BREAST IMPLANT SIZING 101
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Thanks for your insight. No, I did not have rads, or any chemo. I was a stage 1, and less than 1 cm. so doc. said I did not need anything. It has been 10 years since I got the expanders on both sides. The problem happened when I got a revision on the left side. I have many revisions on the right side, but never encountered a problem like this. The cancer was on the right, and not the problem side. I don't know if I can find out what TE I had since it has been so long ago. My records would be with Kaiser. I could try to find out. But my right implant rises quite high, which I like, so wouldn't I need a higher rise TE rather than a lower?Although, since I have previously been expanded, some of the stretching may remain??Want to do the right thing to get the same result as on the right. Thanks again.Hugs
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joie: Well, it likely was at least a 12.0 cm width TE. Your PS is going to base the width of the TE on the width of the Allergan Style 20 475. This is a 12.6 cm width by 5.5. cm projection implant. So options would be:
133MX 400 - Width: 12.0 cm - projection is 6.3 cm.
133 SX 350 - Width: 12.0 cm - projection is 6.3 cm.
If the PS wants to be conservative and use an even narrower base width TE:
133MX - 300 - 11.0 cm width.....5.9 cm projection.
You have a much larger leap with the lower volume TE, but we are looking at DIMENSIONS, not volume.
Where are you in the Kaiser system? I know Kaiser like the back of my hand!!!
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Hi again.. I was in the southern California Kaiser at the Fontana facility.I am not with them anymore, and have not been for the last 2 years. I don' t know if they still would have my records..The expanders were put in year 2000.Thanks for all your help.
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Oh....I thought if you were still with Kaiser I could help you further. I knew Dr. Norman Sogioka who was head of PS at Kaiser Fontana. I consulted with him in the early 1990's. He retired around 2000 - 2002 I believe.
So the previous TEs do not matter and they have been revised in the past ten years anyway. So much is new in the past eight years. So the key will be a TE with a width of 11.0 cm or 12.0cm with sufficient projection to expand you out to exchange to the Allergan Style 20 - 475 ccs.
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I remember Dr. Sogioka also. although my PS at the time was a woman named Dr. Resch.Thanks for the insight on the TE,however, would I use a low or a high rise TE to get the full upper pole that I want. Should the projection of the TE be more than the 5.6 of the style 20 implant,because remember I don't want to be over expanded and have ripples, and how much should he expand to. Less or more than the 475cc that I want in the end?Thanks for all the input. I appreciate it.
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With all of my research, the low height TE is preferable for its ability to expand the breast in the lower pole, where projection naturally occurs, while not over-expanding the pectoral region. You can still have upper pole fullness with a low or short height TE - and the benefit is that it also reduces the risk of rippling or step-off defects in the upper pole. You do not want to be overexpanded, correct, which is why I listed the TEs above. They all have a projection greater than the 20-475 cc implant. I cannot see your skin flap....I cannot judge the integrity of that flap, but your surgeon can and he should select the TE based on where he wants you to be at the time of exchange, but also he is taking into consideration, your history of complication which has changed the integrity of your skin flap. Did he use Alloderm, by the way?
What brought about the need for a revision on that side which led to infection?
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The revision was because of a small area of banding at the bottom which did not allow the implant to fall fully in place. Also, he closed the pocket on the side close to the armpit.The last infection, he did use alloderm which I feel may be what caused the last infection since the alloderm was almost all liquified and a big hole in the middle after less than a month of being in there.I don't know, maybe I will have to give it up and just go flat...I do have good skin though although it is thin in that area because of previous expansion and my thinness. I keep hoping for the best Thanks again for all your information.
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Alloderm is actually truly marvelous when it works, as it did in my case. It is highly technical in terms of what is required to make it work. It is so technical, it is not surprising to me that many plastic surgeons just do not want to bother with it. In the case of thin flap coverage, it really can make all of the difference. I know that if a patient is allergic to certain antibioitics, Alloderm is not to be used. Your PS could try Strattice, which is also a LifeCell product but is animal-based - porcine dermal grafts. It might be something to discuss with your PS.
Don't give up yet.....just let your skin heal and bulk up on protein - which many of us have found helps with wound healing.
Keep me apprised of how things are going for you. Your PS is very experienced with breast reconstruction, right? He performs as many recons as he does augmentations? Just want to make sure....
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Thank you so much for ALL of the information. You have spent your whole day with me. I am very grateful. Now, I know what to look for and how to proceed with some knowledge of what I need in an expander.It is so helpful for people like to be able to help others.Merci beaucoup.
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Je vous en prie!
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Wippetmom have you heard of a new implant that I believe made by allergan? I dont think it is not approved here in the US but my PS is trying to convince me to wait for my exchange for it. Any info would be great. I have sent you a pm before. I was pre BX Mx at that point. I currently have 600cc in each side I am looking for a full"C" cup but am very concerned about looking like "Pamela Anderson". I am a wide frame but was never busty so I want them to look as natural as possible.
I will get one more fill on the 4th and then I will need to start deciding what I will be doing.
Thank you,
Rebecca
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Rebecca: Good luck on getting that Allergan 410 anytime soon. The TEs are not meant to be worn ad infinitum - and who knows - it could be another year before they are available for your PS. I was talking with my PS on Wednesday about it....he said they have been saying "any day now" for years....so don't hold your breath. I'll go look at your PM to me....to refresh my memory...
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Rebecca: Do you want to PM me again with your height, weight, ribcage info? You can post it here as well, but in case you want more privacy...I looked through my messages but I have over 1,000 of them and I despaired of knowing when you might have sent it....
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bumping
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bumping for scrapmom
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What is the difference between the Allergan style 410 and Allergan 20?
My PS told me last week that all Allergan silicone inplants now are cohesive gel . I looked up Allergan on the website and now I am confused.
Suzanne
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The Allergan 410 is called a "true cohesive gel" implant and is available in the U.S. only through plastic surgeons who are part of the clinical trials. It does not yet have FDA approval. The product in clinical trials currently is an anatomical shaped implant. The round silicone implants which we have access to now are silicone "gel" implants. They are catagorized often as "memory gel" implants, but they are not the true cohesive gel implants, e.g., Mentor CPG or Allergan 410 cohesive gel "gummy bear" implants..
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UPDATE RE: SIENTRA CLINICAL TRIALS:
RE:SILICONE IMPLANTS OVER 800 CCS:
Sientra has clinical trials nearly completed for their cohesive gel [gummy bear] implants. They will offer a round version as well as an anatomical version. Purportedly, the Sientra implants are less rigid than the Allergan 410s or Mentor CPGs. I was reading something written by Grant Stevens, M.D., and he states that Sientra implants are slated for FDA approval this year. Dr. Stevens is the doctor who came up with the name "gummy bear" implants. The KEY issue for women who need over 800 cc's in volume, is that Sientra will have implants up to 995 ccs in the high profile style. Here are the dimensions [width and projection] over 800 ccs in volume....
845ccs 15.3 cm x 6.3 cm
895 ccs 15.8 cm x 6.4 cm
945 ccs 16.1cm x 6.5 cm
995 ccs 16.4 cm x 6.6 cm
I will post updates as I find them...
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Thank you, Deborah - I went to PS yesterday for what should be my final fill - currently have 810cc in each side. We discussed the different styles and availablity and actually what would work with me - and we are looking at Allergan style 20. (I kinda like it when a professional states what he would recommend for a family member if they were in the same situation)
The only concerns that he has at the present, is that one side is about an inch higher than the other and he will have to make a new pocket for the side that is too high. He said that he believed that he could do it the same time as the exchange, but it was a possibility that he may have to make it an intermediate proceedure. But I think that I have seen where others have had the same issue and it was fixed at exchange - is that correct?
Thank you again for all your assistance and information, it is very much appreciated.
Suzanne
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Suzanne: Yes, typically that pocket correction is done at the time of the exchange. I am not sure if he is suggesting that he will want to reposition the TE or if he feels that he will need to do the exchange, correct as much as possible, but anticipates further revision will be needed down the road. Style 20 sounds good to me....but find out what size.....
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It is 800 cc, high profile, width 15.3, projection 6.1 - which is a bit wider than my TE's (14cm) but I currently have about 3 1/2 inches between my TE's so PS thinks it will be just right after he adjust the left side.
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The size sounds good to me. That is as much as you could get in silicone and we always say to err on the larger side..volume-wise....
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Thanks for all your input - between you and my PS - I feel really good about these. Of course, he will take the next size smaller in with him, just in case.
Thanks again, Deborah - you are vast wealth of knowledge.
Suzanne
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Hi,
I am having issues on deciding a final size for my implants and need advice.I am currently at 325 CC"s in each side of the tissue expanders. I told my PS Monday I do not want to be very big.Will be happy with a B or small C cup.He said I would need to be stretched to 400 or 450 CC"s for 325 or 350 CC implants. I am afraid this will be too big for me. I am 5ft1in,weigh 114 and small boned,if that helps. I wear size small tops.Do not have broad shoulders.With the 325 CC's in the expanders I currently look huge and do not want the final results this big. I go the 8th for another fill but am thinking I may not let him fill me. I definitely want to be smaller.Any advice I would appreciate.
I
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DFC: I think your PS is on the right track with you. 325 to 350 ccs sounds just right for your frame. Any smaller and you will not be happy. Trust me. The implants will look nothing like the tissue expanders. I don't think it is always necessary to overexpand that much though. If your skin is responding nicely to expansion, I personally think you have sufficient volume to switch right now to 325 cc implants. At the most...try to convince him to only give you another 50 cc's and then wait two to three months for the exchange to 325 ccs. Make sure you find out what STYLE he is intending to use. Be reassured that the 325 cc implants will be smaller than your TEs.
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Bumping for Dana
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Hi guys...
Deborah, you had suggested 550cc fills for me awhile ago. I am 5'8 about 135 lbs and 29" ribcage. TE's are Dermaspan SSp LLp FH13 +4 height 360-430 fill volume.
I went back to my ps, and told him I wanted that size and he said he felt it was too much, and that larger sizes meant larger troubles. My skin has been stretching beautifully, no issues. I was a full c prior. I am currently at 380 cc's and go for another fill in 2 weeks. He wants to swap out for Mentor 400 cc smooth rounds. My TE's look small to me still. I don't want to wake up disappointed. This process of educating myself and choosing while undergoing chemo has kept me engaged in my recovery and focused on the future. It's a breath of fresh air and I feel like this knucklehead has let the air out of my balloons, so to speak
I do have alloderm, and the swap will be completed PRIOR to radiation.
Have you heard anything about complications with larger sizes? I didn't really think 550cc was all that huge. I saw someone with 500cc's on the picture forum, and they look great to me!
Any thoughts as to why I shouldn't go back and really go for the larger size?
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geewhiz: I don't believe that I was aware you would be undergoing radiation therapy. I have some serious reservations, based on recent literature, about exchanging to implants prior to rads. Is this your plastic surgeon's idea preference? I am going to PM you with some additional information.
Here is one article that supports that with implant-based reconstruction, immediate/delayed with rads is the most optimum method after mastectomy. This means immediate reconstruction with tissue expanders, radiation and THEN exchange to implants.
One abstract:
I personally believe it would be better to fully expand you to 430 ccs. Do the rads - and do the three week rads treatment I have been reading about...and then wait SIX months for the tissues to heal and then exchange to the implants. A flap procedure gives you the optimum results after rads, but for implant-only based reconstruction, this is the way I would want to go. In fact, I would insist on it.
http://www.webmd.com/breast-cancer/news/20091104/quick-radiation-works-for-breast-cancer
This does change the picture referable to size for you in some respects.
Deborah
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Essentially, what the abstract I posted above states, is that:
When the expander "is exchanged for the permanent implant before postmastectomy radiation therapy" [this] results in higher rates of capsular contracture". The outcome is found to be more favorable, if the exchange to implants is delayed until after radiation therapy.
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Whippetmom- Wow thank you for all of the information you've been providing to this whole complicated subject.
My question is a little different. First let me give you a little history. 2 yrs ago I was dx with early stage bc. I had a lumpectomy and then chose to undergo chemo and also radiation. I had no problems with radiation, my breast feels a little different underneath (lumpy at surgical sight) but other than that all is good. For a real long time I'd always wanted to have breast implants, but then when I got bc I thought I'd never get that chance. My question is, is it still possible for me to get implants by having undergone radiation? I've not yet met with a plastic surgeon to discuss.
Any information or comments would be greatly appreciated.
Thank you,
Tiff
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