BREAST IMPLANT SIZING 101
Comments
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Whippetmom my PS did not say what type of textured implant, I have an appt on Monday and am working on a list of q's I am going to ask. That will be one of them. I am concerned about the textured implants because of what I've heard others describe as a Velcro-like adherence to the tissue making them less fluid like a real breast. Also, not sure about round vs. anatomical? Are anatomicals always gummies ie: firmer than round?He of course has in his minds eye what will be the best aesthetically . Of course I want that too, but maybe not at the expense of how they feel to me. This is all very confusing to me.
As far as the fills go, I think he was trying to show me that I could handle a larger volume than the PA and I were doing. This has been the worst two weeks as far as pain! She has left the practice so I will continue to see him till surgery, which I think will be good so I can be certain he knows exactly what I want. I do trust him,he has a great rep. And I just talked to a recent patient of his who is happy with her results/ his skills.
I will check in with you all Monday afternoon with more info. Thanks for the support, I've been pretty anxious about this since my surgery date was set and this thread has really encouraged me.
Leah0 -
Hi everyone! I have been given the OK to finish my reconstruction since I am on a break from chemotherapy. This is my second attempt at reconstruction since my reconstructed nipple never healed. I had lat flap reconstruction on my left breast last May with a 250cc tissue expander placed, which currently has 270cc's. My PS said we can stop expansion. I questioned that because the implant in my right breast (nipple sparing mastectomy side) is 370cc's...it is a round textured implant which is set pretty wide on my chest and has rippling when i bend over or lay on my side. My PS said he is going to take that out and replace it with a smaller implant. "SMALLER?" I asked. He informed me that he will place textured gummy bear implants in, but they will look bigger. I guess because they are a teardrop shape? I don't really understand how a smaller implant can look bigger. The only thing that sticks out in my head is the word, "smaller" which saddens me. The biggest size he ordered for my surgery was 350 cc's. His reasoning for a smaller implant is because he said my lat flap side is the limiting factor and he is not sure if he can place a larger implant there. I don't understand why we can't just expand more so that he can fit a larger implant. Has anyone had this problem? I'm 5'4, 117 lbs with a 30.5 inch rib cage. I feel like from the beginning of my reconstruction journey, that my PS never listened to what I desired my implants to look like. I had cleavage before my initial surgery, but not afterwards. I was re diagnosed with mets in my liver and bones last August and with everything I have been through, was really hoping to have a nice rack. Any advice would be greatly appreciated. I did post some pics in the picture forum under "Lat Flap Exchange Questions."
Thank you!!0 -
Hi! I've been lurking on BCO for quite some time now, but this is my first post. Thanks to all the ladies who offer all their knowledge and support, I've learned more on these discussion pages than I have from my own medical team - which has lowered my stress level considerably for this journey...
I've read this thread extensively and would like to ask for your opinion on my TE/Implant situation. I have Allergen TE style 133MV-13 - 400cc fill capacity. I am 5'7'', 135lbs, rib cage measurement approx. 33 inches. I am currently filled to 440ccs and visit my PS this week for the next fill. I assume he will fill another 100ccs (as this has been his past practice though I may ask him slow that down a little....anyway...)
I would like be a small C to med C (leaning towards medium), and would love to retain the projection I have now with the TEs after exchange. I am wondering if you could me give me your opinion on options for implants for me and how overfilled I should go for my TEs? My PS is in Toronto but I am getting my fills done in Windsor (my hometown) - so as much info I have to ask detailed questions before I make the trek to Toronto to see my PS would be much appreciated! Thank you!
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Sorry for the delay everyone.....I have been MIA.....back now....
Sarah: If you go with the anatomical, the most appropriate implant, based on the dimensions of your TEs, would be Allergan 410- 560 gm FX, with a width of 14.0 cm height of 14.5 cm and projection of 6.5 cm. Your TEs have dimensions of 14.0 cm, 14.5 cm and 7.0 cm respectively. There is no "650" gm Allergan 410. This would be a good size for you, but there is another issue at stake here.
I would be a bit reluctant to be one of the first candidates for the Allergan 410 with plastic surgeons who never had access to the device until it was approved a couple of months ago. If they had it in clinical trials, yes. But my feeling is to let them practice inserting this on the augmentation patients. There is a learning curve to using this implant.
For you, Sarah, the Allergan Style 45 would probably match best to what you have with the TEs, as far as the silicone rounds are concerned, but you would need at least 700 ccs and perhaps even 800 ccs in that style.
Talk to your PS about his experience with the Allergan 410. How many times has he used them since they were approved?0 -
Thanks so much for your input, whippetmom. My PS's experience level is a definite concern. I was going to post about it separately on the all about gummies thread. But you have confirmed my worries. As for the silicone rounds - you really think I will need to go up to 700-800ccs? Something to think about and discuss with the PS. Thanks again.
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swalking: Okay, so I just read your second post about prior MX direct to implant sizing. I suggest also, smooth silicone rounds, Allergan Style 20, 650 ccs. You would still be larger than you were previously and you will be happy with the size on your frame. This is the preferable style. I can say that the Allergan 410 would likely be preferable for someone with a lot of ptosis - droop - but again, we have this learning curve thingy....
Deborah0 -
Leah.....and everyone:
GUMMY BEAR, AKA GUMMIES....
Here is a little synopsis on the term GUMMY BEAR or GUMMIES when it comes to implants. Grant Stevens, MD in Marina Del Rey, CA, was one of the principal investigators for the Allergan 410 and Mentor CPG anatomicals, as well as the Sientra cohesive silicone rounds, when trials began twelve years ago. One day, he was explaining to a group of collegues how he would describe the consistency of these specific "highly" cohesive gel implants, and said, "it is like cutting into a gummy bear." So the moniker stuck and they have been called this ever since. These are the only group of implants and implant styles which have this type of consistency. According to Dr. Stevens, the Allergan 410 is the firmest, followed by the Mentor CPG [no FDA approval for that one here in the US yet] and then the least firm, the Sientra cohesive implants. I have only heard Dr. Stevens discuss the Sientra "rounds" by the way.....so I have little experience regarding the "shaped" implants in that lineup. All shaped or anatomically shaped implants must have a textured surface/shell, because they have a risk of rotating in the pocket. Doctors dismiss the rotational risk, but I have personally seen many rotated anatomical implants, [and when they rotate, you really need to switch to silicone rounds or round implants.] Additionally, the Sientra rounds which were in clinical trials, had different dimensions and volume offerings than we see currently. In Europe, where Sientra is called Silimed, there are a plethora of sizes and they even have a 1000 cc cohesive "gummy" round implant. I was very disappointed that Sientra does not offer that size in the U.S. A lot of bodacious gals I know could use that implant.
The Mentor "cohesive or Memory Gels" and Allergan "Natrelle" implants have a much more cohesive consistency than they did in prior generations. But they are not categorized as "gummy bear" implants. Hope this helps.0 -
Leah....There is no rush to the finish line with breast reconstruction. The protocol is to fill to the PATIENT's tolerance....NOT the doctor's! There is no reason to be in agony over fills....
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Sarah.....You need to stay within the width parameters of the tissue expanders. You have a width of 14.0 cm. The Allergan Style 20 in 600 ccs has a width of 14.0 cm, but I just wonder why you have been expanded so much. Just want to make sure that the implant fills up that pocket....
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shredbetty: I responded to your question on the pictures forum, but my concern for you is the same as it is for anyone else whose PS is hot to use the anatomical implants. I don't want to be part of the learning curve. Sorry....let the augmentation gals volunteer for that role. They have not had breast cancer, nor have they had removal of every shred of connective tissue or fat within that breast. They do not have the risk of complication that we have....if the results are unfavorable and revision is necessary.
The rippling you see when you "bend over" is what nearly all of us see. I do not know anyone who cannot see rippling or ridges or folds when they bend over. My recommendation to correct that problem is to stop looking when you bend over. I saw your photos and I would not touch that prophy side. It looks great.0 -
Leah....Did I mention sizing for you? I think that a Style 20 - 425 ccs - a high profile smooth round silicone would be very nice on your frame. And then your PS could use a smaller implant, coupled with the mastopexy/lift on the native side.
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secondtimearound and monicaelise....So happy that YOU two are happy with your results!!
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hez42: What I think would be ideal for you would be Allergan Style 20, 500 ccs. It is a smooth, round, silicone implant. Your TEs are sufficient to get you there right now, without further expansion. However, you are in Canada and Canadian docs almost exclusively seem to use the anatomical implants. Do you want to find out if he is heart-set on using Allergan 410s or Mentor CPGs? If so, I need to know which he uses, and then we can find the most appropriate implant for you. Glad you are here!
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Hello whippetmom, thanks so much for your quick response! I will email my PS and let you know when I get a response.
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Thank you whippetmom!
I am not 100% sure as to why he wants to take out my implant and replace it with a smaller one. All he said was that my lat flap was limiting what he can place there, and that he would need to swap out my prophy side with something smaller. Maybe the flap is too small, which is why he needs to go smaller? I know he has been using the anatomicals since they were in trial, so maybe he has had better luck with them? I have no idea. I am confused and will be getting a second opinion.
Thanks again!
Melanie0 -
I am small with a very petite frame/bones. 5'2", 110 lbs. and a 29 inch ribcage, size 2 in clothing. My first mastectomy was in 2009 with my original diagnosis with NO reconstruction. I just had a prophy mastectomy on the other side (4/10) because of a bad gene (a new one called PALB2 which is closely related to, but not the same as BRCA2) and this time, decided to start the reconstruction process with TE to implant on this side. PS decided to work with just this side right now since my breast cancer side was radiated and would need LAT Recon. (I did not want LAT on non breast cancer side due to back/shoulder issues) So... I am working on one side at a time--this will very interesting, to say the least.
Tissue expander was placed and filled with just 50cc at time of surgery. PS said it was pretty tight and decided to stop at that. Mentor CPX3 Tall Height Siltex Contour Profile Expander 250cc Style 7300.
I know this is still early, since I jsut had the surgery, but I'm wondering the next steps will be. I was always either a 32A (or sometimes 32B in smaller bras) and would like to enhance and go slightly larger than that, but not look over the top. I am extremely worried about looking fake and worried because I have such a thin and bony chest with not much padding or tissue to hide an implant. Also,Right now the expander is poking out into my sternum and into my armpit and I'm worried that it might be too large for my frame, but the PS said it was the smallest and fit well. Does this expander sound right for me? What do you suggest for when I am ready to exchange to an implant? I also don't know if saline or silicone will be a better choice for me. I'm leaning towards saline, just because of its safety.
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shredbetty: That sounds much more reassuring - about his experience with the 410s. Please let me know how it goes...
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weety: It is the narrowest TE in the Mentor line up. I think you have a number of options because of your size. There are a number of Sientra implants [they are the highly cohesive gel implants] in the shaped styles which would work, between 270 and 300 ccs. The opposing original MX side will be the determining factor. It will depend on how much volume your PS can create with a flap on that side - plus an implant, I assume - and then this will dictate the size for your most recent MX. I think that you could safely go to an 11.0 cm wide implant - such as 300 ccs in a high profile implant - Mentor or Allergan. I am not at all favoring saline implants for you - as I believe rippling would be a significant problem. I think also that the size of your future implant is going to hinge on how you fare with fills - how much volume you will be able to tolerate. You may remain close to your TE volume with implants.
But I am concerned about your description of the TE being in your armpit...at just 50 ccs. Do you want to email me a photo? If so, please PM me for my email address. Also, please PM me the name of your PS. I am in So. Cal also.....and know all of the best docs here.
Deborah0 -
Deborah.... Beautiful photo! See PS for post-op tomorrow, can't wait for unveiling! 1st mx/left side looks bigger but I'm not concerned due to swelling. She's moved the implants closer together and there's actually nice cleavage. No arm pit cave. No gauze/mummy wrap just large bandages and surgical bra. The gathering on the bra was digging into IMF (told horizontal incision close to mx incision) so I placed large folded gauze pad between bra and skin, this helps a lot. Would have thought manufacturer would have taken this into consideration and place gathers on outside of bra (not as pretty, but much more comfortable). Will update you after appointment.
I have been having alternating chills and sweats with no fever. Have you heard of this? I'm thinking it might be after-effects from anesthesia?0 -
Anyone that has had their exchange do you think you get the same amount of fullness that you TE gave you after your implant was exchanged. How true to size are the TE? I am filled to 500 now and my swimsuits look good and my victory secrets bras 36C are even a bit snug. I worried with these being so hard and round like hard balls stuck to my chest that maybe after the softer silicone implant goes in I will look smaller when they settle and have wished I had gone up a size. Im using allegan natrelle 20 high profile gel and with my chest measurements 13.5 I could go up-to a 550. Anymore then that kind of scares me. I have a friend who is about my size and went with saline 630 and she looks HUGE to me. She says she regrets going so large.
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Hi Whippetmom. I would love your advise as I am getting incredibly confused over this implant exchange.
At the moment, I am fully expanded at 330cc with TE and the plan is to have the exchange in about 3 weeks time using Natrelle (Allegan 410 gummy bear implants). After some discussion with my PS, it has come down to the choice of 2 sizes, either a 295cc MF, or a 335cc FF.
I am a bit worried that the moderate height may be a bit too low...and the full height, too high. (I don't want boobs coming out of my collarbone!)
I was a size A before breast cancer, and am hoping to be a full size B. Basically, I am worried that the moderate height may just give me the same breasts that I had before (I was very flat on upper pole ....and the full height implants may look fake. (I really need a height in between...which doesn't exist!)
My PS has sent me home with sample implants of both sizes to help with my decision...but in honesty, it's not helping at all as I'm finding it difficult to visualise what either will look like on me.
I am 40 yrs old, 5'9", weigh 134lbs, and my rib cage is 31.5"
Do you have any suggestions that may help in my decision? Many many thanks in advance!
Nina
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mackman my PS said since he has started using the new gummy implants the complaint he is getting is "I thought they would be larger" I think they end up looking smaller then patients thought I have read that a few times on this board too that women were disappointed they were not the size they had hoped for. SO maybe if in doubt go a bit larger??? This is the reason I decided NOT to use the gummy.......
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Hmmm. I was told that due to my frame (I'm quite slight up top), that round ones would look like two rice bowls on me. I don't want to look fake...but don't want to look too natural with low set boobs, if you know what I mean. After everything we've all been through, at least we can hope to get a nice new perky breasts again!
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Love the new profile photo, Deborah!
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Hello whippetmom, I touched base with my PS office as you suggested, and they use Allergan 410 style implants (and do not overfill). Thank you!
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Tangles.... I have Naturelle 20 HP also. I only wanted to be comparable to a full B ..small C. TE's expanded to 440 cc. My implants (jan.'13) are 400 cc.
I am very happy. My TE's were too big for what I wanted, but just by a tiny bit. Actually, I also was a little worried at exchange that 400cc would be too small for the same reason you posted.
I guess what I'm trying to say is that I am probably about 10% smaller than the TE's....which is what I wanted. Bra size is 36 C, but I'm not spilling out of them. The B cups were definitely too small all the way around .
I think you are on the right track to get what you want. WHIPPETMOM would be the expert. Hope this helps.0 -
tangles..I am expanded to 500cc in TEs..exchange tomorrow.. implants are in the air..ps likely to use style 45s. I have been told that TEs usually have more projection than implants, so I am keeping that in mind. I have gotten used to my TE size and its good at 500cc. I think I look like a full C cup in TE and my ps nurse today agreed..altho my ps stated it looked like a small D to him..! IF my TEs were so dang hard and in my pits and go from chest to TE so abruptly, I would be good to go! I am nervous the 45s may have too much projection..but have not heard/read many complain about too much projection. PS stated he would have to stitch lateral side due to narrower implant and would bring a few different sizes..he also mentioned sientras again due to great projection and natural sloping..but we both acknowledged concern about max size of round base anatomical at 425cc. Tangles I am 5'2" and down to 116 with all this worrying and anxiety!! (I was up to 120#) ribcage 28. uploaded some photos for forum..just have to put on there.. i literally stared at my TEs last night for about 15 minutes. U know i feel like it is with a haircut..the day before my haircut; my hair all of a sudden looks great! So here I am the day before my exchange and am thinking, my TEs look pretty good....UGGH!
) I told my ps that breast cancer gave me OCD! 0 -
tangles, if your TEs have a width of 13.5 cm, then by all means, a Style 20 - 550 ccs would be a good choice.
Oops...forget that. Just remembered you PM'd me and your TEs are at base volume 500 ccs. So you want 600 ccs - high profile Allergan or Mentor. /p>0 -
Today I thought just for fun I would pop into Victoria Secret and see what size they think I am. The manager looked at me and guessed B cup Same as EVERYONE keeps guessing. I told the manager I have 36C bras at home and can barely fit these puppies into them. She then measured me and said according to her tape measure I am a large C to small D. I laughed and said NO WAY?!?! Hmmm so now I am even more confused. Maybe I will go get measured somewhere else tomorrow and see what they say I am. I understand these TE are hard and sit up high!!! so how is it I look like a B cup and measure a D? ODD
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tangles - I was shocked when I went to Nordstrom and was measured as a 34DD. Many of us find that we'd been wearing the wrong size bra before BC. Band size is figured by the ribcage measurement and that doesn't change with surgery. The TEs and implants are typically wider than natural breasts so the cup size often ends up to be a surprise...usually higher than you would guess by looking.
I predict you are going to be a regular on the bra threads
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