BREAST IMPLANT SIZING 101
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PECTORAL EXERCISE AND THE RISK OF IMPLANT DISPLACEMENT
I have been doing some research into this issue, as I am finding it increasingly uncomfortable when attempting certain upper body strengthening movements at the gym.
According to Otto J. Placik, M.D., a Chicago plastic surgeon:
" In general, I do recommend that my submuscular breast implant patients avoid pectoralis strengthening exercises because this can cause lateral (outward) displacement of the implants over time."
From another source:
The constant muscle activity over the implant inherent to a submuscular placement has often led, in the late follow up (1-2 years), to implant displacement (with loss of medial cleavage), inferiorly (bottoming), or superiorly (wide chest look or snoopy breast) . These late displacements are, unfortunately, not totally predictable or preventable and more likely to happen in people with large implants, loose tissue, or intense physical activity."
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Thanks, whippetmom. I really want to get back into shape, but I'm ignorant of the dangers. Thank you for posting this information.
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When I attended a seminar on breast reconstructions last fall at MSKCC in NY they did say, when discussing implants, that basically you must cease working out pectorals once implants are placed as you don't want to build that muscle (it is a better container of the implant if it is flabby, basically). I of course, being the Queen of Avoiding Exercise, was rather thrilled to hear that lol. But in all seriousness that does leave a great many options still for exercise that does NOT build up the pecs.
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woo hoo! At least i have a good excuse not to have to do push ups at my tae kwondo training now! Not that i ever did them before anyway lol. It kinda stood to reason that it could displace the implants really. Just nice to see 'written proof'.
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Thank you for the above information on the pec workout. Was just inquiring that of my PS who encourged it. It just doesn't feel right physically or make any sense to. The pecs are involved in so many other exercises that we don't need to isolate them to keep healthy. Is there anything written that I can bring to my PS for his review and perhaps persuade him not to be recommending this to others.
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Hi Whippetmom, I'm new to this forum and found your post...THANK GOODNESS! I have concerns and a very passive (to say the least) plastic surgeon. I'm concerned my reconstruction is not going to be proportional with my body. I'm 5 ft 6 in, and 40 inches around my ribcage. My PS says we will end up w/800cc implants but my tissue expanders are Allergan 600ml w/6X16 AlloMax sling. He says I'm at 660 cc's on either side and I look like an A+ cup...and not a very good one. He said my body frame could easily accomodate a 1200 cc implant but they don't make them anymore. He said the best he could do is 800 cc silicone or overfilling a 800cc saline implant to about 950 cc's. I know my weight is the problem but I'm certain I'm not the first with this issue. He assures me the finished product will be "better than nothing"!!! I don't want just better than no reconstruction at all! I want a nice finished product. Do you have any suggestions?
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Sandy -- you should look for and PM a woman here named MooreTennis (I am pretty sure that is how she spells her user name)... she had 800 cc salines overfilled to 1200 cc's and is very happy. Not sure why your PS says he can only go to 950.
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Lilah- You're Queen of Avoiding Exercise? I'm Queen of the Couch Potatoes! (And all you others had no idea you were surrounded by such royalty! LOL!)
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LOL
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Sandy: You are not going to be happy with only 800 ccs and so you are a much better candidate for the 800 cc saline implants which can be over-filled to 960 ccs, which is Mentor's maximum recommended fill volume. Lilah mentioned Moore Tennis, who immediately came to my mind also when I saw your vital statistics. I just checked and she has 1100 ccs. I would not go any further than this in an over-fill - and actually, I would prefer to stay at 1000 ccs, just to ensure the integrity and safety of the implants. I also believe that Moore Tennis' TEs were larger than yours...Within the next few years, the Sientra true cohesive gel [gummy bear] silicone round implants will be approved [crossing my fingers and toes] and this implant will go up to 1000 ccs. So if your salines need replacing in the future, the Sientra implants will be a great replacement alternative. But for now, it is saline for you missy.
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Kate- you are hysterical, girl!
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Kate<-------she is hysterical.... she has kept me in stitches on more than one occasion! Keep the giggles coming sister Kate!!!! God knows laugher is the fruit of something...hehe!
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Whippetmom
Thanks for the post about exercise. I did lots of upper body stuff using TRX straps and push ups etc and I just can't do it now, it feels so uncomfortable and its been depressing to me. My PS insists I will be ok (I still have TE that hasn't moved a smidge in 8 months) but my muscle feels like its going to tear. I guess I should just find another mode of exercise...ugh like ...running
Diane
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Thank you Whippetmom - not that I wanted to do push-ups - just good info for all of us! Kate and Lilah - can I be a lady in waiting? Waiting for you to get off the couch so I can get on it!
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Ugh! I have never been one for pushups, so I won't be missing much of that one. Just weights and reps for the arms and biking occassionally. And, of course, the Wii--I'm addicted, I must admit. But then there are those days, when getting off the couch just isn't going to happen anytime soon. I'm with you Kate and Lilah! LOL! All hail to the couch queens!
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My doctor gave me six weeks after exchange before he even wants to talk about exercise. Now I am worried about what restrictions he will hit me with. I am going stir crazy here and after reading Whippetmom's post I am feeling pretty sad. Weight lifting is been a part of my life for 18 years. I love it and my YMCA has been my place for socializing for years.
I am interested about the Wii. Does it really give you a workout?
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DiDel~ Be careful with running... I started back too soon and my TE became inflamed and possibly infected. And, mine are COMPLETELY immovable.
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Giselle: Yes, the WiiFit does give you a workout. Kind of like having your own personal trainer. Not great for social networking, but it will keep you in shape. My legs are still sore from doing Yoga a couple of days ago. I like to switch it up. I purchased less heavy, 2 lb weights so that it wouldn't feel like I was lifting much, but I still get toned from these. It's a challenge but there are many who do fitness for a living on these boards who could maybe help you.
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Giselle: Do not despair...it is only certain exercises you really need to avoid. I am not a body builder or true "weight lifter"....but there are some upper body exercises which I can perform and feel safe about doing so, e.g., curls, because I can keep my arms close to my ribcage while doing so. Just avoid: bench pressing, butterflies, wide-stance pushups. Actually, I avoid pushups now period, because it feels so annoying. I was so buff in my 30's and 40's. I am just a marshmallow now and I cannot blame it on anything but sheer cussedness, menopause and refusal to work out like I used to. But I am getting back into it...and I am toning up my arms again.0
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Outcome assessment of breast distortion following submuscular breast augmentation.
Spear SL, Schwartz J, Dayan JH, Clemens MW.
Department of Plastic Surgery, Georgetown University Hospital, 1st Floor PHC Building, 3800 Reservoir Road, NW, Washington, DC, 20007, USA. spears@gunet.georgetown.edu
Abstract
BACKGROUND: Animation deformity or breast distortion during pectoralis muscle contraction following subpectoral breast augmentation is a known entity, but its prevalence and significance remain unclear. The purpose of this study was to identify the incidence and severity of animation deformity as well as its effect on patient satisfaction and interference with certain activities. METHODS: All procedures were performed by the senior author using a variation of a previously described dual-plane technique. The first part of this study was an evaluation of breast distortion by a group of independent observers in a series of 40 consecutive patients who underwent primary subpectoral breast augmentation. The second part of the study was a questionnaire sent to 195 consecutive patients asking about overall satisfaction, degree of animation deformity, and whether there was interference with any activities. RESULTS: Of the 40 patients' photographs that were evaluated, 9 (22.5%) had no distortion, 25 (62.5%) had minimal distortion, 4 (10%) had moderate distortion, and 2 (5%) had severe distortion. Of the 195 questionnaires, there were 69 responses, a 35% response rate. Fifty-six (82%) described mild to no distortion, 7 (10%) were moderate, and 5 (7%) were severe. According to the survey, the most common activities that were problematic were lifting weights and exercising (24 and 19%, respectively). Only one (1%) patient stated that she would not recommend subpectoral positioning. CONCLUSION: Although animation deformities do exist, nearly all patients in this study would still choose subpectoral positioning. Patients who may be better candidates for subglandular placement are those for whom exercise is central to their daily living. As a result of this study, surgeons and patients should have more accurate and reliable information regarding the significance of animation deformity after subpectoral breast augmentation.
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PB:
My information is not extracted from scholarly articles, but from a smattering of recommendations [including my own PS'] made by various plastic surgeons. Some feel it is not an issue and some take serious issue with the topic of upper body strengthening after submuscular implant placement. Here is one doctor who agrees with yours and responded to the following question:
Is it safe to exercise chest muscles after breast implants?
By Peter A. Aldea, MD - Memphis Plastic Surgeon
Yes. After you are completely healed.
There is NO point in having a breast augmentation if it will change the way you live. Once the surgery is completely healed in a few months you should be able to resume all your previous activities.
A few years ago, Dr. Baker, a senior member of The American Society of Plastic Surgeons, from Florida, presented a memorable paper on the negligible effect of (subpectoral) breast augmentation in PROFESSIONAL female body builders. The ability of those women to lift large weights was studied on Cybex machines and was proven not to be significantly changed by the operation.
If they can do it - so can you.
EXERCISE AFTER MASTECTOMY/EXCHANGE IS IMPORTANT:
http://www.realself.com/question/pectoralis-exercise-after-breast-enlargement-augmentation
Comments made by the breast augmentation crowd re: exercise and submuscular implant placement:
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Whippetmom - What can I say but thank you so much for all the info in your last posts. Very giving of your time. Clearly it is important to let your body have a opportunity to heal itself. I will continue to sit on my hands while I recuperate! I will take a look at the sites and discuss this with my PS.
Oh yeah, my husband would rather hug a marshmallow than a buff bod and day of the week!
MBJ - Thanks for the input. I think I will check out the Wii.
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Thanks for all that great info Deb. (And for getting the accurate number of cc's to which Mooretennis was expanded
LOL re: Lady in Waiting Hope!
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Whippetmom, thanks for the links. It makes me wonder that if there are alot of PSs who don't recommend it, and these forums are mainly augmentation patients. My concern would be that we have no fat or breast tissue over the muscle, how distorted would it look for us mastectomy pts.
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Thanks for the info! I will be talking to my PS about the overfilled salines. I'll keep you posted!
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Hi Nancy -- I'm in the same boat..... was mentally fine through the mastectomy surgery, infection surgery with TE exchange and two weeks home IV (argh), and then my final exchange surgery on June 5 for the implants. Hate them. My PS stretched the TE to 600 cc and only put in 475 style 20 high profile. So, I have significant rippling on the top half of the breast and edge of implant is visible. It feels as if there is a gap at the top of the implant and the chest wall. Wonder if the pocket is TOO big causing the rippling. On my augmented side, he used style #15 213 cc and it is way too small.... absolutely no upper pole fullness. It is a finger width smaller all the way around. It has been extremely depressing for me. I thought I was done with all this -- NOT. I've consulted a few other PS and two have suggested going bigger to fill out the upper pole. Definitely going bigger on the augmented side.... but I think I would prefer the style #20, high profile, rather than the 15, moderate. Any input would be greatly appreciated. Oh, one surgeon recommended Alloderm on the top for the reconstructed side to correct/hide the rippling......what are the pros/cons of this?
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vanderlady- I had Alloderm for both the TE placement and the exchange surgery and, yet, I too have rippling on the tops of the breasts. I know some PS are doing fat transfers for the ripples.
The cons to Alloderm is a higher rate of infection and it is very expensive. A lot of insurance companies won't even cover it so make sure you check to see if yours does. Some people don't like it from the aspect that it is donor tissue. I have heard some women say they feel achy after exchange when it is used but I haven't had that experience. Sorry you are not happy with your exchange. I hope they can correct everything for you. Whippetmom is a great one for advice on implant sizing.
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Hi Kate -- Funny, I just responded to one of your posts in another thread! Guess we have a lot in common!
I had the alloderm placed on the bottom at the time of MX.... I did in fact have an infection....staph epi which required a TE exchange. My personal feeling is that it was because my single drain stopped output rather quickly and I began to swell. Staph epi is common where there is fluid build-up. Interesting though that it may have been due to the allograft.
Did you have the allograft placed up top where your rippling is?
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vanderlady:
If you want me to help you with sizing info, I need for you to obtain your TE info - style # and maximum volume - if Mentor TEs, just whether they were low height, moderate height or full height and volume. Also, your height, weight, ribcage circumference.
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vanderlady- I think the Alloderm is up top but I'm going to confirm with my PS on my next appointment and see what she says about the rippling.
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