BREAST IMPLANT SIZING 101
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Just wanted to update that I had my exchange on Weds and except for the nausea that has followed me the last couple of days I am happy that this is finally done. My plastic surgeon ended up using Inspira SRF 560 and even though I am still swollen because of pocket work done on both sides I know she helped me make the right choice for me by using the SRF and not the SRX. She was also able to decrease the major space between the implants and I am sure I will be happy with the final outcome. Thanks again for all the info to help prepare me for this stage!
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hello, thank you so much for dedicating your time to this topic! My daughter googled something for me about how to determine best breast size and ended up on a Reddit page -- you can imagine it was fairly offensive and certainly not helpful!
I have ILC in my left breast, and am 10 days out from my first surgery -- three lumps and five nodes removed. Lymph nodes clean (thank god) but margins were not. ILC is a sneaky bastard. Anyway, will be having a double mastectomy in the coming month.... at a current size of 36F, no way I want to replicate that size, and my only option for reconstruction is implants given my smallish frame.
I've had my initial consult with the PS, and unfortunately did not ask which expander he uses; however, I can report that I am 5'5", 145 (although am on a diet regiment to take me down to 135) and measured the circumference of my chest just below my breasts at 33". As stated above, I am a 36F. If it matters at all, I am also short waisted.
Thank you for any help you can provide... my initial thought was a C or D cup (have no idea how that translates into volume), but having an experienced person opine on what would look best would make me feel so much better!
Thanks
DCBC
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Hi Whippetmom,
Thank you for providing the support that you do. It is greatly appreciated. My TE's are too wide. The PS put them in because I had so much extra breast tissue. He knew I wanted to be small and wanted a Diep. I did not want inserts. I like the idea of having my own skin and fat in my breasts. I lost about thirty pounds from stress since surgery.
So, I have a lot of extra skin by my abdomin but not a lot of fat. My skin was stretched out from pregnancy 19 years ago. Do you think it's possible to have a diep or something similar now that I lost all that weight?
I will be having radiation so I do not know how that will affect future surgeries. My understanding is that radiation continually shrinks the skin. Is this still true?
Thank you.
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Thank you, MrsB, for reaching out! I am so anxious now about finding a doctor who has done a large number of capsular contraction surgeries with as long term a success rate as possible. I like my PS, but I do not have much confidence that anyone in Arkansas has a high level of expertise with capsular contraction. I also need a pocket revision on the right. I have been doing massage and taking vitamin E per my doctor, but I do not see improvement. Instead, I think it is worsening. Bras that fit well for a while are not feeling comfortable, nor fitting well. Is it permissible for people to post specific recommendations anywhere on this site? I saw one post asking about 3 named physicians - a Dr Welk (?) in Seattle, Cassileth in CA, and one other doctor I do not recall. Like everyone, I want the next surgery to be my last breast surgery!!! I know it may be expensive, but if it is done well, hopefully I will be through for a long time, if not for the foreseeable future. Maybe I am unrealistic
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SeattleBound - I'm sorry I wasn't able to be of more help. I don't know the policy guidelines of posting specific recommendations but Whippetmom should be able to help soon. I understand the feeling of wanting to make sure you get an experienced recon/revision PS. My original PS thru my HMO was not experienced in recon. I lived with a less than satisfactory outcome for 5 yrs. until I developed cap. contracture. By a huge stroke of luck my HMO referred me to a great recon/revision PS! Before my appt. I did go online & researched specialists in my area but once I met her I knew I was in experienced hands. She convinced me to go thru expansion again both sides (which I didn't want to do) in order to get the best possible result. She is a perfectionist & my final outcome (surgery 9/15/16) is better than I could possibly have imagined. She used alloderm & Mentor anatomical implants for their textured surface which is reputed to have some effect in reducing cap. contracture although I don't think it's clinically significant. Also visit the Exchange City thread on this site & see if you receive additional advice there. I don't think you are unrealistic in any way. You want the best possible outcome just like the rest of us! Best wishes for a wonderful 2017!
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SeattleBound - I'm sorry I wasn't able to be of more help. I don't know the policy guidelines of posting specific recommendations but Whippetmom should be able to help soon. I understand the feeling of wanting to make sure you get an experienced recon/revision PS. My original PS thru my HMO was not experienced in recon. I lived with a less than satisfactory outcome for 5 yrs. until I developed cap. contracture. By a huge stroke of luck my HMO referred me to a great recon/revision PS! Before my appt. I did go online & researched specialists in my area but once I met her I knew I was in experienced hands. She convinced me to go thru expansion again both sides (which I didn't want to do) in order to get the best possible result. She is a perfectionist & my final outcome (surgery 9/15/16) is better than I could possibly have imagined. She used alloderm & Mentor anatomical implants for their textured surface which is reputed to have some effect in reducing cap. contracture although I don't think it's clinically significant. Also visit the Exchange City thread on this site & see if you receive additional advice there. I don't think you are unrealistic in any way. You want the best possible outcome just like the rest of us! Best wishes for a wonderful 2017!
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Thank you, MrsB88! I have found many specific names since last posting. Would you share your PS's name
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Hi SeattleBound - Just sent you a private message with the info.
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SeattleBound:
For now, please read through this thread....where capsular contracture and fat graft transfer is discussed.
https://community.breastcancer.org/forum/70/topics/744891?page=1
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SeattleBound:
Additional links...
http://www.jaimeperezmd.com/photogallery/fat-grafting-to-breast-11170/breast-capsular-contracture-50306
http://www.breastreconstructionandaugmentation.com/correct-breast-surgery-complications-with-fat-grafting.html
http://www.egms.de/static/de/journals/iprs/2013-2/iprs000023.shtml
https://www.ncbi.nlm.nih.gov/pubmed/264306230 -
DCBC:
You will want to discuss with your PS his plans to reduce the size of the skin flaps at the time of mastectomy. So it is a two-fold plan, e.g., to perform the mastectomy and create two skin envelopes which have been reduced as much as possible. You will want to discuss with your PS, the goal of ending up with smooth round silicone implants in the 500 cc to 650 cc range, again, depending on the size of the skin envelopes post mastectomy. So hopefully a tissue expander with a width of 14.0 cm to 14.5 cm. You would be a candidate for a higher projection TE - and higher projection style implant.0 -
Nanpop: Your PS will need to answer these questions regarding whether you are a good candidate for a DIEP. Certainly, the prospect of radiation makes the topic of a DIEP even more logical, in light of your desired result. Please discuss all of this with your PS and let me know what he has to say
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Thank you for helping MrsB88
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Whippetmom - thank you for the suggestions for building arm strength without putting pressure on my pecs! I also wanted to let you know that my PS used 300cc high profile Mentor smooth round implants - smaller than what you suggested but she was concerned about my thin skin. My left TE had migrated up my chest and she was able to reconstruct my IMF so that the implants are even, which was my main concern. I'm fairly happy with the outcome so far. I am wearing a 32D size bra. Even though I have lost a lot of weight since Dx, this is an increase in cup size from 34B. I will have fat grafting in a couple of months to address some rippling - Does fat grafting also increase size?
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PS appointment 3 weeks post EX this Thursday. I feel like such a heifer with 750s!
Still, counting my good fortune at dodging the rads, chemo, infection. I think of everyone struggling with these challenges.. you are in my prayers.
Just got access to photo forum, will post up real photos when final verification comes. Not good, not bad, just real.
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Whippetmom and others
What is the procedure to remove TE without implants? Does the muscle reattach?
Can the expanded skin be used with tummy tissue? Sounds like this could be plan B for failed implants
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Seattlebound and Whippetmon - my sister used Dr. Love when he was pioneering the use of shaped silicone implants almost 20 years ago and my mom went to him when she had her implants replaced (both mom and sister had cosmetic augmentation, not reconstruction) but they had a great experience with him and his staff in OK. Just wanted to throw in my 2 cents
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Thank you, Orcaporkka
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Hello Whippetmom and Everyone:
I am new to the forums - this is my first post! I am scheduled for Bilateral Mastectomy with reconstruction (expander placement) on January 27th. I have previously met with my PS but am meeting with him again on Jan 11th to go over my reconstruction plan.
I have realized from reading through this thread that there are many questions I should be asking my PS that I had never thought to ask. What are the questions you consider ESSENTIAL to ask my PS at my Jan 11th appointment?
I did learn at my initial consultation that he uses Alloderm, expanders (not sure of the brand/style - but will ask) and the "gummy bear" implant.
I am 5'3", 120 lbs. My ribcage circumference is 29.5". My pre-surgical bra size is 32E. I am looking to be MUCH smaller than my natural size (no bigger than a B cup). My mastectomies will not be nipple-sparing.
Thank you for your help!
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whippetmom,
Wow! What an incredible set of articles and links with a wealth of information. Thank you so much!! With all the time and effort you have given to so many of us for so many years, I hope it is rewarding to know how helpful you are and what a difference you can make in lessening the sometimes overwhelming sense of helplessness that I, for one, feel.
I wish there was an easy way for every woman facing decisions at every point to find all the information in one place. It seems one set of information leads to others. It is a process of following trails to an end point, then back-tracking to follow another! The same with researching plastic surgeons. My questions after the most recent researching are listed below. I am certainly not asking you to do any work for me nor do I expect all the answers from you. If you know where I might find any of the information, that would be great. Taking this route will be costly for me, so I need to do my best to narrow the field!
1) From the different types of fat grafting, which types/methods are preferred or known to be most effective with the least problems? (The Brava stretching sounds unworkable to me 😳 with the number of hours required to wear the cones and multiple treatments - out of town, for me, over several months.)
2) Would I be correct in thinking that problems following a mastectomy (such as capsular contraction) would be best handled by a PS who does a lot of post mastectomy reconstruction work?
3) Is there any resource that can give statistics re: the success rates of a given procedure, or a particular surgeon's success rates? For example, it would be helpful to see if certain doctors have better outcomes in treating and preventing future capsular contracture through fat grafting - with or without implant replacement.
4) Is there a list of doctors who members of this site have used that have been successful in pocket revisions, treating capsular contractions and using fat grafting when indicated? In one topic thread, a member posted a list, primarily related (I think) to doctors who will do prepectoral implant placement.
Finally, on a personal note, have you heard of a situation like mine in which the PS could not get the TE fully up under the pectoralis muscle, so the pocket developed differently from the other side, but a subsequent PS was able to modify the pocket to achieve a similar result on both sides?
Again, thank you very much. It is a real comfort knowing you are thete
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Birdergirl:
It is not so much asking questions as it is RELAYING and COMMUNICATING to your plastic surgeon what you hope to achieve from breast reconstruction. You have large breasts and the size of your skin flaps will dictate to some extent the size of implant your PS will need to use. Cup size is not even relatable here, because implants, post-mastectomy, will not look like native 32E breasts, without all of the fat and connective tissue and weight/heft of your native breasts. I think that probably implants ranging from 450 ccs to 550 ccs would be appropriate and you would certainly not have the appearance as being as large as you are currently. You want to discuss size with your PS and let him know the range you are considering, because this will dictate the size and style of tissue expander he will use.
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Hi everyone!
I continue to read and research everything I can since my capsular contraction and my other implant migration are now becoming noticeable in clothing. Does anyone have feedback about Dr Richard Baxter who is north of Seattle, Dr. Lisa Cassileth in CA, Dr Hilton Becker in Boca Raton, Florida, or Dr Lewis Albert Andres in Scottsdale? I have focused my search specifically on doctors who specialize in, or list and have photos related to, reconstruction after mastectomy.
I cannot find any complaints or malpractice claims on Dr. Baxter and I am impressed with what he has written on his own website blog as well as answers he has written on realself.com. Baxter, Cassileth and Andres seem genuine and humble which appeals to me. Dr. Becker gets a lot of good reviews but also some complaints, as does Cassileth. Becker has invented a number of products and tools related to reconstruction which can be great, but I also worry a bit about that.
Thanks to all who share their experience and knowledge! All comments are welcome
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SeattleBound:
1) From the different types of fat grafting, which types/methods are preferred or known to be most effective with the least problems?
Answer: If you do need or desire to correct contour defects, step-off defects, rippling, the fat is harvested from the abdomen (usually) or outer thigh area (rarely). It depends on where you have the best fat to harvest. No, the type of corrective FGT we are talking about has nothing to do with the Brava method.
( 2) Would I be correct in thinking that problems following a mastectomy (such as capsular contraction) would be best handled by a PS who does a lot of post mastectomy reconstruction work?
Answer: Not necessarily. Your PS may be fine for the job. B
3) Is there any resource that can give statistics re: the success rates of a given procedure, or a particular surgeon's success rates?
Answer: No resource and no list - other than my plastic surgeon list, but it is not specific to revisions or addressing complications.
Finally, on a personal note, have you heard of a situation like mine in which the PS could not get the TE fully up under the pectoralis muscle, so the pocket developed differently from the other side, but a subsequent PS was able to modify the pocket to achieve a similar result on both sides?
Answer: Yes. Some plastic surgeons are just more skilled than others.
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Thank you, Whippetmom.
Is there a place I can share surgeon information to help other women? For example, I am specifically identifying reconstructive plastic surgeons who
-Specialize in breast reconstruction and revision (versus augmentation revision surgery)
-Are skilled in using ADMs (Acellular Dermal Matrix such as Alloderm)
-Perform "pocket revisions"
-Do "prepectoral" implant placement as well as under the pectoralis, when indicated for the patient
-Use fat grafting to augment/fill in areas, as needed (versus moving/transplanting flaps with or without muscle)
I would love to help other women seeking the same skill sets. There seem to be a lot of PSs who primarily do DIEP, TRAM, SGAPand other flaps, especially at teaching and research centers.
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SeattleBound:
You could start a new thread...maybe entitled "Breast Reconstruction/Breast Revision Specialists" or something like that. You would then monitor that thread and invite other women to share the names of plastic surgeons they would like to add to the list. I think you want to refrain from, and also, in the thread header, advise women to not make any defamatory comments or issue complaints or make negative insinuations about a medical provider. This would be in violation of guidelines of this website. It could also be damaging, from a legal standpoint. If someone wants to share a name of someone to avoid, I always ask that they do so privately, via private message, to whoever is inquiring about that particular plastic surgeon. You would not want to put "plastic surgeon names to avoid" on your thread. You might want to private message the moderators and ask them for guidelines.
I think this could be a very helpful service. But you need to do research on your own and add information to your thread, in order to keep it active in the early stages. Best of luck!
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Whippetmom
I posted on the main breast reconstruction page but I thought I'd also directly ask your opinion of what you think might be causing major rippling all around the implants at only 2.5 weeks post exchange. I can see deep rippling on the outside of both implants when I'm just sitting or standing. If I bend over the deep ripples are everywhere, top, insides, outsides, and if I feel the bottom it seems like they are there as well.
I thought I ask if you thought maybe this could be an implant size issue? Maybe she should have used the SRX instead of SRF. I don't know but I just hate this.
As a reminder, I had Mentor Artoura High Profile 375cc expanders filled to 400cc and then exchanged those for Inspira SRF 560cc implants. My chest measurement below implants is 32".
Thanks for your input or anyone else who has dealt with this issue.
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LuckyLady:
It is either due to thin skin and/or often the skin envelope is just more elastic and is larger than the implant. Your TE width was 12.0 cm and your implant is 13.5 cm. The TE was 6.4 cm projection and the implant is 5.7 cm projection. So the TE to implant size ratio is fine. I had a lot of rippling - two fat grade transfers (spread out by 3 months post-exchange and then another one, four to six months (cannot remember) after the first FGT.) Sometimes the capsule just forms around the implant and you see diminished rippling, which is why you always want to wait 3 months before doing anything.
As for bending over and seeing widespread rippling....well, that happens to nearly all of us. Certainly it does in my case, even 8 years after reconstruction. So my advise there is not look at your breasts when you bend over.
Give it more time. There are always options for correction.0 -
Whippetmom
Thank you for responding and sharing your experience. It helps
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Birdgirl
Read post Jan 3 Whippetmom to DCBC re going smaller.
I wanted smaller and my research and PS and Whippetmom were concurring Inspiras maybe 580 but because I had so much skin at exchange, I ended up about same, but a bit wider with 750s. I'm not unhappy, but I didn't get what I wanted. You should address before surgery and get a plan so you get what you want. Are you keeping your nips? Nipple placement may come into play. Did you discuss with PS on your 1/11 appointment?
Whippetmom will have good advice for you.
My only regret is that I didn't find this forum before I started my BC journey!
Good luck. Keep us posted
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