BREAST IMPLANT SIZING 101
Comments
-
Hoptomistic: There you go....I answered the last post first, and now here you are to prove my point about one aspect of reconstruction. I am going to need to have you private message me and attach a photo. The landscape icon next to the goggles icon will allow you to upload photos.
I need to know which STYLE of 300 cc TE has been used, as all Allergan Natrelle TEs are called 133V's. If you have a card or paperwork, it will either have something like a MX, MV, FV, SX, or....perhaps just the width...e.g., -10, -11 or -12. You will likely have a 10.0 to 12.0 width.
Deborah
PICTURE FORUM: Please read the thread....I will find it and post it...
0 -
Click on the link and scroll up to the top and read the entire thread header.
0 -
While I'm on a roll...
Someone asked about Natrelle "Inspira" implants, newly FDA approved. From Allergan:
0 -
Whippetmom, I guess I am frustrated by not knowing exactly what measurements should have been taken. I didn't know about the sternal notch to nipple distance so I have learned something new! If my PS took these measurements at the time of mastectomy, should it be in my surgical record? I think that TE widths of 11 - 16 cm is a fair amount of variaiton, and I think my PS erred on the side of too wide of a TE (15 cm when my rib cage is 33-34inches). It is water under the bridge now, but I can't stop thinking about how things should have been done, and why they don't have a scientific/exact measurement approach to sizing. My PS took no measurements of me prior to mastectomy - he might have taken some when I was under and might have based his decision on the weight of the breast tissue. I have moved on to another PS but one day I may summon the energy to ask these questions of my first PS. thanks.
0 -
Whippetmom, thank you so much for your response and for all you do.
With regards to my pain issue, my pain is not in the incision site. It is also not neurogenic in nature, so PMPS would not be appropriate.
The pain is caused by constriction of a suture line running horizontally across both breasts about 3" above the incision line (which is on the inframammary fold line).
My plastic surgeon used acellular matrix (Alloderm) to support the expander. The pectoral muscle was cut horizontally and lifted, creating a subpectoral pocket. The Alloderm was stitched to the inframammary fold and the lateral mammary fold using sutures. The tissue expander was slipped into the subpectoral pocket. The Alloderm was then reflected over the bottom portion of the expander and stitched to the distal portion (bottom) of the pectoral muscle with sutures. This row of stitches, attaching the Alloderm to the bottom of the pectoral muscle, appears to be too tight on both sides, compressing the expander. It creates a horizontal "valley" in the expander that can be seen through the skin. It feels like a very tight cord across the chest, pulling painfully on the pectoral muscle. In addition, there is an object that pokes toward the skin at the medial end of the line of stitching. This looks almost like a nipple under the skin and is visible when I'm wearing a blouse. The tight "cord" and "nipple" cause pain which is mechanical, not neurogenic. When I use my arms a lot (e.g. thinning apples in my orchard) my breast area swells, causing pressure against this cord. This becomes quite painful.
I currently have only 250 cc in my expanders. If the line of stitching is already too tight, what will happen when more saline is added to the expanders? Won't it become even tighter? Can this problem be fixed (i.e. can the line of stitching from the Alloderm to the pectoral muscle) be loosened during implant exchange? I don't want to be in pain for the rest of my life.
Another issue is the physical durability of the implants. I do yoga, with down dogs, side planks and handstands. This puts a lot of stress on the pectoral area. What style and/or brand of implants is most stable to physical stress? What is least likely to move? What is least likely to break in use?
Thank you again for your advice.
0 -
Wendy....You will need to talk to your PS regarding the pain issues. There are ways to address this but please let your PS give you the options.
If this is going to compromise your reconstruction results, I certainly would consider seeking a second opinion, if fills are problematic and your PS insists that nothing can be done until the exchange. You can take the fills very slowly, spaced two weeks apart, if that would help with the discomfort. The TE is a very rigid foreign body against the chest wall, like a deflated football. As the device expands, it smooths out and often some of the preliminary discomfort ameliorates or resolves.
With regard to implant selection, I would definitely stick with silicone rounds, not anatomicals, which can more easily rotate with vigorous exercise. I think side planks would torque an anatomical implant in short order. I think that a more cohesive implant, like Sientra or the new Inspira implants might also be a good option for a "boot camp" athlete. You do need to be guarded with any pectoral-based workouts though, because the implants can displace laterally. I cannot do some of the things I used to do, in my work out regimen,prior to BMX.
Deborah
0 -
jojo: Measurements are taken at the time of initial assessment or at the pre-op appointment. Some plastic surgeons take measurements and some do not. I do not know why some do not. If I can help you further, please let me know.
0 -
Whippetmom:
I had a bilateral, tissue and nipple sparing mastectomy on April 13th. I currently have Mentor CPX4 tissue expanders (450cc capacity) filled to 420cc on both sides. I am 5' 5" tall and weigh 118 pounds. My ribcage circumference is 31". Prior to surgery I had silicone implants (I was originally a 34B prior to augmentation). I can't recall the exact size of the silicone implants, but believe them to have been 325cc (pathology reported the weights of both on removal at 333 grams). Prior to the mastectomy, my bra size was 34D. My plastic surgeon will be using Mentor "Gummy Bear" ultra high projection implants.
My surgeon apparently adds 60cc of volume (versus whatever the expanders are filled to) when he does the exchange (i.e., the final implants are 60cc more than whatever the final fill on the expanders was). I would like to be slightly smaller than I was prior to surgery in April (I'd like to be a full C). I'm currently trying to decide whether I should fill the expanders one more time, or stop at 420cc.
Any advice would be greatly appreciated.
0 -
Hi Abbiejean! Welcome to Breastcancer.org!
You definitely came to the right community and the right thread to ask about this, and hopefully soon you'll get wise and supportive answers that will help you with your decision. Please let us know what you end up doing.
Hugs,
The Mods
0 -
Abbiejean:
I am not sure if you have a low height, medium height or tall height mentor CPX 4. Assuming it is the medium height, which is the most commonly used TE style in the mentor lineup, your dimensions would be 12.7 cm wide and 10.8 cm tall and 7.0 cm projection. There is no ultra full shaped "gummy bear" anatomical implant in Mentor, with high-profile being the largest profile in that style. So if you have a medium height CPX 4, and IF your PS is using an anatomical, the most logical choice would be 440 mL or 495 mL. Now there IS an ultra full projection smooth round silicone implant, but it is a cohesive gel implant and not technically a "gummy bear" implant. In that ultra full profile style implant, I would recommend 590 ccs. It will take more ccs in that ultra full projection style implant, I would recommend 590 ccs. It will take more cc with breast reconstruction, because there is no underlying breast tissue to add to the volume on the chest wall. So 590 ccs is really not going to be too large for you.
Every plastic surgeon has his or her own idea about what is required regarding fill level versus implant choice, so I cannot speak to your doctor's protocol in this regard. It is a matter of dimensions really. Your TEs are 12.7 cm wide and 7.0 cm projection and the 590 cc ultra round is 12.5 cm wide and 6.3 cm projection.
Deborah
0 -
Whippetmom, thank you very much for your thoughtful reply. What you've said makes sense, but why would there be such a great difference (100 to 150cc) between the two different implants you've mentioned? Would both sizes render the same projection?
Thank you again.
0 -
Abbiejean:
I know that it is a connundrum, but it is what it is. The easiest way to describe it is that it is primarily weight distribution -anatomical vs round.
0 -
Whippetmom, I posted my stats in March but you recommended that I let you know what I thought when I was filled around 400cc. I will give you my stats again so you don't have to look back. I had nsbmx in late January and TE's placed on Feb. 3rd. I am 5'1", 120 lbs. My ribcage is 30". I have Allergan 133MX-13 TE's that have a 500cc fill volume. Before my BMX it was a 34D. I wish to be smaller. I am now filled to 400cc. I am really happy with how they look. I don't have extra skin or any droop. If they were not like wearing a coconut bra I would want to keep them. My PS has suggested putting in Natrelle 410 anatomical with 450 to 475cc. I don't really care if they are round or shaped, I just don't want them to be flat. I like the projection I have. What are your thoughts??
0 -
-
Ang: 445 gm Allergan 410-MX.....
0 -
Ang: You could also hold off on the exchange for two or three more months and wait for the Natrelle Inspira implants to be in distribution. You could use a 520 gm ultra full projection implant in the SRX or SSX. A round implant with a greater fill level in the shell than other silicone rounds.
0 -
Hi Whippetmom!
Well, I thought I was doing well with recovery from implants, I did everything to the letter with recovery and PS had me wearing the band for three months. I went to reach for something and got a big bulge in the upper pole area of my healthy breast. I called and the soonest I can get in is Tuesday afternoon (due to my schedule). What do you think about this pic? Has the implant escaped from the pocket? I have the band back on and will wear it until I see him. I feel good, no fever, etc.
THANK YOU!
0 -
If you have anatomicals, it has likely displaced in the pocket. I don't think I would wear the band, if this might be the case. Wait until you can see your PS
0 -
Good morning Whippetmom! Thank you for replying. They are not anatomicals.
0 -
Round implants can become displaced. I will be interested to hear what your PS has to say.
0 -
Whippetmom -
First, thank you for all that you do - I am so grateful.
I had a BMX on May 5th and go for my second fill on Thursday. My PS wanted me to start thinking about my options and gave me some reading material, but I find that this forum might be a better resource ;-)
I have Allergn 133-MV-12-T TE's and prior to surgery was a 32E. I am 5'7, 128 lbs and my rib cage is a 31. I would like to be smaller (full B/C)...what type of implant should I be considering? I don't want to look like I have coconuts for boobs, but I also don't want too much sag...what size/shape would be best for me?
Thank you in advance!!
0 -
When you say your PS gave you reading material, which brands does he use or did he offer to you? That should help me in my search for the right implant. Do you currently have excess skin overlying the tissue expandes? I definitely feel that you need an ultra full projection style implant and in Allergan that would be style 45, either 500 ccs or 550 ccs. You definitely can carry off either of those sizes, considering your pre-existing breast size. You could also wait until August for the exchange, at which time the Allergan Inspira implant should be in full distribution. That implant has a higher fill level than other silicone implants and an ultra full projection style, smooth around about 415 or 465 gms , should be a good choice for you. Talk to your PS about these options.
0 -
Whippetmom -
My PS gave me Mentor and Allergan reading materials, but did mention he likes to work with Mentor implants. I do not have excess skin overlying the TE's currently.
Thank you for giving me discussion points for the PS ;-)
0 -
whippetmom - FYI, Allergan said although the Inspira's were FDA approved in February, there is still red tape to go through. They have a tentative launch date now set for end of June assuming all is set.
0 -
Oh good news! I thought for sure it would not be until August, but end of June is better
0 -
Hello All!
I have my exchange set for July 1st!
Excited as my TE's feel like kettle bell shells stapled under my chest muscles. I suppose I've gotten use to them and I do like not wearing a bra... So I keep focusing on the silver linings especially when I get the good old nerve zaps that could bring me to a halt for how that left armpit still aches thanks to the node removal.
My BMX was 3/27 and my last fill was two weeks ago. I am at 320cc's. Small and tidy which is new for me as I was very big pre-DCIS. I was DD's so I have loved having small and stopped the PS at 320. I picked silicone round as I have good pec muscle and he feels I should have a good result with little or none rippling of any kind. I go back to see him on the 18th for pre-op. But, now as I sit here, I am concerned that my little itty bitties might be too small? So, my question is are the TE's larger than the implants so when the implants are placed they will be smaller than the TE's? I've been reading through some forums and skimming through "projection" and I must have missed that before. I don't want anything hanging or swinging (do fake boobs even do that?) and I definitely don't want to be what I was. Top of my ribcage measures at 33 inches if that helps?
Any insights?
0 -
Hi Whippetmom,
I am 38 and was going for breast augmentation. The PS asked me if I had ever had a mammo. Because I had not he suggested I have one first. This decision may have saved my life! I am now planning bi-lateral mastectomy with reconstruction.I have DCIS measuring 4cm in my left breast.
I was told I don't have enough tissue or fat to donate for a donor recon. So my options are implants either with single stage surgery with alloderm and implant or 2 stage surgery with tissue expanders then implants. Allergen is the implant type I was told would be used.
I am 5ft, 6", 125lbs. Measurement under my bra line is 31". Measurement over my nipple line is 35". I like a comfy bra so I usually wear a 36B or 34C as it gives me more size under clothes...hence my interest in breast augmentation.
Since that initial plan has drastically changed I first and foremost want to be cancer free. But close behind that I want a positive cosmetic outcome. I have read a lot about the discomfort of TE and wonder if single stage direct to implant would be any easier. Before this diagnosis I had discussed at 275-300cc round silicone implants. I am wondering how to achieve a similar volume after mastectomy.
Any help you can offer would be greatly appreciated.
0 -
KBELL: I'm sorry for the late response. I will get back to you tomorrow with some recommendations.....Thank you for your patience.
0 -
PhillyEmma: I will get back to you tomorrow also!!!
0 -
PhillyEmma
I need your height and weight. Additionally, I need to know the brand, style and recommended volume of your tissue expanders. If you have ample skin flaps (and you likely do) your implant size should not be smaller than your implants. In most cases, implant volume is anywhere from 50 ccs up to150 ccs (sometimes more) than the TE volume. I am referring to he ACTUAL TE volume, not the level of fill.
0
