BREAST IMPLANT SIZING 101
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My PS has been using Allergal 410s under the research programs for a long time. When the Mentor anatomicals came on the market I ask him about them and he said he would not switch over.
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Exchange is scheduled for next week Oct 14. I am a bit nervous since the medical card, with my TE info, says 133-MV - 12 while the PS has the - 13 in his notes. He wont know until he gets in there but says he will have plenty of variety to choose form. I am filled to 330cc. If I have the 12s, they have a volume of 300 so not much overfill. I was really tired of the pain from stretching the muscle and skin. Plus I am happy with the way the TE looks. However - the TE placement I knew was temporary. The implants are supposed to be more permanent. I am sorry for those needing revision surgeries. PS is recommending Allergan 20....450 or 475cc. And, I am also nervous that some ladies are exchanging their Allergan 20 for anatomicals. But I do trust, and like, my PS. He took out the drains himself and has done every fill himself. He spends as much time as I want during an office visit and answers all questions. He even answers emails. So, fingers crossed this will be the right choice.
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Hi Whippetmom,
I am 6'2'' tall, weigh 190 pounds (bmi of 24) and I believe a 38 inch ribcage, if using bra band size is reliable. My TE's are Mentor siltex contour profile 550 cc, with the front of my card showing breast implant size being 550-660. I lost track of how much saline was filled, but they are very full and at the last appointment he said I was done with fills. Not sure if this is relevant, but I lost 150 pounds so had plenty of extra skin to work with. Skin is in very good shape other than scarring from skin cancer areas/excisions. The current projection is overall very good, but a smidge on the too big size for my tastes, so a tiny bit flatter would not be an issue. A lot flatter- bummer.
I do like the projection that the TE"s currently offer, but not necessarily the roundness... in my case it looks clearly like implants. I am a little nervous about his lack of experience with the gummies, but he is overall a highly experienced PS. I will ask him more detailed questions at the next appointment. He mentioned (I think- if I am keeping my facts straight) that the allergan implants were harder... something about a 3% value for Mentor and 7% for allergan. I am most worried about the pain. My TE's since April make it impossible to exercise even minimally and I constantly restrict my arm movements in an attempt to minimize swelling. At work (I teach elementary) even minimal use of my Smartboard (reaching up to write on it) causes a lot of swelling and pain. I want (need) to be able to at least be able to get through a work day with the ability to go for a long walk in the evening or use the elliptical.
I am not very excited about the idea of the implants looking flat. Do you think avoiding gummies all together is a better choice? I am completely overwhelmed with trying to sort this out, and I truly appreciate your input.
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HappyTeacher - take a look at #3 in the header above. Whippetmom will need a couple more pieces of information to answer your questions - rib cage, TE make & model, etc. Once you post those she will chime in soon and address your concerns.
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Bra band size is not reliable because most women wear the wrong band size (usually much too big) and even those in right band size might wear within an inch or two of their actual snug ribcage. Measure your ribcage with a soft tape measure (just under your TEs) or use a string and then measure that out against a ruler. Measure snugly, after an exhale.
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Happy Teacher, quite a few of us here have implants that are cohesive gel (gummy bears) and by and large, we are happy with what we have.They aren't hard so you can forget that worry. I've had rounds too and there is very little difference in feel. In my experience, implants are a good bit flatter than a full TE. How you are going to look is hard to predict, especially at first. Implants can take a couple of months to assume their final shape. They don't get bigger, but they will smooth out and look more natural. Gummies already have a natural shape but even they look better after a few months too. Much depends on how your chest is shaped. You will probably be surprised...everyone is at first when they see their implants, but if you go with Whippetmom's suggestion, you will likely end up happy. If you have unrealistic expectations, you could have a more difficult adjustment.
I think I look great in clothes. Without clothes, I look as if I am wearing an invisible minimizer bra all the time. I have the largest gummies available in the U.S. with the most projection (Allergan 410 740cc FF) but what I have are breast mounds...not cone shaped breasts. I don't fill out a bra cup all the way to the end so yes, I'm flatter.
Your pain could be from the TE irritating or pressing on a nerve. If that's the reason, getting your implants will be a huge improvement.
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happyteacher: Please talk to your PS about your arm swelling and pain. I am wondering if this could be lymphedema, which should be addressed and for which you should receive therapy and support. A compression sleeve might be very helpful for you during the day. This is pretty important to identify and please do not let your PS dismiss it. Ask for a referral to a therapist, so that this can be ruled out as the culprit for your pain and swelling.
I feel that you need Mentor or Allergan high profile smooth rounds - 700 ccs to 800 ccs. I am concerned about the use of anatomicals for one very clear reason. You state you have had an astounding weight loss, and congratulations are in order for that, to be sure. But this means you have a lot of excess skin and I just do not know that the anatomical is the best choice for you. Certainly, you would need the largest size - the FF-740 grams - but I would ask you to find out for me which STYLE of TE you have. Is it low height, moderate height or full height? If you could send me photos, it would be very helpful. You can private message me with photos.
Deborah
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dianems: This clears things up for me. If you do have MV-12s, then his plan to use 450 ccs or 475 ccs in a high profile smooth round silicone would be ideal....right on the money. Stick with his plan. I think you are going to be just fine.
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Wow, this is the exact thread I needed to see exactly when I needed to see it. Thank you so much for all your input, I hope you can help me.
I saw the PS today and I want direct or immediate implants.
This means an implant that is put in immediately after the oncol surgeon removes all the cancerous tissue. No expanders are used. So with the one surgery the patient wakes up with implants and needs no more surgeries. My sister had a double mastectomy 2 years ago using this type of surgery and her breasts look fabulous. Even 2 days after surgery.
My understanding is that this option is for women with 'small to medium' breasts. I'm not sure what that means? I'm a 36 B. Also, it's for women without droop. (not sure why that is.)
Not all PS's know how to perform this procedure or suggest another option but the PS I saw is very comfortable with it but suggested doing it a different way for reasons that may be of interest to others.
He suggested waiting 7 days after the oncol surgeon removes the cancerous tissue to put in the implants in. The incision would not be healed so reopening it to put the implants in would be easy and would not interfere with healing or scarring.
He's suggesting this for 2 reasons.
1. If I were to need radiation the implants would need to be removed.
2. He wants to see the 'viability' of my skin. To make sure I heal well. The added weight of the implant could be too much for me. I am petite or thin in their words and I guess this is a concern for blood supply and circulation. Also, although he rarely sees necrosis he wants to be certain there is none before proceeding.
After 7 days and if all healing is going well and the path report indicates no radiation is needed he will reopen the incision and put in the implants. (no expanders)
My obvious concern is the size of the implant!
May I send you photographs for your input? It would be greatly appreciated!
Thank you for this thread!
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OceanSky,
I was a 30E before surgery and had direct-to-implant surgery (with nipple-sparing). My breasts were not exactly perky anymore, but I did not have more than minor ptosis (my nipples were still above my IMF). Many PS's actually do do the surgery on larger breasts these days as well, but it all depends on skill of surgeon. Ideally, you need to be staying at a similar breast size, or going smaller, but depending on your tissue flaps (i.e. you have "empty" breasts but lots of extra skin from breastfeeding, etc) you can sometimes go a bit bigger. I am not entirely sure what "small to medium" means either because on what size frame? I am a 30E (29" ribcage), but the same amount of breast tissue on a woman with a 36" ribcage would be a C cup. I used to always see people say it was for "C cup and below" but uh, on whose body because C cups are not the same across the board!
There are a few women around here who have done direct-to-implant and some threads on it.
So to clarify, your PS wants to wait the 7 days as he might need to put TE's in anyway after the pathology comes back? This relies on getting the pathology report back in 7 days (i.e. to know margins, etc) of course I guess. This is fair enough though I guess, and I have seen women get TE's and implants put in later down the road either by choice or after the loss of an implant and healing time, which I guess is not much different, though if he put in implants and it turned out you needed radiation they could also just swap them for the TEs.
As for viability of skin, this can be a concern. There is some data out there to indicate the risk or necrosis/tissue death IS higher with direct to implant compared to TEs, likely due to more stress on the tissues, but that being said, he also should not be putting in an implant that is bigger than your tissue flaps can reasonably support. Mine were 435ccs (and I still am a 30E, though look different) and similar to my pre-surgery tissue removed (371g and 446g), but I have seen women get 700-800ccs in direct to implant as well as they had the tissue flaps to support them. I have also seen women get 250cc implants. It all depends on what your skin flaps can support. Whippetmom may be able to help you somewhat with range and implant choices, but I expect she will also say that it is going to depend a lot on what the PS has to work with after the BS is done his job with the mastectomy - something she can't see
My PS brought in 3 different sizes/styles implants into surgery based on the measurements he had taken and our discussions, and then used sizers in the OR to determine what size he would put in.Oh, and I definitely did not look "fabulous" 2 days after surgery though! It took a while for things to settle (and swelling and bruising to go down). Just saying that to say don't expect the exact same experience as your sister. I am overall happy with the outcome (and my recovery, I was fortunate to have a VERY smooth and easy recovery), but I am going to be doing a revision, probably in January or February anyway. This is not because of any fault of my PS or his skill, or even any complications, and is just purely for some cosmetic fine tuning. So just be aware that direct to implant does NOT always mean "one and done" (and this is why I don't really like to call it one-step as it is often also called). And there are other women here who have needed further surgeries in less "optional" circumstances than me due to infection, necrosis, implant failure, etc and some have even had to go to TEs after direct to implants failed.
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OceanSky: I am a bit wary of this plan to go under anesthesia again, seven days after the mastectomy. I just have never heard of this being done - in five years of talking with thousands of patients. I have never read about it being done either. Certainly, as DiveCat stated, women have had "delayed reconstruction", but that typically means months, not days after the MX. Could you private message me with photos and also with the name of your PS. Unfortunately, I have a slew of plastic surgeons on my list from Florida that are doctors to avoid - more so than any other state in the U.S. Also, include your height, weight and ribcage circumference - measuring with a tape measure under the breasts, not around them.
Deborah
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Deborah, I will gladly send you photos. Am not sure how I can attach Iphone photos in a PM? Can you advise please?
This surgeon is very well known and people fly in from all over to have him do all kinds of recon work.
He was with MD Anderson here in Orlando before it recently became affiliated with U of Florida's cancer program, now called Florida Health/Orlando Health.
He developed a procedure to successfully transplant lymph nodes in patients who've developed lymphademia (sp?)
His name is Dr Richard Klein. His partner Dr. Lee was named in the list of top plastic surgeons in the U.S. He does only recon work, not cosmetic work.
Here's a recent article about him and a unique surgery he pioneered for patients with lymphademia.
He was with Moffitt Cancer Center (the only cancer center in Florida affiliated with the NCI) some years ago.
He does more types of breast recon than any other PS in Florida that I'm aware of. (This I found on a site that listed top PS's on a website by different states.)
He went over every option with me, and I'm a candidate for this type of surgery due to my size. He's comfortable with this process but not as comfortable w/ direct immediate implant for the reasons I stated.
I can have expanders put in but don't want them. I don't want to have to come in once a week for fills, etc.. I do realize that I can't expect to have the exact same result as my sister but she had zero bruising and really beautiful results.
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Ocean Sky, I know each doctor is different. I went every 3 weeks for fills and went slowly. Some times only 60cc depending on how I felt. If you want to expand rapidly, I guess you would need to go every week but, I thought slow and easy was a better option for me. Good luck. My exchange is next Tuesday!0 -
whippetmom
Thanks for your invaluable help Deborah. I am grateful you take the time (and I know it is a LOT of time) to stay on this board and help us. Your information and research has helped many women. Hugs and a pat on the back to you!
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Deborah, I tried to PM you, but I got the message that I can only send 'so many PM's per day' I only sent one today so am not sure why I'm unable to do so.
I will contact you asap.
I have my surgery scheduled for Oct 20 and am very appreciative of your feedback. Am guessing it's possible to 'switch' to expanders but I was looking forward to having this procedure done.
An additional benefit I see is that it's only one surgical procedure at a time. He didn't say that, but another BC.org member mentioned it in PM.
I have a neighbor who is a PS, (he does mostly cosmetic work). He's an older gentleman who is now sharing his practice with his son. He's well regarded in Orlando and we've been neighbors for years. He's been in Maine all summer but got home yesterday. I'll call him this evening and ask him for his thoughts.
Thank you again Deborah for sharing your expertise!
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Whippetmom
I have a question and I am not sure if this the correct forum but I do believe you might be able to help me understand what happened. I had a bilateral mastectomy in July . I opted for reconstruction at time if surgery silicone implants 410 cc. I was a 36 c prior. 5 weeks post surgery the incision line on left breast opened up and began profusely draining what appeared to be purulent drainage minus the smell( I am a nurse) . The PS took out the implant and replaced it( I had a mass on my abdominal wall so we did it at the same time it was excised) about 6 weeks post mastectomy. Then a week and a half after that surgery the right breast developed a blister and opened up on incision line with the left reopening a few days later. It was horrible. I had fluid dripping down all day and changing pads was difficult as I remain with some limited motion on both sides and some lymphedema( I believe ) on left side. I though it was infection but nothing came up in the cultures. I had another surgery 2 weeks after the previous one and I had no problem with just removing everything until later so I didn't have to postpone chemo Any longer. The PS opted for expanders which seem to be working out. A week and a half after they were placed I started chemo( today) . What could be the reason this drainage Occured and recurred. My PS said she's never seen It happen before. I am still worried about the expanders possibly opening. The right one had looked healed and good to go at 6 weeks then got the blister. I'm baffled. Any insight? Have you heard if this before. I live in Miami ( I saw you have a list for Florida doctors)! Thanks for your time!!
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OceanSky, I had huge breasts but had a bilateral mastectomy with immediate placement of permanent implants. I'm not sure I understand why some say you can't have it if your breasts are too big. They aren't big after the BMX, that's for sure. I had 2,370 grams taken on the left side (5.22 lbs) and 1,810 grams (3.99 lbs) taken from the right. (Told you I had some bodacious boobs!) As far as ptosis goes, you could have hidden a small child under there! There was no extra skin left. The implants placed were 800 cc silicone Style 20 rounds. They were tiny compared to what I was used to.
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Happyteacher- Please get checked out for Lymphedema. I had my BMX May 2012, TE placement in Sept 2012 and Exchange surgery Dec. 2012. Three weeks after I had exchange surgery I started noticing that my ring on my ring finger was starting to leave indentions on my finger. After talking to my MO she referred me to an LE therapist who determined I did indeed have LE. I went almost a full year of therapy before my therapist moved. If you do have LE, a therapist can show you how to do manual Lymph massage at home to keep it under control as well as wearing a compression sleeve and gauntlet. It has been almost 2 years since I've started wearing my sleeve and I still wear it from 630am until about 9pm M-F 365 days. If you keep seeing signs of swelling see your doctor and get checked.
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OceanSky, I forgot to say that I am in a rather unique position to comment on the difference between direct to permanent implants and TE's. Due to an infection which had nothing to do with the BMX or implants (someone gave me their staph infection in the hospital) I lost one implant and ended up with a TE on one side and a nicely healing implant on the other. The TE side had muscle spasms right away, fortunately controlled by valium. Over the next three months I had the "fun" experience of weekly trips to the doctor for fills followed by the inevitable increasing tightness and discomfort from super-stretched skin and muscle as my left side "blew up" to what looked like enormous proportions. (Think 1/2 of a good sized coconut shell glued to one side. It stuck out so far, I could literally put a full Solo cup on the shelf at the top and not spill a drop!) I plastered my left chest and side with Lidocaine patches, which worked pretty good combined with Tylenol. Meanwhile, my original permanent implant on the other side was happy & never caused me one second of trouble. My TE experience was certainly uncomfortable, but until the last fill, I didn't have the pain that others complain of, so I consider myself lucky.
From my perspective, having had both experiences at the same time, the direct to implants wins hands down! Having a TE while you are trying to recover from a mastectomy is MUCH harder than having a permanent implant occupying the same space on the other side. If you have a plastic surgeon who is experienced in direct to permanent implants, I say go for it. Be aware, however, that you could wake up with TE's anyway. If the breast surgeon doesn't leave enough good tissue flaps for the plastic surgeon to work with, he might not be able to put in the implants.
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OceanSky: Oh yes, I am familiar with Dr. Klein. He is very well-respected in the plastic surgery field. I am sure you are in very capable hands. I have just never heard of the method of reconstruction he proposes. He is a pioneer in many regards, and so I would be interested to know more about this procedure. I PM'd you...with my cell number so that you can text me photos.
I think you need to choose the reconstruction journey that you feel comfortable with, and then go from there. If tweaking needs to be done, well, tweaking needs to be done. We have all been there and many of us tweaked ad nauseum. So many of us want it just to be a one-shot deal and then we are done with it and it does not always work out that way. So if you trust your doctor, then let him make that decision for you. I know Dr. Klein is interested in aesthetics...and he is not just all about getting the job done and sending you on your way. So in the end, it is the choice that brings us some degree of peace that we must settle on, and then rest in that decision.
I will watch for your photos!
Deborah
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Ctillie: I am baffled also! Unfortunately, there are some cases, and very few, in my experience, where the patient experiences implant failure, despite repeated attempts to remove and replace and remove and replace the implants. I know also that proper placement and proper closure of the implant or tissue expander is very important, and something is going on with those incisions. It could be a foreign body reaction to the suture material...but certainly the PS would have ruled that out by now. If this happens again, the PS should do a pathology of the skin at the incision site. Is your PS recommending anything topical for the blister? Let's just pray that everything calms down and you have no further issues with wound healing. Incidentally, do you have Alloderm or some other dermal acellular matrix?
This is just an aside...I tell you, I deal with wounds all of the time with my whippets, as they have thin skin, race for sport, run too fast, tear their skin and on and on. What do I smear on their wounds? Manuka honey and coconut oil. Top with gauze and let steep. And everything heals. I am my own vet, because these dogs would cost me a fortune otherwise. Google "Manuka honey and wounds" and you will see a plethora of information. Just my thoughts on this matter. Here is an article supporting the use of that expensive, precious honey from New Zealand.....
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Thank you Chrisrenee...I hope she follows up with this also....
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Sandra, thank you for sharing your experience with direct implants and TE's. I'm a bit on the fence but your experience is very helpful to me.
First, I have a small frame and am considered 'thin' by doctors. 5'5'' and 120. I'm a B cup. I only mention size because I believe that BC.org mentions direct implants being used for people with medium to small breasts and without droop. So perhaps it's really up to the surgeon to decide.
I have had to come to terms that even though my sister is 7 years older than me she heals far better than me. Her direct implants were beautiful. She didn't have a bruise on her and her breasts looked like a 20 year olds. So I want that but am having to realize that we're different people.
Deborah, thank you for sharing your thoughts and I'm very grateful for your help with this. I'm glad you're with me on Dr. Klein. He is an expert at micro vascular surgery so I feel that I'm in very good hands.
Meanwhile I spoke to my neighbor who is a plastic surgeon. We've been neighbors for many years and he's a friend as well as a PS. He's an older gentleman who still practices PS but now with his son. He's been in Maine all summer but just got home and he mentioned to my husband that I could call him about this anytime.
I called him tonight and of course Dr. Klein might be a bit of a sore subject for other PS's in town including my neighbor and his son who is also now doing reconstruction. Sigh. I can't begin to understand all that goes on amongst those in a profession I don't know about.
What I do know is that my neighbor was the 'go to' PS in Orlando for many years for cosmetic surgery. He's done more 'boob jobs' and facelifts and cosmetic surgery than perhaps anyone around still practicing. He felt that I would do well with either procedure but asked which procedure Dr. Klein had suggested.
I mentioned that PS's don't seem to 'suggest' anything. They will share the positives and negatives of each option but don't make suggestions as to which procedure to choose. It's almost like Dr. Klein gave me a menu of choices. But he did say how he would choose to proceed...To wait 10 days to put the implants in to see how I heal, to make sure I don't need radiation, and to be careful that the weight of the implant didn't impact the healing process.
Anyway, my neighbor said either option would be fine, but that he felt that TE's might provide a result that could be better controlled for a desired affect. Of course that's the procedure he's done so many times.
Sandra, your comments about the pain of TE's really make me think! I'm on the fence now. I'm certain Dr. Klein would not have allowed me to consider direct implants (10 days later) if he weren't certain the result would be good. He was very confident.
Did other people have pain with TE's? The idea of going in for 'fills' is not appealing!
I need to decide because my cancer surgery was scheduled today for Oct. 20 and the implants are scheduled to go in on Oct 30. If I want to make changes to that schedule I should do so tomorrow!
Thank you Deborah for creating this thread and for your faith in Dr. Klein. I will get my pictures to you asap. Thanks for the encouragement Sandra, your comments are very, very helpful. Boy, can that cat type!
Best to all...
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Hey Oceansky
Glad to see you in here getting the advice that you need. On the issue of TE pain, I had TE's in for 6 months and I wouldn't describe what I had as pain - it was uncomfortable at times but very doable and I had no pain with the actual fills. Everyone is different though - so it will be hard for you to use that as part of the decision process I think. I am almost 3 weeks out from my exchange surgery and am very happy with the results. I had a great caring PS and that makes all the difference going through this. I had confidence in him from the beginning and I had some early healing issues that required a little more than the normal exchange to rid me of some rather large scars. Sounds like you have alot of confidence in your doctor so I would say trust him to guide you in the direction that has the best final outcome. Someone on this site initially told me that this journey I was on was not a speed race and it sure hasn't been one - but so far so good. Good luck!!
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Oceansky, I will chime in w/my 2 cents. First, I think you should trust your PS since he is very highly regarded. And many PS never agree. I am petite, 5'3" 107#. I had no upper pole and VERY small breasted (93 cc and 100 cc) 30AA (and I had been properly fitted for a bra). My PS said no to direct implants because of the positioning of my nipples (I had a NSBMX) and I was just too small. My TEs were not painful but uncomfortable with the fills but only for a couple of days. I went back to my regular activities with some recovery time,naturally. Sounds like you are in good hands. Pun intended!😉
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Ctillie- Not to butt in here but I also developed a blister on my incision(which happened to be the whole incision since they were purse string) after my exchange surgery. It opened up the whole top layer again. Blister was unexplained. I had to heal it open and also had the drainage (I'm also a nurse) but wasn't sure initially whether we were dealing wit infection or not. Turns out it was just the drainage you get when the skin is creating new skin. Did a wet to dry while it was healing. Sometimes looked almost creamy with clear fluid. Healed beautifully but took ablout 3-4 weeks. Hope this helps.
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OceanSky,
When direct to implant was new (at least the modern version of it, which was pioneered by Dr Salzberg in NY....) it was generally done only on smaller breasts. I think this was just for the reason that like anything, techniques and knowledge develop with more experience and it was new at that point and used in more limited situations. BC.org is not the only site that still says it is for "small breasted women" sometimes almost as a rule, but I have been researching this for enough years, and known enough women to do direct to implant, to know this is not set in stone.
A surgeon's skills and experience matter, their comfort level, as does your own body. Like I said, my breast tissue transplanted to a woman with a 36" ribcage would be a C, so having a rule about breast size...and cup size since most people (80% being in wrong size bra) have no idea how cup sizes even work, including surgeons, seems odd.
The risk with very ptotic breasts is primarily with NSM (whether direct to implant or not), as the blood supply to the nipple is not as reliable, and proper nipple placement may be harder. I don't usually see it mentioned as an issue in non-NSM, though admittedly I see direct to implant a lot less often in non-NSM (Sandra above being one of those exceptions!). Sandra above had large breasts, which an implant could not "replace" in volume, but she also did not have NS so her pockets were made smaller and suitable for direct to implant.
I have similar stats to you in that I am 5'4", 118 lbs, but I was a true 30E (UK sizing, with a 29" under bust and a 34.5" overbust). I had NS and no issues really, though as I said unlike your sister I did have a lot of bruising (but I have always been a bruiser) and it did take a while for them to settle (it can take months for you to see final results). I also will be having a revision (again, not due to lack of skill of my PS, but to improve some things), so it was not one and done for me BUT I did not do it to definitely be one and done, I did it to hopefully avoid the TEs. Going in I thought that even if I needed another surgery later to tweak, I was still no worse off in needing 2 surgeries than someone doing TEs/exchange, and I would avoid the TEs.
For me this was more a convenience thing than a worry about discomfort. I was going purely prophlyactic, and wanted to be able to return to work, which can be hard to get away from, without missing more time for appointments and a new surgery within a few months as best I could. I am the main breadwinner, and my income is also partly dependent on volume of work, so it just was not feasible to miss much work. With my revision, it is non urgent so can schedule it for when it works for me again even if that is a year from now without having to live with TEs until then. A VERY big factor for me was I live 2.5 hours away from my PS. A fill appointment would mean an entire day off work to drive there and back (and perhaps require my husband to need to miss work as well if it turned out I could not drive comfortably after a fill). A PS I saw who was more local would have done TEs, simply as he was more comfortable with them, and he works a block away from my office, but I really wanted the PS who was further away.
I asked my PS what he would recommend his wife do, and he was upront he would recommend the direct to implant and felt the same way as me about that I would not be any worse off if I needed a revision than if I had done TEs anyway, I had enough healthy skin tissue, was prophylactic so not concerned about radiation and so on, so it was worth a shot and made little sense in my case to do TEs as there was no added benefit to them in my case.
Many PSs do express a preference for TEs as they can "get things right". I also see that often repeated as a reason to avoid direct to implant. I talked to a couple PSs about this, and really, this is more the case if the patient is unsure of what size they want to be, wants to go bigger, or the PS or patient refuses to do revisions. The chance to "get things right" that they refer to happens at the exchange surgery, when adjustments can be made to the pockets, and so on. TEs are wonky and so yeah, tweaking of pockets is often necessary for the implants. It does not guarantee further tweaking might not be needed after exchange (many do go back for further revisions). And there is nothing that says those that do direct to implant can't get tweaking as well later on. Some really are one and done and very happy with their results (which sounds like your sister) but many do go for later tweaking, be it fat grafting, implant swap, or whatever to refine their results. One does not have to be stuck with what they get after direct to implant if they are unhappy!
A lot of it is also what the PS is used to and experienced in. I would not want a PS who is not confident in their direct to implant skills to use me as a guinea pig anyway...if my PS, who is very experienced in direct to implant, had been more comfortable with TEs for me, I would have done it that way.
Feel free to PM me if you have any specific questions about my own experience, results, recovery, etc!
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Divecat,
Very well stated. An excellent summation reasons and the thinking of different PS's.
I just got off the phone with Dr. Klein's nurse and she was great. She said, 'We have people come in with magazine photos saying 'this is what I want to look like' and all kinds of ideas. She said Dr. Klein does what he think will give the patient the best result. Period.
She says that I will see him again next Tuesday and can go over any questions with him. Although surgery dates have been set she says those get changed all the time. She said they've learned that patients need that 2nd appointment because the same kinds of concerns I have, other patients have concerns about whatever's been decided on so they do the second appointment.
She also explained that while they do a lot of TE's they also do plenty of direct implants and she said it's based on frame size, breast size etc...For women who want to go bigger, it's not an option. She also stressed that TE's hurt, that they're uncomfortable and everyone reacts differently to the fills and the amount of fill they can tolerate.
She said she's seen many 'after' patients and she honestly doesn't see a difference in patients who had TE's and those that had direct implants.
So when I see Dr. Klein next Tuesday it's in his hands, and I'll go from there. She did stress though that if he suggested a protocol then it was not because I suggested it. It's because he feels it's the way to go.
I was very relieved after talking with her. She said they've learned that patients need that second appointment with Dr Klein before surgery for this exact reason.
I'm very appreciative of all the input from people who have had direct implants! Clearly most people have had TE's and when I asked Dr Klein why PS's don't do more direct implants (and his answer was referring to patients who are good candidates for it), he said 'because a lot of PS's don't know how to do them. It's a relatively new procedure (not new) but relatively new.
I'm of the belief that my PS neighbor who has been doing this for decades knows what he's talking about but he can't know what Dr Klein knows because he's several decades older and my neighbor said that everything, (tools, imaging...everything in his words) have improved so much since he went to school.
Best to all...
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Thanks for your reply Whippetmom. I met with my PS and he is suggesting Sientra 425 teardrop implants. Your thoughts??
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OceanSky, the only other thing I can suggest is that you go over to one of the threads on tissue expanders. My friend Moonflower started one called TE's - A Beginners Primer. Here's the link https://community.breastcancer.org/forum/44/topic/819027?page=29#top There are others that focus on TE problems, but Moon started this one so women could get basic info and read personal experiences. Moon also has an enormous amount of experience with TE's, several sets in fact, and once had TE's for two years I believe.
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