BREAST IMPLANT SIZING 101
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whippetmom- Do you know if the FDA has come out with a higher volume implant? I currently have 650 in the left and 800 in the right. I'm hoping that I can eventually get bigger implants.
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Sent a PM to you, Whippetmom.
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Whippetmom, just wanted to let you know he put in exactly what I asked for. The new memory shapes high profile filled to 620cc. I haven't looked at them naked yet but I'm rockin my jammie top!! Thank you for giving me the confidence to march in there and tell him what I wanted. I could tell he was both taken aback and impressed.
Karmenn
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Karmenn......
Cannot wait to hear about the results with the unveiling! You go girl!0 -
Chrisrenee: Not yet. Not in silicone. In saline, you can go to 960 ccs....but silicone is still holding at 800.
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Galsal....Love the photos!!!
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I had a great appointment with my PS this morning. I'm just about 4 weeks out from my 5th surgery and everything is holding. No signs of bottoming out this time. Alloderm and the other work he did to reconstruct the pockets have done the trick apparently and he is 98% confident I won't have to have an LD flap surgery. He said he wants me to stay away from trampolines for another 6 weeks
and keep wearing non-underwire but supportive bras. My left side is so fragile, he said it would not survive if he had to dissect the pocket again. I took one of my soft Wacoal bras with me today and he gave it the thumbs up, especially the soft band. We discussed the minimal but noticeable asymmetry. After the infection and loss of the original implant, the skin was stretched to its max with the TE. He then exchanged both sides for the same size and style implant. But he said the flap on the right is the normal thickness but the damaged left side is paper thin with virtually nothing between it and the implant. That's why it's colder and the reason why it looks smaller is because without that extra padding, it IS smaller. In about 3 months he will schedule the final surgery for fat grafting and to surgically get rid of the remaining mud flap which is really a mini-boob - too big for lipo.
I'm happy.
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Whippetmom,
Can you help? I had a bilateral in Aug. My TE's are filled to 800cc's each. I was a DD. Here are my measurements:5'7, 184lbs, 36' ribcage.
PS will use Mentor 354-4800. Sounds right?
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angelaith: An 800 cc high profile Mentor implant is fine, but WHY textured? Is it because you need a lift...need the adherence? Typically smooth silicone rounds are used for breast reconstruction, because textured implants tend to cause traction rippling. If your skin is rather lax though...perhaps your PS feels that textured would serve to act as a "lift", if you will. Otherwise, the size sounds fine.
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sandra4611...If you are happy, WE are happy! Good patient to PS communication is always a good thing, as Martha Stewart would say.....
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Sandra -congratulations. I like that 98%. We just knew the 5th time would be the charm!! Good idea to skip trampoline practice for awhile - and probably line dancing too.
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whippetmom - yes he did say the textured was to give me the "lift." My breast were quite saggy before. So I had quite a bit of skin to work with..He also commented after the 1st surgery that I had a strong chest muscle, which was good..
Thanks so much for your help! Now I can relax and continue to recover these next few weeks..
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Hi again Sandra. Exactly what did he do besides alloderm. I have bottoming out- and or a displace implant
I read in my surgeons note that the p.s. only used alloderm for support. Why would she not of tightened up some areas?
I would like to take a pole of home many had alloderm for a revision and how many had pocket work done at the same time??
Sandra... are you on the picture forum?
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Dear Whippetmom,
I am so glad there is someone like you to help guide those of us who are not as informed! I have read your article on tissue expanders and implant sizing and was referred to you for help in making sure I am best informed for the next surgery which is the exchange (should be done in the next few weeks). Here is my info and please let me know if I left anything out..
Before my BMX, I was about a 34A (on a good day - barely filled those cups!). I am 50 yrs old, 5'6" and weigh about 140 lbs. I have a medium frame with strong muscle tone and not much body fat. My ribcage measurement currently is at 30". My PS tells me the TE's are Allergan 133MX 400cc. They are currently filled to 365cc on the right and 335 on the left. The right side skin is much more taught so I think he was trying to stretch that side more the match the other.
For the most part, I am happy with the size and the projection of where we are today. So when we do the exchange, I would prefer not to lose any projection if possible. He is suggesting an anatomically shaped implant (silicone gel) with a higher profile to help in the "step off" on the upper chest area. Due to lack of body fat, it is kind of noticeable. I says he is thinking of using a Mentor MH anatomical implant. He did use Alloderm during the BMX.
Any insight and guidance would be so greatly appreciated. I feel like I am working in the dark a bit and don't really know what to be asking or looking for stepping into the next phase.
Thanks again for being there for all of us!
Frances
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Stix, yes I'm on the Picture Forum. My thread is called Bottoming Out.
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Sandra,
I was having pain in both breast and decided to go to Nordstrom for a fitting thinking maybe I'm not getting enough support from the sports bras I typically wear. The woman there was very nice and measured me and had me try on a few bras. I told her I didn't want an underwire bra- they are NOT comfortable for me at all. I ended up with a wacoal bra. The particular one I tried had like a lace covering. She noticed that the side I had cancer and the lumpectomy- even though I also had a BMx- didn't fit the same way as the other breast. The lace bunched a bit. It was confirmation to me that 1) they are not the same size, even though the implants are and 2) I need to consider fat grafting to fill in the divot and/or flattening above the implant.
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Dear Whippetmom - I just found this forum and am grateful for the information that you have provided! Given family history of breast cancer and LCIS, I have decided to have a skin-sparing and nipple-sparing prophylactic bilateral mastectomy in about 5 weeks. In preparation for this procedure, I had a lift and reduction in January to deal with some ptosis and asymmetry and am thrilled with the result. I am 5 feet tall and weigh about 107 pounds and always felt that my full 34C bust was too big for my frame. I am a small 32/34B (and lifted!) and could not be happier. But, now my ps has to replicate this great result with implants and I am concerned that we won't really get there. I have not been measured yet so I don't know my ribcage measurement, but I am small.
Since I like the teardrop shape of my breast now and I don't want any fullness on top, my ps has recommended anatomical shaped cohesive gel implants and he says he likes Sientra better than Allergan; he thinks they are not as heavy. I guess I should mention that my ps says there is a chance that he can go straight to permanent implants during the mastectomy since I am small busted (now!) and I don't want to go bigger. I have told him that he can go smaller if that would make the one-step reconstruction possible and successful. Do you have a view on what would be the best implants and size for my body size and desired outcome? Are you aware of successful one step reconstructions with the new cohesive gel implants?
These past 2 years since learning of LCIS have been very tough and while I can't believe that I am actually going to have the surgery, I know that it is the right thing for me and my family; I have young children and want to be sure I am around and healthy for them. And I also want to be happy with my reconstruction. Any additional information you can provided to me would be greatly appreciated. Many thanks; you are an angel.
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Frances: Yes, that would be the Mentor CPG 323 anatomical, 390 or 440 ccs. This will permit you to keep your projection - the projection of the 323 implant is actually higher than the projection of your TEs.
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BigAppleMom:
If you are going to do a one-step, there are a number of options with Sientra shaped, but it all depends on your chest wall characteristics. I think that my favorite would be the Round base shape...around 320 to 370 ccs. But you might be able to use the Oval base high projection, around the low to mid 300 ccs, or even the Classic, around 350 ccs. I think something in the 300 plus cc range will be your goal. Again, it depends on whether your PS needs some height on the chest wall or needs some width, to attempt to replicate the shape and appearance you have with your native breasts.
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Thank you Whippetmom for your thoughts! I will take your suggestion to my next appointment. Again, thank you for being such a wonderful resource to us all!
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Thank you so much, Whippetmom, for the quick and informative reply. I will take this information to my next appointment to help with my discussion with my ps and will report back.
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BigAppleMom-
We just wanted to welcome you to Breastcancer.org, and tell you how glad we are that you've found our community. It's a source of much support and information for many women just like yourself, as evidenced by the response to your initial post. We hope you'll stick around and get to us more!
Good luck with your surgery, please keep us posted on how everything goes. You're in our thoughts!
The Mods
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Whippetmom - I have my exchange surgery 11/14 - pre mastectomy I was a 34B. My TE's are filled with 530cc's. I want my final results to be somewhere in between. My PS recommended between 450 cc - 430 cc. I'm 5'5 142 lbs and my ribcage circumference is 30". I'm 43 years old. Does this sound about right? Also I am very torn still between saline and silicone.
Thanks for any input you may have.
Regards
Amy
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amyo....With your vital statistics, high profile implants with a volume range between 450 ccs and 500 ccs should be fine. I would go with silicone, because you will have significant rippling, most likely, with saline implants. Your stats tell me you are on the thin/slender side and possibly have thinner skin overlying the TEs. The newer generation of siicone is so much better, that it is honestly pretty prehistoric thinking to worry much about anything going wrong with the new silicone implants. However, if you want to stick with a true cohesive gel "gummy" type implant, you could go with Sientra - the HP smooth round Sientra implants in the same volume ranges. I cannot get any more definitive than this, because I do not know the style or actual volume of your TEs. See #3 in the thread header above.
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Thanks Whippetmom. I'm unsure of my TE style the brand is mentor and that is the brand my PS prefers for both gel and saline implants. I'm currently filled with 530cc's. I was going to my planning meeting wanting silicone gel, he said most of his patients go with saline. I live in NE PA and it's rather conservative. His office said most choose saline for fear of leakage problems. I'm still leaning toward silicone, from what I'm reading about they appear more natural land no rippling. I know this is entirely my decision though.
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I had my appointment this past weekend to discuss the exchange. I was expecting to discuss the implant choice, but instead was prepped for what (not) to do after surgery. At the end, I inquired. My PS responded of course, but not in a way that invited discussion. I did confirm at least that he is planning to move forward with an anatomical option (the new ones from Mentor), but no clue on size or specifics. I am strangely Ok with this. Usually I research a lot, and due to the kindness of Whippetmom know quite a bit more than what I would otherwise have known. At the end of the day, I trust my surgeon. He has been spot on so far. At this point, the TE's hurt so much that anything is going to be better. So, December 12th is the day and it can't come soon enough. I wish everyone out there a gentle journey.
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amyo: That is interesting...and the fact that most of his patients choose saline is a little disconcerting. It makes me wonder how archaic is this practice? There are a lot of plastic surgeons who are approved only to use saline implants. PM me with your plastic surgeon's name. Let me check him out. I have been on BCO for 6 years and 80% to 90% of the women on these boards who have come through my thread have silicone implants.
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Looking forward to hearing from you after the exchange, happyteacher!
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whippetmom - remember when you were helping me choose implants back in 2012? You had some great suggestions for silicone implants, but I told you my Kaiser PS only used saline. You said that this was not a Kaiser policy, and that I could go to one of the other facilities and get silicones if I wanted.
In the long run, I stayed with the PS I had because I had such faith in him. When I asked why he only used saline, he said when it came to removing and replacing saline implants, he could make a very tiny incision, since the salines were completely deflated prior to insertion or removal.
Additionally, he had the opportunity to add saline individually to each implant, essentially creating custom sizes for women whose body measurements were different due to things like genetics, or even radiation. He almost always got perfectly even implants on each side.
One day I was talking with my MO, and found that the other surgeon in the PS department who did breast recon ALSO only uses saline. When I asked why, she said that she had asked the surgeon this question, and the answer was that even though today's silicone is totally different from the silcone implants of the past, there are still unanswered questions for her.
For example, if you slice open a cohesive gel or gummy implant, it will hold its shape. It will not immediately run out, like the old silicone did, or even today's saline does. We've seen this plenty of times on videos.
However, if you place this sliced-open gel implant on a surgical towel for 24 hours, it will ooze an oily slime onto the towel, leaving a stain. The PS said since there were no reliable studies of what this substance could do inside the human body, she was not comfortable using silicone implants until further research was done.
So I guess my point is that sometimes the PS's preference for saline is not because of ignorance or lack of experience, but because of carefully thought out choices on the part of the surgeon.
(And did I mention that I LOVE my 700cc salines? Always warm, no rippling, DH says they feel real to him... and yes, I got EXACTLY the models that whippetmom recommended)
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I had bilateral with immediate DIEP flap on September 10. Based on the CT results we knew that one side would be iffy due to my blood vessel structure. The right side failed during surgery so my husband made the decision since the left was already working to just leave the left in place and do an expander on the right side. He based his decision on what would be the fastest way to get me out of surgery since I was in surgery for over 15 hrs and had 5 bags of blood. I'm happy with the DIEP side and I know the expander side is still a work in process. My major concern is getting both to match when the implant is put in so I'm not lopsided which is how I feel now with the expander. Looking at exchange surgery in January/February 2015. My DIEP side is approximately 560 grams.
Height 5'4"
Weight 155
Ribcage 36"
Allergan style 133 MV tissue expander maximum fill volume of 600 ml
Plastic surgeon's recommended fill volume is 620 ml
I would appreciate your input. Thank you - Missy
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