BREAST IMPLANT SIZING 101
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Oops, just saw your reply! To answer your questions, my surgeon appears to have removed most of the excess skin, so it's tight over my TEs--but I do have an uncomfortable bulge on either side under my armpits.
Thanks so much for the recommendation! My PS is easy to work with, so I'll look up your suggestion and see what he says. I also don't think he'll have any problem with 750cc, since he was considering 800cc at one point in our early discussions.
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Amy: I would be happy with 800 ccs for you also....I just did not want to push it. So ask him to take in the 750s and 800s and ask the nurses to be your advocates to help the PS determine what looks best. Good thing about the skin. Yes, the dog ears or mud flaps under the arms is common. They can be liposuctioned and revised either at the time of exchange or as a third procedure, once everything settles. The reason it is most often done after the exchange, is that in many instances, the "bulges" resolve on their own - at least in whole or in part - and so the PS only needs to address the residual. If it is done after the exchange, it would be three to six months post-exchange - it takes that long for everything to settle enough to know if anything further is required by way of revision.
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brokendreams: You need to PM Timtam - hit search above right corner of the webpage and under "member name" type Timtam. Her profile page will come up and you can PM her to request the pass code for entrance. You have been on bc.org since June so you should have no problem getting on right away....
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Deborah,
Thanks so much for your response. I also wanted to ask if you info on alternative techniques of replicating an areola without taking skin from somewhere else on the body. My PS asked if I didn't have any "extra scar tissue" for that, and I don't, and don't wish to offer any skin up, but certainly want him to make nice areolas. I asked him if he couldn't manipulate the skin around the reconstructed nipples to give the appearance of areolas and he smiled and rolled his eyes, as if anything might be possible. Not the most talkative guy, yet agreeable, it seems, to trying things. Wondered if you knew of anything, as I haven't found any in my searches yet.
Best, orchidgal
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Deborah, I also meant to thank you for your delicate reference to "women who are on the plus-size end of the spectrum". I've been starting to wonder if everyone here is so much smaller than I am! I kept reading about exchanges at 400-450cc -- I'm already there, and I need to wear pads so I don't look so flat in my current clothes. Interesting thought about the fat on the chest wall--sure doesn't seem to provide much padding to me (ouch!), and I thought the BS had probably scraped most of that out, but that wouldn't have been necessary, would it? So the chest wall fat maybe squooshes up around the implants a bit and makes it harder to judge the volume needed--hmmm, that makes sense!
Glad to know these lovely "dog ears" will eventually be gone. Makes it so hard to sleep on my side like I want to, and they look really odd, too. So, OK, patience, Amy, patience!
And thank you again SOOO much, Deborah!
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Hello Whippet Mom (and others who have contributed to this thread).
I am so happy to have found this site since I had a unilateral tissue and nipple sparing mastectomy in May, 2010, have tissue expanders in place and need to make decisions about type and size of perrmanent implant. My PS is involved with a study on gummy bear implants and suggests that would be best for me (so I assume he made the "pocket" compatible). I am definitely not happy with the way the TE looks, and am hoping the final implant will be better. The TE is higher, rounder, and more full on top than my natural breast and looks very uneven when undressed or when I am wearing a bra and clothes. Nipple height is signifcantly different. Any suggestions on type and size for the final implant would be very welcome.
Height 5'7", Weight 119.5 lbs, ribcage measurement about 29.5 inches. The tissue expander is a Allergan Style 133MV Series Tissue Expander Matrix. The plastic card says is printed as 400 cc, but the fill volume record written in pen says "cc volume fill 240 cc" and "cumulative fill volume 240 cc. It got further injected with 50cc at a later appt.. I don't know about the height.
My medical situation: 4 separate IDC spots in the right upper outer quadrant of my right breast, all < 1 cm, Stage 1, Grade 1, ER+, PR+ (on two of three tests), 0/5 nodes, Her2 -, BRCA -, Oncotype 20.
Thank you in advance for any help you can provide.
Shelala51
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Thank you so much for all the wonderful information. This website has been such a wealth of knowledge and I have referred to it since I was diagnosed with breast cancer on June 27, 2010. I will definitely talk to my plastic surgeon about the type of implant he will use. I'm just now at 300 cc's, so I guess I have a little ways to go
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ChattaChick - I'm very close to your size and I agree, it seems like there aren't quite so many plus-sized women here. I'm also at around 400ccs right now, though I will probably only go to about 600ccs with my implants. I was large before too and don't feel the need to go back there again. I hate being able to see my stomach, but I'm working on getting rid of that and am surprisingly comfortable in my smaller breasts. That doesn't mean I don't worry about being too small once the implants are in, but I also worry about being uncomfortable too. It's so hard to know what you're going to look like, especially when the TEs are so bizarre. Anyway, I just wanted to let you know that you're not alone. Not everyone is teeny weeny and not everyone takes this opportunity to go bigger than they were, which is how it sometimes seems on here.
Tory
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orchidgal: I did find a photo of a breast reconstruction which indicates that the nipples and areolae were created exclusively from skin from the breast mounds, exactly as you discussed with your PS. Click on the link and scroll down to see the photo...
http://www.breastreconstruction.org/bilateral-mastectomies-tissue-expander-alloderm-case.html
If I come up with anything else...I'll post it here..
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My DH just got home from a trip and I need to spend time with him...
I promise to get to the other new posts tomorrow!
Deborah
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Tory: I sent you a PM. I'm very glad to meet you!
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Some of you know that my exchange in June came out with an implant higher than my natural breast. I need to start over from scratch so that the skin in my lower pole can be expanded. I've been struggling to choose a PS and have it down to two. I'm meeting for the second time with both this week. I'd like to ask them about TE and implant sizes.
I'm 5'8", weigh 160, my bras were 38 BC but I'd like to be a full C. My ribcage is 35" if I measured correctly.
I'm still not sure if I am going with silicone rounds or gummies. I love the feel of my implant now which is silicone round. Do I need a different TE for different kinds of implants?
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Shelala: Because you are a unilateral, the focus for you is chiefly gaining symmetry with the native breast. It depends on the size of your native breast - and if you have ptosis - significant droop, very little droop, you are small or large breasted. Your PS will want to select a profile to match the native breast. It also depends on whether you will be having a lift and/or augmentation of the native breast. The anatomical gummy which most closely matches the dimensions of your TE, is the 410 MF in 375 gms..13.0 cm wide by 12.1 cm height by 5.2 cm projection. This would infer you would need to be overfilled - possibly to 500 ccs or more. But your PS may be looking at a much smaller volume and a different style of implant, based on the characteristics of your native breast. Your TE does not represent how your implant will look after the exchange, as long as the right implant is used.
I would suggest you email me your photo or post a picture on the pictures forum so that I can give you a better idea of what to discuss with your PS regarding the ultimate outcome.
Deborah
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Did anyone have anatomical TE's? The ones with two ports. The manufacturer starts with an S. I don't have my info in front of me.
Do these give a good result?
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Hi Whippetmom,
Just thought I'd update you. I had my surgery on Sept 8th. All is good on my 4th day post op. I had a good deal of blood loss so feeling pretty woosey still (HGB went from 141 to 88). I have 250 cc implant on the left side "to hold the space" and an expander on the right side. The surgeon will begin expansion in two weeks. Apparently I was one of the most difficult cases they have had due to the bleeding and the density of the breast tissue removed (he described it as like cutting through rock). The surgery was 5 hours instead of the planned 3. So for now I'm sitting her with drains and incisions. The hardest part is over (waking up from the surgery knowing I can't go back) now I'm ready for anything (mind you I'm still on pain killers!! LOL).
I'll definately take your recommendation to the PS as he is awesome and listens to me. For now it is all about recovery from this first stage.
Thanks for your wisdom.
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Claire: I personally think that this time you need a low height TE, which has the specific function of leaving the upper pole alone, while expanding in the lower pole of the breast, which is where projection naturally occurs. That would be my choice. Your issue with the implant also sounds like the inframammary fold is higher than the native breast's IMF....is that true? Did you email me your photos? If so, PM me and let me know what name they are under. If the IMF is too high, it needs to be recreated. I would highly recommend that your PS use the new style of TE, which has suturing tabs for increased stability - keeping the TE from migrating laterally or superiorly in the pocket. Mentor makes this and it is called the CPX3 - Siltex low height Style 7100. There are other styles also - moderate and full height versions. So discuss this with your PS. Referable to implants, your PS would need to be part of the clinical trials in order to use the anatomical gummy bear implants. I have mixed feelings about the use of an anatomical shaped implant after the pocket has been shaped by a round implant for some period of time. It would be like fitting a square peg in a round hole. Read this article and see what Grant Stephens, M.D. [the PS who coined the term "gummy bear" implant"] says about the anatomical implants. On page 3 of this article, he mentioned that the anatomical gummy bear is not the implant of choice for a woman who has previously had round implants. Now this is Steven Teitlebaum's opinion as well, and these two plastic surgeons probably have inserted more gummy bears than most plastic surgeons in the U.S.. You probably will not hear this from other plastic surgeons, but the reasoning makes sense to me. Refresh my memory and tell me what style and volume of TE you had and what style volume of implant was used.
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lovesnature: Do you mean Silimed? Well, it is Sientra in the U.S.
http://www.sientra.com/datasheets/tissue%20expanders%201.pdf
Jaimieh, who is often on Exchange City, had this style of TE. I think she has pictures on the pic forum... I think it is a perfectly fine TE. It is more expensive than the Allergan or Mentor TEs, and not as readily accessible probably, which is why we do not see it often.
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Whippetmom, yes it is the silimed 20799-470AGU.
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Does this typo of TE require a certain implant? Also I don't have access yet to the picture forum.
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No, your PS could use any type of implant following expansion with the Silimed TE. Did you PM Timtam to request entrance to the pictures forum? Look in the upper right hand corner of this webpage and click SEARCH. Then enter the name Timtam in the members search box and send her a private message.
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Thanks Whippetmom, I'll pm Timtam.
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Whippetmom - yes I sent you pics in June - you said exactly what 3 PS said about my fold. One of my choices is the PS from Sloan Kettering that Lilah has. Both of the plastic surgeons have access to gummies. I wondered also about my present implants being round and the gummies not. it was going to be one of my questions.
I don't know what kind of TEs I had but I do know he filled the 400s to 550. My implant is a silicone round 500 natrelle style 40 - i think they are moderate height but it doesn't say. REF - 40-500 SN 14058583 - don't know if these numbers mean anything. I love how it feels - although I think it is too small, but its hard to tell because it is so high on my chest.
Can you give me the link to the article?
Thanks so much!!
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got home a couple hrs ago and changed into my sports bra (PS told me to get out of the hosp "bra" asap... it was literally hanging off of me... they have 1 size: large!). foobies are sooooo cute. the perfect width (thanks Deborah) and perfectly symmetrical. I love them!
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Michele: I am so very happy for you! Hooray! This is good news indeed!
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Claire: Oh my gosh, I forgot the link! Here is it...
http://www.marinaplasticsurgery.com/article-gel-implants.pdf
Remember to look on Page 3....
I cannot fathom why your PS used that Style 40. It is so archaiac....I mean...WHY use it? It is essentially a moderate profile implant which has a very low profile. I don't think you need much more volume - just a higher profile implant and the IMF revision. I think 550 ccs or 600 ccs should be fine.
Claire...PM me and tell me what email address you used. I have searched my email in June and cannot find your photos...so you never mentioned your screen name in the email....
I want to see your photos again and I might have some other thoughts...
Deborah
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Claire....also, PM me and tell me the other two plastic surgeons you are considering...
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Claire -- if you love the feel of the regular silicone I say stick with that. The gummy is definitely firmer. It has some squish but it is not "yippee squishy"
I also found as a uni that although my IMF is exactly right -- even with my natural breast -- the natural breast does hang lower than the gummy. I'm not sure it has anything to do with the gummy though... I think it's just a skin thing and a volume thing. In my case, as someone who is NOT slim (let's just say voluptuous my natural breast has more volume than the implant. I don't know your stats so this might not be an issue for you, but the gummy does not go as big as the regular silicone. That said, it really does depend on your situation. It sounds like you have two doctors in mind who both want to lower your IMF (which sounds necessary). Was your remaining breast left alone completely or did you have a lift? These are things to consider as well. What I'm saying is: your issue with the current reconstruction is NOT about the implant but about it's placement... so since you know you love how it feels, stay with what you like and get them to put the new one in the right spot
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Michelle: Congratulations on getting your new squissies! Such relief. I had the opposite probelnm: they sent me home in a too small bra OUCH!!! Heal quickly and let us know how you are doing.
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Dear Whippetmom-
I am desparate and in need of some advice and have been directed to you. My exhange surgery is Thursday (9-16-10) and I cannot decided what size to go with. Here is my info: I am currently 5'7" and carrying more weight than I should be. I am back at the gym and hoping to take off approx 30 lbs once this is all over with. I had a bilateral masectomy on 5-4-10 and had tissue expanders put in at that time. Previous to BC diagnosis I was a DD cup size and hated it. I currently had 620cc's in my TE and am measuring a D Cup. There are still too big for me, although I was able to make use of all of my old 36D bras again.
My PS is bringing Allergen Naturalle High Profile Smooth implants to surgery in 500cc and 550cc and he wants me to tell him that morning which size to use??? My first instinct was to go with the 500cc because when I lose weight my boobs will look bigger. I am nervous that I will make the wrong choice. I just want to be a standard C cup and my PS is not much help. I have never been able to wear those cute tops because my boobs were always in the way!! Am I really going to notice a big difference between the 500cc and the 550cc?? Please share your opinion with me. I tried measuring out the sizes in water and it is impossible to make a decision when you are looking at water in a measuring cup??? HELP!!!!
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Hi,
I had my bmx 3-25 and finished rads the beginning of July. My skin did very well with the radiation and my ps is thinking of doing my exchange in November. I just don't want to 'rush' anything and want to be sure my skin has had enough time to heal. I had an allergic reaction to the glue in the stickers they placed over my marks and still have the 2 round spots where the stickers were. My rads onc assures me the marks will go away.... My skin is very thin on the cancer side and I do have the rippling from the TE. My question is do you think that is enough time to heal? I need to measure my rib cage but I am 5'5 and weigh about 118. I was a AA (at best) before all this and do NOT want to be big. I was always fine with my small chest. I do feel my ps understands this but I don't have a clue about sizing of implants..
thanks,
** just measured my rib cage and it is 28"....implant sizing suggestion for someone who wants to be no larger than an A?
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