BREAST IMPLANT SIZING 101
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Cthies:
Hello fellow whippet owner! Yours sound like sweet little show bred whippets. Mine are gnarly, out of control race bred whippets. Jack is the size of a small greyhound.
So I agree with you that you should be at least at 650 ccs - and I recommend rounds - Allergan Style 45 - 650 ccs or even 700 ccs. Your MX style TE is 13.0 cm wide and 6.7 cm projection at 400 ccs. A Style 45 at 650 ccs is 13.2 cm width and 6.2 cm projection. I am quite sure your TEs will take you there. She might even be able to get 700 ccs in those pockets. Much of this is determined at the time of exchange, but it is best that the PS have several options on hand.
Since you might ask, "why not anatomicals"...I fear your skin envelope might be too elastic, with your history of reduction, and why run the risk of rotation. You really need a snug fit with an anatomical implant and I just do not know if that could be achieved, when there was probably quite a bit of ptosis at one point.
Deborah
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Hello, and thanks for creating this forum! I had a bilateral mastectomy last year and at the time I opted out of reconstruction. I didn't know what my treatment options were going to be, and frankly I was in such shock from the diagnosis that I felt I couldn't think straight. My surgeon cut away a lot of skin so my chest is flat and relatively smooth. But after recovery and living "flat" and with prosthetics, I have come to want some kind of implant. I had a consult with my PS and she feels that my skin looks fine for expanders, a slow fill process and then implants, likely with some fat grafting. I want to schedule my surgery and I want to figure out what other questions I need to ask before going ahead. My PS didn't really discuss the type of expander or implant she would use, though we did discuss size. I'm not looking to go too large. For reference, I am 5'6, 130 lbs and rather lean-looking- small boned. I had been a B or C cup prior to my mastectomy, but the C prosthetics and even the Bs seem too big to me now- maybe because so much breast tissue is in the upper chest- but at any rate, I am going for a A+/ small B size, which I think will work best with my frame. The only place I do have fat is my tummy, and my PS said that the fat grafting would take some of that away, and that nipple recon down the line could use lower belly skin and almost give me a "tummy tuck" -lite. Have any of you had experience with that- the sort of "thrown in" tummy reduction? If so, what is that really like? And as far as implants, are there specific things I should be considering? Thank you for the expertise!
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Hello, I am 10 days post exchange. Yesterday was the big reveal.... Then, the big let down. My Natrelle textured410's are 740cc. I'm 35 years old, 5'6 and 150lbs. My natural breasts were a very full DD. These are wide, flat and have little projection even though they are the high pro. Implants. They look like they'll fill maybe a b cup. I look horrible in clothes. T-shirts are the worst. There is just no "boob shelf" as I call it. Ps said I was healing nicely. I didn't have the full melt down until I got home and really looked. They are symmetrical but super firm. Will they drop at all? Soften? Develop some sort of breast shape? I'm at a loss. Of course it's the weekend so dr. Won't me calling me anytime soon.
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Karc80, I can sympathize. I had a uni implant and an augmentation to match on the non mx side. I was also disappointed at the vast difference in projection and height. It is obvious, especially in tigher t-shirts. My PS says to wait 6 months because it can take that long to settle. I'm at almost 4 months and nothing has moved yet. However, I've spent alot of time browsing these forums to read about the drop and fluff and EVERYONE's seems to drop eventually, usually sooner than mine. So, although it's hard to be patient, all I can do it wait. From what I have read, you will look better soon. Hopefully someone else jumps on with more experience in the drop and fluff department.
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Whippetmom, I have been away from posting due to a really bad respiratory virus going around. I have been coughing so hard, I pulled my pectoralis muscle on the left side! As if it needs any more stress! Anyway, at my last fill, my right side is now 300ccs also. Left and right are different shapes, but not too noticeable under clothing. I bought a 34C bra that fits, so assuming that the implants match the size of the expanders, I am where I want to be. I told the PS that, and confirmed with him that the implants may be 100ccs bigger than the TEs.
Questions: 1) Is it true that the overall amount of stretching is most important to prepare for TE to implant exchange versus shape? And, 2) Is it true that waiting a longer period before exchange is better in terms of the development of the "tissue pocket" that the body forms around the TE?
I sure hope all of this works out well in the end!! You, and these blogs are such a gift for all of us. Thank you
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I'm back again. My PS is like a kid with a new toy. He is very excited that the clinic is going to start carrying an extensive inventory of Mentor MemoryShape implants. I'm 5'8" and currently 195 lbs. My ribcage is 39.5". My PS placed Mentor CPX3 Med Ht Contour Style 7200, 450 cc. I'm at 450 right now and today he said we'll probably go to 510 or 570. Your original recommendation was "at least 600 ccs in a smooth, round Mentor moderate plus profile implant. This would give you the width you need and enough of a mound. You could go up to 800 ccs and still never be as large as you were prior to BMX." What is your opinion of the MemoryShape Implants? PS said he would place a implant slightly larger than my ultimate TE fill. His recommendation for the MemoryShape implants is pretty convincing but I don't want to be swept up with the exciting "new" thing.
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KRI239
Yes, fat graft transfer and donor site skin transfer could create a flatter tummy. I had fat graft transfer twice and eight years later, my stomach is still flatter because of those procedures. I did not have a whole lot to lose, but enough, obviously!
I am thinking for you, implants in the 350 to 400 cc range, based on your stated preferences for sizing. Your PS sounds pretty savvy - I think you are in capable hands.0 -
Karc80
So you have the full height full projection style. I often find that the styles where the width is nearly the same or identical to the height, the implants sometimes just look flat and wide. I would need to know the style and volume of your TEs, to try to determine why they look so vastly different than your TEs. I gather you liked the size of your TEs, which is why you are so unhappy with the anatomicals?
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SeattleBound:
I do not understand question No. 1. As to No. 2, well, depending on the degree of expansion, whether the skin has responded well to expansion, and the PS feels that he can use a larger implant quite easily, one month after the last fill might be okay. It depends also on how fast the patient underwent expansion. I think at least four months from tissue expander insertion to exchange is good. My PS waited three months for the exchange after the last fill. Some plastic surgeons wait two months, some wait four months. It all really depends on the surgeon, his schedule, how well your skin has stretched. Too many variables to answer this question sufficiently.0 -
Hi whippetmom,
I have reviewed so many of your posts as well as so many others on the discussion boards when I was diagnosed with breast cancer in January 2015. Information overload until you find yourself needing advice for a particular treatment because you are finally at that particular point in this journey. This still may be a bit premature but since you are the expert in breast implants, I was hoping you could begin to help me. I had a mastectomy Sept. 8 2015 to remove all positive margins with immediate reconstruction using alloderm and a tissue expander followed by 28 treatments of radiation. I will find out the type of expander and how many cc' they filled it with. However it has shrunk a bit since completing rads. My ps said she would fill it 30 cc' s at time of prophylactic mastectomy and another 30 cc's after. She also mentioned at time of swapping TE's she was considering anatomical implants. How will you begin to suggest what size, brand etc. if I don't know how many cc's it is filled with? Should I send you a picture with all measurements when I'm close to that point? I also haven't seen any posts from anyone who has had radiation. Please advise me. I am so thankful to all the woman who have shared their story. It helps so much knowing you are not alone and the positive feedback and suggestions are so necessary for someone like me. Every detail of breast cancer has such a learning curve! It's almost impossible to know if you are making the right decision. Other woman's experiences help pave the way!
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Not sure if you can help. I have just received the Integra PMT tissue expander. PS says the capacity is 850-900. I have the awful external remote port which is causing a whole new dimensional set of problems and I simply cannot wait to get them OUT OF ME! I am hoping to speed the process up as much as possible because of the ports and the problems they cause.
I am 5'3", 120 pounds, 30' circumference. I received 300 cc's at time of TE surgery. I am looking to be a full C, possibly D but concerned this might be too big. I am definitely going to have the 'gummy bear' implant, teardrop shape. How many cc's do you recommend? Like I said, I am trying to get this over with asap because the port is going to be hanging from me until my exchange and they are disgusting and painful. So, if I can handle bigger fills each time, I am very much planning on the torture.
Please share your thoughts, tips, anything. Thank you!!
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Hi,
I had a mastectomy with immediate implant placement (left side only) in December. My surgeon, after telling me to be patient for a couple months, has finally agreed with me that my implant is too big! I am 5'4", 135lbs, rib cage measurement 30", cup size A (well, to be honest, I never really wore bras that had cup sizes, just flimsy wireless bras with sizes like S, M or L!) I've always been small breasted and I like it that way. Since I was given this larger implant, I've had to put padding on my natural boob to even them out!
The implant I currently have is a "Style 15 Natrelle Silicone 421cc". I did the "rice test" by filling a ziplock with enough rice that when I put it in my bra, my boobs look even. The rice measured approximately 50-70ml. Any advice as to what implant to replace this with would be much appreciated!
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I'm not sure as to the type of expander I had. We filled to 710 cc then exchanged for 740. I think I was hoping for something more boob like. These are reminiscent of my TEs around fill #2. I have pics if it helps. Do these implants drop at all? I still have visible swelling on top and a slight feeling like I'm wearing a tight bra around the lower half of my chest
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my exchange surgery was this morning. I just looked at the results for the first time a few moments ago. Will these natrelle inspiras 545cc high profile implants drop or take on more of a natural slope? Right now, they just look like a round implant, not terrible different from my expanders although the a bit more symmetrical and slightly closer together. I'do have swelling on top and sides. Please share your experience
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Rermi50: Once you find out the style and volume of your TE, let me know. There are a couple of threads on the reconstruction forum relating to radiation and breast reconstruction. Under TOPICS, look in the breast reconstruction forum section and scroll down until you find the threads. You can send me photos at a later date, once you have had your PMX.
Debortah
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Sammy7751: Yes, they will change shape. You need to give it a good two weeks.
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Karc80: Yes, send me a private message with photos. I cannot recommend much though without knowing about your tissue expanders
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T-Time: The "rice test" is useless. So.your TE width is pretty much going to determine where to go with downsizing. Decreasing volume is trickier than increasing volume, because the pocket may need some work - such as what is called a lateral capsulorrhaphy, in order to make sure the new implant does not migrate around in the pocket. Lateral migration I could especially be a complication, if pocket revision is not undertaken at the time of exchange to a smaller implant. You could stay with a Style 15 and go down to 286 or 304 ccs, or perhaps an Allergan Natrelle Inspira implant, SRM or SSM, 275 gms or 300 gms.
Deborah
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spiritualabundance
Those TEs with the external port do sound archaic! Why not an internal port? Ouch! Could you identify which style you have? I think they are indeed large, but the width looks like it is entirely within reason, at the lower end of fills. Perhaps you could be done with fills. HOWEVER, I do not know how this translates to an anatomical implant. The dimensions need to be pretty darn precise and the anatomical needs to be a little bit wider, taller and have more projection than the pocket created by the TEs. Anatomicals are not the be all end all and everyone envisions perfectly natural teardrop shaped breasts, and I can tell you, that is a misnomer. Maybe in breast AUGMENTATION you can get a more natural shape than with rounds (although I have seen them used in augmentation and I honestly cannot tell the difference). So if it means getting the size and shape best for your frame, you may need to ditch the idea of anatomicals. But let us see which style you have and try to calculate the dimensions. Click on the link above....
Deborah
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I'm not sure if this is the right place for this question. I had double mastectomy in January and have been undergoing reconstruction via tissue expanders. I had final injections yesterday and am getting geared up for radiation. I was devastated today when I was advised that I have to have healthy breast reduced because it is overshadowing my left side where I need radiation. Have you ever heard of this? My doctor closes early on Fridays so I'm totally stressing about this. Will I lose everything and have to start over again on right side or will it just fill back up to where it is now? I'm devastated that I'll be lopsided the 6 weeks I have radiation!!!
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Sandib65:
Fear not, that TE can be refilled quite easily. You will be fine. The pocket will retain memory of the expansion and it might just take a few weeks ( or less) to reexpand. Make sure you read all of the radiation threads to get the latest and greatest info on creams and oils to use on your skin!0 -
Hi Whippetmom,
Reading your various answers to all posts has been so reassuring. Thank you. I am calming down as I learn more and adjust to the fact that I may be a person whose mild pain and and overall discomfort with TEs will continue through to the exchange surgery. Still grateful to be alive with a very low risk of recurrence!
Regarding pocket shape, does the volume of the fill - such as my TEs' 300ccs - determine the result at exchange more than the dimensions of the pocket? I ask because my right TE is not fully extended top to bottom due to the PS's inability to get it up under my pectoralis muscle and his "tacking it down" at the bottom. I assume it is folded up somehow inside. It projects more than the left and is a more round, compact shape than the left TE. The left TE has migrated somewhat toward my armpit at the top. As I noted, both are filled to 300ccs. 1) Will any "pocket revision" be needed on either side? And, 2) Do all PSs use some form of securing the pocket, building a "sling" at the bottom, using "Alloderm", etc. This is a topic I don't understand.
Thank you, again! Sending out the best wishesto you and all those going through this experience!
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Seattle: Attached are some links within this BCO group that specifically address exchange issues. Most are in the 'breast recon' forum and there are two threads that I found particularly helpful when I was going through this stage and reading everything I could find.
A Breast Reconstruction Forum
https://community.breastcancer.org/forum/44
Exchange City
https://community.breastcancer.org/forum/44/topics/728266?page=1
TE's – A Beginner's Primer
https://community.breastcancer.org/forum/44/topics/819027?page=1
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SeattleBound: Yes, and it is very common for tissue expanders to migrate and so pocket revisions are very common at the time of exchange. One or both pockets may need revision. The TE that has migrated laterally might be because the pocket was wider than the width of the TE. If so, the PS will perform what is called a lateral capsulorrhaphy in order to secure the pocket laterally so that the implant will stay in the proper place. Pocket dimensions really trump tissue expander volume.
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Thank you MinusTwo!
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Hi there whippetmom!! I had my skin and nipple sparing BMX on Wed 3/30. My TEs are Mentor Artoura Textured High Profile 475CCs. I am 5'4" tall and weigh around 140. My ribcage circumf is 34". My old bra size was barely a 36B. I want to be a full C this time around. WHat do you recommend? My PS loves the textured anatomical tearshaped implants. But Im not convinced that will look best. I look forward to any advice!
Thank you in advance. 0 -
My experience with expansion was the first 2-3 (60-90cc each) were easy and then the fourth one was unbearable! Suggest smaller increments as you are nearing your desired size. First three used muscle relaxers prior to and post expansion for a few days but fourth needed to resort to pain meds I hadn't used for 6 weeks since DBL MX. More pain than I had felt through entire surgery and expansion process since I didn't expect it. My PS told me after a sleepless pain-filled night to use the pain pills and can vouch that they were needed.
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warriorwannabe:
So if your PS uses anatomicals, the only two I would recommend would be Mentor's moderate height, high profile anatomicals - either 555 ccs or 620 ccs. They approximate the dimensions of the Artoura TEs. If you chose silicone rounds, and if Mentor is the only brand she uses, I think that 550 ccs to 600 ccs in a high profile implant would be a good size for your frame. You could go with the ultra full projection style in Mentor, but that would require going up to 700 ccs, although the dimensions would still be comparable to your TEs. So you have some choices and I think that you just need to go over them with your PS.
Addendum: Check back once you are filled to 475 ccs so that we can discuss how you feel about the size0 -
thanks whippetmom - let me clarify, my PS prefers the anatomical, but will do whatever I want. I THINK I prefer the round implants based on pictures Ive seen of the tear shaped ones (they look a little flat and droopy to me).
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