BREAST IMPLANT SIZING 101

curveball

lago wrote: Uni's can be done if you got to an experience surgeon. Check out this example here 

Yes, they are symmetrical, but the caption says that the right breast was lifted in addition to the reconstruction on the left. In fact, all the case studies on that website were either bilateral or the unaffected breast was altered to match the implant. I'd like to see photos before that was done, but maybe there aren't any. When the natural breast is lifted, isn't that often done at the same time as replacing the TE with the permanent implant?

whippetmom

mammalou...



Your TE size and degree of overfill sounds fine to me. 14 cm width is just right for your ribcage. I cannot predict though the outcome referable to the native breast. It is up to the PS to determine how much he needs to reduce that breast to achieve symmetry. But the numbers on the MX side sound good. I envision a moderate plus profile implant - e.g, Style 15 in Allergan - at around 533 ccs. He might be able to use a high profile implant - Style 20, 600 ccs would match the width of the TEs. Or, does your PS use anatomicals? But talk to Lilah. She is a uni, and had a reduction of the native breast. My prediction is that with either size of implant mentioned above, you would be a healthy C cup.

Lilah

Curveball -- I'm a uni and my before was quite droopy!  I needed a lift (and reduction) to get a match (and I would say my natural breast still has more ptosis than the implant).   I've seen very good uni matches but either a lift (and sometimes reduction as well) is required or, in the case of some small breasted women, a slight augment to match things up.  With that said, there are women who do neither and achieve symmetry (or don't and don't care, preferring to leave the native breast untouched).  In a bra you get evened up anyway (with respect to droopage).  And as for me I'm glad I had the lift/reduction because I look much better regardless.

t43179

I talked to my PS yesterday and asked him again if I shouldn't go bigger since I like the expanders that are overfilled by 30cc's.  He told me if I go bigger than 350cc's he would need to mess with my pockets which could cause problems.  Has anyone heard this before?

GreenMonkey

MonkeyME, home from the hospital! New hospital, new doctor, new TE's.  Now their both up where they should be and they're even!!! Glad I did it.  

GraciousGal

I'm scheduled for my exchange surgery on May 14th. My TE's are the Mentor style #7200, medium height with recommended fill of 450 cc's. My final fill (April 3rd) got me to 640 on the left, 620 on the right. My PS plans to put 600 cc silicone, high profile implants in. I am 5' 6" at 160 lbs. I'm trying to get down to 145 or 140 but that will be sometime after the surgery, I'm sure. My ribcage measures 31" under the TE's. I'm long-waisted (15" from hollow of neck to belly button). What is your recommendation for the implant size. I'd like to be somewhere close to a D cup. I'm happy with the TE size - even thinking they are kinda large now. But I know it's due to the overfill that my PS wanted. Thanks in advance for your input. It's been a rough journey and it is nice to see a light at the end of this tunnel.

christine47

mammalou,  I am about your size (height and weight, maybe just a few pounds less), anyhow, I am a bmx and have 600cc High profile Allergan implants, they are perfect, I wear a C or D cup.  Not sure if this helps, just my 2 cents.

Lilah

t43179 -- when I went in my PS took in a few sizes and told me she would see what fits.  How does he know exactly what will fit before he removes the TEs? 

Whippetmom?  Can you explain?  Isn't it common for a PS to bring in a few different sizes and see?

lago

Lilah your PS had experience. He chooses TE's with implant sizes in mind.

GraciousGal

Lilah,

My PS told me that he uses "sizers" to try out what will work. Then he has someone open the sealed implants the size that he decides will work the best.

marial

Yes, after filling to 600cc, my plastic surgeon said he would take in a few sizes and would use sizers..we also had a discussion and he knew I wanted to 800cc if they fit ok..and that's what I ended up with..my 600te were too small for sure

whippetmom

Lilah:  Yes, the PS should order a number of implants and this is why they use saline "sizers" in the OR.  It is a bit different with anatomicals, because your PS had more options to consider which might work from a width standpoint - whereas with rounds, if we look at midrange plus or high profile, there would only be two choices.  The width of the TEs is the guiding factor.  So let's say that the TE is a 13.0 cm TE.  An implant with a width of 13.0 or greater can be used - and this works best with a bilateral, because with a unilateral, the width of the TE has been selected based on the width of the native breast.  It is more exacting with a unilateral.  The implant should match the width or be somewhat greater than the width of the TE.

Carrol2

mkw I'll chime in mine shifted a little bit too. My PS mentioned it during my fills that it moved a few inches. Was not a problem at all.

t43179

My PS didn't mention that he had sizers.  He ordered my implants ahead of time and was matter of fact that he thought I need a 350cc.  Maybe not all PS's bring a different sizes to the OR. I don't live in a big city.  Maybe that has something to do with it.  I wish he would bring a 375 or 400 with him! 

maldvr2

Hi, Can you help me figure out what size and type implants I need.  My TE's are mentor, I believe full size.  They extend under my arms, come high on my chest and extends to where my bra band would be.  The TE,s are 450cc.  I am at 500cc now.  I am 5'3" and 145lbs. The measurement below my TE's is 31".  I am very concerned that they will come out large,round and flat!  I would like to end up around a large C.  I don't want them flat.  I want as natural projection as possible but at the same time I don't want them to narrow.  Can you please give me some advice?   Thanks!!  Annie

Blessings2011

Hi, maldvr2 -

I think you'll need to know the exact name and size of the TEs, because that tells whippetmom the exact dimensions (width, heighth, and projection) of the expanders (and the size of the pocket the PS has already created for you.) Mine were INAMED 133-MV/700s.

For the first few weeks, I had Sponge Bob Square Foobs. They were absolutely square and flat, and extended up to my collarbones and all the way under my armpits.

Later on, they took on the shape of diagonal loaves of French bread under my chest. Weirdest thing ever!

Now, finally filled to 620ccs, they look almost normal, and my PS and I (with whippetmom's guidance) have chosen implants that will give me the look and projection I want. Just waiting for exchange surgery!

whippetmom

Annie:  If your TEs are full height Mentor 450s, they would be 12.5 cm width and 6.5 cm projection.  I think 500 ccs in a high profile smooth round silicone implant would look nice on your frame.  In Mentor, this implant would be 13.2 cm in width and 5.3 cm in projection.  In Allergan Style 20, 13.0 cm and 5.2 cm projection. The additional projection of the TEs is necessary to provide ample implant coverage with the skin flaps. If your PS used Allergan, he could use a Style 20 high profile implant with a volume of 475 ccs, which is 12.6 cm width and 5.5 cm in projection.  But personally, I think you could use the 13.0 to 13.5 cm width just fine.

Deborah

whippetmom

GraciousGal: You are just fine with your plastic surgeon's plans for you.  I like 600 cc high profile smooth round silicone implants on your frame.  It will be even more incentive to get down to 145 pounds, because the implants will look larger as you lose weight.    It all sounds good to me!

whippetmom

Please note:

I am using my iPhone these days primarily for responding to posts, because I am away from home so much these days.  I am doing some design work again...

So if I miss your post and you have questions, if I have not responded within 24 hours, PLEASE send me a private message, reminding me of that post! 

Deborah

Fearlessfoot

Dear whippetmom & anyone else,

My plastic surgeon selection process went well after visiting three who had very different approaches and styles.  Two I really liked.  I selected the one who has the best working relationship with my breast surgeon.  However, I will meet with him again because I still have a lot of questions and hope there is room for negotiation.  He will use a kind of anchor shaped cut.  He will try to save nipple and areola (breast surgeon expects margins to be clean), but will have to move them up considerably due to the ptosis.  He does not believe in using acellular dermal matrices unless necessary and proposes to do a completely sub-muscular support using the pectoralis major, serratus anterior, and even the rectus abdominis muscles!  He said that the brand he prefers are the silicon gel Mentor cohesive.  I was dismayed that he could only offer A cup size like 225-280 cc.  This to me seems to small and I cannot imagine being happy with anything less than B-size cups, coming from my 34DD size.  He said right now, pre-surgery I am probably 400cc.  I am willing to undergo tissue expansion if needed to stretch the muscles to be able to have B size cups.  What do you think?  He says he studied under a famous NY PS named Bostwick (who has since passed away).

lago

Fearless I think my PS did the same thing because he never mentioned Alloderm. I went from a barely 34 A/B to a full 34D. I did TEs. I'm sporting allergen Naturelle style 15 mid-range profile 397cc. They are 13.1cm wide and project 4.2 cm. Is your PS using high profile?

I do notice when I use my pec muscles but it's getting less and less. June will be 1 year post exchange.

Estel

From my understanding and whippetom will clarify for all of us - the complete sub-muscular placement of implants is rare.  Again, from my understanding ... most of us have the bottom part of the implant under the muscle, but the top part is not.  I think for both partial and the complete ... we are going to have distorment issues when the pec muscle flexes.

I totally agree too with kayb that you need to understand fully what it is going to mean to have those muscles displaced.  I worked out 3x a week with weights before my surgeries ... huge part of my life ... and I can do next to nothing what I was doing before with weight training.  You need to know the full implications of what he is going to do ... don't want to scare you but you need to know.   

TinaT

Dawne-Hope - You said, "...most of us have the bottom part of the implant under the muscle, but the top part is not".  Didn't you mean just the opposite?  The Alloderm (or other matrix material) sling is like a hammock that supports the implant along the bottom and sides because there is no muscle support in those areas.  At least, that's the way my surgery was done.

Seems if a PS is intent on a completely submuscular implant it would end up being pretty small even with some stretching.  I hadn't heard of this approach...

lawyerrunnergirl

Hello BC Friends!  I am trying to figure out how many CC's I need to get back to my 32C size after bilateral mastectomy six weeks age. My plastic surgeon says he can't answer this. I have tissue expanders right now, and they are so strangely shaped that I'm not sure if I can tell if I'm the right size based on how they look.  Won't the implants look different-more round and less like footballs.  I've tried on my pre-surgery bras and they seem to be filled at my current size, but friends tell me I'm not as big as I was before.  All the pictures I can find online of implants with cc's listed are for augmentation, and those women have their own tissue with the implants, which makes it impossible to tell how they would look without the tissue or what size they would be.  Please help!!  Any input on your bra size and number of ccs would be greatly appreciated!  If I get enough information, maybe I can get comfortable with how many ccs I need!

Estel

TinaT - No, I meant what I said. We'll see what whippetmom has to say. 

Estel

Tina, I've done a quick search and I think I am wrong and you are right.  I'm such a visual person ... what I wrote is how I always pictured it ... but according to this page I am wrong:

http://www.implantinfo.com/breast_implants/partial_submuscular_breast_implants.aspx

whippetmom will set me straight.  Sorry for the confusion. 

Edited to add:  But that link is for augmentation, not reconstruction. Hmm... now I'm really curious.  The researcher in me wants to know!     

whippetmom

Monkey: I hope you are going to send photos to your prior PS.... I am glad you went through with the correction surgery also.

whippetmom

Lawyerrunner...as kayb stated, read the header - especially #3 - provide the info and I can help you with sizing.

whippetmom

A "submuscular" placement is typically used to describe placement where the Implant is covered in the top two thirds by the pectoral musculature. An older method of placement, which indeed is rarely used today ( with the advent of dermal matrix materials like Alloderm) is know as "complete submuscular" placement. The top two thirds of the implant are still under the pectorals, but the lower pole is placed under the anterior serratus and rectus abdominus musculature. My sister has this latter placement. She had an "old school" PS.

Fearlessfoot

whippetmom & others:  thank you so much for all the info. 

Measurements: under bra line rib cage: 30 inches, height: 5'7", weight: 133 lbs

In my initial meeting with PS, he said he recommends Mentor silicon gel cohesive, 225-280 cc.  But I want to have a B-cup size.  I currently wear a 34 DD bra. 

The PS said he doesn't like to use acellular dermal matrices (ADM) like Alloderm or the porcine-derived one used in Switzerland, Strattice, because they are additional *foreign materials" and do not have immediate blood supply to prevent infection and deliver antibiotics to skin.  Because I have significant ptosis, my surgery will involve cutting out and moving the nipple-areola to a higher spot and then a type of anchor cut and stitching under the lower half of the breast to eliminate excess skin, and here the risk for necrosis of the skin is very high.  He says using musculature for the support rather than the ADM will be better for this providing blood supply to the area.

But I think he was envisioning immediate placement of the implant and that is why he said it could only be an A-cup. I really think this will be too dramatic a decrease for me. When I look at B cup photos, I feel much better about it. I think this means that I will have to consider using tissue expanders to be able to reach a B cup under complete submusculature. I need to have further discussions with him about ADM vs. compl.submusc. because as a few of you have pointed out, that placement is very "old-school" -- although sometimes the old-fashioned way can be of good quality and better in some ways, I can imagine.

Can you please explain how to access the photo section that has been referred to?