BREAST IMPLANT SIZING 101
Comments
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MommyatHome and Stix, My next PS appointment is in 4 weeks and I will ask him about drooping on the cancer side. What kind of "fix" was advised for you? I was wondering if the procedure they use for a breast lift would work. That is the incision I have now since my nipples had to be removed as well. I did not have Alloderm but maybe that is what will be recommended. Please let us know what your revision will entail. Thanks, Diane
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Diane,
My ps is only willing to do fat grafting. She said everything else looked good and she didn't want to invite trouble; infection etc.0 -
thanks Dianems. I was at my surgeon's today as I have had significantly more pain after my fill last week. I went from 60 to c70cc's of fill but my 450cc expanders are now at 500. I just am not sure I can get through next few fills and can't wait to get to exchange. Dr. said I have some capsular contracture happening which is why they feel so much harder ( I thought it was due to the overfill) she wants me to continue self massage or find a therapist who is able to help me. Argh! Can't wait till I can post on the Exchange City thread.
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dianems,
Is the "drooping" excess ptosis (so that the IMF is still in place but the breast is "drooping" over it excessively) or is the implant actually falling under and below the IMF - and so the IMF is actually moving lower down your chest? The latter is bottoming out.
This is kind of hard to explain in words, but here are a couple of image of bottoming out (in augmentation patients, but the idea is same). You will notice a "double bubble" effect on right breast in the first photo, this is a result as that woman having breast tissue which you won't have, and that breast tissue staying above IMF while implants drops below, and in the second photo you can see how the left side IMF the has fallen down the chest but there is no "double bubble", possibly as she had very, very little breast tissue to start off with.
In this case, you would need surgery to repair and reinforce the IMF (Alloderm, stitching, etc), Essentially providing an internal bra to try and reinforce that area and keep the implant supported above the iMF.
Ptosis is a bit different, and in this case can result from very stretchy/thin skin with a heavy implant (ptosis of course also happens with natural breasts and is completely normal - some of us have it from puberty, some develop it with age, pregnancies, breastfeeding, etc). I imagine a lift to remove excess skin/tighten things up can help, but you may have it happen again (wearing a proper fitted bra may help reduce the tension on the skin and tissues however).
This chart shows examples of ptosis, notice how the IMF remains intact (represented by the black line) but the breast is still moving lower.
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That is a great example of grades of ptosis Divecat!
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When is your surgery Divecat
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There WAS supposed to be a question mark after Divecat, but the goofy system will not let my iPad correct anything....
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Yeah, my iPad and this site do not get along either
I don't know the date yet, I just talked to my PS's assistant this morning and she just is reviewing the schedule and will be in touch hopefully before I leave for holidays this weekend.
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Hi Whippetmom,
It's been a while since I've been on here, but I'm meeting with my PS tomorrow to discuss implants so I'm requesting your help.I had a right mastectomy in April and a left prophylactic mastectomy with TE and alloderm placed in October.I'm 5'1, 150 lbs. with a 34" ribcage.My natural breasts were a 38DD.I don't want to be that big, but would still like to be somewhat big.What would you recommend?My dr says he uses Natrelle, but is not opposed to using others.I'm trying to get as much projection as possible.Any help is appreciated.Thank you so much.
Nancy
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Oh by the way I'm currently at 660ccs on the left and 690ccs on the right.
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Hi Whippetmom, I haven't been on in awhile. I have been consulting for the last 9 mos. pretty much everywhere. Boston, NY, and Miami. I am considering Brava-AFT or switching to one of the implants you suggested earlier. I'm wondering if I can switch to am anatomical at this point? I have allergen natrelles style 15. (492ccs). The TEs were 133 MV 400 fill. I believe I filled them to 470. Lots of rippling and no upper pole fullness. So fake looking to me. I will need pocket work like you had mentioned. Just not sure if I can go with an anatomical and would it look better aesthetically on me?
I had mantle rads for Hodgkin's lymphoma at age 29. Probably a hurdle for FG? No blood supply I guess. Anyway, still considering Dr Delvecchio and BRAVA too. May try that first? And if not successful, try plan B. Any thoughts from one and all is greatly appreciated! Thanks!
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DiveCat, thanks for the detailed reply! I think I have ptosis. I had it on the right, pre-cancer, and was actually considering a breast lift. The incision used for that looked scary so I hadn't yet talked with a doctor. Now I have the same incisions that are about an inch above the IMF. I don't know if they are in the crease from my native IMF or if the incisions were purposely made a little higher. (I will ask at next visit.) Anyway, I had hoped this surgery would make them look symmetrical but, didn't discuss the ptosis with surgeon beforehand. Whippetmom, how will fat grafting help with your drooping? Also, I have divots when I tighten my pectoral muscles. These are at the spot where a nipple should be. Wonder if fat grafting would help with that.0 -
Fat graft transfer will not help ptosis....will not help pectoral animation.
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Hello everyone..just wanted to chime in on this. I just had surgery yesterday..got TE's out and implants put in. I have no idea what kind of implants I have other than that they are silicone. When I went in for my preop with ps I thought I was going to be able to pick out my implants, that was not the case. He said it was a gametime decision, he would know what implants to put in when I was on the table. I guess the reason was because he didn't know until he opened my chest up, what size would be the best for the pockets/slings. I had 460cc's at my final fill..which ended up being wayyy to much. Before the mastectomy I was a 34D....he ended up putting 500cc implants in and said they would end up looking like 400cc's. Which was totally fine with me because those suckers hurt ! I could put my whole hand in between them. They look fabulous today !! I can put ONE finger in between them now. Maybe each ps is different when it comes to this tho
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That is great ganzgirl...so glad you are happy with your results
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Whippetmom, How disappointing
What do you suggest to fix the ptosis and pectoral animation? I thought you, maybe it was Mommyathome, were having fat transfer to help with drooping......0 -
Dianems,
When I saw my ps about my concerns she said fat grafting may work to fix the dip in my chest above the implant. I am hoping to schedule that for April or late march... She would not fix the divot on the side of my breast near my arm pit because she said its not bad and we could be risking causing more issues. She also won't address the drooping on the left side (cancer side) because she said most people's breasts aren't even and again we can be playing with fire. She said if it worsens then she may address it but not now. So just fat grafting for me.0 -
Dianems: Some plastic surgeons will employ a technique where they perform a pectoral release down the chest wall, but you will have to google "pectoral animation and breast reconstruction" and see what you come up with. You can find plastic surgeons on realself.com answering questions like this one. However, this release can further thin out the skin in the upper pole sometimes, and then you might end up with other issues to address. My recommendation is to stop flexing and animating the pectorals. Honestly, it does get better as years pass and the pectorals relax. I hardly notice any animation, five years post-exchange
As far as ptosis is concerned, it depends on your skin elasticity. Perhaps you could go to a Sientra textured round implant, which would form and adhere better to the chest wall and also give more upper pole fullness. Talk to your PS about this. If your skin has been overstretched by tissue expanders, and you have smaller implants, you might need larger implants or certainly, pocket revisions to reduce the pocket dimensions. Again, please talk to your PS about this.
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GatorGirl, I know how you feel about the fills. I showed up one day, for a fill, but instead told him I was done. It was just too uncomfortable. I felt like I had juice boxes in my chest. Good luck, yes the implants feel so much better.
Mommyathome, Yes, I am concerned about messing with revisions and taking a chance for infection. I guess I had unrealistic expectations that this reconstruction would mean perfect- looking breasts. My cleavage before was lopsided due to ptosis on one side. I was looking forward to lower cut shirts to show off my new boobs.
Whippetmom, Thanks, I will research the options so I can have an informed discussion at my visit. I will need to recheck the charts to compare dimensions of my TE with the implants. I imagine each surgery increases scar tissue and risks and PS are not that eager to keep trying for cosmetic perfection. Really the ptosis bothers me more than the animation. When others talk about going without a bra, I am jealous. But I feel like I am being petty - I should be overjoyed that the cancer is gone. And it is only 3 months since EX so maybe I need to give it more time.
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Dianems: you can send me photos via private message, if you want further assessment.
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Hi Whippetmom,
Thank you for what you do! I am grateful we have someone to help us with this confusing process. I am a Uni and have Allergan 250cc 133MV-11 TE on my left side. I'm 5'5" 120lbs with a 29" or maybe 29 &1/2" ribcage. The right will be augmented to match. I do not want anatomical because of the fear of rotation. I'm considering saline. Which implants do you think we should go for
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To be honest, I get so few women requesting sizing for saline implants. However, I can recommend Allergan or Mentor, and suggest that you have close to maximum fill with these saline implants. I would choose a HP style, and you can see the different sizes in the attachments. Mentor's HP implants have greater projection than Allergan's equivalent style. You could be a candidate for implants with a volume ranging from 320 ccs to 400 ccs. I
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Thank you, Whippitmom! There are pros and cons with both saline and silicone. I'm leaning toward saline for now, but it's not set in stone. I'm sorry I should have asked for recommendation for silicone at the same time. If I decide to go with silicone, what doyou recommend?
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LoverofLife - just curious, why are you leaning towards saline?
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Minustwo, I like the fact that silicone is lighter, softer, and shows less rippling. However, I had mastectomy on one side so I will need to have my native side augmented for symmetry. From what I understand it's more difficult to match with silicone( correct me if I'm wrong, Whippetmom). Also, I don't scar very well. Saline seems to be a better option as it does not require a big incision compared to silicone. I still need to have annual mammogram done on my native side and the thought of possible silicone implant rupture from the procedure scares me. Another reason I'm leaning towards saline is that I don't have to worry about doing MRI every two years to check for ruptures.
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Loveroflife: If silicone rounds, 350 ccs to 400 ccs and small implant on the native side. Your PS could also use a Mentor Spectrum expandable implant on the native side. This would enable him to really refine the size in minute increments and keep adding or removing even weeks AFTER the exchange, after the MX side has settled. He just closes off the port of the Spectrum and you are done
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Hi, I had my second revision surgery two days ago for a droopy side. He used strattice and also used the ryan flap. first revision the alloderm didn't hold (with a different surgeon) It looks promising. But, it is quite a bit higher when compared to the other side. Time will tell. I am hopeful
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Thank you, Whippitmom!!
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Stix: Hoping right along with you on this one!
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I am going for my preop tomorrow and would like some advice. This will be my 8th surgery in a year in a half and hoping this will be my last one. I have had numerous infections so I had to have the silicone gummy bear teardrop implants removed. I did not like then for the brief time I had them as I had upper pole volume but nothing in the bottom and they had low projection they were the allergan 410s 595 ccs. So now i have the TE in and are filled to 650 ccs. The problem with the TE is they are placed way to high on my chest. There is a two finger space between my collar bone and the TE. The mastectomy scar is not even and low. I would like the scar in the middle of the implant.I am just at a loss how to convey to him I do not want the implants this high. The volume needs to be in the bottom and middle not so much in the upper pole. Thank god these are only. TE expanders. I am going to try the round silicone 700 ccs. Haven't decided which ones yet. Any suggestions on how i convey this too him. Really want this to be my last sugery. My surgery is scheduled January 29th and I am just so anxious. Whittetmom and I had discussed what types to get a awhile back so most likely will go with her recommendation this time and not the dr.
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