BREAST IMPLANT SIZING 101
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Breast Implant Associated Anaplastic Large Cell Lymphoma BIA-ALCL was first recognized by the FDA in 2011 as a possible lymphoma linked to breast implants. In 2016, the World Health Organization recognized it as a distinct entity. In March of 2017, the FDA agreed with the World Health Organization. As of last year, there were approximately 359 cases worldwide. There are now around 460+. The FDA lists 28 cases with smooth implants but the ASPS actually clarifies to say that all of these cases had previous sets of implants, either textured or unknown surface. This has resulted in a movement to say that this lymphoma is only linked to textured breast implants (and possibly expanders). The current theory is that contributing factors are bacterial contamination, chronic inflammation, and genetic predisposition. Doctors have joined globally to create and implement a 14-point plan that will hopefully reduce the risk for bacterial contamination. Unfortunately, not all patients have had a common bacteria present. It also does nothing for genetic predisposition. The common denominator is the textured surface. The most implicated has been implants with macro texturing (larger, rougher). The highest number of cases has been with Allergan. When first announced in 2011, the US risk was around 1:500,000. This year, the ASPS puts the risk around 1:30,000. That's still rare, but a huge jump. Australia puts their risk at 1:1,000 - 1:10,000. The US numbers are rising as more public awareness is made and more symptomatic women are pushing for testing. A study done in the US specifically on Allergan 410 put the risk between 1:3,000 and 1:4,000. This is still a rare disease but there are a lot of unknowns. Whatever implant you choose, the most important thing is to be educated on the risks and know what to watch for. The most common symptom is a unilateral swelling/seroma. The cells begin in a fluid that develops between the implant and the scar capsule. Other symptoms have been a breast mass, capsular contracture, skin lesions, and general lymphoma symptoms like lymphadenopathy, weight loss, and night sweats. An educated patient can play a huge role in the diagnosis and treatment of this disease because the knowledge base is just not there yet. The National Comprehensive Cancer Network (NCCN) put out algorithms for diagnosis and treatment in late 2016. These should be the guidelines that any oncologist or plastic surgeon follows.I am not a doctor. I have been studying BIA-ALCL for a couple of years and run a support group for women diagnosed and those struggling to get tested. We also work on public awareness aimed at clinicians and trying to create a better bridge of communication between patients and clinicians in regards to this cancer. The past year has been a whirlwind of changes and we expect to see many more. Best of luck with your decision. I do not have breast cancer so I can't help too much with that. I just want to try and offer more assistance on questions related to BIA-ALCL.
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Jamee: Thank you for joining BC.org to share this information. I have thought that the association would be linked to anatomical implants, since textured rounds are so rarely used anymore. Please keep us apprised of further findings.0
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whippetmom-
You suggested the Natrelle Inspira Round gel implant to me (450-600cc's). My exchange surgery is coming up on Jan 9th and I have requested my PS bring those to surgery as well as the anatomicals he suggested. The more I read on here the more I am leaning towards the rounds.
Could you explain the difference between the Inspira Soft-touch and the SCX? I'm so confused and trying to make sense of it by searching the forum and getting kind of lost in here!
Oh and my TE are pre-pec with alloderm
-A
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If would imagine that the most distinctive difference between the two would be the higher cohesiveness of the gel encased in the shell of the SCX implant. i think it is not going to be much different - in terms of "feel" - but with the SCX, you have the latest and greatest on the market.0
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Hi Whippetmom,
You helped me four years ago with my exchange and ultimately he used more than you suggested 650cc Mentor HP rounds. I am exchanging on 1/10/18 for 450-475cc of the same implant and am very excited. We originally discussed and planned for exchanging to Pre-pectoral, a big and very expensive surgery. I pulled the plug yesterday, deciding after much research and thought to keep sub-pectoral since " if it isn't broken, why fix it". Besides the animation deformity of the muscle and some arm weakness, I have no pain, no extreme reason to need this change.
What are your thoughts on this? My main concerns were this: support of the implant over time with just Alloderm and skin, sagging over time with the loss of the support of the muscle, chest wall cancer surveillance for recurrence, colder implants with less insulation, dmpling and the need for further surgeries ie: fat grafting due to less covering over implant. Id love to know what you think as it's becoming more widely available but many PS still won't touch it.
Thanks for your input!
Mimi
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Mimi68I would not change it personally. Apart from the expense, it is a major undertaking for a little bit of animation. Honestly, 10 years out, I don't even notice it anymore. I can do push ups without that weird sensation and clutching up of the implants.
Gravity is a pain. Anything to help support the implants is good in my book. My personal concern is that it would be much harder to detect a recurrence, if one should raise its ugly head. A lot of insurance companies cover MRIs every 3 to 5 years for breast reconstruction. My healthcare provider does not. Getting those routine MRIs would be an important factor for me - whether or not to go prepectoral.
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Sorry… I cannot figure out how to get the attachment to appea at the bottom of the post, rather than at the top. It sure looks weird that way.
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Hi Whippetmom,
Thanks so much for your input. I agree, personally as a patient and as a nurse, I am wary of new high billing techniques that often do not put the patients well being first. I've read many recurrence posts on this very board are on the chest wall. I'm with you, besides some deformity in the gym, heck, we are alive, and fit and well. I hope I don't get push back on the Pre-pec board for advocating for new gals there in the process of deciding, to consider both sides of the story. Nothing is black and white in medicine. It's about survival and living with quality. Now, for those with chronic pain, I am happy that they have an alternative.
As a side note, again a sincere thank you for your original input four years ago. I'm beyond ecstatic to finally be getting the smaller more athletic size I should have had. I just couldn't bear more surgery until now.
Happy New Year, Cheers!!
Mimi
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Hi Whippetmom,
I've been quickly getting an education on sizing as I've scoured this thread. I have had a prophylactic skin and nipple sparing pre-pec DMX due to gene mutation and family history in December. When I went to my pre-op visit with th PS, I was so concerned with taking charge of my health that I asked few questions, and now I have several, and my PS has been on holiday! I have TE in, am now curious as to what you think will be a good implant. I am 61.75 inches tall, 110 lbs, and my rib cage is 29 inches. Before surgery, I wore a 32C, and I'd like to be at least that size. My TE are Allergan 133MX-13-T with alloderm, filled at surgery 300 cc. The PS didn't give me any ideas on what he was thinking other than that he uses Allergan implants. What do you think
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Mimi68: Thank you for sharing your expertise. It costs a lot less for a surgeon to perform pre-pectoral placement vs a submuscular placement. So it is beyond me why they're charging so much money for the pre-pectoral reconstruction.
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1IOUGirlsdaughter:
Easy peasy! Allergan Style 20, 500 ccs, or, preferably, Allergan Inspira implants, also in the 500 cc range. There is the SRF style (485 ccs) and the new truly cohesive version, which would be around the same volume. I do not have a size chart for the newest FDA approved version,
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Whippetmom,
It’s all the Alloderm, they use a large amount to support the skin in the abscence of the pec muscle. Alloderm is a VERY expensive material. The surgery also takes much longer (3.5 hrs) due to the sewing of the pec muscle back to the rib cage and requires drains. Every extra 30 minutes adds up to more Anesthesia costs, facility costs etc. Perhaps direct to implant w/ mx is more straight forward but revision from Sub Pec is far more expensive. Both require lots of Alloderm.
Mim
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Hey ladies 😀 I have not been on this site in a long time and looking to possibly change my implants to a smaller size and just saw your post mini and whippetmoms comments! I know how helpful whippetmom was to me and I didn’t take all of her advise and it led me to be bigger than I wanted to be, I miscommunicated to my PS and it was totally my fault. I can relate to everything you are saying Mimi too.
When you refer to reoccurrence at the chest wall, my doctor told me with dCiS the reoccurrence would be obvious on the breast since all of the tissue has been removed in the breast. Is this not accurate? Also, with sizing, since I am going smaller, will my skin too too stretched to do that?
I don’t want to take over anyone’s post, but since it’s related thoughtbi would ask this! Thank you!
Cath
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Hi Cath,
Well it looks like your story and mine are almost identical as we have the exact same DCIS type and grade. I too am completely at fault for ending up too big as I instructed my PS to give me exactly the size I am. I will be taken from a 650cc Mentor smooth round high profile down to a 450 or 475 cc, depending on what looks best. If I had my way, I would be getting Allergan which in those volumes has a smaller diameter than the Mentor of the same volume. My PS only uses mentor. The diameter of my implants are the size of dinner plates on my chest LOL. Regarding reoccurrence on the chest wall, when I was trying to make a decision between going to pre-pec with this revision next week or staying sub pectoral, I was told that the breast surgeons in the group completely signed off on the minimal risk of not detecting reoccurrence on the chest wall with pre-pectoral as it will sit now behind the implant. Despite that reassurance, I have read on this board and I have met several women who have had reoccurrence especially with the aggressive DCIS that have indeed re-occurred on the chest wall. It’s just not worth the risk of developing an advanced cancer undetected behind the implant for me.
So yes they do remove all of the breast tissue from underneath the skin however your breast tissue extends from the breast skin in front all the way to your rib cage to the muscle on the chest wall -they scraped both surfaces. Despite taking out all of the breast tissue, most surgeons and oncologists will tell you that there’s no way to a sure that 100 percent of the tissue and/or cancer cells have been removed. Without having radiation after, I feel that I should at least remotely expect perhaps a reoccurrence sometime in my future even if it’s a minimal risk. To answer your question regarding skin flap and size, my plastic surgeon had reassured me that should I go with pre-pectoral he would have absolutely no issue reducing the tissue to the size of the implant that I wanted to go to-in my case smaller. Larger would be far more difficult and likely not possible.
It is such a personal decision and it has a lot of varying opinions as it is a new procedure but ultimately I am happy for the women who need the relief from the sub pectoral techniquewho experience chronic pain. That’s just simply not the case with me.
Mimi
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Thank you, Whippetmom! I look forward to seeing my PS and discussing these options.
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Hi all!
Just wanted to update I had my swap out surgery yesterday! Went with Natrelle Inspiras high profile 420cc's
THEY FEEL SO MUCH BETTER ALREADY from the TEs!
Thank you Whipplemom for the suggestion, I think these will work better for me than the anatomicals would have.
YAY! So happy to have this part over!
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Congrats to you!!
Mim
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Hi I am looking for information on sizing. I am 5ft 4in. 130lbs. Rib cage measures 31in. I have TE Mentor Artoura, round ultra high profile 535cc. This is my 2nd time with tissue expanders, the first time my left side leaked, requiring replacement before starting radiation. A hole developed along incision line during radiation and I had the left TE removed immediately after finishing radiation treatment 9/2016. My right TE leaked 10/2017. 12/20/17 I had a latissimus dorsi flap reconstruction to left and new TE placed to right. I was a small 36C previously.
Thank you for any help!
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KEEPSAKE: I am trying to respond to your PM, but you must have inadvertently clicked off acceptance of private messages!
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amtreb: Congratulations! So glad you are happy!!
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Muxxxy
Provided your PS feels he can safely use a small implant on the Lat flap side:
On the right: 535 ccs - Mentor smooth round ultra full projection style implant. If your PS has access to Allergan Inspira, an extra full projection smooth round, 445 ccs. On the left, an implant of sufficient volume to to match the right.
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Hi, I am 2.5 years post bilateral mastectomy and recon and have had neck and shoulder pain for the last year. Long story but I also noticed my left implant is drifting. I recently moved away from where my original recon was done so I found a new PS and went for a consult. I am so so so confused. He told me pretty much everything opposite of my original PS. He wants to remove both implants, replace with rounds, told me to wear a bra 24/7 and to massage them daily. I have started some capsular contracture too. Pretty much the direct opposite of my original PS advice. I left there pretty overwhelmed. Not sure this is the right topic for my questions, but has anyone else been diagnosed with CC and "waited to see" before operating and removing the implants? Like maybe it won't get any worse and I can live with it.? It is grade 2 as of now. I have always felt my implants were tight, like when I take a deep breath I can feel pulling. I have Allergen 410s. Once you get CC are you prone to getting it again? We didn't discuss size or brand of implant, I think he could tell I was a little overwhelmed. I said I would schedule a follow up once I thought about it all. Thanks for any input!
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Hmmmm, I think you may want another opinion. I had 410's and had CC. I was told not to ever massage the 410's as you want the pocket to stay tight. I don't know what stage CC I was, likely 2 or greater, though.
I had my implants replaced with pre-pectoral smooth rounds. There is a slightly increased chance of repeated CC, and my PS prescribed Singulair to use after, but I decided not to take it. So far (since September) so good. I am massaging the round ones.
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My PS believes in scar massage and wearing a bra. He's even an underwire bra guy. He has me in a surgical mask at night. I am just about a 24/7 girl!!
I really think it's how the PS was trained and what they've had success with. I have followed everything my PS said mine look as good today as they did one year ago when they got in.
Coach Vicky
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lkscolo:
The only way to reduce the grade of a capsular contracture is by performing fat graft transfer. The procedure is called a pericapsular lipoinjection. Otherwise, the cc generally worsens over time. The problem with this is that it distorts the implant and can impact skin integrity and stretch out the skin envelope. I would certainly would side with your new PS over the former, who appeared to find nothing wrong.
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Vicky...Why are you wearing a surgical mask at night? You had me giggling at that one.
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Thank you for responses. I think I am confusing people. I meant to say my original PS was giving me instructions on anatomicals and this new PS hates anatomicals and uses rounds so that is the difference I suppose. I wasn't having any CC for the first year with my original PS, this has all started to happen over the last year. I guess my real question was about the CC and how urgent it is to get it fixed. I will proceed with other consultations for sure but I guess I was just shocked at how different the protocols are when it comes to implants and aftercare! :0
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Lkscolo, if 410's are textured I'm betting that's why you were told not to massage them. And if the rounds would be smooth I think that would be why you would be told to massage the new ones. But it really is interesting how very different PS's protocols can be.
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WhippetMom
It all started with the size I wanted to be. I wanted to be large and the largest my PS would go with 600cc with 6.1 projection. I am 5 feet tall and 123 pounds.
Then we had the discussion where I said I would not need a bra and he said b/c of my size I would wear a good, sturdy bra!
He asked if I slept on my back and sometimes I do. Then he said over time (a long time) my implants could shift under my arms if I always slept on my back so to wear support at night!
Here is your next laugh... sometimes I awake in the night. I am on my back. I start feeling my implants to see if they are on my chest!
Vicky
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WhippetMom
It all started with the size I wanted to be. I wanted to be large and the largest my PS would go with 600cc with 6.1 projection. I am 5 feet tall and 123 pounds.
Then we had the discussion where I said I would not need a bra and he said b/c of my size I would wear a good, sturdy bra!
He asked if I slept on my back and sometimes I do. Then he said over time (a long time) my implants could shift under my arms if I always slept on my back so to wear support at night!
Here is your next laugh... sometimes I awake in the night. I am on my back. I start feeling my implants to see if they are on my chest!
Vicky
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