BREAST IMPLANT SIZING 101
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Hi Whippetmom:
Hope your week is going well!
I wanted to check back in with you because of my situation with the capsulectomy and over the pec silicone implant - I have a history of seroma and, of course, contracture. The swelling has lessened greatly in the past week or so which is nice. Except now the reconstructed side is too small relative to the natural side. Be careful what you wish for, right? I kept going on about needing to be smaller after having what was a huge, projected and hard implant with the seroma/contracture..So, yikes. Does it ever end. Maybe I need to ask for a larger implant. More concerning is that I have so much rippling. My understanding from what I've read is that rippling tends to get worse not better over time. Also I'm concerned I may have signs of contracture again . There's a line that runs from my armpit toward the nipple that looks almost like a scar or a stretch mark - that area seems attached to the implant so the implant doesn't seem as mobile as it was. I think the pocket is supposed to tighten up a bit but that doesn't seem normal. I will go see my PS again. She said there's not much to be done about rippling. This is super disappointing because the first implant had no rippling at all. This one looks prune-like in the wrong light. Which is most light, really. My PS doesn't tend to use Alloderm so I don't have that. I'm wondering if I should ask for Alloderm, a bit larger implant or a re-position to under the muscle (initially I had really wanted to avoid that). I don't have much fat for FG and my PS isn't big on it anyway. Should I just wait it out for 6 months to see what happens - try to be patient? I, like all of us I'm sure, would love to put these reconstruction surgeries behind me as soon as possible so that I could feel like my body and spirit are truly healing.
Thanks again for all you do - for the knowledge, patience and reassurance. I hope all good things are coming your way and you're enjoying Spring, wherever you are!
Best wishes to everyone.
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Willa: Over the muscle placement is going to have a higher risk of capsular contracture and rippling will be more of an issue than it would be if you had implants submuscularly. Overs are just problematic. I think you have my opinion on the matter.
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whippetmom, can I just thank you. I am pouring through old exchange threads and have found a number of your posts and a wealth of imfotmation going back several years. The decision making process is very difficult. Your contribution to this topic has been so helpful to me. I appreciate it greatly. Again, thank you for your candor.
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Suburbs:
Absolutely! I am happy you are finding information to help you on this journey
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Hello Deborah; all!
Looking for input. Pretty recent DCIS Grade II of right breast, s/p lumpectomy a couple of weeks ago but didn't get clear borders. Pretty strong family hx and I'm young (39) but done with kids, so I'm going with B/L mastectomy, most likely with immediate reconstruction. They will have to take my nipple.
Met with plastics who said 800cc gummy bear immediately and I won't be same size, I'll be smaller than current which I'm ok with (I don't want back/shoulder issues from bra, and plan to lose weight, etc) but she expressed concerns about being proportionate as I'm curvy. I am 5'3 and 180lbs (working on losing weight, hopefully 20-40lbs), my ribcage is 34inches. Current bra size in a Fantasie bras are 34-36F (european sizing). Not candidate for DIEP per PS bc though I'm technically overweight she said my waist circumference is relatively small. I have a big butt
I'm worried that at my goal weight 800s would be too gigantic but plastics says 800 is already smaller. Need input! TIA0 -
pgmit:
"800 ccs" can describe a number of implant styles. It all depends on whether it is a moderate plus profile, high profile, extra full projection/profile and whether it is Sientra (although I am not sure if Sientra goes up to 800 ccs),Mentor or Allergan classics or Allergan Inspira implants. They are all silicone rounds, but can have different and sometimes significantly different dimensions. 800 ccs sounds fine, but make sure you know which manufacture and which style your PS plans to use.
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sorry for being vague. I know my surgeon uses allergan (not sure which, I scheduled an appt for tomorrow and can ask. They didn't have any 800ccs for me to look at and didn't discuss shapes/profiles so that's what I'm hoping to get advice on I guess. My breasts width along ribcage she measured about 15 and 16cm wide each. I don't recall the other measurements.
Her plan was over muscle too if that matters. What should I ask if anything at appt tomorrow? They said they didn't have many pictures of women with larger breasts like mine and my age (39) at my curvy yet petiteframe...her words not mine!
TIA!
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pgmit - I may be wrong, but I didn't think that the original Allergan 410 "gummies" were used over the pectoral muscle. You'll have to ask. You'll also need to clarify the size, type, style number of the tissue expanders that the PS plans to use. If you are having anatomical implants down the road after expansion, that will be very important to hold the implants in place.
Ask to see & hold a couple of different types of implants. Ask to see pictures of some of her reconstructions. Discuss the differences between round & anatomical and which she prefers and why.
I'm sure WhippetMom will have more ideasb
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Minus two, thanks for input! I will add those to my list of questions/requests!I won't be getting tissue expanders as the will be leaving most of skin and just taking nipples. My natural breasts are large enough that I will have enough skin and pocket I guess. So I'm not sure if that factors into things? So nice to have you ladies that have more experience! I'll take all the input I can get
TIA!
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Hi there! I just had my second fill (of probably three, maybe four) and am starting to think about exchange.
My expanders are placed prepectorally - Mentor Artoura, Ultra High Profile (TEXP110RUH). 455cc, 11cmx11cmx7.6cm. I'm currently filled to 250ccs.
I think I'm more or less happy with the current volume of my expanders, but I feel like they project too much. Looking at the dimensions of Mentor's anatomical implants, the model with the greatest projection appears to be 7.1cm. Does this mean that I will lose some of the unwanted projection from the TEs when I undergo my exchange?
Thank you in advance!
Ashley
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breastcanceryogi:
The anatomical implant chosen must closely correspond to the width, height and projection of the tissue expander. Typically one with slightly greater dimensions in order to get a snug fit. So when you mention a 7.1 projection anatomical, I presume you are referring to the largest volume anatomical in the moderate height high profile category? If so, that is not the right implant. Honestly, I just cannot pinpoint a good anatomical match for your 7.6 cm projection Artourra TE. You are in the US? Are we looking at the same Mentor chart?
Also....what are your stats? Please provide response to #1 in the thread header.0 -
whippetmom- thanks for the reply. I apologize for not following the instructions! I think I was half asleep.
I'm 5'10", about 145, and approximately 31-32" ribcage.
When I mentioned the 7.1 projection, I was just looking at the biggest volume for reference, yes. I agree it's not the right implant. Yes I'm in the US.
Until I looked at my implant card, I hadn't realized that there were *ultra* high profile TEs! From what I've read, it seems like it's a much more common problem to not have enough projection than too much.
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breastcanceryogi:
The Artourra tissue expander has some unique properties, with advantages over most other tissue expanders. I have only had a handful of women with the Artourra TE. This is from theMentor website:
" The Artourra Breast Tissue Expander is the first and only expander capable of providing precisely controlled pocket formation for more predictable expansion outcomes. The ARTOURA™ Breast Tissue Expander is the only expander with Dynamic Control Technology™ designed to prevent unwanted dimensional changes for more consistent and desirable results."
The question for your PS is "what implant do you plan to use?" He presumably has controlled the dimensions for a specific implant, if he's thinking of an anatomical implant. However, I don't know where you are now in terms of projection. Only your PS knows at this point. He must know which anatomical implant will approximate the dimensions of your tissue expander. If I were to guess, the most likely anatomical would be 390 mL moderate height high profile, with the following dimensions : 12.0x11.3x6.0. Generally, the increased projection could be providing natural ptosis/droop. I just do not know how that corresponds to an anatomical, which has a risk of rotating if the pocket is not specifically created therefore. I think an option would be a Mentor ultra full projection smooth silicone around, 535 mL. The dimensions of that implant would be 12 cm in width by 6.1 cm projection. One size smaller would be 480 ccs with dimensions of 11.4 cm x 5.8 cm. Also worthy of consideration - the most often used Mentor silicone round, high profile - perhaps 450 ccs.
The reason I asked if you were in the states, is because the European Mentor anatomical implants are different than those in the US, and actually have dimensions more closely representing those of the Artourra TE.
By the way, how do you feel about the width of your tissue expander's? Do you feel they are proportionally situated on the chest wall? Or do you have a pretty wide gap in the cleavage area? Just wondering, because with your ribcage dimension, I think you could easily use an implant with a width of 12.0 + cm.
So, in the final analysis, with this Mentor Artourra tissue expander, I think you just need to pick your doctors brain about what implant he has in mind for you. Please come back and let me know what he has to say.
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pgmjt - I have Allergan 410 gummies and they are pre-pec (on top of the pec, not under). They are wonderful in terms of comfort! I am incredibly active with a lot of sports that involve use of my arms, as well as in an active profession (PT), and I also do push-ups as required for my annual military fitness test. Under the pec was absolutely not an option per my surgeon due to my activity level, and I would allow it anyway. My size implants, however, are small compared to what you are seeking. I wanted an A-cup, but the nurse kept saying they had to over expand and so when my surgeon exchanged for implants he went with the tightest fit in the pocket (needed for anatomics), and what matched the volume of what they took out (TE + fill) and that was a 310cc. It was like a C cup on me. I was very upset and hated how big they were. He exchanged the non-radiated side for a 250cc 10 days later, but the radiated side wasn't healed enough to tolerate more surgery so that will happen in 2 more weeks (8 weeks after the initial exchange). The 250cc is a B on me so I'll have to live with that. They can't size down any smaller because nothing smaller/flatter exists in the footprint (width/height) I need. Anyway...my point is that even though I haven't seen them supported much on this thread, pre-pec anatomic implants are great for the right person and that person is usually very active and uses her pecs a lot for work and/or sports. An anatomic and a round look very different when placed over the pec. The anatomics are closer to a natural shaped breast. Mine do have a little rippling, but I don't have much body fat (not enough to fat graft). There are threads on this website for women who changed from under the pec to pre-pec for better comfort with active lifestyles.
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thanks for sharing your experience. I also have a pre pectoral TE, and I used to be active (before all of these medical isdues) but not as active as you-I'm sure I would not be able to pass a military fitness test. It took me almost a year to lose my strength, so it will take time to regain it. My PS is very happy with how my TE looks. I do not know how many cc my TE is. He asked me to try to access if my 2 sides are symmetrical. Since I have only one TE. I was a c cup, and for the sake of fitted clothing and what I am used to , I am going to try to stay this size. The TE side feels about the same as my natural side, altho the projection is slightly less on my TE side. Maybe that means I need a bit more expansion? I will see him again next week. At this point I am amazed how , even with a TE, I really don't feel like I had my breast removed. Ok, not that much, but I am glad I made this choice.
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whippetmom- thank you for your thorough reply! At my next fill (two weeks from now), I will definitely ask my PS what implant(s) she intends to use. I'll report back!
Now that I have had a few days to get used to them, I believe I overreacted on the projection. I think it may just be that TEs are awkwardly shaped! 🙂
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Whippetmom:
Back again for another round of advice.
I had BMX 2/27. Just had my first fill this week due to infection which cleared nicely (here's praying never to return!).My stats:
- 5'.2", 95lbs, ribcage 27.5/28"
- TEs: Allergan 133MV-11 -- MEDIUM (250cc I believe)
- Filled to 50ccs at surgery, then first fill this week of 75ccs. I was not going to go for that much but we went to 50cc and I was fine. Did not hurt but I'm healing and everything has gotten better. I guess because it's been a bit since surgery. Nipple/skin-sparing, so I have not been shocked by the "look" of anything.
- Pre-BMX size: AA/A (I got 32s but not sure I was every fit properly.)
- I have pretty good "space" between breasts. But otherwise, at this point with only 125ccs there, nothing really weird going on.
- No chemo/no rads.
I know cup sizes are hard to fathom, but I want to go small B. I'm afraid of ending up too large. My quandary: my surgical PS is in Houston and my local PS doing fills. I can choose either for surgery but their styles vary. I like both -- females. And would love to stay close to home for this round. Local wants to fill more quickly (once week from now on -- pushed for 75cc for first, but we stopped to see at 50cc, and I agreed). MDA PS more conservative in approach. They do not overfill and are very centered on my petite frame. I'm getting advice from both freely.- What do you feel would be good "estimate" to shoot for with fills? (Again, I realize no perfect answer.)
- And how in the world do I determine all this about what type of implant? I don't want a round LA look. I'm a bit of a tomboy, want more than I had, yes, but I play tennis badly and snowboard. Honestly, at 50ccs, I was about as big as before! LOL I'm already feeling a bit freaked by having 125ccs because I'm just used to being small.
- Final question -- realize just your humble opinion -- but how long to wait between final fill and surgery? MDA wants 3 months -- local 6 weeks. Lovely. How do I know what is best to do with differing opinions?
THANKS!!! Your advice is most comforting in this madness we find ourselves in.0 -
Eastcoast:
My preference:
Fills: every two weeks
After final fill: 3 months to exchange.
Are you getting silicone rounds or anatomicals
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Thanks, Whippetmom!
I have NO idea what type of implants I'm shooting for. We have not discussed yet. I've just had my first fill. Guessing I should start discussing now.
Any suggestions based on my body size or request that it not look too "round" and artificial? I'm sorry, I guess I'm fairly uninformed on this piece. I've done so much research on all other steps, just getting to this now following surgery.If I only fill to 250cc -- what is this typically going to relate to with regard to cup size? ANY way to guess on that? I don't think I'm going to be able to tell where I want to be or am based on this "clunky" TE look. I've read lots on this forum and realize the TE is higher profile and larger. It's just hard to imagine how I'll look and what to advise the PS regarding.
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Do you know which implants are causing a form of cancer? I read about it being the ones with the ridges. Are those the ones that are also called the gummy bears? I had the Inspira implants.Is that one safe? I haven't seen any reports listing the brands.
Thanks!
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Any implant can be textured. However - it is important to note ALCL is EXTREMELY RARE. Also that it is treatable and not usually fatal. I don't think we should be starting any scare campaigns. Most of us with reconstruction are monitored very carefully.
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I am brand new to this but am worried. I had a bi-lateral mastectomy in February I had mentor TE put in. So far I have 735 cc's in each. I am 5'6" and have a broad chest and back. I never had a big chest, was a small B before mastectomy. I was hoping to be a solid D with reconstruction. My PS won't tell me much about my TE, he says I will get to many different opinions. However, I know that the fill isn't to 600cc with a overfill max of 800cc. Because they look so differently than a natural breast, I can't tell where am. PE keeps telling me I will know when I'm happy...I don't know that I will. I'm so confused. I'm afraid I won't be big enough or I will be to big. Please help, I'm so lost and confused. Idk if I'm even in the right place. Any help would be great
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I wasn't trying to start a scare campaign. I just asked a question.
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Gosh, I have not been seen by anyone regarding my reconstruction for six years!
Maybe I should get a f/u appointment one of these days..😉0 -
EastcoastTS:
I would look at Allergan Style 20 - 300 ccs or Allergan Inspira, SRF- 265 ccs or 295ccs. Discuss these with your PS. Your implants will need to be brought more medially, if there is a considerable gap.
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Leslieinva:
You have smooth round implants. There are a lot of choices now with implants. I have just always preferred smooth rounds, but that is just my own personal preference.
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Yvonne:
If you want to send me photos, you can do so via private message. What is your weight and rib cage circumference
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Thank you!!!!
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WhippetMom,
My Plastic Surgeon said my first mammogram will be six months after reconstruction. Then I will have annual mammograms. FDA regulates my implants are scheduled for breast MRI at the 3 year mark and then every 2 years.
This was also the one who told me I would ALWAYS need a bra! He recommended that I sleep in a support vest because I sleep on my back. He said over the years my implants can shift to my sides.
I hope this helps
Coach Vicky
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Hi..have been reading this forum for a while now and getting great info - thanks. I need some help with the next step of my journey...choosing my implants. After my BMX (no radiation) I currently have tissue expanders under the muscle...Allergan 133-MX-14, 14cm wide, 13cm high, 7.1cm projection. I am 5'2" tall and currently weigh 185...did gain 10 lbs from chemo that I have yet to lose. My ribcage measurement is 37". My previous bra size was 40B. My PS uses Allergan implants. We haven't discussed implant size yet...my TEs are 600cc, currently filled to 660cc. Right now TEs are high on my chest, without good projection - I would like to have good projection with my implants. PS said she prefers round implants. Advice appreciated...thank you.
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