BREAST IMPLANT SIZING 101
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I am so excited!! Dr Namnoum in Atlanta has worked it out with my insurance, (he is out of network) and he is dropping the extra charges that would have made this surgery out of reach for me. I will only be paying an extra 1k. He had his assistant call me, saying he just really wants to be able to help me get this all behind me. He told her that he knew he could make me look much better.
I am going back through tissue expanders, and size wise, as crazy as this sounds after all my recon, I am trusting him to go in with the right expanders. And expansion, he says, we will make judgement calls as we go along.
The pre-op called, they talked about the anti-anxiety med they give beforehand to ease my nerves...ummm, HELLLLOOO!!!!, I will go skipping and singing into that surgery : )
This whole process has absolutely been frustrating, annoying etc...but how fortunate we are to have doctors like Khouri and Namnoum...who just really honestly care, and love what they do.0 -
geewhiz,thats great, I know I paid $400 copay everytime for each surgeon upfront and then the path and anesthesia and hosp and so on billed me separately for their srvs. The surg I believe with this system hosp are independent contractors. My insurance has paid a lot for sure. The hosp bill alone for the bmx was $69,000. thats on the insurance statement where the bill shows,then what they paid and then what my share is when the srv will be billing me.
Hopefully insurance pays most of all this for us.
I have never been a stomach sleeper but worry if the implants will move to my armpits cause I am a side sleeper. Currently sleeping top side up in the recliner. I know my friends who got augmented mentioned that they were worried about stomach laying and sleeping. The one swore her implant got "imploded" during a routine mammagram. Thats the only good thing I can see about all this is I get to laugh at my yrly ltr from the imaging center to come get my mammagram. Nope all the tissue is gone so they would just get an image of the implant and muscle and skin so believe the dr is supposed to order an MRI every 2-3 yrs. Anyone know if thats correct? Would it be the MO ordering it? Is it the usual,IV and then face down with the concrete blender noise?
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Whippetmom,
Did you get my photo?
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Thanks Layla!
With regards to the MRI..that's a bit of a crapshoot. Your onc can order an MRI, or annual scans, or every few years. But, many doctors feel this is unnecessary exposure to radiation. My doc will scan only when symptoms really present themselves. A year ago, I had a terrible hip pain that would not go away for a month. I was really worried, so we scanned. I have never been so happy to hear I have a major hip injury, lol.
And yes, with a breast MRI, or at least the one I had, you lay face down on a cushioned table with these holes cut out for your breasts. Somehow they get scanned from below. It was very easy and not nearly as nervewracking as the enclosed ct scan.0 -
Tina: I had TEs exchanged for implants just under 6 weeks ago. For the first 4 weeks after exchange, I had to go back to sleeping on my back (with the TEs I had finally graduated to a combo of sleeping on my back and side, but never my stomach). Last week it started to be more comfortable for me to sleep on my side for short periods. A few days ago I noticed I could sleep for longer periods on my side before the discomfort woke me up, and can even lie on my stomach for 5-10 minutes. I actually want to avoid lying on my stomach for longer periods for the time being as I think it's too early to be putting pressure on the sides of the pockets for extended periods. But I can see where a few months from now I will get to a point where I can go back to sleeping primarily on my side and sometimes on my stomach.
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Layla2525 - I have recieved two of the mammogram reminder letters now. The first one was very shortly after my BMX so I found it a little upsetting. The most recent one just made me roll my eyes as I've had ultrasounds and MRIs at the same facility since surgery. Since the breast surgeon can never remove 100% of the breast cells there is still a thin layer of them just under the skin. That's why you still need to have breast exams by your breast surgeon, oncologist, etc. In theory if a new cancer did develop it would be very superficial and easily felt.
It was explained to me that the routine MRIs would be every two years to look for implant leaks rather than cancer, but now I'm hearing that they've relaxed the recommendations on that since the implants have improved so much. Something to add to my list of questions!
geewhiz - There's actually no radiation exposure from an MRI
so that's not a reason to avoid one. They are expensive, however, so insurance companies often don't want to pay for them. Dragonfly2012 - Thanks for the input. I've just never been a stomach sleeper so never do it. I'll pass your info along to my friend that choosing implants doesn't mean never sleeping on stomach again.
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Thanks for the info, Whippetmom! I plan on heading to Nordstroms for a fitting. How long should I wait to do that? I figure I will be swollen for a little while and I guess will do the sports bra thing. Don't want to go get a fitting until it is the right time...should I wait until the 3 months to allow for drop and fluff?
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Whippetmom or Anyone, I hope you will remember me but I haven't made a post since March. I have had 4 surgery's due to infection of TE's this year. I finally had to have them removed May 1st to heal and then reinserted July 20th to start the process over again. I haven't posted but have been reading and am so happy for all of you that have great success.
My Questions for you are #1. My first TE's were Mentor style 6200, medium height contour profile, 15.6X13.3X8.0CM. Can you tell me what CC's these can be filled? I was thinking thay would hold up to 800 ccs and had planned to have around 700CC's Mentor High profile silicone implants...then came the infections and removal of those TE's in May.
Now I am filled to 510 CC's and was just told by my PS that we need to set a surgery date and that I could only have another fill or 2 at 60 ea so 120 +510=630 CC's, he overfills. He was on his way into see another patient (his nurse is out so he was short staffed) when he mentioned my TE would hold 550...I though HUH...but couldn't talk to him until next week. I couldn't get my complete measuremnets on the TE's he put in the last surgery but I assumed he wouldn't change without discussing with me. My Question #2. Can a 550 TE be filled tp 700 to accomodate 700 High Profile Mentor Silicone implants?
My height is 5'7, weight 162, 33 inch chest measurement under bra line. What size do you think I need to get a D cup, I was a DD but don't mind going smaller. I can get the type of TE on Monday and already have a call in but they were out whhen I made the call just am a little concerned, he put the wrong size in me the last surgery. Thanks so much for any info anyone can give me.
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Hi, I have Mentor silicon cohesive gels which were one-step (no TEs) placed completely sub-muscular (no Alloderm) on the same day of the nipple-saving BMX (NS on one side, reconstruction on the other). After a lifetime of large and pendulant breasts 34DD, I wanted a small bustline and have ended up with a size I am very happy with. I fit usually into a large 34B or small 34C. If anything, I wish I were a little bit smaller. Since it was necessary to reduce the skin and move up the nipple areola complex (NAC), I had a key hole cut for the NAC and anchor shaped cut like when having a breast reduction. So I have some intramammary fold problems on the underside and a bit of loose skin on the sides, that my PS says can be corrected with simple outpatient adjustment (I assume that means cutting and restitching!). I lost my reconstructed nipple but everything still healed nicely just flatly, and I will have to figure out what to do there because I would like my NACs to match in color and projection. However, my PS said he will see me in October to discuss all this. My concern: my breasts have never seemed to "drop and fluff." They still seem very firm and not squishable. Could this be due to the implants being place totally sub-muscular? Could it be because my PS never had me do any massaging either? He said he didn't believe it in. I have not been sleeping on my stomach either, although PS said I could do so if I wanted to now. Could the problem be that I have been exercising my chest muscles (jogging and stretching) which keeps them taunt? Thanks for any insights!
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Fearless: The Mentor CPG are firm and not squishable. They don't drop and fluff like silicone round implants.
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Caro -- I had a 600 cc TE filled to 850 cc's... it's fine to overfill the TE.
Fearless -- it sounds like those cohesive gels are firm like the Allergan 410 gummy... although it's difficult to say for sure. All implants are placed submuscular, I believe. Of course the thickness of each individual woman's muscle can mean different results (firmness-wise). Since you had a one-step and the muscle wasn't stretched, and I'm just guessing here, it may be that your muscle is thicker. I have a 410 and I did find that over time it got a little softer and more pliable... but not much drop and fluff.
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Thanks, Lilah, I am hoping he will overfill that much. Aso, do you think I should go with a 600 or 700 Mentor high profile silicone for my size, or go with saline because they project more? I wish there was a way to get a tummy tuck out of this because my tummy has a fold from prior surgeries and lots of skin. Thank you so much for the reply, after all I have been through this year with 4 surgery's, I just don't want to go through another to replace the te to a larger one if he made the mistake. God Bless all of you ladies and hope you all get exactly what you want!
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kimmygal: Thank you for letting me know you sent them! I just responded to your email!
NOTE: If anyone sends me photos, and if I have not responded within 24 hours, please remind me or let me know you have sent them so that I can look for them.
Deborah
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Caro4: Your PS used 800 cc TEs the first time....and I guess you are saying he used 550 cc TEs this time? Frankly, I think that the 800s were too large and too wide for your frame. We do need to know which style and actual volume of TE he did use this time to know the current width. Find out on Monday.
Deborah
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Fearlessfoot - Am I remembering correctly that your PS does not sever the pectoral muscle at the bottom, but leaves it attached to other muscles? So you did not require a support sling at the bottom of the implant? I don't think that method is used much here. But, it seems that without stretching the pectoral muscle with tissue expanders or releasing the muscle it would be difficult to get much projection when placing an implant behind it. Again, I'm just speculating.
Sorry you lost your reconstructed nipple and that you are looking at more procedures ahead
. Keep us posted!0 -
Caro4: I'm no expert but for what it's worth I had 350cc TEs (sorry, don't know what make) filled to 630cc's, then exchanged for 695cc silicone rounds. The only reason I know the TE capacity was because at the pre-op appt for my exchange, my PS was presenting my case to the gallery of residents/fellows/medical students that usually accompany him, and he told them that he choses a TE that provides the width and height that he feels is suitable, and pays no attention to the cc capacity. Actually, it's a good thing I didn't know... if I was aware my TEs were overfilled to that extent, I'm sure I would have walked around expecting to explode at any minute!
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Caro -- Whippetmom is the expert when it comes to advice about size. You should review the header on this thread and send her (or post here) the details she needs to give you the advice you need!
Tina -- Fearlessfoot had the onestep, I believe... so no TE was used... she really did go straight to implant (and please, Fearless, correct me if I'm wrong)!
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Lilah - Yes, Fearlessfoot had direct-to-implant surgery. However, I thought she was the one whose PS does not sever the pectoral muscle at the bottom so no need to use a sling to support the implant. I thought I read that some PSs make an incision to insert the implant behind the musculature and actually leave all the chest muscle connections intact. Seems that would flatten things a bit. Perhaps I'm thinking of someone else or I misunderstood...0
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OK Tina. I actually have never even asked my PS how she does it! Though I do know its submuscular.
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Hi, I'm new. Had Bil Mx with TE July 2012, IDC, on Tamoxifen. I'm 5'4, 150 lbs, was 36B before preop. TE is at 600 cc, wil have 550 silicon gel implant later. What size will I end up having. Hoping for just a C cup. Present TE size seems enormous and appears high on my chest. Will the 550 cc implant appear the same in reconstructed breast vs breast augmentation.
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aquapink: From the thread header....
3. IMPLANT SIZING INFORMATION:
If you are interested in discussing implant sizes, make sure you compile and provide us with the following information:
.....if you have TEs [tissue expanders] - we need to know about them. The style - Mentor or Allergan most likely - and whether they are short height, moderate height, full height if Mentor and style number if Allergan. We also need the recommended fill volume of the TEs - the number of cc's.4. "WHAT CUP SIZE WILL I BE?" OR "WHAT SIZE IMPLANT DO I NEED FOR A "C" CUP?"
I CANNOT PREDICT CUP SIZE. PLASTIC SURGEONS - THE SMART ONES - ADMIT THAT THEY CANNOT PREDICT CUP SIZE WITH ACCURACY!
It is very difficult to determine cup size with breast reconstruction patients, as volume does not easily translate to a specific bra size. There are so many factors which determine how implants will look on any one individual, e.g., your ribcage circumference, whether your chest wall is bony or if you have a fair amount of adipose tissue surrounding the chest wall.... if you have any ribcage deformities or other structural issues which might impact implant placement.
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Hi Whippetmom & anyone else who can answer
Here is a question from my new book "Breast Reconstruction for dummies"!!!!
So, my expanders are allergen 400cc. I was filled to 150cc during my mastectomy. I start fills on Wednesday.
How much will I need to be expanded to reach a small D cup?
I am in pain and so tight now. Not sure how I will tolerate the expansion.
Any insight would be appreciated.
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shabby6485 - I had quite a bit (350cc) put in each TE at the start. I was uncomfortable and tight for several weeks. I don't know how much of the discomfort was from the MX and how much was from the TE and fill. It was hard to take in a deep breath! However, I breezed through the rest of my fills after that initial stretching. My PS and his PA typically added 50cc during a fill, but I got to decide how often to get them (minimum 1 week apart) and they always told me I could go back to have saline pulled off if I was too uncomfortable. I think slow and steady is the way to go if your PS is flexible about it. Hang in there!
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Whippitmom or anyone, My TE's are Mentor Medium Height Contour Profile 13.5X11.7X7.4 at 550cc's. My measurement under my breast is 33 1/4 and I am 5'7'' at 162 lbs. My question is how large can I fill and what is the size of cup will I be? I was a DD before my diagnosis and don't mind being smaller but I am afraid he may have me too small because he mentioned maybe 2 fills which would put me at 630 CC's and I know he overfills. My concern is I know I will be much smaller than I look now in my TE's. Any help would be appreciated. I know he has me down for Mentor High Profile silicone implants unless I want Saline...What advice can you give me for more projection. Thanks so much for any suggestions.
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Hi, TinaT, Lilah, Loulou,
Thanks for your comments, info, questions, and encouragement! I don't know if the PS severed the pectoralis, but I had immediate, one-step done same day as BMX. My PS doesn't like to use accelular dermal matrices (e.g. Alloderm or Strattice) when possible infection is an issue. I was going from large, pendulant breasts to small ones, so the NACs had to be moved up and excess skin removed, using a keyhole and anchor style incisions. I had great risk of skin necrosis because of all these stitchings, so he used my serrata anterior muscle as part of a sling and also the fascia of my abdominal rectus (all was done interiorally -- no scars or soreness from stomach area! all stomach muscles intact!) Using a muscle allows immediate blood flow without "interference from a foreign body" -- the Alloderm -- according to my PS -- and thus allows better delivery of antiobiotics to the healing skin and incisions. The Alloderm eventually grows into the tissues but apparently it takes a while. I don't know to what I owe this, but I didn't have any other problems -- except for losing the one nipple -- and I healed twice as face as the doctors said was the normal timeframe. I don't really understand the pocket concept or how these muscles were stitched in place. My projection is very good from my point of view, and I fill a 34C bra (B cup would have been fine by me). But alas, I guess the Mentor cohesives may not soften up like I was anticipating. My PS did not explain that aspect. But I am quite happy to have small firm noobs for other aesthetic reasons -- no sliding out of bras or bathing suits or falling underarms when I lie down! For me, after a long life of large breasts, smaller is better now! (But to each his own! Chacun à son goût!) I may be a freak of nature because I think Whippetmom was a bit surprised by my statistics and results. I certainly have not run across anyone else who has had the same procedures so I feel a bit lacking in comparison or comradery.
STATISTICSI am 5'7", currently 130lbs, rib cage 30 inches, previously 34D or DD.
BMX, immediate reconstruction same day, NS on left, reconstructed NAC on right (not due to cancer but due to compromised NAC due to lumpectomy incision) from excess breast skin. Total sub-muscular placement with pectoralis, serrata anterior, fascia from abdominal rectus.
Mentor CPG 332 Gel Breast Implant Cohesive III, (silicon anatomical shape), Tall Height, Moderate Plus Profile,270 cc, 11cm x 10.5cm. Now wear bra size 34C.
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Fearless -- it is probably more likely that the firmness is due to the pocket work and the muscle architecture that covers the implant. My memory of comments from others who have had the Mentor gels was that they were not particularly firm.... but then those women had the smooth round type and perhaps the fact that you have an anatomical shape means it is textured (like mine) and that too can add to the non movement.
I think how firm implants feel is variable even when two women have the same kind. I do know that even among those with smooth round silicone, the firmness/moveability is variable, depending on what sort of pocket work is done and on the individual woman's body/muscle thickness, etc. I have what is called a gummy, as I've said, and it doesn't move much... and while it is firmer than my remaining native breast, it is pokeable (if that is a test). It does seem that you will experience less drop and fluff; that's what I found with my Allergan 410. But there IS softening over time... it's just subtler. The whole idea of drop and fluff is more crucial for the rounds, though; with your anatomically shaped implant, you've got a natural shape already.
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shabby: 500 ccs in a high profile smooth round silicone implant will look nice on your frame. Go over my previous answers to you.....four days ago....
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Caro4: Your PS will be able to get you into an implant which is larger than your tissue expanders. I think you have sufficient skin flaps, if you were large breasted prior to BMX. I do not think it would be a problem exchanging you out to Mentor high profile smooth round silicone - 700 ccs. That would be my recommendation in a high profile implant. I know that Mentor has the ultra projection style implant available now. I do not know about the dimensions though. That implant tends to be pretty narrow and you do need some width on your chest wall. You can always send me photos - PM me if you want my private email address. I think you should wait and send me photos when you are filled to 550 ccs.
Deborah0 -
Whippitmom. Thanks for the advice, now I will talk to my Dr. about it on Thursday. He mentioned surgically putting in a larger expander, I have been through 4 surgeries already and had no idea, he changed it to a smaller one the last surgery. I don't want to go through another so I may have to settle with what I have. I am going to tell him to go as large as he can. Thanks so much, when you go through all of this, you just want to be happy with the outcome. I pray all of you ladies get exactly what you want and I need to remind myself the main thing is I am cancer free and that makes me a winner.
God Bless!!0 -
Three weeks post-exchange, and I am loving the size and shape of my Allergan Natrelle Smooth Round, High Profile, saline implants (68HP-700).
Righty has softened up considerably, and appears to be heading towards D&F. Woot!
Lefty, though, still has a few issues (swelling from additional pocket work during exchange), and PS says it may take 2 - 3 months to resolve. But other than that, I am healing well, and all-in-all, very pleased.
Once again, a huge shout-out to Whippetmom, for giving me the right questions to ask my PS BEFORE exchange. It made a huge difference in my outcome. xoxoxoxo
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