BREAST IMPLANT SIZING 101
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Deborah, you are amazing! You give so much, rest my dear friend!
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deekaay:
Does the prophy side implant feel like it has less fill than the MX side? I just wonder if it is leaking. This would cause more rippling to be evident and also, would create folds in the implant which might protrude laterally or medially...as what would occur with a ball as it deflates. Another thought is that the prophy pocket is larger than the other and permitting the implant more movement. I think I would get this addressed before getting nipples.
Deborah
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Anna...((((((((thank you)))))))),,,all rested...
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Deborah, geez, I hope it's not leaking, I don't think it's smaller, but it is less poofy since swelling went down. I posted 3 more pix on the forum that give a current look at me-can you take a look?. Actually, they look pretty decent and the ripple doesn't show until I raise my arm. My theory is similar to your second thought--I wonder if the pocket is bigger than the implant. I asked the PS when I went in 2 1/1 weeks ago if I needed a larger implant on the prophy side and he said no, I just have very thin skin and muscle coverage. He said a larger implant would still show ripples. Too me, it seems a little loose. Maybe it's w/i normal limits but with no experience in this area, I don't know. If I pull the skin tight at the bottom of my foob, everything tightens up nicely and looks and feels good. That makes me think it could be tightened up. PS felt fat grafts would take care of it. My left bc side is firmer since I have Lat flap there and rads which keeps things firmer.
I appreciate your help with this. Thank goodness for you experience and that of the other women on here! Glad you got some rest, deekaay.
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deekaay: I posted comments over on the pictures forum...
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Deborah- Thanks for the feedback on fat grafting. I do think it is something I'm going to look into for the rippling. If nothing else, maybe I, too, can get rid of my MENOPOT! LOL!
deekaay- I swear I can feel the implants, too. It's not a smooth feeling like I thought they would feel like. My rippling seems to get worse when I lean over or move my arms a certain way.
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FYI... from little me..
I did get 50cc larger implant for my minor rippling. It fixed the entire problem. My surgeon is in favor of a bigger implant if there is rippling. In sever cases... it won't work as well, due to thin skin.. but it would help enough for the fat grafting to finish the job.
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Laura, so you had a revision for the sole purpose of getting a 50cc larger implant? And that fixed the ripple problem? May I ask if insurance paid for this? Did you get the revision on both sides? Did you ever have to have fat grafts after? So many questions from me tonight!
Hope you had a nice vacay and that your son's dr. visit goes well. deekaay
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I had ALL intentions of getting a revision...due to ripples and the non rads boob falling. But then I said to myself, NO... that is just your vanity speaking Laura. Well.. I had my check up... and my Plastic said... You need a revision, your implant has fallen out of the pocket..
So I told him I wanted the fat grafts while I was HAVING to do surgery anyway. He said that a bigger implant would fix my rippling about 90% ( I think he said)... and it did.
My insurance covered... BCBS.
I have not had fat grafts. I will make up my mind on this in Oct. It all depends on my sons health, and .. a few other things. I do not need fat grafts for ripples, only for under the rads boob . It did not drop and fluff like a normal implant will. so it is about 1/2 higher than the non rads breast. SO.... do I go under the knife for this?? Knowing me.. I will not be having Fat grafting. I think anyone whose PS thinks it will work 90-100% should go for it.
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deekaay and kate33 - I can feel my implants too, especially on the sides. I can see the rippling when I bend over or hunch my shoulders.
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Estepp: Good luck with your son and the endocronologist. May it be an easy fix.
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Where did I miss the post about Laura's son and seeing an endocrinologist?
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I'll PM you Laura!
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Deborah - I think she posted that on EC thread lol.
Laura -- prayers for you son! Hope the Endo solves all and puts an end to his discomfort and misery.
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Yeah, Lilah...I saw it there. I have done the same thing...I have answered questions on the EC thread, thinking I was on the Sizing 101 thread. VEWWRY, VEWWRY INTEWESTING!
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I blame it on my chemo brain LOL
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I'm going to have my implant removed in a couple of months and have the TE put back in to stretch the skin on my lower pole. Has anyone had the natural breast lifted when the TE was put in? Pros and Cons to this?
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Claire: Wouldn't do it. It is like giving you a lift while blindfolded. Why not do the lift when you have the exchange - the second exchange?
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I blame everything on chemo brain and, if needed, add 6 gen. anethesias for good measure. Basically, I can be responsible for NOTHING in my house! lol Plus I have cats. You can always blame something on the cats. Gives them a sense of pride!
My favorite was the study that said chemo brain has been shown to last up to 10 years. I figure I can milk that for a decade!
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thanks Esteppp...... I too am trying to decide on a revision for several reasons one of which is rippling. 3 out of 4 BS in consutation felt a large implant will help with the rippling. I guess I figure is I never do the revision, I will always be slightly disappointed. Whereas if I give it one more try, perhaps they can be where I want them to. Then the other side of me says.... well, what if they are not, what if there is a complication. Thanks for your positive words, that certainly helps. Pam
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deekaay- LOL!!!
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deekay: You said a mouthful LOL!@!!
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Another question on TEs. One PS said she would put the TE lower than my natural breast so that when she does the exchange, there will be enough skin for the breast to have more of a natural droop. I don't think she used the word droop - but chemo brain made me forget her exact terminology
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Claire: When my dr. did my MX he underlined where my natural breast line was, and matched an expander to this exact size. Being a Uni, it was important for him to match it with my natural breast. When I had my exchange, he underlined my natural breast in the exact same area and he used a High Profile implant on my MX side and a moderate profile on my natural side to get symmetry. I have never heard of putting them in two different places. Have you recieved any help from Deborah yet?
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Claire: The PS probably used the term "ptosis". I do not at all agree with the recommendation to lower the inframammary fold. I think it is a bit archaic....a technique sometimes used a decade or so ago, but not currently - especially since the advent of products such as Alloderm. I know that the plastic surgeons I respect [Louis Strock, M.D., Scott Spear, M.D., Kenneth Shestak, M.D. and others, do not advocate this at all. The way to create ptosis is to overexpand or give additional stretch to the skin beyond the size of implant you ultimately intend to use. I would not even think of lowering the IMF....I can show you a photo of what happens when the IMF is placed lower than the natural breast..
Take a look at the photo on Page 558...when you get to the page, type in "inframammary fold" sans quotes and then scroll down until you come to the link to Page 558....
Institute of Reconstructive Plastic Surgeron, New York University - 2007
"There are several important points to note when creating the pocket for the tissue expander. Firstly, when creating a pocket for the tissue expander it is important that the pocket dimensions match the expander width, so that the expander edges do not roll up. Secondly, the inframammary fold should not be altered. Thirdly, if the native breast skin flaps are thin, it is best to provide complete muscle coverage over the tissue expander and subsequently the permanent implant. This can be achieved by mobilizing the serratus anterior muscle laterally.
Once the expander is placed, it is then filled immediately to a volume that does not jeopardize the circulation to the overlying skin flaps. Two to three weeks following placement of the expander, when the breast incisions are healed, expansion may begin. Expansion proceeds on a weekly basis with 50 to 100 cc of saline added each visit, depending on how the overlying skin changes with expansion (e.g. tightness, erythema) and patient comfort. The expander is usually over-expanded by 25-50% to improve skin drape over the permanent implant. This redundancy in skin envelope size allows for differences in profile of implant versus expander and also allows for skin recoil post-expansion. After expansion is completed, an additional 2 to 4 months is allowed for tissue equilibrium to occur prior to implant exchange with either saline, silicone or biluminal (saline/silicone) permanent implants."There are a plethora of such edicts regarding leaving the IMF unaltered. The concensus appears to be: Don't mess with the IMF.
Deborah
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vanderlady - I had rippling on one side only and it appeared smaller. MY PS did a revision and put a larger implant on that side only. I have two different sized implants-left side is style 20-700cc and right side is 20-650cc. While that did not completely fix all the rippling it is definitely better than it was. When I stand up straight I don't see the ripples-just in certain positions. I was like you in thinking that I would always be disappointed if I didn't try to look better. I decided to get it done. I figured I couldn't be any more unhappy than I was. The PS told me it could end up looking worse. Well I'm here to tell you that I am pleased with the results and happy I went with the revision. I have an appt. with him on Thursday to discuss nipples/aerolas and maybe fat grafting.
I also want to add that Deborah helped me tremendously in making my decision on the revision. Thanks Deborah!
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don...I am glad you are happy with your results!
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Whippetmom-I read your comments on the IMF. The question is if my Dr. places an implant larger than my TE what happens in my case? I will not get a droop? I can see if you are matching a natural breast it would be even more important but if you are bilateral does it change the way they do the expansion at all?
Also does seeing rippling with your TE mean you are more likely to get rippling with your implants?
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sweetie: How much droop do you want? I have a bilateral and I have a lot of droop - because my skin expanded very well and very quickly to expansion. But my TEs were 400 ccs and my implants are 550 ccs. It depends on how your skin responds to expansion. For a unilateral, you want more drape over the fold, to approximate the appearance of the native breast. So let's say claire's PS uses a 400 cc volume TE: He could overfill this TE to 500/550 ccs and then use a 400 cc or 450 cc implant, depending on the level of drape he needs to match the native breast. Most of us do not want droop...most women have lifts performed on the native breast so that they can reduce the amount of droop. I don't think this is necessary in your case.
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sweetie: Forgot to answer your second question...and I guess you cannot go to the pic forum....it is down and being transitioned to the new website...
RE: TE ripples inferring you will have ripples with implants: No, not necessarily, especially if you are seeing ripples because you have a lot of loose skin overlying the TEs. But if the rippling is secondary to thin skin and thin skin alone, it probably means they will be present with implants. It depends on the size of the skin flaps after MX...large skin flaps, small TEs usually can equal ripples.
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