BREAST IMPLANT SIZING 101
Comments
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Michele: I like the way your PS thinks! My kind of guy! I agree with 400 ccs for you, because although you are small, you do have a 31.5 inch ribcage and you need the width of the 400 cc implant. I would predict - and this is just a prediction because I have not seen pictures of you; I do not know how much tissue you have overlying the chest wall, and I do not know what your ribcage looks like, but I would take a wild guess at a "C" cup. Do not let this freak you out though, because a "C" cup after MX is not like a C cup in a natural breast. It will just look nice and natural on your frame. You will look fine in all of your clothing and you will probably look better in some clothing - like swim suits perhaps.0
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Hi,
Whippetmom: Just like so many others I wished I had found this site 3 weeks ago. With that said any info you can give will be helpful. I am having a bilateral mast. next week with tissue expanders placed in immediately. I will be having radiation after expansion. Is there anything I should ask or do now that will help me to have a good outcome. I am overwhelmed with all of this info. I am not familiar with some of the terminology etc... I am 4'10" AA woman. I weigh 147lbs and currently wear a 36D. I would like to be smaller maybe a B or C "cup" with a mid or high profile? Please help.
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Kate: LOL!! You are right--Who would have guessed that our breasts would become bullet proof weapons!! Soon you will be turned back into a princess by the boob fairy and then you will have to resort to your bulletproof, kick-a** boots!
Deborah: Thank you for clearing the exchange sizing and how it's so different from how they will finally look! You just reminded me why I am expanded so much larger then what I thought that I would originally go with. So, maybe just maybe, I will end up with a D cup but look like a C except in a bikini?? Wouldn't that be grand! Although my 540 cc uniboob looks very odd and hard right now, hopefully she will become soft and squishy and I will fit into clothes for the first time in my life!
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Dawn-Hope: I just realized you were the one referring to them as weapons!! There is no way I can do yoga until I get this TE out--My PS sewed it down to keep the shape of my old breast and to prevent it from going to far under my arm, so I can only raise my arm so high until the exchange. Also, everytime I get a fill, I am back at ground zero and have to retrain my arm to work properly.0
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whippetmom: My PS is intending to do an exchange with silicone because we think they feel more natural, but she (as well as my surgeon who is following me still), suggest that I don't fill past 400cc. They think I'm fine at the 300cc I'm filled to right now. I know that my skin is thin and that the surgeon had to cut very close to the skin at the bottom of the right breast because of the location of the tumor. My PS has decided now that she doesn't want to do interim fills as we had planned, but wants to have me look at photos and decide at the time of the exchange what size implant to use based on photos I like. What is your impression of this plan? I have to say I'm not comfortable with it at the moment.
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I wonder if I didn't measure my ribcage wrong... based on what others are posting, 30.5 in seems big for a 5'0" person?
Regardless, I think I'll listen to my PS (and Deborah- LOL!). I trust him and he's been spot-on so far (except for these wiiiiide TE's).
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scarecrow: Why don't you email me your photos so that I can see how things look at 300 ccs. I just want to make sure you have sufficient skin flaps to exchange to implants with a volume of 500 ccs, which the is volume I personally think would look nice on your frame. I sort of have the same impression you have about the idea of searching through breast photos. I do not know how you can look at photos of augmented breasts and know what volume of implants to use in a reconstructed breast. For instance: An augmented patient with your same frame and size might have breasts you like and the chart may reflect that she has implants with a volume of 325 ccs. However, it might take 500 ccs or more for you to have the same appearance, because the augmented patient is starting out with something - some degree of tissue in the breast and an unadulterated chest wall off of which no breast tissue has been dissected. It just ain't apples to apples, if you get my drift.
Also, you know, just thinking off the top of my head here, I am not sure how much a Spectrum expandable establishes the width of the pocket. If it does it in the same manner as a TE, you have at least a 14.0 cm width to work with and, if your PS wants to stop expansion at 300 ccs, you want to make sure your PS is going to be doing some pocket work to narrow those pockets, since she will be using a narrower implant. You would need a 600 cc high profile implant in order to meet the 14.0 cm width requirement. Currently, your Spectrum has you at the underfill status - less than 525 ccs - and that even is establishing a wider base width - around 15.0 cm. But again, I am pretty ignorant about what the Spectrum does regarding forming the size of the pocket. So discuss the width issues with your PS also. Again, you can email me photos so that I might be able to help you further. PM me if you want to do so.
Deborah
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Clarity: What is your ribcage circumference? Measure around the ribcage, just under the bra line. It should be around 33/34 inches if you are wearing a 36 band bra.
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Michele: You are probably correct with your ribcage measurements, if you wear a 34 band bra.....I would not recommend implants any smaller than 400 ccs....if your skin permits.....
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Whippetmom: Yes I am 34.5 around the bra line.
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yep, 34 bra. a 36 when I was fatter (or PG or nursing). I guess I'm just short and squat...er.. "solid". LOL. so 400 it is. I'm pretty sure I'll have enough tissue. at 300 cc I'm "tight" but not thinned out. does that make sense?
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Clarity: I am going to share with you what I personally think will work well on your frame and get you to a place where you are happy with the size. My recommendations only. Your PS will be able to see you, take measurements, determine if there are any ribcage issues, determine your skin integrity, see how much skin is overlying the chest wall, et cetera, and so he will select the TEs based on the aforementioned, as well as other parameters. Okay, so with that disclaimer read, I think that TEs with a width of around 13.0 cm would work well - and because you are petite - and because it happens to be a good TE style - the low height TE would be a good choice for you. It all depends on what style of TE your PS favors and whether it will work for you. I think that implants with a volume ranging from 400 to 475 ccs would be nice on your frame. However,in order to achieve the necessary width, this might dictate that the implants would be a moderate plus profile style, as opposed to a high profile style. HPs and MPPs are the two most common styles used for breast reconstruction.
So this gives you some idea regarding sizing. I would refrain from telling your PS what "cup" size you hope to be, because it is too difficult to make this assessment and you might end up being smaller than you like. The goal is, skin permitting, to have implants which look nice on your frame, fill up a bra cup and give a nice profile in clothing.
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Whippetmom: Thanks. I will be in touch.
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Hi Deborah (whippetmom)- I have my exchange on Tuesday and I am going with the Mentor Smooth Round High Profile 375 cc implants as I didn't want to go too big. I had sent you my measurements (5'4", 115 lbs, 28" ribcage circumference) and you had concurred with my PS that this would work for me. One thing my PS said is that your implant is always going to look about 25 cc's smaller than your TE. Just wondered if you agreed. I'm o.k. with that. Just want to know what to expect. I just posted my photos on the picture forum if you want to see. Thanks!
Kate
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Hi there, just met with the plastic surgeon I've decide on today for the first time. He said he uses Half Moon TEs. I'm 5'5", 125 lbs., petite frame, 32C/D depending upon the day ;~) Wondering if anyone else has had Half Moon TEs recommended or implanted them. He said that they provide a great pocket for a nice inframammary fold, without pushing up the slope where it looks unnatural. He also performs a neurectomy on the primary pectoralis to decrease or eliminate spasms, "jumping," & rippling. Anybody had that procedure, either?
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Kate: You do have sufficient expansion to exchange out to a 400 cc implant. Why don't you call your PS on Monday and ask him to use a 400 cc HP instead? Frankly, I think even a 425 cc HP would be nice on your frame. Forget about cup size....it is all about what looks good on your frame.
I just looked at your photos and you could easily use the 400/425 cc volume at the time of exchange.
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orchidgal: I have read clinical studies of the use of crescent-shaped tissue expanders for breast reconstruction surgery, but you are the first I have personally encountered on this forum whose PS will be using same. The premise for avoiding expansion of the pectoralis/upper pole is a good one - and so the low-height or short-height tissue expanders by Mentor and Allergan are very popular, as is a less commonly used SSP tissue expansion system developed by a Michigan PS. I will be very excited to follow your expansion process. The only question I have is referable to the width of the crescent or half-moon shaped TE. What volume would your PS be using? Are you having a BMX?
I would think you might want high profile implants with a volume ranging from 400 ccs to 500 ccs - something around the middle of those numbers could be a goal. It all depends on the size of your skin flaps after MX, skin integrity and your PS' "plan" for your end result. Are you also having a nipple-sparing? That would come into play with sizing also.
Referable to the pectoralis neurectomy - I have not heard of this. I certainly know all about implant "animation" - and so this is, again, a "first" for me to hear about. I will be excited to follow up on this also. Does your PS have any papers published on this technique? Please keep me in your posting loop so that I can follow your progress after surgery. Thank you for sharing this!
Deborah
EDITED TO STATE: I do see that in older literature, the low height tissue expander is referred to as "crescent-shaped." So yes, we have seen a number of crescent shaped tissue expanders used on members of these forums. It is a popular style of TE. There is a crescent or half-moon shaped expandable implant [Mentor] which is used for reconstructive procedures, although presumably not for breast reconstruction. ]
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Deborah,
Thanks for your informative message. Early in my DX I was in so much shock that I did huge amounts of research, and found Dr.Marchi Rigotti's work on this. Seemed logical, and since I have smaller breasts, and am put off by large upper pole recons, it felt right for me. The three PSs I interviewed before didn't use them. I was willing to go with one, but due to a number of communication issues, I chose to cancel her, then my BS suggested Dr. K., a man. Supposedly, a perfectionist. While he doesn't take my insurance, and it will cost a lot, he has a much smarter approach, I think. I met with him on Friday, and he laid out his first phase surgery plan that takes about 4-5 hrs. I will ask him what type of TE's he will use, the brand and size. I am having a skin-sparing BMX w/ SNB. A recent bi-lat. lumpectomy revealed that there is abnormal tissue in the nipple 2 cm margin, so they're gonna go, boo hoo.
He does procedures to remove the fat pocket left in the front of the upper arm, and fills in the SNB hollow.
I've only found one or two papers online re the neurectomy and semilunar TEs. None that he has written on the subject. Some docs are using botox, a cheaper route, and just as effective, but when I asked him if he would do that he told me about the neuroectomy method he prefers. He also makes a different type of dermal matrix pocket on the side rather than underneath. He doesn't cut pectorali muscle, nor does he suture the matrix to the serratus, (relief!) but does so onto the chest wall. All these things make sense to me even though I'm not a surgeon, I'm into anatomy, have been very physical and active my whole adult life, and intend on keeping my body as intact as possible. Hoping that opting for this more refined surgery will leave me with greater integrity in the recon, and thus less complications. you never know, though, but this is the horse I'm placing my bets on ;~)
Here's a list of what he'll do in the first phase of surgery, during the eight hr. BMX & recon:
Assist BS w/ BMX
Recon anterior axillary fat pad
Thin axillary fat pad
Pec muscle advancement to fill axillary hollow
Placement of TE
Incorporate Dermal Matrix
Neurectomy of Pec Major Nerves
Shortening of MX scar
So, let me know if you have any more thoughts on this. You are such a gift to this board in offering your expertise, wisdom, humor and support. I'm so grateful to have found BCO so early, and now to be having the benefit of your advice in this.
Best,
Melissa
PS I think he is probably using on of the "short" ones you mentioned, as he calls them "half moon" but will see him week after next and find out for sure.
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Melissa: A very interesting approach. But WHEW!! Out of pocket? We are talking $100K plus! This is the average cost for implant-based reconstruction.
I love the notion of filling in the axillary hollow! Shaving the SNB side armpit is a nightmare for many of us.
It is interesting that I am familiar with Dr. Rigotti's work in trials of stem-cell rich fat transfer for improving the outcome for the radiated breast, but I had not heard of the neurectomy studies.
Keep me posted!
Deborah
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Clarity: Also, discuss with your PS the use of fat grafting in the radiated breast after rads and prior to the exchange. And then at the time of the exchange as well. I posted the information above but I am copying it here for you to share with your PS...
If you are undergoing radiation and have tissue expanders or if you have had radiation in the past with delayed mastectomy and plan to have tissue expanders, please ask your PS about fat graft transfer during the expansion process.
Fat graft transfer to the radiated breast after reconstruction:
http://www.ncbi.nlm.nih.gov/pubmed/19484176
And one more:
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Bump
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Deborah,
My PS does these as a service to the women who must go through reconstruction, and he seems to love his work. He says he has successful results working with irradiated tissues as well. PS takes whatever my insurance pays for each surgery, and then is charging me 5k for the 1st procedure, then probably =/<5k each for the other two following procedures, so it will be 15k max, not bad for such thorough work. My decuctible & co-pay for my insurance is 12k, so in all, this episode of BC will probably be cost, 24-30k, not counting holistic healings. My hospital is fully covered by my insurance, as is the BS. I'll ask him what possible side effects can be expected from neurectomy of the major pectoralis muscle. As for armpit hair, have been getting waxed since '79, so hardly any hair there anymore, luckily. Having SNB both sides. Would advise those who will have SNB to get waxed there so it will be a while before the hair grows back. </p>
Melissa
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Melissa: What a wonderful surgeon to do this for bc patients! I will be so eager to follow your reconstruction journey!
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Okay Ladies: I finally figured out how to reduce the size of my pic's on TimTam's site and I called it "The unifoob that could!".
Deborah: Thanks again for all of your help-I added a few more pictures to the site that you haven't seen yet---let's see what he says today and if I will finally have an exchange date!
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Hi Whippetmom. I've been reading this forum for a while. During the time I've been getting my "fills" over the few months, I've been trying to figure out what size I want to be for my exchange. My exchange surgery is scheduled for 9/1. I would love your opinion on what size silcone implants would be best for me.
Out of this whole journey, it's been kind of interesting and fun getting my fills but, at this point, I'm worried that I won't know when to stop! :-) Anyway, I'm now 500 cc's and would like to go a little bigger for my final exchange. My PS does overfill prior to surgery. My expander ID card says Allergan 133MV-14. I don't see anything on the ID card describing the height of the expanders. I'm kind of interested in having implants in size 550 or 600 cc's. Do you think either size would be good for me, or if you have a different number in mind?
My ribcage is 30". My height is 5' 7", weight is 131#. I hope I gave you all the info you need, but if you need anything else, let me know. And...thank you SO very much! You mean so much to all us gals! Diane
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Deborah: I had my meeting with the PS and his team today. They were all impressed with how much I knew but I of course gave you 100% credit!!! He most likely is going to go with a 500-550 high profile, or at least that is what we talked about. He said he might do some lipo/fat grafting at the time of exchange but that I would need to do more, later. He said he will probably use maybe a 400 on the other side. We are aiming for the end of August for the exchange. Thanks again!!0
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Diane: I think 600 ccs in a high profile style, smooth silicone rounds, would be very nice on your frame. You need at least 600 ccs to match the width of your TEs in an HP implant. Make sure your PS is going to use high profile implants. The number you gave me tells me the width of your TEs - 14.0 cm. So I personally think that 600 ccs would be an excellent choice for you! Your PS could also order 650 ccs and he could determine, at the time of the exchange, which volume would be best for you.
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MBJ: I am sure your PS will revise and tweak these numbers in the OR - just to get the right volume in the native breast to match the MX side. It all sounds good to me! I am excited for you! Excited to see photos after the exchange!
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here's the new avatar ladies, me on the right, hubby (catboy) in the middle, daughter on the left....better?
Nope, I'm a girly girl
even if I am a 54 year old Disney princess.Yes, the cat (Emma) weighs 19 pounds and has a ginormous crush on Charlie, my husband.
It's both disturbing and hilarious. She'll climb up on him and when we ask her to give him a sweet kiss", she does. All this while holding him still with her arms around his neck. He's 6'1", and he can barely breathe when the little porker does it.
I'm used to women chasing him; but the cat is too odd.
Laughed so hard at you guys thinking that was me!!!
love ya
a
p.s. I'll try to find a bigger avatar, not great with doing this, but will try.
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Deborah: I modified my post on timtam's site--The PS team asked me if you had your own website and if this is what you did for a living!! I told them we should pay you, but that you do this out of the good of your heart. They were taking notes of everything you told me to do!! I was channeling you today, that's for sure. I am so lucky to have found you, this site and all of these women here!! I feel very luck indeed. Thank you from the bottom of my heart
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