BREAST IMPLANT SIZING 101
Comments
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augusta: Yes, the Mentor MPPs - 225 minimally - sound fine and considerably smaller.He will hopefully take several into the OR and use the size that looks best.
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Has anyone every had someone refer to youur reconstruction as an upgrade or boob job????
I have been going through surgeries for years due to complications AND am still going through it. This relatiavely new person/friend
knows of my history and rcn. problems which has forced me to go out of state. I have
had 10 surgeries- I stopped counting maybe 11. I am appauld, but moreso
surprised at insensitivity to women with breast cancer.
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Hi Whippetmom! I had my exchange on 8/7 with the 800 CCs Allergan Inspira as we discussed. My PS and I discussed implant sizing extensively and we agreed to move forward with the 800 CCs. I am one week out of surgery and still feel like I look flat. Everyone tells me to give it time and that in 3 months or so things will look different. I am trying so hard to be patient.
Is it really possible that these implants will perk up and make me feel whole again when I am in clothes?
My PS has reassured me that I can have another exchange in a few months if I am still unhappy.
The problem is I don't know "what" I am supposed to look like right now. Should the implants be perky and projecting through my clothes? I am so confused.
This whole process is causing me to get very depressed.
As always, thank you for "being there" when we all have questions and concerns.
Elkay
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Elkay: It takes weeks and sometimes months for everything to settle. The implants are often flattened out and misshapen. Some can look like pancakes on a griddle.
Mine looked like hamburger patties for a week or two. Give it time. Most importantly: STEP AWAY FROM THE MIRROR! IT IS CRAZY MAKING. Hang in there and let me know how things look at the end of the month.0 -
whippetmom: It's ironic you responded today! My right implant is changing
! It is actually transforming into a breast-like shape!!! The left implant hasn't changed much but I'm not worried. Tomorrow will be 2 weeks post op and you and everyone else are right........I definitely need to step away from the mirror and be patient!As you know, we sometimes feel very vulnerable and sensitive during this journey, and I for one panicked when I first saw my implants.
I will update you at the end of the month with my progress.
I just can't thank you enough (along with everyone else) for being so kind and compassionate. It means a lot!
Elkay
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Elkay:
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Hi Whippetmom, I could really use your advice. I am now 4 months post exchange, and have had some challenges with my implants flipping over backwards. The R flipped 6 weeks post op, and flipped back on its own the next night while asleep. I was all set to schedule my fat grafting, when suddenly the L flipped a month ago, again in my sleep 3 months post op. He said he has never seen this happen before, and thinks it may be due to me having "loose skin". I suppose he means my 53 year old skin doesn't have much resilience after 4 pregnancies and a 50lb weight gain from Lyrica which I then lost when I discontinued the med in 2012.
To refresh you of my stats, I am 5'7 1/2", 145lb, med build, 32" ribcage. My natural bra size was 38D-36DD, R mx removed 514 grams, L was 527 grams. My TEs were Mentor CPX4-450, moderate profile, expanded to 475. PS placed Inspira SCX 470 above the muscle. Not only does the flipping bother me, but there is a LOT of rippling now that swelling has subsided. I asked the ps what could be done. His 1st response was "we can put in a bigger implant". I told him emphatically "No". He said he could tighten the pocket and fat graft, which I am considering. He then recommended changing to textured anatomicals as they act like Velcro. The Inspira 460s are very close in size to my natural breasts, only narrower. I still wear same bra size. I had wanted to be smaller, more of a full B to C cup. The implants are heavy to me with just my skin and some Alloderm supporting them, although the heaviness doesn't bother me until night time. I was so fed up with the flipping and the discomfort, I asked about removing them and getting a flap. He referred me to Johns Hopkins for SGAP consult as he only does DIEP and I am not a candidate. The Hopkins ps talked me out of SGAP, said my implants look great (they do look good), and recommended I keep them, revise to tighten pocket and do some fat grafting. He manually flipped my implant right side up during the consult, and I was super relieved!! He too said he had not seen this happen in any of his pre-pec cases. He said the discomfort (feels like inside of skin is peeling away from the implant when I get up from sleeping) is most likely nerves regenerating and to give it a year (or three) it should subside to the point I don't notice the implants anymore.
I am hoping you can tell me if it is possible or even advisable to downsize and what size would give me more of a C or even B cup? I wonder if that would make it more comfortable (less weight for a pre-pec install). I worry about aesthetics though, messing up a nice looking result other than the rippling. Or should I just stay where I am and try to get used to the feel of these and proceed with fg? One way or another, we are doing a revision to tighten the pocket & FG. He is booked til October for the OR. Thanks for your kind advice.
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I had my exchange on 8/15 with fat exchange. I had large concaved area on inside and top of right breast. The fat grafting (both breasts) on the upper pole looks really good. The area on the inside of the right breasts looks like a third breast. How long does it take for the fat to settle? I also have area on the outside of the right breast that looks like the implant edge. Am I being impatient? Will these issues resolve themselves. I really don't want any more revisions,but I have come this far, I am going for as close to perfect as I can. She did go with 650cc natrelle inspira.
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Campbell - it takes 3 months or longer for your implants to settle. The best advice most of us got from the "exchange" thread is to walk away from the mirror. It's hard, but there is so much interior healing going on it's the best thing you can do.
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Shoregirl:
Why don't you private message me a photo? If your silicone round implant is flipping because the pocket is too large, you would have the same issue with an anatomical implant and its high risk of rotating in a too large pocket. I am perplexed about your feeling too large, since the TE volume was pretty average for your frame. At this point I need to see what is going on.
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Hey whippetmom, I was told you might be able to give me some advice. I had my implant exchange a year ago. I have 400 cc Sientra shaped implants. My PS told me at a recent check up that he thought I was expanded more than I was. My implants are high and tight. The pocket is too small. They have never dropped. He said the only way to fix it is to put a smaller implant in. I'm not crazy about more surgery and I have beautiful 3D nipples. Do you have any thoughts
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Horsefly:
Have they always, from day one, been "high and tight"? I am just wanting to rule out capsular contracture. You can send/private message me a photo, by the way. I think that it might be a "placement" issue also, coupled with perhaps underdissection of the inframammary fold, in which case they would likely never drop. If you exchange to something else, I would advise a smooth round silicone implant, which will be softer and will not have the height of a shaped implant.
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whippetmom,
how do plastic surgeons " tighten a pocket"? i am curious...was inflated to 400 cc at bmx. too big for me.PS removed 60 cc so now i am at 340 cc. i want to be smaller and he said he could remove some more depending on how much smaller i want to be. path report showed 297 grams (?) breast tissue removed. i am afraid the skin was already stretched too much from the 400 fill at bmx.. exchange on oct 20... will see him tuesday next week..
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Kae:
The procedure is called a capsulorrhaphy, which is an internal suturing of the skin flap/pocket. Typically it is a lateral capsulorrhaphy, to narrow the pocket to accommodate a narrower and smaller implant. There is also a newer procedure called an "internal bra capsulorrhaphy", which entails the use of a mesh product to support the new implant. In any case, this is a delicate surgery, to the extent that the patient really needs to 24/7 wear a supportive bra and follow exercise restrictions, in order to not disrupt the capsule revision. Whether you will need this in order for your PS to use a smaller implant is something he can discuss with you. It might not be needed, in order for you to go a bit smaller.0 -
thanks whippetmom!,
i do not want that and i will discuss it with him..
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Hi Whippetmom,
My wife is coming up on a double prophylactic nipple/skin sparing MX next week (1st surgery, and then implants in December)
- Rib cage below breast/bra: 41 3/4"
- Bra size: 40-42 B/C (she's never had a real fitting so like you said, it's a bit variable)
- Weight: 205
- Height: 5' 6"
The info I have on expanders and implants is:- Allergan for both expanders and implants (don't yet have model numbers, etc.)
- Implant style: silicone (gummy), natural (tear drop), smooth
She is looking to stay about the same size. Or said differently, we're just hoping to keep things as reasonably similar to her body today as is possible. Based on the above, do you have any tips on fill, etc? Is there more information that is helpful?Best,
Michael
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I had the exchange on 8/15. Got 650cc natrelle inspira silicone, under muscle implants with fat grafting. I have some really bad rippling on the inside of my left breast. That is the non cancerous side and no radiation. Will rippling resolve with time? Do you get any more projection with time? The are very flat now
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Hi Whippetmom- I am 2 weeks away from exchange (yay!) and just want to make sure I have all the right info when I meet with the PS one last time next week.
I've talked with him about my concerns about being too large when all is said and done (I'm 5' 1", 99 lbs; 28.5" around ribs). Filled to 240cc and although it seemed HUGE at first, I've settled into it and it's not too bad. Maybe a tad bigger than I'd like. On a previous visit, he planned to order Natrelle Inspira smooth round in 195, 200 and 220cc's; any of which I guess are ok? But he mentioned, and I've heard, that the magnet, etc on the TE's can account for 60-80cc's of the total size and can be figured into the implant sizing? If that's the case, does that mean I am closer to 300 cc's now? So if I only want to be a tad smaller than I am right now, are the implant sizes he's considering too small? Am I being too conservative?
Thank you!
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Michael:
I think we need some clarification on the type of implant your wife would be getting at the time of exchange. All teardrop or anatomical shaped implants are textured, not smooth. I think your wife is ultimately going to want to have implants in the 700 cc to 800 cc range. This translates to a tissue expander - perhaps an Allergan 133/MV or MX (MXpreferable) 600 ccs.
The only concern with an anatomical implant, is that if there is a lot of adipose tissue on the chest wall, the anatomical shape can kind of get swallowed up. The only other option is to use the highest projection style anatomical out there and I just think you could achieve a better result with the Allergan Inspira extra full projection style implant. It is also considered a "gummy" type implant.
I honestly hate the use of the word gummy bear, because it really is confusing. It is either textured anatomical or textured or smooth silicone round. Grant Stevens, MD came up with that "gummy bear" moniker in reference to the Allergan and Mentor anatomical implants which were in clinical trials at that time. It is really sort of an obsolete term now. 🙄
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campbellx5
Everything will either resolve with time, or you will see the need for perhaps some fat grafting six or so months from now. I always suggest waiting at least that length of time, because either the issues can resolve, or something else might come up that you also want to have addressed. I cannot really speak to the projection question, as I do not know what style of Inspira you have.
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in post op got 800 Inspira,but
They put the wrong implant in TCX vs SRX....what happened...???
Is there a benefit to textured
At this point just want it out
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whippetmom,
im guessing smooth implant will be more comfortable than textured? implants are not stitched like expanders,right?
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The Dr said he is having the SRX FedExed from CA and it will be at the hospital tomorrow at 2pm...that he can swap this TCX for the SRX with local anesthesia tomorrow.
So confused, is that safe, will it make a mess of the pocket and placement work that was so meticulously done...unfortunately with the "wrong" implant.
From the little research I have been able to do with my iPhone while in post -op, it appears to be a "SRX" made with the gummy bear cohesive gel, just approved for use this year???
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TrmTab - I tried to answer your question on the exchange site about cohesive gel. Sorry for the mess. WhippetMom will know more about pocket work.
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today's replacement surgery didn't happen, Saturday OR is dictated by emergencies and I had the unfortunate time of there being surgical emergencies
still have TCX instead of SRX, thoughts?
In leading up to my planned exchange for an 800 SRX, my TE deflated and it wasn't sure that I would be able to exchange to an 800 versus having a TE put in at about 500 and then fill to the 800.
Maybe I should just think of this as my 800 TE until my exchange in Nov/Dec...so swollen now, I am huge
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TrmTab:
The SRX is fine. But piecing it all together, I finally see what the issue is and I have to say that I do not much like the idea of you going right back into surgery for something that is NOT emergent in nature. This is to fix the doctor's error in inserting a textured vs a smooth implant? I would personally rather wait until November or December, just as you stated. Get out of the hospital and let things settle and calm down a bit and see what you think of what you have in terms of shape and size.
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Sorry for my meltdown this past weekend...it was just moving too fast.
To recap: 5'8" 200 lbs 38" ribcage, had planned an SRX-800 exchange.
After surgery, after doctor had left the hospital, the nurse is giving me my exit papers and the medical device card...for an Inspira TCX 800...and the meltdown began.
I finally did leave the hospital and am now recovering from this implant exchange. The TCX is a higher cohesive ratio than the SRX, so I guess that means this will be firmer and ???perhaps??? have more projection than the SRX? So those would be considerations to include in the potential exchange in Nov/Dec to the SRX?
Plus have concerns about the Textured surface vs smooth given recent data, so before this was put into me was firmly set against textured/wanted smooth round...but, if I wind up happy with the size/firmness I wonder if the risk of another surgery is higher than the risk of ALCL?
Currently very swollen, sore and as of today quite bruised along the medial line and on my native R breast that I assume was being pushed out of the way as they worked on my left.
Thank you , TT
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TmTab ..,meltdowns are Ok. We have all had them. Be easy on you.
Hugs your way,
Coach Vicky
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TrmTab, my PS recently went to a seminar that was dedicated to the risk of ALCL and textured implants. She learned: Women who were diagnosed with ALCL all had a rare mutation on one of their genes. I'm sorry I don't recall what, but it is fairly rare and not routinely tested for at this point. Also, all women had a colonization of a specific bacteria on the implant. The bacteria (again I don't recall the name) is present on common surfaces and especially in areas such as drain pipes and plumbing.
Women who have ALCL have to have both of those factors in place. The good news, though, is that the bacteria is easily wiped out with betadine. If your surgeon flushes the pocket with betadine prior to implant placement, that removes the risk. My surgeon always does that, so she is confident enough now to resume the placement of textured implants.
Hope this helps. How is your implant feeling today?
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Thanks for this update. I see the PS at 1pm for a routine follow up, will ask about the procedure and the flushing of the pocket.
Compared to the MX, which was raw flesh and I would have thought more prone to bruising, I am seriously bruised along the breastbone. I believe where he did pocket work to break up scar tissue from the TE/MX and weirdly, my native right breast is all bruised on the inner side, like they were pulling it over and leaning on it while working on the left. Didn't expect that collateral damage. My breast has never been bruised like that in 56 years, it like I was in a car accident and the seat belt slammed against it, can't be good for the breast tissue.
Will report back if any new news after 1pm post-op.
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