BREAST IMPLANT SIZING 101
Comments
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Seedsally:
I think that you will probably be looking at around 800 ccs in a high-profile smooth around silicone implant. Your TEs are more than sufficient to get you there. I am just wondering why you will be filled so quickly to 750 ccs, which makes me think they want to get fills completed and then start chemo. Typically they do chemo and wait around three months and then do the exchange. Why don't you ask this question about timing.0 -
Mariejune:
I know of very few cases where implants are inserted under the muscle after mastectomy. My only concern about over the muscle placement is that it might make it harder to detect a recurrence that is under the implant and near the chest wall. I would just want some reassurances from the plastic surgeon in that regard. I do not know of any photos, unless someone on bc.org has had OTM placement and might have posted in the Pic Forum. That person would have to be your height weight and build and have the same size implants, and still this might not be helpful, as we are all different and it might not be the same result you would achieve.
By the way, nearly all of us have dynamic distortion or "implant animation" after MX. Mine do what yours do - when I open a jar, dig ice cream out of a carton, do certain exercises.
Perhaps their are degrees of animation and you might be in a different category.
I feel you should also discuss this with your breast surgeon.....to get his/her input regarding the change in placement.
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KYmarathonmommy:
I would think that Allergan Natrelle, Style 45, 800 ccs would be a good size. This is a smooth round extra full projection style implant. You might be a candidate for this size, because of your native breast size before BMX. Another option would be 12 in Inspira implants, extra full projection style-695 gms or one size larger. I think you could use 14.5 cm in width.....
I am surprised that the Mentor Artoura TEs moved so lateral. This tissue expander is designed to prevent that from occurring. So it will be up to the plastic surgeon to perform lateral capsulorrhaphys (securing the tissue near the armpits) to keep implants from moving laterally after the exchange. The right side is likely painful due to the pressure of the TE on the ribcage, which is possibly why your surgeon is moving a bit slower on expanding that side. I would rather give it more time and wait for the pressure to resolve and fill in little increments. You do want to achieve symmetry and it might require a different profile implant on the left side.0 -
Whippet mom I believe you make be right about the chemo thing. I was not expected to need chemo but my BS asked my daughter while I was still in recovery where I wanted to go for chemo treatments. Then the same DR called me this week and asked me to choose my oncologist ASAP and get the name and number to her quickly so I could get in for an appt soon. She told me my nodes on the cancerous side was ok but something odd was going on in the nodes in the noncancerous side. She knew I wanted to be closer to my home if I needed chemo. So I was lucky to get accepted to an oncologist unit about 50 miles from my home to a well known oncologist. I'm guessing there is some reason why they are hurrying everything so much. But I am only 10 days out from my BMX and recon. I still have 1 set of drain tubes in. I am set for my post op check with the BS in 5/19. I have my 2nd post op visit with the PS Monday 5/2. The question you mentioned I will try to remember to ask her then.
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My TEs are under the muscle. Thank you so much for the advice! I have an appt to discuss radiation this week so the PS is trying to get me fully expanded asap. The right muscle and TE are pretty high up on the chest, and I'd be ok with that if the left was not so low on the chest. I really hope if I have to have radiation that we can get these TEs figured out to where there is less discomfort. The PS said she would not do the exchange for nine months after radiation, so that could be a long 9 mos in my current state. Would an 800cc implant work with a max 500cc TE? Any other advice you could give on how to deal with the pain and pressure would be greatly appreciated!
Thanks again for taking the time!!!
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Hi Whippetmom-
Would love some advise on implants. I'm currently almost 5 months out post bilateral mast w/immediate recon- skin and nipple sparing free tram flap. I have a great deal of tissue missing at my sides and thick scar tissue around upper/outer areas of new breasts. I'm 5'5" 124 lbs, smaller framed but lower body is quite curvy. Current measurements post op are 28.5" under breasts, 31" across recon breast, 36" hips. I've always been smaller chested, but not quite this small and would love to be back to my old size.
PS is recommending 150cc teardrop gummy bear implants, placed behind my muscle. He is additionally recommending fat grafting at same time to help fill the concave areas at my sides (I'm extremely sensitive in these areas and was told this would help. Still trying to research/verify this prior to procedure). I would love to be a bit more chesty at top (though nothing large- not my style). However, not sure about having implants under a free tram. I am hoping smaller implants= minimized discomfort? Have many or any other women come to you with this? PS gave me thumbs up a month ago for secondary surgery but I'm still battling neuropathy, scar tissue, skin sensitivity, etc. Still debating a revision surgery (which I will need anyway to address a nipple which is now and inny). I'm honestly just scared to put myself through more and sort of irritated I'm needing implants after going through a free tram procedure. That aside, any advise on implants is greatly appreciated while I decide my next step.
Many thanks!
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MINUSTWO......
Private messaged me and pointed out my posting blooper! I meant I rarely see implants placed OVER the pectoral musculature. Sorry for any confusion!
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Kymarathonmommy:
I think that based on your TE dimensions and prior breast size, 800 ccs is likely doable. Please ask your PS abut this.
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Tasal:
Many free tram flap procedures include the use of implants for augmentation purposes. I am a huge proponent of fat graft transfer. It is a useful tool for correction of tight scar tissue, divots, step off defects, deep rippling, AND it can regenerate tissue...(stem-cell rich fat) and this could and should help resolve the discomfort. Let me know how this turns out for you.
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Thanks whippetmom!
Makes me feel better to hear that as I've looked everywhere for someone that's done a free tram flap and implants later and haven't had any luck. I originally had thought my breasts would be slightly augmented with the fat grafting- but my PS is against that idea all together for whatever reason. However, he does recommend it being used to fix the areas at the side of my ribs and towards my back whereas I have no tissue under the skin. Given my current measurements of 28.5" under breasts and 31" across breasts, do you feel a 150cc gummy bear teardrop implant will give me more fullness in my upper breasts? PS says it should add about a 1/2 cup size.
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Tasal: 150 ccs is a pretty small implant, but it all depends on how much your skin will allow. Perhaps ash him to try 250 ccs
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Hi whippetmom,
Looking for some advice as I think I am nearing the end of the TE expander process. Had a 60cc fill yesterday bringing me to 370cc and while I would like to go for another fill, I'm not sure that's feasible. Here are my stats: 46 yr old, pre-DMX size 34A (padded). Height: 5'3 1/2 Weight: 123 Rib cage circumference (under TE) almost 28". TE: Allergan 133FV 300cc (same on both sides). Path report measured right breast specimen at 14x12x2.5cm and left breast specimen at 13x11x2cm. I want to achieve a full B/small C after the exchange and cleavage would be nice too as my breast mounds are very far apart (which may be limited by my anatomy). Recommendations? I meet with PS next week to discuss next steps and want to know my options before that discussion. Thank you
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31yrs old. 5'1. 107lbs. 29" Circ (yes I'm tiny)
Expanders: Natrelle 133MV-12 300CC
Implants: Natrelle Style 45 600CC, Smooth Rnd high projection
2011 Breast Lift. age 26
April 2014 Breast Aug. Gummy Bear (don't know CC's) Age 29
Sept 2014 Triple Negative BC diagnosis, Bilateral Mastectomy, 8 rounds chemo and 48 rounds radiation ending May 2015. Age 30
Dec 2015 Moved skin from my upper back to my radiated breast and inserted expanders. Age 30
May 2016 exchanged expanders for implants. Age 31
The expanders were filled to 500 and 530CC (I never paid attention to my card which states that they are 300CC expanders until now and I'm a little freaked out of the "overfilling" issue). The "goal" was to have as much upper volume and I could get, size mattered none to me as long as i got that vava-voom up top! However, I woke up from surgery last week and was already frightened.These implants are 600CC and look/feel very low, they sit not only under my arms, but touching in the center as well. To say very little projection and no upper fullness would be an understatement. Reminds me of a flat booty laying on my chest! I'm now 5 days post op and can already see and feel rippling. Where do I begin with my confusion and questions? Am I just doomed to have "normal" breasts or did this PS totally miss the mark last week? I get that my case is really congested with factors, but whoa. I have a post op apt w/PS on Tuesday and I want to be prepared with Q/A's to rebuttal her should she come up with the typical "your skin is thin", "they will drop", "give it time", routine. These "new boobs" don't fit me in any way shape or form and hardly the light at the end of the tunnel they kept reminding me of for 20months. First off, what are your thoughts on all this? And second, what would you say on tues if you were me? "I HATE THEM REDO THEM" probably wont fly with the PS or insurance provider. I had 110% faith in my PS from day one, right up until I woke up from this last surgery. So discouraging
Thanks for your time... sorry my post is a novel.
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Tepster:
Your tissue expanders are narrower than were your native breasts which might be one reason that they are migrating laterally. I recommend smooth silicone rounds high profile, such as around 450 ccs Allergan Style 20. I do not know about anatomicals - the full height Anatomicals (which correspond to your FV tissue expanders) tend to be oddly shaped for breast reconstruction for most women. The height to width to projection ratios often do not render the greatest results, e.g., somewhat tall and flattened out. There are also the Natrelle Inspira implants, and something in a HP or even ultra HP style in the low 400 gm range - 12.0 to 13.5 cm width - would be a good option also.0 -
JustKeepFighting:
I think I need to see photos. Could you please private message me and link photos? I will be able to give you some advice before your Tuesday appointment.0 -
Hi, Whippetmom. Thank you so much for all of your advice on this thread. I have a bit of a conundrum.
I'm having a tough time deciding what size to go and whether to get saline or silicon. I'm 5'4" and 175 pounds with broad shoulders and a broad muscular back. Being short, hourglass/inverted triangle shaped and large breasted presented me with challenges before I got breast cancer. I love to look sexy for my husband and when we go out. That's very important to me I don't want to look manly but I don't want to look like a bimbo while I'm at work. I'm a home health nurse and have to spend time alone with men in their homes and don't want that kind of attention.
Before all this happened I was a DD and found myself choosing whether to wear unfitted blouses to camouflage my breasts or things that were more fitted and showed that I do actually have a waist. The unfitted blouses or t-shirts made me look fat and manly and about 30 lbs heavier but fitted things caused my breasts to be the center of attention. My chest circumference is 41 inches and I'm losing weight and confident I should at least be able to get down to 150 lbs and stay there. I've lost 15 lbs since my surgery on 2/25 even though I'm on Femara. I'm hoping to get down closer to 130, which would put me in about size 6 pants.
I like my over the muscle tissue expanders. They're a little more firm than I would like but I love that they don't fall to the sides when I lay down and they're smooth with no ripples. They have enough projection that they don't have to be huge in order to look feminine. Right now I don't have the problems I had before with looking fat and manly in unfitted tops. I love that I don't have to wear a bra and can wear a tight tank and they don't get smooshed down. The only thing I don't like is the stepoff.
I'm expanded to 540cc right now and love the amount of projection I have. I wouldn't mind having a little more projection but I don't want to look like a bimbo when I lose weight. Right now they look fine when I'm standing up straight but when I'm sitting or leaning forward they look a little small. I bought a 40D bra and I almost completely fill it out. Of course the area above the expanders is sunken in and hollow.....my guess is it would take about 100cc to fill in the hollowness.
I was looking online at photos of smaller women with 700cc implants and they didn't look totally ridiculous. I don't think 700cc would be too big if I lost weight. I'd rather be a little too big than not big enough.
Are saline implants a little less firm than tissue expanders? Would I be able to go without a bra in a tight tank at 700cc in saline? How about in silicon? I've been reading that most bigger girls go with about 800cc but I'm thinking the firmness of saline might make it possible for me to have less ccs and still look sexy when I want to.
Thanks in advance.
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StacySue2you:
The Allergan Natrelle Inspira has a greater fill level than the standard smooth silicone round implants. I would choose those over silicone. The Inspira would be plenty firm, I would ask your PS to try the ultra full projection style. 700 gms (in the Inspira) should be fine. If it is round standard smooth silicone rounds, Allergan or Mentor 700 ccs to 750 ccs should be fine - and the more weight you lose the larger the implants will be and the cup size will increase as the band width decreases. The exchange may eliminate the step-off defect, but it might be more due to thin skin in the upper pole, related to the weight and ptosis of your native breasts, combined with no muscle coverage to conceal the edges of the TE. You will have to wait and see if this persists after the exchange. If it does, wait several months and then have a fat graft transfer procedure to fill in the step off defect. It might take two fat graft transfer procedures, but typically fat grafting is pretty good at addressing this type of defect.
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Thank you!
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Hi Whippetmom, I'll be having a double modified radical mx on 6/18 and I'm still not sure what size implant to go with. I'm 5'6", 180 lbs with a 40" rib cage. As far as what kind of implants he uses, I only saw a poster for the Mentor implants in the exam room. I currently have implants which were placed 30 years ago and they are silicone and I'd like to stay with silicone. I have no idea what cc they are? I currently wear a 40C but I'd like to be a little bigger. At the time of my first consultation with my PS he recommened 350cc to 400cc. I don't know if that is going to give me the size I'd like or not? We discused MX to implant or MX to TEs but we didn't make a final decission on which way to go. My post op is on 6/6 and I'd like to have a more accurate idea of what I'd like before I get there. I feel if I'm giving my girls up due to BC I'd like something in return
Thank you
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Hi Whippetmom and everyone,
I recently had my exchange surgery on 4/13/16 and do not like my implants. They are natrelle 410 fx 495 ccs. Prior to my dmx I wore a 34 b bra and I was hoping to go a little larger with my implants. Ideally, I was hoping to be a full c cup, but I think that I am probably now a small b. They are full at the bottom but are very flat on top, when I look down at them they look like an a cup. I had thought that I wanted the anatomical shaped implants, but now that they are in I wish I had went with round. My natural breasts were small, but I think that they stuck out more, and that I had more cleavage. I don't like that these implants are very firm, and that I can not push them up to create cleavage.
I had talked to my ps about doing fat grafts to add volume because I really did not want to go through another exchange surgery and also I had wanted to have lipo of my hip pouches anyway, but now think that I am leaning toward switching out the implants. My breast surgeon went really high with the mx, and when I had in the TEs my chest under my collarbone was very concave, and that is why we choose the full height implants.
I am 5' tall and weigh about 120lbs and my ribcage measures 29.25" under my implants. The TEs were filled to 505 ccs each, which made me a d cup and really liked the projection that I had with them and I felt that I was more proportionate (I am a little bottom heavy). Now I don't have much projection at all, my stomach sticks out farther than my breasts, which is really sad because I really have a pretty flat tummy. I had realized that the implants might be a little smaller than the TEs, but I just didn't expect them to be this much smaller.
I would greatly appreciate any advice, Thanks in advance.
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wenchLori:
Why are you not having a skin-sparing mastectomy?
http://www.hopkinsmedicine.org/breast_center/treat...
Also, I would get a second opinion, because a 350cc or 400 cc implant would be far too small. You will want implants in the 700 cc to 800 cc range. I do not know what your PS is thinking. I would go to Indianapolis... See Christine Kelly, MD. wenchLori:
Why are you not having a skin-sparing mastectomy?
http://www.hopkinsmedicine.org/breast_center/treat...
Also, I would get a second opinion, because a 350cc or 400 cc implant would be far too small. You will want implants in the 700 cc to 800 cc range. I do not know what your PS is thinking. I would go to Indianopolis. See if you can get an appointment with Christine Kelly, MD.
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dgnani: I hear from more women unhappy with anatomical implants - far more so than women unhappy with silicone rounds. 😏 It is a connundrum....
So....Allergan Style 20, 550 ccs or 600 ccs or Natrelle SSX or SRX - 550 gms (this is an extra full projection style implant). Your skin envelope is sufficient....fat graft transfer should be the remedy for a step off defect above the implants, if one remains after the exchange. But a good bra will disguise and erase some of these imperfections and you will be amazed at how "movable" are the silicone rounds over the anatomicals.
Keep me posted!!0 -
Thank you whippetmom for your recommendation, it is greatly appreciated. I called the BS and she will do a skin/nipple sparing mx. She requested the approval for the MRMX just incase something didn't show on the mammo or ultra sound. I was told it's easier to ask for more than you need than to have to get insurance approval and go back in. We've been fighting our insurance for almost 2 months and she wants to be ahead of the game.
My PS said the implants he uses go up to 800ccs so going that big wouldn't be a problem. On my first visit with him the thought of TEs terrified me and I wanted to go directly to implant. After being on BCO for a while and reading all the different experiences it's not something I'd pass up if needed. I'll put my big girl panties on and do what I need to do to get the results I want. I have a pre-op appointment with PS on 6/6 to go over exactly what I want and make all somewhat final decissions then. Of course I can change my mind before the procedure starts.
I appreciate the referal for Dr Kelly in Indy but my Dh will be working while I'm in the hospital and the drive to Indy would be to hard for him to travel back and forth. I don't want to spend any more time alone after my procedure than is absolutely necessary and we have no family in the area. It usually takes 4 to 5 days for the nursing staff to get my bp under control after a major procedure, it drops dramatically and the last procedure I had I spent 8 days in the hospital. It was not much fun.
Thank you again for all your help and support!
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Lori: Thank you for the clarification! Tissue expanders are really not a big deal for the majority of us. I don't even remember what it felt like having them.0
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Whippetmom, I'd love your opinion on my situation.
1. Height: 5'5", Weight 116. Ribcage 29. 2. TE's are Allergan Natrelle Style 133, size 300. Model #133MX-11-T. Filled at surgery to 200cc. Double mx, nipple & skin sparing. Alloderm also placed. 3. PS had recommended gummy bear tear drop anatomicals. However, I was recently informed he is moving and he will not be doing my exchange surgery. Have not met the new PS yet that will be taking over his practice. 4. Pre-surgery bra size was 32C. Pre-surgery my bust measured 33 1/2" at it's fullest spot.
I definitely don't want to be any smaller than I was, slightly bigger/fuller would be great. What type will be better for me? The current PS is very comfortable with and highly recommended the anatomical implant, but I'm concerned the new PS may not be. Will I be in the position to have to find another PS at this stage of my recovery if the new PS doesn't like the anatomicals? Is the Alloderm also used if I choose to go with rounds, or is it only used for the anatomicals? How many cc should I expand to? My PS told me that we will stop expanding when my clothes fit the way I want them to. The problem I see with that, is that these TE's are rounds, so if I go with the anatomicals, my clothes won't fit the same after exchange because the whole shape is different. Pre-surgery I could wear an underwire bra and create some cleavage, are either type of implants "squishable"? So confused.
I'm a bit freaked out that I will be having to change PS in the middle of all of this. Any info you have will be much appreciated. Thanks for your help.
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vivorme:
The anatomical option would be around 290 or 325 gms...Allergan 410 MX style. That might be on the small side. However, I would recommend Allergan Style 20, 450 ccs or 475 ccs, smooth silicone rounds personally, if you want "squishable". Wait until you are filled to 300 ccs to seehow you feel about the size.
Yes, Alloderm applies to rounds as well as anatomicals. There also are the newer Natrelle Inspira implants which are rounds and are very good for reconstruction. You could probably go with the ultra full projection version Inspira - in the 400 gm range.
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FOR ALL THOSE WHO ARE THINKING ABOUT ANATOMICAL IMPLANTS, please read my thread header.0
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whippetmom,
Thank you for your advice! My 6 week follow-up appointment with my ps in on May 24th and I will discuss those styles with him.
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Hi Whippetmom,
5'4" 108 lbs. 28" ribcage circumference
Mentor 8200 Med 450 cc
PS only uses Mentor or Allergan round silicone (no textured or anatomical)
Prior to BMX I was a 34 DD. I had both nipples removed, and a lot of skin removed. When I was fully expanded to I believe approximately 400-450 ccs my skin was VERY stretched and thin-looking. The expanded breasts were too large, but the PS did reduce them prior to chemo. Realizing cup size is unpredictable, I prefer to be much smaller than my natural breasts--a full B or at the most a small C.
My right TE has migrated towards my under arm and has a "football" shape with excess skin on the lower inner portion of my breast.
I have ink on the margin of my chest wall (DCIS not invasive) and the BS I used at the most "prestigious" cancer research hospital in NC did NOT remove the fascia covering my pectoral muscle even though I had approximately 10 cm of LCIS and DCIS, so now I must also have radiation to the chest wall. RO said had the fascia been removed I could have avoided radiation. They also lost one of the biopsy clips during surgery.
My new BS will be removing both axillary tails that were not removed during BMX. I apologize that this is off topic. I hope it helps someone else...had no idea to question one of the most "experienced" BSs and MOs, who have graced the cover of Time magazine, in the state. I have since switched to the "highest ranked" cancer center in NC and have received excellent care. Everyone in the center has been amazing!
I have a new PS who will do the IE at the same time as completing my mastectomy. He recommends IE first then radiation. He will also be doing lipofilling. My next appointment with him is Monday, so I will find out if this will be done during or after IE.
Any advice on size, style, and the implications of radiation is welcomed. I sincerely appreciate your time and dedication to helping us.
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HomeschoolmomNC:
That certainly is a case of professional negligence. I am so sorry that you are suffering as a result, but let's move onward and upward and get you through this phase of your bc journey. So.....I think Mentor or Allergan high profile smooth round silicone implants with a volume of 400 ccs or 450 ccs would give you a natural result. This volume in an implant is not going to render the same appearance as will your tissue expanders with the same volume. You will be smaller. Bra size is a misnomer, because you could take 3 bras by different manufacturers and be 3 different "cup" sizes.
There are radiation threads here on bc.org, where women discuss different methods and products they use to protect their skin during radiation. I would spend some time on those threads.
Please keep me apprised of your journey. Let me know how the rads breast is looking along the way.0
