BREAST IMPLANT SIZING 101
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Megan:
The volume of the implants cannot change.You cannot remove volume or add volume to implants, as you do with tissue expanders. You have a lot of post-op swelling now and I think you need to see how things look a month from now.
Deborah
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Mamina:
I think that since you are going under general anesthesia, you might want to talk to your PS about switching out to Allergan Inspira SRX, an extra full projection implant, 800 ccs. You will have more projection with that implant. That said, the issue also is with the radiated breast. That is where intensive focus on fat graft transfer should be directed. The goal is to improve the integrity of that radiated tissue. You might require two or three treatments of FGT on that radiated breast over the next year or two. But if the radiated side is really tight, it might mean a smaller implant on that side for now. Another possible reason for the flat appearance is that the breast pocket created might bewider than the implant. You can message me photos which might help me direct you further.
Deborah
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Thanks Whippetmom.
I just messaged you a photo. I could try to "selfie" more if you need me to.
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Hello Whippetmom~
Thanking you in advance for all your help. I am still in the expansion phase and trying to figure out what will work best for me. The naught set was a 38D. I want to go a tad smaller so that no bra will be needed
Chest: 38.5, 5'4'', 203 lbs. I have the Natrell MX expanders in now and I have around 310cc now. I still need to complete radation after I am expanded.
Thanks again!
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Hi Whippetmom-
I had a double mastectomy on September 3rd, and had Mentor, 350cc, medium height expanders placed. I am scheduled for surgery to get my implants placed on 1/15/20. My pre-surgical appointment is scheduled for 12/10/19.
Prior to my mastectomy, I was a B cup on one side and almost a B on the other (not very well matched - born that way, lol!). And believe it or not, I can't remember which side was the bigger one. I guess it didn't really matter to me.
I have asked to be just about the same size. I don't want to be any bigger, but not smaller either.
I have asked for saline implants, and my doctor has talked to me about an implant with "channels" that would be less sloshy than the usual saline implants. But I didn't get a brand name, so I'm not sure what that would be.
Height - 5'8"
Weight - 129
Rib cage - 28.5 inches
I am under-expanded right now. My surgeon says this is deliberate on his part because I have very little flesh on top and my skin is thin. I am also hanging lower on one side. He says he's not worried about this and it'll be fixed when the implants are placed.
Any help you could provide would be so appreciated. I really don't even know what to ask when I go for my appointment in December.
Thanks!
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BetsyB22”
I think your PS might be referring to the “Ideal” saline implant. You can read about it here:
https://idealimplant.com/overview/
In that implant, I would suggest 370 ccs, as it corresponds best to the width of your TEs. The benefit is that the PS is able to adjust the volume during placement, which will enable him to gain symmetry bilaterally.
Deborah
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G1973:
I need more information about your tissue expanders. What is the recommended fill level? Please read Section 2 in the thread header. With reference to not wearing a bra....that is not really something I would recommend. Implants 500 ccs and upward will succumb to gravity without support and can become distorted. I am pretty sure you are going to want to at least be in the 500 cc range. It all depends on your skin envelope. The implants cannot be too small for the skin envelope created by the surgeon. Obtain further info on your TEs and we can refine further.
Deborah
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Hi Whippetmom!
I just want to start by saying thank you so much for the work that you do! I just can’t overstate how valuable it is to be able to tap into your incredible knowledge base. Thank you, thank you!
I just want to start by saying thank you so much for the work that you do! I just can’t overstate how valuable it is to be able to tap into your incredible knowledge base. Thank you, thank you!
I have just one more question. My plastic surgeon said that my pectoral muscles were significantly different between my right and left side. This made sense to me because my real breasts were not just miss matched in size, but one hung a little bit lower than the other. As I said in my initial post, he says he can fix this during the exchange surgery. But I wonder if you’ve heard anything like this from the many women you’ve helped in the past?
Thanks again for your help. I am so grateful!
Bets
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Hi whippetmom. I had a right side mx on 7/31/19 and currently have an Allergan MV 12T , 300-cc volume TE.
I am 5'5", 110 lbs, and my rib cage is 29 in. I also have a pectus excavatum deformity.
My last fill was on 10/7 and I am currently @300-cc (which my PS says is more like 350-cc when adding the volume of the unfilled original TE).
My pre-mx size was 34B but my left side is a bit deflated and I have spoken to my PS about having a lift and augmentation on that side. Currently, my TE fills out my 34B bras better than my healthy (deflated) side, and I'd like to even things out. I also wouldn't mind going bigger but don't want them to be overly noticeable. I think I would like to be a very full B or small C if it weren't too 'in-your-face'...
My PS suggested an Extra Full SRX (I believe that's what he said) on the right to replace my TE, and a smaller implant and lift on the healthy left side. He says it's up to me to let him know what size I want to go with, after doing some homework (he suggested the rice test) to see how much bigger I want to go. He said that he would probably be able to fit up to a 450-cc implant on the right side and that the smallest he could do on the left would be 110-cc but would go up from there to match the right.
I haven't done my rice homework yet but I'd love to know your opinion... Can you please give me your recommendation?
Thank you so much!
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Hello Whippetmom
Thanks for the wealth of information you share with us.
I sent you a photo last week and would just like to know if there'd be any change in the suggestion you made on me talking with my PS about switching to Allergan Inspira SRX, extra full projection implant, 800 ccs.
I'm carefully writing out all my questions and suggestions, so that I don't forget anything during my pre-op appointment.
Thanks again, Whippetmom.
Mamina
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Mamina:
I responded to your post via private message. I sent it on 11/16.
Deborah
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Betsy:
Did you know that one half of all women have assymetrical breasts? One breast smaller/larger than the other? My native breasts were assymetrical. It is something your PS can work on to address during the exchange procedure.
Deborah
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Bee24:
With pectus excavatum, you have to address how close you can get the implants and you also need to deal with projection, referable to the native breast. Honestly, I think you are also talking about corrective plastic surgery with the native breast. I would want to consult with a thoracic surgeon or someone who really specializes in chest wall deformities. I have a hard time seeing how a small implant on the native size could ever match a SRX. The rice test is controversial....I have not found that it really does much by way of predicting sizing in breast reconstruction patients. I would consider getting a second opinion before the exchange.
One other option would be to get your PS on board with the idea of using fat graft transfer to help shape the native breast, in addition to the implant. Because you are thin, only your PS would be able to determine if this would be possible. Keep me posted
https://academic.oup.com/asj/article/33/6/822/2801372
Deborah
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Thanks, Whippetmom!
I guess I figured that mismatch of breast size was common enough, but one lower than the other seemed weird to me. I guess not! Also, my PS told me he could address the height difference issue during implant placement, so it's reassuring to hear you say the same thing.
Thanks again for your help. Such a wonderful thing you're doing here!
Betsy
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Thanks so much for your input, whippetmom! I don't know how much my pectus excavatum affects my case as no one on my medical team has has ever brought it up or discussed it with me. I only found out about it when looking through my radiology reports so it may not have been worth including... but it did prompt me to investigate and I found some interesting information. Your link was very informative, too, thank you!
I was hoping to augment my left side to match the right during my TE exchange. The rice test was originally suggested as a way to determine the current size difference between my native side and TE to help choose implant sizes. Can you explain why matching the native side with an SRX would be challenging? Would another type of implant work better in my case? I know that the result would not be symmetrical but I think it would be an improvement.
I'm at Johns Hopkins and feel very comfortable with my PS (he was the 4th PS I met with) and he is definitely on board with fat grafting if needed. I am leaning toward going a bit bigger than my pre-mx 34B. Can you tell me what you think would look proportionate on me? Here is my info again:
TE: Allergan MV 12T , 300-cc volume
Height: 5'5"
Weight: 110 lbs
Rib cage: 29 in.
Pre-mx size: 34B
Thank you!!!
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Thanks Whippetmom.
I got it. I'll keep you all posted.
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Bee24, Thought I'd reply since I'm about your size (except for rib cage 28). I know nothing about pectus excavatum. I have SCX 340 in each breast. These were done at different times. At first, I had the left MX and then a year later had the right MX because a new diagnosis in the right--both DCIS. At the time of the left implant, I had a mastopexy (lift) on the right and during that surgery, the surgeon decided not to put in a right implant because of tissue health.. The surgeon then wanted to do another surgery on the right and put in a saline implant because he said he could better match the left if he put in saline on the right--because saline is more adjustable. While I was deciding, the MRI showed DCIS on the right--therefore, another MX and implant. I also was a 34B prior to MX (never measured though). Now, I can wear a 34C, but when measured at Nordstrom's they said 32DD. I find the SCX to be firmer that I'd like--no ripples, though, and good enough. My husband thinks I could have gone smaller. Hope things go well for you.
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Hi Whippet Mom,
You had suggested the Allergan Inspira SRX in 700 and that what was what I was expecting to get. I ended up with 750 Allergan Inspira SSX. Would you be able to tell me the difference between SSX and SRX? I'm not sure why the switch and won't see my PS for follow up for a week. The surgery went really well and I'm getting around better than expected. I look super weird, so I'm trying to avoid the mirror for now! Thanks again for your help!
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Ibis, Thanks so much for sharing your information. It's so interesting to hear how measurements can differ from the bra sizes we wear. I was never measured professionally pre-mx and wonder if I truly was a 34B... Was it difficult for you to find bras that you like? Thanks again for replying~
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Bee24. There's some bra information on a thread called Bras 101. Nordstrom recommended Wacoal 852189 and I got a few. I also like Bali Comfort revolution because of the wide band. Best to you.
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Bee - your body will be changing for 6 weeks to 6 months after reconstruction so don't spend a lot of money on bras up front. Get something at WalMart or Target. After you have recovered from surgery & everything has settled, do go have a fitting with a salesperson who has been trained in breast cancer needs. You will be surprised at the difference. Nordstrom is a good one & they usually take appointments
And yes, go to Bras 101 and read about literally hundreds of bras
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Hey Whippetmom- Thanks for your service to all of us. You gave me a recommendation of Natrelle 750 to 800 SRX. My tissue expanders are 133S-MX-15T 700cc. have been filled to 650 cc. My question is what size do you think would give me a C cup? I was a D cup prior and really don't want to be that large again. From what I understand implants are smaller looking. I just don't know how much smaller looking! I am assuming I'll be in a compression bra from here on out and that will that make me look smaller still? I appreciate your help and all that you do for us.
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Bee24:
It would be a challenge to get your native breast to achieve the projection required to match the mastectomy side. But unilateral reconstruction is very difficult for me to predict. If your PS feels that a SRX would work and that he could achieve symmetry with the native side and a smaller implant, then that would be great
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hodgepodge:
There is really not much of an appreciable difference between the SRX and the SSX. The SSX is the “soft touch gel"", hence the “S", than the “R" “responsive touch gel. In the extra full profile (and all profiles), there is a SRX, SSX, and SCX. The SRX is the lowest in terms of cohesiveness and “fill" volume. This is followed by the SSX and then the most cohesive (firm) is the SCX. So he gave you the middle range, which is justfine. In the U.S., we had only been given access to the SR and the SC versions. If you are in the states, then I have not kept “abreast" of implant advancements! But ask your PS and see what he had to say.
Deborah
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July11986:
How do you look now? I cannot comment on bra sizies. Refer to item 8 in the thread header! In one bra you might be a “B” cup. In another, a “C” cup. In another, a “D” cup. You can buy the bra that says “C” cup if that is what you want to be. I say, if you are satisfied with where you are with your fill level, than you adjust from there. It does not matter what size the bra is....it matters how you look in clothing and how you feel about the size currently.
Deborah
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Thank you for responding whippetmom! I will let you know what I find out from the PS!
I am mostly happy with things... I have projection but then am super flat across the front, kind of squared off. I am trying my best to stay away from the mirror for a while. It's hard though, because I have to find a dress for a wedding, so I am hyper aware of my unusual profile. I am hoping to round out some!
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Hi Whippetmom,
I had a bilateral mastectomy with retropectoral expander placement on 11/15/2019. I'm currently 5'3", 148 lbs, with a 30" rib cage. My PS used Allergan 133S-SV-12-T (short height/variable projection) expanders that have a fill capacity of 250 and measure: 12.0 x 8.4 with projection of 5.3. I've had 3 fills so far and am currently filled to 170 cc, and it feels like my breasts are still non-existent. Prior to the mastecomy I was an H cup, and underwent a bilateral reduction at the time of the right side lumpectomy in August. When things settled I was closer to a D cup and was happy with the reduced size. Given my frame and measurements, which implants would you suggest that will provide a full but still natural look? Thank you for your input!
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Carebearkid4life:
The tissue expanders are very small for your frame. You need to overfill quite a bit. It sounds to me as though you had sufficient skin flaps for larger tissue expanders. I think you should be in the 500 cc range with implants. Do not go through the exchange until you have your PS on board with sizing issues. You may or may not need to overfill by much. If your PS is talking about anything less than 500 ccs, keep the tissue expanders and get a second opinion. But discuss this with him during your next visit
Deborah
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Hi Whippetmom,
I had my revision surgery 2 days ago and all went well. A lot of pain on days 1 and 2,mostly on the sites where the fat was harvested for the grafting, but I am up and about today. I'm seeing my PS on Monday for the post-op. I'll give you all the updates after that appointment.
Thanks, Mamina.
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Hi Whippetmom,
I have expanders in at the moment (since January 2019) and am likely getting the implant exchange within the next month and worried about sizing. Someone recommend coming here so figured would see what you thought. I have Mentor 650 TE’s in and they were filled to 650. I had 28 rounds of radiation which ended in September and the right side is at least an inch or two higher then the left now. My rib cage size is 37inches and I was approx a 38DD prior to surgery last year. I am 5’5” and currently 190 though 25lbs were gained during chemo so hope to lose it. I guess my biggest concern is I don’t want anything that will be too ..much but still want to have decent volume. My plastic surgeon works mostly with mentor. Would love to know your thoughts. Thanks so much!
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