BREAST IMPLANT SIZING 101
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Thank you Frill! I hope you are doing good as well!
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Thank you Wildtulip I hope you are doing good as well!
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Thank you Whippetmom!
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Whippetmom and All, I was told I wouldn't need chemo/rads after my DBMX w/TEs. Now I'm told I have to do both chemo/rads. At my last appointment with my PS he told me the exact same thing that Whippetmom just said. I asked for advice here some time ago and my PS also agreed wholeheartedly with Whippetmom on the size of implant to use once I'm ready. With the chemo and rads my process is going to take longer but PS doesn't see any problems popping up. He wasn't happy to hear I was having chemo and rads after all. Especially being told over and over I wouldn't need to. Such is life andas long as there is life... I'll take it!
Thank you so much Whippetmom for all you do for us here. I'm sure I speak for more than just myself that we all appreciate and love you very much!!
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Hi there amazing women!
I am also, of course, looking for sizing advice from whippetmom and anyone who is willing to help me.
As for my stats, I am 5'7" tall and 150 lbs athletic build with a rib circumference of 34.5". My TE's were put in place on 05/12/16, and they are Mentor CPX 4 Tall height 650cc reference # 354-9315. My pre-BMX size was 36D. My left (BC) side was naturally always the bigger one, so during surgery they took more tissue from the left than from the right side. I have not been told that I am limited to a particular brand of implant so I would like a recommendation based on what would seem best or ideal for me and also that are choices for both Mentor and Allergan manufacturers.
During surgery my TE's were initially filled to 400cc on the right (non-BC) side and 420cc on my left (BC) side. As of today, they are currently filled to 680cc on my right and 760cc on my left. I would like to be the size I was before my BMX with a little more fullness and perkiness. I believe that we are very close to the correct size at this point but I do hope for more projection than I have currently with my TE's. This coming Monday I will see my PS again and we will check for final symmetry and discuss if we are done with fills and decide on implants and a date for the exchange surgery. My PS keeps reassuring me that the implants will not be quite as wide and will project more than the TE's and I know this seems contrary to what most people experience. My TE's sit very nicely on my chest, they are not in my armpits and they look much nicer than I had expected for TE's. So I am very hopeful and completely trust my PS, I just need more info and a little reassurance and advice.
So besides suggestions for proper implants, I'd love to hear if anyone has had the experience that their implants have more projection than their TE's had, and also, I would really appreciate any opinions on timing for my exchange. My PS usually waits 2 months after the final fill, is there benefit to waiting longer? I did ask on Exchange City, but I'd love your opinions here too.
Thank you so very much for any and all advice on this, and I appreciate your patience with this wordy post. My best wishes to everyone!
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whippetmom - I cannot find the thread "Fat Graft Transfer and the Radiated Breast". How do I find it? using Search function and typing in those words does not work. Maybe there is some other way to search that I'm unaware of.
I just had fat grafting in my radiated as well as non-radiated breast and my PS may do another round of fat grafting before considering placing TEs....all to help my radiated tissue.
Thanks for your help!
- xo
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WenchLori: Your PS is a good guy
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Heidishorizons:
The projection issue is discussed so much here. It is just different with implants. They are not projecting like torpedos off the chest wall. You will have to wear a bra. Always, I do not care what doctors say, when you have a previous history of larger breasts and you have large implants, it is just imperative that we support the implants. So when you wear the right bras for reconstructed breasts, you will have the shape you are supposed to have. My implants have the same projection as did my tissue expanders. You have 7.3 cm projection with your TEs. You also have tall height TEs, which I just think distorts the projection issue, because of the width to height to projection ratio. You can come close with ultra full projection style implants. Mentor or Allergan smooth silicone rounds - 800 ccs - 6.7 ccs projection respectively. I also like Allergan Natrelle Inspira ultra full projection, 695 grams. The Inspira implants have a higher fill ratio and a number of plastic surgeons feel that they improve upper pole projection for many of their patients. This is something to discuss with your plastic surgeon.0 -
MinusTwo.....thank you!
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Call me green, but would someone please explain projection and pole projection?
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I can't wait to wear any of my normal bras again. I want to wear bras with no mastectomy forms, no mastectomy pockets, that don't look like my great great grandmother would wear them . . . ! I have a Chantal Thomass bra I wore the night before my mastectomy that my bf never even got to see me in. I can't believe I'm even saying it, but I can't wait to wait to open the drawer that is gathering dust.
I'm almost plugging my ears and thinking lalalalalalalalalalalalalalaala fearing that someone is going to say - "You can't wear those bras ever again."
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Bird-of-light:
Projection is the outward projection of the implant off of the chest wall. The upper pole is the portion of the breast above the nipple areola complex, and the lower pole is the area underneath the nipple. That is the easiest way of explaining it I guess.
This is sort of an interesting study of what comprises the perfect breast in terms of upper and lower pole fullness/projection.
http://www.plasticsurgery.org/news/2014/whats-the-perfect-breast.html
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I've been reading this topic and learning SO much. Thank you Whippetmom, and others, for your information and guidance! The video about upper/lower pole is facinating.
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Thank you
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Hi All!😶 I really am not sure if this is the right forum to post on , if it needs to be moved I would appreciate that . I was diagnosed in March 2014 with invasive ductal carcinoma . It had spread to two lymph nodes and the tumor was quite large at 7 cm . I underwent many rounds of A/C therapy , Taxol , and Herceptin . After all chemotherapy was finished I had a bilateral skin sparing mastectomy in January 2015 . At that time I met with the plastic surgeon although radiation was still to be done and she stated that with radiation my reconstruction options would be limited to autologous tissue . I have not had good luck with surgeries and managing the pain with any medications I've been prescribed, and the enormity of the surgery and many incision sites terrified me . Anyway radiation times 35 end and I Just took a few months to heal up and think about my options . Many times I came back to why not implants why can't I do implants it would be so much easier , But felt I was stuck with a flap procedure that I wasn't sure whether I would want to do or not . I made an appointment to see the plastic surgeon last week , it's been 18 months since my mastectomy and over a year since rads were completed . Before I could ask any questions the doctor looked at my breast area she commented that the skin looks really good and that she preferred to do implants if I was willing . I was ecstatic this is exactly what I wanted . Then a few days later I started researching breast reconstruction with implants . I am so surprised at the complication rate that seems to happen for radiated skin . Now I realize why I was told a flap procedure would be my only option , but since the plastic surgeon suggested it I am very confused whether that means my skin seems to show that I would have a better outcome than the average for some reason , or she's changed her preferred method of reconstruction over the last year end just wants to give it a shot ? I guess I really wanted some opinions and advice from what you have been told by your surgeons after radiation end what your outcome was if you tried tissue expander with implants after radiation . Currently I have nothing in my breasts . The plastic surgeon has scheduled me to receive expanders in eight weeks and I just am feeling really confused and worried that I am setting out on a unwinnable journey . I would really love to hear from some people have been in this position and how it turned out for them and if anyone knows from their surgeons or can' imagine why my surgeon would have changed her mind or why she would be thinking of such a better outcome after radiation a year later . I'm sorry if this post is not very coherent I'm just in a very confusing place right now need a little help and guidance to get my thoughts in order end and find out what the best thing for me to do would be . Thank you so much for sticking through this post and for any and all replies advice opinions etc.
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Missy: There have been many advances in breast reconstruction after radiation - over the past two years in particular. Yes, you have a higher risk of complications, but honestly, I know a lot of women in the past eight years who have had successful reconstruction with implants. So absolutely it is worth a try. Please, please discuss the use of fat graft transfer with your PS. We just discussed this very issue a page or two back, so please look back a couple of pages and find the links and references I provided. We all wish the very best to you in this journey. It seems daunting right now, but truly, you get through it and the time passes quickly. Keep us posted on your journey!0
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Actually Missy, it was this page.....Page 462....scroll to the top.0
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Thank you Whippet Mom! I looked over the posts and articles you mentioned. Is fat grafting something that would need to be done before tissue expanders to give that hefty benefit? My PS had not mentioned it at all. The next appointment I have is 2 weeks before TE surgery, should I call and get in sooner if fat grafting is something that I am very interested in doing to possibly improve my outcome?
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Missy:
Here is what I said above to another gal having delayed reconstruction:
"What I have read and actually would prefer MYSELF, would be 1. TE placement and one round of fat graft transfer to the side which will have radiation during that procedure. Expand to as much as possible (if the TE is a 500 cc TE, expand at least to something around 400 ccs). 2. Go through rads. 3. After rads, wait a month and then continue expansion as tolerated. Wait at least three months for the exchange. 4. Exchange to implants and one more round of FGT to radiated breast at time of exchange."
In the other individual's case, she has not gone through rads yet. So for you, the tense would change to "TE placement and one round of fat graft transfer to the side which HAD radiation, at the time of that procedure."
So 1 FGT procedure at time of TE placement and the 2nd FGT procedure at time of the exchange to implants.
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Hi, Missy! I'm about to insist on this ..... I've been doing so much reading and looking the whole thing is driving me crazy. Also not knowing a plan because my DX kept changing early on meant I wasn't clear on the current recon plan, or if the PS was, is just not in my DNA.
Lol, I'll have this written down on my outline of questions. I had read about FGT on one of my ocd research excursions.
My problem is that during what was supposed to be my BMX and the placement, my bp went to nonexistent and they had to stop the surgery. Now my surgeon is scared to do surgery on me and wants as few anesthesia procedures as possible. I'm afraid that is going to play into recon.
My post is long and rambling too. It seems like a lot of confusing stuff, too many decisions that can be life altering and are overwhelming. I'm am about ready to give up on rads so I don't have to deal with that part of it.
And thank you, Whippetmom. I wish I would have come back here and talked to you sooner. I feel so much more prepared to meet with my PS (well her PA) and the RO in a few weeks to advocate my position, rather than just being led by the nose. I'm willing to listen to their side, but I want to have a side in all of this rather than just be nodding and agreeing the whole time
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Whippetmom, how does fat grafting replace the lat flap procedure? That question is probably improperly phrased. It seems so much less invasive, why wouldn't that be the way to go? I thought LD flap over the implant helped the implant feel more natural because of the irradiated skin. Fat grafting seems like it does the same thing without moving muscles around. Are there factors that would keep a dr from wanting to do fat grafting- besides lack of material?
I'm asking because I can just hear some "this is the way we do things here," which I don't want to hear at a research hospital.
Here's another question, which you may or may not be able to answer.... I already know I'm going to get resistance about TE placement before rads, especially when it's rads to the heart side. What is the issue with that? If I would have had TEs in and the decision to do rads was made, they would have been removed. I may have ranted my fear somewhere.....even though I had a skin sparing MX, I've lost weight and there's no spare skin. So after rads, won't there be even less to work with? Isn't tthat a reason to sstart?
I'll stop while I still sound coherent.
Thank you so much for any answers you have0 -
frill - Not answering for whippetmom, but wanted to add that I had fat grafting to assist in providing skin integrity to non-healing and thin areas so that implant reconstruction could be attempted - I did not have radiation, but my skin was treated in the same way as if I had. I had extensive necrosis, multiple surgeries with a lot of scar tissue. Doing this type of fat grafting is relatively new, and not all plastic surgeons are well versed in this procedure. The fat grafting provides vascularity and some skin thickness and increased pliability, and allows the skin to stretch over the implant. It does not replace volume (in most cases), or necessarily provide much in the way of shape over the implant itself. My understanding is that it does not replace the lat flap, but rather allows your surgeon to possibly do traditional implant recon due to improved skin integrity without having to resort to taking muscle from your back. Aesthetic fat grafting is a different procedure and is done for differing reasons. Fat is often added to fill dents, ease rippling, or fill upper poles left vacated by removal of breast tissue where round implants don't reach. It is important to note that these are two different procedures, and what fat grafting allows for radiated skin is the possibility that implant reconstruction can be done, which previously had a relatively failure rate - thus the flap recommendations. I lost an implant that had been in place for two years on the side with thin skin and previous problems, after I had multiple skin tears during a repair of my allograft. After several surgical tries to keep the implant and repair the tears had failed - the implant was removed. Lat flap was recommended at that time, but I have bi-lat LE, with more swelling on the right - didn't want any additional arm weakness on the left, compromised side if I could avoid it. I also have had extensive skin cancer on my back, with multiple wide excisions, and didn't want to move likely additional future skin cancer to the front over an implant. After six months I had a fat graft to the flat side, which was repeated several months later. Data shows that separating the grafts by time provides the best scenario for maintaining the fat - as whippetmom indicated in her post above. Several months later I had an expander placed, expanded successfully, and was able to have a new implant placed in May. I had additional fat grafting with that surgery.
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Hi All,
Whippet Mom, called PS today regarding fat grafting, was told that would only be done after exchange for implants .... I explained that I wanted the benefits to the breast skin to help the process but was told this was not an option. Feel more confused than ever.....not sure what to do now? Does this mean if I truly feel the fg will improve my odds that I should find another ps who is willing and able? Or take my chances since current ps thinks her way will be successful?
Frill, oh girl I love your post, ocd research excursion!!! 😄 I have those every single day!! I really hope your blood pressure behaves so that you can finish your journey!💜
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SpecialK: Thank you!!0
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Missy: Based on the studies I have read and the patients I have talked with who had FGT at the time of TE placement, it seems it would be preferable to do a FGT at the time of TE placement, but not all plastic surgeons want to do it. You have t be on board with the research behind improving the previously irradiated tissue as much as possible and some docs just do not want to do it. I do not know why. You could see Otto Placik, MD in Chicago. Pretty sure he would do it.
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Missy:
In this study in 2012, they performed FGT two to three times PRIOR to implant placement. So essentially this study describes a direct to implant placement following the fat graft transfer procedures.
There are plenty of studies out there and it is not new science. So it is not rocket science either.
http://www.ncbi.nlm.nih.gov/pubmed/21987041
Probably referencing the same study - which took place eight to nine years ago....
http://www.sciencedirect.com/science/article/pii/S1748681511001422
Here is the study data, utilizing fat graft transfer at the time of TE placement: From 2010....
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Sorry for the unciickable links. The website does not support my mobile device. I cannot use the link icon. I sometimes can get it to work in private messages, but not on my thread.
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whippet mom no problem, I can look them up, I really appreciate your help, I will check on Dr Otto too! 💜
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Whippetmom, I've talked to my PS about FGT and he said he doesn't do it at all. I've seen his before and after photos and I'm not sure how he manages to get the results he gets without the FGT but they are beautiful results. I'm crossing my fingers and hoping there isn't a photo album full of failures hidden in my PS office somewhere!
My hubby made the comment the other night that he doesn't think my lumpy bumpy chest is going to look anything like breasts when my process is done. I just smiled and told him to sit back, watch and take my pictures for me. I offered to make a bet with him but he just smiled and said he'd pass. Darn, I had the money spent already :-)
I've heard of the photo area on BCO but I can't seem to find the thread. Any help would be greatly appreciated. I understand it's a protected area of BCO and acceptance is needed. Thank you :-)
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