BREAST IMPLANT SIZING 101

Yaniza

Whippetmom, of course you're right and with your help I have allowed logic to prevail. I too don't expect perfection at the end of the day just an improvement. It's gratifying to know that your sister's situation improved even with all unders.

Gratefully , Yaniza

Remi50

WOW.... YOU ARE A GIFT☀️☀️☀️ I wish that I could have settled my mind down right after the April 5, 2016 prophalctic and converse with you. BIG MISTAKE.. I may have had to agonize about making another decision but at least I could have had time to process what you and a lot of incredible woman offer with compassion, experience and technical expertise on this thread. I was immediately faced with the fact that hemo onco wanted me back on a AI 6 weeks before this surgery.. I was consulting with my breast surgeon because I was left so sick from the initial anazatrole. They were very against me starting another AI so close to surgery so I was concentrating on building my physical strength and agonizing over oophectomy decision. (Still haven't made it yet). So that was something I had to deal with immediately out of the gate from prophalctic mastectomy.. Followed by letting everyone step in and coordinate my only daughter's wedding shower... wedding July 30. (was postponed from last July due to my bc diagnosis). TOTAL OVERLOAD. Upon my breast surgeon's request(she's awesome and an angel), I was also in discussion with a gyn onco about oophectomy because of horrible SE from AI 's and inability to tolerate them. Next two AI's turned out to be as debilitating. Tomoxafin no go because I had a stroke 6 weeks before finding out I had breast cancer.. I was 49 at the time, healthy so I thought, played tennis, run/ walk, kayak , etc (work full time) and no residual effects. I had to step back and take a deep breath and a leap of faith. So I made another consult with ps and discussed at length with her 2 nurse pracs. They basically said it was out of my hands. That it would be a mute factor due the fact of seeing what things were like once inside. I was relieved not to have to make another decision as I still have many more to make. I also felt that they said I would have more upper pole fullness with anatomical so I kind of thought maybe this will work out the way I want it. Is that a true statement about anatomicals giving a fuller upper pole than rounds? Then the The million dollar question, " am I totally overthinking this?". At what point do you step back and have faith and be grateful to have reconstruction even if it's not perfect. For some reason I can't let it go and embrace what I have. We may have no idea how things will turn out and many of us woman catastrophize the worst. (Speaking for myself but I'm sure many of you can relate). I don't mean to go on and on.. we all have a story and one worth hearing!!! I am enamored with your knowledge and wisdom you have to offer all of us. Thank you so much for responding to me and I will send pics to you within the next few weeks..Feeling Grateful for all of you!! Maybe things will turn out ok.. Taking one day at a time and realizing it's OK to want more!! Time however can maybe help with accepting all of this! I have to practice being patient and stop and smell the roses!! I learn something worthwhile and positive everyday on these threads!! I will strive to give back as much as get here!

Remi50

Yaniza

Me too RemI. I wish I had joined this forum before my surgery but everything was happening so fast that my brain was on overload. And we still have to deal with the day to day.

Whippitmom, on a different but related topic... what is bottoming out?

whippetmom

Remi: Just get the oophorectomy....it is a piece of cake. I would not do AIs because of my severe osteoporosis. Have a clear conscience so that you can be assured you have done as much as you are equipped to do, without having to suffer further. If you would suffer with the AIs....the ooph is a pretty easy recovery and no "side effects".

It is not true that anatomicals have more upper pole fullness than rounds. Perhaps some styles - like the MX - might, but much of it has to do with our chest wall characteristics, weight, height, placement of the implants, skill of the surgeon, etc. But you can step away from the mirror for awhile and let everything settle. Keep us posted!

Yaniza

Whippetmom, I just looked up bottoming out. It struck a nerve because my PS recently mentioned loosening the muscle at the bottom and I interjected with "and use alloderm ? ", and he replied, " no your skin is fine". Initially, before surgery he told me he was using alloderm... then of course he went all under the muscle so not needed. I am not sure what loosening the muscle means if not detaching it from my chest wall. He then said he would determine the implant size during surgery based on his measurement of 12 cm diameter for the implant. I'm repeating myself I am sure when I say he will not be making any more decisions while I am unconscious unless it is an emergency.

Yaniza

whippetmom

Yaniza: I am not sure what he means either, because he made so many changes after having told you his plan for reconstruction.

Sweetbea

Hi Ladies, new to all of this. Month ago had full mastectomy of right breast, nipple sparing prophylactic mastectomy of the left. TE's put in during surgery along with alloderm webbing. I believe TE's are Allergan 133MV-12. Had 60 cc's put in during initial surgery, another 60 a week later, then 70 and last one was 90 so 280ccs at the moment. I've hardly looked since surgery,still too hard. Just found out no chemo!!!! I'm 5'1", 125-130 pounds and 31" ribcage. Pre bmx I was wearing a 34C, sometimes B.

PA has been doing fills and wants me to chime in on how I like size. How do I tell??? The TE sit up high and are wide at the top. The right 'bad' breast is also a bit smaller and higher than the other one. I assume due to the nipple removal? They just look very strange right now. I look like a baywatch stripper in a v-neck since they sIt so high up. I think they guessed 2-3 more fills. After weekly fills PS waits 2-3 months for exchange. Original convo with PS she recommended anatomicals and do want a more natural look, just a little fuller and perkier. How will I ever be able to say I like the size, we're there? They're so oddly shaped and positioned that I can't even imagine it. Also, does the nipple spared foob look larger because less tissue was removed?

So sorry to have joined this club but thankful there are so many amazing women supporting each other.

whippetmom

;Sweetbea: I noted in your post that you stated: "Original convo with PS she recommended anatomicals and I do want a more natural look, just a little fuller and perkier." It is a misnomer that you will get "a more natural look" with anatomicals. You might, in fact, get a more natural look with smooth silicone rounds. It all depends on the style and volume of the anatomical, and it depends on your chest wall characteristics and body habitus. In my opinion, anatomicals work for some but not for most and rounds work for most but not for some. I personally would prefer smooth silicone rounds, Allergan Style 20, 425 ccs to 450 ccs. Or Natrelle Inspira, smooth round SRF, 415 ccs. If anatomicals are preferred, it depends on whether you are overfilled and have enough skin coverage for a MX style implant.Your choice would range from a 133-MF or 133 MX - all in the 325 gms up to the higher 300 gm range. A MX style would be preferred, for the width to projection to height ratio.

Remi50

Whippitmom,

Thank you again for listening.. I will keep my posts shorter (hopefully) at this point.. I will send pics next week once I have the bandages off.. I'm pretty sure I had at least 2" more projection. 1 " projection further (each breast) . I'm so anxious that I did not write down what I measured the morning before exchange.. Would that make a big difference for you in deciding what size I can go with and what style or do you determined by the style of TE's and how much they are filled? I feel liked I failed by not writing them these measurements before exchange so I have the proper info for you. Will the pics help in deciding as well?

Remi50

Remi50

Whippitmom,

Do you have a comment on my ps's statement to determine what she felt were the best style implants?Surgeon expressed that she thought anatomicals were a great way to go because they had best results in deterring rippling. Curious because I have some major rippling on front and inner breasts. Almost like too much skin left over... Any thoughts?

Thank you also for the encouragement on oophectomy.. I'm just so afraid I will have depression due to no estrogen. Yet, that's my best fight of no reaccurance. Yet, I am on lupron shots so supposedly that is a good treatment and reduces estrogen significantly resulting in acceptable treatment according to the docs... A lot of docs do not think prophylactic oophectomy is necessary. That lupron is a good alternative. I am not depressed at all on lupron.. Only when I start the AI's . It's so confusing. ie: Even the docs don't think prophalctic mastectomies are a way to go. Out of all my docs only one felt I was making a good decsion. I am so glad I made the decsion to do so as they found multiple ares or Radial scarring and LCIS a precursor to bc.. Have you ever heard any comments on depression and oophectomies and can you suggest a good thread to post on? May as well get some feedback while I'm waiting to get the appt. for oophectomy..

Remi50

MinusTwo

Remi - don't forget - step away from the mirror. As Whippetmom said, it will be more than a month with anatomicals before you will be able to see the outcome. So pictures at 6 weeks might be relevant. Yup - its REALLY hard to do. We've all been there!!!

Paxton29

I'm always amazed at everyone else's sizing. I just had my exchange and wound up with Sientra textured shaped, 270 cc on right and 320 cc on left. I'm three days post exchange and they look fine to me, symmetrical and roughly the same size as I was pre-BMX, big B. I'm 5'11", 136 pounds. I think my PS did a good job; I didn't have much skin, I think. Anyway, I'm grateful!

Andraxo

Beanybaby - sorry for delayed reply, I was away at a therapy conference. I like the shape of the gummy bears. Rounds don't make sense to me, especially being placed over the pec...too much projection at the top and I have so little body fat for fat grafting to conceal it better. I think they would look unnatural and ridiculous on my lean athletic build...I think I'd have actual cleavage, which I don't want. The gummy bears look like the shape of my natural breasts before mastectomy. My personal risk of recurrence per med onc is 1% in the next 5 years. No routine scans are planned during that time. At my next f/u in Nov I will ask what happens after 5 years when my risk is unknown. I'd likely push for MRI screening because I doubt I would ever be symptomatic until it was way too late.

Remi50

thanks minus two.. I will try to keep this in mind..one day at a time!!

Remi50

Yaniza

Hi Whippetmom. If I was 25 pounds heavier... say 139 pounds at 5'7", my ribcage circumference would be larger. How is this measurement used when determining the base diameter of an implant.? Does the the base diameter of a person's natural breast change with weight changes or is it just projection and/or volume that changes?

I hope I am explaining myself clearly enough.

Thanks,

Yaniza

yogadedra

I am kind of embarrassed to give my measurements as I am a bigger woman. Please don't judge me. I weigh 225, 5' 5" and my rib measurement is 39". My PS uses Natrelle Implants. I am leaning toward getting the Inspira extra full so I can get the projection I desire. He has mentioned that maybe we might need to use saline...Of course we won't know how much my tissue will allow for expansion until that process begins. I am scheduled for dbl MX surgery Oct 20th, 2016 and explanders will be placed as well.

Any advise?

Anonymous

Yogadedra, I do not have advise, but I'm sure others will. I just wanted to say that I have found this community to be very non judgmental. I wish I had joined when I was first diagnosed, as you did, and I'm glad you are here to receive support. Please do not be embarrassed..I can see from your picture that you are a beautiful woman. Be kind to yourself and surround yourself with people who make you feel good.

Sweetbea

Thanks Whippetmom. Just met with PA and nurse and feeling much better. Had another 90cc's added to my 133 MZ-12 expanders so now up to 370cc's. They think one more fill and then 2-3 months before exchange. I'm healing well so hoping it's more towards 2 months. They explained that I'll meet with PS a couple of times to discuss what I like and am looking for, she'll chime in on what will/won't work or might not fit my frame well. I went through a lot of pics with the nurse today and seems like I was leaning towards the teardrops more so than the round. I didn't care for the extra pole projection up top. Too Baywatch for me. I do want the the lower projection so would want the MF or MX on the Natrelle. Nurse said that she orders about 30 implants to go into surgery and PS keeps going until satisfied with the look and symmetry. Since I kept nipple on one side there is some extra tissue so will either do pocket work or different size implants. Nurse said with teardrops they sit high up in pocket originally and then settle, for some it's in a day or two and for others a while longer. These rock hard TE's are getting old. Also for those getting nipple reconstruction, saw many pics of that and was pleasantly surprised at how well they were matching up.

So much to think about and I do realize that the cosmetic aspect is the least of the concerns right now but it's kind of nice to be focused and stressing about how my rack is going to look rather than frantically googling tumor stages and treatments. Thanks all for wonderful comments and sharing of stories. Very helpful.

OG56

Hello Whippetmom, I have had a second reoccurance and will be seeing the PS on Friday regarding Skin and nipple sparing BMX with implants.My BS said my breasts were broad based (tissue goes around my sides) which is more of a challenge with implants.Saw the PS he will use Full height Ex projection Expander 133 FX 16cm, 850 cc,

Ht- 5'4 3/4

Wt- 175

Ribcage 39"

Bra Size 38-40 D

I appreciate any advice you can give me

Linda

LemonMom

Sweetbea,

My PS wanted me to assess volume. I tried on my work blouses that I previously wore with a padded bra to see if I filled them out without causing the front buttons to "pull". My TEs were very wide (and hard) like most but that was the best way that I could figure to assess the volume. I am 5'4" & 135 lbs and very athletic. I ultimately went with Inspira 470 Xtra Full Projection (SRX?) and I am very happy with them. PS says there is a loss of ~50cc so really translates into ~420cc. I think my PS is excellent and I look really normal even with the extra projection - it still is less than the TEs and I, in no way, look overdone. I do have a few ripples probably because of fat loss but nothing worth another surgery. I wish you all the best and I trust WhippetMom and you have to be comfortable with your surgeon.

Sweetbea

Thanks Lemonmom. My TE's are so high and wide that it's hard to judge in normal clothes. Just look so strange to me so having trouble visualizing. TE's are rock hard and very painful for a couple of days after each fill but want to keep going at a good clip so dealing with it. At this point I guess any foobs that aren't trying to kill me will be an improvement and after these TE's I'll be so happy to have something else in there that it won't matter. I haven't told many people about this and don't want to look like I had an obvious boob job. For now just grateful we caught it early and prognosis is good. If I can have a decent looking new set that is symmetrical I'll be thankful.

MrsB88

Remi I had my double mastectomy revision surgery on the same day(9/15/16) as you. My original reconstruction was with smooth round silicone implants too small for the large quantity of skin I had left after mastectomy. The only area that looked OK was in the upper pole. I spent the past 6 yrs. wearing lower cut tank tops with open button down shirts to look my best in clothes. I developed capsular contracture on the right implant & my new PS took one look at me & said " I have to remove both implants & reconstruct you in order to get a positive aesthetic result". She was convinced I would have a better result with anatomicals due to their lower risk of capsular contracture and less rippling. I researched several sites on the internet to get as much info. as possible re: anatomicals, size, etc. I did mention to her that I was used to having upper pole fullness from my previous implants & liked the projection I got from the expanders. I read on one site that showing your PS photos of what you like and what you don't can be helpful in giving them a visual of what you are aiming for. Talking about cup size, cc's, etc. can't always translate well between a patient & the PS. I took some pics to an appt. & when she saw what I liked she said "well, I can put 750cc smooth rounds in if you want that fullness but you won't get the projection we're aiming for". Ultimately, I went with the anatomicals, the largest size 685cc and projection 7.1cm that Mentor makes. I am 5'5" tall & 140 lbs. (Need to lose approx. 15 lbs to be at my goal weight.) I have a 31" ribcage. I, like you, was disappointed in the difference between the expanders (slightly more projection) and the implants. At 2 wks. post-op it's hard to say what the final outcome will be but I have projection for the first time in 6 yrs! Hopefully I don't have too much swelling and won't end up much smaller. She had to do a dual plane surgery using alloderm to create new pockets for the anatomicals. I am not by any means large busted with these 685cc anatomicals. I still have drains in so I can't try on bras yet but I'd guess I'm a 36 full C or D. I do not have upper pole volume. I read a few places that anatomicals give fuller upper pole volume but that is not my experience. I do like the anatomical shape much better than the rounds but that is individual preference. I hope my info. helps you somewhat. Hang in there which many others have advised and try to be patient If you are still unhappy after the timeframe advised by the moderators then let your PS know. I believe you said your PS is a woman with a great reputation. So is mine and if she's a perfectionist like mine she will want to make you happy with your outcome.

HollyD

Hi all. Looking for a hopeful solution here and not sure if my chances are any good for reconstruction revision after radiation to the right breast which I received with TEs still in. Skin held up well with minimal burning although tissue itself is of course rigid and taught. Had one revision after my initial exchange surgery of 400 cc Mentor high profile smooth round memory gels on each side. PS revised the right to remove a bit of scar tissue and put in slightly larger implant at 425cc. Left breast is ok looking, I was told sparing nipples was risky and a bit of a hassle in the event they don't take or survive. My right breast looks like a small twine tied pork chop. I'm wondering if there's hope or a chance of another revision to make them a bit bigger and possibly rounder or normal looking after rads. I had 33 treatments to the chest wall. Some discoloration but nothing too unsightly. My rib size is 36" and pre mastectomy size was 36C. I am currently more of a 36B in bras and would really love to fill a C. Do I have a chance in hell after the radiation? My Ps says to follow up in January 2017. He seems to think I am done. I'm 5'7" and 155 lbs.

whippetmom

Remi: First Question:

I do not need your projection measurements. Photos (private message me with them) would help.

If your PS feels anatomicals would best address your rippling issues, then I defer to her. There are gals who have anatomicals and still have rippling, so it is not a "cure". It might ameliorate somewhat, but if you have extra skin, you need to fill up that skin somehow and I worry about anatomicals rotating if the pocket is larger than the anatomical chosen.

I started taking antidepressants when I went on Tamoxifen. Effexor is known to reliably diminish night sweats and hot flashes. I stayed on it through my oophorectomy. I think all of the hormone depletion does mean that some will need to augment with an antidepressant. I am still taking one.

whippetmom

Yaniza:

I am not sure what you are asking. Sorry..

whippetmom

yogadedra: We call you gals "BODACIOUS"......You are not alone! Okay, so I just feel that nearly every gal who is your size, has been fine with the largest smooth, round silicone - 800 ccs. I would definitely go with the Inspira SRX, 800 ccs. Now, the only caveat is: Are you really large busted now, and do you want to be as large as possible? If so, you might need to go with saline. I would rather use the implants as an incentive to lose 25 pounds though, because the reconstructed breast does not change in size and when your ribcage circumference diminishes, your cup size goes up and your breasts are larger on your chest wall. The Inspiras are really nice....worth thinking about.

BTW: I lost weight after the exchange and went down a band size and up a cup size.

whippetmom

Wildtulip: You are so sweet..... Very kind words for yogadedra. No one should feel embarrassed on bc.org!

whippetmom

OG56:

Well, a great many women who have been through here have had quite a bit of adipose tissue (broad based) laterally....sort of impeding the armpits, if you will. This should addressed in a revision, sometimes partially at the time of the exchange and then as a revision, several months after the exchange. It is an excision of the excess tissue. I would look towards ultimately having the same implant as I mentioned to yogadedra - Allergan Natrelle Inspira, SRX - 800 ccs.

whippetmom

HollyD: You need fat graft transfer to the previously irradiated breast. If your PS has not mentioned fat graft transfer by now, you need to find another PS. It can improve the texture of your skin, soften your skin and it is the only thing, barring an autologous Lat flap or DIEP or etc, and frankly, I would try fat grafting first. It is minimally invasive. The breast pocket is not opened....no exchange of implant UNTIL the integrity of the skin is where it needs to be. Then the PS can determine if another implant - size or style - is necessary. I have seen miraculous changes with fat grafting to radiation damaged skin. Go find the thread "Fat Graft Transfer and the Radiated Breast". The links are outdated and I need to update them, but you can read posts from other women who have had FGT. Please PM me and I will give you some names of plastic surgeons in your area so that you can get some consultations regarding next steps. Do not go through any further surgery until you explore this topic! I just provided links about FGT a page or two back. Scroll back a couple of pages to see if you can find it.

whippetmom

Holly: Sorry....the link attachment does not work with my iPad. You will need to cut and paste....

http://www.ncbi.nlm.nih.gov/pubmed/21987041

Probably referencing the same study - which took place eight to nine years ago....

http://www.sciencedirect.com/science/article/pii/S1748681511001422

Here is the study data, utilizing fat graft transfer at the time of TE placement: From 2010....

http://www.ncbi.nlm.nih.gov/pubmed/20048576