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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 7, 2010 11:01PM - edited Oct 31, 2017 04:13PM 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 DISCUSS WITH YOUR PLASTIC SURGEON THE DIFFERENCE BETWEEN SMOOTH AND TEXTURED IMPLANTS (WHICH INCLUDES THE "GUMMY BEAR" ANATOMICAL IMPLANT) AND RISKS PERTAINING THERETO: NEW FDA FINDINGS

http://www.breastcancer.org/research-news/fda-upda...

https://www.medscape.com/viewarticle/887654

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". 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:

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

ALLERGAN:

Page 33 breastimplantadvice.com/wp-com

ALLERGAN NATRELLE INSPIRA

Newest generation of silicone "cohesive gel" implants. "With regards to silicone implants, they are prefilled, and it turns out that the traditional Allergan Natrelle implants are only about 86-87% filled with silicone gel, whereas the Mentor MemoryGel implants are 91-92% filled. Hence, the enhanced upper breast fullness that many patients liked better with Mentor implants.

Now, the Natrelle INSPIRA™ implants are available from Allergan, giving patients and cosmetic surgeons an additional option. The INSPIRA silicone gel implant is an "over-filled" or "fully-filled" silicone implant – 96-97%. Hence, a moderate-plus profile INSPIRA implant can give patients who need a moderate-plus profile implant, the high-profile look they desire from Mentor. The advantages of silicone implants include a decrease in the risk of capsular contracture, an enhanced warranty, a more natural feel, and less palpable rippling. And now patients can avoid the risk of their breast feeling too hard from an overfilled saline implant!"

9. NATRELLE "INSPIRA" - NEWEST FDA APPROVED ROUND IMPLANTS FROM ALLERGAN:

A Beverly Hills plastic surgeon succinctly explains the benefits of this new implant.

"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.

ANATOMICAL IMPLANT INFORMATION:

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

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! 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 9, 2017 04:33PM LettyF wrote:

Hello,

Well things have changed a bit. I went for a fill thinking I would be 600ccs then and my PS put 100ccs in the left and only 70 in the right because he said it looked bigger. I went on vacation, nothing strenuous and no injuries but my left breast looked smaller. I went yesterday for a fill and he suspects a leak in the expander. He did not put saline in the right and put 180ccs in the left and measured/took pictures and I'm going back Friday to have it checked. He said if its a slow leak we can do a couple aggressive fills to get me to 685ccs and put in the anatomical "gummy bear" implants as these would have more the projection I was looking for but if its a fast leak it will have to be replaced. He said he does not over fill with the anatomical because you want the pocket to be snug so there's no rotation. I know when you first responded to me you suggested a round 650-700cc implant. I want the surgeries to be over but I don't want to rush and get the anatomical and then regret it. What's your thoughts and do you know of women who have the anatomical and are pleased with them.


Thank you,

Dx 1/6/2017, DCIS/IDC, Right, 2cm, Stage IIA, 0/2 nodes, ER+/PR+, HER2- (FISH) Surgery 2/1/2017 Mastectomy: Right; Prophylactic mastectomy: Left Surgery 5/2/2017 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 8/16/2017 Reconstruction (left): Tissue expander placement Hormonal Therapy 9/4/2017 Arimidex (anastrozole)
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Aug 9, 2017 05:09PM MinusTwo wrote:

Letty - I have had Allergan 410 anatomical implants since 2011. I continue to be very pleased with everything about them.

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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Aug 9, 2017 06:12PM noodlesmom wrote:

Whippetmom- Thank you! You are not just a wealth of information, but such a voice of reason in the midst of so much noise! I do trust my PS, but feel much better knowing that you've weighed in and concur. So appreciate the help.

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Aug 10, 2017 12:17AM whippetmom wrote:

LettyF:

Why not the Allergan Inspira SRX? It is a smooth silicone round and has excellent projection. The anatomical works great for some. However, I am not making recommendations for any textured implants at this time. Please read the first part of the thread header and talk to your PS.
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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Aug 10, 2017 12:14PM BabyKeegs716 wrote:

Hi Whippetmom!

I've been following this thread for a while, but my first time posting. I'm scheduled for a DTI BMX on 08-28-17, but I'm having some second guesses on the DTI part. I'm currently an A/B and would like to be fuller after recon. I'm 5'7", 112 lbs, rib circumference is 28. My PS hasn't said what brand he uses, but he does use alloderm in the process. He mentioned ultra high profile rounds and I believe he said he'd try to use 260cc
Dx 2/20/2017, IDC, Right, 2cm, Stage IIIA, Grade 2, ER-/PR-, HER2-
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Aug 11, 2017 06:26PM doroth2 wrote:

Hi Whippetmom!

I just found this thread and am so happy I did. I had a nipple sparing double mastectomy on 7/12 with expanders placed over the muscle. I am 5'8", 145 lbs (though trying to get back to 135), have a 34" rib circumference. My expanders are Natrelle 133MV-14-T and will be exchanging to Mentor high protection smooth rounds, hopefully in November. I had my final fill yesterday, but I'm worried I am going too large. I wore a D bra before surgery, but I didn't feel or look that large. I am trying to decide if I need to go back next week and have some saline taken out of the expanders. My surgeon suggested that I live with then for a week and then make a decision. Just trying to figure this whole thing out.

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Aug 11, 2017 07:10PM whippetmom wrote:

BabyKeegs:

I am not sure about the DTI part either. If you are want to be a bit larger, I cannot reassure you this will be accomplished.

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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Aug 11, 2017 07:15PM whippetmom wrote:

dorth2:

The corresponding smooth round HP Mentor for your TEs would be 600 ccs. I do not think that would be too large at all for your frame. You will be justslightly smaller than you are currently, presuming you are filled to 500 ccs.

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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Aug 12, 2017 06:11PM augusta2 wrote:

Thank you, Whippetmom! I held off on replying until I had more info from my PS. Additional info - Although my TE's hold 250 ml, they are only filled to 200, and that feels too large. When I asked my PS's nurse about implant size, she said the dr. is ordering the following for the OR: Mentor smooth round silicone implants in Moderate plus profile - 200 and 225 ml; and high profile - 225 ml. Does this seem reasonable to you?

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Aug 13, 2017 09:54AM - edited Aug 13, 2017 10:01AM by whippetmom

augusta: Yes, the Mentor MPPs - 225 minimally - sound fine and considerably smaller.He will hopefully take several into the OR and use the size that looks best.

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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Aug 14, 2017 06:44PM - edited Aug 14, 2017 06:46PM by Stix

Has anyone every had someone refer to youur reconstruction as an upgrade or boob job????

I have been going through surgeries for years due to complications AND am still going through it. This relatiavely new person/friend

knows of my history and rcn. problems which has forced me to go out of state. I have

had 10 surgeries- I stopped counting maybe 11. I am appauld, but moreso

surprised at insensitivity to women with breast cancer.

stix Dx 1/22/2010, DCIS, 1cm, Stage 0, Grade 3, 0/3 nodes, ER-/PR- Surgery 4/8/2010 Mastectomy: Right Surgery 8/15/2010 Mastectomy: Right; Reconstruction (right) Surgery 4/30/2013 Mastectomy: Left; Prophylactic mastectomy: Left Surgery 9/11/2013 Reconstruction (left) Surgery 7/29/2014 Reconstruction (left) Surgery 1/11/2015 Reconstruction (left)
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Aug 16, 2017 02:23PM - edited Aug 16, 2017 05:36PM by Elkay7

Hi Whippetmom! I had my exchange on 8/7 with the 800 CCs Allergan Inspira as we discussed. My PS and I discussed implant sizing extensively and we agreed to move forward with the 800 CCs. I am one week out of surgery and still feel like I look flat. Everyone tells me to give it time and that in 3 months or so things will look different. I am trying so hard to be patient.

Is it really possible that these implants will perk up and make me feel whole again when I am in clothes?

My PS has reassured me that I can have another exchange in a few months if I am still unhappy.

The problem is I don't know "what" I am supposed to look like right now. Should the implants be perky and projecting through my clothes? I am so confused.

This whole process is causing me to get very depressed.

As always, thank you for "being there" when we all have questions and concerns.

Elkay

Dx 3/7/2017, DCIS, Left, 6cm+, Stage 0, Grade 3, 0/2 nodes, ER+/PR- Surgery 4/18/2017 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Aug 20, 2017 03:09AM whippetmom wrote:

Elkay: It takes weeks and sometimes months for everything to settle. The implants are often flattened out and misshapen. Some can look like pancakes on a griddle. Winking Mine looked like hamburger patties for a week or two. Give it time. Most importantly: STEP AWAY FROM THE MIRROR! IT IS CRAZY MAKING. Hang in there and let me know how things look at the end of the month.

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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Aug 20, 2017 02:47PM - edited Aug 20, 2017 06:45PM by Elkay7

whippetmom: It's ironic you responded today! My right implant is changingHappy! It is actually transforming into a breast-like shape!!! The left implant hasn't changed much but I'm not worried. Tomorrow will be 2 weeks post op and you and everyone else are right........I definitely need to step away from the mirror and be patient!

As you know, we sometimes feel very vulnerable and sensitive during this journey, and I for one panicked when I first saw my implants.

I will update you at the end of the month with my progress.

I just can't thank you enough (along with everyone else) for being so kind and compassionate. It means a lot! 

Elkay

 

Dx 3/7/2017, DCIS, Left, 6cm+, Stage 0, Grade 3, 0/2 nodes, ER+/PR- Surgery 4/18/2017 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Aug 24, 2017 06:31PM whippetmom wrote:

Elkay: ThumbsUp

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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Aug 24, 2017 07:45PM Shoregirl wrote:

Hi Whippetmom, I could really use your advice. I am now 4 months post exchange, and have had some challenges with my implants flipping over backwards. The R flipped 6 weeks post op, and flipped back on its own the next night while asleep. I was all set to schedule my fat grafting, when suddenly the L flipped a month ago, again in my sleep 3 months post op. He said he has never seen this happen before, and thinks it may be due to me having "loose skin". I suppose he means my 53 year old skin doesn't have much resilience after 4 pregnancies and a 50lb weight gain from Lyrica which I then lost when I discontinued the med in 2012.

To refresh you of my stats, I am 5'7 1/2", 145lb, med build, 32" ribcage. My natural bra size was 38D-36DD, R mx removed 514 grams, L was 527 grams. My TEs were Mentor CPX4-450, moderate profile, expanded to 475. PS placed Inspira SCX 470 above the muscle. Not only does the flipping bother me, but there is a LOT of rippling now that swelling has subsided. I asked the ps what could be done. His 1st response was "we can put in a bigger implant". I told him emphatically "No". He said he could tighten the pocket and fat graft, which I am considering. He then recommended changing to textured anatomicals as they act like Velcro. The Inspira 460s are very close in size to my natural breasts, only narrower. I still wear same bra size. I had wanted to be smaller, more of a full B to C cup. The implants are heavy to me with just my skin and some Alloderm supporting them, although the heaviness doesn't bother me until night time. I was so fed up with the flipping and the discomfort, I asked about removing them and getting a flap. He referred me to Johns Hopkins for SGAP consult as he only does DIEP and I am not a candidate. The Hopkins ps talked me out of SGAP, said my implants look great (they do look good), and recommended I keep them, revise to tighten pocket and do some fat grafting. He manually flipped my implant right side up during the consult, and I was super relieved!! He too said he had not seen this happen in any of his pre-pec cases. He said the discomfort (feels like inside of skin is peeling away from the implant when I get up from sleeping) is most likely nerves regenerating and to give it a year (or three) it should subside to the point I don't notice the implants anymore.

I am hoping you can tell me if it is possible or even advisable to downsize and what size would give me more of a C or even B cup? I wonder if that would make it more comfortable (less weight for a pre-pec install). I worry about aesthetics though, messing up a nice looking result other than the rippling. Or should I just stay where I am and try to get used to the feel of these and proceed with fg? One way or another, we are doing a revision to tighten the pocket & FG. He is booked til October for the OR. Thanks for your kind advice.

Faith, Hope & Love, the greatest of these is Love 1st Cor 13:13 Dx 12/2/2016, DCIS, Right, 5cm, Stage 0, Grade 3, 0/2 nodes, ER-/PR-, HER2- Surgery 1/27/2017 Lymph node removal: Sentinel; Mastectomy: Left, Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Aug 28, 2017 01:23AM Campbellx5 wrote:

I had my exchange on 8/15 with fat exchange. I had large concaved area on inside and top of right breast. The fat grafting (both breasts) on the upper pole looks really good. The area on the inside of the right breasts looks like a third breast. How long does it take for the fat to settle? I also have area on the outside of the right breast that looks like the implant edge. Am I being impatient? Will these issues resolve themselves. I really don't want any more revisions,but I have come this far, I am going for as close to perfect as I can. She did go with 650cc natrelle inspira.

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Aug 28, 2017 11:52AM MinusTwo wrote:

Campbell - it takes 3 months or longer for your implants to settle. The best advice most of us got from the "exchange" thread is to walk away from the mirror. It's hard, but there is so much interior healing going on it's the best thing you can do.

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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Sep 3, 2017 04:28PM whippetmom wrote:

Shoregirl:

Why don't you private message me a photo? If your silicone round implant is flipping because the pocket is too large, you would have the same issue with an anatomical implant and its high risk of rotating in a too large pocket. I am perplexed about your feeling too large, since the TE volume was pretty average for your frame. At this point I need to see what is going on.

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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Sep 3, 2017 10:31PM Horsefly wrote:

Hey whippetmom, I was told you might be able to give me some advice. I had my implant exchange a year ago. I have 400 cc Sientra shaped implants. My PS told me at a recent check up that he thought I was expanded more than I was. My implants are high and tight. The pocket is too small. They have never dropped. He said the only way to fix it is to put a smaller implant in. I'm not crazy about more surgery and I have beautiful 3D nipples. Do you have any thoughts

Dx 2/22/2016, DCIS, Left, 6cm+, Stage 0, Grade 3, 0/3 nodes Surgery 3/22/2016 Lymph node removal: Left, Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Nipple tattoo, Silicone implant, Tissue expander placement; Reconstruction (right): Nipple tattoo, Silicone implant, Tissue expander placement
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Sep 3, 2017 10:44PM whippetmom wrote:

Horsefly:

Have they always, from day one, been "high and tight"? I am just wanting to rule out capsular contracture. You can send/private message me a photo, by the way. I think that it might be a "placement" issue also, coupled with perhaps underdissection of the inframammary fold, in which case they would likely never drop. If you exchange to something else, I would advise a smooth round silicone implant, which will be softer and will not have the height of a shaped implant.
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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Sep 4, 2017 12:43AM kae_md99 wrote:

whippetmom,

how do plastic surgeons " tighten a pocket"? i am curious...was inflated to 400 cc at bmx. too big for me.PS removed 60 cc so now i am at 340 cc. i want to be smaller and he said he could remove some more depending on how much smaller i want to be. path report showed 297 grams (?) breast tissue removed. i am afraid the skin was already stretched too much from the 400 fill at bmx.. exchange on oct 20... will see him tuesday next week..

kae, 1-10-17, IDC,2.5 cm, right,er(+)pr( +),her2(+),grade 2;DCIS, right, er(+),per(+),grade 2; DCIS,left, er(+),pr(+),grade 2, 2-17-17- Taxotere, Carboplatin ; 2-17-17- Herceptin , Perjeta, Lupron ; july 14,2017,BMX,TE's,SNB
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Sep 4, 2017 10:44AM whippetmom wrote:

Kae:

The procedure is called a capsulorrhaphy, which is an internal suturing of the skin flap/pocket. Typically it is a lateral capsulorrhaphy, to narrow the pocket to accommodate a narrower and smaller implant. There is also a newer procedure called an "internal bra capsulorrhaphy", which entails the use of a mesh product to support the new implant. In any case, this is a delicate surgery, to the extent that the patient really needs to 24/7 wear a supportive bra and follow exercise restrictions, in order to not disrupt the capsule revision. Whether you will need this in order for your PS to use a smaller implant is something he can discuss with you. It might not be needed, in order for you to go a bit smaller.
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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Sep 4, 2017 11:42AM kae_md99 wrote:

thanks whippetmom!,

i do not want that and i will discuss it with him..

kae, 1-10-17, IDC,2.5 cm, right,er(+)pr( +),her2(+),grade 2;DCIS, right, er(+),per(+),grade 2; DCIS,left, er(+),pr(+),grade 2, 2-17-17- Taxotere, Carboplatin ; 2-17-17- Herceptin , Perjeta, Lupron ; july 14,2017,BMX,TE's,SNB
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Sep 5, 2017 11:38PM MLScott wrote:

Hi Whippetmom,

My wife is coming up on a double prophylactic nipple/skin sparing MX next week (1st surgery, and then implants in December)

  • Rib cage below breast/bra: 41 3/4"
  • Bra size: 40-42 B/C (she's never had a real fitting so like you said, it's a bit variable)
  • Weight: 205
  • Height: 5' 6"
The info I have on expanders and implants is:
  • Allergan for both expanders and implants (don't yet have model numbers, etc.)
  • Implant style: silicone (gummy), natural (tear drop), smooth
She is looking to stay about the same size. Or said differently, we're just hoping to keep things as reasonably similar to her body today as is possible. Based on the above, do you have any tips on fill, etc? Is there more information that is helpful?

Best,

Michael

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Sep 7, 2017 02:07AM Campbellx5 wrote:

I had the exchange on 8/15. Got 650cc natrelle inspira silicone, under muscle implants with fat grafting. I have some really bad rippling on the inside of my left breast. That is the non cancerous side and no radiation. Will rippling resolve with time? Do you get any more projection with time? The are very flat now

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Sep 8, 2017 10:31AM noodlesmom wrote:

Hi Whippetmom- I am 2 weeks away from exchange (yay!) and just want to make sure I have all the right info when I meet with the PS one last time next week.

I've talked with him about my concerns about being too large when all is said and done (I'm 5' 1", 99 lbs; 28.5" around ribs). Filled to 240cc and although it seemed HUGE at first, I've settled into it and it's not too bad. Maybe a tad bigger than I'd like. On a previous visit, he planned to order Natrelle Inspira smooth round in 195, 200 and 220cc's; any of which I guess are ok? But he mentioned, and I've heard, that the magnet, etc on the TE's can account for 60-80cc's of the total size and can be figured into the implant sizing? If that's the case, does that mean I am closer to 300 cc's now? So if I only want to be a tad smaller than I am right now, are the implant sizes he's considering too small? Am I being too conservative?

Thank you!

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Sep 8, 2017 05:09PM whippetmom wrote:

Michael:

I think we need some clarification on the type of implant your wife would be getting at the time of exchange. All teardrop or anatomical shaped implants are textured, not smooth. I think your wife is ultimately going to want to have implants in the 700 cc to 800 cc range. This translates to a tissue expander - perhaps an Allergan 133/MV or MX (MXpreferable) 600 ccs.

The only concern with an anatomical implant, is that if there is a lot of adipose tissue on the chest wall, the anatomical shape can kind of get swallowed up. The only other option is to use the highest projection style anatomical out there and I just think you could achieve a better result with the Allergan Inspira extra full projection style implant. It is also considered a "gummy" type implant.

I honestly hate the use of the word gummy bear, because it really is confusing. It is either textured anatomical or textured or smooth silicone round. Grant Stevens, MD came up with that "gummy bear" moniker in reference to the Allergan and Mentor anatomical implants which were in clinical trials at that time. It is really sort of an obsolete term now. 🙄

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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Sep 8, 2017 05:13PM whippetmom wrote:

campbellx5

Everything will either resolve with time, or you will see the need for perhaps some fat grafting six or so months from now. I always suggest waiting at least that length of time, because either the issues can resolve, or something else might come up that you also want to have addressed. I cannot really speak to the projection question, as I do not know what style of Inspira you have.

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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Sep 8, 2017 05:23PM - edited Sep 8, 2017 05:56PM by TrmTab

in post op got 800 Inspira,but

They put the wrong implant in TCX vs SRX....what happened...???

Is there a benefit to textured

At this point just want it out


Dx 9/2015, DCIS, Left, 1cm, Stage 0, Grade 2, ER+/PR+ Surgery 12/21/2015 Lumpectomy: Left Surgery 1/10/2016 Lumpectomy: Left Hormonal Therapy 2/5/2016 Arimidex (anastrozole) Surgery 6/3/2016 Mastectomy: Left; Reconstruction (left): Tissue expander placement Hormonal Therapy 1/1/2017 Arimidex (anastrozole) Surgery 9/8/2017 Reconstruction (left): Silicone implant

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