BREAST IMPLANT SIZING 101
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Whippetmom. I had a BMX 10 weeks ago, skin sparing, nipples removed, Alloderm and immediate reconstruction. I had radiation before the mastectomy so the radiated side is still very tight but the other side has dropped and settled. I was limited to what size implant I could put in as I did not do TEs. How long do you advise letting these settle before revision? Right now they look mismatched due to the tightness and the side that has settled looks too small.
They put in Mentor 323 555cc high profile, moderate height. I am 5 ft 7 in and 190 lbs, ribcage measurement 37 in. I live in Canada so dont know if options different than US.
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Previvor: You should NOT feel dreadful... and I wish more women outside of the US and Canada would find their way here to BCO.....
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Juliecc: Yes, Allergan Style 20, 500 ccs. This is the style which corresponds nicely with your TEs. You will not be too large. It will be a perfect size for your frame! Tell Dr. MG hello from me. I think she remembers me....knows that I have this "blog" of sorts...her patient five years ago. I honestly did not f/u as much as she would have liked, so have not seen her for a year and a half...and my five year mark was November of this year.
Deborah....
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Mommyathome: I need your TE style/volume info again.
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thanks whippetmom,
One of the big difference I see is length of hospital stay. I stayed in hospital for five nights after BMx and TE insertion (until drains had stopped draining) and expect to stay in at least overnight for exchange.
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Thanks, Deborah, I will. I'll also ask her how far I go with fills if I'm aiming for 500cc implants. I'm not sure what her methods are.
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Sorry Whippettmom!
Natrelle style allergan 133SX-14 500cc
I was filled to 650cc. I like the size the te are now. I'd like to keep most of the size
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Oh Deborah - it is SO nice to have you back on the boards again! I smile every time I see your beautiful avatar
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I have a great husband and support system. However, I have a few friends who commented when I had my exchange surgery that it must be great to be "all done with it" and no longer ask how things are going. I'm still struggling daily with my hormone therapy and am looking at another minor surgery and upcoming ultrasounds to monitor a few new lumps - I definitely don't feel done with it yet, but I only discuss it with my husband and the few people who seem to get it and ask how I'm doing.
For those feeling truly unsupported and frightened - in addition to BCO please check to see if your hospital or health system offers breast cancer navigation services. Sometimes this is just a single referral nurse and sometimes it's a larger program, but there might be some great resources available if you just reach out. No need to go through this alone!
Deborah, glad you're on the other side of surgery. Happy healing!
Best wishes to all...
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I agree-- your hospital should have someone either specifically in oncology or the breast care department to help with support groups or steering you towards someone or discussion groups that can help with depression. In my area nw of Chicago they hooked me up with the Wellness Place in Palatine, that has tons of programs, wellness talks, one on ones, massage, etc etc... I think many hospitals now have someone or a dept that should be looking after you.
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Previvor...yes here in Canada after BMX with TEs or implants they usually only keep you one night, unless there are complications. They show you how to do own drains before discharge. I can say I would NOT have liked staying in even another night, and was worried I would....it was so uplifting to go home to my own surroundings and get into my own routine at home. Drains are very manageable. Mine come out tomorrow...1 week post-op. PS's nurse will take them out in his office.
Exchange here is usually an outpatient day surgery.
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Julie, I do not believe she is an advocate of overfilling, but she probably will bring you to your recommended fill level. Depends on your skin integrity.
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Whippetmom....Did you have any advice for me?
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lindacam: Sorry....I did not see your post earlier!
I honestly think that there is no implant revision which will work, based on your description, until that previously irradiated implant goes through an integrity change. It may take a year, on its own, with diligent skin softening agents, to change, but I do not think it will be substantial enough to give you the symmetry you desire. One option is to have your PS (in two months - you need to wait at least two months - ) use a Mentor Spectrum expandable implant on the radiated side. Then, over a period of up to six months, he could gradually expand that pocket and that might be a way to achieve better symmetry.
In cases like yours though, I think fat graft transfer is truly beneficial. Stem-cell rich fat has proven to soften the taut, unforgiving radiated tissues and causing that tissue to relax and change integrity. I do not know where this might be done in Canada, but it is worth investigating. This would require the least amount of surgery - is least invasive - as the implants remain in place and no disruption of the incision is necessary. I think this is highly preferable, over implant revision, because you are increasing your risk for compications, with implant disruption. Ask your PS about this. Talk with him about your options and determine how to best approach this over the next two months. Let me know what he has to say.
Deborah
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Thanks so much. My PS does not see value in massage. What do you recommend?
I want to do least invasive on radiated side. Maybe put a little larger implant on good side and tighten skin.to match tighter left side.
Yes she does do fat grafting.
Linda
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lindacam: I did not mean "massage". You don't massage textured or anatomical implants. I just meant "skin treatments" - topical application of oils and creams and just anything to help soften the skin. As I stated, it would take a long time to see results and even then, it might not improve symmetry. Go with fat graft transfer....Please read my thread "Fat Graft Transfer and the Radiated Breast"....
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Whippetmom I sent you pm after updating my photos on the picture forum and would be interested in hearing your comments, considering exchanging to 650cc from 550cc, All my details are in the PM and on my thread there.
Thanks in advance
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Caty, will your PS do a revision for that small amount of increase? 100 cc's is only 6.6 tablespoons. That's not much when it's spread out over an entire implant. Are you hoping to change the style of the implant too?
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My PS has no problem doing a revision, have a few issues to deal with, have some scar tissue which I believe is causing flat area on righty, some excess fatty tissue underneath, and also some very pronounced rippling when I bend over, which the larger implant should help to reduce
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Hello whippetmom. I need your help, please. I'm having revision surgery next month and I'm looking for projection and upper pole fullness. Unfortunately I am quite overweight right now but I've started working with a nutritionist and have begun an exercise plan so hope to be in better shape soon.
I'm 5'4 and almost 200 lbs. My rib cage measurement is 36. I currently have 650 cc moderate profile Sientra round implants. I'm having some very weird rippling issues in my right breast and my left breast is noticeably larger and really no projection at all. I asked my PS for Natrelle Style 45 in 600 or 650 cc's. What do you think? Thanks for any advice!!
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Cateyz2: So, so sorry I missed that private message!! I just looked at your pictures and posted my thoughts and recommendations.
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Cateyz2: That is not "fatty tissue" under the implant. I am not sure what the PS is seeing there. This is why I think you need a second opinion.....I have names....
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NOLA: Your implants have a width of 15.8 cm. The Allergan Style 45 implants are too narrow for your pockets. The 800 cc Allergan Style 45 - largest available - only has a width of 14.2 cm. I think that the best implant choice would be Allergan Style 20, 750 ccs or 800 ccs. Either volume will STILL be narrower than your current implants, and your PS is going to need to perform lateral capsulorrhaphys, in order to make sure there is no lateral displacement with narrower implants. If your PS balks at this, ask him why he used such a wide implant in the first place. I think you will be much happier with Allergan Style 20.
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Whippetmom, I posted a reply on my picture thread, Please Read
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Hello! I have lurked here and there from time to time but this is my first time posting. Now I am at the point that I need whippetmom's advice! I had my BMX in February with Natrelle style 133MV13's placed. I am currently filled to 660cc but not sure how much more I want to go. I told my PS that I wanted to go as big as I could until such point that it would negatively affect cosmetic outcome. He rattled off some part number, but I dont' remember if he said 800 or 880cc. I know you can't accurately predict cup size after the exchange, but I was just hoping for some kind of idea. I have heard repeatedly that you lose a lot of projection after, but my PS said he didn't think I would lose a whole lot? I don't want to end up being smaller than I would like but I also don't want to be freakishly huge. I am somewhat confused because I remember always reading that women usually had trouble getting big enough to their liking. I am 5' 6-1/2", 165 pounds with a 34" ribcage. Right now my measurements around my chest is at 42"...this would put me at a 34H bra size! That can't possibly be correct as I don't look that big, but I know my measurements are accurate. Can you give me some direction as to what my outcome might be if I am to go up to the 800 or 880cc size that my PS mentioned? I want to be large-chested. I am broad chested and have a long torso so I really think that it looks appropriate on me. Thanks so much!
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...And I just looked up my TE specs and saw that the recommended fill is only 400cc. What does that mean that I am already filled to 660cc and am likely going to be filled to accomodate an 800+cc implant? I did notice after this last fill that there was more "give" to the side of the implant, as in they are not quite as hard now, a bit more squishy.
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cateyz2: I replied back to you!
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MissMamaBear: Well, that is quite a leap from a 400 cc TE to a 800 cc implant. I mean, if the skin is willing, I suppose it can be done. I am concerned about skin coverage over the implant and potential complications, because, believe you me, I have seen complications. If you were large breasted PRIOR to BMX, that is entirely different, as you would then have skin flaps which could accomodate that leap in volume. Some styles of TE, such as the short height TE, have a way of accomodating implants nearly twice the volume, because they expand exclusively in the lower pole and provide sufficient projection for good skin coverage over a larger implant. Implants in silicone only go up to 800 ccs....so there is no "880" cc silicone implant available here in the US or Canada. I personally would suggest Allergan Style 45, 700 ccs, if your PS can get good skin closure. This is the ultra full projection style implant. Otherwise, the same volume in a Style 20, high profile Allergan implant. (This seems like a safer bet, IMHO.)
Honestly, I would rather women find the incentive to lose ten or fifteen pounds, than go with the largest implant available. From a health standpoint, this is always preferable. Many of us know that losing weight makes the implants look better on the chest wall anyway....so we have the first real motivation in a long time to lose weight. Just my thoughts....
Keep me posted. I just do not want you to experience any complications. Essentially, your PS should have used a larger tissue expander, if he was taking you to implants with twice the volume of your TEs. Plastic surgeons should CHOOSE the TE with the style and volume of implant in mind. Grrrr...
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Thank you so much for the info whippetmom! My PS and I didn't discuss what I wanted my end size to be prior to BMX so I am thinking that is probably why he went with the smaller size. He probably assumed I didn't want to be very big since I was considering the DIEP flap and he said I would just barely have enough stomach tissue to give me back what I was losing (small B cup). I don't know how much losing weight would affect my situation as I don't seem to lose much at all around my chest area and any gain/loss is pretty much evenly distributed throughout my body. Even when I was super skinny at 100 pounds (really UNDERweight) I still had the same ribcage size. I could probably lose up to 20 pounds and I would be the only one who would even notice.
Sorry if I didn't make this very clear, but what I was asking about fill volume is that the recommended fill volume per the manufacture for my TE is 400cc. I am currently at 660cc on each side and he is planning to fill me to 800+ including over-fill. So, I am looking at a total fill volume of 860cc-900cc, probably. Is that even advisable with the recommended fill volume only being 400cc? Could I risk springing a leak in my TE or something this way?! As far as I know he is planning to do saline, not silicone. I had asked about Gummies but he said they didn't make them big enough for what I wanted.
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There is no way I would risk that degree of overfill! I am sorry, but that sounds crazy to me. Each manufacturer has WARNINGS about excessive overfill!
Mentor and Sientra literature states, as a warning:
"Excessive inflation of the device may result in tissue necrosis/thrombosis."
Allergan Natrelle states, as a warning:
"Avoid overfilling more than the recommended volume"
I would not fill but another 50 ccs....otherwise, remove the TEs and insert 600 cc TEs....
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