Topic: BREAST IMPLANT SIZING 101

Forum: Breast Reconstruction — Talk with others facing decisions about whether or not to have breast reconstruction, and if so, what type and when.

Posted on: Jan 7, 2010 11:01PM - edited Jan 31, 2022 05:10PM by whippetmom

Posted on: Jan 7, 2010 11:01PM - edited Jan 31, 2022 05:10PM by whippetmom

whippetmom wrote:


DISCLAIMER! I am not a physician or medical professional. The information provided is my own personal opinion. You must discuss every aspect of your reconstruction with your plastic surgeon.


PLEASE NOTE: New information!!

Allergan now has a very easy chart to follow to help you see how sizing works in relationship between the tissue expanders and the ultimate style and volume of implants to be selected at the time of the exchange.

https://www.natrellesurgeon.com/Content/PDF/Matchup_Guide_FNL.pdf

INFORMATION WE NEED:

1. Your height, weight, ribcage circumferece (measuring under the bra line or under the tissue expanders with a measuring tape).

2. If you DO have tissue expanders already, we need to know the exact style of TE (Mentor, Allergan, Sientra, SSP) AND the volume - the mfr's recommended volume, NOT your current fill volume. So if you have Mentor TEs, they would be LOW HEIGHT, MEDIUM HEIGHT or TALL HEIGHT. If you do not have the "height" information, you might have a style "number", i.e., 354-6311 or 354-7114...etc. If they are ALLERGAN TEs, they would be one of six styles, with letters such as "MX" or "MV" or "SX" or "SV" or "FX" or "FV". They might have the number 133-V followed by a number like "13" or "14". TO SAVE TIME (FOR MOI) YOU COULD LOOK UP THE DIMENSIONS OF YOUR TISSUE EXPANDERS....

3. Also, please advise if your PS has told you that he/she uses one brand or style of implant exclusively so that we can save time in our research.

4. Your pre-mastectomy breast size is also important, because it does have some bearing on expansion, tissue expander volume and the need for good tissue coverage over your future implant.

5. OVERFILLING OF TISSUE EXPANDERS: There is no hard and fast rule regarding overfilling of tissue expanders. Some plastic surgeons overfill, merely because they always do for every patient. Some never or rarely overfill (my plastic surgeon was in that camp.) She felt that if the right tissue expander was selected, there was no reason to fill beyond that which the manufacturer recommended. In cases where the patient's skin envelope is very tight, and a larger implant is desired, overfilling would have some benefit. In the case of a unilateral breast reconstruction, where the future implant needs to mirror a native breast which has some ptosis (droop), overfilling can help achieve that needed symmetry.

6. CUP SIZES: There is no predictable way to tell you what cup size you will be with a specific volume of implant. Maybe with breast augmentation it is done, but it is all entirely different with breast reconstruction. Plastic surgeons cannot guarantee or predict cup sizes! Cup sizing is tricky, because you might be now wearing the wrong size bra. So you might tell me you wear a 36B, and you really could instead fit better in a 34C. Also, after reconstruction, there are only sports bras and European bras that we recommend as the best option for reconstruction patients. So you might tell me you want to be a "C" and end up in a European bra, like a "Freya" or "Chantelle" (my favorites.). So you might wear a D cup! But you will LOOK like a C cup or even a B cup. It is confusing, I know but you will see what I mean when you are on the other side of this.

UNILATERAL VS BILATERAL MASTECTOMY,

NOTE: IF YOU HAVE HAD OR WILL BE HAVING A UNILATERAL MASTECTOMY- REMOVAL OF ONLY ONE BREAST - THERE ARE DIFFERENT FACTORS INVOLVED WHICH MAKES IT DIFFICULT AND SOMETIMES IMPOSSIBLE FOR ME TO ACCURATELY APPROXIMATE TISSUE EXPANDER TO IMPLANT SIZING. THE REASON IS THAT SYMMETRY IS THE KEY. NOT IMPLANT SIZE. NOT IMPLANT VOLUME..NOT IMPLANT STYLE. YOUR PS WILL SELECT THE TISSUE EXPENDER TO CREATE THE TISSUE ENVELOPE WHICH WILL MATCH (AS CLOSELY AS THE SURGEON IS ABLE) THE HEIGHT AND WIDTH OF THE NATIVE BREAST VOLUME. THIS IS HIS FOCUS, AND ONLY THE PS CAN SEE THIS, MEASURE THIS AND IMAGINE OR CALCULATE WHAT IMPLANT HE MIGHT USE AT THE TIME OF THE EXCHANGE. REMEMBER…SYMMETRY - NOT SIZE. IN MOST CASES, THE TE WILL BE LARGER THAN THE FUTURE IMPLANT. SOMETIMES SIGNIFICANTLY SO.

SILICONE IMPLANT LINE UP:

MENTOR: www.mentorwwllc.com/global-us/...

ALLERGAN:

Page 33 breastimplantadvice.com/wp-com

ALLERGAN NATRELLE INSPIRA

"The new Natrelle INSPIRA™ implant is a silicone gel, smooth round implant. The smooth round implants are the more classic implant style as compared to modern anatomically shaped implants that mimic the natural distribution of breast volume. However, the new implant differs from other round implant options with its higher fill ratio.

The Benefits of Higher Fill Ratio

Higher fill ratio means that there is slightly more silicone gel filler per unit of volume. In the case of the INSPIRA™ implants, a more highly cohesive gel filler is also used. In my experience, I've noticed a slight difference in feel and lower wrinkle susceptibility in implants with a higher fill ratio. The denser volume of gel filler in the implant can result in a decreased chance of rippling and longer shell longevity.


BEFORE THE MASTECTOMY...READ AND DISCUSS WITH YOUR SURGEON!!!

http://www.forbes.com/sites/elaineschattner/2017/0...

https://www.sciencedaily.com/releases/2016/07/1607...

https://www.practicalpainmanagement.com/patient/co...



DISCLAIMER! Please read my biography under my personal profile. I am not a physician or medical professional. 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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Aug 13, 2022 04:56PM - edited Aug 13, 2022 04:57PM by jennik78

Hi Whippetmom, The PS and I met again for my final expansion and he now thinks the Mentor Xtra 375 moderate plus is best but will also have the 400 moderate and the 450 high profile in the OR. We will be doing fat grafting as well to smooth things out. He says 450 will probably be too big/tight. He said he is willing to work with other brands that might have a better combination of projection and my width but he likes Mentor the best. My TEs are now fully expanded to 280 - I do like how they project and fill a 34b my bra. I know probably unimpressive to others but pretty curvy to me!

Immunotherapy 11/1/2021 Keytruda (pembrolizumab) Surgery 5/1/2022 Mastectomy (Left): Nipple Sparing; Mastectomy (Right): Nipple Sparing Targeted Therapy 6/1/2022 Lynparza (olaparib)
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Oct 28, 2022 02:00PM whippetmom wrote:

It has not been easy restoring my account. For some reason, my password was compromised and my message box and “favorites” are inaccessible. I do not appear to be getting any notifications. I am not technically challenged, I just finally had some time today to at least change my password and post in my thread!

Hope everyone is well!

DISCLAIMER! Please read my biography under my personal profile. I am not a physician or medical professional. 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 4, 2022 10:13PM k-gobby wrote:

it is good you are back.

I have few of the details you spoke up, but am clicking on links you posted. I had a TE put in Feb 9th, but I ended up with a blood clot and 6 months later I am off.

Now looking to get the left TE out and the right breast removed, so 2 implants. They will be silicone. I believe the PS said Iay need fat grafting, but I forgot to ask. I will question him in the portal.

I was not big busted and was able to get skin saving, all else removed. The right side I may get to m keep the nipple. Really, since late June of 2021, I have found I am Brca2 + and Her2+. Stage 2. Foreign. All of it, until my genetic test and pathology on my tumor.

It is good to have a forum with women and men, who have cancer.

Chemotherapy 8/14/2021 Other Surgery 2/1/2022 Lymph node removal (Left): Sentinel; Mastectomy (Left): Skin Sparing; Reconstruction (Left): Tissue Expander Targeted Therapy 2/1/2022 Talzenna (talazoparib) Targeted Therapy 2/1/2022 Perjeta (pertuzumab)
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Nov 5, 2022 12:59PM jennik78 wrote:

My exchange was a few days ago and Mentor MemoryGel Xtra SMHX-400 were "installed." So far I think they look OK and a good match what I was looking for without suddenly having a very different physique. I think I like the moderate high so far and hopefully the loss of projection compared to expanders is offset by keeping my nipples.

Immunotherapy 11/1/2021 Keytruda (pembrolizumab) Surgery 5/1/2022 Mastectomy (Left): Nipple Sparing; Mastectomy (Right): Nipple Sparing Targeted Therapy 6/1/2022 Lynparza (olaparib)
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Mar 20, 2023 10:37PM snm wrote:

Hi! I'm new to the community and so grateful that it exists. I currently have tissue expanders in and have been experiencing rib pain starting right below expander and extending down about 3 fingerbreadths (only hurts when I push on that area)- couple inches in front of former drain hole. Is it common to get rib pain with TE and will it go away when swapped out for implants?


Also wondering how folks have decided on nipples - recon vs tattoos vs nothing?

Thank you!



Surgery 2/1/2023
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Mar 21, 2023 01:40PM - edited Mar 21, 2023 01:40PM by minustwo

snm - I had pains the entire time I had TEs. Yes, it went away once I swapped out for implants. Edited to add - there used to be a couple of TE threads where we all agreed they were as hard as turtle shells.

I settled for nothing in place of nipples. Nothing was going to replace the sensations, so....

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Mar 21, 2023 02:13PM snm wrote:

Thank you minustwo! I feel relieved to know that about tissue expanders and the pain associated with them. I will get implants in May and I'm nervous about having another surgery. I heard recovery time is short but not sure what that means - 2 weeks? Would love to hear how others handled implants-swap experience.

My recovery from BMX was painful with limited mobility and back spasms for first 2 weeks but then slowly got better over few more weeks. Stage 1A (high grade DCIS with microinvasion on left), preventative on right.

Regarding nipples and no sensation I hear you. Thinking I might need something to have closure--maybe tattoo would be ok?


Thank you


Surgery 2/1/2023
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Mar 21, 2023 11:55PM - edited 17 hours ago by moderators

snm - I know the BCO site in in the middle of migrating from a total mess to a new platform, but hopefully you will be able to go to 'all topics' and search for 'tissue expanders'. This is one of the threads that really helped me, although it not really active. https://community.breastcancer.org/forum/44/topics...

Edited by Mods to make link hot.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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18 hours ago mavericksmom wrote:

Hi snm, I just had my exchange surgery March 2nd. It was so much easier from my other breast surgeries!

I am a bit unusual because I have had BC 3X, in 2003, IDC treated with two lumpectomies, (second one for clean margins),chemo and radiation. It 2018, 15 1/2 years later, BC reared it's ugly head and I was Dx with ILC in same breast, treated with left mastectomy with DIEP reconstruction (January 2019) and Aromatase Inhibitor. Three and a half years later, August 2022, I was diagnosed with DCIS with microinvasion, and I had a right mastectomy with tissue expander.(October 2022)

Yes, the TEs are rock hard and uncomfortable as....well, you know! My exchange surgery was great and I would do it all over again without hesitation! I was an out patient for my mastectomy, and the exchange surgery as well. Honestly, once I got the anesthesia out of my system, I felt really good! I took the prescribed medications, tylenol, Celebrex, and Gabapentin (neurontin) for the pain. He gave me a few oxycodone but I never took any because I do not like the constipation it causes and honestly, I had next to no pain, so I didn't need it!

No drains with the exchange. I had some unique issues that are not common, so I won't mention, but I did get constipation from the anesthesia and surgical medications. That was probably also due to my body and how it reacted to the drugs.

I think the worst part was not being able to unwrap the bandages, surgical bra, and the abdominal compression garment, due to the liposuction I had. That meant no showers until after I saw my surgeon for first post-op visit 5 days later. Really, if that was the worst, you can tell, it wasn't bad at all!

I am almost three weeks out and feel back to normal. Now it is really hard sticking to the restrictions I have for the next three weeks! That is a good thing!

By the way, if you are wondering why I didn't have a bilateral mastectomy in 2019, I wanted a bilateral mastectomy and was refused! Long story, and really water over the dam now, so no point in going into it, especially since my surgeon sadly passed away unexpectedly in the spring of 2021.

Any specific questions you have, just ask! The best thing about these message boards is that there is always someone who can help you with questions and your feelings. It is full of people who really understand and care, like minustwo, who helped me so many times!


Dx 6/6/2003, IDC, Left, 1cm, Stage IA, Grade 1, 0/24 nodes, ER+/PR+ Dx 12/4/2018, ILC, Left, 1cm, Grade 2, ER+/PR+, HER2- Hormonal Therapy 8/2/2022

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