BREAST IMPLANT SIZING 101
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Whippetmom --
Thanks for the info on the Sientras. I will ask him and do my own research on them prior to my appt with him on 9/7. No door stops here! The tear drop configuration sounds intriguing. Not to be nosey, but did you have any kind of reconstruction? I don't see any surgeries on your list. Just curious.0 -
I had a BMX with tissue expanders, followed by smooth round silicone implants. And then this was followed by two rounds of fat graft transfer to help correct a step off deformity and rippling.
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Getting ready for my exchange next week. Whippetmon thanks so much for all your help. I will be having 450cc smooth round High profile silicone mentor placed. I am currently expanded to 400 but after talking to whippetmom decided 450 was better and PS said he did not need to expand me any further to accommodate this. Getting anxious but ready to be done.
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Sherry: Refresh my memory regarding what I told you. Based on what your PS told you, I just want to make sure 450 ccs is enough! I communicated with you via private messaging and it is not easy to go back and find our conversations as it is if we had discussed this on the open forum.
Thanks...
Deborah
ADDENDUM: I found our PM links. We had some confusion because you thought you had Allergan TEs and they are actually Mentor 450s, underfilled to 400 ccs. Correct? I just want to make sure that we have the width right. 450 ccs HPs should be fine for you, but you never did tell me which STYLE of Mentor TEs you have and this would be important. Let's say that you have the moderate height TE, which is the most common style used, you have a width of 12.7 cm. So as long as your PS uses Mentor HPs - 450 ccs - the width will be fine. If he uses Allergan HPs, they would need to be 475 ccs. Just want to clarify.
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vik11 - Hi - welcome! I had bilateral nipple-sparing mastectomies with implant reconstruction (Natrelle smooth round silicone). Your posts just brought to mind something a (female) radiologist said during a recent ultrasound. This was at a dedicated breast imaging center so she sees lots of breasts every day. She commented that she thought I looked so much better than many of the lumpectomy patients she sees. She said that so many women make a choice for lumpectomy based on the assumption that it will give them a better cosmetic outcome than mastectomy. Plus, I think there's a natural desire to keep as much breast tissue as possible. But, as you wrote, if the breasts are small and the mass is large or deep the breast will be altered quite a bit. On the other side of the coin, if feeling is an important issue mastectomy typically will only preserve sensation around the periphery and nipple-sparing usually results in total loss of nipple sensation (or uncomfortable sensation if there is any). There are exceptions, but that seems to be the norm.
So many things to consider. It can feel pretty overwhelming, especially in the decision-making phase.
Best wishes!!!
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Tina--
Thanks for that insight. I'm curious as to why it is that with mx, hormonal therapy is needed? My cousin's wife had mx 5 years ago with chemo and hormonal therapy. I didn't understand that. Also, is that normal to wait so long after mx to have reconstruction done. I see you waited 7 months. Just adding to my knowledge base. Thanks for anything you wish to share!0 -
Vik -- it's like I was explaining to you above... it's to do with the TYPE of breast cancer you have. Some cancers are hormone based (i.e., cancers that feed on estrogen or progesteron in your body) and require, therefore, drugs to limit their presence in the body. In my case it was HER2 and I needed something called Herceptin.
You need to be discussing your pathology report with your doctors; your biopsy should have this info... whether you are ER/PR + or neg... whether you are HER2 positive or negative. If you are triple negative you should be meeting with an oncologist to get more info. I am realizing how early you are in your diagnosis now and why you posted initially about seeking info about what research to do.
A good place to start -- a place I started -- is here on BCO in the main site -- not on the discussion boards -- where I'm sure it can be explained better than I am doing now. I believe if you go to the very top of this page you will see the words "breastcancer.org" in the top right and if you click on that you will be taken to the main BCO page (out of discussion board) where you can do some good and helpful reading. The American Cancer Society also has some good information on its website about breast cancer treatment.
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vik11 - It's impossible for the breast surgeon to remove every breast cell. In particular, there is always a layer of breast cells under the breast skin that is left behind no matter what type of MX is done. This is why even women who have had MX must still be monitored, not by mammos but by manual breast exams. In theory, if another cancer develops it will be very superficial and could be palpated.
Chemo and hormone therapy are not just for preventing recurrent cancer in the breast tissue, but also to treat potential distant disease (mets). Breast cancer can spread either through the lymph system or directly through the bloodstream. So even if the lymph nodes are clear it is still possible that an invasive cancer can spread directly via the bloodstream to other parts of the body.
Direct-to-implant reconstruction is becoming more popular, but can only be done in select patients. Most implant reconstruction is still being done in two stages (as mine was). In my case, the plastic surgeon stepped in immediately after the breast surgeon finished the MX. He placed tissue expanders under the pec muscles. Over a series of months the expanders were slowly filled with saline to stretch the muscles and then they were exchanged for the final implants. So, I had tissue expanders from the time of my MX surgery until the time of exchange surgery. Each plastic surgeon seems to have a different protocol. My expansion period was a bit longer than it could have been because I had 3-4 months of healing issues related to the MX and things were at a standstill.
I hope that helps! There is a lot of information on this site if you go to the breastcancer.org home page.
Take care!
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Hello Everyone ~
I deliberately disappear from here time and time again. Try to pretend my life is normal. Try to focus on something other than my noobs.
I am so discouraged.
My fabulous noobs are no longer fabulous. The right fell all the way down to where it was before. My left is droopy but not terrible. Saw my doctor yesterday. She's suggesting alloderm and I agree but I also know she doesn't like using alloderm - translation being - doesn't have a lot of experience with it.
I don't know what to do now... Does anyone know of anyone in the NY area or beyond that specializes in fixing other PS's fuck ups, who uses alloderm and takes aetna insurance.
Oh... I am a sad little monkey today
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Oh GreenMonkey, I'm so sad for you. I wonder if you contacted LifeCell the makers of Alloderm if they could refer you to a doctor who has a lot of experience with their product. I know my PS actually speaks for them since he has used so much of it in his practice.
Best wishes.
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Hi Deborah,
Since I am getting close to my intended size, I think, I wanted to ask you again for input. From the information I provided you about me and my TE's in June (5'2½", 185 lbs, Allergan 133MX-13-T, 13 cm, chest 34", moderate profile, 500 ccs), I am now at 600 ccs. You recommended at least 600 ccs moderate round silicone, but that I might be a bit smaller than I like. It is SOOOO hard to judge the projection with these TE's! I don't want to be too small either. What is your suggestion for a good size? I don't think I have to worry about being as huge I was before, but I don't want to be too small either. "B" category is a bit small for me, I think, and from the look of 600 ccs, I think they might be a bit too small once the implants are in and implants tend to look a bit smaller. I am now not worried about cup size, since I see how things things expand. It really is hard to tell.
Thanks so much for your time.
Mary Ann
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Lilah --
Unfortunately, the facility that did my biopsy did not check for ER/PR. My bc surgeon doesn't know why they did not. My dcis is not invasive and HER2 did not apply to me. I have been on the "refusing radiation for dcis" thread for several weeks now and it has been immensely helpful in helping me put together a potential game plan for treatment. I had looked into internal rad with the Savi applicator, but being a bit on the small side, lx would remove a good portion of that tissue. Met with RO this past Tues., who said it could be done, but he did not feel good outcome cosmetically. Other option I'm considering is bmx with implants which has lead me to this discussion here. I don't see ps until next month. At this point I have a lot of faith in my bc surgeon. She's great and is very well respected by her peers. ps is friend and college of hers. I've been doing my research every day for weeks now, so I'm not coming into this clueless. However, the research I've been doing and the discussions I've been involved in is that which only pertains to my situation. The newest being bmx and implants. That's why I'm here now. Just trying to get insight on implants from others at this time0 -
TinaT--
Thanks for the insight. Most of TE info I already knew. It's good to learn from others' experiences, especially for me at this time -- not having had anything but biopsy done. I try to stick to info that will benefit me and my particular situation, but it doesn't hurt to learn a liitle more than that. It's very overwhelming just with the info that does pertain to me. Have a great day!0 -
GreenMonkey - Some days it feels like a never-ending battle! You recently had a revision, right? I'm so sorry you're still not where you'd like to be. So you have under-the-muscle implants without any sort of sling? When you say dropped do you mean ptosis or a real bottoming out of the implant(s)? Whippetmom keeps a list of PSs so I'm sure she'll chime in.....0
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vik11 - I was told that biopsy and surgical specimens are typically kept frozen for quite a few years (up to 8) so it might still be possible for further testing to be done on your biopsy tissue.
Yes, most of us are thrown suddenly into this new world and have to crash course through it. Most days, especially in the beginning, are pretty overwhelming. It really does get easier once you have your plan in place.
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Still trying to get a plan in place. It's becoming painfully obvious that the best plan appears to be bmx with implants. With dcis, it seems to be overkill, but at the same time, it has good points. I'm just concerned about TE horrors and future problems with implants. By the end of each day, my head is swimming trying to accept this path and be happy with it. It has been such a help (most days) to come to these discussion boards and talk with others who have already been thru it or in various stages and learn from them.
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vik11 - TE's do not have to be horrors. I just had mine exchanged a week ago today, and I didn't have any trouble with them at all. Looking forward to the "drop and fluff" of my new implant.
You're doing the right thing. Weighing all of the options. Take care.
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vik11,
I opted for a BMX with TEs and soon will exchange for implants. The BMX was performed May 9. I have been getting weekly expansions since. I have had no problems with them to speak of. They do get a little sore after each expansion for a day or two, but nothing that interferes with my activities or sleep by any means. More on the order of the type of soreness after novacaine at the stie from the dentist. My BC was diagnosed by MRI of the breast I got annually because of a history of mantle radiation from Hodgkin's lymphoma almost 40 years ago. Even with a very early stage BC, stage I, <1 cm, 0 nodes, I chose BMX. My radiation history increased the odds of contralateral BC in my left breast, so I "got rid" of both of them. I can tell you that it was the best decision for me. The pain was very tolerable, I healed well and quickly, and it was a FAR better experience than when I had my spleen removed for Hodgkin's in '75! The worst part of the surgery were the drains! Even they were not horrible, just a PIA! They interfered with my sleep only because I don't sleep on my back. Now, other women have different experiences. I tolerate discomfort well, and I was just so darned glad to be out of work for a month!!!!!
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GreenMonkey: So sorry. You have been through so much already. Do they know why that happened?
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Mariwyl --
I was very interested in your last post as I am looking to possibly get bmx next month and I am very interested in others' experiences. Yours was very positive for me as I'm not having a good morning thinking about all of this. Some days are better than others and your post uplifted me a bit. Thank you. I kind of thought the tubes would be a problem since I am a side sleeper. It's interesting that some do not do too bad after expansions, but then there are those who say it's extremely painful. Just out of curiousity, how many ccs are you doing each time? Also, I'm very interested to hear from you and ALL ladies who wish to share about your experience with seeing yourself for the first time after bmx surgery. I'm trying to get myself prepared and mentally primed for what is to come. Thanks for anything you'd like to share. It's so appreciated!0 -
vik11 - I'll send you a PM, too.0
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vik~ You may want to consider a nipple sparing (NS) mastectomy if you decide to go the MX route. Although I did not have TEs filled at time of surgery (so I was 'flat', other than swelling), it was not as drastic to see with nipples and aereolas intact. Given DCIS I would think that you would be a good candidate (also depending how far from nipple) for NS, just need to find a PS who is good at it. More research!
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C-squared --
I've already decided on NS for bmx. I'm pretty sure I'm a candidate, at least that's what I remember my bc surgeon saying at time of consult last week. Good to know that first peek after surgery was not a shocker. And, yes, the research and messaging continues. The messaging is helping to alleviate some of my fears. And, I know time will help to get my head into this so I can proceed with a positive attitude. Surgery scheduled for 9/18 and meet with my ps 9/7, so will get a great deal, I'm sure, from ps that day as far as info goes and getting questions answered. Thanks for your post!
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vik11,
I get 50 ccs each fill each side. I go weekly. I did not have NS BMX, because of my radiation history and I was diagnosed with IDC, not in situ.
I will say that a BIG part of me was looking forward to reconstruction. WHAT??? I had very large breasts before the BMX and ALWAYS wanted a reduction, but was terrified of surgery after my splenectomy (there was terrible pain management back in '75). So, having a BMX with reconstruction more or less made my mind up for me, and helped with a good outlook, I think. I think I will start thinking about stopping the fills at around 700 ccs, depending on how they look.
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I've been at 460ml on each side since the end of May. I had some red areas pop up medial upper breast. Was treated with antibiotics with no real improvement. New red areas came in on the same breast, different area down below mast scar and laterally. There may be some capsular contracture, and pressure areas from it. But it's been 3 months! I'm to go for exchange at the end of the month and had never thought about the possibility of IBC. Do the docs send off the scar tissue for pathology? Any thoughts or ideas are appreciated. Going for pre-op appt tomorrow.
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mariwyl - I hear ya! The Original Girls were 38DDD - heavy, droopy, fibrocystic, and painful. I always wanted a reduction but was too chicken. So BMX with TEs/implants really was not a bad thing to me. (Of course, I would have preferred to not get BC in the first place, but oh well....)
I was filled to 620 ccs. My exchange is next week, and I'll probably be getting high profile, smooth saline implants at 700+ ccs. The PS will figure out the exact amount once he gets in there. (I'm 5'5", 150 lbs, hoping to lose another 10 lbs.)
Thanks again to Whippetmom for all her expert guidance on what questions to ask, which implants to research, and how to get the best info from my PS about what procedures he will do at exchange.
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vik add me to the list who had an easy time with TEs I had no pain or dismofort from them jsut a little sore after the last fill. I was filled with 150cc at the initial surgery and got 6 fills of 100ccs. Then I was excahnged to 600cc implants. everything is looking great so fargetting my nipples done and some lipo on the sides maybe a little ft grafting in october.
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GreenMonkey: When I get to my laptop I will send you a list of names. I agree that you need Alloderm. Do not stress about this little monkey - as it can be fixed. I have learned that there is not much which cannot be fixed, but finding the right one to do it is key. Jamie's suggestion to check LifeCell's website is good.
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mariwyl: 600 ccs would be the minimum I would recommend. If your PS could get you to 700 ccs, that would be a good size for your frame. It is just that 200 ccs might be considered a "leap" for some surgeons. If you have ample skin flaps though, it could be quite doable. So ask your PS about this. It is really important to ask what they can do for you - because I can tell you what size would work best - but if your PS will not take you there.....
I remember that I felt that your TEs were pretty small for your frame - but your PS must know what he is doing and perhaps he would find no problem in going up 200 ccs. Please make sure you talk to him about this and get the size nailed down before the exchange.0
