BREAST IMPLANT SIZING 101
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heebie: I think you are going to end up in the 250 to 280 gram range with the anatomical on your MX side. I do not know what your PS has planned for your native breast. It all depends on your native breast really. If a small implant gives you sufficient height on the native side, you could go with a taller height anatomical on the MX side. There are so many variations of height and projection in anatomicals - so it all hinges on how much your native breast projects and how much upper pole fullness is achieved with an implant. It is difficult for me to say whether you have expanded sufficiently for any particular anatomical. You certainly have enough volume for a smooth silicone round, but anatomicals are addressed so much differently from one PS to another. [If you were going with silicone rounds, for example, I would say 325 ccs or 350 ccs would be very nice on your frame.] Some overexpand considerably for a much smaller anatomical, and some overexpand only a little for the same volume. Ask your PS at this point what size he intends to use and what style he would use, and then come back here and we can discuss.
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Whippet Mom: Thanks for your answer. I am confused about the difference between the Gram amount and the cc amount. Are the anatomicals usually sized in grams and the rounds in cc's?
I will speak to my PS about sizes in 2 weeks when I go back. I just don't know how to judge how big I will look with the gummy to how I look now with the TE. I know the shape will be different, but I wonder about the projection and overall perception of size.
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Yes....anatomicals are in grams and silicone rounds are in ccs...
I agree...it is difficult to assess how you will look with the anatomical implant, because we do not know if your PS will use an Allergan 410 to fit the pocket or if he overfills and uses a smaller implant. If he expands the pocket specifically to fit the anatomical, you will be about the same. If he overfills and uses a larger pocket for a smaller implant, you would be smaller. Again, I do not know his mindset for expansion with the anatomicals. It is entirely different trying to size out anatomicals....
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Mom and everyone... Yes, Judy was grateful to hear many of you had long surgeries like she. I forgot to tell you all that I did inform her of this. Thank you !
Deborah.. thanks! I will PM you when the time comes. You are the best... and I only come to the best ! LOL....:).
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neversaydie - about your chemo anxiety - did you have an Oncotype DX test done? That has made the decision much easier for many of us & I recommend that you ask for it if you have not had it.
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Hi Deborah a;nd All - thanks for your response on the Allergan vs Mentor. I see my PS tomorrow about the exchange and will keep you all posted. I will be sure to ask about the nipple technique he plans on using and will share with you. Have a great week!
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Recent study regarding patient satisfaction of saline vs. silicone implants for breast reconstruction after mastectomy:
http://abcnews.go.com/Health/video/reconstructive-breast-implants-silicone-saline-12124677
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Hi Whippetmom,
I will not have my exchange until sometime next year but was wondering what size implants you would recommend. I am currently in the middle of radiation treatments and hopefully my skin and TE will hold up. I am 5' 5" and 130 lbs. The width of my rib cage is 32". I had a unilateral mx with alloderm and my tissue expander is Allergan 133mx-14. I am currently expanded to 550cc. My native side is a small B size and I would like to be a fuller B or small C. I will be getting a small implant and a lift on the native side for symmetry. The PS gave me a Allergan Natrelle book so I am assuming that is what he wants to use on me. Any advice is greatly appreciated.
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Hi Whippetmom. I finished my rads in early October and am pushing my PS to get these painful, awful TEs out of my body ASAP. She would be happier if I waited several more months but I cannot deal with pain every day of my life. (They were placed at my BMX surgery 3/16/10).
That said, I go in for a consult with her to see if scarring from rads has slowed or stopped in a couple of weeks. How can she tell?
I am 5'8", 185# with a ribcage measurement of 36. I have Allergan 133LV-15 TEs with a recommended fill of 400 --- I am filled to 420. I would like to go a little bigger if possible. Recommendations?
I am strongly leaning toward silicone, but my PS says 95% of what she does is saline. I am happy with her work, but unsure if I should find another PS who works more with silicone? Advice?
Thank you in advance and thank you for all the time and heart you put into helping so many women.
Jen
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bher: You have a TE with a width of 14.0 centimeters. There are two different styles of Allergan Natrelle smooth round silicone implants which would work well for you. One would be a Style 15, which is a moderate plus profile implant. In this style, I would recommend 533 ccs or 587 ccs. In Style 20, which is a high profile implant, I would recommend at least 600 ccs and perhaps 650 ccs. If your skin is really tight with your TE currently, your PS will probably want to use the smaller of either two styles. Since the key is gaining symmetry with your native breast, it will all depend on how much droop you have with your native breast after it is augmented. Your PS may need to use the smaller implant to enable a little more ptosis or droop. So go over these styles and sizes with your PS and see what he thinks might work for you.
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packjen:
Jen: Ask to be one of the 5% of her patients who gets silicone.
Because you have the low height TEs, you have the ability to exchange out to a substantially larger implant without much of a problem. That said, sizing is largely predicated upon the integrity of the skin on your rads side.
In a perfect world, I probably would have recommended that you have high profile round smooth silicone implants with a volume of around 700 or 750 ccs. I just do not know that your PS is going to get you there with your current TE volume. Your TEs have a width of 15.0 centimeters, and so to get that width, you might need to go to a moderate plus profile style of implant. I would say that the smallest size I would recommend would be 616 ccs in Style 15 [Allergan Natrelle], which has a width of 15.2 cm. Based on the type of TEs you have, I think it is quite feasible, skin integrity permitting, to use an implant with this volume.
Another thought I have is that since your PS has a fondness for saline, she might consider using a Mentor Spectrum expandable saline implant. This implant is unique in that it permits gradual filling over time. With this implant, the PS can add saline in small increments over a period of up to six months, which might enable her to exchange you out sooner than later, and also might permit going a bit larger than you could with silicone rounds. Once you have achieved as much fill as you desire or tolerate, the fill port is disconnected and voila! You are done. I would choose either the largest or second largest size in the smooth round Spectrum.
http://www.mentorwwllc.com/breastsurgery/augmentation/cs_ba_prod_adjust.htm
This should give you some fodder for discussion with your PS...
Deborah
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Whippetmom,
So it looks like I will loose quite a bit of projection if I go from my TEs w/ projection of 6.3 to the 616ccs in style 15 at 4.9 projection. Even though the total ccs is 200 more than I have now I will look smaller/flatter? Is that correct?
Also, can you tell me why so many women tend toward the smooth implants vs. textured?
Thank you for the interesting option of the expandable saline, but I am thinking saline won't give me much/any jiggle or squish. I like a softer breast if at all possible. Am I asking for the moon?
Jen
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Jen: Then you just push for silicone implants. The projection with TEs is a function of permitting the skin in the center of the breast - [where the MX defect typically is located and/or the-nipple areolar complex has been removed or disrupted if in a NAC -sparing] to stretch sufficiently for closure over the future implants. You could closely approximate that with a 700 cc implant in Style 45 - it has a 6.0 cm projection. However, with your rads skin issues, you need that extra skin for good implant coverage and so the Style 45 might be a risk for you. You could tell your PS that you would like for her to assess whether she could use a 700 cc implant in Style 20 - a high profile implant.
Textured round silicone implants are rarely used in two stage breast reconstruction, as they cause traction rippling, and we are already at heightened risk for rippling due to thin skin issues after MX.
Deborah
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packjen:
You might want to ask your Dr. what the percentage of breast reconstruction patients she/he has. If the Dr. does 95% augmentation, that might be the reason for the high percentage use of saline. I chose to have saline. One side is fine. One side has ripples. There are plenty of cases where silicone implants have ripples. Ripples are very commom in thin woman.
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Thanks Whippetmom for your input. I think my PS will probably want to use a smaller inplant because I've been told that I am overexpanded at 550 cc. He has told me he likes to use a smaller implant than the expanded TE size in order to match the slope of my augmented side. Do you know if more saline can be added to the TE after Rads is done? I will not see the PS again until a month after my radiation is complete. I will continue to follow this very interesting thread.
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bher: Yes, more saline can be added to the TE at some point following rads. Keep me posted on how your skin is doing once radiation is underway. Talk to Laura [Estepp] over on Exchange City and ask for tips on taking care of your skin.
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Whippetmom - I was hoping more expansion was possible after rads just in case I need it. I am a little more than half way through my radiation treatments. My skin is very red (no blisters) and is getting tight around the expander but the RO thinks it is looking good. It is a very uncomfortable process. I will check out the Exchange City thread. Thanks!
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bher: What are you using on your skin? You should be slathering product on that rads skin. I think Laura used Aquaphor and perhaps something else also.
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Whippetmom - I have been using Utterly Smooth cream (recommended by RO) since before starting Rads and then a few weeks ago added Miaderm. I am continuing putting on the lotion. I have not used Aquaphor but may try it. The TE tightness is bothering me more than the sunburn skin. I will be so glad when radiation is over.
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Hey there everyone,
just back from my exhange surgery: Mentor smooth round high profile 375s. Everything went great. 5 hour surgery, have one drain in each side, ace bandage wrapped all around my torso. A bit sore, but have lots of meds to choose from! Wish I could see them!! Extremely happy, it was so easy. Best wishes to all, and thanks again for your support. As soon as I get these drains out, etc. I will take photos and post to Tim Tam's site.
Happy Holidays! Melissa
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Congratulations, Orchidgal!!!
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bher: Sounds like you are on the right track with creams. Just hang in there....it seems like forever but relief is on the way, because your exchange date will be here before you know it!
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Melissa: Congratulations! I cannot wait to see photos!!!
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JEN
I wish to pipe in here, from one RADS sister to another!
It is not only your skin they are looking at to get a bigger implant. IT IS YOUR MUSCLE. After rads... it just does NOT want to expand much more.... MAYBE 50cc( at exchange).You could try to get a few more fills now. and then wait 6 weeks after that for exchange... that might help you get a bigger implant.. Also........ since your rads breast WILL be harder than your other....... PLEASE ASK FOR SILICONE..... this is your body... you TELL her what you want. Deborah is right on. PLEASE get the silicone , closest to the SAME SIZE as your TE... because your Rads breast WILL be a tiny bit smaller than your non rads side... Also..... YOUR RADS BREAST WILL NOT NOT NOT......" drop and fluff" they do not settle...
My rads breast is a tiny bit smaller looking and it is perkier than my non rads implant. It is not that noticeable... so I am 100% AOK with it.... I still look really pretty ( foobs)
Your PS can take one look at your skin and know if you are ready for exchange... if they do enough rads/implant reconstruction. Mine told me at first...6-12 months until exchange. THEN I knew my skin looked great 2 months after rads... SO, I went to him... he took one look at me and said.... YES, you can have exchange at 3 months.
.. He was right.If you have any questions about rads and implants... please PM me. I do not check this thread very often.... but Deborah ( my dear friend....) will give rads/implant girls my name, if she feels I can be of help to them.
So far... I am a success story of rads and implants.... but it took much research and trusting the right people... to get me here.
Peace!
Laura.
( Hi Deborah....love you)
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Congrats Melissa!!
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Love you too Laura...
Jessica: Finally! An avatar....and you are so lovely!!!
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Deborah--lol
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Hi Deborah(- just PM'd you) and All.. PS scheduled my exchange on Jan 5th. He briefed me. In doing so he said he would prefer to make a new incisions under the breast to do the exchange rather than using the old incision - Can anyone share with me their experiences? Does it matter? I thought he would use the old incision - less scarring. Anybody have any advice to share? Also do you think that January is too soon to get exchange if I had my last fill Dec 4? Read somewhere in this forum that the longer you wait after the last fill the better. My last fill was 500cc's and wondering if I should have gone a little more - he is bringing in 550cc's - 600 cc's and 650 cc's into the surgery room to test. He mentioned pocket work. Is this the standard procedure w/exchange ? He only mentioned the work be done below my breast - guess I had some extra space to squeeze in a larger implant if he uses the 600 or 650. Not sure . I do not want his pocket work to shorten my midriff - make me appear short waisted. Any advice out there? thanks so much for being out there!
Congratulations Orchidgal!! I hope you have a speedy recovery!
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bnita: I did not get a PM from you...it might have gone into cyberspace???
There must be something going on the the inframammary fold region....I know of very few cases where a new incision is made for the exchange. You could send me photos or post them on the pic forum, so that I can see what is going on with your IMF region that he feels he needs to made adjustments. If you have stretched sufficiently - if your skin has responded well to expansion, which only the PS can really determine, January should be fine. But I just want to know what is going on "below the breast". Pocket work is very common - not something to be concerned about - but let's see what he is talking about in the IMF region.
Deborah
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Deborah: Odd that you did not see my PM. PS said it would be simpler to exchange via the IMF region - he commented that most augmentations are done that way.. He could add the fipples sooner because my scars would not have to reheal. I really do not care if it takes longer for fipples as I am in no hurry. He said that he could go through the original scars for exchange if I wanted - but may be slightly longer - do you think? . I can post my pics as soon a I get some privacy at home - kids running around. So there is really nothing unusual with IMF other than PS preference of entrance. He said my skin has responded well to expansion. I thought maybe because I wanted 600 cc'd he had to go via IMF. The pocket work just concerned me because I thought it was because of the larger implants though I will gladly give up the larger size as I do not want a shorter torso. When I asked the assistant if I should get another fill - she said it would not make much difference for the exchange. I am getting confused - but I do feel better now that you told me pocket work is common. So I should not worry about the torso issue with pocket work - I should have the same size torso as I have now - correct? Also, since implants life expectancy is 10 - 20 yrs - can they use the same incision for exchange? I hope these questions are helpful to others as well. I edited my original post 3hrs ago - rushing out of the house with the kids to shop and it was sloppy like the weather we are having today. thanks agian
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