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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 8, 2010 12:01AM, edited Nov 11, 2014 02:22AM 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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Jan 6, 2011 12:10AM whippetmom wrote:

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.....

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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Jan 6, 2011 12:12AM whippetmom wrote:

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.

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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Jan 6, 2011 12:14AM whippetmom wrote:

Dee:  Oh yes, the Style 45's would work just fine with a 33 inch ribcage.  I am so glad your PS is willing to work with you and order Allergan implants if this is your preference!

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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Jan 6, 2011 01:57AM MBJ wrote:

Jujubees!  Lol!!!

MBJ-Unilateral MX-METS ENTIRE LIVER, BONES Dx 2/3/2012, 3cm, Stage IV, Grade 3, 0/2 nodes, mets, ER+/PR-, HER2-
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Jan 6, 2011 01:41PM , edited Jan 27, 2011 11:39AM by fire-dancer

Deborah - I really appreciate your input and think I will go for the extra fills, like you suggested.  When I get my TE size I will let you know, I don't go till next Tues. 

I have just begun over at the picture forum.  I have not been able to post any of my own shots yet (but wish to), I am a bit behind on the whole computer-thing...I have no idea what I'm doing (yes, it's very sad! ;-)  But the women whom I have commented on/viewed their pics have been extremely helpful in seeing how things progress. 

It's weird how all of a sudden my mindshift went from surgery: the planning, prep & the recovery...to now -  fills, cc's, implant sizing, etc.  Now that the fills have begun I have so many more "new" things to think about.  I did so much research on the BMX that now it's over I realize I didn't give much thought to what came next, and am scrambling to figure out what everything means.  I definitley need to talk to my PS and get his take on what he prefers/uses, Mentor/Allergan & the profile suggested for me, and just his take in general.  I don't want any surprises down the road! :-)

Well, thanks again and I will be back in touch...enjoy your weekend!

Megan

~Megan~ "...whatever tears at her, whatever holds her down...& if nothing can be done, she'll make the Best of What's Around" ~David J. Matthews Dx 8/26/2010, DCIS, 3cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR+
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Jan 6, 2011 02:24PM terry54 wrote:

Deborah..love the colorful Smilejujubees ....

My PS office gave me all the pre-op and post op instructions today which includes wearing the same 2 sports bra I wore after my mastectomy. They are the Veronique Sports Bra and were very comfortable and supportive. Might have to get another one to get me through the post exchange period. My surgery is set for January 26...I am already getting the jitters even tho everyone says that its not as bad as the mast.

I will be hanging on to this forum to get me thru this...

Thanks so much for all your info and great advice and will keep everyone posted.

Terry

Dx 9/27/2010, DCIS, Stage 0, Grade 3, 0/10 nodes, ER-/PR-, HER2+ Surgery 11/01/2010 Mastectomy (Left); Lymph Node Removal (Left); Reconstruction: Tissue expander placement, Breast implants (permanent), Nipple reconstruction (Left)
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Jan 6, 2011 10:12PM treelilac wrote:

Deborah: I wish to have your expert opinion on this. I like what my TE's look and will have exchange surgery on 1/20/11. My TE is Allergan 133FV-11, 300 cc. I'm 5'3", 117lb, and my rib cage circumference is 28 3/4". (When I went to the mall, they measured my size to be 32 C.) I only have 200 cc total fill. What kind of implant should I get to maintain "status quo" (maybe slightly smaller)? My PS knows what he's doing but I feel he doesn't put a lot of efforts into the planning part. He also joked that I'm making his life difficult when I mentioned maybe smaller. What did he mean? (I only had UMX so augmentation on the other side is in due order.) Thank you!

UniMX with TE (11/8/10) @ Age 42------microinvasion Dx 9/17/2010, DCIS, 1cm, Stage I, Grade 1, 0/3 nodes, ER+/PR+, HER2+
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Jan 6, 2011 10:25PM Letlet wrote:

Love the jujubees!

Dx 8/27/2010, IDC, 3cm, Stage IIIa, Grade 3, 6/23 nodes, ER-/PR+, HER2+
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Jan 6, 2011 11:48PM whippetmom wrote:

treelilac:

Okay, well, even though you are underfilled by 100 ccs, you still have the "footprint" of a 300 cc TE inside that skin envelope.  The width of that TE is 11.0 and the projection is 5.0.  So, you have the width which is 11.0 cm, because the width is what it is, and you probably have around 4.6 cm projection at this point. 

I would recommend a Style 20 - Allergan Natrelle - smooth round silicone implant - 325 ccs.  You need to match the width you have currently with the TE and this implant is as follows:  11.2 cm width by 4.6 cm projection.  I think that approximates very nicely what you have with your TE - and it does take greater volume with the implant to match what you have with the TE. 

If you have access to the pictures forum, I have bumped up for you photos of DENRULZBC and DAWNE-HOPE.  This will give you a good idea what this volume would look like on your frame.  Dawne-Hope is active here and I will ask her to PM you and tell you her stats and implant size. 

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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Jan 7, 2011 02:08AM treelilac wrote:

Deborah: Thank you for your explanation and recommendation! But the strange thing is that I have 9 cm projection. When I came home from the MX, I only had a small mound from the 100 cc initial fill. But the second 100 cc is miracle molecules. Maybe the TE has stooped to the bottom? But I just saw my PS and he didn't comment on any abnormality. (He also measured the projection in this visit.) I hope it's not capsular contracture...

I'll write TimTam for approval.Smile

Jo

UniMX with TE (11/8/10) @ Age 42------microinvasion Dx 9/17/2010, DCIS, 1cm, Stage I, Grade 1, 0/3 nodes, ER+/PR+, HER2+
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Jan 7, 2011 02:29AM whippetmom wrote:

Jo:  Impossible!  Not unless the TE has rotated?  You can always shoot me a photo.  PM me for my email address if once you get to the pictures forum you think it looks strangely unlike anything you see there. 

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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Jan 7, 2011 11:19AM treelilac wrote:

I know! (The fill record is from the PS, although I thought the nurse in hospital told me the initial fill was 200 ml.) TE can rotate too? Surprised  Why does rotation cause it to look bigger than the real size? I wonder if he has considered this in his planning for exchange. I'll send you an email once I minimize the picture byte size.Laughing
UniMX with TE (11/8/10) @ Age 42------microinvasion Dx 9/17/2010, DCIS, 1cm, Stage I, Grade 1, 0/3 nodes, ER+/PR+, HER2+
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Jan 7, 2011 11:30PM whippetmom wrote:

treelilac:  You don't need to reduce the photo.  Just email it.  I'll PM you with my email address.

What you are describing sounds strange but there must be some logical explanation.  Yes, TEs can rotate.  I just received photos from another BC sister who had a malpositioned TE. 

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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Jan 8, 2011 05:00PM treelilac wrote:

Could it be the alloderm? I have no idea how much he put in there.

UniMX with TE (11/8/10) @ Age 42------microinvasion Dx 9/17/2010, DCIS, 1cm, Stage I, Grade 1, 0/3 nodes, ER+/PR+, HER2+
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Jan 8, 2011 07:33PM whippetmom wrote:

treelilac:  You know, I just looked at your previous post where you stated your PS "just measured the projection" during your visit.  So therein lies our answer.  I was going by the dimensions listed by Allergan/Mentor - which have no bearing on the dimensions which will occur once they are inserted and filled.  So yes, when the breast mound is measured in this fashion, the numbers will not match those listed by the mfr.

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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Jan 8, 2011 08:41PM treelilac wrote:

So with Allergan Style 20- 325 cc, would I still get the same contour? I guess this is what he meant, making his life difficult. I also looked at DENRULZBC and DAWNE-HOPE's pictures. I'd be extremely happy if my results look like them.

UniMX with TE (11/8/10) @ Age 42------microinvasion Dx 9/17/2010, DCIS, 1cm, Stage I, Grade 1, 0/3 nodes, ER+/PR+, HER2+
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Jan 9, 2011 12:12AM whippetmom wrote:

treelilac:  You do not have 9 cm of projection.  Your mound measurement might be 9 cm....

I think you would be very happy with 325 ccs....high profile, smooth round silicone....Style 20

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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Jan 9, 2011 02:54PM Double-or-Nothing wrote:

treelilac:  Again, I'm about your size.  I didn't know that the implants came in low - moderate- high when I had mine put in.  I got moderate.  If I have them replaced, they will be high profile the next time.

Dx 1/9/2009, DCIS, Stage 0, Grade 2, 0/3 nodes, ER+/PR+
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Jan 9, 2011 05:30PM treelilac wrote:

Deborah and Double or Nothing: Thank you for your suggestions. I'll bring them with me when I talk to my PS before the exchange surgery,

UniMX with TE (11/8/10) @ Age 42------microinvasion Dx 9/17/2010, DCIS, 1cm, Stage I, Grade 1, 0/3 nodes, ER+/PR+, HER2+
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Jan 9, 2011 06:24PM gymnut wrote:

hello whippetmom (deborah?)

what an amzing wealth of knowledge & information!

i'm newly diagnosed & currently deciding between re-excision/radiation and mastectomy/te/implant, possibly w/ one on the other side for "symmetry".  it's a huge decision & i'm just trying to get all the information i can so i can make the best decision for me.

you mentioned a picture site or picture forum a few x's.  can you tell me what that is or how to access it? one of my goals, after getting rid of the cancer & getting back to being & staying healthy & strong (hence the name) is to be as comfortable with and in my body and whatever changes as possible.  i'm struggling a little bit to find out what will best help me get there.

also, did you (or anyone else out there?) have the opportunity to "try anything out" so to speak, before having the mastectomy & implant(s)? i really have no concrete sense of how something like that will feel on my body & would like to know if anyone had an experience of being able to maybe wear a bra wear silicone implants or something like that.  of course it wouldn't be the same but i can't figure any way to simulate it and need a clearer idea of the options i need to choose between.

although this forum does not exist specifically for my benefit, thank you everyone for sharing your information and support with each other/everyone else.  it's an amazing resource and i'm so glad i decided to search for something today.

take care, all! 

Dx 12/14/2010, DCIS, Stage 0, ER+
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Jan 9, 2011 10:29PM MBJ wrote:

Gymnut:  You might PM Val61 as she is an aerobics instructor and had a BiMX and has done just fine.  There will be a period of adjustment no matter which one you decide to do.  I didn't have an option of choice but there are some slight adjustments when you have an MX as there will be excercises you will no longer be able to do or that will need to be modified.  That being said, if you have radiation now and need further surgery or an MX after the fact, there are many complications with scar tissue build up.  I needed physical therapy after my MX, had an augmented reconstruction to match my MX side and I am very happy with the results.  There is a longer adjustment period of time with an MX.  Hope this helps and best of luck with your decision. 

MBJ-Unilateral MX-METS ENTIRE LIVER, BONES Dx 2/3/2012, 3cm, Stage IV, Grade 3, 0/2 nodes, mets, ER+/PR-, HER2-
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Jan 10, 2011 02:41PM whippetmom wrote:

gymnut:

Welcome! I think it would be good to navigate around these forums - those dealing with radiation and reconstruction, lumpectomy vs. mastectomy, and then formulate your decision.  The majority of  us on the breast reconstruction forums have had a mastectomy - either one sided or bilateral. There are many members who share your diagnosis stats. So scroll through the topics on the Breast Reconstruction forums and keep posting!

http://community.breastcancer.org/forum/44

As far as finding an implant simulation is concerned, there is a kit you can purchase from Allergan Natrelle.  I am not sure how helpful it will be, but it at least affords you the ability to try out the implants and see how they feel. I don't think it approximates how it would feel after MX though, because of sensory loss after MX. 

http://www.natrelle.com/pre_consultation_kit.aspx

In order to get onto the pictures forum you will need to spend more time posting on the forums.  The pictures forum is a private, protected space where we have our own personal photos and there is a vetting process required for entrance thereto.  So post five times in a 24 hour period as you are permitted.  You can send a private message to anyone if you have a specific question and this does not factor into the 5 posts/24 hour ruling. 

We will keep track of your posting and I will send you information on the pictures forum accordingly....

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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Jan 11, 2011 07:23PM madison777 wrote:

Hello Deborah,

I had a double mastectomy in November.  I just had my second fill yesterday.  I am so stuck on how big to go.  I am not getting much guidance from the PS.  I was very small before surgery.  Only about 150 grams of breast tissue was removed from each breast.  Obviously, the size and shape of my breasts will be very different now.  I have no idea what style of tissue expanders I have.  I will have to call the PS tomorrow.  What do you mean by : "We also need the recommended fill volume of the TEs - the number of cc's"?  My PS likes overfill each TE with 100 cc's and let them sit at that volume for a month before exchange.  Thanks!

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Jan 11, 2011 08:58PM , edited Jan 11, 2011 11:11PM by ericavw

Madison777, I'm in your same boat (in my head at least). I had a unilateral MX a month ago today. I was an A before surgery, and lucky us small women... they don't make implants that small. So, I know I HAVE to be at least a B (and have an augment done on the other side so they match). I have the Allergen Natrelle Style 133V TE's (ask your plastic surgeon for a card. Mine gave me one at my first visit post-op). I'm going for my 3rd saline injection on Thursday. I'm at 240 cc's now which is pretty comparable to my right "real" breast. On the card he gave me, the recommended fill volume is 400 cc's. And I believe, that is the most he was going to do for me anyway. Talk to your PS, and ask him what he thinks would be a good size for you (personally, I love my PS's nurse. She's awesome. She measured me, noted my size, height, weight, etc) and said a big B or small C would be fine for me. I'm 5'9", 140 lbs (pre MX, I should say. I gained 10 lbs laying around and eating over the holidays. Haha.) and typically a size 6-8. My PS does 60 cc injections each time (so far) so I'm estimating another 3 injections, and then he has me wait a month for my exchange. Also, look online at pics. That helped me size wise a bit. Sometimes I think some pictures look great, and then I say "Woah! 600cc's. Okay, maybe not for me!". Overall, I think looking at pictures and going by your body type is key. 

Erica♥ : Unilateral MX with Alloderm, exchange to Allergan gummy on MX side, and Allergan Natrelle silicone round to match on native side Dx 10/11/2010, IDC, <1cm, Stage Ia, Grade 1, 0/3 nodes, ER+/PR+, HER2-
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Jan 11, 2011 11:22PM whippetmom wrote:

Madison:

Tissue expanders come in different sizes.  For instance, here is a link to Allergan's breast implant and tissue expander matrices.  Scroll down to Page 30 for all of the styles and sizes [volume ranges] for Allergan's TEs...

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

You can see that there are a lot of TE options out there.  Mentor does not have as many as Allergan - Mentor only has three styles, whereas Allergan, I believe, has six.

So I need to know if you have a short height, moderate height or full height TE.  I need to know the volume.  If you can obtain just the catalog number, I can find it or if you can get the width and volume of the TE, I can determine which style you have.  But this information should be given to the patient after the TEs are placed.  They are medical devices and patients should have this data for their records.

Also, I need your height, weight, ribcage circumference.

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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Jan 11, 2011 11:27PM whippetmom wrote:

erica:  Look on your card and tell me what STYLE you have.  It should say, MV, MX, SV, SX, FV, FX....or - there should be a number like "12" or "13" - which tells me the width of the TE.  I essentially need to know your width.  And I need your ribcage circumference. Measure under the bra line...

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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Jan 11, 2011 11:33PM ericavw wrote:

Thanks whippetmom! I PM'd you. But it's a 133MV. Under my bra line is 31"

Erica♥ : Unilateral MX with Alloderm, exchange to Allergan gummy on MX side, and Allergan Natrelle silicone round to match on native side Dx 10/11/2010, IDC, <1cm, Stage Ia, Grade 1, 0/3 nodes, ER+/PR+, HER2-
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Jan 12, 2011 12:32AM Lilah wrote:

Erica -- there is no rule that says your PS is required to fill your TE to capacity.   I'm sure Whippetmom can help you find a good ultimate implant size... but I just wanted to throw that end (as it seemed to me from reading your post that you feel you have to 400 -- capacity for your current TE).

Dx 6/2/2009, IDC, Stage IIa, Grade 3, 1/17 nodes, ER-/PR-, HER2+
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Jan 12, 2011 02:45AM , edited Jan 12, 2011 02:45AM by MBJ

Erica:  I am a Uni 6' tall and 150 give or take.  I had the same expander as yourself and I was filled to 535 and changed out to a 550.  It's now been almost 5 months since my exchange and although I wear a 34DD or 36D I look like a small C cup in clothes--I have shrunk alot!  My PS augmented my other side to match.

MBJ-Unilateral MX-METS ENTIRE LIVER, BONES Dx 2/3/2012, 3cm, Stage IV, Grade 3, 0/2 nodes, mets, ER+/PR-, HER2-
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Jan 12, 2011 11:12AM , edited Jan 12, 2011 11:14AM by madison777

I called my PS and got the information regarding the TE's.  They are both Mentor, medium height, style 6200, 275 cc normal fill volume.  I am 5 feet 1.5 inches tall and weigh 112 lbs.  Thank you so much for any guidance that you can provide.  My ribcage measurement is 29 inches.

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