Posted on: Jan 7, 2010 11:01PM - edited Nov 4, 2020 01:14PM by whippetmom
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.
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. GRAMS VS CUBIC CENTIMETERS: Essentially interchangeable. A gram is a measure ofmass/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.
SILICONE IMPLANT LINE UP:
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!!!
Posts 14161 - 14190 (15,291 total)
Mar 28, 2017 12:09AM Krisincali wrote:
Thank you so very much! My expanders are 14cm wide, and 14.5cm high, high profile Allergan. does that help? Yes, I was thinking between 400 and 500 cc would be good as long as they are not so wide!
So you don't think the Naturelle 410s are good? Your recommendation is the Inspira...
Thank you for your input!
Mar 28, 2017 03:28AM whippetmom wrote:
Krisincali: Well, 600 ccs then in a smooth silicone round Allergan Style 20 or Mentor HP, if your TEs are 14.0 cm wide. Or Allergan Inspira SRF 600 ccsor SRX - 605 ccs.
Mar 28, 2017 06:22PM willa216 wrote:
Hope your week is going well!
I wanted to check back in with you because of my situation with the capsulectomy and over the pec silicone implant - I have a history of seroma and, of course, contracture. The swelling has lessened greatly in the past week or so which is nice. Except now the reconstructed side is too small relative to the natural side. Be careful what you wish for, right? I kept going on about needing to be smaller after having what was a huge, projected and hard implant with the seroma/contracture..So, yikes. Does it ever end. Maybe I need to ask for a larger implant. More concerning is that I have so much rippling. My understanding from what I've read is that rippling tends to get worse not better over time. Also I'm concerned I may have signs of contracture again . There's a line that runs from my armpit toward the nipple that looks almost like a scar or a stretch mark - that area seems attached to the implant so the implant doesn't seem as mobile as it was. I think the pocket is supposed to tighten up a bit but that doesn't seem normal. I will go see my PS again. She said there's not much to be done about rippling. This is super disappointing because the first implant had no rippling at all. This one looks prune-like in the wrong light. Which is most light, really. My PS doesn't tend to use Alloderm so I don't have that. I'm wondering if I should ask for Alloderm, a bit larger implant or a re-position to under the muscle (initially I had really wanted to avoid that). I don't have much fat for FG and my PS isn't big on it anyway. Should I just wait it out for 6 months to see what happens - try to be patient? I, like all of us I'm sure, would love to put these reconstruction surgeries behind me as soon as possible so that I could feel like my body and spirit are truly healing.
Thanks again for all you do - for the knowledge, patience and reassurance. I hope all good things are coming your way and you're enjoying Spring, wherever you are!
Best wishes to everyone.
Mar 29, 2017 02:26AM - edited Mar 29, 2017 02:27AM by whippetmom
Willa: Over the muscle placement is going to have a higher risk of capsular contracture and rippling will be more of an issue than it would be if you had implants submuscularly. Overs are just problematic. I think you have my opinion on the matter.
Mar 29, 2017 07:30PM Suburbs wrote:
whippetmom, can I just thank you. I am pouring through old exchange threads and have found a number of your posts and a wealth of imfotmation going back several years. The decision making process is very difficult. Your contribution to this topic has been so helpful to me. I appreciate it greatly. Again, thank you for your candor.
Mar 30, 2017 02:46AM whippetmom wrote:
Absolutely! I am happy you are finding information to help you on this journey
Apr 2, 2017 03:38PM - edited Apr 2, 2017 04:03PM by pgmjt
Hello Deborah; all!
Looking for input. Pretty recent DCIS Grade II of right breast, s/p lumpectomy a couple of weeks ago but didn't get clear borders. Pretty strong family hx and I'm young (39) but done with kids, so I'm going with B/L mastectomy, most likely with immediate reconstruction. They will have to take my nipple.
Met with plastics who said 800cc gummy bear immediately and I won't be same size, I'll be smaller than current which I'm ok with (I don't want back/shoulder issues from bra, and plan to lose weight, etc) but she expressed concerns about being proportionate as I'm curvy. I am 5'3 and 180lbs (working on losing weight, hopefully 20-40lbs), my ribcage is 34inches. Current bra size in a Fantasie bras are 34-36F (european sizing). Not candidate for DIEP per PS bc though I'm technically overweight she said my waist circumference is relatively small. I have a big butt :) I'm worried that at my goal weight 800s would be too gigantic but plastics says 800 is already smaller. Need input! TIA
Apr 2, 2017 05:25PM whippetmom wrote:
"800 ccs" can describe a number of implant styles. It all depends on whether it is a moderate plus profile, high profile, extra full projection/profile and whether it is Sientra (although I am not sure if Sientra goes up to 800 ccs),Mentor or Allergan classics or Allergan Inspira implants. They are all silicone rounds, but can have different and sometimes significantly different dimensions. 800 ccs sounds fine, but make sure you know which manufacture and which style your PS plans to use.
Apr 2, 2017 09:08PM pgmjt wrote:
sorry for being vague. I know my surgeon uses allergan (not sure which, I scheduled an appt for tomorrow and can ask. They didn't have any 800ccs for me to look at and didn't discuss shapes/profiles so that's what I'm hoping to get advice on I guess. My breasts width along ribcage she measured about 15 and 16cm wide each. I don't recall the other measurements.
Her plan was over muscle too if that matters. What should I ask if anything at appt tomorrow? They said they didn't have many pictures of women with larger breasts like mine and my age (39) at my curvy yet petiteframe...her words not mine!
Apr 2, 2017 11:01PM MinusTwo wrote:
pgmit - I may be wrong, but I didn't think that the original Allergan 410 "gummies" were used over the pectoral muscle. You'll have to ask. You'll also need to clarify the size, type, style number of the tissue expanders that the PS plans to use. If you are having anatomical implants down the road after expansion, that will be very important to hold the implants in place.
Ask to see & hold a couple of different types of implants. Ask to see pictures of some of her reconstructions. Discuss the differences between round & anatomical and which she prefers and why.
I'm sure WhippetMom will have more ideasb
Apr 3, 2017 07:20AM pgmjt wrote:
Minus two, thanks for input! I will add those to my list of questions/requests!
I won't be getting tissue expanders as the will be leaving most of skin and just taking nipples. My natural breasts are large enough that I will have enough skin and pocket I guess. So I'm not sure if that factors into things? So nice to have you ladies that have more experience! I'll take all the input I can get :)
Apr 4, 2017 12:34AM breastcanceryogi wrote:
Hi there! I just had my second fill (of probably three, maybe four) and am starting to think about exchange.
My expanders are placed prepectorally - Mentor Artoura, Ultra High Profile (TEXP110RUH). 455cc, 11cmx11cmx7.6cm. I'm currently filled to 250ccs.
I think I'm more or less happy with the current volume of my expanders, but I feel like they project too much. Looking at the dimensions of Mentor's anatomical implants, the model with the greatest projection appears to be 7.1cm. Does this mean that I will lose some of the unwanted projection from the TEs when I undergo my exchange?
Thank you in advance!
Apr 4, 2017 02:19AM whippetmom wrote:breastcanceryogi:
Apr 4, 2017 08:33AM breastcanceryogi wrote:
whippetmom- thanks for the reply. I apologize for not following the instructions! I think I was half asleep.
I'm 5'10", about 145, and approximately 31-32" ribcage.
When I mentioned the 7.1 projection, I was just looking at the biggest volume for reference, yes. I agree it's not the right implant. Yes I'm in the US.
Until I looked at my implant card, I hadn't realized that there were *ultra* high profile TEs! From what I've read, it seems like it's a much more common problem to not have enough projection than too much.
Apr 4, 2017 01:33PM whippetmom wrote:
The Artourra tissue expander has some unique properties, with advantages over most other tissue expanders. I have only had a handful of women with the Artourra TE. This is from theMentor website:
" The Artourra Breast Tissue Expander is the first and only expander capable of providing precisely controlled pocket formation for more predictable expansion outcomes. The ARTOURA™ Breast Tissue Expander is the only expander with Dynamic Control Technology™ designed to prevent unwanted dimensional changes for more consistent and desirable results."
The question for your PS is "what implant do you plan to use?" He presumably has controlled the dimensions for a specific implant, if he's thinking of an anatomical implant. However, I don't know where you are now in terms of projection. Only your PS knows at this point. He must know which anatomical implant will approximate the dimensions of your tissue expander. If I were to guess, the most likely anatomical would be 390 mL moderate height high profile, with the following dimensions : 12.0x11.3x6.0. Generally, the increased projection could be providing natural ptosis/droop. I just do not know how that corresponds to an anatomical, which has a risk of rotating if the pocket is not specifically created therefore. I think an option would be a Mentor ultra full projection smooth silicone around, 535 mL. The dimensions of that implant would be 12 cm in width by 6.1 cm projection. One size smaller would be 480 ccs with dimensions of 11.4 cm x 5.8 cm. Also worthy of consideration - the most often used Mentor silicone round, high profile - perhaps 450 ccs.
The reason I asked if you were in the states, is because the European Mentor anatomical implants are different than those in the US, and actually have dimensions more closely representing those of the Artourra TE.
By the way, how do you feel about the width of your tissue expander's? Do you feel they are proportionally situated on the chest wall? Or do you have a pretty wide gap in the cleavage area? Just wondering, because with your ribcage dimension, I think you could easily use an implant with a width of 12.0 + cm.
So, in the final analysis, with this Mentor Artourra tissue expander, I think you just need to pick your doctors brain about what implant he has in mind for you. Please come back and let me know what he has to say.
Apr 5, 2017 08:38PM Andraxo wrote:
pgmjt - I have Allergan 410 gummies and they are pre-pec (on top of the pec, not under). They are wonderful in terms of comfort! I am incredibly active with a lot of sports that involve use of my arms, as well as in an active profession (PT), and I also do push-ups as required for my annual military fitness test. Under the pec was absolutely not an option per my surgeon due to my activity level, and I would allow it anyway. My size implants, however, are small compared to what you are seeking. I wanted an A-cup, but the nurse kept saying they had to over expand and so when my surgeon exchanged for implants he went with the tightest fit in the pocket (needed for anatomics), and what matched the volume of what they took out (TE + fill) and that was a 310cc. It was like a C cup on me. I was very upset and hated how big they were. He exchanged the non-radiated side for a 250cc 10 days later, but the radiated side wasn't healed enough to tolerate more surgery so that will happen in 2 more weeks (8 weeks after the initial exchange). The 250cc is a B on me so I'll have to live with that. They can't size down any smaller because nothing smaller/flatter exists in the footprint (width/height) I need. Anyway...my point is that even though I haven't seen them supported much on this thread, pre-pec anatomic implants are great for the right person and that person is usually very active and uses her pecs a lot for work and/or sports. An anatomic and a round look very different when placed over the pec. The anatomics are closer to a natural shaped breast. Mine do have a little rippling, but I don't have much body fat (not enough to fat graft). There are threads on this website for women who changed from under the pec to pre-pec for better comfort with active lifestyles.
Apr 5, 2017 08:56PM 2FUN wrote:
thanks for sharing your experience. I also have a pre pectoral TE, and I used to be active (before all of these medical isdues) but not as active as you-I'm sure I would not be able to pass a military fitness test. It took me almost a year to lose my strength, so it will take time to regain it. My PS is very happy with how my TE looks. I do not know how many cc my TE is. He asked me to try to access if my 2 sides are symmetrical. Since I have only one TE. I was a c cup, and for the sake of fitted clothing and what I am used to , I am going to try to stay this size. The TE side feels about the same as my natural side, altho the projection is slightly less on my TE side. Maybe that means I need a bit more expansion? I will see him again next week. At this point I am amazed how , even with a TE, I really don't feel like I had my breast removed. Ok, not that much, but I am glad I made this choice.
Apr 6, 2017 10:58PM breastcanceryogi wrote:
whippetmom- thank you for your thorough reply! At my next fill (two weeks from now), I will definitely ask my PS what implant(s) she intends to use. I'll report back!
Now that I have had a few days to get used to them, I believe I overreacted on the projection. I think it may just be that TEs are awkwardly shaped! 🙂
Apr 12, 2017 04:53PM EastcoastTS wrote:
Back again for another round of advice. ;) I had BMX 2/27. Just had my first fill this week due to infection which cleared nicely (here's praying never to return!).
Apr 13, 2017 02:27AM whippetmom wrote:
Fills: every two weeks
After final fill: 3 months to exchange.
Are you getting silicone rounds or anatomicals
Apr 13, 2017 09:47AM EastcoastTS wrote:
I have NO idea what type of implants I'm shooting for. We have not discussed yet. I've just had my first fill. Guessing I should start discussing now. :) Any suggestions based on my body size or request that it not look too "round" and artificial? I'm sorry, I guess I'm fairly uninformed on this piece. I've done so much research on all other steps, just getting to this now following surgery.
If I only fill to 250cc -- what is this typically going to relate to with regard to cup size? ANY way to guess on that? I don't think I'm going to be able to tell where I want to be or am based on this "clunky" TE look. I've read lots on this forum and realize the TE is higher profile and larger. It's just hard to imagine how I'll look and what to advise the PS regarding.
Apr 13, 2017 11:52AM Leslienva wrote:
Do you know which implants are causing a form of cancer? I read about it being the ones with the ridges. Are those the ones that are also called the gummy bears? I had the Inspira implants.Is that one safe? I haven't seen any reports listing the brands.
Apr 13, 2017 05:49PM MinusTwo wrote:
Any implant can be textured. However - it is important to note ALCL is EXTREMELY RARE. Also that it is treatable and not usually fatal. I don't think we should be starting any scare campaigns. Most of us with reconstruction are monitored very carefully.
Apr 13, 2017 07:53PM Yvonne_Strong wrote:
I am brand new to this but am worried. I had a bi-lateral mastectomy in February I had mentor TE put in. So far I have 735 cc's in each. I am 5'6" and have a broad chest and back. I never had a big chest, was a small B before mastectomy. I was hoping to be a solid D with reconstruction. My PS won't tell me much about my TE, he says I will get to many different opinions. However, I know that the fill isn't to 600cc with a overfill max of 800cc. Because they look so differently than a natural breast, I can't tell where am. PE keeps telling me I will know when I'm happy...I don't know that I will. I'm so confused. I'm afraid I won't be big enough or I will be to big. Please help, I'm so lost and confused. Idk if I'm even in the right place. Any help would be great
Apr 13, 2017 09:46PM Leslienva wrote:
I wasn't trying to start a scare campaign. I just asked a question.
Apr 14, 2017 01:33AM whippetmom wrote:
Gosh, I have not been seen by anyone regarding my reconstruction for six years! Maybe I should get a f/u appointment one of these days..😉
Apr 14, 2017 01:52AM whippetmom wrote:EastcoastTS:
Apr 14, 2017 01:55AM whippetmom wrote:Leslieinva:
Apr 14, 2017 01:57AM whippetmom wrote:
If you want to send me photos, you can do so via private message. What is your weight and rib cage circumference