraid it will keep me from being able to focus. Since I cancelled my last fill, when I have my next one, it will be a four week lapse between them. It is amazing how much better I feel now. Maybe I just needed some time off. Thank you for sharing!
You all are the best! Thank you so much!
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Dawne-Hope: I lost my mom to BC many many years ago (45!), and not a day goes by that I do not think of her and wish that she were here to share in my life - and me in hers.. It does get easier. It does get less painful and less sad. But times like this are hard. You will find your way, even without her.
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Dawne-Hope:
And there will be a lot of women on these forums just itching to take you under their wing. A lot of mothering goes on here on these forums. I am concerned that you might be getting too much saline fill at one time. For the gals who have a tough time with fills, 50 ccs at a time is suggested and spacing the fills out two or three weeks is also recommended. However, I think you probably only need another 50 ccs to get you where you need to be for a 350 cc implant. Canceling your fill appointment was probably the best gift you could have given yourself at this juncture.
MODIFIED TO STATE: In consideration of your low volume TEs and your small frame - even increments of 25 ccs per side might have been more appropriate.
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Dawn-Hope - My first fill about killed me......I would have rather had the BMX surgery again over that fill. Then I read here to take valium which I was given at the time of my surgery and never took it. So the next fill I took one an hour before my fill and then continued to take them that night and next day. It really worked! So I am ready for my next fill and next.....I just needed to realize taking the medicin doesn't make me a wimp it makes me smart!
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Dawn-Hope- Whippetmom is right about the 25 cc's. Towards the end that is all I was doing at a time. My PS taught my DH how to do the fills at home so we were able to do just a little at a time. I even saw a posting where someone was doing their fills at home, too, and were doing just 10 cc's at a time. Basically, my PS left it up to me to decide how much and how often and when I was stopping. Yours would do the same I'm sure.
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Whippetmom: Yes, the Mentor 500's were one of the sizes you had recommended. I told my PS that that was the size I was thinking only because I noticed these seem to have more projection then the Allergans you had recommended. After looking at my last picture, are you still thinking the same sizes? I will probably get my (hopefully) last 100 cc's at my next fill (if I can take it). BTW--Between the rough and the smooth: I had heard the rough can prevent encapsulation but I notice many get the smooth. Can you explain the pros and cons of each? Thank you as always, you are a life saver.
Dawn: I am so sorry you are having a rough time of it. After reading many of the women's posts here, I had my PS give me a prescription for a muscle relaxer and I always take it 30 minutes before and usually into the next day or two after. I have a high tolerance for pain but when it comes to this, I prefer to be a "wimp". Heed Whippetmom's advice--go as slow as you need. I also massage mine just like I would massage any other sore place on my body and this seems to help. Of course, I don't recommend this in public LOL.
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MBJ: Yes, I said 500 ccs, but I was referring to high profile implants with that volume. On EC, you stated you were looking at moderate plus profile. MPPs are wider and have less projection than the high profile style. Just wanted to clarify that I did not suggest MPPs for you. HOWEVER, you are a unilateral and this means that finding an implant with the correct width and projection to match your natural breast is going to take precedence over your desire for one implant style or another. Your natural breast dictates to a major degree, which style of implant your PS will choose.
You do not want textured implants. They can and will almost assuredly cause traction rippling. I think that textured implants should be the last resort for women who have recurrent capsular contracture. Apart from this, smooth silicone is the first choice.
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The nurses told me the PS will sit me up on the OR table during the exchange as he is trying on different sizes to see how they look upright. I think he likes small and natural and I wish Deborah was right there in the OR telling him"NO-those are way too small- look at her wide shoulders- go with the 475's! " I hope to post pictures of this journey in the next week or so
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Waldo: You have to remind your PS before surgery that he might like small and natural but that is not YOUR preference and you are the one who has to live with them.
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I definitely plan to remind him. He's probaly still chuckling over the playboy playmate's picture I handed him at my 4 week post op appointment. He did say (after pointing out she is 23 and I am 53) that at he does get what I want and he knows where my head is at.
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Whippetmom: Thank you! I must have read your post a dozen times and still I read it wrong-blame it on chemo brain. What I thought you said was the Mentor Plus 450 or 500 but when I re-read it right now you said at least a 500 in a high profile but my dr might be looking at a moderate plus. I am glad that I asked about the textured versus smooth because I sure wouldn't want rippling. God, I hope I am not repeating my questions-I really do have chemo melt down more often then I want to even think about. I guess I will have to see what is going to match my existing breast-I will have to ask my PS if he plans to do my natural breast first so we can try and match that not the other way around.
Waldo: Funny --my PS prefers really natural looking breasts, too! I think I told him in the beginning that I wanted a more natural look but now I just want more projection LOL! Good luck in your exchange and I hope you get everything you desire. BTW: I didn't know that they sat you up during the exchange--makes sense I just never thought about it. I can't wait to see your final results!
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Can anyone tell me how to find the forum for the reconstruction photos? I am having my PBM July 1st and would like to see what to expect for expanders with 2nd stage implants.
I tried to PM TimTam as directed, but no response for weeks. I did hear she was not feeling well, so I completely understand, just wanted to see if anyone else could pass me the information.
Thanks~
Jen
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