BREAST IMPLANT SIZING 101
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Hi Jane:
Read above what I said about height, weight, ribcage. Also, I need the "total recommended volume" of your TEs. Will they hold 300 ccs...400 cc's.....500 ccs? And then the part about "Questions to Ask your PS".....read that section. But also, as I stated above, there is more to calculating size for a unilateral than there is for a bilateral as symmetry becomes the primary focus. If you want to post photos on the pictures forum or email them to me privately - PM me.
Deborah
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Thank you
I will follow up.
Jane
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bump
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Hi whippetmom-- I'm hoping you might be able to help me, as I plan to downsize to smaller implants. I have been reading this forum since my bilateral mastectomy on Dec. 15, 2008. It has been very reassuring to learn from the experiences of others while on this post-cancer journey, through chemo and breast reconstruction. At first I wasn't planning to do breast reconstruction, but I realized I really missed having breasts, especially when I tried to wear my summer sundresses and tank tops! My TE's were put in on June 15, 2009. I had a problem w/ one rotating and had surgery to correct that. My PS recommended Mentor silicone implants and we discussed size as he did my fills. I ended up with 450cc high profile, to give me the 34C/36B that I was before. I am 5'5" and 116 lbs. My exchange was on October 9, 2009 and even though my new breasts do fit my old bras, I immediately felt that I was too big. Also my new breasts are very low, heavy and do not have a nice slope at the top. I then learned this was because I am a thinner person and I have high profile implants. My PS suggested I have fat injections to help the slope. So, when he did the nipple procedure on Dec. 21, 2009, he also did fat injections on the top of both breasts. The plan was to try and get my new breasts looking good...and hopefully, I would learn to love them. But, I'm just not at all happy with the fact they are too low, big and heavy. And I don't feel like they are 'me'... If I had known then, what I know now, I would have asked for smaller implants. (At the time, I thought my PS would know best and give me just the right breasts! Ha!) Yesterday, I met with my PS and we discussed doing an exchange for smaller implants. Although he had previously said I could go smaller, even after getting nipples, he pointed out the possibility of the nipples pointing downwards, if he lifts the bottom up and puts in a smaller implant. Again, if only I had known that, then I would have held off on getting nipples! We did discuss going down to a 350cc moderate profile silicone implant, with a slight lift, which will involve lots of tight stitches at the bottom. It's still feeling tight and uncomfortable from the previous inframmamary incisions, so with any luck, it won't be too much worse. What I'm really hoping for are nice, smaller, higher breasts (maybe a 34B?) with a good slope at the top. I've tried to find photos of gals my physical size and so far, I'm thinking I should have implants somewhere between 300cc's and 350cc's, and a moderate profile would be best to help with the slope. But, I'm really worried about ending up the wrong size, again...so, I'd very much appreciate your thoughts.
Thank you!!! Chris
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Chris: I need you to email me photos or post them on the pictures forum. Something else is going on, because 450 cc's in a high profile implant should be just perfect for you. I am afraid you are going to be unhappy with downsizing after nipple reconstruction. I think you might be trading one problem for another. I need to see how those implants are sitting on your frame. Also, reassure me that you have Mentor high profile implants. Do you have your little card with this data? I like for you to "see it in writing" - just to make sure the profile is accurate. I need your ribcage circumference as well.
Please PM me and I will send you my email address for photos if you wish to do this privately. If you have pictures forum access, you can post them there as well.
Deborah
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Thank you, whippetmom-- I realized I forgot to supply my ribcage circumference. It is 29 1/2". And, I just found my little card and it reads: Mentor Smooth Round High Profile Gel, Ref 350-4504BC for each breast. My PS also confirmed I have 450cc High Profile, when I met w/ him, recently.
I don't have access to the pictures forum, since I have just been reading and not posting over the past year. But, Timtam said I might be able to access it in the future. I will take some photos and email them to you.
Thank you so much for your help! Chris
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Hello Whippetmom...I am sort of new to this forum, but have been reading thru all of your info and found it very helpful...thank you so much. I had a bilateral Mast in July of 09, with tissue expanders. I'm scheduled to have my exchange surgery on 03/08/10. I have Allergan 133SV tissue expanders, the right side is filled to 420cc, and the left to 375cc. I think they are 375 cc tissue expanders. Right now they seem to be very wide, and go under my armpits quite a bit...will this be different after the exchange? Also, how much more projection do you have with the implants then the expanders? I am going to go with Saline. Thanks again for all of your info!!!
pinkribbongirl
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Pink: Your TEs are short height, variable projection and this style has the tendency and inclination to take on the unattractive shape of a football. They are designed to expand in the lower pole where projection naturally occurs and avoid expansion in the upper pole. They are a good style - I happen to like them - they are just sort of wonky looking during expansion. I cannot give you much further information about sizing without some additional information - height, weight, ribcage - as outlined in my original post above. You can always PM me with that info if you want discretion.
Deborah
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Hi whippetmom,
I am 5'11" and weigh about 150 lbs, my rib cage circumference is about 29 1/2. I'm not sure what type of implants he will use...maybe Allergan since thats what type of expander he used. He said that he would probably bring in 400 to 450 cc expanders and use whatever looked best. I don't want to be huge, but I don't want to be flat either. I was probably a medium saggy B cup before surgery (gotta love the results of breast feeding 3 kids!!). So by expanding the lower pole, will they still be flatter at the top? Also, what about them going so far under my arm pits?
Thanks again for all of your help and info!!
pinkribbongirl!
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Pink: I feel you need to push for at least 450 cc's. I would have liked to see a little more volume for your frame - 500 cc's, if possible. You will be a candidate for two implant styles. The first is Allergan Style 20 - a high profile silicone round. You might also be a candidate for the Allergan Style 45 - if you have a long torso and a sternal notch to nipple [imaginary nipple if you have not had a NAC-sparing mastectomy] distance of >21 cm. If you go to Exchange City and find Page 99, I have a pictorial chart listed which will tell you how to properly measure and then a calculator which you can use to convert inches to centimeters. So....the Style 45 implant is narrower, which would be appropriate for your smaller ribcage, but it is taller and has greater projection. It is not the same type of projection as you are getting with your TEs, however. The short height or low height TE is designed to expand in the lower pole and to not stretch the tissues in the upper pole or pectoral region. The goal is to avoid a step-off defect or contour deformity at the top of the implant. This step-off defect occurs more often with women who are thin and have little tissue coverage over the ribcage. So the style of TE which your PS used is designed to help ameliorate that type of defect. The lateral encroachment of the TEs under your armpits will be corrected at the time of the exchange.
Deborah
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Whippetmom,
I have a question sort of related to sizing and sort of not. I have a 250cc mentor siltex low-height contour expander filled to 265cc (which puts me at a full 34B)--the smallest that mentor makes from what I understand. Chest circumference is around 29. I say around because my expander is about an inch too low,( something that will hopefully be corrected at exchange) so I actually measure about 28 3/4 but before mastectomy as best I can remember I was exactly 29" below the imf. I am 4'11" tall and 105 lbs, very small frame. When I say very small, i mean very small. THough I am 34 I have to wear juniors size clothing because womens sizes are always too wide. I tell you this all so I can ask this question.....I am planning on exchanging with saline implants as I am just not comfortable with silicone. Do you think it is possible, with my very small size that I can get a good cosmetic outcome with saline? I have a relatively small peck muscle and very little tissue on the non-mx side (not even enough to fill a AA cup). My PS says I might have some rippling or be able to see the outline of the implant translating into an unnatural appearance. He really isn't sure exactly how this will look as he has never worked with a patient as small as me (and he works for MD ANderson in Houston, TX!) I am really nervous and wondering if I should just forego the reconstruction alltogether, since I am so small on the other side anyway. What kind of outcome do you think I will get?
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Hmmm....interesting question. I have a couple of thoughts here. Since you want saline, ask your PS about using Spectrum expandable saline implants. Smooth saline ONLY! This way he could gradually add the saline, allowing time for the skin to adapt and add or remove more as desired. Then once you are happy with the volume and appearance, he seals it off and voila - you are done! [I do not really know of anyone who has used the expandable for other than gaining optimum symmetry in a unilateral MX...used on the healthy breast for augmentation, but this might be something to consider in your case.] Here is the Spectrum chart:
http://www.justbreastimplants.com/implants/mentor_1400.htm
In thin, small-framed women, yes - rippling can be pretty bad with saline implants. The method used above might be one way of ameliorating the problem. The rippling can be masked well and concealed with the right bra - so in clothing you will look just fine.
So why are you against silicone? I investigated the silicone breast implant controversy back in the 1990's. I dissected hundreds of medical records and performed research ad nauseum regarding silicone safety....and I did not think twice about using silicone for my own breast reconstruction.
If you have had radiation and want the reduced CC risk with saline or if you have some other reason for being against silicone, I understand. [BTW: An expanded response has already been sent to your message box.]
Talk this over further with your PS. I'll be interested on his take re: the Mentor Spectrum expandable saline.
Keep me advised!
Deborah
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BUMP
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Whippetmom,
I wish I had known about this site a few months ago. I googled for info on tissue expander pain and size info and have picked up so much info reading here! I am scheduled for exchange on 3/26/10, I had PBM on 11/2/09. I sort of look at it as my 50 year old birthday present to myself. My mother and grandmother died of BC. After a couple years of abnormal mammograms, microcalcifications and 2 biopsies I knew this was the right choice for me. I had no problem making the decision to have surgery and the recovery had only a couple issues. But now I am totally clueless and every time I ask the PS or nurse questions I can't understand the answers.
I hope you can help me with some implant questions. I just got a copy of my surgery report yesterday at what I hope was my last fill. I have Mentor TEs, 354-6311 Siltex tall height contour, 250cc volume. I was told the capacity is 500cc. I am now at 325ccs, and for me I feel huge, bumping into everything. 250 was fine but 300 was painful for 8 days. I just had 25ccs and it wasn't as bad but I don't think I want to do anymore. I felt at 250 I fit my old bras pretty well and looked bigger than the almost B that I was. My PS does overexpand. My implant will be a smooth round Mentor (75% sure I'm going with silicone) and for reconstruction they use high profile. I am 5'2", 104lbs, 28" ribcage. I'd like to be a full B. Am I wishful thinking with only a 250 or 275 implant? My skin is thin and so tight now, I might have to settle for a "perky" A!
There is a problem with my right TE also. It has always been about 1/2" higher than the left. The PS says she will "try " to correct this at exchange. Do you think she can? Or is she wishful thinking...
Hope this is enough info for you. Thanks for being here for all of us!
Cindy
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Cindy:
I perfectly well understand your decision to have a PBM. My sister did the same four months after my breast cancer diagnosis. We also have the family history you have as well.
I feel that you need some additional width on your frame - if even an additional centimeter! I am hopeful and see no reason that you should not be able to exchange to at least the following:
Mentor High Profile standard silicone round implants: 300 cc's. This would give you a width of 11.1 cm and a projection of 4.5 cm. I think you at least need this to achieve the look you want. It would be better to wait three months for the exchange. Stay where you are at 300 cc's and let everything settle and heal and then go through the exchange.
I am a little concerned that your PS states she will "try" to correct the TE defect at the time of exchange. I have never heard of it NOT being corrected! About 30% of those undergoing tissue expansion experience some distortion with their TEs - usually with TEs migrating towards the armpits and second by implants moving too high on the chest wall. I have never heard of a PS NOT fixing this at the time of exchange. Well, I should say I have seen this not repaired at the time of exchange but I consider this a botched surgery. She just has to lower the implant and recreate the inframammary fold and I can send you the link to the repair manual for this if you need it. Frankly, I would tell her that if she feels there is any doubt that she cannot do this, perhaps you should go to someone who will be able to do so. Ask her if she has had a TE migrate like this and repaired it successfully at the time of exchange. This is very important....we want to get as much right the first time - with the first exchange. So ask these questions and if you need to - email them to her or fax them to her. You have every reason to obtain answers to these questions. Let me know if you need anything further. Once you have been posting here for awhile - you can have access to the pictures forum. It is a private forum separate from bc.org.
Glad you found us! Come over and join us on Exchange City for further discussion.
Deborah
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Thanks Deborah for bumping the implant smaller than TE thread. Good info there and I understand things a little better now
Navy
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Whippetmom,
Deborah, thanks so much for your help! The nurse who has been doing my fills had also said that I'd probably need the 300 to get a full B. I don't know why my PS (at Johns Hopkins) waits only one month after the last fill to exchange but I'm OK with this. My exchange will actually be 6 and a 1/2 weeks later. We were just notified that our insurance is changing to another carrier beginning April 1, so I'd really like to have surgery in March. I probably can't be denied but I just don't want any headaches at this time.
I will definitely have a pre-op meeting with the PS and tell her she needs to get the height correct. That is more a priority than size! I was told I didn't have much skin after the mx and my TEs weren't even expanded at surgery. As soon as I got home I noticed the right was higher. Luckily it hasn't moved higher, but it would nice if it fell a little! I do want as much as possible to go right the first time. Just like everyone else I want it to be the only time!
I have a small family, two brothers. I have one aunt, 8 years older than me, with 3 daughters age 25 - 35. None of them have had any breast issues, and hopefully they won't! Did your sister have TEs? How is she doing?
Today we're dealing with about 15" or more of snow on top of 30" that fell 5 days ago! My yard looks like a white desert. Hope you're not in the rainy area of CA.
Cindy
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Cindy, While I was waiting for my exchange, I started squeezing the top of my expander (so that the bottom was filled out more)....kind of like a mother cat picking up her kitten. It really helped to soften up the muscle and made my expander so much more liveable....also helped it to drop ever so slightly (which was a good thing). Naturally you should check with your PS before doing anything. My PS wanted 2 months from last fill to exchange. I chose 4 months because it fit my schedule better. My expander looked & felt so good that my oncologist and my gyno thought it was my implant. I was acutally nervous that my implant wouldn't look as good as my expander....LOL....needless worry!!! Best wishes
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Ruby: Great recommendation for correcting this defect! It never crossed my mind to attempt this manipulation with the tissue expanders, but since you have done it successfully, I will refer them over to you!
Cindy, perhaps demonstrate this in front of your PS and tell her you would like to try to self-correct this over the next six weeks while you await your exchange.
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Hmmm... good idea. Thanks! Mine don't seem to have much give in them but it's worth a try. I'll check with the PS first though.
Cindy
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I had my unilateral Allergan 20 350 cc implant put in on 12/10/09 and my other side lifted. After all swelling is done, now 2 months later - both my PS and myself think that while I am "near perfect" - I might be even MORE perfect if I switch down to a 325 cc implant - which has slightly less volumes and slightly less projection - the sisters may look almost like twins!! A it is right now - its pretty good - but you know - it might be even better! Do you know if having a larger implant in for two months would have stretched my skin and going smaller (even though only 24cc's) will cause a skin sag?? Or will there be increased internal scarring due to a new surgery??? What is the experience on this kind of thing??? Thank you!!
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Sorry for a few typos above, my keys are sticking - it is a 25 cc reduction in the Allergen 20.0
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biscuit: Downsizing 25 ccs should be fine. It is a very small amount really, but if it is a matter of fine tuning or tweaking just that minute amount to get "perfection", then that is what you do. Many women go through a second exchange procedure without complication. I do not think that two months is long enough though. What if you saw some changes in the next few months which would make surgery unnecessary? I would say go ahead and schedule surgery, but schedule it out two or three months from now at the least. I frankly think that I do not have the "fullness" I had six months ago. I am eleven months status-post exchange surgery. My skin has softened and relaxed and I just do not look as round and "out there" as I did in the six months after surgery. So that is my take on this....that for 25 ccs....it might behoove you to wait and watch another few months.
Deborah
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Hi whippetmom (the expert as far as I can tell!)
I am new to this site so I am posting in a couple places...forgive the newbie
My name is Kristen and I was diagnosed with BC on 10/20/09 then had double masectomy with tissue expanders placed on 11/25/10. I went through a lot of unusual pain (according to PS) so much so that I wasnt filled till 6 wks post-op. I had two total fills and after last one developed a red spot where a courner of my expander (skin thin here--expander right there) seemed to be irritating from the inside out. PS went safe and said no more fills, lets schedule exchange for 2/25/10, maybe stretch you a little more right before surgery, and he will bring in to op room different sizes of implants to try to get me a little bigger (was smaller than an A cup and would like to be a solid
. I wanted one more fill to get a little bigger than I am now. I am 5'7'' and weigh 125lbs. My skin was left very thin on left due to cancer. The help I am asking for is this: What questons do I ask PS on tuesday 2/16 for last appt before exchange? Will I be able to get a little bigger with possibly not be stretched anymore with him trying diff. sized implants (silicone)? I dont know off hand what brand he uses. What will I see after operation--can I get in on the private picture forum please?
Thank you for your support and advice
Kristen
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Kristen: You will need to send a private message to Timtam, who is moderator and guard-at-the-gate of our very private pictures forum. Here is her link:
http://community.breastcancer.org/member/11047/profile
Referable to questions to ask your PS:
1. Could you use Alloderm at the time of exchange surgery? Below you will find info on Alloderm grafts, which many of us "thin-skin" gals and even those w/o thin skin have and it provides a "sling" in the lower pole to support the implant. Most of us had Alloderm placed at the time of tissue expander placement. This would help and possibly eliminate the risk of implant exposure or skin breakdown.
I would have other questions but I need to know how many ccs you currently have in your TEs and if you have any info about them - the manufacturer, style, recommended volume.
I need your ribcage dimension [see my original post above]
Right off the top of my head, with your height and weight I am thinking at least 400 to 450 ccs. Possibly a high profile implant if your ribcage is 32 inches or less...
Deborah
ALLODERM:
http://www.lifecell.com/alloderm-regenerative-tissue-matrix/95/
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Hi Deborah
Thank you very much for responding. My PS did use alloderm at time of operation and says he will use more to reinforce thin skin. I will be made completely of this stuff.
Info: my ribe cage is 29 inches. My TE is an Allergan 133MX-11 that is 11cm wide, 10cm high, and 5.9cm projection. Manufacturers website say 300ccs suggested capacity. At time of operation (pretty sure on this) I had 180ccs with two fills both being 60ccs equaling 300ccs on each side. (I will be able to confirm this Tuesday 2/16 when I see him).
I am a little pissed that I am may be maxed out and he has never said that exactly. My frame and thin skin has always been an issue though. Plus I have this red/burned looking spot at the out corner of right expander where it pokes out (not literally) towards my armpit. This is the spot where both surgen and PS said no more fills because maybe my body is saying it cannot stretch anymore. I did want to be a little bigger--maybe another 50-60ccs on each side. What do you know about women like me that go in for exchange and have a larger silicone implant placed bigger than expander? is this done? Are there any other questions that you can think of to ask PS on Tuesday 2/16 when I go in? (I am not sure of brand of silicone implant he uses but I will find out)
Thank you very much for any advice or time you give me...i am grateful
Kristen
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Kristen: My answer to that question re: "implants larger than expanders" is that many of us - perhaps as much as 75% of us - have implants with a volume greater than our tissue expanders. I know Val61 had less expansion [less than 300 cc's] than you, and she has Allergan Style 20 in 425 cc's. My TEs were filled to 425 ccs and my implants are 550 ccs.
Your skin integrity issues though present an argument against too much volume. In your case, I think I would wait as long as possible for the exchange. Give that skin several months of healing. You definitely need a high profile implant and we probably need to keep the pocket as narrow as possible - within the parameters of your TE expansion, if you have "issues" with the outer aspect of your TE currently. Therefore, a Style 45 - ultra full projection implant - might be a strong consideration also and with your height and slender build - it might be an excellent option.
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Deborah
Unfortunately it seems I do not have an option of waiting any longer. My PS told me 2/25 for the exchange...14 weeks from original operation(11/25/09). He told me that spot that is irritated will remain so until he backs it up a few layers of Alloderm. Besides my 'spot' on right I have three hard stiches that look like pencil points that are pushing through my skin on the left . One is so close to the skins surface that I have to check it through out the day so that when it does acctualy come through i have to call the PS right away. That with the right side issue seemed to say to the PS that it was my time for exchange. Plus I am a teacher and have gone through the hassels of setting up a sub for a week and a half, writitng a letter to the superintendent and having the union try to get me more sick bank days. Your first paragraph about larger expanders gives me such hope! Thank you so much for all of your help and insight!!
Kristen
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Kristen: You just have to go over all of this with your PS and let him know how important it is for you to exchange to implants with at least 400 ccs. Since you work and have these other skin issues, you do not want to have to do this a second time!
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Deborah...I know I'm probably too early for this thread but I am trying to understand. I'm just 3 weeks post op from a BMX and I have Allergan 133MV Tissue Expanders with 500cc capacity.
I was originally a D cup but told the PS I wanted to go down a cup or 2 in size. I asked him if he generally gives an initial fill during surgery and he led me to believe he didn't really do that routinely but when I woke up they told me he was able to fill each TE with 250cc so I'm half way there. I do have this weird 'dimple' on each side of my pectoral muscle that has sunken in...directly under my collar bone that I'm not too happy with...is this normal? Will it go away?
I'm due for a fill in a week. He likes to go slow and fill 60-100cc every other week and said he can overfill the 500cc but I don't think I want to go that big.
I'm 5'6" small boned and my weight has been fluctuating. I'm around 135 and I would like to stay there My rib cage measurement is snug 32" relaxed 33".
I want silicone in the worst way but the PS is really really really pushing saline. He claims 95% of his patients get saline. In the event I get my way...what do you suggest?
Thanks in advance for your guidance!
Kat
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