BREAST IMPLANT SIZING 101
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noodlesmom:
There could be various reasons for what you are feeling. It could be that you have the “extra cohesive” version of the Inspira line of implants, and that might be a bit too rigid for your body type. The other possibility is, as you mentioned, capsular contracture. With capsular contracture, the implants are often raised up higher than they were originally, and might even be distorted. If is it capsular contracture, the implants would feel very hard to the touch.
There is a likelihood that complicating the picture is that you have post-mastectomy pain syndrome, which occurs in 30% and even up to 60% of patients who undergo a breast procedure. PMPS typically means that muscles and nerve fibers were disrupted (severed) during surgery, and also, anesthetic pain control was not adequatelyundertaken during the surgery. So plastic surgeons are not often too keen on suggesting to patients that it is likely PMPS.
First: Go see your plastic surgeon. Better still, go see a DIFFERENT plastic surgeon, and let him examine and determine if this is capsular contracture.
Second: Request a referral to a physical therapist who PRIMARILY works with breast cancer patients = who knows exactly what PMPS is and how to help ameliorate some of the discomfort. It MUST be a PT who knows myofascial release techniques.
Lastly: If you did receive the most cohesive version of the Inspira implants, and if it is determined that an exchange surgery is in your future, go with the Inspira Soft version, or the Mentor Xtra Smooth Round silicone implants.
Keep me posted!
Deborah
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Thank you so much Deborah, this is very reassuring and helpful - I feel confident going into surgery now that I have a second opinion, if you will. Thank you again - appreciate it so much! -Kate
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Just wanted share an update on my reconstruction journey. My prior posts on this thread detail my disappointment with my former PS. My breasts had an unnatural appearance, size was too small (Mentor MemoryGel Xtra 465cc on both sides), right was smaller than left and the overall shapes were different. My original PS only wanted to do fat transfer and refused to do larger implants, use different sizes to correct the obvious size difference, or address any of the other issues. Thanks to @whippetmom for sending me a list of recommended PS in my state, I found a great PS 2.5 hours away. Yesterday I had revision surgery. Implants were changed out to slightly larger (545cc on the right and 520cc on the left) to correct the size difference. He used the recently FDA approved Mentor MemoryGel BOOST style implants, which are supposed to have a more natural feel and shape and minimize rippling. He also did fat transfer (175ccs harvested from outer thighs/saddlebags, 40ccs injected around implants), moved my right nipple a bit so it’s more in line with the leftone (crescent lift) and added some tissue under my right nipple to give it more projection (right side was my cancer side, so the nipple was cored out and had less projection than the left). I’m obviously still swollen, but even at this stage they look so much better, more symmetrical and more natural. I’m super optimistic about the final results. Such a relief since I was completely unimpressed with my former PS’s work and was worried that was as good as it would get. Hopefully I’m done with surgeries for a very long time!
*Sorry my stats aren’t showing below my signature. They disappeared with the update to the site and I just don’t have the energy to add all that info again.0 -
Kaycee: Wow! I am impressed with the revision techniques your PS used! It is a reminder that we are not “stuck” with a less than satisfactory result from breast reconstruction. Sometimes we think it is one and done, but that is not always the case - not with me…not with many others.
I am so glad you posed this update and I am happy for you!
Deborah
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i am 70 yrs, 5'7", weigh 185 lbs, rib cage circumference 38 in. I had bilateral mastectomy early Feb 2022.
Instead of expanders, my PS put in Mentor Smooth Round Spectrum Saline adjustable implants in both breasts. 525 cc. I am current filled to 625 cc in my left breast, and 550 cc in my right breast. I have almost nothing below my breast fold and the implant sets high on my chest. The implants are uncomfortable, too high and what I have looks like a 14 year old's breast, but wide. I believe he has overfilled due to my complaining of how by breast look like I only have the top, but no bottom.
I finally saw today. He has given me “man” breasts! I look like an overweight man that has fatty breasts! I could just diePlease help!
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also, I live in South Florida. Can you provide list of good reconstruction plastic surgeons
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Hi Whippetmom,
I am hoping you can assist with a recommendation regarding implant size as I feel very lost. I am 5'6" and weigh 140lbs with a 30" rib cage. I was fit with pre pec Allergan 133S-MX-11-T 300cc fill volume TEs in November 2021. I am currently filled to 350cc which was my final fill before planned exchange surgery in August. My PS is planning on Allergan SCX implants in the 350-450 range. I have a bony chest and carry most of my weight from the hips down. I was an A cup pre mastectomy and am hoping to look like a small C cup following the exchange (I know we don't go by cup size but wanted to give an idea of what I am striving for). I am worried that I did not go large enough with the expansions or that the 350-450 SCX implants will not result in my desired outcome. Any advice you can provide would be very appreciated! Thank you so much for all the time and knowledge you have dedicated to this site! You are a gift
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I’m hoping for some assistance with implant sizing please. I’m 5’4” 230lbs with a rib cage circumference of 42”. I had a bilateral mastectomy on 4/7/22 and had my expanders immediately filled to 600ccs which felt very small for my size. I have since been filled to 700ccs but I have the option to fill to 800ccs and I’m just not sure what’s right for my body size. I do plan to lose weight once this is all behind me but maybe I’m just used to seeing myself with DDD breasts. This is all so challenging. I believe my PS prefers to use Natrelle implants. Thanks in advance
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I noticed Whippetmom hasn't been on in awhile. There have been so many challenges with the BCO format, but I sure hope she can still check in maybe once a month or so. Hang in there ladies, because her advice is the gold standard.
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dyslca_637 - Just in case Whippetmom doesn't see your post, we suggest sending her a private message to see if she is still around. Click on her profile name, and under the information at the top, you'll see the option to send a private message. Meanwhile, we hope you can get some advice from other ladies here too!
Hope this helps. Please let us know if we can be of any assistance!
The Mods
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1. 5'5" 160 lbs (about 20 pounds up from before chemo- hoping to get back there). Rib cage 31.5" I had nerve grafting which he said that we don't want to push on it with the implant- and would want to stay a moderate size- which I am fine with.
2. Over the muscle allox2-fh11se expanders with volume of 230-280 with a projection of 5.7 and 11" width
3. PS uses mentor and mentor boost has not been approved yet for purchase by the hospital
4. I was an "A" meaning I wore anywhere between 30c-32b-34a bras. I am pear shaped and carry most of my weight low.
5. PS is suggesting Mentor moderate plus implants filled at 350 12" width I think that because of my overall medium build that is going to be too little projection (4.1). I do not want to be flat like before but I'd like to have moderate sized breasts. I suggested MemoryGel® XTRA Smooth Round High Profile plants SHPX450 and he said I might be too busty.
Thoughts?
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jennik - I hope Whippetmom checks in since she is the absolute guru & 'breast whisperer'. However she hasn't posted here since May and may be frustrated with the site changes & problems. Wishing you the best.
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I see questions dating back to May. If you still need an answer to your question, please letme know!
Deborah
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Jennick78
Huh? You ABSOLUTELY will not be too busty! In fact, you will not be happy with anything less. It is impossible for you to be “too busty” with a 450 cc implant. Don’t settle for less!
Debora
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Deborah - GREAT to see you. Thanks for popping in. You are absolutely "the breast whisperer". Hope you're doing OK.
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Hi Deborah. Glad to see you back. I had posted in May regarding a recommendation on implant size. I was previously fit with bilateral pre pec Allergan 133S-MX-11-T 300cc fill volume TEs. We ultimately filled to 400cc. I am 5’6” and weigh 140 with a 30” rib cage. I just had my exchange surgery on 8/1 with Natrelle Inspira 485cc SCF implants. I am not necessarily unhappy with the way things look but it is soon after surgery and I am not sure if the look will change with healing. I have some slight rippling on the right (mostly with bending forward) and it seems as though I can feel the upper edge rubbing on my skin on the right. I am not sure if I will eventually need fat grafting for the rippling or if a revision will be needed. Do you feel that the 485cc implants are appropriate for my frame or would you have suggested another size? Also, do pre-pec implants go through a drop and fluff period like sub-pec or is what I see pretty much what I am gonna get? I am trying to decide if the SCX would have been better than my SCF or if that would create more rippling or a step off. Not sure if you can have it all or if it’s a trade off. So many questions…
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Hi Deborah. Glad to see you back. I had posted in May regarding a recommendation on implant size. I was previously fit with bilateral pre pec Allergan 133S-MX-11-T 300cc fill volume TEs. We ultimately filled to 400cc. I am 5'6" and weigh 140 with a 30" rib cage. I just had my exchange surgery on 8/1 with Natrelle Inspira 485cc SCF implants. I am not necessarily unhappy with the way things look but it is soon after surgery and I am not sure if the look will change with healing. I have some slight rippling on the right (mostly with bending forward) and it seems as though I can feel the upper edge rubbing on my skin on the right. I am not sure if I will eventually need fat grafting for the rippling or if a revision will be needed. Do you feel that the 485cc implants are appropriate for my frame or would you have suggested another size? Also, do pre-pec implants go through a drop and fluff period like sub-pec or is what I see pretty much what I am gonna get? I am trying to decide if the SCX would have been better than my SCF or if that would create more rippling or a step off. Not sure if you can have it all or if it's a trade off. So many questions…
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Hi Whippetmom, The PS and I met again for my final expansion and he now thinks the Mentor Xtra 375 moderate plus is best but will also have the 400 moderate and the 450 high profile in the OR. We will be doing fat grafting as well to smooth things out. He says 450 will probably be too big/tight. He said he is willing to work with other brands that might have a better combination of projection and my width but he likes Mentor the best. My TEs are now fully expanded to 280 - I do like how they project and fill a 34b my bra. I know probably unimpressive to others but pretty curvy to me!
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It has not been easy restoring my account. For some reason, my password was compromised and my message box and “favorites” are inaccessible. I do not appear to be getting any notifications. I am not technically challenged, I just finally had some time today to at least change my password and post in my thread!
Hope everyone is well!
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it is good you are back.
I have few of the details you spoke up, but am clicking on links you posted. I had a TE put in Feb 9th, but I ended up with a blood clot and 6 months later I am off.
Now looking to get the left TE out and the right breast removed, so 2 implants. They will be silicone. I believe the PS said Iay need fat grafting, but I forgot to ask. I will question him in the portal.
I was not big busted and was able to get skin saving, all else removed. The right side I may get to m keep the nipple. Really, since late June of 2021, I have found I am Brca2 + and Her2+. Stage 2. Foreign. All of it, until my genetic test and pathology on my tumor.
It is good to have a forum with women and men, who have cancer.
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My exchange was a few days ago and Mentor MemoryGel Xtra SMHX-400 were "installed." So far I think they look OK and a good match what I was looking for without suddenly having a very different physique. I think I like the moderate high so far and hopefully the loss of projection compared to expanders is offset by keeping my nipples.
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Hi! I'm new to the community and so grateful that it exists. I currently have tissue expanders in and have been experiencing rib pain starting right below expander and extending down about 3 fingerbreadths (only hurts when I push on that area)- couple inches in front of former drain hole. Is it common to get rib pain with TE and will it go away when swapped out for implants?
Also wondering how folks have decided on nipples - recon vs tattoos vs nothing?
Thank you!
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snm - I had pains the entire time I had TEs. Yes, it went away once I swapped out for implants. Edited to add - there used to be a couple of TE threads where we all agreed they were as hard as turtle shells.
I settled for nothing in place of nipples. Nothing was going to replace the sensations, so....
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Thank you minustwo! I feel relieved to know that about tissue expanders and the pain associated with them. I will get implants in May and I'm nervous about having another surgery. I heard recovery time is short but not sure what that means - 2 weeks? Would love to hear how others handled implants-swap experience.
My recovery from BMX was painful with limited mobility and back spasms for first 2 weeks but then slowly got better over few more weeks. Stage 1A (high grade DCIS with microinvasion on left), preventative on right.
Regarding nipples and no sensation I hear you. Thinking I might need something to have closure--maybe tattoo would be ok?
Thank you
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snm - I know the BCO site in in the middle of migrating from a total mess to a new platform, but hopefully you will be able to go to 'all topics' and search for 'tissue expanders'. This is one of the threads that really helped me, although it not really active. https://community.breastcancer.org/forum/44/topics...
Edited by Mods to make link hot.
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Hi snm, I just had my exchange surgery March 2nd. It was so much easier from my other breast surgeries!
I am a bit unusual because I have had BC 3X, in 2003, IDC treated with two lumpectomies, (second one for clean margins),chemo and radiation. It 2018, 15 1/2 years later, BC reared it's ugly head and I was Dx with ILC in same breast, treated with left mastectomy with DIEP reconstruction (January 2019) and Aromatase Inhibitor. Three and a half years later, August 2022, I was diagnosed with DCIS with microinvasion, and I had a right mastectomy with tissue expander.(October 2022)
Yes, the TEs are rock hard and uncomfortable as....well, you know! My exchange surgery was great and I would do it all over again without hesitation! I was an out patient for my mastectomy, and the exchange surgery as well. Honestly, once I got the anesthesia out of my system, I felt really good! I took the prescribed medications, tylenol, Celebrex, and Gabapentin (neurontin) for the pain. He gave me a few oxycodone but I never took any because I do not like the constipation it causes and honestly, I had next to no pain, so I didn't need it!
No drains with the exchange. I had some unique issues that are not common, so I won't mention, but I did get constipation from the anesthesia and surgical medications. That was probably also due to my body and how it reacted to the drugs.
I think the worst part was not being able to unwrap the bandages, surgical bra, and the abdominal compression garment, due to the liposuction I had. That meant no showers until after I saw my surgeon for first post-op visit 5 days later. Really, if that was the worst, you can tell, it wasn't bad at all!
I am almost three weeks out and feel back to normal. Now it is really hard sticking to the restrictions I have for the next three weeks! That is a good thing!
By the way, if you are wondering why I didn't have a bilateral mastectomy in 2019, I wanted a bilateral mastectomy and was refused! Long story, and really water over the dam now, so no point in going into it, especially since my surgeon sadly passed away unexpectedly in the spring of 2021.
Any specific questions you have, just ask! The best thing about these message boards is that there is always someone who can help you with questions and your feelings. It is full of people who really understand and care, like minustwo, who helped me so many times!
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Thank you so much for sharing! Great to hear that you are feeling back to normal after 3 weeks post exchange! Gives me hope!
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Why can you only wear a sports bra or European bra after a mastectomy? Do you mean immediately after the surgery while recovering, or even years after implants have been placed?
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coffe - many doctors say no underwire ever. other doctors say only underwire. So you can see it's a conflict. It will also depend on the outcome of your particular surgery. Talk to your plastic surgeon. If you're in the US, you can call for a free appointment at a Nordstroms. They have certified fitters for breast cancer patients.
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I figured to pop in and say I had one taken Feb 2nd, one of two drains for 3 weeks. The more you move the more liquid your body produces. I got use to the 24/ bra. Blood clot arrives, right sight removal postponed till Dec 28, 2023. Interesting. Hematoma developed, so I sent pictures through the portal. One week post op saw my breast surgeon 1st, who took pictures and sent to the plastics Dr. He was at thecairport heading out on vacation, so he called my hospital. My post office hours later with the plastics team had me readied for surgery at 8pm that same day. New implant removed, area cleaned out and implant put back in. New drains, a bigger Size you can only get in surgery. The other size I had was also available to be planted in out patient surgery. I had no idea.
So, the healing has been good. The incision has healed and there are faint white lines on both sides.
I must add I was wearing a light compression Bra and fluid starting to build around the right implant. I did not know that could happen. Twice I. 2 weeks. I cold the office gave me at work delayed my doctor visit in mid March. Mt 2nd aspiration to remove the fluid, well I could have had a drain. Hello no! I have padded my sports compression type bras and nearly 1 werk plus, both sides look more alike.
Tattoos, fake nipples? Oh my. I was a 25 year platelet donor. As soon as my platelet number rises after I finish lynparza drug in June, I will return. I have not had any drug that is lifetime banning.
Lastly, I had the left expander in after my 1st Feb surgery. They wanted the tumor out. The radiator was to happen, so no implant. The radiation was deemed not useful for me. A could weeks later, the blood clot.
I had the expander in for 10 months. It was not hard, but it did feel weird. It extended a bit longer, bit overall, it was ok.
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