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Topic: BREAST IMPLANT SIZING 101

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

Posted on: Jan 7, 2010 11:01PM, edited Nov 11, 2014 01:22AM by whippetmom

whippetmom wrote:

BREAST IMPLANT-BASED RECONSTRUCTION AFTER MASTECTOMY:


Please scroll to the bottom and find your tissue expander information and dimensions and/or breast implant information so that you can be well-informed about your optionsllll

PLEASE READ THE FOLLOWING INFORMATION IF YOU HAVE QUESTIONS REGARDING BREAST IMPLANTS.

It is very important and even crucial that you discuss all of your concerns, hopes, desires and plans for your breast reconstruction outcome with your doctor. You have every right and every reason to want to get it right the first time and to know what your options are in this regard. Please let your doctor know that you are very interested in being a partner in the decisions he or she will make regarding your breast reconstruction journey.

This thread is essentially an informational link for those who are preparing to undergo mastectomy [unilateral or bilateral] with immediate reconstruction with two-stage tissue expander placement or have already undergone reconstruction and you are in the tissue expander fill phase of this process.

1. TISSUE EXPANDER - OVERFILLING AND REASONS FOR DOING SO:

Overfill is sometimes performed and it can be done so for a myriad of reasons. It can be done because a PS always does it in his practice [which makes no sense to me]; it can be done for assurance of good implant coverage with the skin flap; expanding out the skin a bit more so that a larger implant can be used, or in order to achieve ptosis [droop], especially in unilateral recon. It is not necessary in all cases to overfill and some docs never overfill, some rarely ever and some always do. But for those who are small-breasted prior to MX, it often is necessary, so that there is good skin closure, if a larger volume of implant is needed or if symmetry with the contralateral breast is required for ptosis and symmetry.

2. SILICONE VS. SALINE?

Please note that the question of whether you should have silicone vs. saline implants at the time of exchange is one which you can research on your own, and you can find various threads discussing the differences on bc.org. However, the overwhelming number of women on these forums now have silicone breast implants

Breast Implant Shapes and Styles:

There are many styles and shapes of implants. There are silicone round implants, which typically have three profiles used in breast reconstruction. A moderate plus profile, a high profile and a ultra full profile implant.

Round implants - the moderate plus/midrange profile, high profile and ultra full profile are the ones used for breast reconstruction. The moderate profile is rarely, if ever, used for breast reconstruction.

There are anatomical implants, which come in a variety of styles in Canada and Europe, but only offer three styles in the U.S. There are shaped implants, which are different than anatomically shaped implants.

Anatomical implants look like this:

Shaped implants: Sientra

Round implant on the left and shaped Sientra on the right:

ALLERGAN 410 - "GUMMY BEAR" IMPLANTS:

There are numerous threads here on bc.org which discuss the merits of these implants versus the standard silicone rounds. [We are happy to help with sizing in this regard as well, although please note that breast reconstruction experts state that the tissue expander should be chosen specifically for expanding and creating the breast pocket for the corresponding cohesive gel/gummy bear implant. Therefore, it is probably more uniquely important that you discuss with your PS where he/she intends to go in terms of implant size/projection at the time of exchange.]

MENTOR CPG IMPLANTS:

UPDATE: October, 2014: Mentor has just received FDA approval for four other styles of CPG anatomical implants. No data regarding the styles or volumes and dimensions is yet available for the US market. You can find Canadian and UK links with sizing information, if you want to research further. I am not going to comment on sizing or styles until more data is available in this regard. It could take months before the new styles are available to plastic surgeons. However, those surgeons who had Mentor CPG implants in clinical trials, will likely have access already or sooner than those who have not been in clinical trials with the devices. Plastic surgeons may be provided with style and sizing information fo the new CPGs, long before they receive the actual implants, so if you are considering anatomicals, please discuss this with your plastic surgeon.

http://www.prnewswire.com/news-releases/fda-approves-new-styles-of-the-mentor-memoryshape-silicone-breast-implant-275099851.html

IMPORTANT INFORMATION RE: ANATOMICAL AND SHAPED IMPLANTS

There are a plethora of plastic surgeons who are trigger happy about the anatomicals, because they were so long in achieving FDA approval. There was such a hoopla about them....and they were touted as being the end-all-be-all of breast implants. But the plastic surgeons who are most experienced about using them in clinical trials, KNOW that they are not a one-size-fits-all implant. There is a criteria to follow when using the anatomical implants. Grant Stevens, MD and Steven Teitlebaum, MD are the two principal Allergan 410 clinical trial docs, and they BOTH say that the dimensions of the pocket MUST be created specifically to match the dimensions of the anatomical implant.

"Anatomically shaped implants such as the gummy bear implant project more on the bottom than on top, mimicking the shape of a natural breast. If an anatomical implant rotates because the pocket holding it is too loose, it causes a distorted appearance that does not occur with round implants."

Dr. Stevens also advises against using anatomical implants when the patient has previously had round implants.

"The shaped form-stable gummy bear implants, such as the 410 and the CPG, are not ideal implants for women who have had previous breast surgery and have already pockets for those previous implants. Those women have pockets which are generally too large to safely accommodate the shaped form-stable implants. However, the Sientra form-stable silicone gel breast implants, which are round, can be safely placed in these patients."

According to Florida plastic surgeon, David Bogue, MD:

"Shaped implants require a form-fitting pocket to allow for adhesion of the implant to the pocket to prevent rotation. In a single stage reconstruction with acellular dermal matrix, this can be achieved because the capsule will form around the shaped implant. However, concern exists when using a tissue expander prior to exchange to a shaped implant. The capsule has already formed and there is no guarantee that adherence to the new implant will occur. The implant space should also be fairly tight around the shaped implant to help prevent rotation."

This is from Robert Cohen, MD - Arizona plastic surgeon:

"The concerns about anatomical implants rotating in the pocket are mostly due to surgeons that did not adhere to precise pocket dissection techniques. If the breast pocket is designed to the size of a textured anatomical implant, the risk of rotation is minimal. In a recent large study by Sientra of their anatomical implants, the rotation rate was 0%."

Another plastic surgeon, who has used the Allergan 410 in clinical trials, and knows the principals of "precise pocket preparation, writes as follows:

"Shaped implants require precision in pocket dissection and placement. If a round implant spins, it is still round. No change in breast shape will result. This is not true for a shaped implant. If the implant turns, the breast will change shape. If the surgeon makes a pocket larger than the implant, and places a round implant, the implant may shift or spin within the pocket. Not a problem, the breast won't change shape. If the surgeon creates a pocket larger than the implant and places an Allergan 410 implant (or a tear drop saline implant for that matter), the implant may shift or turn, changing breast shape. That is not good. So here, precise pocket dissection within less than a centimeter tolerance is important. The implant must fit easily but precisely into the pocket. This is not hard to do, if you know how and are experienced at atraumatic pocket dissection. I have been using an atraumatic techique to create the pocket since 2004, and have extensive experience with shaped saline implants. Placement is also an issue. I believe that shaped implants should have a slight tilt to them to achieve optimum aesthetic results, and this is based upon my experience with them. This is true whether a saline or silicone gel shaped implant. As sometimes I also lower the inframammary (breast crease) fold, properly setting the crease level is essential with the Allergan 410. So for me, from my first Allergan 410 implant case forward, working with a teardrop-shaped implant is nothing new to me. The surgical technique, simply put, must be more refined, meticulous and precise.

"I urge caution for everyone interested in cohesive gel implants and would not recommend them to a majority of my own patients for several reasons, chief among them being that in most breasts, smooth (round) silicone implants will produce a more naturally looking, feeling and moving result" says board certified plastic surgeon Dr. William F. DeLuca of DeLuca Plastic Surgery. “I also think it's important to understand that today's (round) silicone implants are backed up by over 30 years of clinical research, testing, innovation and real-world use."

WHAT TO DO IF AN ANATOMICAL IMPLANT ROTATES:

Switch to a round implant...per Steven Teitlebaum, MD, Chief Allergan 410 clinical trials plastic surgeon.

Rotation

"These implants only come in anatomical shapes, meaning that they project more on the bottom than they do on the top. One of the risks of such a design is that if the implant rotates in the body, it will create a distortion. Care is taken during pocket dissection and insertion in order to minimize this. It is a very rare, but very possible complication. The only way to fix it if it occurs is to remove them and replace them with a round implant. Rotation is at greater risk when the tissue is loose, for instance in a revision when a patient wants to go smaller. But even with the additional risk of rotation which is not present with round implants, the total rate of reoperations are lower with these implants than with standard round gel implants. For many patients, however, the thought of a rotation is very unsettling and they choose against gummy bear implants."

Article provided by Dr Steven Teitelbaum, board certified plastic surgeon in Santa Monica California.

3. IMPLANT SIZING INFORMATION:

If you are interested in discussing implant sizes, make sure you compile and provide us with the following information:

Height, weight, ribcage measurement [measuring the circumference of your ribcage under your tissue expander(s) or under your bra line]. Also, if you have TEs [tissue expanders] - we need to know about them. The style - Mentor or Allergan most likely - and whether they are short height, moderate height, full height if Mentor and style number if Allergan. We also need the recommended fill volume of the TEs - the number of cc's. (NOTE: If you have PMT Corporation tissue expanders or any other unlisted manufacturer, please see if your PS will provide you with the dimensions of such devices.]

4. "WHAT CUP SIZE WILL I BE?" OR "WHAT SIZE IMPLANT DO I NEED FOR A "C" CUP?"

I CANNOT PREDICT CUP SIZE. PLASTIC SURGEONS ADMIT THAT THEY CANNOT PREDICT CUP SIZE WITH ACCURACY!

It is very difficult to determine cup size with breast reconstruction patients, as volume does not easily translate to a specific bra size. There are so many factors which determine how implants will look on any one individual, e.g., your ribcage circumference, whether your chest wall is bony or if you have a fair amount of adipose tissue surrounding the chest wall.... if you have any ribcage deformities or other structural issues which might impact implant placement. We can sort of "project" where you might want to be...or estimate the implant volume which you could "aim" for - so that you can sort of look at the prize ahead of you. Most of us have found though, that it is better to continue with tissue expansion until you have reached a desired volume and appearance, and then compare these dimensions with the breast implant dimensions found on the links at the top of the Exchange City thread in the Breast Reconstruction forum.

5. BREAST IMPLANT SIZING IS SPECIFIC TO YOUR VITAL STATISTICS

Implants of a specific volume will look different on A 5'10" 176 pound woman with a 35 inch ribcage, than they will someone who is 5'3" tall, weighs 110 pounds and has a 29 inch ribcage. So height, weight, ribcage circumference, body habitus - all of these things come into play when determining what style and volume of implant will best fit someone's frame.

6. UNILATERAL MASTECTOMY/ SINGLE MASTECTOMY

If you are a unilateral MX, symmetry issues come into play and this determines the style and volume of implant selected. The focus is on attempting to match the appearance of the native breast. It is impossible to calculate the size of implant needed with a unilateral reconstruction, without knowing the SIZE of the native breast, whether that native breast is ptotic (droopy), whether it will undergo a lift and/or an augmentation. The key is for the PS to select a TE which will enable him/her to expand that MX side sufficiently to provide enough of a skin envelope to use an implant which will match, as closely as possible, the native breast. In this case, the physician may bring a number of implant sizes and styles into the OR at the time of exchange, in order to find the best fit possible to match that native breast.

QUESTIONS FOR YOUR PLASTIC SURGEON:

In the interim, here are very important questions to pose to your plastic surgeon. Ask your PS if he/she tends to place you in an implant with a volume larger than the TEs, or if he/she prefers to place you in an implant smaller than the TEs. If your PS likes to overexpand - overfill - ask about this. It is important to know what is in your PS' mind about where he intends to go with your reconstruction, because this will assist us in calculating to what extent you require expansion in order to exchange to the desired implant size and dimensions.

Based on everything I have read in my four years of researching breast reconstruction, the tissue expanders SHOULD be placed by the PS with the foreknowledge of the approximate size and style of implant he/she intends to use for you down the road. It should not be "let's just throw this tissue expander on her and see where it takes us." The WIDTH of the tissue expander is a very important consideration. Proper placement of the tissue expanders is a very important consideration. Please discuss these issues with your PS.

TE and Breast Implant Data: We should be given a little plastic credit card with information regarding our TEs and our breast implants after surgery. ASK FOR YOUR CARD! These are registered medical devices and the manufacturer intends that patients have access to this information. Make sure that you ask your physician's office for this information and retain it in your medical files.

It should be stated that a great deal of other criteria goes into implant selection. Also of importance: Your torso [short or long], any potential ribcage or chest wall deformities or issues [e.g. pectus excavatum, pectus carinatum], and how much tissue you have overlying the chest wall.

AFTER THE EXCHANGE:

Just remember that just after the exchange, the implants can look misshapen and flattened out and sometimes downright bizarre! You need to give it two weeks - sometimes much longer. DON'T OBSESS ABOUT THE SIZE OR SHAPE RIGHT AFTER THE EXCHANGE! STEP AWAY FROM THE MIRROR!

EMOTIONAL ISSUES AFTER THE EXCHANGE:

Many of us and I mean MANY of us go through a period of sadness and depression after the exchange. It is an emotional journey we have been on since diagnosis and we suddenly seem to start experiencing all of the emotions we have placed on hold throughout the mastectomy and TE expansion process. So just rest in knowing that we have been there and we know what you are going through right now. Try to avoid obsessing over the appearance of your new breasts. Feel free to ask any questions or voice your concerns, but it is quite normal as this point in your journey.

There are other women throughout the bc.org family who also have important information to share and we hope they add their thoughts to this thread so that your breast reconstruction journey is made easier and also so that you feel empowered about this aspect of your breast cancer recovery!

TISSUE EXPANDER AND BREAST IMPLANT CATALOGUE LINKS:

ALLERGAN:

http://breastimplantadvice.com/wp-content/uploads/2012/03/Allergan-catalogue-file.pdf

CATALOGUE FOR CANADIAN AND EUROPEAN PATIENTS

http://www.allergan.com/assets/pdf/ca_natrelle_si...

MENTOR - CLICK ON IMPLANTS OR TISSUE EXPANDERS

http://www.mentorwwllc.com/global-us/Breast.aspx

SIENTRA:

http://www.sientra.com/Content/pdfs/Product_Catalog_Breast_Implants_and_Tissue_Expanders.pdf

SSP - Specialty Surgical Products/DERMASPAN TES: (Dual chamber tissue expanders allowing the surgeon to control upper pole and lower pole expansion. A unique tool for expanding the lower pole, where projection naturally occurs in the native breast and an often difficult challenge for expansion after breast reconstruction.)

Dermaspan

QUICK LINKS - IMPLANTS ONLY

MENTOR:

http://www.justbreastimplants.com/breast_implants/mentor_specs.htm

ALLERGAN:

http://www.justbreastimplants.com/breast_http://www.allergan.com/assets/pdf/ca_natrelle_silicone_dfu_en.pdf/allergan_specs.htm

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Nov 20, 2012 09:54PM Layla2525 wrote:

Michy, I am about your size,at 5'4 and vary from 140 to 159. I was really small. I got 550cc and now my B bras are a little small. I wanted to be a C cause I was so small before. I think with the 500cc,that should be enough to do the B. You might wanna get a second opinion. Whenever,I was unhappy with a dr,I called my breast coordinator and got a diff dr.

I also second what Blessings said. hope all our advice helps.

bmx w/TE on 2/13/12,exchange to Mentor high profile 600cc gel implants on 08/30/12,07/01/2013,new Natrelle 45 gel,replaced Mentors due to capsule. Dx 12/19/2011, IDC, 1cm, Stage I, Grade 1, 0/2 nodes, ER+/PR+, HER2-
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Nov 21, 2012 06:53AM Crescent5 wrote:

Hi Michy,

We have a lot in common. Just to confuse you further, I'm 5'4", about 132 and my implants are 400ccs in style 20 for projection. I have my own nips, so that may help with projection as well. My bra size range is 34DD-36D (most often 36C). I'm very happy with my projection. I had one implant shift laterally that was repaired surgically and one that rode so high I looked like I was smuggling a loaf of bread under my pecs.

I had a revision 6 months after exchange with a fabulous PS (I'm not sure if she specializes in revisions, but she could). Most PSs will have you wait that long before considering revision for a number of reasons. Most importantly, you're not fully settled until then. That fixed the lateral problem.

For the high rider, I found a massage that pushed that implant right into it's proper position. I tried them all, trust me. Here is a youtube of the massage, but please be warned. This is an augmentation patient, and she's topless. It may be difficult for some of us to see. Also the comments are really vulgar. Check with your dr to make sure massage is appropriate for you.

http://youtu.be/AYnFo6j9AMc

Lastly, for this latest surgery, I had to wear a surgical bra for at least 6 weeks. I found something this time around that may be coincidence or may have some truth. I think that bra helped shape the girls into a pointier shape (which I really wanted). So this time around I've been on a mission looking for those old fashioned pointy shaped bras. They're ugly as sin, but if it's helping solidify my shape, I'll keep wearing them for another 2 months (I'm 2 months out from revision).

My advice to you is to start looking for a possible revision PS. You may not need it, but it's good to line things up just in case.

Dx: ALH, LCIS 10/10, PLCIS 11/10 ~ PBM 1/13/12 ILC 4mm & 7mm found post MX Stage 1 Grade 2 ER/PR+ HER2- 0/9 nodes Oncotype Score = 6, Tamoxifen 4/12 ~I want this sh*t to leave me alone Dx 1/13/2012, ILC, <1cm, Stage Ib, Grade 2, 0/9 nodes, ER+/PR+, HER2-
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Nov 21, 2012 10:08AM Merlcat wrote:

I'm new to this too but I've read so many wonderful things, I am hoping that the gurus here can help me with my sizing too? :)

I'm 5'10", 128 lbs with a 28 inch rib cage. Pre uni mx I wore a 32 DD which I thought was too big for my frame. I definitely don't want to be DD in my reconstructed side and know (ugh) that I will need a redux and lift of the non effected side. I don't want it to be reduced *too* much in the event that I end up needing a mx in the future on that side( I want to be sure I have enough skin on that side left for that potential eventuality. I currently have a naturelle 133mx-13t nw filled with 430 ccs....when I asked yesterday about the capacity, I think the p.s. said 500 ccs.

I think that I'd like to be a small d?

Dx 10/8/2012, DCIS, Stage 0, 0/4 nodes, ER+/PR+, HER2- Surgery 10/29/2012 Mastectomy (Right); Reconstruction: Tissue expander placement (Right) Surgery 01/23/2013 Reconstruction: Breast implants (permanent) (Right)
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Nov 21, 2012 06:21PM MichyLL wrote:

Layla2525, thank you so much for your input! It makes me feel better to hear that after all is said and done I might still end up a B. :)

Crescent5, what does "20 for projection" mean? How do I find mine? Unfortunately my PS says no massage, which I don't get, but I'm going to physical therapy starting Friday :) . As far as another revision DR. I will definetly be looking for one first thing next week! I wonder if anyone here knows of one in or near Boston.

Merlcat, you are in the best hands here. These women are very very resourceful! Best of luck!

michy
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Nov 21, 2012 07:54PM , edited Nov 21, 2012 08:05PM by Crescent5

Michy there are different styles for different projections. Mine are high profile, which are style 20 (allergen).There are other numbers for different projections/profiles. Yours should be on the card they gave you. My revision PS is in Boston. I'll PM you. Oh geez, I just noticed you're from Methuen. I should have given you my PS's name earlier! She's at MGH.

Dx: ALH, LCIS 10/10, PLCIS 11/10 ~ PBM 1/13/12 ILC 4mm & 7mm found post MX Stage 1 Grade 2 ER/PR+ HER2- 0/9 nodes Oncotype Score = 6, Tamoxifen 4/12 ~I want this sh*t to leave me alone Dx 1/13/2012, ILC, <1cm, Stage Ib, Grade 2, 0/9 nodes, ER+/PR+, HER2-
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Nov 22, 2012 01:08AM whippetmom wrote:

Merlcat: Your PS is choosing the right size for you. I would say 475 ccs or 500 ccs in Style 20/Allergan.

DISCLAIMER! I am not a physician or medical profesional. The information provided is my own personal opinion. You must discuss every aspect of your reconstruction with your plastic surgeon. Dx 10/15/2008, IDC, 1cm, Stage Ia, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Nov 22, 2012 06:22AM sherry67 wrote:

Whippetmom,
I'm getting a second opinion from another PS regarding finishing my reconstruction due to cant wait for my Ps I call to get status update because the Sientra are on back order and they never call me back....the new one uses Mentor Memory Gel implants was woundering what you thought about this brand..are they as good as the Sientra implants..

Dx 2010, IDC, 2cm, Stage IIb, Grade 3, 11/23 nodes, ER+/PR+, HER2+ Hormonal Therapy Tamoxifen Targeted Therapy 03/04/2011 Herceptin Chemotherapy 03/04/2011 Abraxane, carboplatin Surgery 07/28/2011 Mastectomy (Both); Lymph Node Removal: Axillary Lymph Node Dissection (Right); Reconstruction: Tissue expander placement (Both) Chemotherapy 09/04/2011 Adriamycin, Cytoxan Radiation Therapy 11/22/2011 External Surgery 08/20/2012 Prophylactic Ovary Removal (Both) Surgery 02/15/2013 Reconstruction: Breast implants (permanent) (Both) Surgery 07/09/2013 Reconstruction: Breast implants (permanent) (Both) Hormonal Therapy 07/11/2014 Arimidex
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Nov 23, 2012 08:31AM Merlcat wrote:

Thank you so much for your input! It'll be interesting to see how much more saline my rs fills my the with next week when I go back.....

Dx 10/8/2012, DCIS, Stage 0, 0/4 nodes, ER+/PR+, HER2- Surgery 10/29/2012 Mastectomy (Right); Reconstruction: Tissue expander placement (Right) Surgery 01/23/2013 Reconstruction: Breast implants (permanent) (Right)
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Nov 24, 2012 03:08PM janiceg415 wrote:

I'm back and still unable to make a decision

I have been unhappy with the lack of size & projection since my 7/5/12 implant exchange for a uniMX,  on a f/u visit with my PS I told him that and he said he could do a revision. I asked what are you going to use "a bigger implant", he didn't clarify but said they have different shapes.  That was they extent of his answer, I have been less than pleased with the lack of communication.  So tentatively I was set up for revision 12/21 with him. 

But I decided to seek a 2nd opinion this time with a woman, who I absolutely adored.  I think she spent over and hour with me, going thru each aspect, including the lack of upper pole fullness, a divot on the side and the look of a "stuck on implant" lack of inframammary crease definition.   She did however, say that the mastoplexy side was a good job, and wouldn't want to touch that.    She suggested the possible removal of implant, place expander to generate more skin, and place larger implant/ with high profile, and fat grafting to upper and side of breast.    I was enthused by her plan but not so sure about changing back to an expander and going that route again.  She also was first to talk to me about fat grafting.  One problem with going with her is that I definitely have to wait for after 1st of year as she has no surgical openings (and I would like to be able to get this done in 2012 due to my deductible having been already met).

SINCE the two PS differed so very much, I thought I might as well get a 3rd opinion and see where that would go. 

Much to my surprise the 3rd PS (a male) said he thought my 1st PS did a pretty good job, he said that he could see some of the problems I spoke about, but said he would have felt badly if this was his work that I was unhappy with.  He said yes he could do some revision, but very slight.  He even suggested waiting for a bit to see if the implant changes how it looks.  He also said that maybe I would be a good candidate for the Sientra "gummy bear" implant as it has a more conical shape, however, these have not been available in my area as of yet (central Wisconsin) and didn't know when it would be. He also mentioned that I should check with my insurance company as all revisions may not be covered just because we think the breasts are not symmetrical.  He said that it could be considered more cosmetic than trying to just achieve symmetry, even though my original diag. was MX for dcis.  I have a foob created by a silicone implant I guess I should be happy with that.

SO as you can tell I am just as confused as I was to begin with.   ANY THOUGHTS ON THIS OVERLY LONG POST would be gladly welcomed.

Janice UniMX 2/23/12 with TE, no lymph node involvement Dx 11/23/2011, DCIS, 1cm, Stage 0, Grade 3, 0/1 nodes, ER+/PR+ Hormonal Therapy Aromasin Surgery 12/09/2011 Lumpectomy (Left) Surgery 01/20/2012 Lumpectomy (Left) Surgery 02/23/2012 Mastectomy (Left); Lymph Node Removal: Axillary Lymph Node Dissection (Left) Surgery 07/05/2012 Reconstruction: Breast implants (permanent) (Left) Surgery 12/21/2012 Reconstruction: Breast implants (permanent) (Left)
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Nov 26, 2012 06:28PM whippetmom wrote:

janice:  I do not like the dismal perspective of PS #3.  Here is what the law provides:

Breast Reconstruction Defined

Breast reconstruction is covered under insurance as a result of the passage of the Women's Health and Cancer Rights Act of 1998. The law mandates insurance coverage for breast reconstruction and the alteration of the opposite breast for symmetry for women who have undergone mastectomy.

If you need to get it done this year, go to your original PS and have him clearly outline what he will do and what implant - volume and style - he intends to use.  Otherwise, go with the female PS and do what is necesssary to obtain the best result possible.  The PS submits the paperwork to the insurance company and it is all in the "coding" and verbiage they use which ensures coverage. 

Deborah

DISCLAIMER! I am not a physician or medical profesional. The information provided is my own personal opinion. You must discuss every aspect of your reconstruction with your plastic surgeon. Dx 10/15/2008, IDC, 1cm, Stage Ia, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Nov 27, 2012 07:55AM janiceg415 wrote:

Thanks Deborah,

I did call the 1st PS and was told that he has ordered Mentor high-profile silicone implant in sizes from 535 - 590 ccs.  My expander was 133 LV-14 and the original implant is a smooth round 450cc moderate plus profile gel.  What are your thoughts on the implants sizes proposed?

I asked about fat grafting and was told it can be done, but like I've heard before it doesn't always take.  Does anyone know why that is and what is the percentage of optimal results?    He said he wouldn't do that at the same time of revision it would have to be at later date because of increased chance of infection.  

Can't wait to put this behind me and quit fretting about it all.

Janice UniMX 2/23/12 with TE, no lymph node involvement Dx 11/23/2011, DCIS, 1cm, Stage 0, Grade 3, 0/1 nodes, ER+/PR+ Hormonal Therapy Aromasin Surgery 12/09/2011 Lumpectomy (Left) Surgery 01/20/2012 Lumpectomy (Left) Surgery 02/23/2012 Mastectomy (Left); Lymph Node Removal: Axillary Lymph Node Dissection (Left) Surgery 07/05/2012 Reconstruction: Breast implants (permanent) (Left) Surgery 12/21/2012 Reconstruction: Breast implants (permanent) (Left)
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Nov 27, 2012 02:47PM , edited Feb 23, 2015 07:20PM by Moderators

Hi Deborah, I had LD surgery last Tuesday Nov 20.  I had TE in both sides but I would love your help with sizing and implant decision.  I am going to my follow up appointment with PS tomorrow and I will give you all the details when I get home.

I am 5'5", 120 lbs and small frame.  I have done really well with recover for only 7 days, all drains are out and I am feeling great, I love having some shape back.

thanks Nicole

Dx 6/24/2011, IDC, 1cm, Stage IIIa, Grade 2, 11/18 nodes, ER+/PR-, HER2+ Surgery Mastectomy (Left); Prophylactic Mastectomy (Left); Reconstruction: Tissue expander placement, Latissimus Dorsi flap (Right) Surgery 07/04/2011 Lumpectomy (Right) Surgery 08/04/2011 Lumpectomy (Right); Lymph Node Removal: Axillary Lymph Node Dissection (Right) Chemotherapy 09/20/2011 Taxotere Targeted Therapy 01/05/2012 Herceptin Surgery 03/09/2012 Mastectomy (Right) Radiation Therapy 04/24/2012 External
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Nov 27, 2012 08:25PM Estel wrote:

Janice - I haven't had fat grafting I've just read a lot on here...you're body absorbs the fat. All our bodies are unique, though, and who knows at what rate your body will do it. It seems odd to me that he won't do it at the time of exchange? Do you have a history of infections? Personally, I would opt to go under anesthesia as little as possible and do it all at the same time...if you don't have extenuating circumstances. It seems like most women need two or three rounds of fat grafting for optimal results.

BMX 2/2010 with immediate reconstruction. Exchanged with silicone implants 7/2010. Diagnosed with LE 9/2010 Dx 9/2009, DCIS, Stage 0, Grade 2, 0/2 nodes, ER+/PR+, HER2-
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Nov 28, 2012 12:51AM slinky wrote:

I am going to swap out my current implants to Sientra teardrop shaped.  I was told by the doctors office that the larger size in this style has not come out yet.  Their office will get them in February.  I currently have 650cc's and want the same size, but more projection.  I am hoping the ripples and divots I have will lessen with the Sientras.

I have had one round of fatgrafting, but the fat has hardened and turned into small lumps around my current implants.  Doc will do more fatgrating when he puts the new implants in - I just hope the fat doesn't lump up again. 

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Nov 28, 2012 03:04AM Chantal10 wrote:

I have rippling and it makes me crazy. Currently I have silicone. I have had 1 round of fat grafting and while it did fix one area, it reabsorbed in the other areas. My ps said he won't do it again. The ripples are too deep to fill. I don't have enough fat to transfer. The only suggestion he has is to switch the new sloped gummy implants, but it seems these implants have their own issues, ie heavier, firmer, can rotate. Anyone have any alternative advice? Maybe I should just give my self a hug and move on... Idk

Dx 11/20/2011, IDC, Stage I, 0/1 nodes, ER+/PR+, HER2- Dx 7/30/2014, IDC Radiation Therapy Internal Surgery 01/05/2012 Mastectomy (Both); Lymph Node Removal: Axillary Lymph Node Dissection (Right); Reconstruction: Tissue expander placement (Both) Surgery 03/08/2012 Reconstruction: Breast implants (permanent) (Both) Surgery 07/05/2012 Reconstruction (Both) Surgery 07/30/2014 Lumpectomy (Right) Surgery 09/04/2014 Lumpectomy (Right) Surgery 09/09/2014 Lumpectomy (Right) Hormonal Therapy 09/20/2014 Tamoxifen Chemotherapy 10/20/2014 Cytoxan, Taxotere Radiation Therapy 02/10/2015 External
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Nov 28, 2012 09:46AM Grier wrote:

Quick question about expanders and implants:  Do you need a Sientra expander to go to a Sientra implant or can you start with an Allergan expander and get a Sientra implant?  Or does the expander have to do more with what shape you are getting (teardrop vs. round).

Dx 8/22/2012, DCIS, Stage 0, Grade 3, 0/1 nodes, ER+/PR-, HER2+ Surgery 10/09/2012 Mastectomy (Both); Lymph Node Removal (Right); Reconstruction: Tissue expander placement (Both) Surgery 01/15/2013 Reconstruction: Breast implants (permanent), Nipple reconstruction (Both)
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Nov 28, 2012 10:20AM , edited Nov 28, 2012 10:21AM by hawaiik


Implant choice
Hi Everyone,
I'm having my " exchange surgery " thurs 11/29 and wondered if you have any recommendations for implant choice. I currently have mentor smooth round spectrum saline adjustable implants. They are filled to 500 cc's. I am switching out to silicone. I think my surgeon likes mentor. I'd like more cleavage as I'm bony in the middle and have a depression at the top of my right implant which also slides slightly to the right when i lay down. Very small imperfections but since they can be improved I'm going for it .My rib cage is 29 1/2 inches 5' 3 & 5/8 inches tall 123 lbs Also having some scar tissue released and some fat transfer to fill in some areas. Also they are above the muscle. Thanks, Karen

ER 70% 1-2+, PR 50% 1-2+ BMX with DTI Recon SalineDec27 ,2011 , exchange surgery to silicone 11/29/2012 Dx 8/3/2011, DCIS, 1cm, Stage 0, Grade 2, 0/2 nodes, ER+/PR+ Surgery 08/01/2011 Lumpectomy (Left) Surgery 12/27/2011 Mastectomy (Both); Lymph Node Removal: Sentinel Lymph Node Dissection (Left); Reconstruction: Breast implants (permanent) (Both) Surgery 11/29/2012 Reconstruction: Breast implants (permanent) (Both)
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Nov 28, 2012 10:47AM annemarieh wrote:

Goodmorning Grier! I too am getting Sientra implants. Right now I have Natrelle TE. (I still have not discussed what shape of implants yet). Going back into OR friday to have some necrotic tissue removed. Good luck!!

Dx 2/18/2010, DCIS, 1cm, Stage Ia, Grade 1, 0/2 nodes, ER+/PR+, HER2- Radiation Therapy External
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Nov 28, 2012 11:52AM julee_stayin_strong wrote:

Going in for my second fill today. I'm wondering about all the excess fat i have under my armpit, i am over weight, but is this just excess swelling or am i going to have a "mini-muffin top" under my arm??? i am only 3wks out of surgery. it seems like my boob is just to the side, maybe it is too soon to really tell??? let me know what you guys think. THANK YOU!!!Laughing

Dx 5/18/2011, IDC, 3cm, Stage IIIa, Grade 2, 12/20 nodes, ER+/PR+, HER2- Surgery 06/17/2011 Mastectomy (Right) Chemotherapy 07/11/2011 Adriamycin, Cytoxan, Taxol Radiation Therapy 12/19/2011 External Hormonal Therapy 02/14/2012 Tamoxifen Surgery 11/06/2012 Reconstruction: Tissue expander placement, Latissimus Dorsi flap (Right) Surgery 03/19/2013 Reconstruction: Breast implants (permanent) (Right) Surgery 07/18/2013 Prophylactic Ovary Removal (Both)
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Nov 28, 2012 01:05PM sherry67 wrote:

Grier,
I'm getting sientra implants and do not have there expanders...good luck

Dx 2010, IDC, 2cm, Stage IIb, Grade 3, 11/23 nodes, ER+/PR+, HER2+ Hormonal Therapy Tamoxifen Targeted Therapy 03/04/2011 Herceptin Chemotherapy 03/04/2011 Abraxane, carboplatin Surgery 07/28/2011 Mastectomy (Both); Lymph Node Removal: Axillary Lymph Node Dissection (Right); Reconstruction: Tissue expander placement (Both) Chemotherapy 09/04/2011 Adriamycin, Cytoxan Radiation Therapy 11/22/2011 External Surgery 08/20/2012 Prophylactic Ovary Removal (Both) Surgery 02/15/2013 Reconstruction: Breast implants (permanent) (Both) Surgery 07/09/2013 Reconstruction: Breast implants (permanent) (Both) Hormonal Therapy 07/11/2014 Arimidex
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Nov 28, 2012 03:57PM Layla2525 wrote:

How can a person get the tear drop gummy bears? Are they approved for use in USA?

bmx w/TE on 2/13/12,exchange to Mentor high profile 600cc gel implants on 08/30/12,07/01/2013,new Natrelle 45 gel,replaced Mentors due to capsule. Dx 12/19/2011, IDC, 1cm, Stage I, Grade 1, 0/2 nodes, ER+/PR+, HER2-
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Nov 29, 2012 01:32AM , edited Nov 29, 2012 01:34AM by Chantal10

Hi layla2525, yes, they are approved since April, at least in California, but I believe it's nationwide, actually sure of it. You have to weigh pros and cons. Silicon, softer, not as "heavy", but can ripple, esp if you are thin or thin chested.. The tear drops are much firmer, "heavier", and can, but not always, rotate and they generally lessen the ripple factor.

Dx 11/20/2011, IDC, Stage I, 0/1 nodes, ER+/PR+, HER2- Dx 7/30/2014, IDC Radiation Therapy Internal Surgery 01/05/2012 Mastectomy (Both); Lymph Node Removal: Axillary Lymph Node Dissection (Right); Reconstruction: Tissue expander placement (Both) Surgery 03/08/2012 Reconstruction: Breast implants (permanent) (Both) Surgery 07/05/2012 Reconstruction (Both) Surgery 07/30/2014 Lumpectomy (Right) Surgery 09/04/2014 Lumpectomy (Right) Surgery 09/09/2014 Lumpectomy (Right) Hormonal Therapy 09/20/2014 Tamoxifen Chemotherapy 10/20/2014 Cytoxan, Taxotere Radiation Therapy 02/10/2015 External
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Nov 29, 2012 01:42AM cailindearg wrote:

I just got the tear drop silicone Sientra implants 2 weeks ago. I'm assuming they are the same as "gummy bears", they are approved in the US. Originally my PS was talking about saline implants but I said I was interested in these silicone "tear drop" shaped implants. He just ordered them and my insurance approved it. I think they became available in the spring of this year.

Dx 5/21/2012, DCIS, Stage 0, Grade 3, ER-/PR-
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Nov 30, 2012 08:00AM Merlcat wrote:

Woohoo! I am SO excited...PS is pleased with my healing and ROM, filled another 60 ccs and now PS, husband and I are please with size, SO January 23/13, I am having this brick of a TE replaced with cohesive gel implant, fat grafting ( yay, I get to ditch the little wad of fat I have at the top of my leg near my hip) and a lift on the other side

Dx 10/8/2012, DCIS, Stage 0, 0/4 nodes, ER+/PR+, HER2- Surgery 10/29/2012 Mastectomy (Right); Reconstruction: Tissue expander placement (Right) Surgery 01/23/2013 Reconstruction: Breast implants (permanent) (Right)
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Nov 30, 2012 12:14PM kayb wrote:

Mericat - How exciting! I think having this all move forward is so healing to our psyches. You'll be rid of that brick and feeling squishy in no time!

DX May/2010, synchronous bilateral cancer, ER+/PR+, HER2+
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Nov 30, 2012 03:16PM whippetmom wrote:

Nicole: I need your TE information. Please read #3 in the thread header.

DISCLAIMER! I am not a physician or medical profesional. The information provided is my own personal opinion. You must discuss every aspect of your reconstruction with your plastic surgeon. Dx 10/15/2008, IDC, 1cm, Stage Ia, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Nov 30, 2012 03:51PM whippetmom wrote:

Chantal: I do not think you are a good candidate for gummies, now that you have had silicone rounds. Some of the principal investigators and users of the gummies feel that in a woman who previously had rounds, the anatomicals just were not rendering a satisfactory result. I am wondering if the pockets are too large for the implants. What volume and STYLE do you have currently? What volume and style of TEs did you have? Maybe we can figure this out.

DISCLAIMER! I am not a physician or medical profesional. The information provided is my own personal opinion. You must discuss every aspect of your reconstruction with your plastic surgeon. Dx 10/15/2008, IDC, 1cm, Stage Ia, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Nov 30, 2012 08:43PM , edited Feb 23, 2015 07:20PM by Moderators

thanks :)

I am 5'5", 124 lbs, ribcage measurement 32.5

tissue expander 133 MV 12 (I think they are Allergan)

at surgery the planwas to fill 60cc, but they could only do 30 cc, they said I am too thin and that my skin was turning purple, so they took some out leaving 30 cc in each one.

Dx 6/24/2011, IDC, 1cm, Stage IIIa, Grade 2, 11/18 nodes, ER+/PR-, HER2+ Surgery Mastectomy (Left); Prophylactic Mastectomy (Left); Reconstruction: Tissue expander placement, Latissimus Dorsi flap (Right) Surgery 07/04/2011 Lumpectomy (Right) Surgery 08/04/2011 Lumpectomy (Right); Lymph Node Removal: Axillary Lymph Node Dissection (Right) Chemotherapy 09/20/2011 Taxotere Targeted Therapy 01/05/2012 Herceptin Surgery 03/09/2012 Mastectomy (Right) Radiation Therapy 04/24/2012 External
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Nov 30, 2012 09:25PM Estel wrote:

Nicole - I'm about your size...they put 50cc's in me at first and I was really tight.

Remember as you go through the fill process they can take it out anytime if it hurts too badly. I found muscle relaxers to be more helpful than narcotics for pain (Flexeril or Valium). But we all are different.

You're in the best place for support, advice and encouragement.

BMX 2/2010 with immediate reconstruction. Exchanged with silicone implants 7/2010. Diagnosed with LE 9/2010 Dx 9/2009, DCIS, Stage 0, Grade 2, 0/2 nodes, ER+/PR+, HER2-
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Nov 30, 2012 09:59PM whippetmom wrote:

Nicole:  Let's see how you do with subsequent fills.  A Style 20 HP implant with a volume of 425 ccs would be the very minimum I would recommend for you in terms of implant volume.  But I would like for you to report back with future fills and let us know how you are doing and how your skin is doing as you expand.  It also would be possible to go with a Style 15, which is a midrange projection implant - with a volume of around 371 ccs.

Deborah

DISCLAIMER! I am not a physician or medical profesional. The information provided is my own personal opinion. You must discuss every aspect of your reconstruction with your plastic surgeon. Dx 10/15/2008, IDC, 1cm, Stage Ia, Grade 2, 0/1 nodes, ER+/PR+, HER2-

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