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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! Please read my biography under my personal profile. I am not a physician or medical professional. The information provided is my own personal opinion. You must discuss every aspect of your reconstruction with your plastic surgeon. Dx 10/15/2008, IDC, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Aug 4, 2019 10:15PM HappySpring13 wrote:

Hi VegGal - Thanks for letting me know that! Are yours placed under the muscle? I am currently under but the exchange he said he does over the muscle now. Wondering if there is a different feeling, like a feeling of relief. My chest wall always feels tight and sometimes I have pain since the placement of them in 2014.




Dx 11/1/2013, DCIS, Right, 2cm, Stage 0, Grade 3, ER-/PR- Surgery 12/3/2013 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Aug 7, 2019 08:56AM MarthaMo wrote:

Hi Whippetmom, so sorry to hear about your situation. Thank you for coming back to help us! I'm repeating my msg with updates. I had prophylactic bilateral mastectomy with expanders on 20th of march this year. I had lumpectomy 4 years ago, but decided on mastectomy because of BRCA1 positive results. My breasts were really asymmetric, and I was worried about how it is going to look like, and how skin is going to stretch on the radiated side, but for now everything is perfect. I have a really great surgeon I guess, but there is never enough time to ask him everything when I get to meet him.

So now I have Mentor expanders Style 9200 450cc w: 12,7cm h:10,8cm projection: 7cm (w: 4,9 in, h: 4,2 in projection 2,75in)

I finished fillings 3 months ago, with 450cc both sides. I don't know what was the size of my real breast in cc's or grams, I only know surgeon told me I can not get that projection with implants, it is going to be at least 0,5 inches less in projection. My bra size was 70C European (I went to bra fitting), and my rib cage is around 27-28 inches.

My surgeon said we'll think about type of implants in a few months, when it comes to my exchange surgery (scheduled for September), he is opened to everything, but I would like to prepare, to know what are my options, to know what to discuss, although I really trust him.

I'm 173cm & 56kg (5,7ft & 125 pounds), with almost no fat on my ribcage and upper part of my body, so I'm not sure if I'm a candidate for a round implants, I'm afraid they would look strange and not natural on me. I couldn't find any Mentor implant with the same dimensions as my expanders, so I don't know what are my options at all.

Also, I would like to add one more question, but fell free to ignore it if it is off-topic. My breasts after mastectomy are not completely numb. Actually, they are getting better and better, and I'm so happy i have feeling in them. Will they become numb after the exchange surgery? I'm so satisfied with how everything feels and looks with expanders, I'm afraid that maybe it is too early to be happy.

If you find time to answer me, I would appreciate it a lot!

Dx 6/5/2015, Right, 2cm, Stage IIA, Grade 3, 0/12 nodes, ER-/PR-, HER2- Surgery 6/16/2015 Lumpectomy; Lymph node removal: Underarm/Axillary Surgery 9/1/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery Prophylactic mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy AC + T (Taxotere)
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Aug 7, 2019 10:44AM VegGal wrote:

HappySpring, yes, the new implants are pre-pectoral. I do feel much relief. They look better, too.

Good luck

Dx 1/12/2016, DCIS, Left, <1cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR-, HER2- Surgery 3/11/2016 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 6/10/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 9/8/2017 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Aug 7, 2019 08:34PM whippetmom wrote:

Hodgepodge:

I would suggest the Allergan Inspira, SRX, which would give you extra full projection. The volume would be 650 ccs or 700 ccs.

Debora

DISCLAIMER! Please read my biography under my personal profile. I am not a physician or medical professional. The information provided is my own personal opinion. You must discuss every aspect of your reconstruction with your plastic surgeon. Dx 10/15/2008, IDC, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Aug 7, 2019 08:50PM whippetmom wrote:

HappySpring:

I am not sure of the style you have. There are several 410’s with a 595 cc volume. Allergan Inspira smooth rounds would work - SRX (to give you extra projection), 650 ccs. This puts you in the 6.0 plus cm projection arena. Talk to your PS about the possibility of using this style implant.

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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Aug 7, 2019 09:03PM whippetmom wrote:

MarthaMo:

After mastectomy, anatomical implants are not going to give you a tear drop shape or natural shape, any more so than would round implants. Frankly, I can never tell the difference, other than that anatomical implants rarely look as good, in my humble opinion, as round implants. There are some gals on this forum who have anatomicals that look very good, but they are the exception, rather than the rule. Also, issues with the recall of textured implants would completely rule out the use ofanything other than smooth rounds. So I would suggest Allergan Inspira, SRX, 495 ccs or 525 ccs.

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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Aug 7, 2019 09:36PM lila3357 wrote:

hi Deborah

i literally am one week after exchange surgery and just had bandages removed today. i know that i need to live with myself a little bit to be fair ...but right know i am feeling miserable. Given what i have been through to get to this point I so much very much wanted to like the outcome. I told the PS that i didn't want to be bigger than i was (34/B...for what that is worth) and i feel like i am really small and rippling. I was told to give it some time for the swelling and fat injections to settle to really see the final outcome....give it some time.

I came across this thread and figured i would ask...bc i am prepared to do it again if need be (UGH)

I am 5'3, 105lbs, rib circumference is 32inches, i am very thing and implants (and TE's were) right on my ribs

i have Allergan, Naturelle inspira, Style: SRM 310cc

  • Any input you have is very much appreciated.....thanks so much



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Aug 7, 2019 11:00PM MinusTwo wrote:

lila - if you read the "exchange" thread, you'll get a better feeling for what happens down the road. You need to wait 6 weeks to 6 months for the internal healing and the implants to settle. As everyone says on that thread - STAY AWAY FROM THE MIRROR. It's hard, but at this point you can not get any kind of valid impression about what you might look like.

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 8, 2019 10:14AM MarthaMo wrote:

Thank you so much for taking time to answer! Now I’m sure I’m gonna use round ones. I realized my surgeon also prefer them, I was just worried about will I get natural shape with them. I hope Allergan implants are available in my country.

I can’t wait to get soft implants, although my expanders look unexpectedly good, they are so hard. Hope I’ll be back in few months with updates.

Dx 6/5/2015, Right, 2cm, Stage IIA, Grade 3, 0/12 nodes, ER-/PR-, HER2- Surgery 6/16/2015 Lumpectomy; Lymph node removal: Underarm/Axillary Surgery 9/1/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery Prophylactic mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy AC + T (Taxotere)
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Aug 8, 2019 07:55PM hodgepodge wrote:

Whippetmom, thank you for the advice! I will be having the consult with the PS very soon for the exchange. I can't wait to get these expanders out!

MinusTwo - great advice but I know it's going to be hard to follow :) The results of the exchange are scary to me. Hoping for the best!

Dx 12/7/2005, DCIS, Right, 1cm, Stage 0, ER+/PR+ Dx 4/1/2019, IDC, Right, <1cm, Grade 2, ER+/PR+, HER2- Surgery Lumpectomy: Right Radiation Therapy Whole-breast: Breast Surgery Mastectomy: Right; Prophylactic mastectomy: Left Surgery Lumpectomy: Right
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Aug 21, 2019 11:43AM KD09 wrote:

Whippetmom – thanks for this very long standing thread. Your dedication and endurance to maintain and answer questions speaks volumes to those who read it.

I had BMX surgery with reconstruction 6/27/19 and would appreciate your input on implant size:

I am 5' 9 ½" tall, 162lbs, with ribcage circum 35". Pre-mastectomy size: wore bra 34C. Surgically removed: 533g on Left and 525g on right.

TE: Mentor CPX4 suture tab, medium height, smooth 550cc. Dimensions: Width 13.5cm Height 11.7cm Projection 7.4cm

Don't know PS preference for brand/style. Thank you

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Aug 22, 2019 08:21PM - edited Aug 22, 2019 08:49PM by k4523

Whippit mom, I know it is here somewhere, and feel stupid that I can't find it, but where do we submit required information? Hopefully here! Thank you so much for any assistance you can offer. Very confused after today's PS visit, which is my ;last prior to my exchange.

Dbl Mastectomy 6/19 with spacer placed.

I am 5.5", 145 lb
presurgery 34 B

measurement around ribcage is 35"

Alloderm Select Tissue Matrix Contour Medium Perforated.
Mentor Artoura Ultra High Profile Smooth Tissue Expander

i've had 6 fills of 60cc ea, so total of 360 ccs per side


PS uses textured implants w/ silicone. Initially said he would use high profile, but today said he;d use a lower profile, and wider. That confused me, I don't want wide and flat lol.

Also have done everything as told, but today both my left and right spacers had rotated. so added 'revision bilateral reconstruction' to my surgery next month.


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Aug 23, 2019 11:57AM - edited Sep 13, 2019 03:47PM by

don’t let him use textured implants!!! https://www.tmc.edu/news/2019/04/textured-breast-implants-linked-to-cancer/

Dx 6/17/2019, IDC, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR-, HER2- (FISH) Surgery 8/19/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Aug 23, 2019 07:33PM - edited Aug 23, 2019 08:47PM by TETM28

Hello - I am trying to get an idea of the implant size I should have after my mastectomy. I just found out a mastectomy is my only option so I have just begun my research. I would like to try to have implants around the same size of my natural breasts, but I am not sure if that is even possible. I don't have my appointment with the plastic surgeon for a few more weeks and my surgery is just three days after, so I am trying to do all the research I can now to be able to make the best decisions I can and to have my questions ready!

Height 5'7"

Weight: 170

Ribcage circumference: 33.5"

Current bra size: 32G

So far, based on research and advice here is what I have decided: round, high profile, silicone. Right now I amhoping I won't have chemo or radiation after surgery because as of today, my lymph nodes are negative, but they will be checked during surgery too.

Thank you!

Dx 7/31/2019, DCIS/IDC, Right, 4cm, Stage IA, Grade 1, ER+/PR+, HER2- (FISH)
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Sep 1, 2019 11:33AM whippetmom wrote:

lili3357:

Please send/private messageme photos. You have three months for everything to settle before deciding where to go next. The SRM is a fairly low profile implant....so it may be the lack of projection you are seeing at this point

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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Sep 1, 2019 11:38AM whippetmom wrote:

KD09:

I would recommend, minimally, 650 ccs in a round, Mentor extra smooth high profile implant.

Debora

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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Sep 1, 2019 11:42AM - edited Sep 1, 2019 11:43AM by whippetmom

k4523:

No to textured implants! I also do not like the suggestion of lower profile implants. Do not go through an exchange surgery with this MD until these issues are made clear. You failed to provide the VOLUME of your tissue expanders. You stated your fill level, but that does not tell me the dimensions of your TEs.

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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Sep 1, 2019 11:46AM whippetmom wrote:

TETM28

I think you are going to want to talk to your plastic surgeon about using an extra full projection style implant - either Mentor or Allergan Inspira. Possibly 700 ccs to 800 ccs. The key is not going too wide, but still achieving projection and volume.

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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Sep 2, 2019 08:32AM TETM28 wrote:

Thank you Deborah! I very much appreciate your help!

Dx 7/31/2019, DCIS/IDC, Right, 4cm, Stage IA, Grade 1, ER+/PR+, HER2- (FISH)
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Sep 6, 2019 09:06AM - edited Sep 6, 2019 12:44PM by Doreo

Hi Deborah,

Thank you for your continuing support! Your input and the support offered through everyone here continues to be invaluable.

I had nipple sparing BMX surgery with reconstruction 6/26/19 and would appreciate your input on implant size:

I am 5' 10" tall, 167lbs, with 35 " ribcage circum.

Pre-mastectomy bra size: 38B - (a small B that has been through 2 pregnancies and 50 years!)

Surgically removed: 400g on Left and 319g on right.

TE: Allergan 133S-MX-12-T. 400cc.

Dimensions (WxHxP)12cm x 11cm x 6.3cm

I am not sure about PS preference for brand but they generally use round smooth high profile gel.

I am right now overfilled on both sides - left is 560 and right is 500. I have a fairly lean torso and my breasts are fairly wide set.I f I could end up somewhere slightly smaller than the TEs right now I would be fine. But from what I understand the difference between the TE and the gel implant is going to seem softer and possibly smaller anyway so I don't know what to do.

Thank you!!

Dx 4/16/2019, DCIS, Left, 6cm+, Stage 0, Grade 3, ER+/PR+, HER2- Surgery 6/26/2019 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 10/11/2019 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Sep 6, 2019 10:01AM Moderators wrote:

KD09, TETM, Doreo and all the newbies here, we are sending you a warm welcome to the BCO Community. Sorry your circumstances have brought you here but we sincerely hope that it will be a source of great support to you. Please, let us know if you need any help from us, we're always here!

Kind wishes,

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Sep 6, 2019 11:57AM Doreo wrote:

Thank you Mods for the welcome! For me, it has been nine months of lurking and learning from all of the terrific members here. I am so grateful for the knowledge I have gained and the support I have witnessed across the discussion boards. Although I have not posted before today I consider this community to be a source of great support! You have been with me through it all even if you didn't know it!

Dx 4/16/2019, DCIS, Left, 6cm+, Stage 0, Grade 3, ER+/PR+, HER2- Surgery 6/26/2019 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 10/11/2019 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Sep 6, 2019 02:37PM HopeWins wrote:

whippetmom - hoping I could ask a question or two. I'm two weeks out from bmx with DIEP flap and I'm healing well. I understand I'm still swollen and things won't look as they do now in a couple months. That being said, I also don't think I'll grow any fluff in the upper and inner part of my breasts where there is none. I'm skin on ribs at the upper poles and there's no hint of cleavage.

I knew going in that I had barely enough tissue to match my current size. I thought I might be OK with that, especially if they ended up being a little perkier, but they are definitely not perkier. I feel like I have half the breasts I used to have. This is likely the distribution of the tissue which is wider with less projection than I used to have. Volume might be close but I feel like I look out of proportion with the rest of my body now.

I know I have to give myself time to heal and the PS will do a revision that can include lipofilling/fat transfer, etc. My issues are: I don't want multiple surgeries after this next one. I don't want to keep traumatizing other parts of my body by harvesting fat. I want to move on from this chapter in my life sooner than later and I want to do it with a body I'm comfortable in.

Are you aware of women who have successfully added a small implant after DIEP? Any recommendations? I see the PS in two weeks. I like to go to my appts with an idea of what I want so that I can ask appropriate questions and prepare myself mentally.

Here are my stats:

  • 5'8"
  • 150lb
  • Rib cage 32"
  • Previous bra size 34C, sometimes 36B
  • I did just measure myself again and I measured 34B, but I still have swelling under my arms and in my foobs.

TIA!

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Sep 11, 2019 02:29AM whippetmom wrote:

Doreo:

I would suggest looking at the Allergan Inspira SRX 445 ccs. You will not be happy with anything smaller. They will be smaller than where you are now with your overfilled TEs. You say your breasts are wide set. Are you saying that this is an anatomical issue or are the tissue expanders placed too laterally?

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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Sep 11, 2019 02:33AM - edited Sep 11, 2019 02:45AM by whippetmom

HopeWins:

Absolutely! There are many women who have had a DIEP and augmentation with implants. It is called “hybrid reconstruction “ in some circles. I cannot help you with size, since I have no idea how wide (how many centimeters) or what kind of volume you have with your DIEP. Have you discussed this with your plastic surgeon? Here are some links of interest.

https://community.breastcancer.org/forum/44/topics/841802

https://www.realself.com/question/fayetteville-tx-implants-diep-flap

https://www.drleokeegan.com/articles/immediate-post-mastectomy-hybrid-reconstruction-diep-flap-plus-implant/


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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Sep 11, 2019 07:06AM Moderators wrote:

Doreo, we're happy our Community could help and so glad that you decided to join in! Again, welcome to BC.org!

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Sep 11, 2019 07:52AM TWills wrote:

HopeWins, I’ll be having implants added to my previous bilateral DIEP next month. I’d be glad to share any info with you before during and after although I don’t know a lot yet lol. There’s not a lot of info that I’ve found out there. We are very close to the same body frame and size.

Dx 11/2016, IDC, Left, 4cm, Stage IIB, Grade 3, 1/14 nodes, ER+/PR+, HER2- Surgery 12/12/2016 Lymph node removal: Left, Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic mastectomy: Right Chemotherapy 2/2/2017 AC + T (Taxol) Surgery 7/9/2017 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Radiation Therapy 7/30/2017 Whole-breast: Breast, Chest wall Surgery 8/27/2017 Hormonal Therapy 11/8/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 3/1/2018 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Sep 11, 2019 02:12PM Doreo wrote:

Thanks Whippetmom!

It's anatomical - and honestly since I have always been small I didn't think much of it. Since I had nipple sparing MX PS has pointed out that in order to keep the nipples in the middle of each breast without getting into moving the nipples, the implants will be as far apart as the expanders currently are. I never had cleavage to speak of, but PS said if I wanted to go larger with the same projection, I would be able to close that gap a little bit. I do not want to end up with huge pancakes or big round balls and I am having a difficult time visualizing the end result. The upper pole of the Allergan Inspira SRX is not as full I think - so that seems good. I will go to my consult armed with info - thank you!

Dx 4/16/2019, DCIS, Left, 6cm+, Stage 0, Grade 3, ER+/PR+, HER2- Surgery 6/26/2019 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 10/11/2019 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Sep 11, 2019 03:29PM HopeWins wrote:

thank you Whippetmom! Very helpful. I'll discuss with my PS

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22 hours ago Alden722 wrote:

Hi Whippetmom! I have finished fills but haven't done my pre op appointment, and was sent home with info on saline and silicone implants. I would also appreciate any other guidance.

I am 5'3", usually around 130 lbs, and chest circumference of 30.25"

My TE are 300cc Allergan 133MX-11-T

Prior to my diagnosis I wore 34C or 36 B (the 36 B usually fit better, but it depended on brand).

I was happy with how things looked at 270cc, but my PS likes to over fill a bit and I am now at 320cc. My goal was not to go bigger, just look like I did before.

I have been sent home with a bunch of info from Allergan, so it would appear that is the brand PS prefers.

Thanks!

Dx 12/31/2018, IDC, Left, 2cm, ER+/PR+, HER2- Chemotherapy 1/28/2019 AC + T (Taxol) Surgery 7/22/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy

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