BREAST IMPLANT SIZING 101
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JJMD: Absolutely! Please do not go through with the nipple reconstruction if you think you will be downsizing.
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I see my ps tomorrow for a one month check. I think I already know theyre a little bigger than I wanted to be. In clothes I guess they look ok, but looking at myself naked they look much too big. I know some side work will be done, but dont think that will help with the projection I see when looking at myself. Itll be interesting to see what he says tomorrow. I plan to ask about the concept of going down a size also. I know its early so will see what he says about how long to wait before doing further work.
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Thank you so much for you input DiveCat and Dulcigirl. Dulcigirll, I am glad for you that you ended up with a result that you are happy with. I think I need to have another consult before the nipple reconstruction.
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Hello Whippetmom,
I have a question. I have met with my plastic surgeon. Just a preliminary meeting since I hadn't decided whether to go with LX or BMX. My breast surgeon (who I love) forewarned me that he is very good at what he does but is very dry, to the point, and not a real personable guy. I found her description spot on but still trust her judgement. He explained my options to me while strongly urging me to go with TE and implants which is what I want. I have decided to go with BMX and need to go back to see him again. At my first appt. one of his first questions was "what cup size are you?" Honestly I don't know. I always wear sports bras. Have never been a Victoria Secrets kinda girl and have never been professionally measured. I honestly would like smaller breasts when I am all done with this. I was always small until I turned 50 and put on a few pounds which I intend to lose after all of this. What is the best way to convey this to him? I have a feeling he is going to just look at me and say "o.k. what size do you want?" I've looked at the pictures on the forum and it looks like most everyone goes a little larger than what they started with. I absolutely do not want that! Or can you direct me to pictures of women that went smaller and post how many cc's and what kind of implants they went with? Sorry to carry on but this petrifies me. I don't want to spend the rest of my life unhappy with the outcome.
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- KLJ: What is your height, weight and ribcage circumference? Measure like this....
0 - KLJ: What is your height, weight and ribcage circumference? Measure like this....
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It is also quite odd that he asked you your bra size. He should be measuring you, as your TE width needs to be chosen in close proximity to the base width of your native breasts. Bra manufacturers differ in band and cup size, and US women typically wear the wrong bra size to begin with. One mfr might have you in a 36 B, while in another style or maker, you might be a 34 C. Crazy question to ask you.....
Perhaps he performs more augmentations than breast reconstruction procedures?
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KLJ:
My PS did ask me my current bra size, but that was more like "interesting notes for his file" (and I know my size is accurate as I get professionally re-fitted about once a year). It was not at all determinative of my goals for surgery (or rather, our mutual goals) which we discussed in detail. I want to be a bit smaller too. I am 5'4"/116-118 lbs, and very active, and have always thought my breasts (32DD) were a bit too big for me. He took all sorts of measurements (from IMF to nipples, from collarbone to nipples, width of each breast, ribcage, etc) to determine the appropriate TEs for me and to contemplate the future implant. So, I am not sure why your PS (or mine even) NEEDS current bra size as, like whippetmom said, it really isn't what they should be basing the information for TEs or implants on. Though that he asked for it does not mean that you have to recreate that size!
You should discuss the possibility of going smaller if that is important to you in advance of surgery, as it can affect some things like options and your surgery itself (like whether you can do NS, or direct-to-implant, or whether you might need a reduction or lift first or during a revision). This is YOUR surgery, your body. You need to be clear with your PS AND you need to be comfortable with your PS as you will be seeing a lot of him/her AND there will be many questions along the way. You need to feel comfortable raising them and letting your PS know what YOUR goals are. There ARE personable PS's out there if you don't feel a fit with this one!
Anyway, as I said I am also aiming for smaller, but as I am doing a NSM there are some limitations to how small I can go without affecting nipple placement too much, though some of this will depend on how things go after BMX and through expansion (as in perhaps my skin is elastic enough to shrink up quite a bit after surgery and to allow a smaller result). My PS intends to take out some skin from above the IMF during the initial BMX/TE placement if it won't compromise the nipple placement too much, and then he said he can do a small lift at my exchange or at a later revision if I still need to take out a little more to get me to the smaller side of things that I want if my skin has not cooperated enough in shrinking smaller on its own.
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Hi Whippetmom!
I'm finally posting after reading all the rave reviews about you.
I'm 4 weeks post op BMX and am feeling great. I'd like to hear what your recommendations for me as far as implants go. Here are my stats:
Height - 5'4"
Weight - 167
Ribcage - 38"
Style of TEs - Allergan 133MX-15-T (700ccs)
I'm currently at 330 cc's and am already looking pretty close to what I was before (C cup). I didn't ask my PS if he overfills, but I've heard from other patients that he does. I was told by his PA that I can do the tight, white Tshirt test and let them know at any time when I'm ready to stop. So far, there is a small dent in the upper portion of the left TE - is this normal? That is the affected side. And it looks more "puffy" on the side near the armpit, but I had 17 nodes removed, so it could be swelling. Also, it almost looks like that TE is slightly lower than the other one, but everyone says I'm looking great. Should I send you a photo?
I've heard that the gummies are a good option... any thoughts on those?
Thank you!
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bc101: I just do not think Allergan 410 anatomicals are a good option for you, if that is what you mean by "gummies", because there is no comparable implant to fit the dimensions created by your TE. Well, I should say, there IS a corresponding anatomical, but it is not a style currently FDA approved. So you could still use a Sientra implant - which is also a true cohesive gel "gummy bear" style implant. However, I do not think there will be a size in Sientra which will be adequate for what you need. You can send me photos. I will PM you with my email address.
Deborah
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Saw my ps today, 5 weeks post exchange. While he does say there is still alot of swelling, he was completely open to what I had to say about how they seem. For starters he reiterated what he said right before exchange- that he will lipo around the sides, and that will help alot with the wideness of the things. Then he said because of the amount of tissue (not fat to lipo out) on top of them (anatomicals 410s), he recommends switching to a round-- and go down to about a 320, from the 400 approx size my implants are now. I told him that while I look I guess fine in clothes- when I look at myself I look quite large. He also said (because I remarked on how hard they feel), that the rounds would be softer. And use a low profile. So Im pretty happy with the plan. I see him again in 4 weeks for another check up and then get a time table for the swap out.
Of course I forgot to ask brand of the rounds, but oh well.
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aviva: What does he mean by "low profile" round implants? That sort of alarms me a bit. How low? You need the same width as your anatomicals. What is the style and volume of your Allergan 410s?
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I pm'd you- but will post here what we said, I just wanted my facts straight before I shared publicly. I dont mind otherwise. I asked about pocket work for the different shaped implant, and he said none to very little would be needed. More stated how the lipo would help with the width issue.
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I called my ps office to find out what he would plan on- theyll call back. But Im almost positive on the silicone. They use Allergan I think tho she said he started using Sientra also, so will see what she says after she asks him.
I looked at the Allergan brochure, link at the top of the page, and saw the current width of my 410s (13.0 and 13.5 ) and projection (5.2 and 5.3cm)...generally scrolling thru the rounds, for the cc he was saying, they seem more narrow, so will have to discuss more how that will work. Tho the projection (3. something) sounds alot better...And see what Whippetmom suggests
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Aviva, I switched from rounds to anatomicals and had to have a lot of pocket work revision. It made recovery take longer and was the cause of pain that felt like I'd been hit across the lower ribs with a baseball bat.
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I would think there would need to be some. I have been reading you guys saying how the pocket work is difficult, and lipo also. So would be a harder recovery than the original exchange. But Im ok with that to get to a place I will be comfortable with in the long run. Any fix ups are a few months away anyway...
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aviva: I think I know where you are going with all of this. See my PM re: photos. You may well be happier with a much lower profile...
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I don't post much here, but I just wanted to thank all of you for sharing your stories and your questions & answers. I have completed my fills at 350cc's and am now just patiently waiting until my exchange next month. I have read over lots of the threads and posts here, looked at more pictures of breasts than I ever thought I would, and have taken lots of notes, but I'm still wondering what my breasts will look like at the end of this journey. I guess I won't really know until after all the surgeries and sometimes I wonder if I am spending too much time obsessing about it. I am placing a lot of trust in my PS and I know I will be fine with whatever the results will be. At least I will be cancer free and I am appreciate to have so many more options than women decades before me ever did. I also want to thank Whippetmom for the time she spends advising us all! It is such a comfort to have another 'expert' besides the PS helping along the way.
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Just want to jump in here for a minute and say something about pocket work.
If you have a PS who does it, and does it right, consider yourself lucky.
I had lateral capsulorraphies on both sides, thanks to some incredible insight by whippetmom.
When I brought it up to my PS, he told me he doesn't like to do it, as most of his patients generally don't need it, and it just causes a longer recuperation time.
But my case was unique... I needed SMALLER implants than my TEs, because of the amount of weight I lost.
Only with considerable pocket work to narrow the pockets could I end up with implants that didn't migrate to under my armpits.
Yes, I had more pain, more restrictions, and a longer healing time.
Was it worth it? You betcha. I definitely would have needed a revision PLUS pocket work if he hadn't done it at Exchange.
So please, don't freak out if your PS mentions pocket work. If they're skilled enough to say that, hopefully, they have their eye on your best outcome, rather than just shoving some stock implants in there and hoping for the best.
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The dual chamber TE wasn't used on me yesterday. PS said once he got in there that I needed a short TE or they'd be up in my neck. One of those things cna't tell until in there. Another can't tell until in there - I'm much more round chested than he would have thought. Sounds to me that it's a validation of why being nice and flat wouldn't work well for me - too round. I'll learn on Tuesday what make/model/size TE was used. Only filled to 60cc, said I was tight with that.
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Well I had my bilateral mastecomy on January 29. During the surgery my ps put in 300 cc in my prophylactic side (which they ended up finding ADH and LCIS during the surgery) and 500 cc in the cancer side. She tried to put more in prophylactic side but felt the skin couldn't tolerate it. So I was supposed to have my first fill on Tuesday feb 11 but as I was leaving the house for the appt I slipped and fell on ice. I was in inscrutiatibg pain and was in a panic that I did damage. My ps would not do the fill that day. I am going this Tuesday hopefully for my first fill. She said she likes to try 100cc. I am planning to take my pain medicine, which is dialaudid and a Valium. How much pain should I expect? I'm currently still pretty sore and on dialaudid, Valium, Motrin, etc etc. I am very nervous but also excited about beginning this part of the reconstruction!!! I was told the dr got all the cancer so it's basically "just" completing this reconstruction process and doing follow ups w bs and ps. I am truly blessed and want to say thank you to everyone on this sight that ever read and responded to a post I made! You are an amazing support system!
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MommyatHome - I never had more than 50cc at any fill. So I avoided serious pain and only had to use Tylanol.
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Mommyathome--You received 500cc's in a tissue expander at the time of BMX???? Holy cow, that is alot! I received 350/360cc's at time of my BMX and was extremely uncomfortable for two months--so much so that I dealyed fills until about 8 weeks post-BMX. It is completely understandable that you are still on heavy pain meds. My advice to you is to wait until you feel good enough to discontinue the the Dialaudid and Valium before you get any fills. I received about 50cc's per fill and only needed to take Tylenol for a day or two after each fill.
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MinusTwo
My ps pretty much tells me where we are headed and what we are doing.... I have no idea seeing I've never been through this. Can I request she only do 50cc? It would just mean I'll be going to her longer for fills right? It won't mess anything up??
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Mommy at home-wow that's a lot of fill. I had 300cc in my prophylactic side and 100 in the other at time of surgery. My fills were 50 cc and really only felt tight.
Babs
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Loriwny
I was surprised too. I just have that feeling that I took my shirt off and was dragged down the driveway.... Like road rash. Does that make sense? My bs suggested intake my dialaudid and Valium before each fill. Do u typically go to work the next day? I'm only 2 weeks out and I'm planning to take 8 weeks off and wonder if I'm not done w my fills and she only does them on Tuesday's, will I work the next day? I teach grade 6 so I need to be on my game when I return!!
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Yes, you can request less each fill. It will take longer but you shouldn't have as much pain. I came out of surgery with only 100cc in each side and went in every 2 weeks for 50 ccs, but I'm sure glad I took my time - as much as I hated the darn TEs.
I agree with Lori. Don't get any fills until you feel good enough to get off the heavy pain meds first.
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Whippettmom
Can you chime in? Am I being filled too quickly? What are the cons for this? Pros?
I obviously have no clue, how would I? I've just been pretty much going along with what the ps is suggesting/doing.
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I would start out small, 25-50cc and see how you and your skin tolerate it. There's no rush and you should feel comfortable. You don't want to have to go in to have any removed if it hurts too much. You have the right to do that too. I got 50 each week and took Motrin if it was uncomfortable. Only the last fill was uncomfortable and made my skin itch!
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There is NO con to going slower! It will just take longer to finish. but it is worth it. I also had fills of 50 every other week. Some women can handle more, some less. If you are comfortable with 50 (for example) you can try 60 or so next time. Slower, smaller fills give your skin and pec muscles a chance to stretch more slowly. And you would definitely be able to teach the next day. The day of fills I took tylenol and the next day felt a bit tight, but still functional.
Someone here once said, "This isn't a race!"
I do think some doctors think that giving us as much as possible at time of bmx helps emotionally as we wake up and see SOMETHING still there. But if you are this uncomfortable you will need to ask to hold off on fills til it feels better. Then go slowly at first and see how you do. Often women may have enough extra skin for room for large fills...but that pec muscle still has to stretch in ways it wasn't made to do!
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Mommyathome - I had extremely large breasts prior to my BMX, plus very lax skin and very lax pectoral muscles - yet I was given only 180ccs in the OR, and fills every two weeks at 50ccs. There were a few times I got more; a few times I got less. The PS said he went by how the skin looked and felt, as well as what feedback I was giving him.
I think you'll find that many women here follow the guideline "Low and Slow." In other words, it's not a race.... I can't think of any reason to fill so quickly, unless you have some kind of deadline you're trying to meet.
Some of us had discomfort during fills, others had none at all.
I would have been very freaked out had my PS told me to drug up on Dilaudid and Valium before each fill. As it was, I only noticed slight discomfort the night after fills, but I quickly adjusted to the 50ccs he was injecting.
You call the shots here. There's no reason to suffer with large amounts of saline at each fill. In fact, if you feel you have too much, you can even ask that some be removed.
Wishing you the best!
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