BREAST IMPLANT SIZING 101
Comments
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Hello Whippetmom,
On 13 October you responded to my question with this post:
I would go with Allergan Inspira, quite honestly. SRX - 615 ccs. Here is the question though: With a 30 inch ribcage you were wearing a 38 band bra? You should have been in a 34 band size with a 30 inch ribcage. So I think you also could use 650 ccs in the SRX Inspira. You would likely not need any extra fill. Tell your PS you do not want droopy breasts! If you have large skin flaps, you need to sufficiently fill up the skin envelope.
I had neglected to share that I have lost 45 pounds.
My Plastic Surgeon recommends Natrella Style 45 Size 600. I am expanded to 525cc now. He says he will remove some extra skin but I wonlt have "side" boobs.
Your thoughts?
Thank you.
Coach Vicky
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marimucho:
Please read the thread header. Especially read #1 and #8. I do not know any plastic surgeon who goes by "cup sizes" with a breast reconstruction patient. There are many bras out there and one bra might make you an "A" cup and another might make you a "B" cup. It is a matter of your chest wall characteristics, width of your native breasts, and gaining enough volume and projection to make a decent size mound when all is said and done. I am not sure what kind of "autologous" surgery you are referring to - is it a Lat dorsi or a DIEP or?
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Willa:
Yes, there are small implants which would work for you. It is a challenge to match a native breast, that is a "given", and this is why many women do augment the native breast with a small implant. What your PS will do, if you do not want to touch the native breast, is get enough expansion in the tissue expander in order to create a natural ptosis (droop) to match the native breast. Has your PS told you that you have capsular contracture?
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sarsmile:
Can you please private message me and attach a photo of your TEs? I want to see how they are placed. When you say they "touch in the center", that is something I want to observe before talking implant sizes. They should NOT be touching in the center. 13.0 cm should NOT be too wide for a 31 inch ribcage. My ribcage is 29 inches and my implants are 13.5 cm wide. Please send me photos.
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Coach Vicky:
Allergan Style 45 is a good implant. I cannot comment on the size, because I cannot recall your TE details.0 -
What do you need to know and I will send it.
Coach Vicky
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Whippetmom: Thanks for your response. I so appreciate your insight.
I emailed my PS with info about what is going on and she said I have contracture. The implant is sitting really high and is hard. It's also mis-shapen. She said she could eliminate the scar tissue at the exchange but I guess once you get contracture you are likely prone to it again. This is worrying me a lot.
The expander she put in was always slightly larger than my native breast. She didn't say she did that on purpose (to get a droop later) but based on your comment maybe she did.
I'm seeing her on Wed at which point maybe she'll give me some idea on the actual options for implants and we could be in touch again?
Thanks again!
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Coach Vicky: Read #1 in the thread header. Your vital stats and TE mfr, style, volume
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willa: I do not worry so much about recurrent capsular contracture, if you have a PS who will perform fat graft transfer. It can reduce the grade of the contracture to a manageable and tolerable level. I would definitely ask your PS to perform fat graft transfer at the time of the exchange, especially in light of having developed cc at such an early stage in the reconstruction process.
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These are the notes I have on my TEs:
Mentor CPX4 with suture tabs.medium height, style 9200, 550 cc.
Before surgery I was a 38G, 175 pounds.
I am 130 pounds and my rib cage is 30.
Thank you again for your help. I am grateful.
Coach Vicky
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Whippetmom: Thanks for your words of encouragement about capsular contracure. I'll talk to my PS about fat grafting and see what she has to say. I was also reading that it's best to move the pocket to another position, ie under the muscle if it was initially over the muscle, and vice-versa? I don't want to go under the muscle, though.. so we shall see.
Thanks again! Happy weekend to you.
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Willa: Yes, some plastic surgeons feel that changing position, going from a smooth implant to a textured implant - that doing something different will possibly reduce the risk of capsular contracture occurring again. I do not know about going from smooth to textured, but placing the implants under the muscle does seem to reduce the risk overall. However, with the success of fat grafting, I would not monkey around with removing and replacing implants. Wouldn't it be better to do something non-invasive as far as the capsule is concerned? So talk with your PS and keep me posted!
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Coachvicky:
Your tissue expanders have a width of 13.5 cm and the proposed Style 45 at 600 ccs has only12.8 cm. I don't know about reducing the width. Why a narrower implant? Your PS would need to do a lot of pocket work - to make sure that implant does not migrate around in a too large pocket. You can handle the 13.5 cm width.
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Dear whippetmom,
I have been reading through a lot of the older posts. I found one from last year where you were talking about eventually switching out your style 20 550cc (which you previously suggested would work for me) for SRX 580 with the same diameter of 13.5 but with a projection of 6.4. You stated the other option was a style 45 with the same diameter of 13.5and projection of 6.4 but was 700cc and you did not want to go that route.
My question is this. If the dimensions are the same, how are they able to contain different volumes?
My PS appointment was rescheduled for this Friday and I just want to be as informed as possible with what I might suggest I want.
Thanks!
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Hi Whippetmom: Thanks again for your input on fat grafting. In terms of doing something else - I need to exchange to final implant anyway so that's why the PS is suggesting she remove the scar tissue at that time. I don't want to keep the saline implant which is what she used at the original MX - I would like silcone. I hope this makes sense.
Thanks again! I feel like I'll be at least a little smarter when I see her on Wed
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Thank you whippetmom! As for the autologous procedure, I was referring to fat grafting. Maybe fat grafting is not considered an autologous procedure. Thank you for helping me. I appreciate it.
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luckyLady - the dimensions of the base and the volume can be the same, but the implants are various "shapes" - some are more "half dome, some more "conical" if that makes sense?
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I know the doctor said he will use a dome shape on me, as he finds them to look more natural on some patients and felt that they would look best on me. I am not sure what the cc's add up to, so that is why I am thinking of size in relation to cup size. This is all happening so fast. I breasts are perky but soft looking...I don't want to look like I have these hard mounds on my chest. I am petite. Plus, I know they would distract me if they were too large. I know I will have the advantage of checking out the size since I will have the expanders, but it is far away...at least my surgery seems like it will never get here, and who knows how long it will take to have them filled at all. I wish I had a better idea of what by chest will look like one day. I look online and see many and size is not clear to me as well as the amount of scarring. Some reconstructions with silicone implants are so uneven and dents. I think I am assuming I am going to have these perfect breasts like one does with an elective breast augmentation without a mastectomy involved.
Nothing is perfect. I know this is the case with cancer and treatment and reconstruction and everything else we must face. But I am learning that the more understanding I have and the more I narrow down my layman's ideas, the better I feel. I guess knowledge is somehow a way to feel I have control of something.
Thanks for the help.
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Thank you so very much. I believe my plastic surgeon's concern is my petite torso and my insistence that I don't have "side boobs.". He has seemed to be worried about me being too large. He said at our last meeting that he will have to remove skin from below my incisions. I had about 85% of my skins saved and there has been sag below the incisions since my mastectomies that expansion never completely filled.
Again, thank you. I will be better prepared when we meet again.
Coach Vicky
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orcaporkka thanks but that's the question.
The volumes of these implantsare different but the dimensions are the same. Same diameter. Same projection. How can there be different volumes? I'd like to know how that's possible and what effect it does have on shape before I even suggest it to my PS. My exchange is two weeks and 1 day away and I'm kinda going nuts. That's why I have so many questions about what will look right on me. I just hope after seeing her again Friday and talking this out will help settle things for me.
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LuckyLady:
it is because of the fill ratio.
"The Natrelle® Inspira® implants are designed with a 95% fill on average, offering more projection at every width of the implant. The result is more fullness in the upper pole of the breasts."
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Marimucho:
No, you said it right. "Autologous fat grafting". I was just reading too quickly. Autologous flap surgery is different, and that is what I read into it. My bad.
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We do have a Pictures Forum - photos of women here on bc.org who have undergone reconstruction. It is separate from the website. Please see the link for instructions. It is instructional only. You must contact Lilah or nowheregirl for entrance.
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Thanks. Whippetmom.
So since the dimensions are exactly the same (13.5 diameter 6.4 projection) does that mean the shell of the SRX is thicker than the style 45 and that is why one holds 700 and the other only 580? Does that make the SRX more firm like a tissue expander? Why would you personally want the SRX over the 45? I tried to get access to the picture forum but was denied because I haven't been a member long enough and haven't made enough posts. My exchange is before the minimum time period of a month passes. I appreciate your input
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LuckyLady:
A technical explanation from a Beverly Hills plastic surgeon, re:the difference between the new Inspira line and classic silicone rounds: I think it sufficiently explains it all.
NATRELL "INSPIRA" - NEWEST FDA APPROVED ROUND IMPLANTS FROM ALLERGAN:
"The new Natrelle INSPIRA™ implant is a silicone gel, smooth round implant. The smooth round implants are the more classic implant style as compared to modern anatomically shaped implants that mimic the natural distribution of breast volume. However, the new implant differs from other round implant options with its higher fill ratio.
The Benefits of Higher Fill Ratio
Higher fill ratio means that there is slightly more silicone gel filler per unit of volume. In the case of the INSPIRA™ implants, a more highly cohesive gel filler is also used. In my experience, I've noticed a slight difference in feel and lower wrinkle susceptibility in implants with a higher fill ratio. The denser volume of gel filler in the implant can result in a decreased chance of rippling and longer shell longevity."
My recommendation for the Inspira over Style 45 is related to all of the above.
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Hi whippetmom & bc community
I am 3 weeks post-op on BMX with direct to implants. As my swelling goes down, I am beginning to notice visually and through pain, that my Natrelle 410 implants sit very high on my chest. The top of the implant seems to be about 1" above the top fold of my armpit on my right, dominant side and slightly lower on my left. I experience pain near armpits whenever I move my upper arms inward and whenever I take deep breaths. I was hoping that they would "settle" but the more I read about drop & fluff it seems that is not applicable to reconstruction.
I asked PS to go small (A or
and with as much natural droop as possible but this things feel like they got shoved way higher into my pectorals than necessary or comfortable. My PS did not measure me before surgery and now I look at my implant tags and they say 255cc and FF (highest and fullest projection). Of course, no PS showed me any implant catalogues so I had no idea about height and projection.I swim, hike, run and I'm feeling devastated that he may have put in an implant that is too long for my body. I am not sure how to address this with him. Or if there are any solutions like banding the top of my breast to push them down. Wondering if you know anyone who has had this experience.
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Renee - please read the 'header' of this thread and provide your stats so that Whippetmom can give you an informed answer.
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Ahh, right. I am 5' 9 1/2" but torso is not long (legs are). Weight: 124lbs. Rib cage: 28 1/2".
PS used Natrelle 410, 255ccs, FF which translates to 11 cm wide, 11.5 cm high, 4.4 cm projection
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Hi Whippetmom:
I'm following up here because I saw my PS yesterday. I'm frustrated and confused.
As a reminder, I'm awaiting exchange from saline to silicone and have a confirmed grade 4 capsular contracture.
I'm 5 3 1/2; 108 pounds, ribcage 28.5 ( I re-measured). Generally I wear a 34 A or B bra.
My PS is not going to do fat grafting. She wants to use Inspira. My breast before MX was 140cc (or grams?) Gosh. Sorry, don't know how that volume is measured. She'll have Inspira 110 - 160 in the OR and see what looks best. Inspira is really new and very full, right? Wouldn't 410s be better because they have a more natural shape? My natural breast isn't full at all, although it' s not super droopy. The nipple points up. I do have prominent ribs/sternum and no fat for coverage of implant. That said, when I had the initial saline - prior to contracture - there wasn't any rippling and you couldn't see evidence that there was an implant in my body.
I am adamant about retaining a natural and very small look My PS says she understands. She's said this over and over. But I just cannot in a million years see how this Inspira implant is going to at all match my other natural breast. I feel like I'll have a barbie boob which is how I feel now with the cc.
Thanks for your insight. I'm trying to understand this situation and am just not getting it. These PS' do this stuff everyday so I'm sure they have their reasons but I need to better understand.
Hope your week is going well.
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Hi willa216,
I had 410s put in just over 3 weeks ago as direct-to-implant. I am not liking them but I posted to whippetmom that I think it is because the PS put in a size that is too tall. They start building my breast mound too close to my collar bone. And they are too close to my armpits. Unlike the round implants, the 410s also have a heighth measurement. Please go over this with your PS. I did not since I had no idea about heighth & width.
What I did do was go over & over & over that I wanted as natural/saggy (yes, I used those words) and small as I could go. I asked for an A or small B and sacrificed IMF incisions for lateral incisions so I could be smaller than the 34B/32C that I was. I'm probably a full B now but I did not want or expect my breast to start so high up. BTW you can view the 410 catalogue online.
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