BREAST IMPLANT SIZING 101
Comments
-
Hi whippetmom,
I am 5' 11" tall and weigh 165 pounds. My chest circumference is 34". My pre-surgical cup size was a B.
The TE I have in place is an Allergan Natrelle style 133MX-14 with an expansion size of 600cc.
I am currently expanded to 560cc and will stop there. Surgery for exchange will be around the first week of August.
My ps (who incidentally does amazing work, I adore and trust her implicitly) told me that symmetry is unattainable but balance certainly is. I'll have an implant placed in the native breast.
Thoughts?
Piscean
0 -
Thank you! Wow, 450 is significantly smaller in volume, do you think I should lower my expectations for an outcome similar to what I am now? Sounds like it. The surgeon had said "the last 50ccs is for me, to create the fold." So I was thinking 600-650 as the ballpark. Or are the anatomicals just shaped differently and not comparable in terms of volume?
Also, she said she will do the implant exchange first, then the reduction
0 -
Hi Whippetmom,
I just had Allergan Natrelle style 133V expanders (catalog # 133 MX-15) put in this Tuesday. My ps said that the recommended volume is 600 cc but he is going for overfill of 900. He said that I am wide (a nice way of saying fat, me thinks) and so he put in a wide expander. His nurse told me today that this likely means I will end up with low profile. I admit to being a bit disappointed by this news. I was really hoping for moderate profile. But I will take what I can get after all these years. He also said that I am a bit lopsided, with my left slightly higher than the right (which makes sense as I had radiation on the left side so it is tighter) and he will do what he can to correct this.
What are your thoughts on recommendations? PS and I agree that we want to shoot for anatomicals but he said it will depend on how well I stretch. I have a lot of scar tissue from past surgery and radiation.
I am 5'2 and currently weigh 219 (I am looking to lose some before going for exchange surgery....somewhere around 20 pounds at least by then). My measurement under the tissue expander is 40.
I was a large C (maybe even a D but I refused to try) before my bi-lateral mastecomy. However, I'm not sure how much this will matter because nothing was spared. They removed everything.
Thanks for your input, it is much appreciated.
Oh and my ps also used alloderm if that makes a difference.
0 -
Ruth7733:That is crazy! A low profile implant? That is archaiac....no one uses the low profile rounds anymore - especially with breast reconstruction. With a 15 cm width TE you could go to a 750 cc or 800 cc Allergan 20. I also don't know about overfilling to 900 ccs. That is a lot of overfill on previously irradiated skin. Let's see where you are....what your skin is looking like and what you think of the size, when you reach 600 ccs. Do NOT go into surgery not knowing what you are going to wake up with on your chest wall, and just say "NO" to low profile implants!
0 -
Ruth....Wait, wait, wait...no skin sparing? If not, WHY NOT
0 -
Piscean....I have seen many unilaterals with symmetry. It certainly IS attainable! You are in Canada. How about the Natrelle Inspira implants - 525 ccs to 600 ccs. Did she explain to you what she meant by "balance" rather than symmetry? I honestly have never heard that comment made previously.
0 -
Hi Whippetmom,
My bi-lateral mastecomies were done in 2001 (I was 25 years old). I remember we asked the surgeon about whether he would be saving my nipples and/or skin and he said that due to the size he thought my tumor was (with palpation he thought at least 3-4 cm) and what suspiciously looked like possible IBC he did not feel that anything should be saved. The skin near the tumor (which I found during a self exam in the shower) was very red and dimpled. It ended up not being IBC but the tumor itself ended up being double the size they thought. It was very deep and was a little over 8 cm large. It had also spread to 10/13 nodes.
My ps now does plan to use fat to soften up the scarred tissue but he says that won't be done until the implants are placed. I've been reading in various places on here that it should be done before placement of the TE's.
I really like my ps but I'm starting to get a bit nervous that things are not going as they should be.
The low profile statement was made by his nurse and not him (he was not in the office at the time) so perhaps she is mistaken. I certainly hope so
I was filled to 300 with insertion on Tuesday and I have to say that looking at them now, 600 cc would not make much of a bump. I really wanted to be at least a C cup which the ps said he could do, but that is with filling to 900 cc.
You are probably wondering why all this wasn't done back in 2001 when I had my mastectomies. Well we tried but my body kept getting infected every time they put the TE's in. One infection put me in the hospital for about a week. Finally I think we just gave up, saying that we would revisit it at a later time. Now is that time I suppose.
0 -
Oh Ruth.....I see. Okay, yes, this does make sense now. So I would advise drawing all of this out for as long as possible.
Yes, this is where fat graft transfer can truly make a difference for some one like you. Certainly it could have been done at the time of TE placement...but assuredly you want this at the time of the exchange and possible two additional sessions thereafter. But I have had a few non-skin sparing gals come through these portals, and none of them had a low-profile implant placed at the time of exchange. So I still say that is out. The slower the better when it comes to fills. Every two weeks would be better.
Could you private message me and tell me where you live and the name of your PS? Was DIEP or another autologous reconstruction method ever discussed
Deborah
0 -
Thank you Deborah, I sent you a private message.
0 -
Hi whippetmom,
Balance being as close to symmetrical as possible, but since one breast will be augmented and the other reconstructed, there will be the difference of breast tissue in the native breast that will look different than the recon. side. She is very detailed oriented and symmetry implies exactly similar breasts. This, I believe, is impossible with a single sided reconstruction.
Thanks for the info on type and sizing! Have a great day!
Piscean
0 -
Symmetry really has more to do, in breast reconstruction, with placement - and proportion, with the level of the IMF equal bilaterally. I have viewed a number of unilateral reconstruction results where symmetry has been achieved. You want the native breast and the reconstructed breast to fill out the cups in the same bra and be at the same level on the chest wall. Once you get to the Pictures Forum, I can direct you to some unilateral recon photos where symmetry was indeed achieved.
0 -
Going to U of M for a second opinion on my breast implant reconstruction. Had two revisions and it still is not right..... Wish me luck. Will keep you posted.Stix
0 -
Stix- I'm sending lots of luck your way!
0 -
Yes I lost projection with the style 10, I think his logic was the circumference to fill the pocket without getting too many cc's along the way. I think it was a mistake as now I have the diameter of a D cup but no projection to fill the cup. Bras are a difficult thing to find as one side is a small B the other a D without filling the cup.
0 -
hi whippet mom. I am currently in the expansion process and will have radiation and 6+ months recovery before any sort of exchange. Looking for your recommendation...
I currently have Natrelle 133mx-12t expanders with a fill volume of 400cc.
Prior to BMX I wore 34b or 36a bra and have a 33inch ribcage. Ultimately l'd like to be a full b cup and look as natural as possible.
Your thoughts
Thsnks!
0 -
minivan: Probably Mentor moderate plus smooth saline, 650 ccs to 700 ccs. However, it all depends on your skin envelope. If you had large breasts pre-BMX, you may have pretty ample skin flaps, and if the implant is too small, you will be back to more ptosis (droop) than I think you will want, so the implants need to fill up the skin flaps. There is a Mentor contour profile saline implant, in Siltex, which is textured and textured implants are pretty notorious for rippling. I have personally never known anyone with a contour saline implant. In that contour style, you would need to be in the 600 to 650 cc range. Another option is the Mentor Spectrum expandable (saline) smooth round implant, which enables the PS to keep filling after the exchange, so that you can gradually fill to the point where you are happy and then the PS closes off the port in his office and you are done. In this style, again, in the 600 cc to 650 cc range. Again, this all depends on your skin availability and that is up to the PS to determine what size of implant is needed to avoid too much droop. Make sure you tell your PS that you don't want to go down that road again.
0 -
patty101014:
You will have a number of options by the time of your exchange surgery. By then, Natrelle Inspira implants will be widely distributed and available (FDA approved in February but not in order status at present). There is the Allergan high profile smooth round silicone implant, 500 ccs to 600 ccs most likely, in the Inspira vs Allergan Natrelle smooth silicone rounds. If you decide to go with anatomicals, the corresponding Allergan 410 would probably be Style MX - 410 or 445 gms. The anatomical sizing differs from the rounds, primarily by virtue of the need to address the dimensions of the implant, rather than volume, and provide a nice snug fit in the expanded pocket so that the anatomical implant does not rotate.
Let's wait until you are through with rads and into the recovery phase and then see what is on the market at that time....and also see where you end up in terms of fill level.
Deborah
0 -
thank you so much! Such a long journey... I appreciate all of your work on this thread
0 -
We all love our whippetmom! Thanks, Deborah, for all that you do...
0 -
Height: 5'4". Weight: 140 pounds. Ribcage. 36". Pre-surgery bra 42DDD.
Bilateral Mastectomy 3/25/2015 for Stage 1 IDC. Negative lymph nodes. Inframammary incision with long full chest apron flap. Incision is along the lines of an underwire on each side. This was possible due to very large breast size with nipples around waist level. I do not have an incision into the breast area since the surgeon was able to work through the very large hole left by the "underwire" incision.
Immediate reconstruction with Alloderm (6X16) and 650 mL Mentor medium height tissue expander on each side. Fill at surgery was 50 cc to prevent wrinkles. Two more fills so far, 100 cc each, for a current total of 250 cc.
The plastic surgeon gathered the skin into the incision line, like gathering a bodice on a dress with an empire waistline. Some of the skin at the incision line was in a deep pucker and turned black. It took about 5 weeks to heal completely.
I am now 2 months post-surgery. Incisions have healed, but I have constant pain in a horizontal line across the breast (showing a valley). Plastic surgeon says this may be caused by the suture line between the Alloderm and the pectoral muscle. The discomfort caused by the expanders is tolerable but this pain feels like a tight cord binding across my breast. I have to take painkillers, which I would like to stop.
Lower breast skin (above incision and medially) shows peau d'orange skin. I am doing Manual Lymphatic Drainage self-massage which may help a little. I think this is caused by truncal lymphedema. It gets worse when I use my pectoral muscles (e.g. pulling weeds in the garden).
I would like to have reconstruction to a smallish size (B cup) as a final size. I am 61 years old so I would like a rounded, natural shape (not pointy). Most of all, I would like to get rid of this pain.
Thank you for your advice.
0 -
Well- I went for my 2nd opinion on my reconstruction. It was to say the least unusual. When I left I think the doctor seemed disturbed that I was coming to him because I have had 2 revisions from two other PS. I told him I wanted another opinion for the droopy implant so I am not continuously going through more and more surgeries. Wondering if he had a perspective on the failed surgeries. Two other PS said the skin is too stretched. One was leaning toward a diep or strattice to fix the problem ( which the ps was not too keen on strattice) and the 2nd is leaning toward another revision of tacking the imf one rib higher and tightening the strattice.
I went into this 2nd opinion and the dr. asked me what he could do that nobody else has??. Hmmmm isn't he suppose to tell me that?? His demeaner was less than delightful. But the sad part is- I think his demeaner was this way because he felt like he could not fix it- to look like my good reconstructed side. So sad.
I could tell by the residents face- by the way she was sadly looking at me when he was talking- that she was less than delighted by his demeaner. I made it a point to state that i could not wear specific clothes because one side had protrusion and the other did not- therefore, it was more than blatant of my dissatisfaction
has anyone else had this interaction with a physician. I am quite appauled . Thank you
0 -
Hi Whippetmom!
I am currently in the expansion phase. Here are my stats:
1. Height 5' 6", weight 142, rib cage 32.5"
2. Mentor CPX 4 550, 13.3h x 13.8w x 6.9 projection
3. He works with Sientra, mentor and allergen
4. I am typically a 34C when I am good about diet and exercise. A full D when I am not.
Currently, my expanders are at 540cc and fill my 34D bra nicely.
Any suggestions on what you think would be good and why would be awesome.
Thank you for spending the time to help me - and all these lovely ladies - navigate through this process!!!
0 -
Oh be still my heart, AZ....there is nothing like a whippet puppy...
0 -
Wendy: Please read what I said to minivan a few posts above, referable to filling up the skin envelope in women who had overly large breasts prior to BMX. I envision an ultra full projection implant being used , OR, in the alternative, perhaps a textured Natrelle Inspira implant, which might give the semblance of a "lift" with its adherence abilities on the chest wall. Sientra textured rounds could do very much the same - Textured Rounds Moderate Profile, 625 ccs. This implant has the added benefit of having more upper pole fullness, which is typically difficult to achieve with such significant pre-surgical ptosis (droop of the native breasts.) Allergan Natrelle Inspira implants would be a consideration, and they should be in wide distribution by the time you are ready for exchange. 700 gms in the Xtra full projection style could be discussed with your PS. Wait until ou have reached around 500 ccs fil and and then let me know.
With regards to your pain issue, I am not clear on the reason for your pain around the incision site. It could be keloiding of the scar, which can be quite painful, or hypertrophic scar pain....cannot quite tell what you are describing. But also it is possibly that you have post-mastectomy-pain syndrome, which is pretty common and nearly always accompanies those who have lymphedema - especially truncal lymphedema. I recently posted something on the PMPS thread here on bc.org and I will repost it here. The link always ends up above the text. Please discuss this with your breast surgeon or plastic surgeon. This might all be ameliorated at the time of the exchange, but in the meantime, there is a pretty simple fix that has helped a number of women....
Deborah
0 -
byebyeboobies: Options: Mentor or Allergan high profile, 550 to 600 ccs. Sientra is great, but might not have enough projection for you, if you end up liking the projection of your TEs. An ultra full projection implant mgight be a consideration, and I would "hold out" and wait for Natrelle Inspira implants which should be available this summer. In the Inspira, you would want to look at the smooth round full projection 540 gms or the xtra full projection style, 550 gms. If an anatomical implant is desired, the closest in Mentor would be the Memoryshape medium height full projection, 555 ccs or Allergan 410 - MX style 520 gms.
I would rather you come back here when you are filled to 450/500 ccs, and we can discuss how you feel about the size, width, projection, etc.
Deborah
0 -
Whippetmom,
I am currently at 540. The projection is nice but I am not sure about the width. I don't like that my arms hit the side of my breasts, although my PS said that it seems more pronounced because they hard hard...the permanent implants won't seem as blunt.
I am not really exploring the anatomical implants because of the rotation risk.
What are the advantages of the Natrelle Inspira? My exchange won't happen until August (BMX on 4/20) so if need be I can always wait for the Natrelle. My doctor has mentioned he likes working with Sientra but they don't have an ultra high profile equivalent, so his recommendation is the Mentor Ultra High profile 480 or 535.
Thoughts?
0 -
Those implants you mentioned are textured implants. Are you sure you want textured rounds? They tend to be firmer, can cause traction rippling and generally are rarely used, UNLESS the patient has the degree ptosis (droop) where the textured implants acts as a lift with more adherence to the chest wall. I see Sientra textured implants used now by plastic surgeons, but Mentor and Allergan choices with rounds are almost exclusively smooth surfaced.
I think the volumes mentioned are too narrow. Why use a 13.3 cm tissue expander? I think that 650 ccs - staying closer to your 13.0 cm width - would be best. If they are looking too lateral - towards the armpits, is it because you have a wide gap in the cleavage area? With a 32.5 inch ribcage circumference, 13.0 cm is not at all too wide, unless you have some other chest anomaly at issue. Do you want to send me photos? You can upload them in a private message. BTW:My ribcage is 29 inches and my implants are 13.5 cm in width.
0 -
Hi! I had a unilateral mastectomy and currently have a TE in place. The goal is to swap it and put a smaller implant in the other side for symmetry. I have pectus carinatum and my ribcage is slightly higher and unusual on the mastectomy side.
I am 5'1" and weigh about 106. Prior to surgery I typically wore a 34B bra. I have a Natrelle Style 133V series 300 cc TE. The PS plans on expanding it to 350 or 400cc.
Right now I am expanded to 240 and I look like I have a softball under my skin! My TE side is slightly larger now than the other side. My ribs are now very prominent coming off my sternum on the TE side and I have a depression above my breast. The PS said he would fill that in with lipo, but I'm not sure about around the ribs. I will ask on that.
Any recommendations? My breasts have always been "far apart" due to my high sternum. I was hoping that higher profile implants would help with that. I also have a small frame and am somewhat narrow. Thanks for your help!
P.S. - I am also new to this board. Can you tell me how to get to the "Picture Forum"? I can't figure it out! Thanks!
0 -
Hi Whippetmom,
I have been looking for objective information on sizing of implants and tissue expanders. It seems to me that the circumference of the rib cage and body height don't provide enough information for sizing. The rib cage creates an ellipse, and two women with the same rib cage (circumference of ellipse) can be quite different if one is wider because her chest isn't as deep. The major axis of an ellipse measures the width and the minor axis, the depth. It seems to me that a plastic surgeon ought to be able to measure the axes of a women's "chest ellipse" and there ought to be some sort of algorithm/app that would allow a women to visualize how a certain TE or implant would look. I see my PS in a week and am going to ask him more questions about just how scientific their measurement processes are. Just wondering what you think about this (that rib cage # isn't enough) or whether or not such algorthims already exist - they just don't tell us about them!
0 -
jojo: Whoa! You had me at ellipse!! It really isn't rocket science. There are really only three basic styles of tissue expanders (two options within the styles - V or X) currently "utilized"by plastic surgeons. There are other "types" out there (dual chamber), but I rarely see them used. Most women fit into the category of requiring anywhere from a 10.0 cm TE (a very petite/slender waif) up to 16.0 cm. I honestly, however, rarely see TEs wider than 15.0. So the AVERAGE range of tissue expanders (from what I have seen in the past six years) will be 11.0 cm to 15.0 cm in width. Not much of a variance. Other factors come into play, such as chest wall anomalies, e.g., pectus excavatum, pectus carinatum, and/or spinal deformities, e.g., scoliosis, kyphosis, etc. A very minor degree of "deformity" can call for a different width or height or projection of the implant in order to achieve balance, proportion and appearance on the chest wall. The degree of mastectomy defect can also become an issue for the PS when selecting the right TE and implant
For me, weight, height and ribcage circumference tell enough of the story to get a good idea of what will work, and then when we factor in native breast size (are you going to have a quite ample skin envelope or a pretty tight skin envelope) we can calculate further from there. Typically the TE is chosen (especially for a unilateral MX) to approximate the width of the native breast. Essentially the same holds true for a BMX, but there is more allowance for using a narrower or wider implant when symmetry to an already existing mound is not the priority.
I would love to be a little birdie in the office when you ask your PS this same question!
Please let me know what he has to say!Deborah
ADDENDUM: Most plastic surgeons will take measurements - native breast width, height and the sternal notch to nipple distance. If you have a considerable degree of ptosis/droop, this also plays a role in TE and implant selection. I
0
