BREAST IMPLANT SIZING 101
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Deb - I'm your size just 5 lbs lighter. My TEs are up to 530 ccs. I'm going to go over 600. It is now a bit bigger than my natural breast which is a B/C. I love how the TE fills my bra. I'm praying it stays this way.
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Thanks Claire!
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Hi Whippetmom. I hope the new year finds you well. You may not remember, but we discussed implants for me a few weeks ago, but things have changed and I now have more questions.
To recap: Bi-lat mx 3/16/10 (cancer only on left side); finished rads early October; current TE are Allergan 133LV-15 now overfilled to 520ccs; 5’8”, 185#, 36” below bust measurement.
I had a PS who said she did almost all saline implants upon exchange. Come to find out she is not certified to do silicone. So I changed to a different PS who will give me round, smooth, silicone implants.
My right side currently has a big dent (step-off?) at the upper pole that the PS said was due to the way that the mx was done. The previous PS said it was due to the crescent shape of the TE, but the left side looks good and does not have this issue. In order to correct this my PS says: “When you have the exchange of implants, the new implants will be smooth high profile silicone implants. This should give you more upper pole projection compared to anatomical shaped expanders you currently have in now. Hopefully the right upper pole concavity would be alleviated with this. We could try a 500ml implant on the right and a 475ml on the left.”
I think these implants will be too small in projection and in width – I like the size I am now with the TEs at 520mls and the bigger projection (6.3), though I could stand to lose a little on the width. The TEs are very close together giving me a very steep cleavage, and even so with the overfill I currently have some discomfort in my armpits from the width of the TEs. So I could lose some width, but going down to 12.6 and 13 from 15 might be too drastic. No? Also projection would drop from 6.3 to 5.5 on the 475ml and 5.2 on the 500ml – that’s a big drop in projection.
I asked if we could do another 100cc fill to bring me up to 620 and then go with 650s on both sides and fat grafting in the dent. He responded: “650 ml are fairly large implants that may pose some increased risk for you in terms of being heavier and puts increased pressure on your skin flap and incision line that may result in wound breakdown, skin necrosis and delay wound healing. Don't get to fixated on the numbers. Every patient is different and unfortunately we have to work with what is available from the manufacturers. I would recommend holding off on the fat grafting until down the road when we can reassess if it is even needed after the implant exchange.”
I have done the research and see that silicone 650s would weigh 24.375 oz ea – OK that may be a little heavy (over 7 oz heavier each than my current 520ml saline). Should I push for another fill and 600s? This is really as small as I am willing to go on width and projection. I don’t know if I can just tell him I don’t want to go smaller than that or if I need to find another PS. My scars healed beautifully, btw. So no reason to suspect poor healing.
Sorry for such a long note, but what would you suggest I do?
Thanks,
Jen
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Hi Whippetmom. I hope the new year finds you well. You may not remember, but we discussed implants for me a few weeks ago, but things have changed and I now have more questions.
To recap: Bi-lat mx 3/16/10 (cancer only on left side); finished rads early October; current TE are Allergan 133LV-15 now overfilled to 520ccs; 5’8”, 185#, 36” below bust measurement.
I had a PS who said she did almost all saline implants upon exchange. Come to find out she is not certified to do silicone. So I changed to a different PS who will give me round, smooth, silicone implants.
My right side currently has a big dent (step-off?) at the upper pole that the PS said was due to the way that the mx was done. The previous PS said it was due to the crescent shape of the TE, but the left side looks good and does not have this issue. In order to correct this my PS says: “When you have the exchange of implants, the new implants will be smooth high profile silicone implants. This should give you more upper pole projection compared to anatomical shaped expanders you currently have in now. Hopefully the right upper pole concavity would be alleviated with this. We could try a 500ml implant on the right and a 475ml on the left.”
I think these implants will be too small in projection and in width – I like the size I am now with the TEs at 520mls and the bigger projection (6.3), though I could stand to lose a little on the width. The TEs are very close together giving me a very steep cleavage, and even so with the overfill I currently have some discomfort in my armpits from the width of the TEs. So I could lose some width, but going down to 12.6 and 13 from 15 might be too drastic. No? Also projection would drop from 6.3 to 5.5 on the 475ml and 5.2 on the 500ml – that’s a big drop in projection.
I asked if we could do another 100cc fill to bring me up to 620 and then go with 650s on both sides and fat grafting in the dent. He responded: “650 ml are fairly large implants that may pose some increased risk for you in terms of being heavier and puts increased pressure on your skin flap and incision line that may result in wound breakdown, skin necrosis and delay wound healing. Don't get to fixated on the numbers. Every patient is different and unfortunately we have to work with what is available from the manufacturers. I would recommend holding off on the fat grafting until down the road when we can reassess if it is even needed after the implant exchange.”
I have done the research and see that silicone 650s would weigh 24.375 oz ea – OK that may be a little heavy (over 7 oz heavier each than my current 520ml saline). Should I push for another fill and 600s? This is really as small as I am willing to go on width and projection. I don’t know if I can just tell him I don’t want to go smaller than that or if I need to find another PS. My scars healed beautifully, btw. So no reason to suspect poor healing.
Sorry for such a long note, but what would you suggest I do?
Thanks,
Jen
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sorry for the spacing issues on my post above. I copied it from Preview and can't get it formatted correctly here.
Jen
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Jen: You will be unhappy with anything less than 600 ccs. Trust me. I would prefer 650 ccs for you. The PS is going to need to perform lateral revisions to narrow the pockets from the 15.0 cm down to 14.0 cm. I am in full agreement with your position and as long as your skin integrity is good, I think it sounds entirely within reason.
Let me know if you need anything else.
Deborah
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Thanks Deb. Do you think the divot on the upper pole will be fixed with round implants?
BTW, I have Kaiser ins. If I need fat grafting later to fix the divot, do you think they consider that cosmetic or part of my reconstruction process?
Jen
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Whippetmom,
Thank you for your response. As always you are right there to answer our questions and offer your reassurances...its so appreciated!
Just to make sure I understand...revision on the left side is definitely needed and the benefits would outweigh the risk involved. The right side is more of a symmetry issue and surgery just to correct that would not merrit the risks. I have to be honest, since I am having surgery anyway, I would like to see the symmetry issue addressed. Do you think his solution of exchanging the right implant for a 450-475cc HP is a viable solution?
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What do you think? when i go to the PS i am bringing pictures that I took before my bmx and i traced over them where i would like to see my new boobs. A little higher and rounder of course. I don;t know if this is a good idea or not but i figure it will give me a visual to show him what is in my mind.0
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Jen: I think you need to send me photos. I want to see what is going on. Or post them on the pictures forum. There are enough issues you have and I don't want to overlook something. I'll PM you my email address.
I have Kaiser also and yes, fat graft transfer is indeed covered. I have had it done twice. If you have any trouble up in No Cal with this issue, let me know.
Deborah
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Carrol2: You need to go back to my 12/31 post where I responded to your questions.
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Whippetmom,
I just posted photos on TimTam's site under the title of "Overfilled TEs - note to Whippetmom".
Thanks,
Jen
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Hi Whippetmom,
I have been following your expertise postings the past month and think it's time to seek your advice. I had single mast (left size) on Nov 1st and here's my info. 5'2 and 120 lb. rib cage is 29 1/2. TE - Allergan 133MX -13 500cc.
As of today, I have 560cc which was suppose to be the final fill. Saw my PS today and he said I need another 30cc since I told him that I want to be close to my TE size now after the implants. I was between a 34 A and very small B before mastectomy. I had originally told him I want to be a regular B cup. I will also have a smaller implant on my right natural breast for symmetry. Because of changes in my insurance coverage, I had to move up my exchange surgery date to end of this month.
Please let me know what else I need to ask my PS. Thanks for any suggestions.
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Hi Deborah/whippetmom...I saw my PS today...have another appt. in a month when I will be schedule for my exchange surgery. He said we would continue our implant debate at that time.(I addressed many of your implant suggestions w/him concerning sizing/projection/type...etc.) I could tell he was quite surprised. He said he almost always used Mentor but will order Allergan 45's, if that is my wish and if the diameter is correct. Speaking of the diameter...I measured my ribcage at a little over 32" right under the bra line, but had my husband re-measure yesterday and he said it was a little over 33"...perhaps I didn't have the tape as high in the back as he did...I don't know... Anyway...was wondering if you thought the allergan 45's(800cc) would still work if the over 33" is correct? My PS said he had planned on using the mentor moderate plus implants(800cc) but I don't think that would give me nearly the projection I need... I also mentioned the saline implants that can be overfilled to 960cc and he said that he wasn't opposed to saline, but that he didn't want to over-fill because he had seen it cause pretty significant rippling as the implants lost some of their volume. He asked if I knew that saline could lose up to 10% of it's volume yearly through leakage. Actually I wasn't at all aware of that and now am more confused than ever since that was the way I was leaning. Any suggestions? Thanks!
Dee
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Hello Everyone;
I was hoping someone could tell me how to get to the picture forum. I will be having Bi-Lat-MX with reconstruction in Feb. and as you all know have lots to figure out before then.
Thanks!!
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Polly,
You need to send a Private Message (PM) to member TimTam and request access to the picture forum. She will give you permission and instructions for loggin on.
Good luck and let me know if I can answer any questions. I had Bi-Lat-Mx with Tissue Expanders placed last March. Then I went through chemo and rads and am now awaiting my exchange surgery.
Jen
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whippetmom I read your post thanks, you have been very helpful. I decided to take pictures to the surgeon of my breasts before my bmx to help me communicate with him the results i was hoping for. He thought it was a good idea. He explained to me that the implants wont have the fold in the flesh so much like a natural breast that hangs. He said they are more like mounds. Basically my 46 year old breasts before surgery were sagging and my new ones will not lol.
He measured me and we agreed a C cup is good for my frame which will require TE. I did not question further because less than C for me would seem to small since I was a DD. I always thought C would look better and easier to buy clothes for.
He put me at ease quite a bit about getting the TE. He seemed to think this surgery would be less painful in most cases than a BMX and I got through that quite well. He said 20% chance I will need drains.
He uses round smooth medium profile silicone implants for most people unless there is a special reason not to and there is not for me.
My insurance allows one night in the hospital but he said i could go home that day if i want to.
no lifting anything more than 5 pounds the first week.
limited raising of the arms for 2 weeks.
3 weeks start doing things but base normal by 6 weeks.
so now even though insurance companies have to cover recon i have to wait for the approval process to go through. So they will call me when they hear back. I expect then to make a preop appointment to be in February and I am going to try to plan the surgery for first week in April when my sister can come stay with me for a week.
He says he waits 8 weeks before he starts the fills.
I guess this will be a very long process. My whole breast cancer ordeal seems like it wont be over until maybe October 2011.
Here is how I figure my timeline
June 23rd 2010 diagnosis
Aug 9th 2010 bmx
October 5th -Dec 7th 2010 chemo
April ? 2011- Tissue expander surgery
June? 2011- fills
August ? 2011- Implant exchange
Sept ? 2011 - n@@ples
Oct ? 2011 - tatoosOh well I will at least plant o look great for xmas next year.
Anything else anyone thinks I should be asking him?
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Hello Jen;
Thanks for the info. Now I have another question. How do I find Tim Tam to send a message, I have looked through all the forums and cant find her. Any suggestions.
Colleen
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Hi Whippetmom,
I was directed over here with some questions about implant sizing. I am 1 month out from BMX, and have begun fills. I am now at 170 cc's, plannning on going weekly to "fast-track" if my body can handle weekly fills.
I am 5'6", 125 lbs, about 30" ribcage. I do not know my TE type, will find out next week at fill. Prior to BMX, I was a solid A cup/small B (on a good day). I am hoping to be a nice, solid B cup, or I'm thinking maybe a C? I guess my fear is looking too big for my frame, but on the other hand I don't want to go through all of this and feel "too small". I would like to enhance my cleavage and have some projection, but don't want my chest to be "all implant". I do have a medium to longer torso than most, I am a pretty lean person. I physically active and while I want the look of a nice bust, I don't want to look overdone.
Last week the nurse practioner mentioned getting to 350 cc's to get to the size I am looking for. This week my PS said get to where I like the size then go one more. well, I am not sure about what size would work for me. Any advice you have would be appreciated. Thanks in advance!!!
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Polly,
top, right corner "search" button; search by member name; enter TimTam; a list of her entries comes up; select one, then select her name, then PM her.
Jen
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Polly: You can PM myself, Whippetmom, Lilah, Firni or Estepp and we can help get you to the Picture Forum.
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Terrry54: Your TEs have a width of 13.0 cm and since you are happy with the volume you have currently, I believe you will want 500 ccs at the minimum and perhaps 550 ccs in a high profile smooth round silicone implant. And then the native breast can be augmented to match.
Deborah
As an addendum though: I am 5'4 125 pounds, 31 inch ribcage and my implants are 550 ccs - high profile smooth round silicone and I am a DD cup. You will NOT have the projection you have now with the TE - the projection of the TE serves the function of stretching out the skin and getting some ptosis or natural droop and also ensuring good skin closure over the implant. I personally think that 500 ccs would be more than sufficient for your frame, but certainly 550 ccs, if you want that extra oomph. You have to consider how much implant your native A breast can tolerate also.... You are wearing the wrong bra size though - you should be a 32 band.
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Carrol: I would not want "medium profile" implants for your frame. Moderate Plus or "midrange profile" perhaps. As to the issue of no natural fold - it depends on how much skin you have after the BMX. I have plenty of fold - my breasts droop naturally. But I had plenty of skin also. So not EVERYONE will have mounds - it depends on how much expansion is undertaken - how much skin you have to begin with - how well your skin responds to expansion - a number of factors.
Deborah
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Megan: I do need to know the size of your TEs, when you get that info. Essentially - the volume and the width. I personally feel that a width of 12.5 to 13.0 cm would be nice for your chest wall, and high profile smooth round silicone implants - because you can use the height of the HPs. I feel that around 450 ccs or 475 ccs would be about what you are describing to me. I would not go much smaller. You could use a moderate plus profile or midrange profile style - if your PS insists on using something smaller. If so, I would recommend 397 ccs in the Style 15 [Allergan] or 400 ccs in Mentor's moderate plus profile style.
Have you been to the pictures forum?
Deborah
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whippetmeom i think i am confused by what profile means.
I misquoted, my doctor did not say everyone gets mounds he said that that fold is hard to get sometimes. It seems to me like i have a lot of skin. I was surprised when i woke up from my bmx it's almost like an A cup of skin, so hopefully it will work well going from a DD of skin to a C.
I am so small now and I don't mind it that much but i don't feel very sexy, part of that is i have no hair though. But once my big DD breasts were gone my frame seemed so much slimmer. Like now I can see the top half of my abdomen lol. Also I can see the curve of my waist more now.
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Deborah,
Thanks so much for all your info. I forgot to mention that my PS favors Mentor silicone implants also.
I am so confuse about the TE quantities of ccs vs. final cup sizes. I read some postings where some have their TE fill only to 400's and still able to achieve a C cup. Yet I will be fill to the max and more (590cc) and will be getting a B cup (which I will be very happy with
) PS mentioned he will bring a few different sizer into the OR before making final decision. Is this normal ?I have been wearing a 34 band for a long while and seems comfortable ( use to be able to fit into a small 34B before menopause and losing a few pounds a couple of years ago). Maybe I am measuring my rib cage incorrectly.
Terry
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terry - most women wear the wrong band size. I wore a 34b for years until about six months before I found out I had cancer and then found out I was actually a 32c. 34 band felt comfortable to me but it wasn't giving me the support I needed. Since my new foobs, I can wear a 30 band because support is more important now than ever.
Cup size is relative because our bodies are all different, our rib cage size is all different. I have 325cc implants and that's a d or a dd on me. Don't get hung up on cup size. Even though I wear a d or dd now, my foobs do not project like my real ones did.
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Thanks Dawn-Hope. I definitely will need to get some new proper fit bras after the exchange. Really looking forward to that also.
Whippetmom: I recall you had mentioned going to Nordstrom in one of your post. What is the normal time frame to wear regular bras afterward? Thanks again.
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Terry: We all come in different shapes and sizes. So 400 cc implants on a 5'2 110 pounds woman with a 28 inch ribcage will look quite ample, while the same 400 cc implants on a woman 5'8" tall and 170 pounds with a 36 inch ribcage will look like jujubes on the chest wall. [If anyone does not remember what jujubees look like.] Hope this helps.....
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Oh...I hope you are wearing a nice soft cup supportive bra right after surgery. The key is to wear a bra which will encapsulate the implants and keep them secure - keep them from migrating during the settling period. A good sports bra with cups will work also.
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