BREAST IMPLANT SIZING 101
Comments
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Okay.. quick question. My reconstruction is on hold... I have to go thru chemo first then wait 6 mos. But I was curious (don't know why I just now thought of this) but can you still get TE's AFTER the fact?
I mean, since I didn't get them at the time of my BMX, is it too late? Is Flap my only option? Or can I still have TEs done 9 mos from now?
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Anne: You most assuredly can still go through tissue expansion with exchange to implants nine months from now. A number of women undergo delayed reconstruction after treatment regimens are complete.
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Thanks WhippetMom! That eases my mind!
So, (looking at the bright side) I have plenty of time to research research research!
Yay for me. In the meantime I get to be the flat-chested bald chick. Que sera sera.
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Hi There! I'm having surgery on Sept 8th. I'm having immediate reconstruction with implants, not two stage but thought i'd ask anyways.
Height is 5'6" Weight 150 lbs Ribcage is 35".
PS has stated he is going to place 450 cc sub muscular.
Does this sound about right?
Thanks for the any input.
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Hi Whippitmom,
I wrote to you on last month for help on sizing and you really helped me quite a bit. However, I think I gave you some incorrect measurements and since I am getting close to being filled to 450cc (your recommendation) I would like to check again with the correct measurements.
I am 5'3" and 130lbs. Under my arm is 33" and ribe cage is 29.5". I have a small frame and narrow shoulders. I have a Mentor Siltex Med Ht Texture Contour 6200-550cc TE (which according to the specs is 13.5w x 11.7htx 7.4 proj) I will be getting smooth silicone rounds in high profile as you suggested. I am so afraid of being too big (I was a 34DD) and it is so hard to tell since the PS left so much skin and it looks really horrible.
I think 400, 425 or 450 but I am really confused. Please help. I had a BMX on Aug 4th.
Thanks so much.
Nancy
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PitPat.. For a one-stage, it all really hinges upon how much of a skin envelope you have after MX. If you are large breasted currently, you probably have sufficient skin flaps. Have you communicated to your PS what size you would like to be? If it is 450 ccs, a moderate plus profile implant would be best.
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PitPat.. For a one-stage, it all really hinges upon how much of a skin envelope you have after MX. If you are large breasted currently, you probably have sufficient skin flaps. Have you communicated to your PS what size you would like to be? If it is 450 ccs, a moderate plus profile implant would be best. But you are in Canada....is your PS using a standard silicone round or an anatomical implant? Best check. A width of at least 13.0 cm and up to 14.5 cm would be best for your ribcage.
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Nancy: I am concerned when you say the PS left too much skin. I want to make sure there is not going to be too much ptosis or droop. Could you email me photos? I know you need a high profile implant, but now I am concerned about the excess skin issue and too small of an implant. I think you need at least a 550 cc implant to fill the envelope. The other option would be to use 450 ccs [457 ccs, or something like that if Allergan Style 15] in a moderate plus profile implant. Or, because of your projection currently, an Allergan Style 15 in around 500 ccs, but you would need to have some pocket work laterally for this narrower profile implant. Maybe you should send me photos or post them on the pictures forum. I will PM you my email address.
Deborah
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Thanks for the reply whippet...PS is using the silicone rond as he believes that I would end up with an upper edge if he used anatomical. He did explain the profiles, but I didn't write down which one he said. I know he is not going withthe high profile and he says there will be lot so skin. I'm just surprised that he is going sub muscular as with the reading I'm doing it seems as if the muscle shuld be stretched first. I asked that I be about the same as I am now. Large breasted? I'm not small and I'm not big I'm an average C cup at the moment and for the next 3 and a half days.
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Submuscular placement without expansion is done all of the time in the breast augmentation realm. So your PS has calculated approximately what degree of skin envelope he will have, which is why he recommended 450 ccs. Just make sure you ask him for only the moderate plus profile, the moderate profile [without the plus] would be too round and flat. It is very rarely if ever used for breast reconstruction.
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Deborah
I printed out your response to me about sizing and all. He took the paper and placed it in my file. before I left the office..he said "Carm-who is this lady?..she knows her stuff."
he agree's with your recommendations and said you are a gift to women. Thank you again.
Oct 5th is my exchange..cant wait. I also love love love my PS.
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T&C: Well, KUDOS to your PS! He sounds like a great guy who wants you to be happy. What more can I ask for? His thoughts about me are so very appreciated. I will keep doing this as long as I have the ability to do so! I look forward to seeing photos of his handiwork in October!
Deborah
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PitPat: I read your post again and saw that you would like to be the same size you are currently. In order to do so, I believe you will need at least 500 ccs - 550 ccs. So talk to your PS and let's see if he can assess the ability to use one of these two sizes at the time of surgery. You will have some skin loss due to surgical excision and retraction, so please clarify with your PS your desires as thoroughly as possible. With the one-step, it typically means that the patient will be smaller than they were prior to MX...it is one of the trade-offs for having a single stage reconstruction.
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twirl --- that's so cool.... isn't it a great feeling when you can come to an agreement with your PS!
Whippetmom -- Yes, you are a gift to ladies --- and invaluable .... thanks!
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NEW YORK HAS SIGNED INTO EFFECT A NEW LAW....
Stating that breast surgeons must inform a woman of breast reconstruction options prior to performing a mastectomy....
http://www.nytimes.com/2010/08/19/nyregion/19surgery.html
It is difficult to believe that there still are women not being informed that insurance will cover breast reconstruction, but apparently this is all too sadly the case. Hopefully other states will follow suite...
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I met with the plastic surgeon... we are tentatively scheduled to do a DIEP with TE's, so a DIEP and TEs with an exchange .... has anyone else done this?
I haven't read this anywhere else?
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Anne: There was a thread last year referable to DIEP plus implant reconstruction.
http://community.breastcancer.org/forum/44/topic/737114?page=1#idx_18
And I remember reading an article about how use of an implant could enhance the cosmetic results of a DIEP flap procedure. I'll look for it....
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Anne: Here it is...
http://www.jprasurg.com/article/S1748-6815(08)00457-9/abstract
Let me know if the link does not work and I will cut and paste it to you in a private message...
Deborah
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Deborah, that is fantastic about NY. I hope every state will do this also. I was told from the get go that I could reconstruct and have an amazing outcome . I was not told about Flaps from my BS. She just told me that in a few years down the road... I could go topless in the Virgin Islands, on the beach if I chose to. I could look that good.
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bumping for newbies
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Deborah, just wanted to update you on my progress. Had my last fill on Tuesday, and he chose to overfill my 250cc TEs to 270cc. Exchange date is Dec. 7. He didn't say what type of implant he would use, but that he would use either 375 or 400. I have asked a couple of times if he could create a "point" or an approximation of nipple tissue, I guess you'd call that ptosis. He said he was interested in that, and would do what he could to achieve that without using another flap. The BS took more from my right side above the breast as that side had a small amount of invasive BS, so he said he would do fat grafting there, and also said that the implants would go higher than the TEs. Recall my TEs are the low height ones. I am going to have photos taken and put up on TimTam's site, hopefully by next week so there will be a before and after. When I asked him what size I would be appt, before this last one, he said a medium C. I said I wanted to be a bit larger and I think that is why he chose to overfill. He emphasized that we don't by any means want to lose the width, and also said that I wouldn't have much of an inframmary fold. My natural breasts had a fold, yet according to the PSs I interviewed who measured me, zero droop. You'll see what I've got so far when the photos go up. Thanks so much for all of your detailed attention to our questions and cases! Plus, your wonderfully researched advise is well appreciated.
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exchange is Monday!!
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orchidgal: Ptosis is "droop"...what you are referring to is creating an elevation of the nipple areola complex to approximate what occurs with a natural breast. I think MBJ asked me about that recently, and I did find one bc.org member who said that her PS was going to use fat grafting to plump up the NAC. Since your PS is going to work on your step-off issue with fat grafting, I think it would be great if he could place some under the NAC bilaterally.
Referable to size, I am hopeful that he can use at least 400 ccs for you. That would be the preferred volume.
Deborah
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Michele: Wonderful! I am excited for you! Please let us know how you are doing and all of the details - when you are able to post!
Deborah
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NEW NIPPLE RECONSTRUCTION TECHNIQUE:
Poppy just posted a new thread about this cutting edge product from Cook Medical Biologics. It is a biograft cylinder used to maximize nipple projection either in consort with a nipple flap or without a nipple flap. It might be the answer for women who do not have sufficient skin to create a nipple via the traditional mound flap method - due to having had rads or just not enough tissue coverage over the implant. Worth discussing with your PS...
http://www.cookmedical.com/sur/datasheetFeature.do?id=5161
Deborah0 -
Deborah, O Great Breast Whisperer, I come seeking your wisdom! :-)
I've seen how much help you've been to so many women here, and I'd really like your opinion. My situation isn't really all that complicated, at least, but forgive me if I'm long-winded (long-worded?).
Here's my story: I am 55 years old, height 5'7", weight 190 lbs, and ribcage (bra band under TEs) of 36". Before my surgery I was at least a 42DD (my PS says I was more). I had a BMX on August 12, no rads or chemo or Tamoxifen (yay!), and had immediate TEs with an initial fill of 250cc each. My PS placed the TEs partially under the chest muscle and used an Alloderm "sling" on the lower part of each breast. Since then I've been expanded to 400cc in each side (with a lot of muscle cramping after each fill), and I think we're taking it up to about 650-700cc before exchange. I'm thrilled to end up anything smaller than I was before, but I'd still like to be maybe a small D. So what do you recommend for my implant?
I will say that it feels really weird right now to be able look down and see my stomach without boobs in the way! And my shoulder that was hurting for years is now pain-free because the bra strap isn't putting pressure on the collarbone any more! (Big boobs are not as wonderful as some people seem to think.)
By the way, I just noticed today that the TE wallet card I got says I have a "Style 133V Series Tissue Expander Matrix" and it has the Natrelle logo on it (which I know is Allergan). However, I asked for a copy of the stickers they took off the TEs (in my PS's medical records), and they say "Style 133MX Tissue Expander, Allergan, 700cc, Ref 133MX-15". My card has two serial numbers on the back, one of which matches the sticker (the left breast), but the other doesn't match the right breast, and actually on both stickers the "L" box is checked! Not a big deal, I guess--I looked it up and the TEs are essentially the same--but it still bothers me that the card isn't accurate.
OK, I'll quit typing now. (Told you I was long-worded...) Thanks!!!!
~ Amy
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Amy: So glad you asked!!
So you have moderate height, extra full projection TEs, volume 700 ccs, width 15.0 centimeters. Very good. Since you had large breasts prior to BMX, did the PS reduce skin or do you have pretty substantial loose skin overlying the TEs? All of that loose skin has to be taken up by implant eventually. It may be that at 400 ccs expansion, you have sufficient skin envelopes for a 700 cc implant. However, I would say 750 ccs would be the preferred size for you. Using Allergan - the Style 20, 750 ccs. This volume matches the width of your TEs and you want to maintain the same width with the implants as well.
It takes SUBSTANTIALLY more volume to form a breast mound in reconstruction. Also, women who are on the plus-size end of the spectrum often have more adipose tissue - thicker covering over the chest wall, which can obscure, or as Kenneth Shestak, M.D., would say, "tend to swallow up the implants." We have a lot of bodacious women on bc.org and they have all learned by trial and sometimes first time error, that it takes more implant to give them the look they want. Sorry for being so clinical about this, but the goal is to get you where you need to be and get it right the first time. We avoid implant switching whenever possible. So I don't want you to be disappointed after the exchange. You will not be too large with this volume of implant. If you want to email me photos, PM me. I might revise my thoughts a little with photos, and I might see something else to address.
I do want to make sure you talk to your PS about your goals to reach 750 ccs...you certainly have the TEs sufficient to get you to that volume.
Deborah
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Believe it or not, I forgot a question. My PS says he likes to do the exchange one month after the last fill. I know this is a shorter time than is often recommended. What are the pros and cons of this?
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Well, we typically see that the longer the better, in order to achieve retention of the skin expansion process. However, in your case, since you were larger-breasted pre-BMX, it might not be an issue at all for you. Did your PS tell you how far he will take you with fills prior to the exchange?
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I Had my last fill to my TE's and will have my exchange surgery in about 2 months. How do I get into the pic forum?
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