BREAST IMPLANT SIZING 101
Comments
-
Hello Deborah,
Thank you in advance for your generosity in sharing your expertise. This is such a complex process and I would never ever have imagined that someone out there would be able to help with such a critical part of our recovery and I am very appreciative.
I am going in circles right now as my PS is not terribly open and communicative. I like him and trust him but getting anything concrete out of him is challenging. So I am hoping for your guidance to fine tune my questioning with him.
I have just finished chemo March 18 and am about to start radiation (breast and axilla) in 4-6 weeks so I feel a little under the gun right now and like I won't have a second shot at this. I had a BMX on November with immediate TE's. I am not sure of the model and size but am trying to get that info. I think they are Mentor (the round one with the fill port on top) as my PS showed me some Mentor rounds that he was planning on using (no size or model number yet of course). I will use silicone.
I am wondering if you could advise what might be the best size implant and then I can ask him more questions around how he plans on doing this. Right now I look an OK size but it is very flat and I fill out my old size B bra but I want to end up about a small C or large B and am a little concerned about projection and cleavage. It is kinda hard to tell and the TE's are quite high with the left one a little offside and wrinkled but the right one looks actually pretty good.
Last fill Feb 16
Potential radiation start date April 15, 22, 29 TBD)
Total volume (my records need to check) 280 mls
height: 5 foot 4 1/2- 5 inches
weight: 167 lbs hoping to go to 145 after all this
measurement under rib cage: 37 inchesMany thanks in advance! Have a great day!
Yo
0 -
Deborah I emailed you the photos.
0 -
Yo...get the information on your TEs so that I can calculate dimensions. I do hope your PS intends to expand you as much as possible before rads - .to even out all of the sharp angles of the TEs.
I will also have you email me photos of your TEs, once you have your final fill before rads.
Deborah
0 -
So is seems most everyone has their expanders placed "under muscle". My PS prefers over. Any thoughts on this issue?
0 -
Thanks Deborah,
As soon as I get hold of the info will be back.
Have a good day!
Yo
0 -
kim1967: Are you certain about this? Are yours currently over the muscle or are you going to have this done? I know there is one group in San Francisco doing this....but it is too controversial. Most oncologists feel it makes detection of any local recurrence nearly impossible....I would love to know what your oncologist thinks about this. Are you SURE that the TEs are not at least partially under the muscle - under 1/3 to 2/3 of the pectorals? In most cases, they are not under the muscle in the lower pole or lower portion of the breast, which is why many women have Alloderm slings to support the lower pole. I would clarify this....
0 -
Please help, I'm feeling overwhelmed by all the choices! I'm having a bmx w/immediate TEs on April 5th. I'm meeting w/the PS on Thursday to determine my boob (foob?) goals for reconstruction. I'm trying to be as educated as possible, but having a hard time processing all the choices -- shape, contour, profile, etc. I'm 5'6", 127 lbs., 32" around the rib cage, just below the bra line. Any guidance on TE & implant sizes that would be approriate? Mother Nature has put me at a 36B, but like many others, since I have to go through this I want to improve on size just slightly. Am not a Dolly Parton wanna be, but no harm in gaining from this bc experience. Can anyone help me with pros & cons of different styles? I've looked at the different web sites suggested here, but still a bit overwhelmed. Any guidance will be much appreciated.
I've put together a list of questions for my PS based on the incredibly wonderful info here -- a huge heartfelt thank you for all y'all!
0 -
Whippetmom - Yes obsolutly sure. Wasn't a conversation with Onc. My breast surgeon is the primary on my team that monitors for reoccurance she feels there is no issue with detection. She drives everything regarding my boobs, even PS surgical follow-ups are done in her office. My understanding it was more of a capsular contraction (sp??) issue, but they don't find the same stats in their office. That said, had I gone with saline, they would have recommended under muscle because of rippling. Talked with MANY women in their practice (6 months to 10 year relationship). Beautiful work, all happy.
0 -
CandyB, you've come to the right site for info. Sorry you have to be here but you're with others going thru the same issues. Whippetmom (Deborah) will get back to you or you can PM her. She is called the "Breast Whisperer" for good reason! I found this site after I had my TEs placed but she helped me with the implant sizing info. Exchange City is a very helpful thread also. Good luck to you!
Cindy
0 -
Candy: Don't be overwhelmed! You will be well-educated as the journey progresses!
Your PS will be selecting a tissue expander based primarily on the current base width of your natural breasts. He will also take into consideration any ribcage issues or other factors, such as skin thickness - how much tissue coverage you will have for the TEs. That said, the most commonly used and "popular", I suppose you could say, TEs used would be the short height or moderate height TEs. Mentor and Allergan are the two most commonly used. I happen to like Allergan TEs better....more styles and projection offerings than Mentor. The styles which seem to work best for women with your height/weight/ribcage, are in Allergan, the SX [short height, extra full projection] and MX [moderate height, extra full projection] styles. They render the most volume with a narrower base width than do other styles. This works best for those with a ribcage measurement of 28 to 32 inches. This is all providing you have good tissue coverage, because they are full projection style TEs. The PS will likely have sizers in the OR and will have the option of using the style which will be appropriate for the pocket created after the BMX.
So, based on information you provided, with a goal towards the future,and providing there are no ribcage defects or skin integrity issues, I think you would be a good candidate for a high profile implant in either Mentor or Allergan. This would be the smooth, round silicone implant. If you could tell your PS you would like to achieve something in the range of 500 or 550 ccs, he could plan the expansion accordingly. For instance, in Allergan, the implants would be: Allergan Natrelle, Style 20, 500 ccs or 550 ccs. In Mentor, simply high profile style implants in smooth silicone rounds.
After you discuss the above with your PS, you can ask him what style and volume of TE he thinks would be appropriate. Ask if he can see any reason that he might NOT be able to expand you sufficiently for high profile implants of the volume range noted above. Ask if you have any chest wall abnormalities which might complicate expansion. It is rare if you do, but I am always surprised how many surgeons do not discuss this with their patients and I would just want to know of anything which might compromise the reconstruction journey and have an intelligent discussion regarding how to address such issues prior to surgery.
Candy, most of us have a very distant memory of the mastectomy or the expansion process. Honestly, the time goes by so quickly. You just plod through it, stay healthy, take the fills very slowly - every two weeks and NOT weekly - and you will be on the other side of this before you know it!
Any other questions....let me know.
Deborah
0 -
(((Cindy)))) You are a sweetie!
0 -
kim: So this is very interesting. You must have excellent skin flaps! But submuscular placement reportedly does lend to a reduced risk for capsular contracture than does "subglandular" placement. Of course, after MX there are no "glands" remaining, so I suppose the only term is "over-the-muscle" placement. Wow....I heard of one other woman on these forums who has the same placement. Or....maybe you are the "one"?
Do you have pictures on the picture forum? I would love to see what they look like...
Deborah
0 -
I don't have access to picture forum, but have sent you a PM with my e-mail address. Send me your info and I am happy to share. I am also happy to post on the forum once I figure out how to access.
Thanks!
0 -
Deborah, you are the Sweetie! I go in for exchange on Friday. Thanks to you I have already gone over questions/concerns with the PS. But I have my list ready to take with me to go over everything again! I wish you got paid for doing this. You deserve it!!
Cindy
0 -
Cindy: How exciting! I want you to get everything you wish for! Let us know how you are doing once you are able to post when you are home! And then we look forward to photos!!!
I'll keep you in my prayers!
Deborah
0 -
Deborah,
Thank you! Your knowledge, time, and kind thoughts are very much appreciated! This thread has been hugely helpful to me. I feel much more prepared for my PS visit today. To all that contribute on Sizing 101 -- thank you! It's very reassuring to be reminded that this will all be behind me eventually. Don't like bc having such a large role in my life. Too much else to enjoy and do.
Candy
0 -
Deborah thanks for your thoughts. I did take some pics of my funky TEs. I've been calling them Thing 1 and Thing Ewww!! Hopefully I'll be so happy with the implants I'll have the nerve to post the before and after!!
Cindy
0 -
I'm back Whippetmom for more advice please!
I had a fill yesterday at 420cc and I want to stop now. I have 133MV-14 series TE's 500cc. I look head on into the mirror and look very wide.
My right breast has a nice round mound on the upper inner quadrant as opposed to how the fill affected my left TE by pooling more in the left lower (nice curve there though)
My left inner portion looks horrible as there is a 2x2 flat slanted plane of extra skin (plus hair follicles resembling large pores) I don't know if this will get rounded out once I have the exchange or if I'll need an additional procedure to get rid of some extra skin.At our last consultation;), I have written down: 14.0 cm width Allergan style 15 in midrange profile silicone with 533cc. I have lost 10 pounds since my surgery 9 wks ago.
I'd like to go down now to something in the 400 range and maybe more of a high profile model? I'm just sagging so much now. I'm disappointed they're not higher up there...So I'm 5'6", 139 pounds and my chest circumference is: 32-33in. I will try and send a picture to you later today...my camera is charging now. I am interested to see if you think that 'extra skin' on my Left will smooth out or not.
I also found it interesting how the time frame from last fill to exchange has such an impact. Does it make it better for the overall roundness of it all? I was hoping to look at the first week of May if yesterday was my last fill.
Again, thanks for your help and your time Deborah...it is very much appreciated!
Kat0 -
Cindy, thing 1 and thing ewww. I love that!
0 -
Kat: I need photos. Yes, additional skin can be revised at the time of the exchange.
I want to get you into a high profile implant, but we are somewhat limited because of your 14.0 cm width. I wish the PS had used a 13.0 cm wide TE for you instead. So you CAN go with a narrower implant, but your PS is going to have to reassure you that he can do some additional pocket work to tighten up and narrow the pockets. If we use high profile implants, I think you need at least 475 ccs in Allergan Style 20 - HP's - even 500 ccs - knowing that you will not be any larger than you are now with your TEs and you will likely be a little smaller. I am just worried about this excess skin and want to make sure your PS is going to "clean" everything up for you in this regard.
I will be looking for photos...
Deborah
0 -
You are amazing! I need a little longer charge yet on my camera. I will definitely send them by this evening. Thank you so much.
Kat
0 -
Bumping
0 -
Well, I'm armed with ammo and I'm ready for my PS appointment! Initially, there was nothing available so I just had to mention that I felt the TE's weren't under the muscle as they should be and maybe I should have 'another set of eyes' check me out and low and behold there was an appointment available after all!
I'm going to try and get an exchange date and I'm going to request 13cm wide HP 550 Natrelle 20s. With extensive lateral pocket work and a plan to do a little mastopexy with the exchange and a post surgical date to do the final trimming up. Of course I will do a lot of listening to make sure we are the same page.
If my last fill (at 420cc) was this past Friday (March 26th) how long should I wait for an exchange date? Is it really good to wait to long in my case of needing the lateral pocket revisions? How does he do those anyway?
Thanks again for all your help.Here's to high profile perfect foobies! (I hope)
Kat0 -
Kat...You are hilarious! You ARE a squeaky wheel!!! Excellent decision about size, by the way! Regarding how much time to wait....well....in your case I think one month would suffice. You already have sufficient expansion and I think you had sufficient expansion prior to your last fill. So just schedule it for sometime in May. Update me after your appointment!
Deborah
0 -
Thanks Whippetmom,
I am new to this sight and all the information has been great. I feel like I am bothering my PS when I ask about the outcome of my reconstruction. I have a TE in and I am fully expanded and waiting for the next surgery which is an implant and a lift. When I asked my PS about going a little bigger he told me he put a TE in for my original size and he cannot expand it any bigger, he does not over expand and says he can't go bigger then my original size. I also asked about putting an implant in my other breast instead of a lift and he seemed to brush that aside. Any advice?? Should I push harder for what I want? Can a bigger implant then the TE go in the breast area? My insurance is covering this, do you think he is hestitant because of the insurance. I will pay the additional money to get what I want, should I address that with him? A lot of the pics I saw on the PS website for reconstruction did not look natural, they looked like the TE shape, square and odd. After going through this difficult process I want to have my breast look as nice as possible, I don't want to settle. Your advice would be greatly appreciated.
0 -
Just got my first fill today 100 cc's. Wow....... what a difference. I had LAT flap surgery 10 days ago, and I must say my PS is an artist. I am happy already. I can only imagine how they will look when he's done. I know it won't be like my natural breasts, but gee, I never thought it would look this good this fast.
I'm 5'8 1/2" tall and I weigh 150 lbs. I'm shooting for a 350 cc limit. Dunno what size that will give me, but the PS said he would like to see me as a full C, he thinks that will match my build. My prostethis were D's......and frankly, they were a little too large.
0 -
Stacy-Joy and Pamelajo - I have spent far too much time on the computer today and I need to go attend to my hubby....so I will answer both of you tomorrow morning!!
Deborah
0 -
Stacyjoy: I think you need a second opinion. It is entirely possible to be somewhat larger than you were prior to MX. It is entirely acceptable to have an implant put in the opposite breast for symmetry. I am a little dismayed by your plastic surgeon's lack of interest in helping you achieve the best possible results from breast reconstruction. I would personally want to get a second opinion. Many women here on these forums start out with one PS and then switch to someone else for the exchange, if they can see that they are not going to get the results they want with the first PS. But give me the information I need at the top of the thread. You can PM it to me if you like. Height, weight, ribcage and info about your TEs...I can help further with this info.
Deborah
0 -
Pamelajo: What is your ribcage circumference? Please provide your TE information.
Armed with the info I have, and based on how much volume the flaps lend to your mound dimensions, I think that you probably need implants with at least 400 to 450 ccs to achieve the size and appearance you want. It takes far more volume to achieve the proper dimensions with breast reconstruction than it does with augmentation. You could send me photos once you have another 100 ccs and we could get a better idea of where you might be at the end of expansion.
Deborah
0 -
Deborah, You've helped me so much before and have given me the courage to pursue what I want with my ps! Thank you so much!!! I'd appreciate your help & advice again. I'm a unilateral with an allergan/Natrelle 163-440 (expanded to 460) Saline on the mx side. My good breast was augmented witha Natrelle 468-230. My ps lowered the crease when he did this giving me a very odd look which you saw & can see again on the picture site. Since that time I had fat grafting done to mx side but nothing to the augmented side much to my dissatisfaction. I still do not have the projection on the mx side to match my augmented side + there is some slight tenting on the mx side cleavage area.
I met with my ps yesterday and he has suggested switching out to silicone allergan HP 20 550cc for the mx side. He's going to go larger to try to fill out the side toward my arm. He's going to put in internal stitches on both sides to improve the creases & tenting. He will raise the pockets slightly The augmented side will also have an Allergan HP 20 to "match" the mx side.
My rib cage is 29.5 & I weigh 130 (unfortunately) at 5' 3". Do you think these implants will look good on my & give me a large C or larger???
Thank you so much for all you do for all of us on BCO!
0
