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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 12:01PM - edited Apr 17, 2016 06:57AM by whippetmom

whippetmom wrote:


This thread is where we discuss implant-based reconstruction and where we endeavor to help you with some idea of the implant style and sizing that might best work for you.

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".

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. GRAMS VS CUBIC CENTIMETERS: Essentially interchangeable. A gram Gis a measure of mass/weight and ccs a measure of volume. It is the dimensions of the implant that matters more than the discrepancy between the "size" of an implant designated in "grams" as opposed to one designated in "ccs".

6. 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.

7. "DROP AND FLUFF": Drop and fluff" is a term created long ago by the breast augmentation crowd....to reflect how the implants can settle and take on a different appearance and more natural appearance. Doctors do not use this term and I do not use it, because this is not breast augmentation. In breast augmentation, since women are going larger and the breast envelope is smaller, the implants often sit up and ride quite high on the chest wall, and appear very taut and/or flattened in appearance. With augmentation, it takes a while for the native skin and tissue to adjust to the implants and so those galls do experience what they call dropping and sort of filling out or not being so compressed and gaining projection.

8. 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. Y

ANATOMICAL IMPLANT INFORMATION:

http://www.cohesiveimplants.com/gummy-bear-or-regular-breast-implant-which-one-is-right-for-me/

7 Questions to Ask Your PS About Anatomical Implants:

http://www.cohesiveimplants.com/7-questions-to-ask-when-interviewing-plastic-surgeons-about-gummy-bear-implants/

Plastic Surgeons weigh in on the benefit of round silicone vs. anatomical implants: Please note that these discussions were in 2011, before the Allergan 410 or Mentor CPG anatomicals. Most of these references are to the prior generation of anatomically shaped silicone and saline implants.

http://www.realself.com/question/the-benefits-anatomical-breast-implants-round-counterparts

IF YOU PREVIOUSLY HAD BREAST AUGMENTATION (prior to MX) Please read further:

This is from Grant Stevens, MD, PRINCIPAL clinical trials investigator for the Allergan 410 and Mentor CPG anatomical 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." Quote is in this article:

http://www.cosmeticsurgery.com/articles/archive/an~283/

And in Dr. Stevens' interview article re: cohesive implants...

http://www.marinaplasticsurgery.com/wp-content/themes/marinaplasticsurgery_com/news/articles/gel-implants.pdf

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. Dx 10/15/2008, IDC, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Jan 8, 2010 12:40PM Kristinka wrote:

I would like to confirm for all you newcomers that Whippetmom really knows what she is talking about when it comes to reconstruction after mastectomy.  I so wish I had known which questions to ask my PS before my MX.  Better late than never, I guess!  Thank you for posting this, Whippetmom.  This is a great overview of the issues facing all women undergoing reconstruction with implants.

Dx 5/13/2009, DCIS, 3cm, Stage 0, Grade 1, 0/1 nodes, ER+
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Jan 8, 2010 12:54PM lexislove wrote:

This is excellent, thank you for taking the time to post this.

Im having my exchange surgery 2 weeks from today, and to be honest the only thing I know is that I have been expanded to 400cc's, my implant will be the "gummy bear", and in the end should be a B/C cup.

I have left it all up to my PS to make me look as normal as possible in clothes. Im not expecting a miracle, I just want to be even.

The only thing that concerns me is how well my skin will take to the implant since I did have rads.

The whole reconstruction thing for me, is harder to understand than chemo/rads. Ive left it up to the expert......in my case....my PS. Im so tired of decisions.

Dx:2007, 2B, Triple+, June 2008:Lupron,Zometa,Tamox.Jan 2010:Poor metabolizer of Tamox switch to Femara.Feb 2010: cyp2d6 test reliable? Back to Tamox. Ooph soon.
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Jan 8, 2010 01:05PM Estepp wrote:

I wanna give this Medical Knowledge geek... a traditional Laura.." Wahooooooooooooooooooo"

Ladies... You have great knowledge here.

Bless your ministry Deborah!

Laura

We are the Ta Ta Sisterhood! Her2+ BC is what I had.... and yes sisters.. I had lymph node involvement...Plus Radiation AND Implant only Reconstruction. DX 6/25/08
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Jan 8, 2010 01:20PM Breastless wrote:

I too wish I came to this forum before going through recon.  Deborah has a wealth of knowledge regarding TE and implants.  Thanks again Deborah

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Jan 8, 2010 07:29PM musiclovermom wrote:

Thank you for this resource!

Dx 7/21/2009, IDC, 1cm, Stage II, Grade 3, 0/6 nodes, ER+/PR+, HER2-
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Jan 8, 2010 09:17PM Estepp wrote:

Lexi... How is your skin "now"? How did it do during rads? Any real bad burning or skin color that changed drastically?

We are the Ta Ta Sisterhood! Her2+ BC is what I had.... and yes sisters.. I had lymph node involvement...Plus Radiation AND Implant only Reconstruction. DX 6/25/08
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Jan 8, 2010 10:50PM FACECRAFTER wrote:

Yes, whippetmom is a great source of knowledge and research!! 

Remember, to go to "EXCHANGE CITY" in this forum and ask away, when you have gathered all the information, sizing, (use that measuring tape everyone).!!  We're here to help.

Ring the bells that still can ring. Forget your perfect offering. There's a crack in everything. That's how the light gets in. JUDY Dx 8/18/2008, IDC, 2cm, Stage IIB, Grade 3, 5/21 nodes, ER+/PR-, HER2-
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Jan 9, 2010 01:22AM lexislove wrote:

Estepp,

Looking at my breast now, you wouldnt know I even had rads. It has been like this for over a year. During rads I did not blister, burn or change drastic color. About 1-2 weeks after rads, the cumultive effect started to set in and I had some tenderness like you get with a sun burn. Then it past.

I have more of a olive tone, even though Im caucasian, maybe this helped me.

Dx:2007, 2B, Triple+, June 2008:Lupron,Zometa,Tamox.Jan 2010:Poor metabolizer of Tamox switch to Femara.Feb 2010: cyp2d6 test reliable? Back to Tamox. Ooph soon.
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Jan 9, 2010 05:56AM Lilah wrote:

Woo hoo Deborah!  What a great thread :)  And I will echo the reminder: COME TO EXCHANGE CITY FOR FURTHER DISCUSSION!

Cheers,
Lilah

Dx 6/2/2009, IDC, Stage IIA, Grade 3, 1/17 nodes, ER-/PR-, HER2+
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Jan 9, 2010 06:25AM KEW wrote:

Deborah--It is beautifully written, and we've all been so lucky to have your wisdom and support.  Thank you for reaching out to even more women.  Ladies, trust me, this thread has been started by a real gem.

 Hugs--Karen

Age DX: 48. Dx Oct 2008, IDC, 2.6cm, Stage IIa, Grade 2, 0/10 nodes,100%ER+/Pr+, HER2-, Oncotype Score 15. BLM with reconstruction Nov 2008.
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Jan 9, 2010 06:46AM Linda54 wrote:

boy, are all of you new ladies lucky.  I did not have Deborah's wisdom when I was being expanded.  But as it turned out I am very satisfied with the size of my implants.  It is a very confusing process and many women become anxious about this part of their reconstruction.  Deborah is a Godsend.  She can help you help your PS on sizing. 

Thanks Deborah for being here for all of us.

((((hugs))))  Linda

I hate Cancer... Dx 3/7/2008, DCIS, Stage 0, Grade 1, 0/0 nodes, ER+/PR+, HER2-
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Jan 9, 2010 07:37AM Wonderland wrote:

Wow, Whippetmom, this is so informative! I had diep reconstruction and know minimum about the "science" behind implants. I will direct future women who are considering implants to this thread. Thanks so much!

"Put on your coat. It's easier to stay warm than it is to get warm." George the Llama Man Dx 11/2006, IDC, <1cm, Stage IIA, Grade 2, 2/36 nodes, ER+/PR+, HER2- Surgery 11/27/2006 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left Chemotherapy 1/2/2007 AC + T (Taxol) Radiation Therapy 6/5/2007 Breast, Lymph nodes Hormonal Therapy 9/22/2007 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 9/9/2009 Reconstruction (left): DIEP flap Hormonal Therapy 9/20/2009 Arimidex (anastrozole)
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Jan 9, 2010 10:33AM wabiwoman wrote:

Woooo Hooooo!  Power to the People!  Knowledge is Power!

Deborah (aka "breast whisperer") - You GO! Thank you for all you are and all you do.

For the newbies just getting started - listen up - this woman is a gift!

Peace, Geena

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Jan 9, 2010 11:15AM Estepp wrote:

Lexi....after what you told me... and being a rads/implant girl myself.......... your skin sounds GREAT! It sounds like you should be in the ladies who's skin is fine... like me. My skin is fine. Under the skin ... is scar tissue. It is different than the non rad side. But.. as of now... just fine.

Massage is so important for rads breast after exchange. Start it about 6-8 weeks after exchange. We are trying to prevent CC....

If you want to chat about any of this.. PM me... :)...  I feel you are gonna do GREAT!

We are the Ta Ta Sisterhood! Her2+ BC is what I had.... and yes sisters.. I had lymph node involvement...Plus Radiation AND Implant only Reconstruction. DX 6/25/08
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Jan 9, 2010 11:27AM - edited Jan 9, 2010 11:28AM by my560sel

Great job Deborah! You are our RESIDENT EXPERT indeed ! Thank you so much for all your time and effort....

Terri

DX Jan15/09, ILC,
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Jan 9, 2010 11:30AM lexislove wrote:

Thanks Estepp! Ill be Pming you post surgery.

I appreciate you advice and knowledge, Im getting a little nervous as my date nears. Trying to look at all this as a good thing. Ill be even...lol.

I cant believe Ive had my tissue expanders in for almost 2 years!!!! Surprised

Dx:2007, 2B, Triple+, June 2008:Lupron,Zometa,Tamox.Jan 2010:Poor metabolizer of Tamox switch to Femara.Feb 2010: cyp2d6 test reliable? Back to Tamox. Ooph soon.
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Jan 9, 2010 11:52AM Estepp wrote:

Sweet Lexi.. this is why Deb sent me over here... to talk to gals like you and I..:)

We are the Ta Ta Sisterhood! Her2+ BC is what I had.... and yes sisters.. I had lymph node involvement...Plus Radiation AND Implant only Reconstruction. DX 6/25/08
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Jan 9, 2010 12:04PM MooreTennis wrote:

Deborah,  I would like to thank you for the support, knowledge and time you gave to me during my expansion and exchange. You were always there. You are such a gift to all the women considering reconstruction with implants. Again, many, many, many thanks for all you do.

Denise Dx 11/17/2008, IDC, 2cm, Stage I, Grade 3, 0/5 nodes, ER+/PR+, HER2-
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Jan 9, 2010 10:45PM rubytuesday wrote:

Great job Deborah (AKA Breast Whisperer....ROFL...too funny).  Can they make this  a 'sticky' so it is always toward the  top????  Just a thought.  Best wishes

Proud member of the TaTa Sisterhood! :)
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Jan 10, 2010 01:51AM whippetmom wrote:

rubytuesday:  I hope YOU save this thread to your favorites and come help answer questions.  Everyone - RT is three years out from her exchange and she sticks around to help and share her knowledge on other threads and forums.  She is very savvy as well about implant sizing. 

Someone else mentioned seeing if the mods would make this a sticky and I will see what I can do.  I might need to add some legal disclaimers....

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. Dx 10/15/2008, IDC, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Jan 10, 2010 06:56AM Mykidsmom wrote:

Bumping to move it up

Prophylactic Bilateral Mastectomy w/ Tissue Expanders - 12/08 Exchange 04/09 Dx 8/25/2008, LCIS, Stage 0
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Jan 10, 2010 07:26AM Emma8 wrote:

Dear Deborah,

How kind of you to offer so much help to others.  Breast reconstruction is truly very confusing and many of us are women who are used to having a lot of control in our lives but become overwhelmed by this process.  Personally, I'm a doctor (a psychiatrist) with a sister who is a mammographer and bro-in-law who does breast recon, but still I couldn't get the info I needed to help me get control over my reconstruction till it was too late. I was encouraged to just let my PS "do his thing".  But now, as you know, as you have kindly offered to help me on the picture site, I am having problems and will need a second revision. I really think that if I had known about this site, and had the knowledge that you are encouraging in this thread, I would probably be in a better position right now. Ladies, pay attention to this one- it can save you a lot of hardship.  It is really important, even if you use a PS with a wonderful reputation, to be knowledgable and assertive.

Dx 8/24/2008, LCIS, 2cm, Stage 0, 0/5 nodes, ER+/PR+, HER2-
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Jan 10, 2010 02:59PM Anne1962 wrote:

Dear Deborah,

I am not to this point, yet, but I feel very fortunate to have come across the exchange city thread as well as the breast implant sizing 101 thread. I have to admit, though, I was going to leave the decisions entirely up to my BS and PS. However, after reading all the posts on the EC thread, I feel that I should at least go in well informed. If I ever get to this point, I will definitely be asking for your help. I feel that I have gotten to know you by keeping up with your posts here and on the picture forum. Thank you for your knowldge and all the help and encouragement you provide to us newbies and I am sure oldies.

Anne 

Anne1962
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Jan 11, 2010 02:57AM typhoon55 wrote:

Deborah,

Thanks for all your help with the implant decision as well as with everything else. You are one smart woman.

Janet

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Jan 11, 2010 03:39AM - edited Jan 11, 2010 03:45AM by AStorm

This Post was deleted by AStorm.
Gail “Friends are like bras: close to your heart and there for support.” Unknown
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Jan 11, 2010 04:20AM deekaay wrote:

Deborah, a million thank you's!!!!!!!  To have an internal coach to help with questions for the docs is just fantastic! deekaay

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Jan 11, 2010 10:46PM jessicav wrote:

Hi Ladies-

I really could use some help. I had a bilateral mascetomy with breast reconstruction in 2003 and am going to have 530 cc saline implants exchanged for smaller silicone. The implants hurt..they are just too big and I feel like I literally have cantelopes on my chest.  The PS chose the size as I thought he would know best. Ha! The current implants are teardrop shaped and I am concerned about filling out upper pole with round saline. Does anyone have implants that hurt or feel tooo heavy? MRI says the implants are less than 1/3 under pec muscles!

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Jan 11, 2010 11:17PM FACECRAFTER wrote:

Jessica- Go over to Exchange City on this forum. You'll need your sizing (see the top of this page). They can assist you.  JUDY

Ring the bells that still can ring. Forget your perfect offering. There's a crack in everything. That's how the light gets in. JUDY Dx 8/18/2008, IDC, 2cm, Stage IIB, Grade 3, 5/21 nodes, ER+/PR-, HER2-
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Jan 12, 2010 08:43AM AL1841 wrote:

So, if I was a C cup, but want to be smaller is there anyway to tell how many cc's I would need?

Dx 11/4/2009, IDC, <1cm, Stage IA, Grade 2, 0/6 nodes, ER+/PR+, HER2-
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Jan 12, 2010 09:41AM FACECRAFTER wrote:

There is more than cc's involved.  The size of your ribcage, for example, and the type of implant all play a role..the same cc's on one person can be a 'B' on another a 'D'.  Please gather the info listed on the top of this thread and go to Exchange City where we'll help you as much as we can..Deborah, expecially, is the best.  JUDY

Ring the bells that still can ring. Forget your perfect offering. There's a crack in everything. That's how the light gets in. JUDY Dx 8/18/2008, IDC, 2cm, Stage IIB, Grade 3, 5/21 nodes, ER+/PR-, HER2-

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