BREAST IMPLANT SIZING 101
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Whippetmom,
I am not sure what kind of TE I have. I do know I am going to get silicone Mentor implants which are round and high profile. My ribcage measurement under the tissue expanders is 29inches. I weigh 107 lbs and am 5ft 3 inches. I have 350cc filled. The fills have been quite painful. I am so ready for this to be over. I like the size I am and hope that with the implants it doesn't get much smaller. Thanks!
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Whippetmom,Golly, I wish I had this site before my surgery! I keep seeing here where people know the size of their tissue expanders. I never had that conversation with my PS and now when I checked my card it says the volume is 300cc. I am already filled to 350 cc's, which I am thinking will be about a C I thought that I would like this size but my PS does overfill and now I am wondering how could there be room to overfill if the original volume was 300cc. Aren't I already overfilled then? Yet my PS said I could choose the size?? I am very confused now and I don't go back for two weeks to him. What do you think, am I in danger of bursting my seams here?
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Lulivesay and Septmom: I thought I would add my dimensions here as we are about the same size. I am 5'4", 120lbs. I was measured at Nordstrom as a 32D prior to BMX in December and had 200g of tissue taken out of each side. (32D sounds impressive, but it really isn't that big). I had Mentor Silex medium height profile expanders at 275cc. I have a 30.5" ribcage. I was filled (slowly) to 300cc's. I had my exchange one month ago and am the proud new owner of 350cc Mentor medium plus profiles. I look about the same size in clothes, but definitely notice more fullness on top which I like. I was again measured a 32D at Nordstrom.
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Piano girl - thanks so much for your info.
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Whippetmom,
After showering today a scab that I had at the base of my vertical incision after exchange came off leaving a hole in my breast. I could stick my pinky finger in there ( be assured, I didn't but I could). This is the third time this particular spot opened up since my BMx in January. I have an appointment to meet w ps about it tomorrow. The last time it opened she said it was fine it'll close on its own but now it's open again!!! What would you recommend!? If she says it is fine should I push to have it closed? Stitched etc?? What if the skin never heals?!? Please advise me as I see ps in the morning..
Hi piano girl! How r u?
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Whippetmom I just want to make sure you got my PM I sent a few days ago. My exchange is now scheduled for Aug 20 although I still have two fill appts remaining, the secretary said the PS note read that we are finished with fills? I now have 280 cc in and I think she mentioned using a 435 cc implant? I gave you the info on the TEs in the PM. I am 5 ft 4 inches, 125 lbs with a 30 inch ribcage Was originally a B. Was thinking Id like to be a C but now that it is getting closer I wonder if I want to go a little bigger. I don't want them so big I cant workout comfortably but big enough that if I gain weight again (was 150 lbs) they wont look small!
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bethq: I missed it, but I just responded to your question tonight! Sorry for the delay!!!
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Septmom: Well, your PS probably intends to use Mentor HP implants with a volume of 325 ccs up to 425 ccs. It depends on the style of your TEs. It depends on the WIDTH of your TEs.
Deborah
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luvivesay: No, a 300 cc volume TE can easily handle an overfill to 350 ccs to 400 ccs. I still need to know the style - actually - I need to know the width of your TEs. If you have a "card", it should have more information than just "300 ccs"....
Deborah
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Mommyathome: Ask your PS to have a wound care specialist or nurse with wound care experience render an opinion. The burning question is....why is this wound not closing up?
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Whippetmom,
It must not be healing from the inside out. If there's a scab, typically the skin underneath would be healed when the scab falls off right? I can see inside my breast!! There's a clear hole..... Ugh!!! Any predictions of what they'll have to do to fix it?
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Mommyathome- my guess more antibiotics. I would ask to be referred to a wound specialist.
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luvivesay - I had 600cc TEs and was overfilled to 750cc with no problem and they would have accommodated 800cc if I had wanted. I exchanged to 750cc implants that are just the right size for my frame.
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Deborah, I will send you a PM with photos, Thanks!
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I'm not sure if this is the best forum for my issue, but here goes! I have my exchange scheduled for Sept 4th (BMX), and I've got 3 more fills left. My PS comes very highly recommended, and he's a super nice guy. However, I'm getting the feeling that he sees himself as an artist--at least I think that's why he does things the way he does. He's very unspecific about plans, and has only asked me how large I wanted to go. When I ask a lot of questions (and I'm totally that kind of person!), he just tells me that everything is looking great and that reconstructed breasts won't be the same as natural breasts. I told him that I felt uncomfortable leaving my aesthetic future up to him, and he said it wasn't really his decision--it was about the pocket and what fits well. The nurses tell me he gets wonderful results, but I'm not feeling like I have any say in what happens. I tried to show him some photos of what I did and didn't like, but I foolishly was relying on my iPad--and it couldn't get a signal inside the hospital! So I emailed them to him, but he hasn't responded yet. I tried to explain that I don't like a ton of upper pole--the half-of-a-ball-glued-onto-my-chest look. I'm 5'4 and ~118 with a skinny little upper body (27 or 28" ribcage, not good at holding the measuring tape by myself!), and I don't want to look super fake. He said that maybe fat grafting would help, and we could do that as a revision later. I read about PSs who have conversations with their patients about their expectations and what they're hoping for, and I'm not getting any of that. (The nurse who has done all of my expansions is fantastic, and we've talked a lot about it.) I started this whole journey with a diagnosis of DCIS and LCIS, and I was amazed at how much my breast surgeon worked with me--she never made decisions for me, and she patiently talked me through all of the decisions. I'm the kind of person who likes to do a lot of research, and I was afraid she'd be insulted by my questions, but she never was. Same with the genetic counselor and the radiation oncologist (I ended up not doing rads). So I'm not sure how to handle the PS. He's a very nice person, and I don't want to offend him, but I want to talk details and get answers!
What do y'all think? Should I push him more? Should I try to get an appointment to talk to him again? I won't be seeing him in person again before the exchange--only emailing, assuming he ever answers! : )
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Thanks Deborah, I just sent you a PM with photos.
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Mommyathome: My own experience and research regarding non-healing wounds, is that you have to find the culprit. If you have no signs of infection, they need to look for a foreign body, e.g., an embedded, migrating suture or try to determine what else might be preventing closure and healing of the wound. Also, my research supported, for my own case, that covering the wound with a wet-to-dry dressing was preferable to air-drying the wound. Here is what I use: I irrigate/rinse the wound several times a day. Dressing changes several times a day. This is my own theory regarding wound healing. PLEASE talk to your doctor and ask for evaluation and referral to a wound specialist if warranted.
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Oops! Regarding sending me photos via private message, it is the LANDSCAPE icon, next to the "googles" icon, that is used to link photos!
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Well just got back from plastic surgeons office. The PA came in at first to look at it and said, um let my get the dr. The doctor came in and asked how long it's been like that. I said since yesterday afternoon. She said I don't like what I see. I'm able to see the implant!!! Omg!!! I almost fainted! She said she wanted to cut away some skin and re stitch it closed. I asked why this is the third time it's opened? She said the skin is thin and weight of the implant rests right there.... She said if it gets infected I'll lose the implant!!! Again my world was spinning.... Lose the implant?!? I don't have time for more surgery!!!! She cut away skin, re stitched, applied gauze, steri strips and waterproof bandages. I'm now on doxycycline for 5 days and I need to go back to her on Tuesday july 29.
As she had me lay back on the table my abdominal incision was killing me!!! Omg if it's not one thing it's another!! Has anyone had an incision that kept opening? What eventually happened?
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Elizabethaw: Ask him what brand, style and volume of implants he anticipates ordering for yo so that you can research each one. Tell him it is important for you to feel some control of the outcome. Ask him if he plans on anatomicals, and if so, the style and volume, or if they are rounds, are they high profile, moderate PLUS profile, and are they Mentor, Allergan or Sientra? You could ask the nurse to find out for you....
Deborah
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Elizabethaw, I would call and get an appointment to talk with him. I would never want to go in to surgery feeling like I was in for a surprise. He(and his nurses) will have to make the final call at surgery time but he should be willing to answer all of your questions and give you an idea of what he at least Thinks he will be using at exchange...My PS did all of my expansions and I will see him about 3 weeks before exchange to talk about what his plans are for surgery day. He has already told me he would like to use the Sientra shaped 370cc's but if they don't look right he will try the Mentor round. He said the nurses in the OR will help decide what to ultimately use. I am feeling pretty good about my exchange. I hope you get to talk to him it, it is stressful enough with out all of these unanswered questions. Good Luck!!
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Elizabethaw - Hi and welcome! Many of us have been right where you are now - frustrated by a PS who is less than forthcoming about details. I would suggest that you read the header of this thread above and gather all the information that whippetmom needs. Aside from height and weight, she will need your rib cage measurement (that's important), but what she really needs is the brand, style, and recommended capacity of your TEs. They should have provided you with a card about your TEs, but if not, call his/her office because that information has to be part of your medical record. Once you have all that, either post it here or click on whippetmom's name under her avatar and send her a Private Message (PM) with all of the information. She has guided hundreds of us toward the best choice for each of our particular situations. Good luck to you!
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Thanks Whippetmom!
honeymama: I think that you would be fine with a 800 cc HP smooth round silicone implant. That is the size I would discuss with your PS. Becker is a type of implant under the Mentor name, which I rarely see used anyway. So the key would be to get a tissue expander with a width no greater than 15.0 cm, and then exchange out to the Allergan Stye 20, 800 ccs.
Deborah
As MinusTwo as reminded me to include all my info...
BMX to be occurring in the next month (date needs to be set)
Rib cage 37" (just measured under my breasts)
5'3" - 200lbs
Have had 2 lumpectomies performed in the last month.
No TE, as BS and PS both said I could do direct implants.
Will be following all with chemo and rad.
So with this extra bit of info, does your suggestion still hold true. I just want to be the same. I started out a 38D and would really like to stay that way. I know it sounds kind of silly, that I should really be focusing more on the cancer side of it all, but I want to be happy in the end too?
Thanks for your suggestions!
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honeymama: In all honesty, I am not a proponent of one-step procedures, simply because I see too many women needing to go back for revisions and usually, to tissue expanders. But, that said, if you have the ample skin flaps, I feel that they should try instead for Allergan Style 45, 800 ccs. This is the highest projection style siicone implant available and why not go with this one to start with? If they cannot do it, then tell them you want to go to a two-step reconstruction.
Deborah
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Thanks for the responses, y'all! I did send a message to his clinic asking for the specs on the TEs, and I have read over all the info I can find here.
I *think* his point is that if I believe I know what I'll look like at the end--I'll be disappointed. No one can predict exactly how it will come out, so perhaps too much pondering and analyzing doesn't help? (I've been comparing this to taking pictures to your hair salon. You bring in a photo of someone with blonde perfectly straight hair and want yours just like hers--but you have naturally dark super-curly hair and it just isn't going to work.) He's said that the final implants will look sort of like the tissue expanders, only better.
When I tried to explain how I didn't like the upper pole fullness (I call it the "invisible push-up bra look"), he muttered something about the gummi bears, but didn't seem to approve.
The more I read about implants, the more I see different women wanting different results, and it frustrates me that he doesn't talk about the outcome that I'd ideally like. I think he doesn't want to disappoint anyone (he is a really nice guy), and figures you'll be happiest if he just does the best he can without the patient picturing a particular outcome. But some women really want a lot of upper pole fullness and some don't. Some really want softness and some never want to wear a bra again. I don't need to tell y'all that, do I? : )
I suppose I really must schedule another appointment with him. I don't want to make him mad, but I also should have some say in this.
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Elizabethaw - you absolutely should have some say and discuss your expections and his plans and get your questions answered. If he absolutely refuses to have that sort of discussion with you I would get a second opinion. I had my TEs for 9 months between BMX and exchange, saw my PS quite regularly for fills and even every month between last fill and exchange (4 month wait). Each and every time I saw him I had questions and he never hesitated to provide the information or explanation or opinion I was asking for. I had 600cc TEs. His plan was to expand me to 600cc and exchange to 575 cc implants. After conferring with Whippetmom I discussed her recommendations with my PS and I ended up expanding to 750cc and exchanging to 750cc implants.Your PS may have a great reputation and all but you need to feel comfortable with the plan. Regardless of his reputation or experience or previous results he needs to remember that he's working for you..
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I sent the following photos to my PS to show what I did not want. I think what I don't like is the very full upper pole look. Is that the right description? I don't like how it looks like the woman in the photo is wearing an invisible push-up bra. It looks artificial to me. I know some women really want that look--no offense to them, it's just not what I'd like (if possible).
photo 1:
http://artisanbreastreconstruction.com/photo-galle...
photo 2 (an augmentation, actually, but a good example):
https://www.loveyourlook.com/breast/augmentation/g...
I also sent one that did not have that look--just to reassure myself that it was possible!
photo 3:
http://artisanbreastreconstruction.com/photo-galle...
photo 4 is actually an augmentation--it's my fantasy for how I *wish* this would end!
https://www.loveyourlook.com/breast/augmentation/g...
Is it unrealistic to hope for a more natural slope to the top of the breast? My TEs are sort of the opposite of that!
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Thanks, sweetandspecial! It's been a weird experience in that my BS was exceptional in working with me, providing me as much information as she could and then standing back and letting me make decisions. Now I feel sort of like I'm interfering with the PS's work! I also feel like I can't have a nice-looking result because I've had a mastectomy. He points out that I've lost all of my natural breast tissue, so I can't have a natural breast again. I just don't even know what to hope for. I feel like he's saying, "Well, I'll do the best I can."
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I have to admit that my implants look more like photo #1 than the others. I'm fine with that and love them. It would be nice to not have that 'step-off' at the top but I don't feel it's that important to me right now.
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Elizabethaw: With what you are describing, it sounds as though you have full height TEs....and the implants will NOT look like the TEs in that regard.
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