BREAST IMPLANT SIZING 101
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Hello,
I seek assistance with my unilateral reconstruction. I had a right nipple-sparing mastectomy 11/09/17 and recontruction + contralateral on 03/19/18. I have declined chemo (no rec for rads), but am getting herceptin (triple +).
I did engage in discussion with my Plastic Surgeon prior to reconstruction, but she is not really a talker. Before any intervention, I was a small 34A with no need for a lift. I did not really fill the bra cup entirely. I asked to have as small and natural as possible. My contralateral L breast was augmented with a 125cc Allergan Natrelle Inspira SoftTouch SSLP. My R mastectomy reconstruction is a Natrelle 410-MF Highly Cohesive Anatomically shaped silicone breast impast 335 cc. The reconstructed side is like having a big gumdrop on my chest. It is overly round at the top, center, and side of my breast area. More specifically, I have a round protrusion into my armpit and it sometimes feels scratchy/hurts. Initially I did not notice the difference in clothes, but more recently I can tell a fitted shirt exposes the different sizes in breasts.
I am so disappointed because after surgery I realized that it would be nice to have a smaller implant placed so I could have added lipofilling to soften the tissue around the implant, minimizing the rippling. The fact the implant is noticably bigger prevents me from considering how to "make it better". My PS has stated that replacement is another surgery. BTW, when the PS took off my bandages a week or so after surgery, I was devestated.
Me: 5'7", 34in ribcage (band under breast area), 125-130lbs, just turned 49 years old. DX: DCIS grade 2 (expanding like a grade 3). Mastectomy tissue evaluation: T1aN0 tumor 2mm, multifocal. ER, PR, HER2 +
My surgeon states that Allergan Natrelle is the best implant on the market, so I suspect she prefers that brand. I just want to have the best outcome.
With appreciation!
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avefenix:
I think you should switch to smooth silicone rounds this time. Ask your PS if he has access to Allergan Inspira implants. If so, a SCF, SSF or SRF style - around 365 ccs to 420 ccs would be nice, but it all depends on skin envelope availability, with a direct-to-implant. It might be easier to tweak the size with a smooth silicone round vs an anatomical implant.
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Healingincali:
I'm not sure why the two very different implants. I can certainly envision the asymmetry. It also sounds as if there is a placement issue with the anatomical. Switch out to an Inspira round for the reconstructed breast.
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I'm not sure I'm posting in the right thread, as I'm not really seeking suggestions about size. My exchange is in 1 week, my pre op is today, and I need to tell PA what type implant I want - saline or silicone. I have been postponing thinking about this upcoming surgery and as a result I didn't do as much research as I should have. I think I was just exhausted from all the treatment, and wanted a break.
Anyway, I keep changing my mind from silicone to saline and back. I think I want the SAFEST implants, cosmetics are lower priority for me. I read about implant leakage, and I was thinking saline was the way to go, until I read saline can harbor bacteria. Ugh.
I'm also concerned about autoimmune reaction to silicone. I know both saline and silicone implants have silicone shell, so there is no way around it. The reason I'm concerned about autoimmune stuff is that I already have Raynoud's and some inflammation markers (granted, inflammation markers have not been done prior to having TE, so who knows if they are contributing to the inflammation).
whippetmom you are doing an amazing job here, I really admire you for it. Could you please throw some suggestions at me. Yesterday I seriously started considering not recontructing at all and asking my PS to just remove my TE next week. Then I thought it would be stupid to endure TE for 6 months for nothing.
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far away, there is a lot to think about. I am also dealing with 2 other autoimmune conditions prior to BC diagnosis. I had no problems with TE and I'm just 5 days out from exchange with silicone implants. So far so good. Hopefully you can discuss further with the PA and come to a decision. Best wishes
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DebAL, thank you so much for chiming in! I hope you will be happy with your implants. I have a friend who is extremely happy with her Mentor Smooth round high gel (this is what it says on the card she sent me). They are 10 years old, and she is still happy. She had them for reconstruction after BMX for breast cancer.
I haven't noticed any differences in the severity of my Raynaud's after TE placement. I've had it since I was 19 (I'm 41 now). It did gradually got somewhat worse (went from one finger, to several, and now all of my fingers are affected), but I always thought about it as an annoyance rather than a health issue: I could prevent episodes with simple tricks (keeping my hands and body warm).
I don't have any autoimmune disorders diagnosed, and wasn't even aware that Raynaud's may be a manifestation of the autoimmune issues. I was told by my PCP that with Raynaud's and positive ANA (which is a test I had come back as positive) but no other symptoms she wouldn't send me to a reumatologist, but rather retest ANA later. My naturopath actually was the one who ordered the tests, and she suggested to wait until I have TEs out before retesting. When I asked about implants also being a foreign body, so having potential to cause autoimmune response, she just shrugged and said she sees improvement in women after they exchange to implant.
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I am newly diagnosed with DCIS and I'm planning on a double mastectomy with reconstruction. I currently have DDD (boobs and would like to go smaller, but not too small as that would feel weird. I really have no idea what a C or D cup breast looks like, but I'm thinking somewhere in that area. I'm 5'7" and currently 168 pounds, but I'm in weight loss mode and plan to be around 150 when finished (56 pounds down so far). My rib cage currently measures 34. I haven't done a lot of research yet, but from what little I've read, I'm thinking a silicone implant. What size would you recommend for me?
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How long can tissues expanders stay in? I’ve had mine in for six months and can’t switch out to implants until October due to radiation treatments. I am so tired of having them in
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Gemini Girl - I had mine for 13 tortuous months. I hated them so much I switched to DIEP for recon.
Lanne
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I had mine in for 15 months...but it developed at leak at 14 months!
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Spiritedcharm:
I would suggest ultimately (after tissue expanders to get you there), around 700 ccs in a smooth round high profile or extra full profile silicone implant.
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FarAwayToo:
I am so sorry....somehow I missed your post! Tell me what happened the other day. I would have recommended silicone......and implants are so much better than tissue expanders. I hope you went through with the exchange
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Lanne - How was the DIEP? I was hoping not to do that. Why were yours in for so long? If you don't mind my asking. Did you have fat grafting done? Are there any down sides to that? My TEs have migrated under my arms - constant pain
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Hi Gemini Girl - weeeelllll, my DIEP surgery (I had DIEP, a lymph node transfer and my stomach muscle repaired) ran into a few complications - previous surgeries left a lot of abdominal scar tissue, one of my main veins needed a graft, and radiation did a number on my lymph nodes and they had to do the node transfer twice, so instead of 9 hours, surgery was 16. But aside from that it all turned out fine. I was in the hospital for 3 nights and have healed very well. Tummy repair was the most uncomfortable. Last drain came out at 4 weeks. No fat grafting - but my boobs are stuffed! and it goes almost up to my clavical so I'll have a nice slope. My radiated side is noticibly smaller but phase 2 surgery will shape and even things out.
My radiologist recommended a 9 month wait between rads and reconstruction. When I went in to see my PS to schedual exchange, he suggested DIEP. It took another couple of months to schedule a meeting with the DIEP surgeon and schedule surgery, so the TEs were in for 11 months. Such a relief to get them out. My DIEP breasts don't feel heavy or stuck on - they feel natural, warm and soft. My abdominal scar is hip to hip but very thin and healing well too. I don't regret the surgery or long recovery. I'm at 5.5 weeks and still hobbling, not quite upright yet, but I've been taking it very easy - other DIEPers are walking several miles a day at two-three weeks. This was the best route for me.
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Hi Debsmisto - I think I know what you have going on. I have the same thing as you on my right side. And have been dealing with that pain for six months. The part that you said is painful, is it a thin strand of something hard connecting from the front of your armpit down to the TE? And is very tender all the time? That is called cording. To me, it almost looked like they sliced the muscle in two. I’ve found that stretching (it hurts, but you’re hurting anyway), ibuprofen and a gel my rad oncologist prescribed that is lidocaine hydrochloride jelly USP , 2% helps calm it down enough to tolerate. You may need pain meds too, if you’re not opposed to them. I’m told things will feel much better when I can switch out the TEs for implants in October. I hope that helps you some.
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Hi Whippetmom! Wondering if you have any thoughts on sizing for me.
i'm 39, 5'6", 122 lbs, 30" ribcage. I currently wear a 34B bra (though fairly recently was a 32B before I gained 10 lbs- so I'm a small
. I'm pretty perky and want good projection! Because I'm slim, I worry about having "softballs" on my chest with certain implants and would like a natural looking result. If that result could be a cup size bigger thats great but not required. I plan on fat grafting later to avoid rippling and for shaping. I'm between two surgeons right now.
Most likely going with surgeon #1 who uses only round smooth non-textured Allergan only direct to implant/dual plane. He says we start with what fits and in 3 months we can switch to a larger implant if I want, he doesn't believe in TEs. He has a preference for the softer silicone implants initially.
Surgeon #2 would do prepectoral and thinks I'd be happier with a shaped implant, uses Mentor and Allergan, thinks Mentor shaped may be safer than Allergan shaped in terms of the extremely rare lymphoma complication. I am a Hodgkins Lymphoma survivor as well (I had a bone marrow transplant in '98) and I have no idea how to evaluate that decision. He pointed out my chest wall was "full" meaning at the top I might need extra fat grafting to avoid a ledge and I think he was looking a medium height not tall.
Would love your thoughts and guidance as to what might look best on my frame.
Thank you!!!
Sam
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Sam:
I am taking into consideration our prior medical history, but even without it, I would have said pick Surgeon #1.
As far as sizing, as that PS stated, he would use the size he could get to fit the best in your skin envelope, and then you could go larger later if need be. I envision the implant would be in the 400 cc range. Maybe high 300 ccs, if the pocket is snug. Asyou stated, you are perky now and so your skin is not as "elastic" as it would be for someone in their 50s. Keep me posted on how things turn out for you!
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Dear Whippetmom,
Please let me know which implant you would recommend for me. I currently have an Allergen Natrelle TE, 300cc volume, medium height, style 133MV. I am 5'7", 130lbs., rib cage is 31.5", bra size is 32B. PS uses Allergen and Mentor. I went into this morning's appointment with a fill of 325 which would yield an implant of 375. PS said I could stop or get 1-2 more fills but it was up to me. PS said I could remove some of the fill later this week if I decide it's too much. I had one more fill so I am now filled to 385 which would give me an implant of around 435. I don't know if I should unfill or fill some more. I was hoping for more projection but PS says I will only get volume not projection from fills.
Thank you!
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Hi Lanne,
Thanks for the info. I had my second 2nd opinion (LOL) last Wednesday and the PS talked to me at length about options. I am going with the DIEP surgery as well. I’m excited and nervous. Seems like a two-for to me. Natural feeling breasts and a tummy tuck at the same time. I did have a c-section and hernia repair 30 years ago. Is that a direct indicator of scar tissue problems? And I do remember hobbling around after my c-section/hernia repair! Thank you for sharing your experience and your thoughts of your outcome. One more question please, I completed my rads two months ago. How long between your first DIEP surgery and phase 2 surgery?
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GeminiGirl, I haven't had my stage 2 surgery yet. Most Drs seem to want to wait about 3 months btwn DIEP and stage 2 to ensure all swelling is down. (But usually wait 6-9 months btwn radiation and additional surgery?). I wear some type of tummy compression (spanx) almost 24/7 on Dr's orders but it is also more comfortable (and I've almost conquered my frozen shoulder trying to get spanx on and off every day). Stage 2 includes shaping breasts and also your waistline and hips via lipo since the resulting tummy tuck changes your body shape too.
DIEP is no picnic - I honestly thought it was a little harder than BMX for the first couple of days - but it wasn't painful per se - just a lot of incisions and drains to deal with. But when the Drs say a 6-8 week recovery, they are not exaggerating. That long of a surgery takes its toll. If you haven't already, check out the DIEP board. Great info there on what to discuss with your surgeon - especially incision plans and placement, to make sure you're on the same page. If you had nodes removed, ask about a node transfer. I don't think that impacted my recovery. Might as well get everything taken care of!
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BeachSunset
BeachSunset:
I am not sure where you are getting your numbers for the implant volume corresponding to your fill level. The future implant volume is predicated upon dimensions and skin tolerance to expansion. So you would be a candidate for a 425 cc or 450 cc Allergan Style 20, or in the Inspira, which is where I suggest you go, 385 ccs and perhaps even 415 ccs in the full profile smooth rounds. There is no specific formula for the TE to implant volume. It hinges mostly on your skin envelope - skin integrity and elasticity of your skin. My skin allowed for a 550 cc implant and my TEs were 400 cc MVs - just 100 ccs larger than yours. How are you feeling about the size of your TEs?
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Hello all -- like all of you, my head is swimming with information overload and I'm frustrated by the lack of hard and fast rules!
Whippetmom, I would like to ask for your advice. I'm 5'2", 130 lbs, 32" rib circumference, previously wore a 34C bra. My expander is Allergan 133 MX 11-T 300cc. My surgeon uses the Allergan Natrelle brand implants.
I know we're not supposed to use bra sizes, but I don't know how else to express myself, so I'm going to say I'd like to be a full B. I'm not oppose to being smaller, either. My goal is No More Bras unless I damn well feel like it.
I'm filled to 110 cc on each side, and will be adding another 50 to each side tomorrow am for a total of 160 cc. I had a skin sparing mastectomy so there's a bit of a skin excess under my expander. My expanders seem to be placed very high.
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Hi Whippetmom,
I had a BMX at the end of December 2017, then chemo but no radiation I don’t know the type of TE’s I have. I am 5’6” and 137lbs my rib measurement is 34. I think I have 300cc’s in at this time. I want to be a full B. Today I was measured at bra shop and my fit was 36C. I’d like to be a full B. My PS said he will be using Mentor smooth high profile round silicone implants and they will be in the 100cc range, which be close to my current size now. I am confused. Won’t 100cc’s be way too small for a full B. Surgery is October 9. I’m in a panic.Please help. Thank you in advance.
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Krose - it makes a big difference which expanders you currently have. Your PS should have provided you with that information. Give them a call and the nurse should be able to look at your chart to give you the make/model/etc. Also ask to confirm what volume you are filled to so far. That will help Whippetmom is reviewing your specific situation.
As you may have read, expanders and implants don't convert well to bra sizes, and bra manufactures don't necessarily speak the same language about sizes in any case. Please read #8 in the header. Implants won't have the same projection as natural breasts and will usually be wider. It's a good idea to be measured by a fitter who has been trained for breast cancer & implant patients. Nordstroms has these trained fitters. That said, it will take several months after your exchange for your shape & size to settle down, so you don't want to spend too much money on bras before you reach your final result.
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Crawfish:
Allergan Natrelle Inspira, SCX 375 ccs to 420 ccs. Please let me know once you are filled to 300 ccs and we will revisit this recommendation.
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Krose53:
Surely you heard wrong. 100ccs would be useless. Do not go through the exchange without clarifying what your PS is going to do. Call your plastic surgeon's office tomorrow and ask them to check your chart and let you know exactly what manufacture style and volume of tissue expanders were used. The TE info will be in the chart.0 -
Hi girls, I'm a newbie to this site. Have been following a lot since I was diagnosed in Jan. 2018, but this is my first posting. All your information has been so helpful! Anyway, having my exchange surgery on Oct. 5. My TE are Mentor 550, and my PS has over filled, like he normally prefers to do. I'm filled to 640 cc. He likes to use Mentor silicone implants, and feels that 700 high profile round would get me close to my preMX size which was a 38C. 700 sounds huge to me after reading so many other posts. Any thoughts would be so very much appreciated!!
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Thank you very much for the advice, Whippetmom. My PS mentioned using a 280 cc implant and said it would give me about 3 cm projection. It’s hard to visualize but it *seems* like that would be fine
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laxermom2:
With the limited information, 700 ccs sounds right to me. Maybe 750 ccs.
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Hi Whippetmom - your info and help is amazing and I hope I can ask for your thoughts on my upcoming BMX in late Nov. Given family history I am doing a double mastectomy though biopsies on both breasts were done and only the left showed multiple sites of DCIS Stage 0 Estrogen receptive +95%. Right has had suspicious findings & been biopsied w ADH in past so I'd rather be done with the stress and have a better match than go through this 2x. The left nipple cannot be saved due to the location of one of the DCIS sites.
No chemo or radiation is planned (unless we have a surprise in the sentinel node biopsy which is not anticipated).
I am 5'7, 160 lbs. Current bra size 32FF or 32G depending on bra brand (Panache, Freya usually) & style. Ribcage circumference 32 inches. Current measure around breasts pre mastectomy 40 inches. I should mention my usual weight is more around 145 lbs but I've gained during a house move just before this diagnosis.
I know max implant size is 800cc so I'll be smaller no matter what - but I can't quite understand by how much. Like a D? I guess my back will be happy w the weight reduction as G's are heavy though this is not how I'd choose to do it! My PS is doing sub pectoral TE's at the time of the BMX and anticipating doing some lipofilling at the time of exchange as needed.
A bit nervous about the TE's & sub pectoral placement/stretching given how many ppl have pain and I have tight pec's anyway, so trying to stretch a lot pre BMX in case that helps. I also travel constantly for work so when I am back at it w/TE's I hope the airport screeners around the world are not too unkind as I set off alarms for the months while I await implants.
Any thoughts on sizing, shapes/types of implants, and anything else I should do ahead of surgery and TE's etc to make this as successful as it can be in the circumstances?
Thank you!!
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