BREAST IMPLANT SIZING 101
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Hi Whippetmom,
I think my question is going to be how much bigger can an implant be than the expander? Thought I'd say that upfront because I'm sure I'm going to ramble through this post. I had my expanders placed 2 1/2 weeks ago in between chemo and rads so my fills were/are going to be aggressive. I have 400cc Allergan 133MX-12-T. My original BMX was is Dec. Nip and skin sparing.
I was expanded to 300 during placement and the plan was to add 180 at my first fill two weeks out(I know that's a lot) and then another 60 during rads(my RO said he'd be happy to remap).
However when I got to my appt 2 week appt Monday the nurse had 60cc prepared(I know that's the typical amount). I told her the original plan was to add a lot more if possible. She left the room and I could hear her tell him this through the door, when my PS came in the room he said he would try to add 100. He did and I was fine. I'm expanded to 400 now but was expecting to reach closer to 520. Not sure how the plan changed since he didn't examin me before the change. Anyway, I told him I still feel small, maybe a B. He said he would re-evaluate next Wednesday and reminded me that the implant would be a bit bigger. I told him I understood that but I also understand that projection is hard to achieve, he did say he should be using to highest profile implant but didn't say size. I get that my bodies ability to stretch trumps what size I want to be. When I originally got advice from you, you said I should be in the 600-700cc range HP. I'm 5' 9" 165 lbs 34" but that'sa bit swollen from surgery. Originally wore a 36 B. Never had a professional bra fitting, I could have definetly been a C. I can't imagine being anywhere close to that If I stay at 400 with these. At this point i feel they are wide and flat. I was kinda prepared for the opposite. Any advice? TIA!!!!
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Does anyone know how much skin you will need for nipple reconstruction? Does the implant size and pocket size affect the results of the recreated nipple that much?
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Hi Eastcoast TS: I haven't checked in recently, but since you and I seem to be similar size and with similar history, I wanted to see where you are in the process. My exchange will be in mid-Sept. I'm meeting with my PS in about 10 days to go over options for shape and sizing. I'm filled to 240 and still feel a little big (one side is strangely bigger than the other) so planning to implants to be a bit smaller, I think. Though I remember someone saying that implants at 240 would feel smaller than TE's filled to 240. Anyhow, just curious if you've heard anything different and/or learned anything helpful (questions or otherwise) that I can ask the PS during my appointment. I know he's planning for some fat grafting to fill in the bony area on the top so curious, too, if that's in the plans for you? Thank you!
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thx whippetmom for ur help
just to be sure, u mean if the expanders are at around 400 cc the implant should be at 450 or 500 right?
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Hey, Noodlesmom!
Okay, I'll try to help if I can. You may know more than me!
I'm filled to 260 or 270. I know I should know exactly. And I feel like Dolly Parton. Ha ha. I was an AA cup before. My exchange is Sept, too! I can't wait to get rid of the bricks.
I think my PS is going for a little larger implant -- but I'm fine if not. I would guess 300cc max. Whippetmom suggestions align with this. I told PS that skin integrity is my first concern, so not to push it. I've read over and over that the implant will be a little smaller than the TE -- but maybe because less projection it just seems smaller. Ask exactly that. What size is she estimating. My PS is taking multiple implants into the OR.
I also read that the actual TE is about 70cc or so empty -- so add this to your total. Maybe that is bunk.
I'm pretty bony but she (PS) has never mentioned fat grafting. I truly have no fat to give.
Ask detailed questions. Mine were: explain what "gummy bear" is? Because she used that term and I was confused. It's Natrelle cohesive gel that she's using, if I'm not mistaken. Not doing textured due to recent issues, even though rare.
I also asked about pain management. She injects Exparel, which my BS also used during BMX! Angelina Jolie's surgeon used this as well, so it must be decent! Google it.
I have a really big gap that is going to require some major pocket work. Sigh. The little bricks are kinda in my armpit.
I also asked what I'll come home in and what I'll expect not to do. And if she thinks I'll have drains. No but possible.
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mssz: Well, I am confused about your TE size. You said it was 450/550. If it is a FX Allergan, it is a 400 cc or 500 cc implant. There is no hard and fast rule regarding size...it is how much your skin envelope will allow and how much more volume your PS is willing to use with the implant. I was justgiving you a ballpark of where you could be.
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TWills:
The response is essentially the same answer I gave to mssz above. As much as your skin envelope can tolerate and as much as the PS is reasonably willing to go, My TEs were 400 ccs and my implants are 550 ccs. I know gals who had very taut skin over the TEs and they were about to perhaps get an additional 50 ccs to 100 ccs over the volume of their TEs. Some gals have had implants 200 ccs larger than their TEs. When I compare TE volume to implant volume, I am not talking about your overfill amount, but rather the actual volume of your specific TE. So you need to get the numbers from your PS. You say he told you he would use the highest profile "but didn't say size." Well, I cannot answer that question. You need to ask your PS....nail him down regarding size. Ask the nurse what size implant your PS recorded in the chart. Do not go into the exchange without knowing.
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Thanks Whippetmom, you answered my question. Just wanted to make sure that I could go at least 100cc's over my TE size if the skin allows. Just didn't want to lock myself into something by not speaking up now. I've got a while since I have rads first. Of course that will dictate if implants are even possible. Oh the joys of trying to get my boobs back:/
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Eastcoast-
Yes, it sounds like we are pretty much at the same point in the process, and close to the same sizing. I, on the other hand, so have some pockets where the PS can DEFINITELY pull some fat! I usually work out 4-5 times per week, but ever since the surgery, it's been limited so I'm a few pounds up from my norm. Small price to pay for getting the nasty C out, but frustrating nonetheless. My PS said that he always does fat grafting on patients who are bony up top (I am bony up top, but have some to spare lower down!). I think it fills in the ridge at the top of the implant. Though having some lipo will mean yet another spot for healing. One step up, 2 steps back.
My TE's also look different side to side; one is smaller and pointier than the other. Hoping implants will even things out.
I also am not familiar with Exparel but I'll check it out. Thanks for the tip!
I'll check in if I learn anything new and different at my appointment. What's your surgery date in Sept?
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Just sent you a PM.
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whippetmom,
I just wanted to follow up with you. I saw my PS yesterday and he agreed with everything you and I discussed. I will be having the 800 CC silicone implants. My surgery is 8/7 so I will follow up and let you know how it went.
I can't thank you enough for your support and guidance; it was a tremendous help!!!!
Elkay
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Elkay:
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Hi Whippetmom,
I came to this thread back in February and asked questions about achieving symmetry with a UMX (my PS was going to do direct to implant at time of MX). Instead I ended up having a BMX and because of complications ended up with TE's. I'm hoping you can help me with sizing although I have limited information. I'm 5' tall, ribcage 30 inchs, weight -112. My PS placed Mentor TE's, 400 cc's. I don't have any more information than that regarding the actual TE's. I have been filled to 340 ccs (I think, not 100% certain but pretty sure.) I won't be having anymore fills due to the thinness of the skin on right breast. The TE's seem wide but I'm assuming maybe that is the way TE's are? I wore a 34 C prior to DX but I was also 10 lbs heavier. I'd like to stay a C cup if possible. Can you give me any size & style recommendations from this information?
Thank you!
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Sitti: Well, with this limited information, I think you will want to be in the 400 to 450 cc range with smooth round high profile implants. Your TEs should not be in your armpits. I doubt that it is because they are too wide, but rather that they have migrated laterally during expansion or were placed too laterally during surgery. This must be corrected at the time of the exchange and the pockets secured laterally, so that they do not continue to migrate in that direction.0
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Whippetmom, Thank you so much for the reply. I realize my PS (who I have confidence in) is limited by the skin integrity but wanted to get some information prior to meeting with him so I could ask appropriate questions. I probably didn't word my question very well regarding the TE's being wide and also neglected to tell you that my Te's are pre-pectoral (sorry, not very informed on all this
). The cleavage distance hasn't changed and they aren't in my armpits, and after thinking about it I think because they are pre-pectoral, plus not being fully expanded, maybe that's why them seem a little wide. Thank you for helping all of us navigate!
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Hello, whippetmom,
I had a prophylactic BMX with tissue expander in March and am looking for advice on size of implant. I'm 5'5, 110 lbs, with ribcage of 26 in. I currently have a Mentor 9100 series expander, 250ml capacity. My PS is planning for a Mentor round implant. (I think due to my size, choices are limited.) Previous bra size was 34 AA/AAA. With the expander, I wear a 34C bra, and am looking to go a bit smaller with the implant - 34B-ish. I appreciate any advice you might have!
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agusta2
Mentor high profile smooth round silicone implants - 300 ccs. You will retain the same width, but your TEs have a 6.2 cm projection and the implants will have a 4.5 cm projection, so they will be quite smaller than the TEs.
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OK, I am really not sure what I am doing here, not very tech savvy...but I have my 2nd appointment since RADS with my PS on Aug 17 and I need some suggestions regarding switching from TEs to implants, no firm surgery date scheduled...my TEs are Natrelle 133MV, their recommended expansion is 400 cc but my PS had me get to 500 cc before RADS, which I completed in March 2017, MX was in Dec 2016, chemo ended 10/16...I am 5' 6", currently 150 lbs but goal weight (prior to BC) is about 135 lbs...my current rib cage measurement is 35 "..., I had a double mastectomy in Dec 2016 (not sure if my history/diagnosis/treatment will show on this thread)...I told my PS I would like to be a B cup size after reconstruction, but I have heard several people tell me that I will be smaller than my current TE size, which I don't want to be, so I am wondering if I should ask my PS to expand me further now that I am approaching the 6 mos post RADS (healing time), thinking I want to be a FULL B CUP or maybe a C when all is said and done...not sure if I should go with saline or silicone, but I like the write up on the Natrelle Inspira but it looks like that was a while ago and there may be other options introduced since then, can you help me navigate through all these choices??? Thank you in advance for your help!
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Hi Whippetmom-
It's been a while, but I finally met with the PS today. My final fill put me at 240cc's and we both agree that for my frame and pre-BMX size, it's on the big side. I believe you had originally suggested round smooth high profile 300cc's for me, but as of now the PS is planning to go with the Natrelle round cohesive and plans to bring 3 sizes in each style with him. I kind of lost track of what he was saying, but took a pic of his notes. He's planning to try the Natrelle SCF in 200, 220 and 240; he's also bringing the Natrelle SCM in 195, 210 and 240. I think one style is moderate projection and one is high? I told him I want to stay on the small side, but don't want to appear like I have a muffin top for a boob. Are you familiar with any of these styles? I should also mention that my expanders are quite far apart (he said it was due to the shape of my sternum) and he will revise the pocket a tad and fat graft to get them even closer. Surgery is not until next month so I have some time to follow up with questions. As always, thank you for you help!!
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Mapper:
I think Inspira implants would be a fine choice. They are the latest on the market. I think a SRF, 520 ccs or 560 ccs would be good for your frame, skin integrity and expansion permitting. I do not know how much more overfill (if any) you will need to get you there. Talk to your PS about this size and and see what he recommends.
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noodlesmom:
I recommended high profile smooth round implants and the Natrelle Inspira SCF style is a high profile smooth round implant. The sizes are fine. The SCM would just be a moderate height, so considerably less projection but that is fine, since you want to be considerably smaller.
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Hello,
Well things have changed a bit. I went for a fill thinking I would be 600ccs then and my PS put 100ccs in the left and only 70 in the right because he said it looked bigger. I went on vacation, nothing strenuous and no injuries but my left breast looked smaller. I went yesterday for a fill and he suspects a leak in the expander. He did not put saline in the right and put 180ccs in the left and measured/took pictures and I'm going back Friday to have it checked. He said if its a slow leak we can do a couple aggressive fills to get me to 685ccs and put in the anatomical "gummy bear" implants as these would have more the projection I was looking for but if its a fast leak it will have to be replaced. He said he does not over fill with the anatomical because you want the pocket to be snug so there's no rotation. I know when you first responded to me you suggested a round 650-700cc implant. I want the surgeries to be over but I don't want to rush and get the anatomical and then regret it. What's your thoughts and do you know of women who have the anatomical and are pleased with them.
Thank you,
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Letty - I have had Allergan 410 anatomical implants since 2011. I continue to be very pleased with everything about them.
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Whippetmom- Thank you! You are not just a wealth of information, but such a voice of reason in the midst of so much noise! I do trust my PS, but feel much better knowing that you've weighed in and concur. So appreciate the help.
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LettyF:
Why not the Allergan Inspira SRX? It is a smooth silicone round and has excellent projection. The anatomical works great for some. However, I am not making recommendations for any textured implants at this time. Please read the first part of the thread header and talk to your PS.0 -
Hi Whippetmom!
I've been following this thread for a while, but my first time posting. I'm scheduled for a DTI BMX on 08-28-17, but I'm having some second guesses on the DTI part. I'm currently an A/B and would like to be fuller after recon. I'm 5'7", 112 lbs, rib circumference is 28. My PS hasn't said what brand he uses, but he does use alloderm in the process. He mentioned ultra high profile rounds and I believe he said he'd try to use 260cc
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Hi Whippetmom!
I just found this thread and am so happy I did. I had a nipple sparing double mastectomy on 7/12 with expanders placed over the muscle. I am 5'8", 145 lbs (though trying to get back to 135), have a 34" rib circumference. My expanders are Natrelle 133MV-14-T and will be exchanging to Mentor high protection smooth rounds, hopefully in November. I had my final fill yesterday, but I'm worried I am going too large. I wore a D bra before surgery, but I didn't feel or look that large. I am trying to decide if I need to go back next week and have some saline taken out of the expanders. My surgeon suggested that I live with then for a week and then make a decision. Just trying to figure this whole thing out.
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BabyKeegs:
I am not sure about the DTI part either. If you are want to be a bit larger, I cannot reassure you this will be accomplished.
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dorth2:
The corresponding smooth round HP Mentor for your TEs would be 600 ccs. I do not think that would be too large at all for your frame. You will be justslightly smaller than you are currently, presuming you are filled to 500 ccs.
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Thank you, Whippetmom! I held off on replying until I had more info from my PS. Additional info - Although my TE's hold 250 ml, they are only filled to 200, and that feels too large. When I asked my PS's nurse about implant size, she said the dr. is ordering the following for the OR: Mentor smooth round silicone implants in Moderate plus profile - 200 and 225 ml; and high profile - 225 ml. Does this seem reasonable to you?
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