BREAST IMPLANT SIZING 101
Comments
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Ally: There is nothing wrong with the width of your TEs. Your PS needs to perform pocket work - the technical term is "lateral capsulorrhaphy" - needs to do this bilaterally, to present the implants more medial on the chest wall and to prevent them from migrating towards the armpits. Perhaps I like 475 ccs in a HP implant. 450 ccs minimally.
Deborah
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Enerva: Many women have asked for a referral to a physical therapist who knows about lymphadema - breast specialists in the PT trade. My sister is the one who started that PMPS thread, and she had acupuncture, which resolved her PMPS discomfort. I am a firm believer in acupuncture for PMPS!
Also, weren't you considering shaped Sientra implants? That is still an option. I would hope your PS might take in the shaped sizes I mentioned previously, as well as silicone rounds, and see what works best.
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i took notes, I LL ask him on July 02, hopping he nails down my issue this time. Thanks for this info, I LL look into the acupuncture therapy too.
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I was wondering about fat grafting and nipple reconstruction. I know I will need the grafting done and I know that my PS will not be able to use the skin on my breasts bc it is too thin. So basically I want to know what other options I have for nipple reconstruction and if insurance will cover the fat grafting and nnipple reconstruction? Ty all for being on this site it really is very helpful. Also I had my exchange surgery yesterday n the implants look kind of flat. I got the mentor uhp 590 cc will they eventually "fluff out"?
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Don't forget Myofascial Release Massage Therapy and Scar Tissue Mobilization for pain after breast surgery. Worked absolute wonders for me.
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Whippetmom- Thanks for the info. I am so counting the days to my pre-op meeting. Because of this forum, I feel more able to participate in the conversations and actually ask intelligent questions whereas the first couple of weeks I was just overwhelmed!
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Yes Enerva....everything Blessings said above. Ask for a referral for these modalities...
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Blessedbe: Fat grafting and tattoos will be covered by your insurance, with proper coding by your PS. Another option is a 3-D tattoo by a qualified and artistic tattoo artist. Alloderm nipple reconstruction is something to discuss with your PS.
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Hi Ladies - I need your thoughts on this one.
I had Mentor Smooth Round Ultra High Profile 535 cc implants placed in April but they needed to be removed because of infection and I am starting reconstruction all over. I was extremely happy with the appearance of the implants and hope they will be just as nice this 2nd time around. I am considering going a size or two bigger because I am so much smaller than prior to my BMX that my clothes and swimwear don't fit. My dresses are saggy up top. (Better my dresses than my boobs!)
Here is my question to anyone who has had their implants redone and gone with a larger size:
Are you happy with your decision?
Does it feel any different? Heavier?
I am petite and athletic.
Any thoughts or advice is most welcome.
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hi all,
I'm new to this thread, but have been following - amazed at how helpful Whippetmom has been!! Thank you for all the wonderful advice and support you have given everyone :-)
Would love your opinion - I am about 3/4 thru my fills (I think!) and starting to think fwd on exchange (pending chemo if I choose it - that's a whole different topic...but I'm going to have to make a decision one way or the other in the next week!!).
I am 5'5", 140lb. 31.5" ribcage under bust. TEs are Allergan 133FV 400cc.
I am currently filled to 300 cc - and to be honest I don't want them much bigger (was an E cup before - loving them small...am thinking B/C ish - I know it's not an exact translation). I was thinking maybe 400 and done.
Would love to hear any suggestions for discussion w my PS...did I give you everything you need or do you need more?
(Am trying to work out how to access pic forum - have permission from nowheregirl, but my work laptop has barred site...or I'd show you pics)
Thanks in advance!!!
Rain
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I was wondering, how long do you need to wait to do some retweeking after having had permanent implants in? My PS told me in about 6 months he can fix, then when I went in after 5 months, I was told it was best to wait another 6 months, and that it takes a year for everything to settle. Does that sound right? I need to fix the left one because it's a little bit lower, and needs more fat on the upper poleline.
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Salina- I am not in your position yet (exchange is in August) but I am sure many of the ladies here can share their timeline with you. Also, you may want to talk with another PS just to get another opinion. The 6 months sounded reasonable but the year seems a bit long but I don't know. Good luck with your decisions.
Ally
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Salina I agree with Ally, it seams too long, I was told you must wait at least 3 months to be able to have a revision surgery. I am sure there must be another reason.? For example my Ps told me to wait for another months but I then found out its due to him been away in conference in June so he is seen me first week of July to schedule my revision surgery.
Figures
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Rain: I would say Allergan Style 20, 450 ccs minimally and 475 ccs, ideally. You will not have the height or upper pole fullness that you have with the TEs, which are quite exaggerated. Also, not all women need that degree of height - as implants should not be approaching the clavicle, where I see a lot of these full height TEs ending up. But if you do like the upper pole fullness and need a quasi-lift of the tissues, I would advise looking at Sientra smooth round high profile, around 465 ccs. Not quite as much projection as Allergan, but it serves a purpose when upper pole fullness or a lift of sorts is needed.
Deborah
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Salina: I think that six months is a sufficient length of time to wait for a revision. I see no need to wait a year, unless your PS is just hoping you will grow weary of waiting and decide to settle for what you have now. Why don't you get another opinion, as Ally suggested. You can PM me with your locale and I can help you find someone.
Deborah
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Deborah - I have a question that's stumped me a bit since I've never really seen it covered before on this thread, but it's something many of us run up against.
When T.E.s are placed, they have a specific width and the PS should be creating a pocket at that time to correspond with the width. However, the width of the T.E. and ultimate desired projection and cc's of the implant have a bearing on which implants are available to a particular individual. So, in my case, the with of my T.E.'s are 14, however, the corresponding implants I'm interested in (range of 500-600cc's in either allergan or mentor), have corresponding widths that range from 13.5-14.6 in diameter. So which is better, an implant that is smaller in diameter than the T.E., which means some pocket work on the part of the PS to ensure they don't migrate towards the armpit, or an implant that is slightly wider than the T.E. (in which case I'm not sure what type of pocket work might be required).
In other words, how much "wiggle room" in general does a PS have in cm's between the T.E.width and implant diameter before significant pocket work might be needed?
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Thanks for your help ladies! In defense of my PS, he said 6 months, but his physicians assistant saw me this last time, and made the comment that he tends to do the surgeries too fast, and that it really needs 1 year for everything to settle then they can fix it better at that time. Then she said speaking as a friend, it's better to wait about a year. But since my PS let her handle it, I don't know what to think.
Wippetmom- sending you a text
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thank you Whippetmom!!
I DEFINITELY don't need them up in my clavicles!! (One is sitting there currently - I have a daily battle to camouflage it). Want them to look nice and normal - small but in proportion.
I hear you on 450-475. Guess I have a few more fills then. Ah well!!
Again, thanks, really appreciate it. Will let you ladies know where we land (may be some time though..)
Rain
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Bosum - you need to read everything on the header & post your measurements as explained so WhippetMom can weigh in. She's a miracle worker but needs specific stats to do her magic.
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Bosum - the type & size of implant will depend on your stature, weight, height, rib cage, etc. Also go ahead & detail a little about your current reconstruction so she can take that into consideration. Way to go for persuing it.
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Raelan: You just do not want to use an implant too much narrower than the TE, because otherwise you will need pocket revisions - to insure that the implant does not migrate laterally. In my estimation, why use a 14.0 cm wide TE if you plan to use a 13.0 cm wide implant? Why not start out with a 13.0 cm wide TE to begin with. Pocket revisions - lateral capsulorrhaphys - do not always "hold". You can fairly reliabily go from a 13.0 cm TE to a 14.0 cm wide implant. That really is not much of an issue. 13.5 cm should be fine in terms of implant width for you, but that means at least a 550 cc high profile Mentor or Allergan - not 500 ccs.
Deborah
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Bosum: I understand the question. I really do not need stats to tell you that a Mentor moderate plus profile implant is just fine. I cannot tell you what size you would need anyway, because I do not know how much volume is provided by your flap. Also, it depends on whether you plan on adding an implant on the native side. So yes, in answer to your question, Mentor is fine. Forget Brava....unless you have a lot of time on your hands, want multiple surgeries, and I just do not know about going this route with a DIEP. The jury is still out on Brava for me.
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Salina,
My PS, whom I adore and think he has done a great job, says that you CAN do revisions at 6 months (and he will do them), but changes can really continue for up to a year or so. While those changes are not as dramatic as they are early on in the first few months, it is at around a year or so that things really are settled in and that you can say "what you see is what you are going to get" (minus revisions). So, for major things that obviously won't change with more time or that are causing pain and discomfort he will do at 6 months, but if at 6 months issues seem rather minor (like would need little tweaks) and like they might still work out in another 6 months (and aren't causing pain or discomfort), he likes to wait to give the body a full year to heal before more surgery and anaesthetic, for the capsule to fully form, and to see how things really settle. He has seen it happen that women who still had some slight unevenness still at 7 months for example, looked fantastic at 12...and they managed to avoid another surgery to get there by just waiting out the year. But it really depends on personal circumstances; for example if your pocket was not created properly in first place, more time won't fix that, and if you are bottomed out, or something, more time certainly won't improve that situation either!
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DiveCat,Thanks for the info! I did bottom out a little on one breast it's not too bad. Maybe it is better to wait a little bit longer, so everything will settle with the other breast, then hopefully it will be a final revision when I go in.
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Salina: With everything I have read and know about "bottoming out" of an implant or implants, it is something you want to address sooner than later. You do not want the bottoming out to continue to worsen and disrupt and further distort the inframammary fold. Also, when bottoming out occurs shortly after surgery, it is nearly always secondary to overdissection of the pocket, rather than due to weight of the implant. Make sure you are wearing a very supportive bra that lifts the implants upward.
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Whippetmom, Thanks for the discussion of PMPS. My revision was over a year ago (with considerable pocket work and scar tissue removal on the latest mx side done almost a year ago) and still have considerable discomfort, tightness and even pain at times. I'm still doing gentle stretching (PT ended months ago) and have been upset with myself that I must be some kind of wimp because it doesn't feel close to being as normal as the other side. My PS keeps telling me it could take up to 2 years for the internal healing to be complete, is that normal? I pretty much wear a bra 24/7 (the cotton, post-sx close up the front style at night and to sleep) because it feels more comfortable than going without. I'm just tired of dealing with this at times.
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2TA: Yes, it can take a very long time to resolve.
Did you read what Blessings said above regarding other modalities to help with the discomfort? I would bug your care provider for referrals to other specialists...taking advantage of whatever your insurance will cover in this regard. 0 -
Thanks Whippetmom and Blessings! Now that I have new insurance coverage, it's like pulling teeth to get info about my benefits. Tried calling yesterday about LE sleeves (which I have had in the past) and the rep I was talking to still couldn't give me an answer what I'm entitled to in this regard after half an hour! Will try again next week (as I think I see both my MO and PS in July).
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Hi Whippetmom,
I am in the holding period between TE and exchange. I have an appt with my PS on the 8th to look everything over and discuss date and strategy for the exchange. I have pix posted on the picture forum. Could you take a look and tell me your thoughts? I have Allergan TEs - 133MV-14 500cc filled to 570ccs ea. I have some scar tissue on the right that is stubborn and is pulling my nipple down still and I have some edema on the bottom left. My PS says both issues will be addressed at the exchange as well as the sideways migration. She says she will probably address nipple position later at revision as well as fat grafting. I believe she wants to use Allergan Natrelle Style 20 in @600ccs, but will bring in several sizes. What do you think about all of this? I did not want to be as big as I was before if possible (36DD).
My rib cage is 33". I am 5'5", 165 lbs and losing.
We are tentatively scheduling for late August/early September. Are there any other questions I should ask?
Thanks for your input.
Best, Nina
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2TA - I had pain issues for a loooong time after my exchange surgery. I agree with Blessings … myofascial release was a huge relief for me. I hate so much that we have to work so hard for PT after our surgeries. You don't amputate a leg or an arm and send the person home to fend for themselves.
Hope you can find some relief soon. 0
