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 10:01PM - edited Jan 31, 2022 04:10PM by whippetmom

Posted on: Jan 7, 2010 10:01PM - edited Jan 31, 2022 04:10PM 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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Dec 4, 2019 10:21AM whippetmom wrote:

Carebearkid4life:

The tissue expanders are very small for your frame. You need to overfill quite a bit. It sounds to me as though you had sufficient skin flaps for larger tissue expanders. I think you should be in the 500 cc range with implants. Do not go through the exchange until you have your PS on board with sizing issues. You may or may not need to overfill by much. If your PS is talking about anything less than 500 ccs, keep the tissue expanders and get a second opinion. But discuss this with him during your next visit

Deborah

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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Dec 12, 2019 10:09AM mamina5459 wrote:

Hi Whippetmom,

I had my revision surgery 2 days ago and all went well. A lot of pain on days 1 and 2,mostly on the sites where the fat was harvested for the grafting, but I am up and about today. I'm seeing my PS on Monday for the post-op. I'll give you all the updates after that appointment.

Thanks, Mamina.

Dx 3/22/2018, ILC, Right, 2cm, Stage IIA, ER+/PR+, HER2+ Surgery 4/22/2018 Lymph node removal: Right, Sentinel; Mastectomy: Left, Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Radiation Therapy 12/2/2018 Hormonal Therapy Femara (letrozole) Chemotherapy AC + T (Taxol)
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Dec 15, 2019 10:06AM Shell18 wrote:

Hi Whippetmom,

I have expanders in at the moment (since January 2019) and am likely getting the implant exchange within the next month and worried about sizing. Someone recommend coming here so figured would see what you thought. I have Mentor 650 TE’s in and they were filled to 650. I had 28 rounds of radiation which ended in September and the right side is at least an inch or two higher then the left now. My rib cage size is 37inches and I was approx a 38DD prior to surgery last year. I am 5’5” and currently 190 though 25lbs were gained during chemo so hope to lose it. I guess my biggest concern is I don’t want anything that will be too ..much but still want to have decent volume. My plastic surgeon works mostly with mentor. Would love to know your thoughts. Thanks so much!

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Dec 15, 2019 06:00PM Diana67 wrote:

Thank you for your post and open discussion. I’ve been diagnosed with BS in 2012 and had DMX with reconstruction. Allergan smooth silicon filled implants with spared nipples. By now my implants moved to sides, left pockets. One was shifted to left from the start. My MO advised to do revision, with smaller implants, move it the center. Had visit with my PS, my initial concerns about recall was ruled out, but my PS originally he did not seem to see any visual problems. When I expressed my concerns about shifting implants he scheduled me for exchange implants and fat graft. With a new study that has just come out i’m nervous about implants in general. I’m wondering if anyone has done implants for fat graft only exchange?. No muscle- due to my blood clotting mutation for me it’s not the option. From implants choices if it’s the only way to do it- has anyone had natural look and can advice on best options? I’m grateful to outlive my implants. Hope I can achieve close to natural look and be more comfortable with the way way I look. Thank you. Please feel free to reply here or msg me privately.

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Dec 16, 2019 12:34AM Meow5 wrote:

Hi Whippetmom,

Firstly, thank you for all your continued help on this forum! You're an angel.

This is my first post on the forum. I have been reading posts through my Cancer journey and have learned so much from all the ladies here. You are all amazing warriors!

I have my final appt on Wednesday with my PS before getting exchange surgery in early January. Any help you could give me would be very appreciated, as I'm really worried about making wrong implant choices.

Here's my info:

1. Height - 5"4 1/2

2. Weight - 120-125. I weigh more than pre chemo and also have very overfilled expanders so don't know if that accounts for any of the extra weight.

3. Ribcage- 29 inches

4 They took out 245cc breast tissue which was left from my lumpectomy last year (mastectomy was earlier this year) . My pre cancer breasts were perky I'm a unilateral and masectomy was on the left breast which was always smaller than the right. I used to wear a 34b bra (but not sure if that was my correct size). My left masectomy was skin sparing but non nipple sparing. The first surgery (lumpectomy) seemed to reduce that breast to what looked like 1/2 that breast

5. Expander info: 133 plus MX 400cc

Ref 133P- MX 12

SN- 22741042

Initial fill at surgery was 100cc

I'm currently overfilled to 740cc as my PS was trying to expand me as she will be putting a small implant on my Right non masectomy breast for symmetry. My non cancer breast was almost symmetrical at around 550cc but she expanded me quite a bit more.

She is thinking of using truform 2 implant from Allergan. I don't know if that's the soft touch or not. But we don't currently have the truform 3 approved in my country. She usually uses Allergan but is open to other options.

I would like to visually be a C cup. Right now my expanded breast seems too big and I'm padding the other side to try and match. But I like the profile of that expanded breast when I wear clothes. it's strange how without clothes it looks like a big ball on my chest but with clothes it looks more normal So I'm unsure what type of implant will give me a similar profile.

My ps was saying she usually uses the Full profile as the extra full has a tendency to flip. Have you heard of that happening? And what cc amount would you recommend for me. My ps was previously saying maybe low 700 or high 600's. But I've been reading posts on here and doesn't that sound too big for me? Also the expanded breast seems to be going into my armpit. I hope the final implant won't be like this.

Is the mentor extra a good option? I'm trying to pick something that is cohesive as I want to avoid rippling as I'm Prepec. Or would the truform 2 from Allergan be a better choice? Are there differences between the mentor one vs truform 2 with regards to firmness of the implant?

Sorry for all the questions. But I feel confused and worried about all of this.

Thank you in advance for any help/ advice you can give me.

Dx IDC, Left, Grade 3, ER-/PR-, HER2-
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Dec 24, 2019 06:19PM - edited Dec 24, 2019 06:26PM by whippetmom

Shell:

Your tissue expanders have the following dimensions: 14.6 cm width and 7.6 cm projection. I would recommend Mentor Xtra Smooth Round silicone implants, 755 ccs, which have the following dimensions: 14.4 cm wide and 6.7 cm projection. More importantly, I would strongly suggest that your PS perform one fat graft transfer to the previously irradiated skin at the time of the exchange. The, I envision a repeat fat graft transfer around 6 months later. The rich stem cells from the FGT will help soften the skin and begin to heal the damaged tissue. I know of nothing else that works so well to help regain symmetry after radiation.

Deborah

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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Dec 24, 2019 06:25PM - edited Dec 24, 2019 06:26PM by whippetmom

Diana:

Typically the cause of lateral migration of the implants is due to over dissection of the pockets at the time of mastectomy. Also, it can occur when the implants are too small for the pockets created by the tissue expanders.It may not be that your implants are too large, just that the medial space might need to be opened up a bit, but also, more importantly, bilateral capsulorrhaphies need to be performed to secure the pocket laterally. Otherwise, new implants will just migrate towards the armpits again. You could go slightly narrower with implants, if you like, if indeed the revision includes narrowing of the pockets.

Medial dissection is a VERY delicate procedure. If it is opened up too much, you can end up with symmastia, where the breasts meet one another and this is almost impossible to repair. So make sure your PS is very good with CORRECTIVE breast revisions.

Deborah

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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Dec 24, 2019 06:35PM whippetmom wrote:

Meow5

Well, it is not easy and nearly impossible for me to size unilaterals. Everything with a single mastectomy hinges on symmetry. Symmetry trumps size. I think that 700 ccs plus seems like a lot for your frame. I was thinking more in the 600 cc range. Your pocket is over expanded and seems huge, because your PS is trying to achieve some ptosis (droop) on the MX side to match whatever ptosis you have on the right. So honestly, the goal is to achieve symmetry. This means finding the right size and profile implant for augmenting the native breast. I do not know anything about Truform....I need to read up on it.

Your PS sounds pretty savvy and is thinking artistically, vis a vis the over expansion of the MX side and consideration of the cohesiveness of the implant. I leave it in her capable hands!

Deborah

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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Dec 29, 2019 07:46AM 08172016 wrote:

Dear Whippetmom,

Thank you for all you do for us and Happy Holidays! I was hoping that you could recommend the proper size implant for me.

My PS uses mentor implants. My current TEs are mentor smooth high profile 475cc / 13cm wide / 13cm high / 6.8cm projection. I am 5’7”, 155 lbs with a rib cage measurement of 33”. My pre mastectomy bra size was 34b (I was 145lbs then).

I’m in the process of weekly TE fills and am currently at 410 cc.

I would appreciate any advice you have.

Thanks,

Lorraine


Dx 8/17/2016, IDC, Left, 2cm, Stage IIB, Grade 3, 1/1 nodes, ER+/PR+, HER2+, IHC Targeted Therapy 10/1/2016 Perjeta (pertuzumab) Targeted Therapy 10/2/2016 Herceptin (trastuzumab) Chemotherapy 10/2/2016 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 2/20/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Surgery 2/21/2017 Lumpectomy (Left) Surgery 4/6/2017 Mastectomy; Mastectomy (Left) Radiation Therapy 6/29/2017 Whole breast: Lymph nodes, Chest wall Hormonal Therapy 9/30/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 10/1/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Targeted Therapy 2/28/2018 Nerlynx Surgery 5/17/2018 Reconstruction (Left): Fat grafting Surgery 10/25/2018 Reconstruction (Left): Fat grafting Surgery 3/28/2019 Reconstruction (Left): Fat grafting Surgery 7/9/2019 Prophylactic mastectomy; Prophylactic mastectomy (Right); Reconstruction (Left): Fat grafting, Tissue Expander; Reconstruction (Right): Tissue Expander Surgery 5/20/2020 Reconstruction (Left): Fat grafting, Silicone implant; Reconstruction (Right): Fat grafting, Silicone implant
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Jan 2, 2020 07:59AM VaLaMichelle wrote:

Hi!

I was had a left-side, nipple-sparing mastectomy in Sept, 2017, with a tissue expander. In Dec, 2017, I had the expander replaced with an implant and a small implant was used on the right for symmetry. I was very adamant about not wanting to be any larger than my pre-surgery size, but my PS explained that symmetry would be impossible without an implant on the right, a lift in which she would remove skin in a circle around the areola and below, or both an implant and a lift. Because I love to be active, I was concerned about extensive surgery and opted to have the implant on the right, but not the lift. I was not pleased with the results. The reconstructed breast is smaller than the augmented one. Both implants are sub-pec and the reconstructed breast is compressed by my muscle giving it a weird shape -- flat on the top and the nipple points upward. The augmented breast is fuller and the nipple points downward. If I place my hands against my rib cage and move them under my breasts, it is obvious that the base of my augmented breast is lower than the other. In short, the augmented one is obviously larger and fitted clothes enhance this. Regardless, I am feeling VERY fortunate to be cancer-free and back to my normal, active life at 50 y.o. The idea of any surgery again really bums me out. However, I have the textured Allergan implants that have been recalled. My oncologists has suggested that given that I am unhappy with reconstruction results and that I have these particular implants, I should consider another reconstructive surgery. I have visited a new PS who has said that he will need to put an even larger implant in the augmented breast! I was really hoping to be smaller, not larger!! He is suggesting over the muscle, and implants that "fit my skin". I am thin and active and think this will look and feel ridiculous. Symmetry and not having them in the way during activity is important to me. I am willing to have a lift to remove skin, but the PS said that nipple placement wold be an issue if I removed skin on the right. Advice? Thanks!!

Height: 5'7"

Weight: 122 lbs

Rib cage circumference: 28.5"

Bra size before sugery: 34B (I have the same bra-size, but they are "fuller" on the top

Current implants:

Left: 410 MF Natrelle 410 highly cohesive anatomically shaped silicone-filled 255cc

Right: 410 ML Natrelle 410 highly cohesive anatomially shaped silicone-filled 125cc

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