BREAST IMPLANT SIZING 101
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buyo: It does not work to measure your TEs in this manner. Ask your PS' office to give you the data on your TEs - the manufacturer, style and volume. But I think, based on your stated vital statistics, implants with a volume of 650 ccs or 700 ccs would be just right for youv- high profile style implants. This all depends on the style of TEs. You might have 500 cc TEs which are overfilled to 600 ccs and you might require less implant volume - say, 600 ccs. So the key is to get the exact TE info and get back to me and we can nail this down a little better for you.
Deborah
Edited to add: Moderate plus profile implants have a wider base width and less projection. High profile implants have a narrower base width and greater projection.
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Thanks Whippetmom! I'll get the info on Monday.
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whippetmom,
With my DMX on Sept. 23rd the PS will reconstruct w/implants at the same time, no need for TE since I'm going smaller. He was guessing on the sizing though? My currently cosmetic implants are (if I remember correctly 345cc?) which makes me about a large D or DD, I now want to be a C. He said he will probably put back in the same size implants since the BS will be removing all my tissue? Does that sound right? I do have an appt. w/him to go over questions before my surgery so will he just have several implants "on hand" during surgery? I'm wondering how that works. They will be saving my nipples so I'm thrilled with that! Thank you for all of your help on all the boards! Robyn
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Robyn: Refresh my memory again - your height, weight, ribcage?
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I h
This is for Whippetmom
I had my new expander put in on Friday August 13th
I had 120 cc put in. It looks very flat at this time, but if all is well, I plan to start with fills on Sept.1st. I am now wondering what implant size I would need to match the other side, since my PS says he only uses Mentor. I have Natrelle style #20 with 475cc's. They are silicone. If he cannot use the same kind as my right side, what would match in the Mentor?.Thanks for your input..
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Deborah, You are amazing, Thank you so much for your help... I never had radiation and the BS said that if I remove both breasts I will not need radiation... I'm young, no kids, and I think my breast skin is in good shape and I do have a lot of it, the PS even said he will have to trim some of the skin off.... now I'm worried he will take too much skin off... the surgery is on Wednesday and I'm so stressed because of it I can't sleep at night
I will call on Monday and ask again what size implant he is going to put in and if he overfill them... and, what if they say the PS said 400cc and thats it, he already explained that he decided on implant size by my chest size, ribcage... how do I then say I think you can make me bigger without sounding rude...? like telling him how to do his job... I'm shy, I know its lame but I have a problem with insisting on what I really want... how do I say it in a nice way without sounding rude... please help... and, one more question, since you are close to my size, may I ask what size bra does the 550cc makes you? Thank you so much 
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joie: Mentor now has a 475 cc high profile implant. The dimensions are close enough - a few millimeters difference - to the extent you will not notice.0
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venus: I think you can tell him that you have done some research and that this is the volume of implant you feel you will be most happy with. Tell him that you know that it takes more volume to get a good mound on the breast after MX and that you will not be happy with only 400 ccs.
You do want some skin excised - it is like having a mastopexy - because if you don't have some skin taken, you will end up with too much droop. You want them nice and perky again, right?
I am a 34 DD cup, but I look like a 34C in clothing. It is entirely different and not easy to explain, but there is no spillage over in the cups as with the natural breast or augmentation. I fill the DD cup because of the width. I have far less projection than I would have if they were natural or augmented. It is so difficult to achieve projection with the reconstructed breast, and so we need the extra volume and width to fill out a bra properly and give the illusion of projection.
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Deborah, your knowledge continues to amaze me. Even though I have had my exchange, I continue to learn so much from you here and all the sharing gives me a better understanding in knowing I am not alone. Thank you!
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Oh great, Thanks much for the info. One more question: Would you happen to know the style # of the Mentor implant in the high profile smooth 475cc. Thanks again for all your help
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Hello Deborah, I was wondering if you might have a second to go to the photo forum and check out my new photos. I posted a question in there to you also regarding size of implants. Thank you so much for all your sharing of knowledge!!
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joie: Print this out and take it to your PS, because the 475 cc is a new volume implant for Mentor....it might be something he needs to order and it might not be readily available..
Smooth Round Gel High Profile
Sizing Chart8.3 cm 3.5 cm 8.8 cm 9 350-2004 BC 200 cc 9.7 cm 4.0 cm 350-2254 BC 225 cc 10.1 cm 4.2 cm 350-2504 BC 250 cc 10.5 cm 4.3 cm 350-2754 BC 275 cc 10.8 cm 4.4 cm 350-3004 BC 300 cc 11.1 cm 4.5 cm 350-3254 BC 325 cc 11.4 cm 4.6 cm 350-3504 BC 350 cc 11.7 cm 4.8 cm 350-3754 BC 375 cc 12.0 cm 4.8 cm 350-4004 BC 400 cc 12.2 cm 5.0 cm 350-4254 BC 425 cc 12.5 cm 5.0 cm 350-4504 BC 450 cc 12.8 cm 5.1 cm 350-4754 BC 475 cc 13.0 cm 5.3 cm 350-5004 BC 500 cc 13.2 cm 5.3 cm 350-5504 BC 550 cc 13.6 cm 5.5 cm 350-6004 BC 600 cc 14.0 cm 5.6 cm 350-6504 BC 650 cc 14.4 cm 5.7 cm 350-7004 BC 700 cc 14.8 cm 5.8 cm 750 cc 15.2 cm 59 cm 800 cc 15.5 6.0 cm 0 -
Whoa...that did not come out right. So joie, click on this link, scroll down to the smooth round high profile style, click the sizing link and then a new window will pop up with the catalog numbers and sizes. I would print out that sizing page and take it to your PS to make sure he knows the 475 is available. His catalog probably does not have this updated size, which was brought out as it is a popular size for Allergan.
http://www.mentorcorp.com/breastsurgery/reconstruction/silicon-gel-breast-implants.htm
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Venus: Check your private messages - I PM'd you....
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Misty: Going there right now...check over there for my comments...
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Thanks mucho for the info. I will bring to my surgeon. It seems there is a slight difference in the diameter in the 475's between the Mentor and the Natrelle. , but noy significant. Thanks again.
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Deborah, I called and they said the TE I have is the the Allergan 400 cc Integrated TE. Does that sound more right? The PS is planning on taking Mentor Mod. plus 450 and 500 into surgery. This was in his notes, but he did not tell me that. I like him, and know he does very good work. I was spoiled I think with my BS who explained everything very fully to me. I asked to have the nurse email me to answer questions on what he plans to do for the asymmetry. I agree with you that I don't need to be any wider. I really like the width I have. (My ribcage is 31 not 29...I messed up the first measurement) I think it gives me good cleavage and still does not interfere with my arms at the side (does that make sense?)
The volume I have right now is good too. It is funny though that the longer I have them the smaller they seem to me? I wanted to make sure also that you thought I looked proportionate as far as volume? I can't get a straight answer from my hubby....I think he does not want to influence me. If I come out having both of them look like my left side I think that would be good. Thanks Thanks Thanks! Misty
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Fat Grafting in Postmastectomy Breast Reconstruction with Expanders and Prostheses in Patients Who Have Received Radiotherapy: Formation of New Subcutaneous Tissue
Serra-Renom, Jose Maria M.D., Ph.D.; Muñoz-Olmo, Juan Luis M.D.; Serra-Mestre, Jose Maria M.D.
Abstract
Background: In secondary mammary reconstruction in irradiated patients, the use of expanders and prostheses is controversial, given that radiotherapy increases tissue fibrosis and capsular contracture. The authors assessed the usefulness of tissue expansion, prostheses, and fat grafting in patients who had received radiotherapy.
Methods: The authors conducted a study of 65 mastectomized patients (age range, 34 to 62 years) who had received radiotherapy with a 6-MeV electron accelerator. In the first operation, they inserted the Natrelle 133-MV expander (Allergan, Inc., Irvine, Calif.) endoscopically under the pectoralis major at the end of the mastectomy scar and performed total immediate expansion. The authors injected a mean quantity of 150 ± 25 cc of fat in the upper quadrants between the skin and the muscle and also inside the muscle. After 3 months, they removed the expander through the same incision, inserted the McGhan Style 410 cohesive silicone prosthesis, and injected a mean 150 ± 30 cc of fat in the lower quadrants. In the third stage, the nipple-areola complex was reconstructed.
Results: Mean follow-up was 1 year, with controls after 1 week, 1 month, 3 months, and 12 months. No complications were recorded with the fat injections. Patients' mean satisfaction rating was 4 on a scale of 1 (low) to 5 (high), and the capsular contracture was never above 1 on the Baker classification.
Conclusion: In mastectomized patients who received radiotherapy, fat grafting in addition to traditional tissue expander and implant breast reconstruction achieves better reconstructive outcomes with the creation of new subcutaneous tissue, accompanied by improved skin quality of the reconstructed breast without capsular contracture.
©2010American Society of Plastic Surgeons
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Interesting MBJ -- I'm sure that will be useful information for those who have had radiation.
FYI -- McGhan 410 is the same as Allergan 410 (for some reason McGhan, Allergan and Inamed are all the same company and I have seen each name frequently associated with what is, to most, the Allergan 410 -- could be that Allergan bought the others out? I'm not sure). In any case, the 410 under any name is the gummy; so they used the gummy in this study.
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Lilah: I have a file on my computer with all of my photos and supplements and anything to do with cancer, including things that I saved for later in case I would need the information later. I had saved this back when I though I was going to have to have radiation. I hope that it helps other women here who have had radiation.
I reall wish someone would get on board with approving the gummies for all!
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It will come Mary -- I think the so called trial (though they've been widely available in Canada and Europe for 10 years now) is close to the end.
I think I have seen that link posted before (by Whippetmom?) but it's worth seeing it again
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Misty: Okay, with a 31 inch ribcage, the 450/500 cc MMP sounds fine. However, the TE info they gave you was lazy, lazy lazy! Is it a 133FV, MV, MX, SX or LV? The key question to ask: WHAT IS THE WIDTH OF THE TE? IS IT 12 CM WIDE OR 13 CM WIDE? The LV is 15 cm wide, so I am pretty much excluding that, but you can see that they did not give you the complete information you requested. So your PS uses Allergan TEs but Mentor implants?
I think you could also use a 475 cc or 500 cc high profile implant and it would look just fine and would not be quite as wide on your ribcage. But your PS sounds as though he is not going to budge off of his MPPs.
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Whippetmom-I am reading what you have been writing about width and projection. You have also helped me out personally. I have an appt with my PS this week. I wondering how much input do we really have with our PS. I mean when we go to them and say can I be this size and width do they really listen or does it boil down to what they think will fit best. Also don't we have to trust that they really should know what they are doing when picking out sizes for us? I'm just feeling confused that I have to tell him what size to put in me when in reality I'm not really sure what I'm talking about. I am going to ask him about the sizes you recommended but I am feeling under expanded at only 400cc's and he said he doesn't like to over expand too much. I know I need more width because of the wide gap and some lateral work to address it as well, but I'm not sure if by going wider I will sacrifice projection.
one more question-does over expanding make your skin thinner? Are ripples just part of reconstructed breasts, I hear ladies who got gummies or reg silicone say they have ripples so it seems like no matter what kind you get ripples seem to be an issue.
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sweetie - what I did with the information that whippetmom gave me was listen, a lot. She recommended how far I should go with my fills. And as the fills went along and we got closer to that recommendation, I asked if we could go there. It wasn't possible because my skin was too thin. I wasn't pushy, I just waited until the proper came to ask those questions. When we discussed the implants, I asked what size was he thinking and he told me. It was smaller than whippetmom's recommendations and I asked if it was possible to go a little bigger and he said he would try. I was never pushy, I only asked the questions that I did understand. And he appreciated it. I came in with a list of 12 questions one day and he sat with me and went over every one. At the end he said, "Good questions." Ha. Little did he know that I'd done my homework!
I don't know how everyone else does it, but that is how I handled it. Hope it helps.
Good luck,
dh
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I think the issue with ripples tends to happen with thin skin. I have no ripples but I have, shall we say, thick skin
Maybe it's my being a little overweight, but I'm not sure, as some thin women also have no issue with rippling (and some heavy women as well). So it comes down to how thick your skin is to begin with whether you will have issues with rippling (or so it seems to me).0 -
Hi Sweetie~ This is just my opinion but I asked TONS of questions of my oncologist (and breast surgeon) so I figured that my experience with recon wouldn't be any different. BC patients are positively inundated with data and opinions on how to handle chemo and radiation. There is also a wealth of information about lumpectomy vs mastectomy and I know I discussed my options at length with my breast surgeon... But, when it comes to recon... there's a whole lotta nuttin' out there. I think that asking questions SHOULD BE the norm for any medical procedure. But, for some reason, PS's tend to be tight-lipped. I just don't get it... I interviewed several PS's before choosing mine. I like mine because he *will* discuss things with me. For example, a couple visits ago, he and I discussed the width of my TE's and what I would like as far as width for the implants. He definitely has the final say... he can only do what he can do with the tissue he has. But, I want him to know what the best case scenario would be in my mind before he makes any decisions... With all of that said, I think that it is important to realize that your (my) PS *is* the expert and that they went to school for a long, long time to learn their art/craft. I always phrase my questions such that I am respectful and I certainly don't argue. For instance my conversation with him about TE width went something like this:
Me: "I'm finding the width of these TE's to be a bit uncomfortable. Will the implants be more narrow?"
PS: "Yes. I can choose ones that are more narrow."
Me: "Do you mean 'high profile' because I read somewhere that HP can be a good option for those of us who are thin."
PS: "Yes. Allergan has a HP that I like. I usually choose MP or HP depending on the patient. But, if this width is bugging you, I'll definitely go for Allergan 20's."
Me: "Would the final volume change from what we discussed previously?"
PS: "Not really, but based on your skin I think we should back off to 350 or 375 cc."
Me: "I'd like to shoot for 375 cc if we can. I don't want to lose projection."
What he didn't know was that I had already talked to Deborah and she and I were thinking 375-400cc. She and I had ALREADY talked about Allergan 20's and I had ALREADY looked at the dimensions of the implant. Soooo... I had done my homework and felt comfortable asking the questions I asked and was happy with the answers he provided.
Does that help?
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MBJ: I have shared that same data on a now defunct thread - and have the link above in my header post. I wish someone would come along whose PS is willing to try this, because I think it sounds fantastic and could lend such promise to women who have had radiation - if only to significantly reduce the risk of capsular contracture. It is not some new study either - so why we are not seeing it done is perplexing to me. This would pertain though to women who are having delayed reconstruction - rads first and recon at some later point down the road.
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Sweetie: Your questions have been answered quite well above. I think everyone has a way of approaching their PS, but we have every reason and RIGHT to tell them what we hope to achieve and to ask them if they would be able to do this for us. I mean, the question..."I am really feeling that 400 ccs is just not quite enough for me, and I know I would feel better if we could expand a bit further. Is it possible to do so?" Then your PS, who HOPEFULLY wants to please his patient, while working within the confines of your skin flaps, can tell you whether this is feasible. Better to let your desires be made known NOW, rather than after the exchange. My skin is pretty darn thin and my PS preferred to keep me under 450 ccs. But I asked if she could continue fills, skin permitting, and she agreed. My skin did just fine. I made it very clear that I hoped for an "augmentation" out of this train wreck of cancer. My pre-op paperwork states, "Reconstruction/augmentation following bilateral mastectomies." I have 550 ccs.
Deborah
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All your input is very helpful..all of you..My problem now is with the expander on one side and a great looking breast on the other side, I am worried that he won't be able to make it look as good as it did before. My implant had to be removed because of infection.I gave him the measurement of the expander I wanted which was 133MX 400 with a width of 12.0 and a projection of 6.3. This was a Natrelle #. He said he doesn't use the Natrelle, but could possibly find a similar measurement in the Mentor. Well, surgery is done, and I find the expander, besides looking like a big flat pancake, is too wide for my chest. It seems to be encroaching over the middle line in the cleavage area,and is almost touching the good breast. I don't know what he used, but I think he didn't listen to me. According to what Michelle is saying, she has a similar issue with the expanders. But, is that a concern, or at the exchange, with the right implant, will things go back to a normal position, or will the the implant fall in the overly wide opening?Would the pocket have to be closed in that area at the time of the exchange? I wish our PS would listen to us more. We do know what we are talking about. I had a great PS, but I had to pay out of pocket each time which amounted to thousands of dollars, so I decided I had to go with one the insurance company approved..I am interested in your input, and what is your opinion on this..Thanks Whippetmom, you are a doll..very caring
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Whippetmom-
I have the info you need. My tissue expanders are Allergan style 133mx, moderate profile, width 13, height 12, projection 6.7. Recommended fill 500cc; I'm filled to 600cc.
My rib cage is 31in, and I'm 5'4" and 150 lbs, and I was a small B cup before. I'd like to be bigger, but not humongous.
Can you explain the difference between moderate and high profile? I'm still very confused how it affects the finished look. I think I remember him saying something about trying 560cc high profile implants. Can you get projection and cleavage, or do you have to choose one or the other?
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