BREAST IMPLANT SIZING 101
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I am assuming you are not getting radiation?? Do you want fills, want them bigger? You need to do what you want to do and what you feel comfortable with. One month sounds soooo soon for the exchange. Especially if you just had an infection. If she thinks there might be an infection in the expander why wouldn't she just remove the expanders and let your skin and body heal then do reconstruction at a later date.
My situation is different as I had delayed reconstruction but my PS said I will have the expanders in for about 4 months before he will do the exchange.
If you aren't comfortable with her decision I would suggest getting a second opinion!
Best wishes,
Kathy
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Cross-posting of sorts here. Whippetmom has been providing great sizing advice and I haven’t posted on this thread since since 1/11/15 due to my FILs illness. My PA removed 50cc of my 12/2 fill on 12/19 due to pinkness in the upper area of the right breast. After several rechecks, it was decided not to put it back in. The PS wanted to go ahead with the planned exchange on 1/21 only filled to 200cc. I’m 5’2”, 105#. I asked many questions at the pre-op but could not get answers to many questions. I delayed the surgery and the PS did respond with answers to some of my questions but continued to decline to allow healing and attempt more fills. She would have attempted a fill at the exchange. So with Whippetmom’s blessing, I’ve gotten 2nd opinions and have done 2 so far.
At yesterday’s 2nd opinion the PS said that the TE on the right had rotated and that’s why PS didn’t continue fills. He feels there is plenty of skin to fill again and see where it goes. If it doesn’t fill the lower pole, they won’t attempt any more fills. PS said in any case there will be a lot of pocket work at exchange to see if a larger implant would be possible. There is a big tuck on the right that the 2nd opinion PS just can’t guess what it is, how to fix it if it can be fixed until he gets in there. PS said that to get this to look good will require several surgeries. And in his experience, most women my size are hoping for upper 200s-350cc. This is my 2nd attempt at TEs due to initial infection.
I’m disappointed that the original PS didn’t acknowledge the rotation early on and suggest removing and reinserting to get TEs in correct position. Has anyone had experience with TE rotation? And gone through with exchange?
Thanks, Mary
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Mary: You would not believe how many cases of a rotated tissue expander I have seen...where the PS does not mention it or does not believe it needs to be removed and replaced. It sounds as though you are on the right path now, so hang in there. Keep me posted during this journey
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Hi Mary- I just noticed from your sign in you are in Denver--I'm in Parker. I just joined this site and am scheduled for a PBM in April and while I am happy right now with my choice of breast surgeon/PS--more info from those going through it is always appreciated. I'm not sure if you can message me privately your doctors and thoughts on them as I don't know if that is appropriate on the general forum. Hoping you find a doctor that you are confident with and get a good result!!
Stephanie
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just chiming in. I had a slipped TE. i didn't know it..i had a uni at that time. I read the surgeons note. I thought it looked Extremely weird at that time. It never got replaced...and the implant reconstruction turned out f lawless. Fast forward 2 year....Mx with reconstruction. .no implant slip..and had 2 revision s....
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Whippetmom: I had been researching rotation but wasn’t coming up with much info so glad to get the benefit of your experience. The latest PS believes the rotation is what is leaving me at such a small size not thin skin. Not sure if I had the option whether I would have asked them to replace but it would have given me a better heads up.
COhockeymom: I will PM you. If you’ve looked at my signature line, I’ve had some issues and what doesn’t show is that it has been several places.
Stix: Thanks for the reassuring info. While I’m sure the rotation can be fixed, I don’t know whether I can get a bit larger without a new TE. Sounds like you’re going through a challenging revision process. When my BC started, I thought reconstruction was the easy part! And now it’s taken on a life of its own. Are things looking any better for you?
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hi.... my expander looked crazy in 2010....i mean weird. Dropped way down low and lateral....it worked out great on that side. The other reconstructed side in 13... droopy... supposedly thin skin. But i think the pocket was over expanded. Needless to say my first revision on that side...non slipped tissue expander side... ended up looking like pre..revision side droopy and WAY too lateral. Second revision better. A bit flat...but my p.s. said that would round out...personally. .i think i will end another revision to tweek.or. fat grafting. But am only just over 3 wee.ks postop. I HOPE IT DOESNT DROP LIKE B4
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are u on the picture forum. If so...I can tell u if my te...was similar to yours. That side looks fab. Now though and they never removed the t.e. i am sure not everyone will get that outcome. ..but it's promising to hear...right?
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Stix: I have access to the picture forum and actually looked for you a little while ago. I have my pictures ready to go but need to block some time to get it going. Very promising to hear that you had a good outcome. I don't have much skin and it's thin so it makes it harder to work with. Mine is rotated on the outer edge up towards the shoulder; I think the inside lower is close where it should be. PS said a new pocket has to be made at exchange.
I hope your second doesn't slip! I can't imagine going through all of this one side at a time!
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I'm confused on this whole pocket thing and looking 'good' in your TEs. I feel like I have a boob from the front, under my arm and to my back. Is that normal? If a pocket is being 'made', I certainly do not want my breasts in my armpits!
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hi. My TE dropped way too far down and too lateral.
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Went to a well known PS for immediate implants...(He does no cosmetic work, mostly flap reconstruction as well as a rare surgery to benefit woman with lymphademia)...Anyway a well known and regarded PS in the BC community.
He explained to me that he has far more control with immediate implants because the nipple can 'move' with TE's and can't be corrected without surgically moving the nipple.
Just mentioning this for women who are seeking reconstruction. Immediate implants are not an option for all women and frankly most PS's don't know how do to do them.
When asked about choosing a PS...I suggest people choose a PS who does breast recon only, no cosmetic work and if he/she does mostly breast recon flap surgeries...Well, that's a very good sign.
Seek out a few opinions, and if you need to travel for this...I suggest doing so.
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I do think the surgeon has to do a lot of breast reconstruction. Also.. you can have a great reconstructive surgeon and they can also perform other cosmetic 2 stay diversified....protection of their patient inflo for the future.... that's the smart thing to do...
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I was under the impression that TE might not look like real breasts but they wouldn't be lopsided! I'm really not feeling well. Left side is small which is fine. Right side is about 2-3 cm higher than the left and much more filled. I feel that I can't go out unless I wear something super bulky. I have no details about the TEs. Am going to surgeon on tues and hopefully he makes me feel better. I don't think this Is norma
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knmtwins: The latest PS actually said that it’s always easier for him when the TEs look good because he knows that the exchange will go well. Whippetmom is the expert when it comes to implants and pockets for exchange but this is what I understand. There a relationship between the pocket made by the TEs and the implant. If there is a discrepancy, then they have to do ‘pocket work’ so the implant has a good place to sit.
OceanSky: I didn’t ask enough questions before the mastectomy about the reconstruction but I wasn’t a candidate for immediate implants since there wasn’t much left when they were done. LOL. The PS said the best results are with TEs or immediate implants at the time of mastectomy and it’s more of a challenge when there has been a delay for whatever reason. Me, of course!
Stix: My latest PS does mostly breasts so maybe that’s a good sign.
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knmtwins: My fingers are crossed that my TE's did not form this pocket thing for good. My pictures are on the forum ad you can se that my TE is pushed all the way over to my arm pit.. Also, my breasts are so far apart, I could fit my palm. I know that the ps knows about it because he always tries to push them closer together and he mentioned it but he never mentioned how he was going to fix that problem.My ps also specializes in hands and other cosmetic surgery so I'm hoping that breasts are his first passion.
DancinDiva: I hope you get good news on Tuesday.
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Howdid...There was a delay between my double mastectomy and immediate implants because my PS will NOT do immediate implants after a double mastectomy because he wants to see how the patient heals, to make sure she doesn't need radiation...and has no necrosis.
My immediate implants were put in 8 days after my double mastectomy.
No women has anything left after a double mastectomy. All breast tissue is removed in that process.
Am getting a lot of PM's from women who are second guessing their PS, and I agree that they should be second guessing. Get a second or third opinion. Yes, it's a good thing if your PS does a lot of breast recon. It's even better if they ONLY do breast recon. If you find a PS who does every kind of breast flap recon you can be sure they can do immediate implants (if you're a candidate) as well as very competent TE work.
I would NOT stay in my hometown if there were not a surgeon I felt would do excellent surgery during the double mastectomy or a PS who specializes in breast recon. My absolute belief is to find a PS who ONLY does breast reconstruction.
It's your life and your future and you deserve the best. Do research and go where you feel like you'll get the a great result.
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OceanSky: Good advice about PS second and third opinions. Sorry I wasn’t clear about having anything left as I didn’t keep my nipples or much skin because of the margins. Of course, I started small anyway…
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I am one that disagrees that you must find a PS that only does breast recon or no cosmetics (though I understand Ocean's POV). Do find someone with a lot of experience in breast recon, ask to see photos of results - ones that were ideal, ones less than ideal, find out about their training, including ongoing.
Things are a bit different up here in Canada, but very few PSs specialize in ONLY one thing. There are a couple who do a large proportion (but still not only) breast recon, but most I know have 1-2 year waiting lists for a first appointment alone, and then book surgeries a year out (lots end up with delayed recon as a result) and are in select provinces (so if you don't live in that province, provincial healthcare does not pay). However, there are also some PS who are well recognized for their skill and experience in breast recon who also do, say facial reconstruction and cosmetics. In no way do I think this means they can't be as wonderful as someone who does only breast recon, as they can cross skills over as well. It is important to recognize cosmetic augmentation also often involves advanced techniques - they may be very experienced in capsulorraphies, Alloderm use & repair, symmastia repair, and so on. Even cosmetic augmentation often demands more than simply placing an implant, it often also involves reconstruction of a different kind.
Also, quite frankly not everyone can easily travel away from home for surgery for a variety of reasons, including finances and support. I did travel a couple hours away, but I would not have been able to travel out of province (would not have been covered by my Provincial healthcare) or too far away as I wanted a PS nearby in event of complications or that I could easily see for follow up.
My PS does a lot of breast recon - including flaps and immediate implants. He has done many, many breast recon surgeries over the years and keeps up to date on training and techniques. He also does hand and facial reconstruction, and cosmetic surgery including breast augmentation. He is wonderfully talented, trained, and experienced and I chose him after meeting with him for a 2nd opinion. No regrets at all.
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In many cities across the U.S., it would be difficult to find a plastic surgeon who performs only reconstructive plastic surgery of the breast. I believe that the plastic surgeon (in the U.S.)MUST be board certified in "plastic surgery", and indeed also perform breast reconstruction as part of his or her practice. I have many plastic surgeons on my referral list who perform breast augmentation, as well as breast reconstruction.
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I agree that most cities do not have surgeons that do breast recon only. I mentioned in a previous post that my sister had a double mastectomy and her PS does cosmetic work. He put immediate implants in her and her breasts look spectacular. I was with her two days after her surgery and she had NO bruising and her breasts were not bandaged and they looked fabulous then! Crazy She got BC before me and I thought all recon would be like that...
My perspective is based on a few things. I've had a lot of surgeries prior to BC and have always traveled to Mayo in MN or the Brigham in Boston. I look for the best surgeon and go there.
Also, unlike my sister I don't heal well. I have immune and neurologic illness and it complicates surgery for me.
If you have had surgery before and you heal well, have no other health issues it helps. Although if your PS is not good at recon...It won't help at all. Ask for pictures, try and speak to others who've used that surgeon and I would recommend getting at least two opinions.
Also...(And I hear this a lot)... Don't choose a surgeon because you 'like' him/her. You're not trying to make a new friend. If the surgeon is arrogant...Don't discount him based on that. Don't let your emotions get the best of you when making your decision.
My point is that surgeons who do breast recon only are going to give excellent results. If a surgeon does breast recon every single time he/she does surgery they have far more experience as well as a very personal interest and dedication to breast recon.
And yes, I get it...Most people would have to travel to see one. Also, they too are not magical surgeons. If you have thin skin...They can't fix that. They simply work with what you have and make the best decisions based on your individual situation.
Divecat, in the US there is not a long wait to see a breast recon specialist. I know health care is different in Canada. Good and bad differences. There are two breast recon surgeons here in Orlando who are well known nationally and one can get an appointment without a problem.
Am just suggesting doing your homework and putting a lot of thought of thought and energy into this decision. Whippetmom keeps a list of doctors and is a good resource.
On a completely different note...Is there anyone else who is not able to tolerate Tamoxifen? Have had horrible neurologic side effects that aren't even on the side effect list. Am so determined to try and am taking 5 mg every other night (to try and build up) and still can't tolerate it. Without it my risk of BC coming back goes to 18%...About 1 in 5...A bad %. If anyone else has experienced this please PM me. I thought the surgeries would be the hard part...Turns out it's not being able to takeTamoxifen for me that's really scary.
Good luck choosing your PS...
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I respectfully agree with DiveCat & Whippetmom. For your own peace of mind - by all means go get a 2nd opinion but do your homework first so you'll know what questions to ask. Many of us just want to 'get the cancer out' & don't even think about questions until we already have TE's in place. Sure, if you can afford it, you can travel to an NCI designated cancer center. Also remember that your BS and your PS should be able to work well together & it helps if they also know the MO & all meet together in tumor boards to discuss your treatment plan. But - Good heavens, Whippetmom has been guiding people on these threads since 2008 and has seen & heard of every possible type of breast surgery & side effect & complication. I would take her recommendation for a PS w/o question unless our personalities happened to clash when I met him/her.
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I agree with Divecat re: PS doing Breast Reconstruction mainly - yet, keeps their hands in other things.I saw My P.S last week. My concern was that my implant looked flat post revision compared to the other mx. side. He said it will round out- it was b/c he revised the horizontal scar and performed a ryan flap. I don't see how it can round out to match the other side which has projection
However, when I look at my old pictures of my 2010 mx side- it seemed like the breast in the beginning was drooping quite a bit toward the arms (standing with my arms at my side)- Not sure- but today it doesn't droop at all towards the arm presently
Could it be because I do lift some weights at the gym (not a lot- maybe 20-30 pounds with machines). IDK. Anyway, I still have 2 months to wait for the new revision side. however, I will wait about 4- 5 to judge. So far- it hasn't dropped too much toward the floor - so far strattice is holding it. It took FIVE weeks for my implant to drop quite dramatically last revision. ONLY TIME WITH TELL.
I agree with Divecat. Not everyone has the money or the support to travel for surgery. I think you have to stay a couple of weeks for those fat transfers- don't you??? I don't have anyone that can take a week and a half off from work to travel with me. These NOLA places who everyone raves about should consider care givers for a reasonable price while people are down there having surgery. Truthfully, I would not be one bit scared having surgery without my family near me- it may even be nice...
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Divecat lives in Canada... A very different animal in terms of medical options than the U.S.
You don't have to travel to NOLA to have a PS who only does breast recon only!
If you play tennis do you want to play with someone who plays once a month or someone who plays every single day? It really is all about specializing imo.
I don't want someone who does face lifts, butt tucks and derma fills to do my breast reconstruction...But hey that's me!
Go where you want and do what you want...
Am suggesting getting the very best PS you can. That's all I'm suggesting. If you think you can get that with a general PS than do so. You may in fact get a good result. But with a breast recon expert I think the odds go up. Way up. I like to look at the odds of all circumstances and I also want to suggest to other women that they consider someone other than their closest neighborhood PS.
Talking to and listening to women trying to be 'the good patient' is disturbing. Too many are trying to be 'nice' and find a 'nice' PS and get a good result. Life doesn't work like that. Am just trying to encourage women to be proactive and be resourceful!
Bright Blessings...
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OceanSky - I believe in proactive & I believe in questions. Hooray for championing that. I understand about the differences in Canada, but I don't think that's the issue. I wish all women would take more interest in the process. When I joined these boards I read almost all of the previous posts on both this thread & the Exchange thread to find out what else I should be asking.
It's just that I went to the head of the PS department of a major hospital who does do other things besides breasts. 2-1/2 years later I have absolutely NO visible scars and the incisions were right across the midline of both breasts. I did not want flaps. Same incisions were re-opened to install 410 implants, which are great. The pockets he initially created were right on so I had no need for alloderm or stratice and I have no internal scar tissue either. Except for the fact that I have no nipples, you would never know that I had surgery - naked or dressed. He didn't always like my many questions, but I persevered because I knew I wanted the quality of work he could do. If you're good - you're good. I'm fortunate to have a reconstruction success story.
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In some cases I think an arrogant physician needs to be canned. If your physician is so arrogant that he can't see imperfections or gets irritated when you research and ask questions. I said SEE YOU LATER. One of my first PS- would get irritated with questions. They were extremely intelligent questions- not 20 useless questions due to worry. Obviously he was uncomfortable with patient keeping themself informed. Not saying this PS was a bad PS. However, you need to have a good repoire with your Doctor.... And, if he or she has a problem with that THEN I say they get CANNED.
My Old PS - b4 my nipple reconst. - he suggested fat grafting. Well, I didn't research it b4 he suggested it. I asked the possible complications and poss. Long term complications. This PS said there were NONE. I did a lit. search and it showed differently. ALSO I mentioned it to my BS and she mentioned possible necrosis. NOW this PS has a wonderful history of good breast reconstruction and is very well know. However, sometimes their heads get so inflated that you have to watch what comes out of their mouth.
IMO arrogance sometimes means insecurity.
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yeah maybe so stix. I am a deep thinker. Maybe arrogance ISO based in insecurity. Food for thought.
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stix - my PS does fat grafting, now you have me concerned.
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No recon method is perfect. There is always the possibility of a complication. Women who have had radiation may have an uphill climb. Ask questions of your PS. And then ask some more. Get second opinions. Be your own advocate. PS's need patients. All of their work is elective IMO. They omit downside often. Some are so invested in their patients but egos prevail. They need to fill their surgery slots. Ok. I'm off the soapbox...
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Re: arrogant surgeons - my first BS is extremely renowned in the field and was highly recommended to me by a number of different people, including other doctors. I knew he could do a great job on my surgery so I kept trying to work with him, but he was such a poor communicator and so dismissive of my questions and concerns that I came out of every appointment near tears with frustration and anger. Eventually I decided that all those unhappy emotions were going to have a negative impact on my recovery and prognosis, and I switched to another surgeon who made me feel respected, empowered, and optimistic. I don't think its a coincidence that two weeks post surgery, my PS says shes never had a patient recover better. I believe that how your doctors make you feel matters
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