BREAST IMPLANT SIZING 101
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Hand surgery is a sub-specialization of both plastic surgeons and orthopeadic surgeons. A hand surgery fellowship is advanced training for a plastic surgeon, and is one extra year beyond the standard plastic surgery residency. So they are all of a regular plastic surgeon and also more in being a hand surgeon. A hand surgeon certification is a plus, not an indiciation that their training is limited to just hands. It simply means they have advanced training and/or proven and tested skills that other plastic surgeons do not have.
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Ah, Deborah..What a beauty you are-- inside and out!! Over the last week I've read 220 plus pages of your brilliant & OH-SO GENEROUS guidance. All the ladies here are outstanding individuals! You've allowed us a HUGE dose of patient advocacy, placing some power back in our hands as we work with our doctors (and actually have a good idea of what we're talking about--thanks to you!) So here I am.. another very young, old lady... Ready to get on with this phase of the journey.
After living as joyfully as possible, attempting to find the beauty in each day.. there's been a huge stretch of that "helpless feeling" (which is hell for a control freak). The months and months of chemo, days of working when finding the strength to leave my bed or coach was quite a feat.. followed by the bilateral mastectomy, then the prophylactic oophorectomy a month ago. Putting your faith in the expertise of the cancer team is easier said than done. Even more-so what got me through was putting my faith in God. Without that faith I would have been totally lost. My spiritual side is stronger than ever. One day at a time. Yep... a-heck-of a year and journey. One which allowed me to learn so much more about myself. EVEN after 56 young years. We all have more strength than we could ever fathom. I know each & every one here can probably relate on some level.
I'd already made up my mind to go with a BMX before genetic testing proved I have the BRCA 1+ mutation. My Mom had BC when she was in her late 30's and I always figured I'd get BC, too. I have no sisters. I had one sibling, my adored brother who is now deceased-way too young. Anyway, Mom went on to survive 30 years until she developed AML. Cancer sadly took my entire birth-family. I have a wonderful grown daughter, son and granddaughters and the best husband ever. I'm blessed indeed. My prayers always include keeping them well. I have many stage IV ladies on my prayer list. They've been a major inspiration and a testament to the power of the human spirit.
I was diligent about ultrasounds along with mammos due to dense breast tissue and family history. I just wasn't ready for all the various aspects to this disease. Hair loss..pthth.. piece of cake. It didn't really phase me. Yet I'm totally sensitive to the devastating feelings over alopecia many others experience. For me it was the overwhelming layers upon layers of info about this disease I'd never heard of before. That SO blew me away. I spent countless hours researching, just to come up with the same abysmal info re: this aggressive form of BC. Unfortunately I've run into many medical pros who don't have a clue about ER-, PR- and HER2- BC. Let's face it though. We're all in this together. A BC diagnoses is daunting no matter what type. We're all sisters through thick & thin.. we're bound by an unspoken love and understanding.
I was no stranger to silicone breast implants either. Mine were 30 years-old. A small rupture started a year before my DX. I never (thankfully) had a day of problems with my implants. No CC - I massaged them per my PS instructions. NO regrets. The implants helped make the mass more palpable by pushing it closer to the surface- which may have helped save my life. It (the mass) cropped up overnight, which I hear a lot from other TNers. (triple neg gals).
Nothing, absolutely nothing compares to this section of reconstruction. It empowers women to learn how to communicate with their plastics to achieve their desired results. At first it seemed unimportant. But, my philosophy in life has always been with any endeavor... do it as right as possible from the get-go. Why would I settle for less for this?? You've really reinforced my own philosophy here! Now there are other areas of BSO i really want to explore. Thank you all so much for this invaluable information! I've learned so much from each of you.
Hey, I just turned 56 when DXed, and fought the good fight of being triple negative which so many younger women face. Sadly, my daughter was tested and inherited the mutation too. That singularly was the most difficult piece of news. Our granddaughters.. my daughter's girls are amazing young women. I pray when they come of age more progress has been made. My eldest started high school this year.
As I mentioned, my right breast had a mass very close to the skin surface, positioned at 5 o'clock. I wasn't sure if I'd receive expanders at time of BMX. At that point I don't think I really gave a flip. I just wanted to survive. I was in such a rigorous fight mode at that point. I had a wonderful oncologist, oncology surgeon- a great team in general. My reconstruction PS said she might have to go through the skin for any rouge cells, then suture and let it heal first before even talking about expanders. Due to my weight, implants were the only logical option. The good news was post surgical pathology turned out wonderfully. Subsequently no RADS were recommended.
Hence, I woke from anesthesia with placement of bilateral sub-muscular TEs and also placement of bilateral Alloderm slings; 8 x 6 cm. I'm still at the big cancer hospital/ teaching institution in Houston where I received TX. I anguished over what to do with no real qualified oncology surgeons here. So I drove / drive 7 hours each way, each time and have throughout the process. Well, hubby does. Thank God for my wonderful guy who loves me. Needless to say, fills have been pretty slow-go. Right now I'm at a very comfortable 490 ccs each side and bet I could stand 60-80 ccs more and be fine. They are getting tight.. and of course they're rock hard.
On to the "stuff" you need to help me Wippetmom... I'm just shy of 5'6"- well maybe I've shrunk and I'm more like 5'.5". At my last appointment I weighed in at 112 lbs. Quite measly for me due to an overhaul in diet and lifestyle, losing a taste for the 'bad stuff' while on chemo...hitting the gym on good days, lots of fresh veggies, fruits, no sugar, starch.. yada yada. I know I can easily get back to my normal weight of 115-125 lbs. The circumference under my bra line is 30 inches.
Okay, here's one I haven't seen posted. On my report they placed McGhan bilateral 133 MX-12 tissue expanders. Allergan bought out McGhan (I thought) quite some time ago. The books they sent home with me (both with slots for two cards for each implant as medical devices were included) which told me what I already knew... they use both Mentor and Allergan, saline and silicone. Plus my PS and I discussed this as well. For me silicone was a no-brainer after 30 years of feeling like they were 'all me'. Am I even spelling Allergan right?? *sigh* Darn chemo brain!
But NOW I need advice please?
The reason I wanted implants over 30 years ago was being left with droopy boobies after my first child. I wasn't very large to begin with. A b maybe? Obviously the reason now is all different. At that time the PS begged me to go to a D since I had plenty of extra tissue... but I only wanted the fullness of a large B.. small C-- which I received. Those also went a bit downhill after breastfeeding my second child. It held up pretty well, but it wasn't what I'd call perky. I can't remember ever being "perky" and bless my cotton socks.. at my age I'd like a bit of volume AND PERK. Right now my expander foobs aren't even a bit high on my chest or crawling under my arms- though the latter felt that way for a short time in the beginning. It's been a pretty pain-free process for me. AMEN. Maybe because I only got about 80 ccs every 3-4 weeks. My complaint is a deformity- some depression on the benign breast (left) side, which my PS has assured me will get fat grafting. I think others here may call it a step-off or something like that? Anyway, another reason to pack on some poundage. Doctor's orders!
Any advice for me our lovely guru, dear Deborah? I like this expander size but would like to go a bit larger if my expanders allow. My PS has kind of taken the stance of "let's fill you where you want to be" in terms of size. She has remarked how resilient and well my skin has done. At first I thought she over-filled b4 surgery, but not so sure that's the case. She mentioned she thought she could get the exchange done at the size I am now with good skin integrity and decent projection.
Deborah.. you really ARE amazing. ALL 200 plus pages were a much needed education for me. What a true gift you are to us all!!! Soft boobie/fauxbie hugs in the near future I hope. I love the humor, genuine caring, continuing willingness to lend helping hands all have contributed to this section and have made it one of the best discussion board threads I've ever read. You guys ROCK!
So any wisdom from YOUR awesomeness Deborah would be a God-send... MUCH appreciated.
Sorry for the novelette. I've remained silent while reading all this time.. well, now I just can't shut up.
Sorry. I came back to edit realizing I was calling Allergan, Alloderm! Brain-trust indeed. You'd think 200 pages later I'd know better. AND... I really DO. Operating on little sleep. *GRRRR* Please overlook any misspelling and the fact I'm all over the place with my writing.
My prayers and best wishes for all.-- Mindy
Well RATS. I'm back with another correction, FWIW. (probably fairly minor at this point) Make that 8 x 16 (not 6 cm) Alloderm slings were placed bilaterally during surgery.
A mere one of I'm sure many more typos... HA. Didn't get crowned "editing queen" without good reason ya know. 0 -
adgirl5 --
You have such a great attitude! Hearing your history, that's amazing. It's really encouraging to someone like myself. I am just a smidge younger than you and, I too, feel like I'm a young 55. I am a newbie to all of this and right now I'm in a holding pattern as I have only had biopsy and selected my bc surgeon. I've met with her and love her. See ps in 3 weeks. Surgery scheduled for middle of Sept. So, getting as much info here as I can to prepare for appt with him. So, stories like yours are really uplifting to me, as are so many others here. I asked God for guidance when I was first dx, and I know in my heart he sent me here. It has been a lifesaver! Thanks to all of you for sharing your incredible journeys and words of support. I hate having to think about this every day and worry about what lies ahead (the unknown). I know, this too, shall pass in time.0 -
whippetmom --
You mention on your info page that a ps will need to know approximate size and style of implant that will be placed with regard to what size TE he uses. How can I possibly know before surgery what I will want to end up with size wise or shape wise. It's not like trying on clothing, where something looks really cute on the hanger, but when you try it on, it looks terrible on you. May be getting ahead of myself. Is it to early at this time, (since my surgery isn't for another month and have yet to meet with ps) to give you my stats and thoughts about what I think I might be after and get your imput?0 -
Why don't you meet with your PS Vik and see what he/she suggests.
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Ok. Thanks.
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Tina:I do agree about the delicate nature of the hand surgery. That makes me feel better about having a hand surgeon do this reconstruction. Whippetmon:I was diagnosed in nevada but I moved to california and I want to have my surgery here. I will make an appointment with those two women you told me about.Thank you all for such great advice.
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1Sunshinegirl - Or as I prefer to think of it.......a reconstructive breast surgeon who also happens to do hand surgery
. I'm sure the patient needing hand surgery feels just the opposite! I was totally amazed by a picture I saw in the hallway of the surgical floor I was on after my initial MX/reconstruction surgery. It was a large photo of a circle of about 20 hands. Each hand had a big toe where the thumb used to be. Apparently there had been a reunion of some of the patients who'd had surgery there to replace a thumb that couldn't be saved with a surgically amputated big toe. Pretty amazing stuff!
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vik,
For sure. Without God leading the way I could've never remained as positive during the storms. I'm picking up some strong faith from you, too. I learned to not bite off more than I can chew. It was out of my control, so I put my energy into helping others and placed my faith in Christ. You find out who your true friends are. I had such an outpouring of love from people I didn't know that well, and their love helped carry me through. Not as often, but sometimes it went the other way, too- and a few friends ran the other direction, which really surprised me.
Wishing you tons of found strength and love as you go through your journey. It sounds to me like you'll come out on the other side a true champion! Heck, you're a true champion now!
Hugs,
adgirl
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Whippetmom & all. I went back and edited/corrected my, er book.. written after very little sleep. I was calling Allergan Alloderm. Brilliant, eh.
Please Whippetmom.. if you want me to cut through the clutter and give you the basic stats here, I'll sure do it. I'd really love your take on what silicone implants to discuss with my PS this next visit. Exchange surgery is drawing near and I may need to put it off a month or 2 to get a full 3 months from last fill to exchange. That's if she finds it necessary to do another fill. Last visit I got the impression she could place a larger implant where I'm at now.
I'll just DO IT so you don't have to wade though my last post. Height: Just shy of 5'6", Weight: normally 115-125 lbs. Right now 112 lbs and gaining for surgery which will require fat grafting for upper depression, (bony chest) on left side. Right under breast band circumference is 30".
Expanders: 133 MX-12.
Thanks a bazillion for your input!
My best to all here. ag
ETA: My expanders are at 490 ccs bilaterally. Tight, but certainly not painful. Skin looks good.
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adgirl5: Oh Lordy! I had to wait until I could get to my computer before answering your post, because it was hard to keep up from my cell phone.
What a history you have - and praise God for bringing you through this with a beautiful attitude and a sense of humor....and bless your "cotton socks" indeed! Referable to the McGhan vs. Allergan product labeling, I do see a few gals who have been given McGhan cards after surgery. It would be very interesting to find out if there is an expiration date or specific shelf life on hermetically [hopefully] sealed breast implants.
You are one of those cases where having been formerly augmented does benefit you in a number of ways. Currently, your lack of discomfort with the TEs could have a good deal to do with your previously augmented skin envelope. That skin envelope also means that perhaps implants significantly larger can be used. [I was not augmented prior to bc, but I had pretty good ptosis and my skin was very elastic. So my implants were, like yours, 400 ccs, but my implants are Allergan Style 20 - 550 ccs. ]
You have a couple of options. Provided that your skin integrity is good and you have ample skin flaps, you might be a very good candidate for the Allergan Style 45, which is an extra full projection style implant. However, you would need at least 500 ccs in Style 45, and that would bring you just one millimeter shy of your 12.0 TE width, at 11.9 cm width and 5.7 cm projection. I just think that if your ribcage is 30 inches, you might have a broader ribcage and these implants might not be wide enough. [I would have estimated your ribcage at around 28 or 29 at the most - so are you holding that measuring tape taut enough?] Or do you have sort of a swimmer's build? I think that if you like the notion of the extra full projection style, the 550 cc Style 45 would be better - with a width of 12.4 cm. I just think that Style 45s are a bit trickier of a fit - because some gals who have them or have had them, feel that sometimes they are not wide enough to fill out the sides of bra cups, because of their width to projection differential.
Another implant would be Style 20 - 500 ccs or 550 ccs - which would be a nice size for your frame. I think that, based on your over-the-moon feeling approaching, you will need at least 100 ccs greater volume with your implants and 150 ccs or even 200 ccs preferably. [When I talk about TE to implant volume, I am referring to the recommended base volume, NOT the overfill volume. So I am referring to 400 ccs in your case.] I just personally feel that you need to be north of 12.0 cm in width, based on what I am envisioning with your chest wall. It is all going to depend on what your PS is willing to do in terms of size, and allow for good implant coverage with your expanded skin flaps. But I think you would be happy in this size range.
Talk to your PS and let us know what she has to say about sizing....as she probably has a good idea regarding how large she will be able to go at this point.
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vik: Sorry for my last abrupt post. I had a phone call coming in and hit post, thinking I could go right back and edit it and finish my thought. So what I want to share is that it would be a good idea to ask your PS all of the questions listed in the thread header and ask what size of tissue expander he/she might safely use. You need to convey to your PS what you hope to achieve, e.g., if you would like to be the same size or if you would like to be larger than you are currently. The TE will be selected based upon your chest wall and current breast base width, but sometimes there is some play there. My own PS said she wanted to use a 300 cc TE, but might be able to use a 400 cc TE, and I urged her to try the 400 cc TE.
Deborah
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adgirl5 --
You are so funny! A girl after my own heart! Yes, I have a very strong faith because when all is said and done, that's all you have. My faith, husband, and kids are getting me through. It's so true what you said about friends! I have a couple who don't appear to have much interest in checking in on me, but are oh so intersted in updates only when I do see them. Then there are those who have been so great and very concerned and check in with me all the time. I know they will be helping me so much after my surgery. Now, you get to eatin' girl and get some weight on! And, thanks for your kind words, beautiful lady!0 -
whippetmom --
Not a problem! I certainly appreciate what you do for so many others and for sharing your experience with me. Don't think you've heard the last of me wonderwoman!0 -
adgirl5: BTW - I answered your first post - I did not see the second. That was odd...don't know how I missed it and actually I am just reading it for the first time now. You should have plenty of info to discuss with your PS the next time you see her.
Deborah
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Deborah- Thank you so much gorgeous lady. I'm sure you hear this all the time, but you look so much like Ashley Judd who I think is a doll. I DO still think you're more like 35 yrs old from the photo.
You've given me a lot to discuss with my PS who's appears receptive to ideas (thus far) although I didn't have anything solid until I was educated by you. She's QUITE eager to please within the realm of 'doable'. I absolutely feel I need the width and would like as much projection as possible. After reading so much of what you've written though these threads, I imagined "the look" I want would be achieved by high profile smooth rounds with enough width.. So, that's what I'll be rallying for.
AND.. Guess what? You were SPOT ON. I re-measured and I'm clearly a 29" ribcage. I looked at the style 20 and thought the 550 might also be a good option for me. I'd like to throw this all out as possibilities and see what my PS has to say when I see her next month. You've given me some excellent suggestions to discuss. GRAZIE, smarty-pants!
Oodles of warm hugs for your beautiful whippets from me. I'm a dog lover since I was still in diapers crawling.
I'm ever-so grateful for all of your valuable time and will keep you posted if you want.
The caveat.. I'm still worried about the fat grafting as I know not all fat is created equal. My PS explained women with even ample fat don't always do great with grafting and it becomes a work in progress- although she's done a great deal of grafting and acheives nice results. I do hope my fat will cooperate without too much absorption after a relatively short period of time- meaning I'm constantly going back for more grafting. This is an area I need to research further as I don't have a handle on it yet.
Darn bony chest with slight depression!
Otherwise these expanders aren't the worst looking temp solution at all! I know the real thing done right can be pretty wonderful.. and I say shoot for the moon.
My PS likes to see some decent projection. But without the proper width it really doesn't do enough to make a decent breast mound to fill out a bra- or so YOU taught me.
You're a love, Deborah!!!
xxxx Mindy
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Mindy: The step-off defect is a challenge with breast reconstruction, especially when a bony chest wall is involved. Truthfully, I see fewer issues with this when the low height tissue expander is used. My own PS used the moderate height as well and I had a nasty step-off, but FGT did ameliorate the defect and improve it. To tell you the truth, I just hardly notice it now. I could probably have it [FGT] done again and I might, when I swap out these implants for replacements when I am 70 years old. So they have eight years to perfect my future implants and any ancillary remedies for some of these leftover defects after MX. I do not have any belly fat now though and so they would need to take it from my inner thighs, and good riddance I say.
Would you mind sharing the name of your plastic surgeon in Houston? I would like to add her to my list....
Deborah
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Not at all, Deborah. Her name is Dr. Melissa Crosby at MD Anderson.
I wondered if perhaps HP implants might create more challenges with fat grafting. Well.. lots to discuss next month.
Have a good evening & thanks again for your input!
Mindy
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I'm scheduled to go in for exchange next week. Last week the Doc sized me at 400cc smooth round high profiles just like you said whippetmom.
You rock!
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I think I confused the issue when I said I'm expanded at 490 ccs bilaterally. That could be taken as cumulative between both foobs. Actually it's 490 ccs each side. But you probably knew that.
Yeah, my sentiments. They can have my extra fat too. I bet they could get quite a bit off the old bum, since I haven't been off of it much lately. xxxx
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Mindy: The HP implants are not going to be an issue for fat graft transfer. Yes, I knew what you meant about being overfilled to 490 ccs bilaterally.
Thank you for your doc's name! I will add it to my list! I am adding it because I am impressed with her desire to get you where YOU want to be....0 -
Vik-
You nailed it! When all is said and done, your faith is all you have. It's everything we need to get though these trials.... THAT and the support of family and friends.
Wishing you so much luck and love through your journey! My Mom was one of the most positive woman I knew sans any relationship bias. Reflecting back on her BC journey she said, "It was actually one of the best lessons in life I could possibly experience. I don't look at my BC as a bad thing at all." At the time I thought she was a tad loopy. I now actually understand.
xxx Mindy
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Yes Deborah..
Melissa is a gem. Throughout this whole cancer-schmancer experience she's the one that intently LISTENS. I'm not huge on bedside manner as long as the doc truly excels at his/her speciality. My oncologist is a brainiac, though can be as cold as ice at times. However she's at the very top in her field when it comes to aggressive BCs. And in my book that's all that matters.
Crosby's compassion shines right through. We always end our meetings with big (gentle) hugs. It's so obvious she cares about her patients' desires. Sure.. she'll shoot straight when not reasonable. Personally I find her brilliant- NOT egocentric and in the least 'full of herself'.
And she *will* do everything within her power to help fulfill her patients' goals / desires. Her PA, Rachael, is a bright amazing woman too.
xxx
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Wanted to add, I learned very quickly through my reconstructive team that they don't speak in cup size, just as you stated in your initial post.
I consulted a highly recommended PS here who also does his fair share of reconstructive. (hard to believe). I hate to call him the name that runs through my head.. so use your imagination with 4 letters. Five letters could apply too. He smugly stated, "I could get you to a large A cup or perhaps B cup and make you look decent in your clothes, but don't expect miracles."
Needless to say... couldn't dash out of his office quickly enough.
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Whippetmom I had my exchange yesterday.. All went well but I had to have quiet a bit of pocket work on my radiated side. Even though they were both expanded to 400cc the radiate side looked smaller. He could not get ther 450cc in that breast so I ended up with 425cc on left radiatd side and 400cc on the right side. I can shower tomorrow and can't wait to see the results.
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Mindy: At least you hightailed it out of his office. Think of the women who have accepted his dismal pronouncement, feeling that they did not deserve to ask for more - or ask for the best outcome possible. This is what breaks my heart and makes me want to become a lobbyist....if I only had time and if healthcare wasn't in such dire straits right now...
EDITED TO ADD: I just read Dr. Crosby's bio. Very impressive! I am so encouraged by her work in addressing lymphadema issues and also likely she is aware of the post-mastectomy pain issues which impacts so many breast cancer patients. I am going to share part of her bio on the PMPS forum....AND DAWNE-HOPE....PLEASE READ THIS....
Melissa A. Crosby, M.D. is an Assistant Professor in the
Department of Plastic Surgery at The University of Texas M. D. Anderson Cancer
Center. Dr. Crosby specializes in complex microsurgical reconstructive surgery
in cancer patients, with a directed focus in breast reconstruction. Her
research interests are directed at improving outcomes in reconstructive surgery
for breast cancer patients, including surgical treatments for lymphedema. Her
current projects include research in evaluating the clinical outcomes and
efficacy of using the paravertebral block in breast surgery, fat grafting for
partial mastectomy defects, and lymphaticovenular bypass for patients with
lymphedema. She has authored numerous abstracts, book chapters and articles in
peer-reviewed journals and is actively involved in educating the public on
breast reconstructive options.0 -
Let us know how they look Sherry, but please remember that the first week after the exchange the implants can look a bit misshapen and "wonky"....so photo journal weekly so that you can appreciate the changes...
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What a lousy crop-job.
Somehow I lost my chin. MEH. I'll re-crop later. Thought it would be nice to have a recent photo here; Much more importantly, congrats Sherry. I hope you're delighted when you get a gander tomorrow! Yes, remember. If they disappoint... look a little battered, just hang in.. it'll get so much better over time. You won't be seeing a true reflection of the end result this early. This was true too when I had my first boob job vs. reconstruction many moons ago.
Congrats again. Exciting! xxx
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I am learning so much from all of you with your posts and your progress each step of the way. Of course, I can only imagine at this point what you are talking about, i.e. cc's, step off, amongst other bc jargon. But, is what I've come to realize is that all of you are, or seem to be, in an okay place with what you've endured and the place in which you are at present and you continue to persevere with such great attitudes. Now, I can honestly tell you when the days draw near for my surgery and when I'm being wheeled into that OR, you ladies and your attitude is what I will have on my mind. Such inspiration! Yes, I'm nervous. But, soon I will join your ranks and will make sense of what you are conversing about. The foresight I have at this point is invaluable! It makes it all so much less scary. Thank you!
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Mebmarj: Finally!! So let us know how you are doing after surgery!!
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More than just in an "okay" place Vik...many of us would say we are in a better place....
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