BREAST IMPLANT SIZING 101
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Those pictures look like they were professionally taken. Thank you for sharing those. Did your IMF drop after the Alloderm? What is the next plan? PM me if you would like. We are both having implant problems, skin problems IMF problems.... whatever we call it.... Its a freakin' problem that is setting us back- I can't wait until I am free of thinking about this. I still remain optimistic. I am just becoming more creative with my optimism..
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Stix,
The pics are done with my iPhone. I don't have Alloderm but will be getting it Friday in surgery #5. My skin is just too thin and the pec muscles are tight so they are forcing the implants down. I had implant movement on the right side first so the PS added another row of sutures back in December in surgery #3. It seemed to be holding so when the left side did the same thing, he added a row of sutures in March in surgery #4. That side has serious anatomical problems due to the loss of muscle and soft tissue during an infection and subsequent repair surgeries. Plus the skin is even thinner, so it's no surprise that it showed more pronounced implant movement in a shorter length of time. If the Alloderm doesn't work, the PS says Lat Flap is the last resort. I don't think I'll go that far. I'll just forget about reconstruction and go flat.
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Hi whippetmom , My PS wants to do my final fill then after one month he wants to exchange the TE's with breast shapers, leave those in for two months then exchange those for the permanent silicone breasts. The PS said he does this with every reconstruction so as to create a more natural shaped breast.
I cannot find anyone who has heard of this procedure before. Someone suggested I ask you if you had heard of them and what your thoughts are.
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RAM2013 - Are you sure you don't mean sizers instead of shapers? Sizers are used all the time - but generally just to determine proportionate size prior to exchange. I've never heard of anyone having sizers inserted for more than the length of the surgery...
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I have never heard of shapers either. Could not find anything in my internet googling.
I did have sizers put in DURING my surgery. I never had TE's, so before my PS chose which implants to put in, he inserted sizers to check the sizing (with OR nurse input) before removing and putting in the implants. I was of course, not awake for any of it, and sizers are only to be used for that specific purpose.
But yeah, I don't really understand the point of shapers, nor have I ever heard of them. The TE's have expanded the tissues and the pocket should be created by the PS for the implant - if he needs to make adjustments at exchange then he can do so. Once the implant is in, your body should form it's own capsule around the implant, and so on. It seems like a lot of unecessary surgery, and more risks, to do essentially 2 swaps so close in time? To me it sounds like he just plans to put another TE or implant in there before the final implant which makes no sense to me, as wouldn't that just mean your pocket shapes to THAT TE or implant, not the final one?
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Oh, I just remembered you were the poster whose PS was refusing to refill pain meds a couple weeks after surgery?
Something seems off about this. Did he show you what a "shaper" looks like?
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Hi DiveCat -- I have seen the shapers. They are different from sizers. They are not as thick as TE's nor does he add fill to stretch them but they are not as pliable as final implant so he said they are not as comfortable as the final implant.
He said the shapers are used to make a more natural looking shape (I imagine that means pockets) for the final implant. I cannot find anything on google searches nor find anyone who has heard of them.
My concern is as you stated, that this is unnecessary and puts me at risk where it is not necessary. and yes, I was the poster who's PS was refusing pain meds after two weeks post BMX.
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RAM2013: I have never heard of this either. I agree that this is an unnecessary step and I would like to know how he bills the insurance company with these three surgeries. Please PM me with the name of your PS so that I can do a bit of research. I would NOT do this second surgery until we are better informed.
Deborah
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sandra4611: I will be praying for you and for your surgeon tonight....Please check in when you are able to do so to let us all know how you are doing.
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Thanks Deborah. It's 2:30 a.m. and it looks like this will be my second sleepless night in a row. Fortunately I'm first case with a show time of 5:45, so it's nearly time to get up anyway. <sigh>
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Thinking of you Sandra.
Yesterday was my final fill! He overfilled and squeezed in 40 more cc's so I'm at 310 cc's, throbbing since that fill. I am really uneven again and have to find another piece to stuff in the right side of the bra I've been wearing. He said 6 weeks is the minimum time to wait for exchange for me, he said radiated skin likes to recoil and shrink. It had softened up quite a bit in the 3 weeks since I last saw him and is once again tight and painful on the side. He looked at my back scar too (I had a Lat Flap with TE placement June 25th), I told him I've been sore and he said I have no fat back there so when I lean on anything I'm feeling my ribs. He will fix a couple of areas at exchange - one area on back that left a little flap of skin at the end of the scar and my flap is raised up on one side of the boob, he will fix all that and I will get a small implant on my good right side to give me symmetry. Looking at the calendar and trying to plan. Moving along!
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Great question Deborah. I would like to know how the p.s. is billing the insurance company also.....!
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The third time really was the charm. Surgery #5 is now in the books. PS said pockets were too big so they were re-done to hold the 740 cc FF 410's tighter. Implants had bottomed out so fresh new set was positioned several inches higher and Alloderm was placed. It took two plastic surgeons three and a half hours. This feels like it did after the BMX in spite of Exparel. Tylenol is no match for the pain but I know it will get better.
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Rest and heal Sandra!
My exchange surgery is done and I ended up with Mentor high profile 700cc. Was filled to 500cc. Am in more pain than I expected, but it will pass. Happy it's behind me.
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Hello Ladies,
I have a few questions that I am hoping somebody with more experience might be able to address. I had a bmx on April 15th, 2014. Today was my last fill, and overall the process was manageable. I have persistent pain on the left side that today the PS explained was from the TE resting on the bone, and post exchange that will resolve. He then took a few minutes to explain the new Gummy Bear implants from Mentor, and I feel like he thinks this is the best choice. My appointment in November will decide the implants, with my exchange occurring on Dec 12th. So here are my questions:
1. I am worried the gummy bear will be too hard.... particularly given my rib cage issue. I am aware that the TE's are much harder than the squishies, but I am feeling like I would rather go through another surgery in 15-20 years then deal with a harder implant. Does anyone know how they feel? Are they everything the surgeon is so geeked about? Better looking, much better durability, minimal scarring issues relatively speaking? What is the pain level like?2. If my PS is highly experienced over all, but only up until today at least put in 6 gummy bear implants, should I be concerned about his experience level? He is wonderful at what he does overall with excellent results- just not sure if the new product has a learning curve?
3. I read that if you have TE's that were not spefically geared toward the gummy bear shape, rotation may result. I have no idea if mine are the correct size for a gummy bear implant. Anyone know how much of an issue this is?
4. How long do most women take to recover from the exchange surgery? Do most get drains?
I am not looking forward to the exchange, but I am so very, very done with these TE's
Thank you in advance for your time in posting- HT0 -
Good luck Sandra0 -
sandra4611 and 3littlebirds, Wishing you both a complete and restful recovery!
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Hi happy teacher.....I am almost 3 weeks post exchange to gummies, so I will answer from my perspective.
My BMX was in July 2011.and I had exchange to 425cc round silicone implants in October 2011. They were OK, but over time, I developed quite a bit of ptosis and I had a very hollow chest, making my prominent sternum even more noticeable. I had actually asked about the gummies prior to that surgery but they weren't available to my PS at that time. Once he had access, though, he said I would be the perfect candidate for them and they would improve the appearance of my chest considerably. I didn't jump right in, I took a good year to make the decision to go forward. I wanted to be sure of my decision and I knew it wouldn't hurt for my PS to gain experience with this new type of implant. For me, the surgery was a piece of cake. Outpatient, and I think I took a total of 4 pain pills before going to Tylenol, and was off that in about 4 days, so for me, pain was not an issue. They are a little firmer than the silicone rounds, but I had dense breasts, so that's really not an issue for me. On me, they really are much better looking.....my sternum is no longer prominent.
My TEs were not "built" for the gummies, but I had some additional pocket work to assure that I had a good, tight fit. I also went to 475cc gummies to insure a tight fit in the pocket. I understand your concern about the PS and the learning curve. I quizzed my PS about this in detail, and felt he was qualified. I did not have drains this time or with my exchange to rounds, but did with my BMX and TE placement.
My recovery has been very easy. My surgery was on a Monday, I lounged around for a few days and felt well enough to go out to dinner on Friday. My only restriction is to not lift over 15 pounds. I've been doing most of what I would normally do, including several 3 mile walks.
It really is not an easy decision, especially with so many differing opinions. In the end, I decided that my PS is the one with the experience, he is the one who is looking at the "real" me, and I have complete confidence in him, so I let him lead the way. Good luck with your decision. And sorry this is so long!
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Adding my wishes for a speedy recovery to sandra4611 and 3littlebirds.
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PinkWalker--Thank you for your informative post which is right on point with my current situation.
I had BMX 2/26/13 and exchange to Mentor Smooth Round Moderate Plus silicone implants 7/5/13. Just prior to my exchange, I expressed an interest in the anatomicals, but my PS at the time stated that he "did not give me the pocket for those so you cannot have those." I have since learned that he apparently did not want to do "pocket work" to accommodate the anatomicals because this, in fact, CAN be done as long as pocket work is performed to ensure that the anatomicals sit snug in the pocket.
I have never been happy with these rounds and feel that there is too much of a "stripper boob" look in the upper poles and too much ptosis. In addition, they slide into my armpits when I recline and are larger than I wanted (I had approximately 625 grams of breast tissue removed on each side, 650cc exapanders placed, stopped fills at 450cc because I didn't want to be any larger, and received 500 cc implants). Based from what I have learned from this board, the PS should have used smaller TE's because prior to my BMX I did, in fact, emphasize that I wanted to be smaller than pre-BMX but the PS did not "hear" what I was saying! Because of this, I have tightness/pulling sensations in my pectoralis muscles and shoulder blades despite PT, yoga, swimming, chiropractic, Graston massage, and myofascial release breast massage.
I have seen four second opinion plastic surgeons, two of whom did "not want to get involved and fix another surgeon's work" and two of whom agreed to take me on as a patient and recommended a switch to slightly smaller (440 or 475), full height, full projection anatomicals with lots of pocket work to address the lateral migration and ptosis issues. I am now considering a revision to anatomicals after the first of the year.
I would love to hear from others who have had a revision from rounds to anatomicals as well.
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I started out with rounds - Allergan Style 20 800cc's and changed to gummies, Allergan Natrelle 410's FF 740 cc's. There isn't a lot of difference in feel. The gummies are a little firmer but certainly not hard. They are plenty squishy. You don't have the stripper boob look because of the gradual slope down to the fuller part at the bottom. The breast surgeon took so much tissue across my chest during the BMX, I was left with some very thin skin over bone. It feels bruised all the time. There are also "divots." I changed to 410's because they are so much taller and cover some of the divots and low spots, decreasing pain.
Yes, your pockets may have to be re-done so the gummies will fit snuggly. They can migrate a little otherwise. They can have much less rippling than rounds but I still have some rippling due to thin skin. They don't drop and fluff like rounds but settle in gradually and become smoother and more rounded during the first couple of months.
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sandra4611 Wow. Read your last several entries. You have been through it!! I hope that all the worst is behind you, finally, and that it is clear sailing from here out. Enough is enough! I will continue on this thread, as well as the TE thread. I will watch for your posts.
Had left mastectomy in Feb. with TE, which had to be removed after 16 days due to infection. Right breast was diagnosed with cancer last month and just had another mastectomy on Oct. 1 - officially ushering BC awareness month. Left was revised and TEs were placed at that time. 133VMX Allergans. Hydrocodone and Ambien are the only reason I am able to get some sleep on my back, which is very uncomforable for me. Desperate to sleep on my side! The TE fills and exchange journey has begun. First PS visit on Tues., and BS on the 14th for final pathology. Hoping for good news on that end.
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Sandra, Lori, and Pink,
Thank you so much for taking the time to reply. My biggest concern was that they would be too hard and thus decades worth of pain from them resting on the ribcage. It appears that the comfort level is comparable to the rounds, albeit being a bit firmer. I did have very dense breasts, so that part seems to be a good fit. I feel a lot better about pursuing the gummies now and cannot express how much I appreciate the input from those who have actually experienced them.
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Sandra - what does that mean? The pockets may have to be redone in your last post? Are you going to need more surgery after this?0 -
Sandra...sounds like a lot of work for Surgery #5. Hoping for a quick recovery and looking forward to photos in a week!
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Stix, that means if you decide to switch to anatomical implants, the PS will have to reconfigure your existing pockets to make sure the new implants fit tightly.
Yes, I will have surgery #6 in about three months. Fat grafting and removal of the oversized remaining mudflap should be the final surgery.
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Deborah,
The PS said it was almost like starting from scratch so that's why it took 3.5 hours. With tighter pockets and Alloderm on board, he thinks I can withstand the unnatural pull and pressure from the repaired muscles that caused all this migration trouble in the first place. Right now the new set of implants are higher on my chest, lumpy, bumpy, misshapen and weird looking. In other words, normal for new implants.
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happyteacher: I personally would not want to be only the 7th patient receiving anatomicals, in light of the significant learning curve necessary, as explained by Drs. Teitlebaum and Stevens (principal clinical trials experts) over the years. That said, there is only one style of Mentor CPG anatomical available and it is pretty low profile and can appear quite flat in some women....dare I say many women. Also, actual studies have shown that the Mentor CPG had rippling and implant palpability in 10.75% of cases (and this was an augmentation study, so the rippling/palpability percentage would be higher in reconstruction patients) vs. Allergan 410's 2.70%. Also, more importantly, the complaint of neuropathic pain and hypersentitivity was higher in patients with the Mentor CPG as compared to the Allergan 410.
I think I would discuss the use of the Allergan 410 over the Mentor CPG. The 410 has more styles from which to choose. I don't know your height, weight, ribcage, but the CPG might render dissapointing results for those of a certain body habitus. The Mentor CPG is too limiting, in my book.
Read Table 5 in the link below:
Deborah
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sandra2013: Praying that all goes well for these new girls!
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Deborah--With regard to your comment above to happyteacher, "the complaint of neuropathic pain and hypersensitivity was higher in patients with the Mentor CPG as compared to the Allergan 410," do you know of any studies regarding neuropathic pain when comparing the Mentor silicone smooth round cohesive gel implants versus the Allergan 410 implants? Just wondering as I am considering a revision from the Mentor silicone smooth round cohesive gels to the 410's.
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