BREAST IMPLANT SIZING 101
Comments
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Kat: Well, conversely, 95% of us here on these forums get silicone!!! Just the opposite! I prefer silicone for the general population of women who have had breast reconstruction.
You are NOT here too early. Nothing wrong with fact-finding and being well-informed prior to the exchange.
I personally think you are going to want implants with at least 500 -550 ccs. Since you want to be around a "C" cup - and you need at least 14.0 cm width, I would recommend the Allergan Style 15 moderate plus profile silicone in 533 ccs. Err on the larger side....it is not easy to achieve volume with breast reconstruction the way it is with augmentation. You probably still have much of your former size "D" skin flaps and if you downsize too much without mastopexy - or removal of skin - you tend to sag and droop more and I don't think you want that. So it all depends on how your skin is responding as well, which dictates where you should go with implant volume. Is your skin nice and tight over your TEs? No loose skin surrounding the TEs?
Deborah
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Kat....You might be describing a step-off defect. Not sure otherwise what this "dimple" might represent. You can always email me photos. PM me if you want to do so.
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Wow Deborah....Amazing information! Thank you so much.
Currently my skin is doing ok and it is nice and tight....the BS left a lot of skin hence the 250cc fill (and also probably contributing to the indentation as well) I do have some superficial purple discolorations that I first thought were bruising but it's more like a very thin thin scab that comes off a little each day and it's white underneath. PS says it's from tanning. (lovely) I think this is why I didn't get a fill at the 3 week mark and he's taking a lot of time. I will be patient....if it takes 5 months to do the exchange than that's what will happen.
Are these implants the round kind or the teardrop kind? Which one is the gummy bear? (do I want the gummy bear?)
The main problem with choosing silicone over saline is that the manufacturers recommend routine MRI's to check for integrity and placement...initially 3 years after placement and then every other year there after....and whose going to pay for the MIRI's? Not the insurance company and not me either (2,800.00 per implant) I may splurge and do it every 5 years that would be it.
Thank you so much for the help!
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The MRI issue with silicone. I don't know about that one. I have an HMO and I can assure you they are not going to permit me a MRI every three years. I might have to picket Kaiser to get one every five years. I am undaunted by this. Silicone has a 4% rupture risk rate over the first four years.
The silicone implants I am referring to are the silicone rounds which are the standards currently in the industry. The true cohesive gel implants, aka "gummy bears" are only available in certain countries - like Canada - and/or available through plastic surgeons who are involved in clinical trials. The gummies are still under FDA investigation otherwise. If your PS is focused on saline, I am about 99.9% sure he does not have access to the gummies.
Ask some additional questions when you see him and get some idea of where he is going with your reconstruction. Do not hesitate to ask him what size he envisions using at the time of exchange.
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Thanks for the advice. I do believe what I have is a step off you spoke of. I asked both BS and PS if it would go away. BS said "I don't know" and PS said "Perhaps" I wish they would have told me what it was.
I found a link for the Allergan implants and the style you referred to...could that be midrange profile instead of moderate? I found so much other information with what you gave me to go on so many thanks.
I too am undaunted by the MRI issue...I'm going for it!
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I think this MRI thing every few years is new. I had silicone implant in 2001 and was told after 10 years to think about an mri. If you do have to get one, the trick is to close your eyes before they slide you under machine and keep them shut tight (if you have any claustrophobia).
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Kat: The step-off defects might be softened somewhat with the exchange. Many of us have fat graft transfer procedures after the exchange - to address the step-off issues if significant. Yes, Allergan calls theirs "midrange profile" - Mentor calls it "moderate plus" I believe. I just know it is Allergan Style 15.
Katey: Interesting about the MRI protocol change. I have a friend whose silicone implants were placed in 1990 and she had MRIs - but I forget how often. She has fabulous insurance so probably frequently enough. The last MRI did show rupture of both implants with evidence of gel bleed inside both pockets. It certainly was not alarming enough for her to do anything right away - she waited about eight months after the MRI - until a few months ago when she had some "free time" - to exchange them out. No complications whatsoever....And HERS were the older generation of silicone! BTW: She is just amazed at how much better these implants look than did her older versions.
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Yes, I'd have to agree! The new implants look so much better:) Glad to hear there were no complications and it wasn't a rush for your friend to have them removed! Were these the original ones from 1990? My PS would check them annually with a physical exam, just mentioned in last year or so that maybe he'd order one, I don't like mri's so I never pushed that subject!
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I am scheduled for a mastectomy in April with a possibility of delayed construction I will be having the lat.dorsal reconstruction with implants. Here is my question: I have an existing full B cup on my left side which requires surgery and an A cup on my right side. I am 6 feet tall with a large rib cage. I told the plastic surgeon (who wanted to reduce my left side too) that I would rather go up a size on the left and 2 sizes on the right so that I never have to wear a bra again and to create better symmetry. Does anyone see any problems with this? Should I be more specific as to size?
Thanks for all of the help in advance!0 -
To Deborah (whippetmom):
I am most appreciative of the information you so generously share with us. I am in CT and am curious to know if you happen to recommend a PS there or else in NYC.......I already have expanders in but with minor symmastia. My PS states he can correct it when he does the exchange, but I'm a little wary and certainly don't want to go through this twice -- (Exchange then correction!). Also, my PS proposes to create the nipple from my own breast skin and then does a tatoo (but mostly with one color as oppose to three colors for a true 3D effect). So besides recommended PS's in NYC and CT, can you recommend a medical tatoo artist who specializes in really good 3D nipple tattooing?
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Deborah,
One more question: Do you happen to know of Dr. Frederic H. Corbin in California? It sounds like he does amazing work......just interested. Would love to know if there's someone like him in NYC or CT.....
Thanks!
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MBJ: Heavens! Of course you want to go larger, rather than smaller! What is that man thinking??? This is your opportunity to have the size you want [within reason , of course] and SYMMETRY!!! My recommendation is obviously that you have a latissimus dorsi flap on the left with tissue expansion sufficient to exchange you out to an implant reasonably larger than what you are currently. Then, with the right side, what might work best for you, would be for your PS to use a Spectrum expandable saline implant. This would enable him to gradually expand that breast and get near perfect symmetry with the MX breast, once you have completed expansion. We could refine the numbers and give you some idea of what sizing would work if you would give me height, weight, ribcage, etc.
Deborah
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CTGirl: I thought I had the name of someone in CT.....let me check.....I have quite a few doctors in New York I would recommend - some quite highly. How about Albany? Is that too far?
I feel that you should AT LEAST get a consultation or two about the symmastia issue and repair of same and strongly consider having someone else do the second stage of this journey.
I have heard of Dr. Corbin - he does beautiful work. I do not know anyone who has used him for breast reconstruction though....he also does mucho, mucho cosmetic work - which is what he is really known for of course....
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CTGirl: Okay, the name is David Passeretti, M.D. in Darien. Quite a few women on these boards have been to him and think he is fabulous. You would want to at least make an appt. for consultation and see what you think....find out what he would do to correct the symmastia and get you where you want to be at the time of exchange.
http://www.davidpassarettimd.com/
Deborah
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CTGirl, I did some research on 3D nipple tattooing and came up with this link...lucky for you they are in NY. My PS does regular tattooing in the office and that is covered by insurance. I'm not sure if these artists would be covered or not? If it's not going to break the bank, I think I would go out of pocket and have it done anyway. I am not getting a protrusion but the 3D gives you the best of both worlds.
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CT girl, I'll pm you my ps name and number in NYC.
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Oh Kat........I went to that website. Thank you so much for sharing. I have been stressing so much over nipple reconstruction. And now the tears are finding their way out. People in general cannot understand what this is like. Having to go through so many surgeries and chemo and hair loss.......and everything else we have had to put up with because of breast cancer. I would be totally insane with everyone here to share all of the little tidbitds to help each other.
I have an appt with my PS today. I have my questions written down and I am hoping to come home with some answers and a surgery date for exchange.
Thanks to everyone for your support and knowledge.
Navy
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Also, you might want to go over to Exchange City and ask FACECRAFTER for names of artists in your state. She is a tattoo artist for breast recon patients in Florida and she maintains a list of contemporaries in other states who performs breast recon tattoos.
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I am very happy with my results a PS in NYC - a unilateral mx and other side lift. My surgeon is very technically adept - although he doesn't spend a whole lot of time hand holding - but i have had very good results with him - right now we are going to tweak my symmetry by subbing out my 350 cc silicone allergan 20 - for a 325 cc. And while i am "near perfect" - i am going for even more perfect with the 325. He said it was totally up to me and he would respect whichever choice i made - staying put or changing - He is in NYC - i saw 6 PS before choosing him and am very happy with my choice.
whippetmom - i do have a call into him based on your suggestion of waiting more months to see more changes to the look and feel of the 350cc. After my husband read your post - he wants me to wait - but if the PS says he thinks there won't be a material difference between now and 6 more months, I am going to go forward. The smaller implant would address a slightly higher pole on the mx side and just slightly greater volume all around than the lifted side. Of course, the sooner i do this exchange, the sooner i can get going with the finishing touches of nipple etc!
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Hey Ladies...
I had a BMX (skin-sparring) in Nov. 2009. I'm currently going thru chemo. B4 my diagnosis, I had breast augmentation w/silicone. Luckily the breast surgeon was able to leave the implants in following BMX. I was wondering if I decided to go larger from B to C would that be possible without having to get tissue expanders?
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4lumps: I think it is possible to go up 100 ccs without tissue expanders.....depends entirely on the laxity of your skin flaps right now. If they are not tight - if you have some droop - perhaps even 150 ccs.
biscuit: Okay...I don't remember how many months out you are, but nearly all of us wait around 3 months post-exchange for any revisions. So as long as it fits that time frame...I understand your desire to get moving and get on the road to some semblance of "perfection"~!!
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Thanks for ur response
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To Deborah, KatRNagain92 and Katey,
Thank you very much for your responses. Yes, I shall make a consultation with Dr. Passeretti in Darien, CT. By the way, has anyone gone to or know someone who went to Dr. Restifo in Wilton, CT -- just curious..... Also curious about Dr. Lloyd Gayle in NYC -- Deborah, you mentioned not to see him and so did a couple of other posters....just curious why....
I absolutely agree I should get a 2nd and 3rd opinion before deciding who to change to or to stay with my present PS. Problem is, once they make an error, (although maybe not necessarily his fault**) you're now wondering if it's going to be "right" and "fixed" the second time. As I stated, it is minor symmastia and I have to have the upcoming exchange surgery anyways; however, I want it to be done RIGHT on my exchange -- no re-do's PLEASE! Also, after reading all the posts and your recent response Deborah, I'm not sure that I should stay with my choice of saline now.....it's just that if the cohesive gel (aka "gummy bears") develop a minor crack, it doesn't show up on an MRI......and that's what worries me. Up until now, I was going to have the Allergan high profile smooth round saline implants......
(**As I have researched, this is can be a somewhat common problem due to overly large "pockets" made during MX surgery removing the breast tissue and expanders sometimes "shift"--not making excuses for him but would have preferred the opposite problem! Trying hard not to get overly stressed about this!!)
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CTgirl: Lloyd Gale is focusing solely on "cosmetic surgery" now - not reconstructive surgery. I think that some plastic surgeons just should stick with one or the other and it is probably good that he has chosen the other.
I have heard of Dr. Restifo - but only by seeing his name mentioned by one or maybe two other women on these forums. I do not know anything else about him. I do VERY much like Deborah Kennedy, M.D.'s work and she is in Albany. If you can go to Albany, go to Exchange City and ask Dani about her. She is very good at "secondary" work...fixing mistakes.
RE: Gummy bears. You will not even have access to gummy bears unless you go to a PS who is part of the clinical trials process in CT or NY. When I talk about silicone implants, I am referring to the standard silicone rounds - Allergan or Mentor.
Katey gave you a referral also and you might want to check out her PS.
Deborah
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Deborah,
Thank you for your quick reply! Well, my PS is a woman and both she and the OS had this idea that I would get natural symetry by going down a size but I told them both since I have to go through all of this I want something in return. I am 6' tall, weigh 155, my rib cage is 34" and my current chest size is 38". Since my breasts are currently 2 different sizes I told her I wanted the left 1 bigger and the right 2 bigger. I guess this would make me a C cup? What I want to achieve is the ability to not have to wear a bra if I don't have to and I want silicone not saline because I hear that they look and feel more natural. All of my life I have worn padded bras to make up for my right, smaller breast so the thought of not having to wear one at all would be really nice. I also want to avoid the really high, fake round breast look if at all possible--if I had a choice I would get gummy bears in a natural shape--maybe in 10 years the FDA will finally approve them!
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In NYC, Lloyd Gayle is one of the few PS that DOES have the gummy bears, as well as all of the PS at Sloan. However, I chose not to go with Gayle - he seemed to have too many coals on the fire - and was spread way to thin - I did choose Mark Sultan - his work is beautiful - he still does both cosmetic and recon - and loves himself - a good quality for a PS ( i think) - and many women go to him for consult after other work has been done. I have heard from someone on this site that he won't actually do a revision on someone until a year has passed since their last procedure - but that could have been an individual situation.
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MBJ: Another 100 cc's to 150 cc's would be appropriate for sizing up. But if you really want me to nail it down further for you - find out what style and volume you currently have in your implant.
biscuit: Yes, Mark Sultan, M.D. is another PS I have on my "A" team list!
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Hello to everyone.
Deborah, I really wanted to say thank you. You really helped me understand the world of implants. It felt empowering to sit in the PS exam room with knowledge and be able to ask some good questions. Excahnge will be March 11. Hope you are healing well. Take care.
Navy
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Hi Whippetmom: I have had an infection recently which necessitated the removal of my left breast implant.Thinking ahead about my reconstruction, I have a Natrelle style #20 475cc high profile round silicone implant in my right breast. I LOVE it, and want to end up with the same thing on the left. What size expander should I start with to achieve my desired result. I am small 5'3" 100 lbs. ribcage approx.27 inches.PS says I will get a better result if he uses expander again instead of trying to go for the implant immediately. I don't know much about what size expander I had the first time, except that the doctor said it was oval.If you have some insight about what size I should ask for, I would appreciate it. I don't want to over expand, because I don't want ripples. I would rather be a little firmer than having ripples. Thanks in advance.
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Navy: Yep! Feeling empowered in the midst of all of the chaos of cancer! That is what I love to hear! Congratulations on your exchange date!
joie: Just a bit more information.....Did you have rads on the left? You had a bilateral MX, right? I want to research this with you so that we can see how to achieve the optimum results without complications this time around. Typically, you would want to use the same TE again. All of the TEs start out in somewhat of an oval shape. I think that for you - you are so very tiny - a low height TE would be preferred, but you need a narrow TE. So how to get a narrow TE with sufficient volume to expand you out and give projection? It seems to be it would require one of the "X" styles in Allergan - "xtra full projection" either in a SX or MX. That might have been what your PS used. It had to be relatively narrow for your ribcage....but sufficient to exchange to a 475 cc implant.
If you can find out what was used previously....that would help!
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