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Topic: largest cc for direct to implant?

Forum: Breast Reconstruction —

If you've had or will be having a mastectomy (or in some cases, lumpectomy), you're likely facing decisions about whether or not to have breast reconstruction, and if so, what type and when. Deciding whether or not to have a breast reconstructed is a very personal choice. Take the time you need to learn about how breast reconstruction might affect you, both emotionally and physically, before you decide to have the surgery.

Learn about different surgical options and the medical and personal issues around breast reconstruction.

Intro medically reviewed by: Brian Wojciechowski, M.D.
Last review date: November 22, 2020

Posted on: Nov 27, 2020 12:01PM

peggysmom wrote:

Hello ladies- anyone had or know of anyone who had direct to implant recon with larger implants? Thanks

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Posts 31 - 47 (47 total)

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Dec 5, 2020 09:37PM - edited Dec 5, 2020 09:46PM by MinusTwo

PeggysMom - for me, your answer to my questions I asked earlier are relevant to both the size and type of implant. It's difficult to discuss reconstruction when we have no idea the extent of your breast cancer and the prescribed treatment.

What is your diagnosis? How far along are you in the process? Have you had neoadjuvant chemo? Do you know if you will have chemo after surgery? Will you have rads? Are you HER2+, so will you have Herceptin?

If you've answer these in a different post, I apologize that I missed them. Rads certainly make a difference - whether before or after reconstruction.

Did you take a look at Whippetmom's site?

BTW - unless you're in a trial, most docs (MO or PS) do NOT recommend an MRI every 3 years for implant integrity. I don't know where you're located, but I live adjacent to the 1st of 2nd largest medical center in the US - depending on who's talking. The docs I see are pretty up to date & current in their procedures.

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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Dec 5, 2020 11:08PM - edited Dec 5, 2020 11:10PM by DiveCat

“unless you're in a trial, most docs (MO or PS) do NOT recommend an MRI every 3 years for implant integrity. I don't know where you're located, but I live adjacent to the 1st of 2nd largest medical center in the US - depending on who's talking. The docs I see are pretty up to date & current in their procedures."

In a different locale but I also have docs who are up to date and current (via high risk clinic) and this is not protocol here either (for myself or my sister). Nor does my PS recommend. I could/did get MRIs every year before my surgery but now they will only do if there is a raised concern, otherwise cohesive silicone implants are considered to be well, quite stable. Even with a rupture the cohesive nature of them means it is not going far...

Hereditary High Risk, Uninformed BRCA Negative Surgery 4/24/2014 Prophylactic mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 3/12/2015 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 11/14/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 7/9/2020 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting Surgery 12/11/2020 Reconstruction (left): Nipple tattoo; Reconstruction (right): Nipple tattoo Surgery 3/4/2021 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting
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Dec 6, 2020 04:46AM Rah2464 wrote:

Peggysmom I also had nipple sparing direct to implant, however my implants are quite small. I remember in discussions of types of fill that my PS was against saline implants if placed pre-pec. She said you will hear way to much sloshing. I think would be an even larger concern with the bigger implants. Also, if you have a lumpectomy first that may change a little bit your final size. Or you may need to stretch the skin a bit before final surgery so that the tissue will hold properly. I would imagine the biggest challenge would be for the PS to build a secure enough internal sling with alloderm to support a larger implant.

I wish you great success in your journey to get the outcome you desire. It is rarely for any of us a single surgery to perfect outcome. Keep pushing to find a strong fit with your surgeons.

On a side note about the imaging, my original tumor was close to the chest wall, and the only thing my surgeons discussed was pre pec placement. I have had one MRI since the original surgery (at 2 years out). I thank everyone for the information that I will need to push for that type of imaging every three years.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 6/27/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 7/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 6, 2020 11:31AM peggysmom wrote:

Rah2464:

Thank you for your kind words, well-wishes, and for filling me in on your pre-op discussions, it's so helpful!

May I ask if your original cup size was small or did you have to go smaller in order to be a candidate for direct-to-implant? I'm catching up w/ my breast surgeon tomorrow morning for a few minutes to figure out some action plan (it's been 6 weeks).

Oh and BTW as far as I know insurance must cover MRI screening every 3 yrs for implant integrity, the indication by the ordering doc has to say something to the effect of "clinical concern for rupture"- I'm sure they know that so hopefully won't be a fight for you to get those in the future.

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Dec 6, 2020 11:37AM peggysmom wrote:

@minustwo:

For women with implant-based reconstruction the FDA recommends MRI screening for "silent silicone implant rupture" 3 years after reconstruction and every 2-3 years for the remainder of the lifetime of the implant. These studies are covered by insurance as long as the indication is clearly communicated for "rupture". I am in the USA and we follow this paradigm at our institution and multiple such studies are performed daily. Not sure where you live, but this is the FDA recommendation. Whether or not your MO and PS follow these recs is another story.

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Dec 6, 2020 03:13PM MinusTwo wrote:

Well I certainly trust MD Anderson & Baylor, both of which are NCI designated facilities. Are you associated with an NCI facility

Also I have cohesive gel silicone implants, so they don't "rupture". A chunk might break away, but nothing floods into your body. Wondering if what you're following is for the old "liquid" silicone implants?

And why in the world would I want to go through those obnoxious MRI tests every 3 years - even w/o contrast? I'm seen by several docs every year and have in person manual exams. Any one of them would be able to feel a floating hunk of silicone - as would I for that matter. To increase my comfort level, I did have an ULS and a Breast MRI after 9 years. Going forward I will have an ULS every other year.

>>>Whether or not your MO and PS follow these recs is another story.<<<

You really should take care not to malign other patients doctors.

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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Dec 6, 2020 04:24PM exbrnxgrl wrote:

I am also at at NCI affiliated site and I know of no one who has an mri every 3 years to check for integrity of the implants. Like minus two, mine are cohesive gels so there would be no leaking and i’m not sure how big a rupture in the shell would have to be to be detected. I am not saying that there isn’t anyone who doesn’t get regular mri’s to check for implant integrity but in my 9 years on bco I don’t recall hearing that mentioned. All the best

Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur Dx 7/8/2011, IDC, Left, 4cm, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Surgery 9/7/2011 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Dx 11/2011, IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 11/21/2011 Arimidex (anastrozole) Radiation Therapy 11/21/2011 Bone Hormonal Therapy 6/19/2014 Femara (letrozole) Hormonal Therapy Aromasin (exemestane)
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Dec 6, 2020 05:04PM peggysmom wrote:

I really can't stand some of the attitudes here, it just ruins it for all the other lovely supportive people on this forum.

I've bit my tongue with all the passive-aggressive comments and attitudes towards me. I've ignored women assuming the role of "experts" all the while misinterpreting data from studies they link and all the advice posts from non-physicians who are advising without expertise or credentials.

This is my specialty- I work at an NCCN cancer center and these are the FDA recommendations. Whether or not your MO and PS follow the FDA recommendations in practice, is their decision.

Now i'd really appreciate if you could start your own post if you'd like to continue debating that point. Or even better, please don't comment if you don't have anything positive or supportive to say. This thread has been hijacked it's for my question about womens experience direct to implant sizing

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Dec 6, 2020 05:44PM Beesie wrote:

peggysmom, I'm just a patient, as are most of us here. We are sharing our personal experiences and learning. That's what this discussion board is all about. It is understood that we are not doctors or experts, just patients who are trying to help and support other patients. Because we've lived through this and are basing our opinions on our experiences, in some cases our positions on things and our attitudes might be different than that of a doctor. That's doesn't make us wrong - we are just approaching these situations from a different perspective. Personally I think I'm reasonably good at digging through research (I do have a professional research background) but I know that I might be wrong, which I why I try to include links to my sources whenever I can.

So, some links:
From the FDA:

Breast Implants - Certain Labeling Recommendations to Improve Patient Communication Guidance for Industry and Food and Drug Administration Staff Document issued on September 29, 2020. https://www.fda.gov/media/131885/download

A. Rupture Screening Recommendations Update
We recommend that the physician and patient labeling for silicone gel-filled breast implants include the specific, updated rupture screening recommendations as shown below:

Physician Labeling:

For asymptomatic patients, the first ultrasound or magnetic resonance imaging (MRI) should be performed at 5-6 years postoperatively, then every 2-3 years thereafter.

For symptomatic patients or patients with equivocal ultrasound results for rupture at any time postoperatively, an MRI is recommended.

Patient Labeling:

It is recommended that you have periodic imaging (e.g., MRI, ultrasound) of your silicone gel- filled breast implants to screen for implant rupture regardless of whether your implants are for cosmetic augmentation or reconstruction. These recommendations do not replace other additional imaging that may be required depending on your medical history or circumstances (i.e., screening mammography for breast cancer).

Even if you have no symptoms, you should have your first ultrasound or MRI at 5-6 years after your initial implant surgery and then every 2-3 years thereafter. If you have symptoms at any time or uncertain ultrasound results for breast implant rupture, an MRI is recommended.

It appears that the ACR does not agree with the FDA, if I am interpreting the following documents correctly (perhaps I'm not). This might explain the real life experience of many of us who have been living with implant reconstruction for years and have not been getting MRIs every 2-3 years.

American College of Radiology ACR Appropriateness Criteria® Imaging after Mastectomy and Breast Reconstruction https://acsearch.acr.org/docs/3155410/Narrative/

American College of Radiology ACR Appropriateness Criteria® Breast Implant Evaluation https://acsearch.acr.org/docs/3100728/Narrative/


Okay, I will exit stage left now, and promise that I won't post in any of your threads again. My sincere apologies for raising a topic in your thread that I honestly thought was relevant to your decision. I wish you well and hope you get the support here that you are looking for. This really is a great site.


“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Dec 6, 2020 06:19PM peggysmom wrote:

Thank you

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Dec 6, 2020 06:57PM exbrnxgrl wrote:

peggysmom,

I am not sure what’s upsetting you (well, bc of course). As Beesie said most of us are not medical professionals but simply offer our personal experience and support. We were simply relating our own experiences as we know them. Your information indicated something different than most of us had experienced or heard of and we simply stated that. As to going off your original topic, yes that can and does happen with varying frequency on bco and many other forums and is usually a no harm, no foul sort of situation. Again, this is not a place for medical advice, though I am sure you’ll get lots of opinions, but simply to share experiences and support. I saw no passive aggressive comments or attitudes that one couldn’t stand. Again, we all have breast cancer and are simply relating our own experiences. I hope you found some calm and peace as you go through your decision making and tx

Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur Dx 7/8/2011, IDC, Left, 4cm, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Surgery 9/7/2011 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Dx 11/2011, IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 11/21/2011 Arimidex (anastrozole) Radiation Therapy 11/21/2011 Bone Hormonal Therapy 6/19/2014 Femara (letrozole) Hormonal Therapy Aromasin (exemestane)
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Dec 6, 2020 07:07PM peggysmom wrote:

I'd like this post to get back to the topic at hand: experience with sizing & direct-to-implant reconstruction for larger breasts. Thanks

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Dec 7, 2020 12:19AM - edited Dec 7, 2020 12:24AM by exbrnxgrl

Yes, m'am !

Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur Dx 7/8/2011, IDC, Left, 4cm, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Surgery 9/7/2011 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Dx 11/2011, IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 11/21/2011 Arimidex (anastrozole) Radiation Therapy 11/21/2011 Bone Hormonal Therapy 6/19/2014 Femara (letrozole) Hormonal Therapy Aromasin (exemestane)
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Dec 7, 2020 04:37AM Rah2464 wrote:

Peggsymom -

I was small breasted, my PS classified me as A+ and I think she was being generous (ha). She put in 255 cc implants pre pec and those really stretched my skin a bit. In my (completely uniformed ) opinion, that extra stress may have contributed to me having a highly sensitized response to the surgery. I wound up with lots of scar tissue and nerve challenges. Although in reading I have come across information that this response tends to be more significant if you are a thinner person which I am.

I just completed a revision surgery in which my PS removed the old implants, cleaned up the scar tissue, and placed new in. This time preoperatively she gave me gabapentin because of my history of high nerve irritation. She also sent me home with some to take for a few days. It seems to have helped greatly. I am 2 1/2 weeks out and feel so very much better.

I don't know how much the larger size implants weigh. I would think the limiting factor in size is going to be how much weight the internal sling can support. I hope you find a very creative surgeon although you may have to approach this in phases. Please let us know how your discussions go I am sure there are others out there who have similar questions.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 6/27/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 7/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 7, 2020 10:41PM peggysmom wrote:

Rah2464: Great to hear you feel so much better with the revision/new implants. I'll keep looking for a surgeon that is a good fit. Thanks!!

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Feb 11, 2021 04:14AM Rbaltzley wrote:

Good Morning and I love this topic. I just finished having a lumpectomy in October 2020 and will be getting a double mast here soon. I just wonder since I had prior implants and they were removed at that time why I need expanders in. Funny thing is, even though I had some tissue removed and moved around to fix the indent from mastectomy he reccommened 800 cc which is crazy, he said I have a big chest wall. Funny thing is, my last set of implants were only 500 and they were big enough. Decisions..decesions

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Feb 11, 2021 03:32PM Moderators wrote:

Rbaltzley, welcome to our community. If we understand correctly, you had a lumpectomy with some reconstruction to fix the indent, and you're now getting a double mastectomy. There are many decisions to make, indeed. Here is an article from our site on Implant reconstruction. It may be helpful to get a second opinion from another plastic surgeon to help you to make the best decision for your body, and situation. Glad you found our community.

To send a Private Message to the Mods: community.breastcancer.org/mem...

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