BREAST IMPLANT SIZING 101

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  • bobeena
    bobeena Member Posts: 56
    edited November 2011
    Whippetmom- I have been following this forum for a while, and posted back in july with a question about delayed reconstruction after skin sparing mastectomy.  I had my BMX on Aug 31 and now have my expander surgery book for the middle of this month.  I am 5'8" and 125 lbs.  my rib cage is 75 cm where my bra line is.  I have told my PS that I don't want to end up a DD (although my husband probably wouldn't mind Wink)    I'm sorry but I don't know much details about the expander he plans on using, other than the volume is 450 cc (which he will over fill) and my exchange will be with gummybear implants (when the time comes).  My question is does this volume seem reasonable for me?  Is it too large?
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  • mamachick
    mamachick Member Posts: 229
    edited November 2011

    Any thoughts on Dr Robert J. Allen?  He works out of Charleston, New York and Louisianna.  Sent my info to see what they say about DIEP.

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011

    mamachick:  He is very good and certainly world-renowned in the perforator flap procedures realm.  You would do well to get in to see him.  You are in the right area of the U.S. indeed.

    http://www.diepflap.com/

    Deborah

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011

    mamachick:  You go girl!!!  Don't give up until you are happy!  Absolutely!  It sounds to me as though your PS should have either reduced the skin flaps you had, or he used too large an expander and overfilled you beyond what could be filled up by an 800 cc silicone implant.  So because the pockets are too large, the implants tend to migrate laterally towards the armpits.  You are prime for a new PS and a new vision towards better results cosmetically.  Keep us posted on how you are doing!

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011

    bobeena:  I think that 450 ccs sounds good for your frame for TE volume.  I think probably with a width between 12.5 and 13.5 cm - you would be just fine.  No TEs over 14.0 cm in width. So with gummies, this would put you in the high 300 gram or lower to mid 400 gram range with implants.  I would not want to be over 470 grams with implants [if gummies], based on your sizing goals.  Once you get the TEs and start expanding, you will have an idea what to expect and we can go over the numbers again.

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  • christine47
    christine47 Member Posts: 1,454
    edited November 2011

    mamachick, how far are you from Charleston, SC?  I think you have several groups of good DEIP surgeons there.  I am in NC (5hrs from Charleston), and am totally serious when I tell you I would meet you there and stay with you a few days to help you.  I will tell you my fat grafting gave me some more "umph", I am not quite bodacious, but did know I wanted to look down and see breasts, not belly.  We are young, strong and deserve to look and feel the best we can be. 

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  • mammalou
    mammalou Member Posts: 823
    edited November 2011

    Thank you whippet mom. Now if I just knew what it all meant! I never knew there was so much to this. I have 525 cc in there now. How much more do I fill for a c cup?  They are getting worried that I can't stretch much further. I had a lot of skin removed and I am extremely tight. Do the TEs closely approximate the ending size?

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  • bobeena
    bobeena Member Posts: 56
    edited November 2011

    Thanks Whippetmom!  I feel more at ease with your approval of the size of TE. 

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011

    christine....You are so amazingly sweet to make that offer to mamachick! 

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011

    mammalou:  In order to approximate what you have now - width and projection, you would need implants with a volume of around 600 ccs or 650 ccs - high profile implants.  What would best approximate this would be Allergan Style 45 implants - However, your PS is not going to use implants that large, because of your history of radiation.  He wants to ensure good skin closure over the implants and so he is overfilling you a bit and he also wants to try to get a little natural droop.  So he will likely use implants in the midrange profile - such as Style 15.  If he used high profile implants, they would need to be 600 ccs in order to match the width of the TEs.  Many of us [possibly over half] who have smooth round silicone implants, have implants with greater volume than the TEs.  So you need to talk to your PS about what he has planned.  See what he suggests using and then you have room for discussion.

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  • YamahaMama
    YamahaMama Member Posts: 221
    edited November 2011

    Haven't posted recently, but have been trying to keep up with reading the thread, at least!  Thank you to EVERYONE for the support, thoughts, and prayers for my sister and I!  It means a lot...  I've been very introspective, trying to decide on having another surgery, BRCA testing, and feeling very confused, but I know I'm not alone in my confusion...  BC is a confusing journey for us all, and I am thankful for my "sisters" here! 

    If all goes as planned, my "double" sister and I will be having surgeries the same day, same time, and same plastic surgeon, but different places.  Will be interesting to see how we pull that off!  Tongue out  Actually, the original plan was for the PS to do my exchange at one facility while sis is having a BMX at another facility a half-mile away, then the PS would go there and complete sis's TRAM reconstruction surgery.  However, I've decided to go ahead with a UMX on my other side, so I'm afraid the times might have to be adjusted somewhat...  We DO have different general surgeons, so hopefully we can still make it work the same day!  And, since she's going to have to spend more time in the hospital, I can swing by and see her on my way home, since I'll have to drive right by it!  LOL! 

    Insurance has approved the BRCA testing, and just waiting on approval for the prophylactic MX...with the blessings of my oncologist and surgeon.  I need to go back to the picture forum and ask for advice again, since I'll now be a "bi" instead of a "uni!"  So, with any luck, I'll be half-squishee on November 14! 

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011

    Natalie:  Amazing! That could be one for the Guinness Book of World Records if your PS could pull that one off.  And you will be having a PMX as well!  You are on a roll woman! 

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  • Eema
    Eema Member Posts: 493
    edited November 2011

    Whippetmom, I think my question got lost, so I'll ask again, you think I should go with smooth...?



    Thanks!



    Eema

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  • Lilah
    Lilah Member Posts: 4,898
    edited November 2011

    Eema -- I'll go out on a limb and say that Whippetmom always thinks people should go with smooth :)  (I've seen her post this before)... The only exception is when implanting an anatomically shaped implant (textured is necessary for these to keep them from turning in the pocket).  But of course wait for her specific reply to you ...or PM her.

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011

    Eema:  Lilah is correct.  Smooth. Did you read my response to you on November 3rd?  I gave you some data regarding the efficacy of smooth vs. textured implants.  Go back through the posts and find it....

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011

    SMOOTH VS. TEXTURED IMPLANTS:

    Read what some of the top plastic surgeons have to say.  There are some differing responses, but I think overwhelmingly "smooth" is the preferred surface.  I do find what Dr. Chong states regarding droopy breasts and the use of textured implants.  Remember that she is referring to augmentation, not reconstruction.  But it might be a consideration, if those reconstructed, ptotic breasts have quite a bit of adipose tissue overlying the chest wall.  Perhaps this is something to think about further. 

    http://www.realself.com/question/pros-cons-textured-vs-smooth-implants

    Deborah

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  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited November 2011

    Whippetmom, PS is combining my exhange with my nipple recon since my insurance is changing and I won't be able to afford the deductable on the new insurance - do you think they will change that much after exchange, or hopefully all be okay?   If it makes a difference, I have had no problems with my TE's and they have been in for 6 months and they look quite good (even cleavage).

    He is going to put a larger size implant in the rads side since it is a little smaller than the other .   I am nervous because I know the exchange is normally not combined with nipple recon but I have no choice.  

    He will use mentor HP 600 or 650, I think (smooth).

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011

    Fearless:  I think you should be just fine.  Your TEs have been in for quite a long time and you should not experience a great deal of change, if any, once things settle.  So go for it!

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  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited November 2011

    Thank you, Whippetmom.....

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  • Hindsfeet
    Hindsfeet Member Posts: 2,456
    edited November 2011

    whippetmom...you should be paid for your services. You hold our hand through all this and give such excellent advice. Thank you!

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011

    I am richly rewarded every single day, evebarry!  Wink

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  • mamachick
    mamachick Member Posts: 229
    edited November 2011

    Thanks Whippetmom, sorry, was out of town for the weekend.  I am hoping they will review my info and get back to me about Dr. Allen.  Just trying to weigh my options.

    Christine- you are so sweet!!!  I am about 3 hours west of Charleston in Greenville, but if this is the best option I will try to swing it some how. 

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  • tracie23
    tracie23 Member Posts: 598
    edited November 2011

    I have a question.... why do you get fat grafting?

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011

    tracie: Fat grafting has been utilized to fill in ripples and/or contour defects which occur often due to thin skin, a mastectomy defect or other chest wall issues which might cause a step-off deformity above the implant.  Additionally, fat grafting has been employed to soften the skin following radiation....

    http://community.breastcancer.org/forum/70/topic/744891?page=1#idx_25.

    Doctors are also using autologous fat graft transfer to build up a breast mound after mastectomy or in place of implant-based reconstruction.  There are a couple of threads discussing this topic here on bc.org. 

    A couple of abstracts/articles on the subject:

    http://www.sciencedaily.com/releases/2008/10/081008114408.htm

    http://asps.confex.com/asps/2008am/techprogram/paper_14796.htm

    Deborah

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011

    The one link above is to a thread entitled "Fat Graft Transfer and the Radiated Breast"....and maybe Lago will come along and fix the link for me.....Undecided

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  • lago
    lago Member Posts: 17,186
    edited November 2011

    http://community.breastcancer.org/forum/70/topic/744891?page=1

    Fixed. BC.org doesn't like long links

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011
    Lago: Kiss
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  • Crescent5
    Crescent5 Member Posts: 442
    edited November 2011

    Whippetmom, I just wanted to thank you for all the help via email. You truly are an angel. =)

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011
    Innocent
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  • whippetmom
    whippetmom Member Posts: 6,920
    edited November 2011

    Yes, well, today you would hear a great big snort from my husband, if he saw that halo!

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