BREAST IMPLANT SIZING 101
Comments
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Thanks so much for your help! I'll try to be patient.
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Smaarty,
I just exchanged from the 550 rounds to the Allergan 410 anatomicals also for extreme rippling and divots and I definitely have a better outcome, more of a natural slope to them. if you have access to the picture forum search for my thread I use the same screen name there
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I will check it out. I haven't been on pic forum in months. Couldn't find my way around. Will try again. Thanks Catez
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smaarty... I will reply when I get home in a couple of hours!
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don't rush, Deborah. There's time.
Catez, yours look great. Got on the pic forum, still hard to find others.
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Smaarty: Can you PM me the names of the plastic surgeons you have consulted with so that I can research them and so that we can plan out the next steps? I think the 3rd PS is wondering if the implants are no longer covered by the pectoralis musculature. I think he might be referring to the pocket - how the skin flap is attached to the chest wall. But PM me with the PS info and let's go from there. I am inclined to go with PS #3.
Deborah
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Whippetmom -- I am here again after one year from my exchange surgery and I'm looking to do a revision from 500cc natrelle 20 to the 410 ff 575. (rib cage 27") I have severe rippling and all the weight of the implants sit at the bottom of my breasts so it appears as though i have zero upper pole fullness. Will the 410's help any of my concerns? I've seen about 5 different surgeons and half suggest the 410s, the others suggest a major capsulectomy to tighten what appears to be an oversized pocket. Will the 410s detract from projection and overall roundness? I hear a lot of women complaining that their results look like hamburgers and I'm concerned an extra surgery will be a trade off of other issues. I am still fairly young (32) and live in Hawaii and would love to enjoy water activities without being so ashamed of my chest. Thank you so much for your help. It is invaluable.
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ndmk: Please send me a private message and link photos. You can link them by using the landscape icon next to the goggles icon above. Or, let me know if you cannot get that to work and I will give you my email address. If your pockets are overdissected, pocket revisions, (capsulectomies, capsulorrhaphys) absolutely, positively need to happen and those are the plastic surgeons I would go to for revision.
Deborah
Edited to add: Sientra smooth round implants were specifically created to provide upper pole fulness, so these would be a consideration....they are considered "gummy bear" implants, highly cohesive gel, like the Allergan 410, but softer.
From the Sientra literature:
"Providing fullness in the upper portion of the breast, Sientra round breast implants are designed to offer patients an option for more projection while still providing an individualized result.
* High-Strength cohesive gel
* Low-bleed barrier technology
* Smooth surface
* Proprietary Silimed® Texture Technology
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Hi all, I was wondering if anyone could give me plastic surgeon recommendations in Boston or New York. You can private message me. I would love any input about your experience/ and surgeon. I have been consulting for a few months now but I'm unsure if I have the right person. Thank you so much. Dnice
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Dnice - You've come to the right place! Whippetmom keeps a list of PSs from around the country and I'm sure she'll be able to give you a few recommendations when she sees your post. Good luck to you!
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Dnice: I have given you my list for Boston....I am sending you a PM with names for New York!
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I received the list of NY surgeons. Thank you so much. I have not received the list of Boston plastic surgeons. So curious to see if any of the Drs I have consulted with are on it. I also used the search to find anyone who has had surgery by the docs I am considering. Thanks for helping me with that. I am trying to be SO thorough. XoDnice
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dnice: Sent!
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you're the best!
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Hi Ladies--
I'm reading all your posts and they're making me wonder--I'm only at 250cc and they already look rather ample to me. My doc said she was planning to go up to 400cc. Most of you seem to be going up much higher than that. Do I have some strange warped sense of size? I'm 5'11" about 150lbs, so it's not like I'm a tiny woman. I gather that 250cc is rather small? Why do they look so huge to me?
Second and more important question--my doc advised me to massage after each fill, to help distribute the fill and smooth out my nipple and the dents in my breast. Does this sound normal to you? And does it work? I absolutely hate touching these "entities" that are attached to me--so hard and alien. I don't even really understand how I'm supposed to massage them.
Thanks
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hi iwannacookie, I have 492cc implants both sides. I filled to 470cc with the TE's. My PS said to go slightly bigger when expanding with TE's because the implants will be different when placed. I think he meant less projection? They are different. I have a great deal of rippling. I now have to figure out how to correct this. You can probably carry a larger size. Whippetmom is amazing at figuring out sizes for women. As far as massaging, I wished I had been advised to do so, I don't think it could hurt. All PS's recommend different things.
I agree with the implants feeling alien. Mine are cold, hard, rippled. I am looking into fat grafting to improve the look but I'm consulting a lot before I decide. So important you have a good rapport with your doctor. Reading as much as you can about other women's stories can be so helpful too. Best to you. Dnice
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Thanks Dnice--
I haven't really done my homework much, so I don't really even know what to ask my PS. Right now my breasts look quite round and, in my opinion, they stick out a bit too much on the sides. Does the amount of or type of projection dictate how the breasts/expanders are filled beforehand? That is, does this "roundness" mean that I'll be stuck with similar shaped boobs?
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Iwannacookie,
I am also 5'11", but weigh more than you at 165lb. I am filled to 500cc right now and that doesn't seem at all big for me (mind you I was large-breasted before and now look a lot smaller). Do you know what your natural breasts weighed? It should be on your pathology report. Do you want to be about the same size? My PS says she will bring in implants ranging from 550cc up to 700cc at my exchange and I will end up with whatever looks best on me. Good luck!
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Whippetmom,
I saw Dr.
G yesterday for my preop exchange surgery appointment, which is scheduled for
November 14. He presented two implant
options to me: the Allergan Style 410 FF
(740 or 655 gms) and the Allergan Style 20 (800 or 750 ccs). As a reminder, my TEs are Allergan 700 cc Style
133-MV-16-T. I am 5' 8" tall, weigh 179 lbs, and have
a 35" rib cage. My final fill
brought me to 700 cc.In previous communications, your recommendation to me was the Allergan 800 cc
Style 20 Implant, which is where my mindset was going into this appointment. The fact that he presented the 410s as one of
my choices really caught me off guard.We eliminated the Style 45 and Style 15 because of width
and/or projection issues. By choice, I
eliminated saline implants. Before
leaving his office, I chose to go with the 410s, but I am not feeling 100%
confident in my decision and would again greatly appreciate your input.I had mentioned to Dr. G a number of times during fill
appointments that I did not think I was interested in upper pole
fullness. I had also expressed an
interest in the teardrop anatomical implants at one of our earlier appointments. Because I am a taller girl at 5' 8",
he felt that the natural slope of the 410s would be a good choice for me. We did discuss my concerns of rotation and
firmness. He said he would do any necessary pocket work. He also said that he would take more than one size of implant into surgery.He said that the Allergan Style
20 Implants would look much like what I have now with the TEs. I did recently post pictures on the picture
forum if you care to take a look. These
are the numbers we have been taking into consideration:W H P
My TEs 700 16 15 6.6
Allergan 410 FF 655 15 15.5 6.1
PAllergan 410 FF 740 15.5 16 6.2
PAllergan Style 20 750 15 6.0
PAllergan Style 20 800 15.3 6.1
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3littlebirds--I hadn't even thought to find out how much my breasts weighed. But I can tell you it couldn't have been much. I was very very small chested. I wasn't always that way though. When I was a teenager and in my early 20s (I'm 45 now), I was actually a D cup. Though I was closer to an A-B before surgery, my skin hadn't received the memo about shrinking.
Is 550-700cc close to what your natural breasts were?
Also--do you know anything about how and when the shape is determined? While filling, or is at the time of the exchange?
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Iwannacookie,
My natural breasts were actually even bigger than 700cc. I want to be smaller but also fill out the skin I have. I was lucky in that I didn't need a lift or reduction like many larger breasted women do. My PS talked about both Allergan 410s and rounds, but I feel more comfortable going with rounds. I understand the pocket has to be very precise for the 410s otherwise there is a chance of rotation. My PS likes Mentor rounds. She told me her favorite implant is a Sientra, but said it doesn't come in a big enough size for me. I just joined the picture forum and hope to gather up the courage to post a photo of my TEs soon:)
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Hi Everyone,I have been lurking (reading) on this site since my dx in Nov. 2013. So much information to absorb. I had sentinel node bx and port placement Dec 2013. Node was negative and chemo started 2 days later. I had BMX June 10 with nipples removed. My tumor was 3.5cm and located right under the nipple. Due to family history, I elected to do prophylactic on the other side.
I have just emailed my PS to ask about TE brand / size since that appears to be important to the size of implants, and I can't find my card. I am expanded to 320cc now and like the look. I am 5'5" and 130 #. Before surgery, I was a 32 DD and would like to have the same size with implants. It is all so confusing as to projection / profile. My PS did say he has patients that were not happy with the gummy bears since they don't provide the high cleavage look. I am leaning towards silicone but, that is as far as I have gotten with decisions.
Diane
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Welcome to Breastcancer.org, Diane. Thanks for sharing your experience with our wonderful community.
In case you haven't read this section from our site, here is so info on reconstruction that could be helpful.
Thinking of you, and pleased you've joined the conversation.
The Mods
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Diane: Let me know your TE details once you obtain them from your PS!
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Hi to all the new ladies. You've certainly come to the right place. Sometimes we are confused when one place has measurements in grams and others are in cc's. One is weight and the other is volume. The answer couldn't be more simple. There's no formula to memorize. Under standard conditions, one gram of water takes up one cc of volume. One gram is equivalent to one cc. You can Google it for yourself. Just enter "convert grams to cc's" and you will have your choice of many places that will do conversion math. When I got my 410's, the card says 740 cc's but the literature on the manufacturer's website says 740 grams. No worries...it's the same number either way.
Another thing that might be useful for you is knowing how much a cc is . Google "convert cc's to tablespoons" for example. You will see that 1 tablespoon is 15 cc's. So if you get a fill of 50 cc's of saline in your tissue expander, that's only a little over 3 tablespoons (3.38 to be exact) that will spread out over the entire tissue expander.
You will also read words like Allergan, Natrelle, cohesive gel, smooth rounds, textured rounds, anatomicals, natural shaped, gummy bears, Style 20, MF, TE, ultra high projection, 410's, etc. Please refer to the header to learn the differences so you will understand what's being discussed or can use the correct language to get the answer you are looking for.
Like Catey, I started out with rounds. The manufacturer's (Allergan) card reads Style 20 Natrelle Sillicone-Filled Breast Implant 800 cc. Nowhere on the card does it say the word round, but that's what they are. Three months later I changed to another Allergan product. The card says Natrelle 410 Style FF Highly Cohesive Anatomically Shaped Silicone-Filled Breast Implant 740 cc. The card does not say gummy bears. Rather than having to say the entire name of your implants, we shorten it or use nicknames like gummies or gummy bears (which does not necessarily mean they were made by Allergan)...but we don't all use the same language or short cuts. I KNOW...it's confusing, isn't it? Newbies - do your homework. Read the COMPLETE header so you will understand. (And don't use the words cup size!) The term is irrelevant and can't be tied to a particular size, style, or manufacturer.
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Another useful conversion is that there are about 250mm to a US CUP, as is used in cooking, or the size of a standard teacup.
Often turning a volume (or length) in imperial or metric is easier when visualising a more conventional object and using that as a baseline. If you want to size something Like you favourite full style bra cup size, use a plastic bag in the cup while wearing it, and with a friend's help, fill that with water then measure the water in the bag by weight or volume for a rough size. Not super accurate, but gives you a starting point idea of what volume range you may want to look at for you.
Hope this helps.
The Mods
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So, am I understanding correctly, that the shape of the implant--width and projection can be decided after the fills?
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Sandra, great explanation!!!
I would like to add something about the 410's as my PS was in the study before they were approved by the FDA.
Yes, the allergan 410 anatomicals do have a small risk of rotation but if you compare the risk or rotation which is extremely small in comparison to the risk of rippling and capsular contraction with the rounds which happens quite frequently, rotation risk is much smaller then both of them combined and I think they certainly have a much better final appearance than the rounds, especially in reconstruction when there is no breast tissue over them.
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I'd like to chime in about the 410s also. My PS was also part of the study group. I didn't have to have any separate pocket work after TEs and am very happy with the anatomical shape.
iwannacookie - The answer is yes & no. You need to go to the top & read the entire header like Sandra mentioned. Your options are somewhat determined by your TE, and of course by your specific body measurements - in addition to issues like radiation damage, etc.
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It is important to note the data shows lower risk of capsular contracture, especially for augmentation patients who normally have a risk of about 7% over 5 years (it is more common in subglandular implants) but the risk of contracture is still rather high for us recon ladies. Some studies (there have been many studies of 410s since they have been available in other countries for years before they were in the US) have shown that when textured breast implants are placed under the muscle in augmentation patients, there is really no difference in contracture rates between smooth and textured implants, but textured implants do seem to have a lower risk of contracture than smooth implants when placed above the muscle in augmentation patients. Us recon ladies usually have our implants under the muscle, but remain at higher risk of capsular contracture anyway than augmentation patients.
The results of 6-year data (which is the data the FDA used to approve the 410s) cited here http://aes.sagepub.com/content/32/6/709.abstract reported that the rates of capsular contracture were lower in argumentation patients but you will see the risk is still pretty high for recon and recon-revision...almost 1 in 5 for the latter.
As expected after breast implantation, capsular contracture (CC) was one of the most common complications, with 6-year risk rates of 4.6% for augmentation, 6.9% for revision-augmentation, 10.7% for reconstruction, and 18.3% for revision-reconstruction. The rates for CC among augmentations and revision-augmentations were significantly lower with the Natrelle 410 implants than with other standard gel implants. The rupture rate (confirmed plus suspected) across all cohorts was 6.4% by subject and 3.8% by implant. The most common reasons for reoperation were style or size change (augmentation), implant malposition (revision-augmentation), scarring (reconstruction), and CC (revision-reconstruction). The satisfaction rate exceeded 80% in all cohorts.
And while the risk of shell rippling is much lower with textured anatomicals, textured implants as a whole have an increased risk of traction rippling (because tissue adheres to the implant). New silicone implants have a lower risk of shell rippling than saline, but still will have some that may be more visible with so little tissue to cover it.
My PS has been using 410s for quite a long while (in Canada, where they have been available longer) and likes them for augmentation, but not for most recon patients though there are exceptions. There are other PS's who have the exact opposite approach!
Each implant has its own list of pros and cons, so I think it is important to recognize this. Not every woman is a good candidate for every implant. I also don't think it is fair to say that the 410s "certainly" have a better appearance than the rounds, it depends so much on the woman's own body, frame, surgical technique, preference for shape, etc. The 410 may be a preferable appearance to an individual, but may not be to the taste of another. I have known women who have switched out their 410s for rounds because they did not like their appearance or results with them, so there is movement both ways! Many women are very happy with their rounds as well...there are options, thankfully!
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