BREAST IMPLANT SIZING 101
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dogsneverlie - I'm not sure about lumpectomy situations but in the case of a single mastectomy with reconstruction I'm pretty sure insurance is required to cover work needed to achieve symmetry between the reconstructed breast and the healthy breast. For some women this means and augmentation and for some it means a reduction to the healthy side. Someone here will probably have an answer for you but if you want to research I think the law was called something like 'The women's health insurance act of 1998'. I haven't ever looked but I would also imagine there's got to be a lumpectomy forum or thread here where your question could also be asked??
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Hey Babyo20, did you decide on your implants today? I'm at 400cc now! Woo hoo! They keep asking if I like the size, and I say, "yes, but would I like them more if they were bigger?" I've always been so small that now I'm just getting greedy!
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hey Elizabeth! I posted this in another spot but here it is.
lolI went got my final full today. Have a 350 but was at 425 and love my size. Tried on bras although I know it's not totally accurate . I was a 34b but now can wear a 34 c which is what I wanted. I have been rehearing on these forums that implants are usually smaller, my PS said they really aren't but since they are softer they look smaller. So because everyone said to fill an extra 50 when you hit the size you want, although you don't really need to he said, I did. So now I am at 475 and am 5'4" and 130 but usually 120 and small frame. He told me that I was fine that if it made me happy do it but it wasn't necessary and although my skin is extremely tight I did it. He told me itbis okay like having a baby, skin can go back to its original tone but I don't want to harm the skin and what if he chooses a smaller implant will it damage the skin since it was stretched? I left the office feeling sure but now I am doubting it. I have been obsessed with making sure I am bigger than I was but now I feel like I don't want them bigger like they are now but I know being softer they won't be. What sparked this is my husband you'd me that I am huge and I don't want to be huge, only bigger, my husband said I am as big as my friend who is a DD but 5 inches taller but what does he know about boobs. So, how many of you went bigger than you were before and by how much? Do you regret that? If you were used to being smaller was orchard to adjust and did they get in the way of activities?
I guess if he asks me if I want to be conservative or as much as he can I am leaning towards conservative. I was so all over the place with him that I don't think he actually know what I want. lol I just told him make them look good for my frame.
Sorry I am consumed by this just as much as I was when I thought I was the right size. What happens if he under fills by using an implant smaller? Will it look weird or affect my skin or would it just look more natural?
Thanks for your responses. You guys have really been great to talk to here. My PS told me to stay off the internet! Part of me thinks he's right! Lol
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It seems to me from my consults that incision placement can be based highly on their preference (as well as whether you are keeping nipples, already have scar sites from a lumpectomy, size/ptosis of breasts, etc). Also, the BS often had a different preference than the PS due to different goals. I was told about 3 different plans for incision placement by 4 different surgeons.
My incisions/scars are along the IMF (I had NS). They run the entire length of the IMF (to give better access to BS to remove tissue) but are not very visible now that I have dropped and fluffed. You can just see the line at the sides a bit where the breast does not cover it but as they still have a ways to go to lighten up I imagine they will be barely visible in time due to how I scar. I had direct to implant but was advised future swaps could certainly go through same place though the incision length would be smaller. I am very happy with them, my PS did an excellent job (no external sutures, scar lines are smooth, and quite thin).
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baby020,
You can't really go by cup sizes, as it is all relative to the band size, and most women wear the wrong band size (generally they go too big in band, and so conversely go too small in the cup). With a proper fitting you might very well find yourself to be a DD or so! Indeed, many women find they need a larger cup then they think they are to accommodate the width of the implants. Wires should always encompass the breasts, be they natural tissue (swoop and scoop all tissue in there) or implants, but the failure to do so is more obvious with implants I think.
So ignore cup size until you are going for a proper fitting in time. You need to go by how you feel about how they fit your frame/preferences. That should be your PSs aim as well.
I am 5'4", ~118 lbs, 29" ribcage, with 435cc high profile smooth rounds (Allergan).
I was a 30E before surgery, and am a 30E now. But, they look a bit smaller than they were before as they are firmer and sit higher. A 30E is NOT big, it's actually pretty average (see abrabandproject at http://www.brabandproject.com/gallery/search?band=30&cup=E&age=&brand=&sister_sizes=0&search=Search) They do not get in the way at all and I am very, very physically active.
I was a direct to implant, but had looser skin on one side (my larger natural side) after surgery, and it has shrunk up considerably over the last 3 months and should continue to do so...and this is after years of it being "stretched" due to my natural breast. Your PS can also remove extra skin at exchange or at a later revision if it is required.
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Oh gosh, after reading all of these posts, I am wondering if I am too small and need more fills. It seems like most of us strive for the a "c" cup, although I know it is all relative and you can't predict cup size. I'm not sure what my tissue expander is, but I am 5"7" and weigh 190 pounds and am currently filled to 655 cc's. I hope this is enough to achieve what I am looking for. I know if I lost weight, it would make a huge difference, but I'm in the final stretch now and no luck. I was down to 179 pounds and gained a lot of sympathy weight during my time off from work. I'm now blaming it on the tamoxifen - lol! I was previously a 42D (which is my natural breast size) and I DO NOT want to be that size. work. I will be getting a lift/reduction too.
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babyo - glad to see you here (I just posted on the exchange thread that you should come over here
. You provided your height and weight but I don't see your current ribcage measurement (just below the TEs). If you post that then Whippetmom will have the bulk of what she needs for initial analysis of implant size. She's awesome.Frostecat - I'm 5'8" but weigh a little less at about 170 with about a 33" ribcage. Prior to reconstruction I was wearing a 36 or 38D push-up from VS (can't remember and I got rid of the old bras). I had 600cc TEs overexpanded to 750cc and exchanged to 750cc high profile Allergan smooth rounds. I did go to Nordstrom's shortly after exchange and was sized at a 36DDD and picked up a couple bras at that time. The 36 band really felt too tight though so I think I'll probably argue for a 38 in probably a DD cup next time I go. My boobs are noticeable (like they were before) but I am by no means huge and do NOT look like I have stripper boobs. They're just right for me, proportionate to my frame and previous look. I am also physically active and do not have any problems working out, walking, running, jumping (excepts my springs are a lot more sprung than they used to be....lol) pulling the lawn mower rip cord, etc, etc.
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Hmmm I'm wondering if I need more fill. Quite frankly thought I don't know if I can take anymore either. The PS said I was about done, I lost more skin then what they thought I would during surgery. Well at this point in time I'll probably have to wait until my post-op and see what he says. I think he is the type that would fill right up to the end, so if he thinks I need more, I guess we can just do it then. I'd be totally happy with a 38 C or D. When I hit size 40, it all went south from there!
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Baby and Frostecat, I'm size obsessed too! I am so worried about waking up from the exchange and thinking, "oh no, this is not at all what I wanted!"
I'm gathering my photos and info to email to Deborah/whippetmom, and I'll see what she says. Then I meet with the PS for the *final time* (eek!) on August 21st. I have nearly given up on obtaining my TE info. It's very annoying. Apparently the only person in the world who knows what model I have is the PS, and he's out of town for most of August. His PA doesn't know, his nurse doesn't know, my records don't say. I tried the insurance company--they paid for them, but they don't know what model they are. I tried "patient services" at the hospital; they don't answer. I tried medical records; they offer a huge long recording of the procedures necessary for obtaining your records. Grrr. I sent off an email to my BS--her office is awesome--to see if anyone there can help, but if the model number isn't indicated on any of the official records there isn't much they can do either. So I may not have that info.
Yesterday I went up to 400cc, and I think I really like the size. I thought 375cc TE was sort of the minimum I'd be happy with, but I like 400 more. I'll have two more 25cc fills, and I'm afraid I'll like each of them more as well! I do definitely like the projection of the TEs, so I suppose I have to go larger than the TE CCs. I don't know if the PS would go for 500cc implants! Would the extra high profile make a difference? I'm 5'4, ~118 pounds, rib cage of 27 or 28 (I have measured a million times, and I keep getting 27 or 28?).
I should probably quit thinking about it.
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Elizabethaw: Mentor HP smooth rounds - 450 ccs up to 500 ccs. Your PS can order these sizes and try them out in the OR to see what looks best. 475 ccs is a good midrange between these sizes as a goal.
Deborah
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Baby and Frostecat: I do not believe either of you have given me your stats or TE information....if you have, please repeat. Overfill has very little to do with final size, other than it means you will have more ptosis/droop, which you may or may not need. I need to know the original, manufacturer's recommended volume of your TE or TEs.
A. Frostecat: If you are a unilateral, and if you have a larger native breast, you will likely need a lot more overfill in order to gain symmetry with the native breast. But I need to know the original size of your TE...and size of your native breast. Photos would help...which you can PM to me. Size is not the issue, symmetry is the issue.
B. Babyo20: I think you will be happy with high profile smooth silicone rounds, with a volume of 450 ccs or 475 ccs.
You gals are overthinking this way too much!
Deborah
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Overthinking is what I do best!
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I am 5'4" tall. I weight 120 pounds, and my ribcage is 29.5 inches. My TEs were Allergan MV-400 ccs. I was overfilled (not intentionally, but just because I had an initial fill at the hospital) and then 50 ccs every two weeks, which came out to 425 ccs. Frankly, I did not need that overage....my breast skin is very lax...and I have more ptosis than I would prefer. If you skin is NOT lax...and is taut, you may need a bit more stretch to the skin and so overfilling the TEs might be necessary, IF you are going to implants 100 ccs or more larger than your TEs. So I asked to be exchanged to Allergan Style 20, 500 ccs, but during surgery, the PS found that they looked a little too small in the pockets and so she went to 550 ccs, in order to fill up the pockets, and because she knew I would not be happy with 500 ccs. She had my back!
So, I wear bras that range from 32 E to 34 DD. Band size varies by mfr - and I wear Anita, Freya, Chantelle and sometimes Natori. You have to know that European bras fit us better after reconstruction - and they have different sizing than American made bras. (Go to the Bras 101 thread for more information in this regard) So I LOOK as though I have a "C" cup in clothing. I look the same in clothing as I did before BMX, when I was a droopy 34 C cup. This is why you cannot, should not, go by cup size! It is crazy-making and if you keep telling your PS you want a C cup, he will give you your C cup and you will end up looking like an A+ in clothing. As I have said, ad nauseum, plastic surgeons cannot predict cup size for reconstruction patients. Most of them admit they cannot predict cup size for augmentation patients. Our own body chest wall characteristics might make one gal with my measurements fit into an entirely different size bra than me. If you are my height and weight, and your ribcage is 33 inches, my implants are going to be smaller on your frame than they are on me, and you will wear a smaller bra than me. This is because the cup size goes down as the band size goes up. So if I wear a 32 E, you would likely wear a 36 D....and perhaps look like a "B" in clothing. It is sort of a crap shoot to some extent....because we are all so unique in the way we are designed!
Hope this helps!
Deborah
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Thanks Deborah - I will try and call my PS office and see if I can find out what type of TE I have, I haven't a clue!
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Frostecat: Manufacturer, Style, Volume, and if Mentor, it will be a low height, moderate height or full height TE. If Allergan, it will be a Natrelle 133V....followed by either a MV-14, MX-13, SV-13, SX-13, FX-13, you get the picture. Two letters followed by two numbers. OR....it might just be a style number and volume, such as MX-400 or SX-300. Mentor TEs tend to be sized on the half, such as 350 ccs, 450 ccs, and Allergan on the whole, like 400 ccs, 500 ccs, etc. Some short height Allergans are on the half number though....So if your doctor's assistant tells you it is a Natrelle 133v, she is only giving you PART of the information. This information must, my federal law, be placed in your chart! This is a foreign body...an implanted medical device!
Deborah
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Yowsa! I have a call into them now. I just ran out on my lunch break for a measuring tape. I've been watching this board for awhile, but now that I'm getting close to exchange, I'm wondering if I'm filled enough. I'll get back with you as soon as I hear from them.
Thank you Deborah!
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To piggyback on whippetmom's post above:
When your breast(s) was(were) removed, the amount of cc's they weighed was written down in your chart.
It's most helpful in talking to your PS regarding size to talk in terms of the size of your breasts prior to removal. "I want to be smaller, I want to be bigger, etc…than I was before." Talk to him/her in lingo that is clear and concise. Talking in terms of cup size is nebulous. What you think is a "C" cup most likely isn't what your PS thinks is a "C" cup.
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We ALL obsessed to a certain extent prior to exchange! You've got to 'Let go and let Whippetmom'..........if she's got your stats she's an absolute pro at recommending implants to fit you and your (reasonable) expectations.
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Speaking of "reasonable expectations...." I've heard people say that a lot, and I'm wondering how I can determine whether or not my expectations are reasonable. I've read the "emotional issues after the exchange" section, and I know two people who went through that emotional upheaval. How can you prepare yourself to avoid that crash/letdown? How can you measure how realistic your expectations are? I'm not expecting breasts that look and feel the way they did before, but is "natural-looking" out of the question? Should I (we) be prepared for firmer-feeling breasts? What do I need to know in order to stay relatively sane?
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On a different note, I remain irritated at how impossible it is to get my TE model number. I got a response from my BS's office. The nurse there went through my medical record and couldn't find anything about the specific TEs. So she called the PS's administrative assistant, and she couldn't find anything either. I could do the paperwork to get the official notes from the surgery, but it sound as if the TE info isn't even included. I've talked to the insurance company, the PS's PA and nurse, and I've emailed the hospital's "patient services." I can't think of anything else to do but wait for the PS to come back from out of town. It should not be this hard, and for the sake of the women who will go through this after me, I'm going to raise a fuss about it! I may, however, wait until after my exchange surgery to irritate people!
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Deborah, I just got the phone call. I have Mentor Low Height 8100, 450 cc. I am currently filled to 655 cc's. I am 5'7" and 190", rib cage measures just below the breast at 39" and my natural breast size is 42D, which will be lifted and reduced at exchange - I do not wish to be that size again. What is your advice? The PS office said they will measure me at my pre op and order about 4 different styles, then sit me up during surgery to see what works best. I suppose it is kind of hard to tell being that they will be changing the natural breast too.
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Elizabeth - When I think 'reasonable expections' it brings more than one situation to mind. If you went into BC as an AA cup and are doing reconstruction with implants rather than a flap surgery it's probably not reasonable to expect to end up a DDD size, right? Your remaining skin probably just wouldn't stretch that much. Radiation can damage skin integrity to an extent sometimes that it's not possible to use the size implant needed for a desired size. Just stuff like that. Some women do end up with very natural looking breasts and some look quite natural but not quite and some look great in clothes but not so great nekkid, and so on. Individual results are just that - individual. I think mine are beautiful! They don't have nipples and after revision surgery the scars now extend to under my arms, but they're beautiful to me, and they're beautiful to my DH. The scars will fade and at some point I'll probably get 3D nip/areola tats for a more normal look.
I did end up with a bit of an emotional mess for a while but it was nearly 10 months post-exchange. I contracted an intestinal bug Memorial Day weekend (typically get nothing more than the occasional head cold), was still sick during the California Dreaming trip (with some friends from the exercise thread) and started having anxiety issues while in California, wasn't sleeping well, didn't dare eat much of anything for fear of how my gut would react, etc, etc. I think on top of the BC diagnosis, BMX, expansion, Arimidex, exchange, etc, etc, those two weeks of not feeling well were the straw that broke what I thought was a very strong camel's back. My PCP put me on an anti-depressant as soon as I returned from California and I now feel like my old happy, optimistic, more energetic self! The point is, you may or may not have an emotional let down. If you do, it may not manifest until weeks, months or even years from now. Just be aware that if you do start feeling sad and depressed at some point you should talk to your doctor about it.
Holy cow - I wrote another novel.......sorry!
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you brought me to think of another question. Did your PS discuss what size implants he will be using for the exchange at your post op visit? Mine did not when I asked him he said he wasnt sure what he as bringing but I think it's cause he knows that I have been reading a lot so would maybe be an issue telling me. It sounds like many of you are told what your PS will bring? Is that right? I am so nervous now that my message of what I want is lost because I questioned him based on what I read here but also because I got an extra fill he may think I want more. Should I send him a card or message explaining exactly what I want or leave it alone?
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Estel and anyone else who can shed some light....My post-op report is expressed in grams of tissue removed, not cc's. I know that 1 gram is approximately 1 cc when speaking in terms of water. But it differs depending on the composition of what you are comparing. Does anyone know how this relates to comparing breast tissue?
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My PS did discuss size with me at my last fill, I will see him one last time for a final consultation next week. He mentioned size and that he wanted to use the shaped Sientra's but if they don't look or fit right he will try round and let the nurses decide on which look better. Even though I know all of this I keep seconding guessing all of it too..but I really do trust him and I believe he knows what he's doing. At least that is what I am telling myself!! :-)
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PinkWalker - good question. I just checked an online converter and found that 150 grams is about 1/3 pound. So my diseased breast weighed about 1/3 pound more than the healthy one if I remember the amount of tissue removed at least approximately correctly.
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Frostecat: Your PS might be thinking about an implant in the 600 to 750 cc range, IF we are talking about HP smooth siicone round implants. I am using Mentor, for example, since you have Mentor TEs. This means four different implant sizes have a potential to work for you, but the volume chosen is dependent upon the end result after your reduction/mastopexy. Your TEs have the ability to take you to an implant with up to 300 ccs (possibly even 350 ccs) greater volume than the TEs, especially if you have the skin flap availability, which you probably have with your pre MX breast size. I am thinking more in the 650 cc/700 cc range....but again, symmetry trumps volume with a unilateral reconstruction.
Deborah
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babyo20: The implants he requests for surgery will be recorded in your chart. Ask the nurse to tell you which mfr, volume/size/style implants he ordered. Yes, I would want to know what he plans to use.
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Thank you so much Deborah! So I guess I'm pretty good with the cc's I am at now?? Your knowledge on this topic is so very helpful to so many of us!
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Frostecat: I think you are probably just fine where you are.
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