BREAST IMPLANT SIZING 101
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I still have really good projection from my nips being rebuilt. I told my PS that I didn't want too much projection but enough to make it worth my money to get it done. I still love mine and am glad I went through with mine. My tattoos look really good too, again I told my tattooist what I wanted. I even had pictures of friends that have had recon/tattoos on what I did and didn't want. And got exactly what I asked for.
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Chrisrenee77 - I'm going to pm you.
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Kingster, I'm going to have nipple/areola reconstruction on May 4th. My PS said all have done well, so I am going for it. Hope there are some positive outcomes out there!
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Please keep me updated. I have a big decision to make:)
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Through reflection of this process. The biggest decision is placing the nipples. Please make sure you know where you want them b4 your PS places them. Look in the mirror from the side and the front. Maybe use circular bandaids or fake nipples. I have seen way too many mis-placed nipples on different forums... it takes away from good reconstruction
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I'm a uni and my PS drew on my lat flap boob where he is going to place the nipple/areola and I looked in the mirror, the markings stayed on a few days. He said my nipple will be maybe 1/2 cm above where the nipple is on the right boob. He has to go slightly above my big mastectomy scar and get on to the lat flap. The placement looked great and my hubby thought so too. I love my PS and I'm lucky that everyone surrounding him loves him too. phew...lol
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Good afternoon ladies,I have been perusing this board since my bilateral mastectomy with immediate expanders placed, which occurred February 12 th. I have been to my PS office for two fills already for what they say is 150 cc's to date. I have the natrelle 133SV-11 tissue expanders with a 200 cc fill limit suggestion ( PS says we can go a bit beyond this). I am almost 100 pounds and am 5'4" tall with a 28 inch chest measurement below my breast line. Before surgery I was barely an A cup but would really like to be more full after this ordeal. I am hoping someone can help me with deciding what implant size would look good.
My first trip to the PS office was rushed and I admit I was panicked and all I really wanted at the time was to get rid of my breasts ( both turned out to be affected - a fact revealed only after pathology on the "healthy" breast came back!!) . So I just went along with what my PS wanted. But now I am concerned that I will still be tiny- breasted and disappointed after all this ( sounds rude and vain but I really am very grateful for the process). My PS said I measured 10 cms on one side and 10.5 cms on the other but the smallest expanders were 11 cms. I am a runner and am active, something I told my PS. Did this influence his decision on the TE size?
Anyway, thanks for reading and for any possible input you may have to offer! Much appreciated! These boards certainly are wonderful!
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zukicat - send a PM to whippetmom. She is the implant whisperer and is a godsend to all of us. Good luck!!
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thank you! I just sent her a message!
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ZukiCat:
Your TEs have a width of 11.0 cm and projection of 4.7 cm. I would recommend the following implants:
Sientra Smooth Round High Profile - 315 ccs. Width 11.1 cm, projection is 4.2 cm.
Allergan Style 20 - 300 ccs - Width 10.9 cm, projection is 4.5 cm
Allergan Style 20 - 325 ccs - Width 11.2 cm, projection is 4.6 cm
I would not recommend anatomical implants, since you are a runner. I know the arm movements you need to make and anatomicals have a risk of rotation and typically it is implant displacement during exercising that can be culprit for a rotated anatomical.
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Deborah,
I thought you might find this interesting, not sure if you knew, but it will add some more options to some women in US whose PSs use them. These are what I had until my recent exchange. They are used quite often in Canada, from what I have seen.
News release from Allergan website dated February 27, 2015:
http://agn.client.shareholder.com/releasedetail.cf...
FDA Approves Allergan's NATRELLE INSPIRA™ Round Gel-Filled Breast Implants
NATRELLE INSPIRA™ Represents Company's Latest Innovation in Breast Implants
Provides New Implant Option for Surgeons and Patients Seeking Reconstruction, Augmentation or Revision Surgery
IRVINE, Calif.--(BUSINESS WIRE)-- Allergan, Inc. (NYSE: AGN) today announced that the company has received approval from the U.S. Food and Drug Administration (FDA) to market NATRELLE INSPIRA™ round gel-filled smooth breast implants. The NATRELLE INSPIRA™ line is different from other available breast implant styles as it has a higher fill ratio that provides an additional breast shaping option for women undergoing reconstruction, augmentation or revision surgery.
"The FDA approval of NATRELLE INSPIRA™ round gel-filled implants exemplifies our commitment to scientific innovation and to meeting the dynamic needs of plastic surgeons and their patients," said Scott Whitcup, M.D., Executive Vice President, Research and Development, Chief Scientific Officer, Allergan. "In the past two years, Allergan has received FDA approval for three new and important breast implant options which represent the latest advancements in Allergan's growing product portfolio."
The FDA approval of NATRELLE INSPIRA™ round gel-filled smooth breast implants marks the most recent addition to the broad portfolio of currently available NATRELLE® products, which include the NATRELLE® 410 anatomically shaped implants, classic round gel implants and saline implants. Allergan's NATRELLE® breast implants offer the largest number of round gel breast implants with 243 size options and a variety of projection styles. The comprehensive NATRELLE® product line enables plastic surgeons to provide a tailored fit based on a patient's desired look and her individual size and dimensions.
"The FDA approval of NATRELLE INSPIRA™ breast implants heralds a major advancement in the art and science of aesthetic and reconstructive breast implant surgery in the United States," said Mark Jewell M.D., founder of The Jewell District Medical Spa and Plastic Surgery Center and former president of the American Society for Aesthetic Plastic Surgery (ASAPS). "The NATRELLE INSPIRA™ breast implants provide women seeking breast augmentation the option of fullness in breast shaping that can become lost after pregnancy. Additionally, this implant will provide a great revision option to the millions of women in America who have aging saline or silicone breast implants."
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It is now 16 months since I had my T/E exchange. I had a mx on right side and the exchange was an Allergan 410 FX (410 g) and I had an augmentation on the left with an Allergan 410 (170 g). I thought I was doing the right thing and did see my PS not long before the exchange and went over the options again. Can't remember what he was planning but we decided on the Allergan. I am not very happy with it and find it hard and cold~~yes I was told by others that they are hard and cold. I guess I did not expect it to be as hard and added to that is the fact that radiation did me no favours and my PS pretty much says that the axillary area is hard due to the radiation. I have cording which neither PS or MO mentioned though I noticed on the MO report I picked up last week, she mentioned cording. Luckily my PT picked up on on it and is working on it. But I see the PS in May and am thinking that I want to suggest an implant change. Any comments or suggestions?
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divecat - thanks for the info. I'll ask about it when I finally go in for revisin consults. Maybe, these will be the ones that don't ripple....lol. I know. I doub it, but a girl can hope can't she??mariennelizabeth - the coldness of the implant is unfortunately nothing you can do about becaue of thin skin. I had the round smooth and they felt cold and clammy and I hated them too. I had a revision due to severe rippling and got the anatomical implants that are textured and I don't have that coldness anymore, however my rippling persists. My PS coded the surgery for assymetrical reasons in order to have it approved by insurance. I'm not sure how insurance works in BC but here insurance won't pay for an exchange just because you don't like them. There needs to be a medical reason behind it. Good luck!!
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mjh1, thanks. I am not sure whether the insurance here would pay for an exchange either. I know someone who did have hers exchanged and same PS office and I have an email in for her. When I saw my PS in Nov. he did say we could do a latissimus dorsi, leave it as is, remove it but we never really talked about changing it out. No way I will do a lat dorsi though~~enough invasive surgery already!
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Hello ladies. I've just discovered this site - what a GREAT resource! Thanks so much.
whippetmom - I'm looking for some of your excellent advice, if I may. My story ... I'm in the UK, and was diagnosed with BC last May. I had surgery in June - a unilateral skin-sparing mastectomy on the left, with immediate reconstruction using an expander-implant (I think it was one of those "Becker" style ones - but I'm not sure as my BS was not communicative). The recon was sadly a bit of a mess - too small, and ridiculously high. I was referred to a good plastic surgeon in October, and had the implant replaced last month, for another expander-implant. It's a huge improvement, and I have every faith in my PS, but now I'm at the "fill" stage I want to do all I can to make sure I'm not disappointed at the end of this long process.
Basically I would really like to be bigger - before the mastectomy I wore a 34A bra, and it's actually only in the last ten years or so with a bit of "middle-aged spread" that I've even been able to fill out an A cup. I've always wondered what it would be like to have larger breasts. My PS has agreed to augment my "good" side to achieve symmetry, so in principle I should be able to get something I'm happy with. But I'm wondering if his idea of "augment" and mine are the same. I'd really like to go up to a C cup if it's possible (and keep in mind, it's a unilateral mastectomy that I had). I know bra sizes are an unreliable measure - so I'm hoping you can point me towards implant volumes to suggest to him?
My measurements - I'm 5'5", 132 pounds, with a ribcage measurement of 31". I don't have the exact details of my expander-implant I'm afraid. I know it's Allergan, with a fill volume of 400ml (I think mls and ccs are the same?), with a base width of 12cm, and it's a teardrop shape. It has a port that sits under my arm, and I know if I'm happy with it at the end of the fills my PS can just remove the port and leave it as the permanent implant. He's said though he'd like to replace it with a silicon one when the expansion's complete, and I'm happy with that. It was filled to 200ml during surgery, and I've had one fill of 40ml since then. My PS seems very keen on the teardrop shaped implants - and I must say the one I have now is a far better shape for me than the round one I had originally.
So ... if I want to go up to a C cup I'm thinking the 400 ml expander-implant I have isn't going to be big enough. Is that right? Do you know if PSs can overfill teardrop expanders? If they can't, can they replace them with larger teardrop shaped implants? And to achieve what I'm looking for, what sort of volume do you think I should be looking at in the permanent implant? So many questions! Happy to PM you a photo if that helps at all ...
Thanks again. So pleased I found this place!
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There should not be any issue getting a replacement covered by provincial healthcare as a post-MX patient, your PS ought to know how to code it properly. I am in Alberta, and had no issues, and have known several women across Canada have swaps for issues that were related to cosmetic or other non-"medically necessary" issues. While I had some rippling on right side I wanted to correct, it was not a medically necessary exchange, nor was there anything objectively or medically wrong with my previous implants. I had great symmetry. I did not have to do anything except sign the consent to surgery form and show up at the hospital. Replacement as a post-MX patient - be it for size, a different style implant (like 410s to rounds of you want a slightly softer implant), shape,or cosmetic issues - really should not be an issue up here - it's not quite like the U.S. with insurance company approvals.
As for implants being cold...that is going to be a result of your thin tissues over a silicone implant, and I am afraid you can't rely on an implant change to necessarily fix that. Despite being thin and having pretty thin tissues myself after MX, I have not personally had an issue with my implants being cold (either rounds or the anatomicals) - and I am one of those people who is generally always cold and will be in long sleeves and sweaters in the middle of July - so I also do think this varies person to person. Apparently saline warms up in the body more, but there are trade offs and they generally are not preferred in reconstruction.
A lat flap would provide some added tissue coverage to warm things up, at least on bottom but again as you are aware that is another invasive and extensive surgery and recovery. Fat grafting may help, but that is used, at least in Alberta, more for improving rippling and such, not "warmth" and generally the amount they transfer is pretty minimal. However, fat grafting has been shown to improve outcomes of implant recon in radiated breasts so you might want to discuss that with your PS.
One thing to also keep in mind is the risks of going back in for surgery again on a radiated breast, you may increase risk of some of the complications that ready are higher with radiated breasts. That is not to say you should not have surgery if you feel it is right for you, just be cautious and be very sure of what you want to do and of possible results
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Divecat.....thank you!!! I am thrilled....have not been receiving FDA updates for some reason. I have been hoping these would be available here soon! W
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marianeliz.....
marianeliz.....I agree with everything Divecat says above, especially this: "However, fat grafting has been shown to improve outcomes of implant recon in radiated breasts so you might want to discuss that with your PS." That is the first and only thing I would try at this point. Frankly, FGT will change the integrity of the previously irradiated skin, soften up the capsule...so many benefits with radiated breasts. Please see two threads on this issue. Many women have extolled the benefits of FGT and I am one of them. It might be that you will then be much happier with the feel and appearance of your implants.https://community.breastcancer.org/forum/70/topic/744891?page=1
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greenleaf: You are probably going to want to exchange out to silicone implants. We do not have an Allergan expandable permanent implant in the U.S.....the Mentor Spectrum/Becker is the only one in that category. Well, there are a couple of others, but I don't see the used here.
In the UK you have a myriad of different implant options - far more than we have here in the U.S. For instance, in Allergan, you have the TruForm implants, which come in anatomical and rounds, with four different gel options from soft to firm. You have the Inspira implants (recently FDA approved here, as Divecat mentioned above) and you have the Allergan 410 implants, anatomicals, which come in two different gel options - soft and firmer in texture/feel. We only have the firmer option here in the U.S. You also have Silimed implants (called Sientra here in the U.S.) which have shaped and round versions.
I think you will be in the 450 cc to 500 cc range with implants (although some are calculated in grams, not cubic centimeters, but they are essentially the same) ideally, whichever way you go. If you have the equivalent of our Allergan MX style TE, it has a width of 12 cm and projection of 6.3 cm. So you want to try to match and slightly exceed those dimensions with an anatomical implant, in order to get a nice snug fit. Anatomicals have the risk of rotating in the pocket and so a precise and snug, not overly expanded pocket, is essential. The TE can be overfilled, but the size of the anatomical, if an anatomical is used, will need to be sized up accordingly. It is not so crucial with the rounds, although an implant that is at least 12.0 cm in width is important, no matter which is chosen. I personally you could use 13.0 cm in width easily. So discuss all of these options with your PS and see what HE proposes, and then come back and we can discuss further.
Deborah
ADDED: If your TE equates to a MX style at 12.0 cm and 6.3 cm, as mentioned above, the corresponding TE in the U.S. would be a 370 gm Allergan 410 MX....maybe a 410 gm with overexpansion of the TE. With silicone rounds, you could easily go to 500 ccs in a HP style implant. I do not have the UK implant mfr links available though.
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INSPIRA IMPLANTS.....
I love the dimensions of these Inspira ultra full projection style implants. I have Allergan Style 20, 550 ccs,with a width of 13.5 cm and a projecton of 5.6 cm. I do not need or desire wider implants or greater volume, but I have felt that an implant with greater projection would help fill out the pocket and give me a better result.If I went with an ultra full projection in the Allergan or Mentor, I would have had to move up to a 700 cc implant, which is not what I want to do. So Inspira gives me a 560 gm implant with a width of 13.5 and projection of 6.3 cm. Voila! It is perfect! I am not going to do this anytime soon....years down the road hopefully....but I can see where this will be a very good option for reconstruction and for implant revision purposes.
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Oops...those were textured Inspiras. I would want the smooth....550 ccs. Possibly 600 ccs....
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Hi whippetmom - THANK YOU! How do you know all this stuff?!
This is very helpful - I had no idea we had so many more implants to choose from in the UK than the US. It's great to be armed with this knowledge. I'm being treated on our National Health Service - which is fantastic - but rather overstretched, meaning you must be VERY clear and direct with what you need and want from medical stuff. Otherwise you get what you're given! So thanks again for helping out. Will speak to my PS the week after next and let you know what we decide.
All the best from lovely London.
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Whippetmom,
I have been lurking on these boards since i was diagnosed (ILC Stage 2a) and now find myself looking for some help information - your posts here are great! I had BMX Sept 2014 with TE - allegran/Naturelle 133 SX-15-T. Quick summary: I was filled to roughly 390cc (that is all I wanted, i am 51 y.o. and a B cup was all I wanted) then had 25 rounds of radiation to right breast and nodes. Had 3 months to recover and then had exchange 5 weeks ago. My PS used Naturelle 410 FF 535cc implants. I made the assumption that if I was expanded to 390 cc, then the implant would be the same size. I knew that he would not over-expand because the 410's are teardropshaped and need a snug fit. But I was stunned/shocked to realize the disparity in sizes for the TE vs implants. I am so upset with myself for not doing the research beforehand. At my one week follow up, I was still in shock, still assuming PS knows best. He said they need time to settle. The radiated side is very uncomfortable, i really don't think the pocket was large enough to accommodate the implant. It is pushed up under my armpit to some extent, but the left side not so much, leaving me more assymmetrical than I was prior to exchange. I will see him next week - also seeing another PS for a second opionion, but in the meantime, I am curious what you know about exchanging a larger implant, especially when there has been radiation. I have read the manufacturer's literature - for physicians - it mentions the need for a snug fit but doesn't mention anything about exchanging an implant that is nearly 40% larger than the expansion!
I am also curious to know from you or others about asymmetry: Prior to the exchange, I was assymmetrical with the TE, but I assumed he would fix it [again, kicking myself for not asking all the right quesitons beforehand..let that be a lesson to women out there reading this!] I read that during surgery, they should move the patient into a sitting position to check the symmetry. I am going to ask him if he did this..but wondering if other women know whether or not this was done to them during surgery.
thank you for reading and hoping to get some feedback. thanks
jojo
ps: after looking though some previous posts, thought I should add my dimensions I am 5'6" 145 lbs. not sure of actual breast sizes, but I measure 33 inches around at breast fold.
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Hi Jojo,
So sorry you a disappointed with your results. I had my exchange surgery yesterday and my husband was told that they sat me up multiple times to determine the best implants. I was filled to 500cc in my expanders and I received 595cc gummy bear implants. All I can say is that I look so much smaller now. The implants are completely flat. Makes me me want to cry. My expanders were also a little crooked but looked so much better. I know it's really early still so I will try not to look for awhile!
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Hi jojo -
Same here; I was not prepared for just how small and flat they would be. I am seven weeks post op and told it takes time to 'settle'. We'll see.
I had nsbmx with direct anatomical gummy implants. I wanted low C, high B, but there much smaller (to me).
Does anyone know if direct to implant can be changed out for an increase in cup size?
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Hi CaliRN and Jilly
Thanks for the response. The number of tears we have all shed! You do need to wait for things to settle. I found that I was larger after getting the implants than with the TE - makes sense since the implants were so much larger. Did you PS discuss the sizing with you? (500cc --> 595cc)? You said that your TE were also a little crooked - can you tell if you are symmetrical now?
FYI: I read some literature on the Allergan website that the Naturelle 410's when used for augmentation - women reported their cup size increasing overtime. There was no such mention of this for women undergoing breast reconstruction. This is an excerpt:
"For Primary Augmentation patients, 469 (95%) of the original 492 patients had a breast
measurement within 18 months of surgery. Of these 469 patients, 38% increased by 1 cup
size, 53.5% increased by 2 cup sizes, 5.7% increased by more than 2 cup sizes, and 2.8% had
no increase or decrease due to correction of congenital asymmetry or change in shape without
change in size."
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Jojo- I really haven't taken a good look at my new boobs. I'm to scared! Looking down my shirt my right nipple is not really in the right place it's kind of pointing to the right which is how it was with TE's. My PS said if it was still off after the exchange he could possibly fix it in his office. As far as the expansion went I was told to fill until I liked the projection then the PS would use larger implants to match the size of the TE's. Thanks for the info on increasing cup size. I'm sure after my muscles relax the implants won't look so flat.
Jilly- the first PS I went to wanted to do direct to implant and if I wasn't happy with the size we could change it out later with a larger size. So it's possible that you could do that.
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Hi Whippetmom!
I have my second follow up on April 7 with the PS and I will ask him as well but was wondering what your opinion is on this:
I got the implants, recovery was rougher than I anticipated! The part I am happy with is that I now look normal in a bra - my radiated breast was half the size of my healthy breast.
Question: I originally wanted FG but could not get it approved thru insurance. Although my breasts now look normal in a bra, I still have the same shape in the BC breast - sort of like the bottom was cut off. The radiated tissue is also hard. Do you think if I did some FG to the underneath (bottom part) of my breast it might fill it in so it doesn't quite look chopped off like that? I know I would need to save $$$$ to have it done but was wondering what you and/or others think. I do not believe that I would need a lot of FG done.
I also think I should probably not think about doing anything else for 3-6 months so see how it might finally settle - I only had surgery on Feb 24.
What do you think?
THANK YOU!
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jilly59,
It is all going to depend on your tissues and the dimension of the desired implant. What it sounds like you want is actually increased projection, that is not necessarily an increase in cup size or even necessarily a much larger implant and may be achievable without expansion; you can't go by cup size as a wider implant will mean an increase in cup size due to ending wider wires, but you may still have the same or less projection than you have now.
I had direct to implant and recently exchanged to implants with slightly larger dimensions in width (1cm) and projection (0.3cm). I did not want to go bigger, but it was to try and fill pocket for a tight fit as I moved to anatomicals. Still, that will mean going up a cup to a 30F to fit the wider implant now! Really, at this point an exchange is not any different than it would be for someone who had had once TE's and is replacing their implants and wants to go bigger, it all depends on your tissues and dimensions.
Still, give them time. It is still early!
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As always, thanks DiveCat!
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