BREAST IMPLANT SIZING 101
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Whippetmom: Thank you so much for your quick reply.
Here are my stats: height 5'5, weight 145 pounds, rib circumference 32 inches.
I have tisue expanders that are Mentor, Siltex style 6200, medium height contour profile, and their model number is 354-6213. I looked up online their dimensions: volume 450 cc, width 12.7 cm, height 10.8 cm, projection 7 cm.
Since I needed radiation on my right breast, it has become a little smaller compared with the left one, and it also sits now a little higher. The skin has recovered very well.
Thanks for your help
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try....
Your skin and PS permitting, I think that 500 ccs to 550 ccs in smooth round high profile silicone implants would be nice on your frame. You need to find out what is in the mind of your PS though. We might need to tweak those numbers and use a moderate plus profile implant, if he will not place you in implants larger than the expanders. We need to be careful, because of your history of rads, and so it might be necessary to be a bit more conservative. So at this juncture, it is key to start asking these questions. You would do best in an implant with at least 13.0 cm in width and the 500 cc HP is the lowest volume in this style with that preferred width. See what he/she is willing to do and then we can go over the numbers again.
Another issue to discuss with your PS is the subject of lipofilling during expansion. Studies have shown that it improves the texture and integrity of the irradiated breast and it can possibly lower the risk of capsular contracture. It is worth investigating further...
http://www.ncbi.nlm.nih.gov/pubmed/19471898
If these links do not work, let me know and I will PM them to you in text version. I just would be interested to hear what your PS thinks about this.
Deborah
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Ladies -- avoid that Breastcanceraware link... it appears to be some sort of bogus site where OUR posts are being copied! Check out this link to a thread on this subject from elsewhere here in BCO (I am very disturbed by this):
http://community.breastcancer.org/forum/67/topic/754912?page=1#idx_6
Apparently this site is copying our words (not our pictures or our names as far as I can tell). Someone on BCO thinks there's a virus there but I don't (I looked at the link posted by Jenn, who started the thread and who I know from another thread here). I don't know what to say except to boycott that site.
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Deborah if you roll your mouse over that link (without clicking it) you can see what it is a link to...
www.healthegg.com/women-health/breast-cancer-symptoms_symptoms-of-inflammatorybreast-cancer/
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Deborah,
The info you provided is SO helpful. For example, I do not actually know what 'overall' plan the PS has. I told her from the beginning that I would like to be larger than I was (of course not Dolly Parton type). I used to have a B cup. Initially the PS almost tried to convince me to go for a one step procedure (to place,I can only guess, small implants at the time of the mastectomy). I signed for both that and the 2 step procedure, but told her clearly I want to go with TE and then gradual expansion. Thank God I insisted on that. She placed TE with max volume of 450cc.
I think, my PS likes to go with small implants. I felt her pushing me in that direction. Without actually having had a chance to ask her yet, I believe her plan is to go with implants smaller than the TE. But of course, as you mentioned, the fact that I had rads on the right breast is a big factor.
From several of your posts, I see that the width of the final implants is very important. I understand that the width would give the fullness at the base. Do you believe the width is more important compared to the Moderate profile/HP choice?
So, based on your advice, I will discuss the general approach with the PS at my next visit in 3 weeks. Too bad I did not know all this before the TEs were placed. Maybe the PS should have put in 500 cc TEs or about.
One more question. With the TE sort of pointing outwards, my old bras do not fit any more. I remember reading you have Kaiser insurance, just as I do. Is Kaiser covering bras, or what is a good place to buy them from. I'm thinking especially after the final exchange. Hopefully the TE period will end in a few months.
THANKS AGAIN !!!!!
Happy 4th of July to everyone!!!
Donna
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Donna: I am also glad you had TEs instead of the one-step. That would not have been the outcome you would have wanted. There are specific candidates for the one-step and with everything you have described, you are not a candidate.
I think you are fine with the size of the TEs....it is just a matter of changing your PS' views on the exchange we have to work on a bit. My own PS [Irvine, CA] nearly always exchanges her patients out to implants larger than the TEs. For instance, my TEs had a volume of 425 ccs and my implants are 550 cc HPs.
I do feel that the width of the implants is important - as they relate either to the chest wall/ribcage or, in the case of unilaterals, to the opposing, native breast. I would much rather see an implant sitting wider on the chest wall than I would one where there is ribcage exposure laterally, because the implant is too narrow. You do have TEs which give maximum stretch/projection...7 cm....and if your skin does well, there is no reason you should not be able to exchange to an implant with only 50 ccs greater volume than your TEs. However, here are my three choices for you....
I like the 500 cc HP for you [Mentor] : 13.2 cm width by 5.3 cm projection.
The second alternative would be the 450 cc MPP, which is: 13.6 cm width by 4.2 cm projection.....the third, the 400 cc MPP, at 13.1 cm width by 4.0 cm projection.
Where are you located in the Kaiser system? You can PM me if you like with this information.
Deborah
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Is it common to lift the real breast before the exchange in the other breast? My PS will not lift mine until 10 months after the exchange.
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Dear Deborah-I'd like to ask your help. I've had a single mastectomy, and I'm very worried about issues of symmetry. How do you match the two sides?
So far, the expander side is way higher than the natural side. Pretty much all the volume is above the nipple, while on the native side it's mostly below, given age (56) and gravity. I'm wondering how much of this will get resolved with the implant exchange. Right now, it doesn't seem like there's much hope of matching the implant to the real breast.
So that leaves the question of what to do with the other breast to match it to the implant. My question to you is, what is your advice regarding the timing of lifts--to do them at the time of the exchange or to wait, and if so, how long. And what do you find people's experience is--I'm worried that what you gain in symmetry, you lose in sensation.
(One wrinkle on this is that I had breast augmentation three years ago. It was a regrettable decision for several reasons, among them, size-- I started out as a small 34B and ended up a 34D--larger than I wanted. So one thing I hoped to accomplish in all this would be to get back to a a happy-medium size of 34C. What I've talked about with my PS has been to size down the cosmetic implant and have the reconstructed side stay smaller.)
I would like to ask your opinion about what size implant I want to get to a 34C, taking into account all the caveats about bra sizes. I have two more appts scheduled for fills, and I would like to be able to ask the right questions as I prepare for surgery. Also, I feel there's an expectation that I should have an idea much I want to be expanded.
I am 5'7", weigh 140, my chest measures 31". I'll need to get you the model # of my expander. I believe it has a capacity of 550 cc, but maybe 500.
How do I go about sending photos--through the picture forum? I have been on, although not lately, and I'll have to figure out how to post.
I'm so grateful to you for your help.
Best, Joan
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I just realized Claire asked a question about lifts just ahead of me. Please forgive the repitition.
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Deborah,
Thank you for the information. I have saved your email. When the time comes to talk to the PS about the final implant I will make sure that she goes along the lines of you have mentioned.
I am at Kaiser Downey in Southern California. I work there, this is the reason all of my physicians are at Downey. Well, actually the oncologist is now at Baldwin Park, since I was dissapointed by the one at Downey.
Anyways, this PS was highly recommended by my collegues. She is very good, but I find her somewhat rigid. I prefer to have had someone else. However, I cannot go anymore for a second opinion to another PS at Kaiser. Since i am familiar with the Kaiser computer system, I know that the current PS would be able to see the other note. So, as you mentioned, I will have to work with this one.
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Claire and Joan -- I had a lift/reduction on my remaining breast and implant on my BC side. My PS did my lift/reduction at time of exchange. So during TE phase I had one very large natural breast (DD-DDD) and one TE. I was able to wear my old bras but did have to remove the wire from my TE side (PS is anti-wire). I was uneven for sure but my MX/TE was in December and exchange in May so I was able to wear sweaters and other things to disguise the difference. Most of the women who I've seen posting here on this subject had their lift at exchange (not at MX) though a few have had it at MX. I believe that questions about evenness can be addressed by the PS when the exchange (and lift) surgery is done. Although my final results are CLOSE they are not identical. I am now a D cup, which for me is a much better size for me (and looks much smaller than a natural D or even an augmented D).
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Dear Lilah--thank you. What kind of incision did your ps use for the lift? Did you have drains for the lift? How has your recovery been? Did you ever consider doing it as two separate procedures?
Also, can you tell me what you mean when you say you're a D but it looks smaller than a natural D?Is it that your breast fills out a D cup, but there's less fullness underlying/surrounding the breast?
Thank you so much for sharing. Best, Joan
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My lift/reduction incision is the lollipop (they cut around the areola and move it up, then an incision that goes straight down from there to the IMF. I think it's going to heal really well. I was reduced from a DDD to a D (which is probably half the size it was but still a good size). I still have feeling in the nipple too, which I was pretty happy about (apparently you CAN lose feeling there). If you don't need a reduction, if you just need a lift, I think some doctors JUST cut around the areola without the incision from the base of it to your IMF... THAT surgery leaves you with no visible scars. Since I needed the reduction as well I had the lollipop. I did not have a drain on the reduction side (which I HAD because I ended up bleeding and bruising a LOT on that side post-surgery and now have a longer healing period there). I did have a drain on MX side and so recovery from exchange was very easy. I did not consider doing it as two separate procedures because (a) my PS said this is how she does it and (b) I wanted it DONE! I did not not want two surgeries if I could have one.
Re: size... I find that a lot of the women here who wear a D cup and know women with natural D breasts say that though the D is the right size for them, they are not as large as the natural D. My implant fits the D cup bra and my lift/reduction breast also fits but without a nipple on my implant some bras can bag a little where the nipple should be. I think width-wise we are definitely D's but it's more to do with projection. Natural breasts will always have more projection than implanted breasts. Since my natural breast was reduced at time of implant, my PS was able to get a very good match in that regard... my implant is pretty much the same projection as my native breast (and I think once there is a nipple it will be exact).
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Thanks, Lilah--you sound very happy with your results. You have more nerve than I do right now about surgery on the other breast. And my PS has been kind of vague about a lift, maybe because he sees I'm anxious and doesn't want to push it. But his PA didn't pull any punches about it the last time I was there! I have 8 weeks to go, so we'll see. Best, Joan
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Joan -- I really did not have much choice about surgery. I could have had a bilateral MX, which would have made matching easier (and would have removed MORE worry I suppose) but I found it really hard to decide to even remove the one breast... in retrospect the MX was far less traumatic that I thought it would be. That said, I'm glad to have kept one breast -- especially since I do have feeling in the one nipple. Anyway, once I decided on a unilateral MX it was imperative that I do the reduction because the size was way too large. In truth, I had considered reduction at other times in my life but was always reluctant to have scars -- ha! All in all, I'm lucky because my scars are relatively minimal. It sounds like a reduction/lift is not an absolute necessity? If I were you I'd really grill my PS on the subject. Even with all that I've had done my two sides are NOT the same but close enough. My PS said I would look good in a bra (in clothes) and that is certainly true. I also think I look ok without clothes... and fortunately I have a partner who doesn't care (he's just glad to have an alive, cancer-free me
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Claire and Joan:
I see Lilah has addressed most of your questions. I would agree that most women have their lifts/augmentation in the native breast at the time of the exchange. Some have waited a few months after the exchange, as sometimes the PS wants to wait for the implant on the MX side to drop and settle, because they feel this is the best way to achieve symmetry.
This will address the use of an implant in the native breast - something Joan inquired about: Go to the pictures forum and look at sandysunshine's photos and Nedeza's photos. I have already bumped them up for you. If you want to send me photos privately, you can email them to me. PM me if you want to do so. The most consistent results at symmetry seem to be achieved by the use of an expandable saline implant in the native breast and a silicone implant on the MX side. The MX side implant is inserted first and then the expandable implant can be placed in the native breast and saline can be added or extracted during the surgery. Joan, in your case, I would need you to get your TE data - I need to know the width of your TEs - to discuss implant sizing.
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Question: Deborah, since I don't require a lift, should I be concerned with the height of my TE? Or is this natural? Will it come down with the exchange and look more natural or is this something I am stuck with? Thank you!0
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Copied from my answer on EC:
[But I will add that you are perky enough and this is why you do not need a lift!]
MBJ: RE: the height of your TE: Well, the height corresponds to the style of the TE and the more projection you have, the taller the TE on your chest wall. But it is the projection which will be used to give you some "droop" or "ptosis" to match the native breast, and I am sure your PS will use this to his benefit at the time of the exchange. It is just fine...not to worry....
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Thanks Deborah! Perky, I like perky! I hope that they can get a good match with her!
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Whippetmom or ladies- I have a question I have 133FV TE allergan (full height) and the port which is supposed to be on the top has slipped to bottom on the right side. Is this ok or can the TE rotate out of place and if it does can this be easily fixed?
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Wow that's a lot of movement Sweetie! Since the way they find the port is with a magnet, I imagine that they can continue to access it wherever it is. You should see your PS about the rotation though...just in case there are other issues. (Or wait for Deborah to respond
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Lilah-thanks hon! I just got off the phone with the nurse. She said she is going to talk to the Dr. As you imagine this week is busy for them! She said all TE are round so it should be ok, but he may try to move it, but she has to check. Sigh...i just want to get the fills going! How are you doing? Is your gummy settling in nicely?
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It is! I am doing well... even getting (I think) a little droppage and fluffage
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Lilah-I am glad you are doing so well and liking your result. It's encouraging for us "gummy girls" Do the gummies drop and fluff a lot? I'm still sooo undecided about size and need a serious talk with my PS!
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I don't think they drop and fluff the way regular silicone does, Sweetie... because they already have their shape, for one thing, and because of the way they stay put in their pocket (due to textured surface). So the changes are smaller. Regular silicone drops because of gravity moving it's round shape... and that gives the appearance of fluffage
(At least that is how I understand it -- Deborah?)0 -
Yes Lilah!
Sweetie...just as long as it has not rotated or changed position in the pocket to the extent that it is impacting the pectorals or putting your skin at risk. I would like for the PS to see it though....
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Whippetmom-just heard from the nurse. The Dr. said it should be ok as long he can still access the port. He thinks when he starts to fill it it may move more into correct position. It doesn't seem to be bothering the skin or pecs,but it just feels weird like it's backwards!
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Hi Deborah--I did see the photos of sandy with the expandable implant--they look great. In my case, though, I already have a cosmetic silicone implant. I don't know if I'd be a candidate for the expandable since I already have the pocket for the silicone. Do you know?
I actually want to go down a size, so what we've talked about was swapping that for a smaller implant--probably all the more reason I'd need a lift. It really is a moving target!
In any case, I want to show you pictures of what's happening so far with the expander, so I'll get to work on that.
Thanks, Joan
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I'm a little confused about something. Some women say they come home after exchange swollen so they are bigger than they thought they'd be. Then others say they are smaller than they thought they'd be and are told they have to "drop and fluff". So am I going to get bigger or smaller or is there any way to tell?
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Joan: You could go with a smaller implant and it could indeed be silicone, but the expandable implant would work just fine as well. It is your choice! I think that perhaps because you already have the capsule formed for an implant, you might stick with silicone. I have a question re: that augmented breast though: What size and style of implant was used? It might be that the style of implant is giving you the unwanted appearance, so before you start decreasing in volume, let's go over what you now have and see what might give you the results you want to achieve.
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