BREAST IMPLANT SIZING 101
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Merry Christmas to you Deborah! You give us presents everyday with your knowledge!
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Same to you dear Deborah!
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Merry, merry Christmas to all and to Deborah, our breast whisperer!!!!
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Hi friendly ladies
I've been lurking on these pages for a while and would really love some advice.
I had a bilateral mastectomy (one-side was prophylactic) in October 2009. At the end of October 2010, I had Natrelle 133FV 600 cc tissue expanders placed in both sides. I live in Canada, and I am ultimately getting anatomical gummy implants (Natrelle/Allergan?) when I exchange my expanders out. Right now I have 400 ccs in each expander. The prophylactic side is sitting alot lower than the other side. I hope they can correct this at the exchange?
I am 5'10" inches tall, 160-170 pounds (on the high side right now from Christmas snacking-hehe). My ribcage is 34-35". I am unsure whether to stop my fills now, or to have another 120cc fill done on each side before overexpanding (my PS likes to overfill expanders by 25%). I am eager to be done with the tissue expanders, but I want to be happy with the long term result. So I'm hunting for opinions: 400ccs or 520ccs? Will there be a big difference? I just want something appropriate for my frame and to give me back some cleavage!
Thanks very much,
Erin
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Erin: I cannot access the Allergan PDF catalogue from this computer - I am out of town - and so I have to guess about the width of your TEs. I believe they might be 14.0 cm. I will check when I get home this evening. In this case, it seems that 535 gms in 410 FF or 560 gms in 410FX would work, keeping in mind that the TEs are supposed to be creating the pocket specifically for the shape of the anatomicals. I would not recommend anything less than 535 gms. You need the height of a FF or FX style anatomical. If your PS could use a 14.5 cm width implant - something in the lower 600 gm range would be good also.
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Thanks so much
. I'll take these numbers to my PS at my next appointment!Cheers,
Erin
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Just a quick add-on: Are gms and ccs equivalent?
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Erin:...Grams and cubic centimeters.....the former is mass and the latter is volume. They are not equivalent, which is why we need to look at the dimensions of the anatomicals in comparison to the dimensions of the TEs. So your TEs are: 14.0 cm wide by 6.2 cm in projection. Something in the range of 14.0 cm wide with a projection of 5.6 to 6.5 would be something to work towards, although it all depends upon the integrity of your skin and your surgeon's ability to get you to the size of implants appropriate for your frame.
Deborah
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whippetmom, I went to the PS for another fill today. I am now at 550cc's. I talked with my PS about what size I want to end up at. He is going to fill me to 700cc's and probably use 600cc implants. (silicone, HP, smooth round...is what I want and what he first suggested. He can do the gummies also but I don't want them) He mentioned today, because I am somewhat broad across the shoulders, that he may take "sizers" into the OR and see which looks best. He said possibly may use Moderate Profile since I am more broad but I don't think I want that, or do I??? Not sure I'd get the projection I want with those! I am 5'8" tall, approx 127 lbs, 31 in rib cage. I was a large C, small D before and do not want to be that large again. Will be nice to be a little smaller BUT I think my frame needs some size to look in balance and well, honestly, I am used to some size. He said at the 600 I would probably end up about a moderate C cup which I think sounds right for me.
It's funny, i look down at these TE and think they look large and why in the world would anyone want any larger then that? But then I look at my body in the mirror and to me I look odd....not shaped right, out of balance. All so confusing. Any suggestions?
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i am aslo getting filled every 2 weeks - when i get the exchange will the breast drop a little bit i had a masectomy and the implant side is high not that high but i was wondering when they put the implant in does it feel softer
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Nina -- without a doubt the implant will be MUCH softer than the TE.
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EastCoastGirl: Eeek....!!! No, you most certainly do not want moderate profile implants. Please tell your PS to not even consider taking the sizers for this style into the OR. You will be happiest with HP style implants. I just think even moderate PLUS profile would be too wide for your ribcage - even in light of having broad shoulders. You will have 14.0 cm in width and that is certainly sufficient. You also need and want the height of the higher profile style. 600 ccs sounds good to me...
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I would like to join this forum if that is ok. I had a bmx in august with no expanders. I jsut finished 4 tx of chemo and I have an appt with PS on the 4th. I met with him once a month after bmx and he had said i needed to heal. He said the scars need to be able to stretch. I think I had some cording then too. I see there are so many things to consider and ask when i see him next. He mentioned the possibiblity of not needing expanders but i think that is if i don;t go too big.
I am 5'6" and 140 pounds. I was a 34 DD. NOw i think I would like to be a large C, something more proprotionate and that clothes will fit in better. I have no idea how many CC that would be or how many fills that would take. I think my options will be limited because i have medicaid. I know my surgeon only uses round and only silicone.
Any advise on what to ask him?
also is it a good idea to exercise the pectoral muscle to make it strong before surgery?
I am really petrified about this surgery, it sounds painful. I wonder how it will compare to my bmx in which i did not have much pain.
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Carrol2: Certainly you can join! There is really no way to equate ccs with cup size, because we all have different shapes, different ribcage dimensions, and so I make recommendations based on what would look best on your frame. I personally feel that you could use either the moderate plus profile or high profile style implants.
Has your PS explained the various options for reconstruction? Has he told you about using your own tissue - a TRAM or DIEP or latissimus dorsi flap procedure? You would probably be a good candidate for an autologous donor flap procedure and perhaps then you could be augmented with a small implant and you could forego tissue expanders. I feel that you need to hear about this from your care provider
At this point, I do not know how much of your skin was spared for future reconstruction. You say you were a "DD" cup prior to BMX, which tells me you had significant skin flaps. However, with scar tissue and retraction, whether you have enough for the size of implants which would be appropriate for your frame is unclear. I think what you need to ask your PS is if you have sufficient tissue envelopes to cover moderate plus profile implants with a volume of 375 to 400 ccs. This is a relatively low volume, but if avoiding tissue expansion is important, you might want to accept smaller implants in an effort to by-step TEs. So the question to your PS is this: With my current skin condition, what is the largest volume implant you could safely use? That would be a key answer to determine if you will be satisfied with the results from the delayed one-step. If you went through tissue expansion, I would change this to 475 or 500 ccs in a high profile style implant. Have you been to the pictures forum yet? You might want to go there and get a better idea of what to expect with tissue expansion and the results of using various styles and sizes of implants. I do recommend smooth round silicone implants for you.
Deborah
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Deborah: I hope you are having a great New Years!
QUESTION: My breasts have shrunk quite a bit since August and although they are much nicer then what I started out with and larger, my question is: since I am a Uni, can I go bigger? Here are my current stats: 6' tall 150 pounds 31" ribcage current breast measurement 38" down one inch from 39". I loved how they looked right after surgery but now they are much smaller
. PS says fat grafting will help because the left is the smaller of the two but I am not convinced especially since he plans to also make a nipple from that side using a modified V-C Flap--Would any of these do anything, is it possible, should I be happy with what I have? EXISTING:LEFT: Allergan Naturell 20 - 550 13.5 diam 5.6 projection RIGHT: 15-397 13.1 diam 4.2 proj.
Would it make any noticeable difference to go up one size or would I have to go up two sizes or 100 cc's? This is what the choices are:
LEFT: 20-600 13.8 diam 5.7 proj RIGHT 15-421 13.3 diam 4.3 proj or
LEFT: 20-650 14.2 diam 5.9 proj RIGHT 15-457 13.7 diam 4.5 proj
Thanks for your help!
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MBJ: Okay, my personal take on this, after talking with many women in your situation, is this: You feel comfortable physically with your implants, correct? You have had no complications and your only complaints are referable to a size preference. I just would not do it sweetie. I would go for fat graft transfer - absolutely. But you are subjecting your body to any myriad of complications, every single time you go through the type of surgery which would require opening up the incision and opening up the pocket. If you were woefully inadequately implanted or if you were one of those gals for whom 800 cc silicone implants are not adequate and the largest salines are necessary, I would say "yes" indeed. But you look great. You have a beautiful result. In ten years, switch them out for larger implants. By then, the ones you have now will be appropriately aged for replacement. Just wear bras which give you a larger appearance - like many of the Natori bras will do.
I too would like another 100 ccs - but I am not going to do it until I have to do so - because I feel so good and I have no pain or discomfort and there are far too many women who do have discomfort. Post-mastectomy pain syndrome is a complication of breast surgery - and who knows what might trigger the onset of PMPS. Too many risks for me - with what I know now. If you had been given 375 ccs - which is what your PS had originally planned for you - I would be agreeing with you on a bump to 550 ccs...do you see what I mean? But what you have really looks lovely for your frame. Over the next couple of years, augmenting the reconstructed breast with fat grafting will probably be so well-refined - that will be a truly viable and preferable option for many women hoping to just add a little volume to the mound.
That would be my heartfelt opinion....
Deborah
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Deborah: Thank you for your reply as I truly respect your opinion in this. Do you think that fat grafting will truly compensate for the loss of volume after I get my nipple done, too? This is what really worries me--that I will have an even smaller breast and will have to not only pad my bras and wear push ups but also a prosthetic.
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I know that a couple of gals on these forums had fat graft transfer applied under the nipple areola complex and I recall that they were happy with the results. Unfortunately, I cannot recall who had this done. Sorry. I know that fat grafting to the NAC can be done and IS done - I know for certain it is done with some regularity in male gynecomastia. When there is reduction for gynecomastia, the NAC is often left with a sunken appearance, and fat graft transfer is used to bring elevation to the NAC. I think that in breast reconstruction, the singular problem would me the MX scar. If it happens to be quite wide and running through the center of the NAC, it might be more difficult to achieve a successful FGT, because the scar tissue might have a tendency to flatten out and depress the fat graft.
But the thing I want you to remember [and this is for Dawne-Hope also] is that the volume of the implant has not changed at all. The amount of skin around the implant might be diminished a little with the nipple reconstruction, but as the skin naturally stretches with gravity, you should appreciate a return of fullness. My implants actually look fuller now - 1.5 years post exchange - because my skin is more compliant and the implants are very soft in the pockets, and I did lose skin volume with the nipple recon and I also experienced a flattening of the mound, because I had a double opposing flap. I did not know at the time - but this is the type of nipple recon which was performed. My bra size did not change at all.
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Oh, I forgot to mention that Hilton Becker, MD,[ who devised the Spectrum expandable and Becker expandable 50/50 implants marketed by Mentor] uses fat graft transfer to elevate the NAC in his breast reconstruction cases....an excerpt from his website:
"If the nipple areolar complex has been totally removed, then the nipple areolar complex is reconstructed by tattooing the areola and then using either a local flap or a skin graft to create projection for the nipple. Fat injections may also be used to increase the projection in this area."
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Thanks Deborah! I think my scar is too high to have the nipple made from it so I am not sure how they will get around this. I guess I just have to go on the faith that my PS did a great job to start and he will do an even better job to finish it.
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whippetmom - Thank you for the post-nip encouragement. Mine look a little strange right now. Thank you for thinking of me and for your encouragement. There's hope!
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MBJ - I am sorry that you're disappointed. But I want you to know that I think you have an absolutely PHENOMENAL result! You look fantastic! Be encouraged, girl!
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MBJ: Well, from an appearance standpoint, it is nice to have the scar going through the NAC. However, technically - from a surgical standpoint, it would seem it is better to NOT have the scar going through the NAC - especially if the scar is flattened, as mine is. Look at this link and scroll to Page 461 to the section regarding common complications associated with nipple recon.....
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That did not work, did it? I will just type it out from my own book later...
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Deborah: The link worked just great! That was so informative--I really now have more confidence in what they plan to do and how they plan to achieve it. We should start a nipple/areola reconstruction thread so women have a place to go and know what to expect. Maybe on the picture forum?
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Deborah, I have some additional info for you. I had a consultation with my PS about my upcoming revision surgery.(more drop on my left side and my right side is smaller than my left side-pic on photo site) He exlpained that he believes the problem is due to anatomical differences in chest wall (thinks right side is higher and more concave than the left). He is proposing changing the 425cc MPP implant for a HP implant (will bring several sizes to try) on the right side and raising the left side. Additionally he would use fat grafting to possibly help some rippling on the left side and fill divots above both breasts.
I think I have a reasonably good result now and after reading your response to MBJ I am really having some doubts about subjecting myself to more surgery and possible complications. Please give me your honest opinion of my PS plan. Thanks so much!
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Let me go look again Jan!
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Jan: Your PS does need to revise that left side. You risk bottoming out on that side. I think personally that just revising the fold area might be what is needed - meaning - perhaps another implant will not be necessary. So in this case, I feel it warrants going back for correction. This type of assymetry to me has a high value-added factor for just biting the bullet and getting it done right. If it were a minor size assymetry, I would tell you what I told MBJ. But a fold discrepancy is another matter. Your PS knows this needs to be done....
I am glad he is taking in another style implant just to see if it is needed.
You will be just fine.
Deborah
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Deborah,
I am 5'8, 170 lbs, ribcage is 34", The expander is Allergan, 500cc, ref 133MC-14. He has stopped the fill at 430cc's. I still have my natural left, I was a C, guess you can still say I am. I meet the PS to decide on which type of implant I want on Jan 26.
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Hi Deb: I responded to your PM as well. It all depends on what you are going to do or not do at all with the "natural left" breast. 430 ccs fill sseems a bit on the low side....which is why I need to see how you look at this point.
Deborah
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