BREAST IMPLANT SIZING 101
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A quick update and a question: I'm at 365cc and am planning to be over-filled to 500cc. So, the plan is 2 more fills of ~70cc each. I have finally settled on 400cc high profile implants. (Both my PS and Deborah agree so I feel like I should listen! LOL!) So my question is: if my PS uses Allergan (which he tells me he likes better than Mentor for recon patients), which style will he be using (at 400cc HP)? He told me that at the next fill he will order my implants for exchange in Sept and that if I have an opinion on what I want, I should come prepared to talk. So, Deborah~ do I have an opinion?? LOL!
Glad to see that everyone is doing well. FWIW~ I don't have ice-crm scooping issues but getting into my xanax bottle is a nightmare.
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Michele: It would be Allergan Natrelle Style 20, 400 ccs. Here is the link. Disregard the description as being "midrange profile"....it is confusing. This is the high profile style and the Style 45 is actually the "ultra full projection" style.
http://www.justbreastimplants.com/breast_implants/natrelle20.htm
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Deborah - So I'm confused on Michele why do they fill to 500 ccs and only put in a 400 cc implant? Whereas my PS is filling to 400 ccs and putting in a 450 cc? What style (its Allergen) of implants should I ask for the high profile or the ultra full projection? It gets so confusing!
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Forgive me ladies for being lazy, but this is a new forum for me and I thought I'd just throw my question out there and if someone can answer it, that will save me from going back over 30+ pages of posts to see if the answer is already here.
I had skin sparing (skin saving?) BMX with TEs last Thursday. After reading in this forum, I was curious about how much fill I had/will have; so at my f/u appt with PS today I asked the nurse. To my surprise, my husband answered (apparently this was all discussed in the hospital while I was under the influence of morphine and I don't remember it). Anyway, he says I was filled to 500cc at the time of surgery and the PS says he may go up to 600cc before the implants are put in which would be done with one later fill. I was a saggy D before surgery and had told the PS I was tired of big breasts and a B would be fine with me; he said a C would suit me better and we sort of left it open.
So, what will a 500 fill make me? A B or a C? After reading these posts, I don't want the nubs a couple of you mentioned, but I really don't want large breasts either. And does all this sound reasonable to you all? If' I've already got 500 in me, I don't know how much different 600 will look. I'm not very big now.
I got a good report, the nurse said all looks as it should; they took out only 1 of 4 drains but I go back Monday and they'll take out another that was still draining just little too much to come out today. Thanks for any help you can give me with this; or direct me where I can find out my answers. You ladies are a godsend!
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Regina -- you need to send info about your body (see the header of this thread) to Whippetmom -- either here on the forum or in a private message. Size is not based on cc's alone but also YOUR size. No one can tell without knowing some basic facts (again, see above).
Valerie -- some surgeon's overfill and then put a smaller implant in; others will put an implant in that is larger than the TE fill amount. I think it depends on a lot of different variables (most of which I don't know). The only thing I DO know is that my PS always overfills and then puts a smaller implant in... I thought it was to get ptosis (a natural droop) but I don't have much droop so I guess I need to ask her next time I see her what her reasons were. In my case though I have a gummy (Allergan 410 cohesive gel) implant and these are firmer than regular silicone... so would have a little less play when being inserted (so would need more space for placement). I am sure Deborah can elaborate
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Valerie: From my original post above:
QUESTIONS FOR YOUR PLASTIC SURGEON:
In the interim, here are very important questions to pose to your plastic surgeon. Ask your PS if he/she tends to place you in an implant with a volume larger than the TEs, or if he/she prefers to place you in an implant smaller than the TEs. If your PS likes to overexpand - overfill - ask about this. It is important to know what is in your PS' mind about where he intends to go with your reconstruction, because this will assist us in calculating to what extent you require expansion in order to exchange to the desired implant size and dimensions.
Michele's TEs are actually 300 cc volume TEs and so her implants will actually be 100 ccs greater than her TEs. The only thing which is added with this overfill to 500 ccs is projection and the assurity that the expansion will hold with minimal skin retraction when the TEs are removed. Some plastic surgeons just feel they need to overfill every patient and some only overfill when it is needed for some specific reason, and some just do not overfill at all. Not all adhere to the theory of "overfilling." Mine does not. It also depends on the patient's skin flaps. The PS alone can determine the patient's skin integrity and so he or she will determine what is needed to get a patient to a certain volume of implant. You do this long enough and you see how many different approaches plastic surgeons will take to arrive at the same size of implant.
There are three different roads people in our community can take to get to our neighborhood, and everyone seems to take the route they are most familiar with or which consistently seems to get them home without traffic obstructions.
Your implants: Ask for Style 20 - 450 ccs - NOT Style 45 - which would be too narrow for you.
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Regina: I extracted this from the instructions at the top of the page:
If you are interested in discussing implant sizes, make sure you compile and provide us with the following information:
Height, weight, ribcage measurement [measuring the circumference of your ribcage under your tissue expander(s) or under your bra line]. Also, if you have TEs [tissue expanders] - we need to know about them. The style - Mentor or Allergan most likely - and whether they are short height, moderate height, full height if Mentor and style number if Allergan. We also need the recommended fill volume of the TEs - the number of cc's. (NOTE: If you have PMT Corporation tissue expanders or any other unlisted manufacturer, please see if your PS will provide you with the dimensions of such devices.]
"WHAT CUP SIZE WILL I BE?" OR "WHAT SIZE IMPLANT DO I NEED FOR A "C" CUP?"I CANNOT PREDICT CUP SIZE. PLASTIC SURGEONS - THE SMART ONES - ADMIT THAT THEY CANNOT PREDICT CUP SIZE WITH ACCURACY!
It is very difficult to determine cup size with breast reconstruction patients, as volume does not easily translate to a specific bra size. There are so many factors which determine how implants will look on any one individual, e.g., your ribcage circumference, whether your chest wall is bony or if you have a fair amount of adipose tissue surrounding the chest wall.... if you have any ribcage deformities or other structural issues which might impact implant placement. We can sort of "project" where you might want to be...or estimate the implant volume which you could "aim" for - so that you can sort of look at the prize ahead of you. Most of us have found though, that it is better to continue with tissue expansion until you have reached a desired volume and appearance, and then compare these dimensions with the breast implant dimensions found on the links at the top of the Exchange City thread in the Breast Reconstruction forum.
FOR MORE INFORMATION RE: IMPLANTS VS. CUP SIZE, READ WHAT THE EXPERTS HAVE TO SAY:
http://www.realself.com/question/Breast-implants-size-full-b-cup
http://www.breastsurgeondallas.com/breast_augmentation_faq.html
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Wow, lots more complicated than it seems. I'll ask all this Monday when I go to have my drain removed. Thanks so much for the help ladies. It's a shame that we blindly follow "doctor's orders" without having all our info up front and not really understanding all our options.
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Thanks Deborah! I'll ask him 1st which he was planning 20's or 45's... I'm curious. My ribcage is wide but I'm a small person. (5'0" tall, 110 lbs, size 2) So, it is strange...
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Michele: The Style 20's - not the 45's. The 45's are too narrow and would be too tall on your chest wall.
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Oops Lilah....there we go cross-posting again!
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Whippetmom- I am now filled to 300cc's which look huge on me! The question I have is I feel there is a very large gap between my breasts yet they are under my armpits which to me gives a very wide look. I have looked at pics on here and elsewhere and see it seems wider than most. Also I noticed some pics with TE are far apart. Can this be fixed at the time of exchange and is it is big deal to do so? I asked my PS about it and he said he can't really move it over because it wouldn't look good but he could use a wider implant but it wouldn't make a big difference in the gap. Oh I had a NSM so don't know if that means anything as far as location but to me it seems it wouldn't change the postion very much. I am going to email you my recent pic too.
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sweetie- I know Deborah will give you some great advice but just wondered if you saw my pics on the picture forum? I was expanded to 365 and went with 375 implants. I had a huge gap between my TE's. I asked my PS if she could bring them closer. She told me since we don't have breast tissue it's kind of determined by where your pec muscles end, and everyone is different, but that she would do the best she could. She did tell me to go with 375, vs 350 implants, for the little bit of extra width needed as well. If you see my after pics you will see she was able to bring them very close together without having to go with a much bigger and wider implant.
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Kate33- Actually I was just looking at the pic forum earlier today and I did see your pics and mine look a lot like your TE's did. Your final result did look much better than your TE and when I saw that it gave me hope. I will ask my PS about the width because he did mention that. I feel huge right now at 300cc's! I feel like I don't want them any bigger just wider and closer. Also I can feel bumps through my skin which he said are stitches but I feel them all over.
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Hi Deborah and other wise women of the recon/exchange forum,
I have finally finished chemo, 2 weeks out and looking to the future. I'm ready to start thinking more about recon, although I have asked my PS if we can delay it until November so I can have a few months of not being a patient and building myself up. Deborah, I've PM'ed you my dimensions, and I'd be very grateful for any advice you'd have on implant sizing. Thank you so much for all the information I've gained already reading back through lots of the previous posts,
Lisa
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Regina: I just went over your original post again and I have a few comments. The fact that your PS was able to get 500 ccs in the TEs at the time of surgery, is because you had sufficient skin flaps to do so. The droop of the maternal breast - or just vis a vis gravitational pull, if you have not had children - makes for a lot of skin to be filled up by TEs and later implants. I agree with your PS about size and I just do not think you can accurately predict cup size with breast reconstruction. The key is to continue expanding until you reach a point where you can say you are happy with the volume in your TEs - happy with the size. From that point, implants can be determined by dimensions - attempting to approximate the dimensions of the TEs.
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Sweetie: Email me your photos. Unless you have some type of ribcage anomaly, I do not understand why the implants could not be placed more medially towards the sternum. You would likely require some lateral revisions to keep the implants from migrating again, but this is honestly done all of the time. When you send me your photos, remind me of your ribcage circumference again.
Kate...I had no idea you posted your post-exchange photos! I'll go there right now and look!
Deborah
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sweetie- I had the same issues with the stitches. They're supposed to dissolve but mine didn't either. My PS was able to remove them during exchange, though. I felt pretty big with my TE's, too, but lost a lot of projection with the implants. See what Deborah thinks, but my PS said the implants will look at least 25 cc's smaller than the equivalent cc's in TE's. I think it feels like more than that but maybe not after I drop and fluff. Deborah thought I should have gone 400-425 and now I am kind of wishing I had. I was afraid of being too big but the implants just don't feel as big as the TE's. My DH is happy, though, so it's all good.
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Lisa: I have PM'd you back with some additional questions...
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Deborah- I was going to wait until my stitches were out but some of the girls wanted to see what 375 cc implants looked like since their last fills were coming up. Please let me know what you think. I think you were right, though, that 400 cc would have looked better. I should know better than question the implant whisperer!!! LOL!!!
I do have a little lump that showed up yesterday next to one of the stitches my PS put in for the Alloderm. I was freaking out but BS thinks it's just an inflammation from one of the stitches after I stretched too far. I will see my PS on the 21st to have them out so we'll see what she thinks.
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Thanks Deborah, I've replied.
Being a UniMx, I have realised that, for me, it's all about the symmetry. My TE fill progress was a little up and down. I had skin sparing Mx, and started chemo 1 month after surgery. Then I started developing mild flap necrosis, and required 2 minor re-excisions of the incision line, and a "deflation" of the TE. It's been gradually re-expanded, and I've been only occasionally wearing a soft kind of training bra so as not to disturb the healing process. So the discovery this week that with a proper fitting, and the right bra, I not only had cleavage, but symmetry was amazing and emotional.
My 400cc TE sits up high in my right chest sub-pectorally, and my poor little lefty hangs quietly. Hopefully my PS can work some magic.
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Sweetie - my TEs are a little far apart, the PS said he will put the implants closer together - so no worries.
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hereandnow: I'm a uni too. I will have my exchange on August 9th and I am hoping my PS is going to work some magic on my sad right side so that they are a closer match. I am on the picture forum if you would like to have a look.
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thanks MBJ, I'll have a look, and will figure out how to post my photos too.
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Deborah~ well my expansions are finished! I have 500ml in and i updated my pics on TimTams site!
I love how they are looking when i wear a vest,although the roundness looks abit too fake lol.
Got a meeting with my PS and BS around 9th August to discuss my exchange in more detail.She said i WILL have drains after which is a good sign that she will be doing the pocket revision i asked about. Can't wait to see what size and style gummy i'll be getting. This will be one of my 1st questions! =D
I really would like to keep as much of the width as possible.
ok......so.....i know we dont know the exact style of TE i have.....but are you going to say which size and style of gummy you think they are going to go for! LOL Lets see if you guess correctly! It will be fun.
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Whippetmom-thanks, do lateral revisions require a lot or can all of this be just done at the exchange and is that same thing a a pocket revising like M-star is having? I emailed you my pics.
VMUDROW-thanks. so for you it is something simple your PS can do at the exchange?
Kate33- I will remind him about the bumps. I think he mentioned he can remove those. I see them everywhere! I will consider what you said about size since you are petite and although I am tall 5'7" I have a thin frame. I am afraid of going to big but I think it is just because I am not used to it and it feels so different. I mean really right now it is not that big but to me it seems huge based on what I was before. I think I mentioned it to you, but your final result looks very good very natural and I can imagine it will even look better over time when those darn stitches are out!
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sweetie- I think all the smaller women do worry about going too big, thinking it will look fake, but what we think of as too big most will think it looks perfectly "normal" I think. I think you're right- we're just not used to it. I've been small chested for 50 years! So now I am kind of wishing I'd gone a little bigger. It would be nice if you could take your implants out for a test drive first! LOL!
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Ha! Kate33 - Yes, it certainly would be nice to go for a test drive first! As much as they cost, you'd think we'd have that privilege!
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sweetie2040 - My PS didn't seem to think it was any big deal to put the implants a little closer than the TEs are (during the exchange surgery), in fact I didn't bring it up - he just said now when I do the exchange remember that I will move the implants closer together than the TEs are. I feel HUGE too - just not used to having boobs I guess.
The TEs are a little, tiny bit like taking a test drive (maybe?) - the PS can add or subtract saline until you think the size is right and then he puts in a bigger size implant so they look the same volume as the TEs.
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vmudrow: I wish my PS could go bigger then my TE's. Being a uni, he plans to go smaller.
Deborah: I hope I haven't asked this before: Even though I am a uni, do I still need to go smaller then the TE so that my other breast matches? I know that this is true about me not going with the Full Profile, but does this apply even with the moderate profile?
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