BREAST IMPLANT SIZING 101
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I had immediate implants (Mentor CPG 355 cc) after skin and nipple sparing mastectomy mid-Feb. 2014. These implants were smaller than planned due to my skin looking very traumatized from the surgery (so smaller implants were placed to try to make sure skin & nipples survived - which they did). I am currently planning to go back in Dec. to replace my implants with a littler bit larger ones. I am currently barely a B cut right now and had hoped to be a full B. I don't know if this is helpful to you or not. It sounds to me like your ps is giving you good information based on your size. Good luck, hope all goes well.
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Thank you for your reply Deborah. I will not have expanders first, both surgeries will be done at the same time. That's why it's hard for me to choose. The ps will put in what he thinks looks best and what my skin can fit comfortably.
I know it's different for all shapes and sizes but I was hoping someone had a good photo site I could reference?
Thank you for your help ladies:)
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KaraGee: It is not a matter of "choosing" with a one-step with Alloderm. It is contingent upon how much skin is remaining after BMX and also, where the nipples will end up on the mound. So the implant will hopefully be selected in light of gaining ample volume on the mound, but also, allowing the nipple/areolae to present in a favorable position on the mound. You will be quite small, if you end up in the 150 to 250 cc range, but I am sure your PS had informed you of the limitations of a one-step procedure.
ADDENDUM: Talk to your PS and ask him to order implants with a volume of 300 ccs...ask him to try the largest implants he can safely use!
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Dear whippetmom, it's such a blessing to have you there for us. I'm getting my TE placement on 7/23 but I'm very very anxious and stress.... I have mastectomy on the right side on 1/11/13 and completed the chemo on nov. 2013. I don't need the radiation so I would like to have my reconstruction done ASAP. I'm 5'4", 163 lbs, and the ribcage is 34 1/2. I was B cup before surgery and I would like to have bigger size than before (like D
), Please let me know if there are any info you need. I need your help to decide which one is good for me. As far as I know is the PS is going to remove the tissue structures on the left side but will leave the nipple. Thank you!0 -
cherish: Since you are a unilateral, your TE width will be based on the width of your native breast. I would imagine that this would be somewhere between 14.0 cm and 15.0 cm. I envision that you would end up with an implant with a volume around 650 ccs (minimally) or 700 ccs, if you have hopes of being a "D" cup. This means your PS would need to augment the native breast with an implant of some unknown volume as well, to gain symmetry. You need to talk to your PS and ask him what type of implant he has in mind for your MX side. Find out what volume and style of TE he plans to use. Whatever he has ordered will be recorded in your medical chart.
Deborah
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Dear Whippetmom,
It was suggested I come to you for advice. I am four-years post-op with my permanent implant and in the last six months the implant has been giving me problems. I have Stage 4 CC and I want my implant removed; however, I don't want to go to the PS who did it. I wasn't really thrilled with it and I am now looking for a new PS. If you know of a PS in the northern NJ area please let me know. I have a Natrelle Saline-filled 620cc implant. Thanks.
Best wishes,
toni
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Dear whippetmom, thank you so much for the advice. At least I have some idea when I visit the PS. Thanks again
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Deborah, I had my another fill yesterday. My surgeon said my skin is pretty tight and only gave me 30 cc fill, as you said no more than 50 cc. I felt pretty good after. I also asked her what kind of implant she plans to use on me. She said we would have a long conversation about it when my fills are done. I mentioned Allergan style 15 & 20. She said those round implants are old and will not look good on me. I will look like two pancakes on my chest. I think she mentioned about mentor implants. To be honest I don't have much knowledge about the implants and it was a quick conversation during fill., I can't remember much what she said. Any comments?
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toni67: I sent you a PM with info on plastic surgeons in NJ. I also feel that you should discuss Sientra silicone rounds with your new PS...as they are the most cohesive rounds available and they might be a good option with your history of capsular contracture. But I also feel that fat graft transfer is a very useful tool in reducing a cc to a more maneagable grade. Keep me posted!
Deborah
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Xinghong: I do not agree with your PS about the Allergan silicone rounds. That is a first!
So she must mean Mentor CPGs, which means anatomical implants. But there is no CPG implant here in the US which matches the dimensions of your TEs. Are you outside of the US?
If you are not in the US, you have access to all of the styles of Mentor and Allergan anatomical implants. You would probaby be a candidate for a low height full projection or moderate height full projection anatomical - in the 300 cc range in Mentor.
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Thanks Deborah! I am in Canada,. I think that's what my surgeon talked about. Do you think I will still look nature and also have fullness on the top with Mentor CPGs?
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Hi Whippetmom, I'm new here and hoping to get some advice. Another member suggested I PM you, which I did, but that was before I found this thread and realized you would need some specific information. I'm having a BMX with TE placement in August. I've met with my PS once for a consult and have a pre-op with him in a couple of weeks. So far, he hasn't discussed implant sizing or style with me at all. I'm hoping we cover all that at my pre-op. I'll be having rads, so he's mentioned using AlloDerm and possibly some fat grafting with the exchange surgery if I need it.
I'm 5' 1/2", 115 pounds, 30" ribcage. I'm currently a 32D or 34C, but would like to go down to a small B. When I'm eating healthy and maintaining my weight, which is usually around 105 pounds, I'm around a B.
My goal is to look as natural as possible. They'll be sparing my skin, but not the nipple. I was originally thinking I'd do the gummy bears, but then read that you can't use those with reconstruction. I'm not sure if this is true or not. Then I thought I'd do the teardrops, but am reading about the possibility of them rotating. This is where I start to get frustrated and end up back at square one in terms of making any decisions. Any help and insight you could pass along would be greatly appreciated. Thanks so much for taking the time to help all of us!
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Hi Whipetmom,
This is a follow up on our previous exchange. As a reminder, I have 400 cc Allergan expanders, and my PS was recommending 425 cc round base Sientra. I went back to see her yesterday to discuss whether these would be too small and whether we could consider the 480 cc. She is worried that the 480 won't look too good on me because the base is oval and not round and she thinks I need more fullness on top, and they might be to wide on my ribcage. Unfortunately, the 485 Sientra round base are not yet FDA approved, it looks like it would have worked well for me. So, she will take the Sientra 425 and two models of bigger Allergan shaped implants with round bases (up to 500 cc) in the operating room, and use these if the 425 look too small. It sounded like a reasonable approach to me.
Thanks again for your help, it was really helpful to have your feedback to have an informed conversation with my PS, I did not realize the implants are significantly smaller than the TEs.
Huz
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Allydp: There are a number of options for you, but I do believe that I just would not want to risk anatomicals, (Allergan 410 or Mentor CPG), because of the risk of rotation. You are going to have rads and there will be too many things going on with that skin envelope to risk using an implant with a high potential for displacement. The Sientra shaped might be an option - but I have seen so few women with a shaped Sientra, I cannot comment on the rotation factor with that implant. It is shaped differently than the Allergan 410 or Mentor CPG, and so I favor the Sientra in that regard. Sientra implants are all true cohesive gel "gummy bear" implants, and there is a smooth round Sientra, which I think might be a very good option for you. I think a HP smooth round Sientra in the low to mid 300 cc range would be a good choice.
That said, I think that you still would be fine with one of the tried and true Mentor or Allergan smooth round silicone implants, primarily because you said your PS will employ fat graft transfer as part of your reconstruction process. I am very encouraged to hear this, because FGT can change the integrity of previously irradiated skin, making implant-based reconstruction much more plausible and successful a tool, for those who are not candidates for or desirous of autologous flap-based surgery. So with Allergan or Mentor, I would suggest either a smooth round HP with a volume of around 300 ccs up to 400 ccs, or a midrange PLUS style implant (Style 15 in Allergan) with a volume of aroud 300 ccs to 350 ccs. It all will depend on the base width of the TE your PS ultimately uses, which HE/SHE will choose based on the width of your native breasts. But something in the 300 cc range, up to 400 ccs, should be your goal with implants, whatever style or brand ultimately chosen by you and your PS. You will have tissue expanders first, so TEs that are either a short height or moderate height which will get you to the 300 to 400 cc volume with implants will be ideal. This gives you a bit more to discuss with your PS.
Read my thread "Fat Graft Transfer and the Radiated Breast" here on bc.org also, for further information on the benefits of fat graft transfer....
Please keep me posted during your journey!
Deborah
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Huz: What do you mean "Allergan shaped implants with round bases"? There are no such implants. I don't know about anatomicals....cannot recall which style of TEs you have....would PREFER smooth silicone rounds for you in Allergan, if the Sientra shaped are too small.
Deborah
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alludp - If you have access to the picture forum you can follow my journey which involves having fat grafting prior to placement of tissue expanders to help restore some of the integrity of my radiated breast. My PS also used low height TEs on me.
I'm almost through with the expansion process and we continue to "nudge" the radiated side along.
Might help give you a sense for what to expected with radiated tissue.
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Whippetmom Have a question. UMX. Trying to decide between just lifting my unaffected breast or placing implant there( just a bit bigger with implant) . Here is from other thread . Do you know what wroks better /looks better . Just doing lift on unaffected side or palcing implant to match reconstruction from mastectomy .
"HI fairly new to site . I had L mastectomy and TE placed ...found out after would need radiaton so not exchanging until next year but have to decide how much to expand now . If I do implant would need more fluid placed than if I just lift my unaffected R breast . I am doing Pro con list but would love any opinions from people who have had surgery . I am B cup if that makes difference I am triple negative and just finishing up chemo (carbo,taxol,,AC)
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Deborah, thank you so very much for such valuable information! I'm grateful for your take on the anatomicals. I was thinking the same thing. As natural of a look as I'd like, it's not worth the risks and possible complications. And in regards to the Sientras and round silicones, you've given me a great jumping off point with my PS. Thank you!!
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Raelan, thanks. I have access to the picture forum, but haven't logged in for a while. I will head over now and try and find your thread.
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I am new here, but my lumpectomy with radiation was nine years ago. Three plastic surgeons I consulted offered unacceptable reconstruction options. I'll spare the details, I waited till moving to LA to start considering doing it. I am 5'7" and normally about 118-124 pounds, mostly muscle with 32D bra size. Now, at 144 pounds after 2 accidents that prevented exercise, I wear a 32DDDD with an Amoena size 6 prosthesis on the affected side. My affected side is about half the size of my unaffected side. Also, the unaffected breast started to droop and the areola got bigger with the weight gain. I did nurse (21 years ago) but the sagging isn't so much that it's unattractive. The issue is that the affected, radiated side is perkier and smaller and with a smaller areola and nipple.
So, I am starting to exercise again and can easily get back down to my normal size 4 with exercise alone. I have a high metabolism when exercising. But, I'm willing to stay a little bigger than that if needed for fat transfer. I prefer fat transfer because I don't want to deal with capsular contracture and I have an idea that this will match my unaffected breast better and spare me repeat operations.
So, given that when I lose that 20, I'll probably be a D on the unaffected side and a B on the affected side, can fat transfer fill the difference, understanding that my band size will be 32 at most. My measurement is actually 29, but it's nearly impossible to find a bra with a large cup size in that band size. So, I wear a 32DDDD now and expect that I'll be a 32D when smaller all over. Maybe 32DD, but not sure. Right now, I am wearing an old, falling apart Amoena size 7 Energy Light 2U 341 prosthesis but it's too big. I just make do while changing insurance for now. I am guessing I should have a size 6 right now. Some of the silicone is seeping out so I'm thinking of taking a bit out on my own and sealing it back up till I get a new one. Seriously.
Questions:
1. Can fat transfer make up this much size difference? About two cups on a small ribcage but possibly a little more?
2. Will the pumped up breast start to droop to maybe match the other side more, even though radiated?
3. Will the areola get bigger as it's filled and relaxes?
4. If I have a lift on the unaffected side and fat transfer on the affected side, will they droop more or less equally over time? Can an internal mesh be used to prevent unequal droop?
5. Should implants be part of this equation? Is capsular contracture related to keloids, which I sometimes get from a bee sting, for example. It's scar tissue that is hard and a little darker than regular skin, but I only have a few.
Trying to mentally prepare myself and find the right surgeon that can deal with my needs. Ready to be my normal size and shape again now that I'm at the beach and getting fit again and don't want to have to deal with prosthesis, old lady swimsuits, or insecurities about dating/remarrying. I don't think the way I am now is a true barrier for me, but it's a distraction and hassle and I want to be free of this prosthesis and be able to wear a wider variety of clothing and look good in a nightgown.
I posted this here because I am wondering about how many CC's my prosthesis equals. When I first got one, I think I had a size 4 or 5, much smaller, but I was smaller, so maybe that's what I need to be looking for. Can fat transfer make up that much difference in size?
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mimsey: I think you are better off with a successful lift of that native breast, because it might be tough trying to get a radiated breast pocket expanded sufficiently to match the ptosis of your native breast. I think EVERY radiated breast should have the benefit of fat graft transfer procedures - at least one but perhaps two - in order to change the integrity of that skin. I just think it all depends on how large your PS can go with that MX side....it would essentially need to be expanded larger than the native breast (by overfilling the TE) in order to get some natural droop/ptosis to match the native breast. As I have said, symmetry is the goal - not size - with a unilateral reconstruction.
Deborah
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WellSaid:
Someone recently asked a similar question about revision of a lumpectomy defect. Here is what I said...
Reconstruction of lumpectomy deformities is called oncoplastic reconstruction. Typically, the two most common elements utilized currently would be fat graft transfer and flap reconstruction. There are some new flap procedures being used for lumpectomy defect correction {TDAP and LICAP are two...see link below} but you need to talk with your PS. to see what methods he employs in this regard. Perhaps fat graft transfer plus an implant would be another option. I do not know about nipple salvaging, when it has been so drastically displaced with the lumpectomies. I would want an assurance from the PS that he will revise the nipple areola complex for better placement on the future breast mound. Keep me posted on what you learn in August. (NOTE; This last part of the response might not pertain to your situation.)
LinkBut I also think you should consider a reduction of the native breast. Most definitely that should be part of your discuss with any plastic surgeon here in California. It would require a lot of fat graft transfer procedures to match the native breast. That is a lot of surgery. I suppose the BRAVA method is a consideration, but I do not know enough about that procedure...or whether it even is recommended for post-lumpectomy patients. There are BRAVA threads here on bc.org and you could find more information there, if you are interested.
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Deborah,
Thank you very much for your response and the helpful information. I'm so glad that there has been progress in reconstructive techniques.
I will investigate the new flap procedures though I tend to not want to mess with other parts of my body that are unaffected by cancer, for three reasons: 1) No dependable support for long recoveries, 2) Don't want scars that show in a bikini, 3) Don't want to interfere with athletic capabilities, 4) My defect is not that bad and mainly is an issue of size. But, thanks for letting me know and will look into them as the new ones may be preferable.
One option I have considered is to pump up the affected breast as much as possible over time with fat transfer and then reduce/lift the unaffected breast to match. It would take some getting used to to choose to be smaller. I never really thought about size much until I had to consider such options. Having different proportions would require a mental adjustment, but I realize that I'm fortunate to have only a size difference and some scars that pucker when I lean over.
I'm also delighted to hear that fat transfer can make having an implant less risky in the sense that it might reduce the incidence or severity of capsular contraction. Did I get that right? I don't want an implant, but perhaps it's an option. If I were to do that, would it make sense to get one on each side so that drooping differences are minimized?
Yes, I will see PS's. I am trying to determine which insurance I need to get to cover all of this well and how thin I can dare to get and still have fat for transfer. It will be a couple of months before I can see a surgeon, but I want to educate myself and have some procedures at least ruled out so I can focus on realistic options for me. I'm working out and that makes me lose weight, so I don't want to get too thin for fat transfer. When I work out all the time, I have very little fat except in my breasts. Not sure how much I need.
Sorry if I missed these answers in other posts. I'm a bit overwhelmed by all the information and some of the terminology so that sorting it out can be confusing. Thanks for your help.
Wellsaid
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WellSaid: Yes, it has been shown that fat graft transfer after breast irradiation can reduce the risk of capsular contracture, but it also has been shown to reduce the grade of an existing capsular contracture. I do not know if you would require an implant for the native side. It all depends on how much upper pole fullness you can achieve with a reduction and lift - or just a lift. If you achieve enough volume with FGT and/or an implant on the lumpectomy side, you might just need a lift on the native side. You might call Lisa Cassalith, MD, who does fat graft transfer for breast reconstruction patients in Los Angeles. I have never seen her work. You might check out the BRAVA forums for this information. I believe someone might have gone to her, but I cannot recall who - it was a year or so ago. Keep me posted on what you find out though!Deborah
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WellSaid - I realize that you've listed multiple reasons that you have opted out of flap surgery, but I just want to address one of your concerns as it seems to come up on the reconstruction threads over and over. In regards to your reason "3) Don't want to interfere with athletic capabilities". Many plastic surgeons offer flap surgeries, but only surgeons who are trained in vascular microsurgery can offer all the flaps available. There are flap surgeries that do NOT require the removal of muscle from the donor site, but they can only be performed by a microsurgeon. Surgeries such as DIEP leave the abdominal muscles intact.
Good luck with all your research. I'm a firm believer that by asking lots of questions and listening to your gut you will find the right path. Best wishes!!!
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Tomorrow I am going in for my pre-op consult with my PS for the exchange next week. I had emailed Whippetmom all my measurements some months before and she recommended Allergan style 20 in 700-750 cc's. I'm currently filled to 570. My PS had mentioned possibly doing fat grafting. Right now I'm liking my size and I don't care to be any bigger. It would be mainly for the defects as far as indentations. So I'm hoping the FG takes care of that. My TE's are over the muscle and the implants will also be over the muscle of course. The only thing I don't like is that they seem lower than my breasts were before. I think he used a lot of Alloderm for the pockets so am not sure how much adjusting he can do at this point. Aside from discussing type and size of implants, are there any other "good" questions I should be asking?
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I had skin & nipple sparing bmx in Feb. 2014 with immediate implants (one step procedure). I have Mentor CPG 355cc implants. I met with 4 PS before selecting mine and she did not seem to have a concern about rotation and I have read that as long as the pocket is shaped to the implant it should not be an issue. I see that you have written that rotation can be a problem. So question one is do you only recommend round? My implants were smaller than planned due to skin stress from surgery. I am now considering switching to larger implants and my PS says I can probably go 100cc larger. What I really want is more projection and am very disappointed that the US has not approved the various size CPG implants, only Europe & Canada can get them unless you are in a trial/study and I would like to keep my PS. My PS suggested options of Natrelle 410 470cc MH/FP or Sientra 480cc shaped oval. I've been looking and since I can't get the Mentor CPG in LH/FP I see saline shaped might give me more projection. But I hate to go to saline -- sorry this is so long, any thoughts or suggestions?
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bc101: My only concern is the lack kof support for the heavy implants, which you state are already too low on the chest wall. Let you PS know your concerns in this regard. Perhaps you need to go with smaller implants. I cannot recall the style and volume of your TEs. I know they are filled to 570 ccs....need the style/volume/width of the TEs.
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savilleization: Anatomical implant rotation is a risk where the pockets are either overdissected, and/ or a tissue expander is used which is larger than (especially greater height than and greater projection than) the anatomical selected. We do not have access to all of the anatomical styles - the full height/extra projection styles especially - and this becomes a problem because the right TE must be selected and expanded to comply with the dimensions of the TEs. That is often not the case. It does not sound as if that is the case for you. I would be inclined to prefer the Sientra 480 shaped oval - it is supposed to be much softer and less rigid than the Allergan 410.
Deborah
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The style of my TE's are Allergan 133MX-15-T (700 cc's). I'm 5'4'' and weigh 170. My ribcage is 38". Maybe I'm just not used to it since I'm bigger than before. I'm just afraid that the silicone implants will be even heavier than the TE's since they're saline.
I know there is some "wiggle room" so I will discuss this with my PS.
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