BREAST IMPLANT SIZING 101

noodlesmom

I'd love some feedback from anyone who has swapped out implants due to how hard they are. I'm not sure if what I'm feeling is normal, but this forum has always been the best resource so it's definitely the best place to start.

I had a BMX and reconstructive surgery in 2017. My implants are Allergan Naturelle Inspira cohesive 210cc (I'm just over 5 ft and about 103 pounds so the size has been fine). They look ok, but are just so firm! Always a hugger, I now find myself leaning in with my shoulders because I'm so self-conscious someone will feel them (happened with a friend's young teen daughter 🥲). I also haven't slept on my stomach ever since, and getting a massage or seeing a chiropractor (laying on my stomach) is so uncomfortable.

A friend had surgery recently and her doctor used the Mentor memory gel implants. The difference between us is remarkable. Hers feel so much more like natural breasts. Softer, and just with more movement.

I've read about contracture and I'm not sure that's what I have as it's not totally uncomfortable day to day. Is it just these implants? Has anyone had the same experience? I thought the mentor are cohesive as well, but can cohesive be that much softer?

Thanks in advance for the help!

Rah2464

Noodles I have definitely experienced this. After my first surgery, I had a lot of scar tissue, cording, you name it. My foobs felt like cement blocks on my chest. Very firm and very little movement due to the scar tissue. It was painful and uncomfortable. I finally followed my PS's advice about 2 1/2 yrs in and had a revision surgery. She removed all the scar tissue (tested it of course all benign) and put in a softer type of implant. I could sense the relief as soon as I awoke. I am a year plus out from that surgery now and it is still so much better than before. A little of the scar tissue has come back but nothing like it was. These softer implants do show the rippling more however just a warning if you are pre pec.

whippetmom

Katepeony:

Answers to your questions:

1. Mentor Smooth Round High Profile Xtra 355 ccs sounds good to me.I certainly would not go any smaller. And it would be a negligible difference between 355 ccs and 375 ccs. I think high profile vs extra high profile would be better, since implants are over the muscle. Without that pectoral overage, sometimes there is a bit more of a step off (a shelf like appearance in the upper pole) if the implant has too much projection.

2. I don't know anything about the “Memory Gel Boost", but I would wager it was created to rival the Allergan Inspira's most “cohesive" version of the three styles. I would NOT go too “cohesive", because this portends a more rigid implant, and I think you need something with more “give" .

3. Yes, go with the new synthetic material. It does create a support for the implant. The PS will be performing a lateral capsulorrhaphy to address the lateral migration of the implant towards your armpits. The synthetic matrix should help in this regard also.

4. Have the fat graft transfer! Yes…especially if you have a bony chest. Also, there is sufficient documentation out now to support that fat graft transfer can ameliorate if not eradicate problems with pain and tautness after mastectomy. I had two fat graft transfer procedures and I am thankful that I did. If fat graft transfer is offered…do it

Deborah

whippetmom

noodlesmom:

There could be various reasons for what you are feeling. It could be that you have the “extra cohesive” version of the Inspira line of implants, and that might be a bit too rigid for your body type. The other possibility is, as you mentioned, capsular contracture. With capsular contracture, the implants are often raised up higher than they were originally, and might even be distorted. If is it capsular contracture, the implants would feel very hard to the touch.

There is a likelihood that complicating the picture is that you have post-mastectomy pain syndrome, which occurs in 30% and even up to 60% of patients who undergo a breast procedure. PMPS typically means that muscles and nerve fibers were disrupted (severed) during surgery, and also, anesthetic pain control was not adequatelyundertaken during the surgery. So plastic surgeons are not often too keen on suggesting to patients that it is likely PMPS.

First: Go see your plastic surgeon. Better still, go see a DIFFERENT plastic surgeon, and let him examine and determine if this is capsular contracture.

Second: Request a referral to a physical therapist who PRIMARILY works with breast cancer patients = who knows exactly what PMPS is and how to help ameliorate some of the discomfort. It MUST be a PT who knows myofascial release techniques.

Lastly: If you did receive the most cohesive version of the Inspira implants, and if it is determined that an exchange surgery is in your future, go with the Inspira Soft version, or the Mentor Xtra Smooth Round silicone implants.

Keep me posted!

Deborah

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KatePeony

Thank you so much Deborah, this is very reassuring and helpful - I feel confident going into surgery now that I have a second opinion, if you will. Thank you again - appreciate it so much! -Kate

DaughterOfBarb

Just wanted share an update on my reconstruction journey. My prior posts on this thread detail my disappointment with my former PS. My breasts had an unnatural appearance, size was too small (Mentor MemoryGel Xtra 465cc on both sides), right was smaller than left and the overall shapes were different. My original PS only wanted to do fat transfer and refused to do larger implants, use different sizes to correct the obvious size difference, or address any of the other issues. Thanks to @whippetmom for sending me a list of recommended PS in my state, I found a great PS 2.5 hours away. Yesterday I had revision surgery. Implants were changed out to slightly larger (545cc on the right and 520cc on the left) to correct the size difference. He used the recently FDA approved Mentor MemoryGel BOOST style implants, which are supposed to have a more natural feel and shape and minimize rippling. He also did fat transfer (175ccs harvested from outer thighs/saddlebags, 40ccs injected around implants), moved my right nipple a bit so it’s more in line with the leftone (crescent lift) and added some tissue under my right nipple to give it more projection (right side was my cancer side, so the nipple was cored out and had less projection than the left). I’m obviously still swollen, but even at this stage they look so much better, more symmetrical and more natural. I’m super optimistic about the final results. Such a relief since I was completely unimpressed with my former PS’s work and was worried that was as good as it would get. Hopefully I’m done with surgeries for a very long time!

*Sorry my stats aren’t showing below my signature. They disappeared with the update to the site and I just don’t have the energy to add all that info again.

whippetmom

Kaycee: Wow! I am impressed with the revision techniques your PS used! It is a reminder that we are not “stuck” with a less than satisfactory result from breast reconstruction. Sometimes we think it is one and done, but that is not always the case - not with me…not with many others.

I am so glad you posed this update and I am happy for you!

Deborah

prm

i am 70 yrs, 5'7", weigh 185 lbs, rib cage circumference 38 in. I had bilateral mastectomy early Feb 2022.

Instead of expanders, my PS put in Mentor Smooth Round Spectrum Saline adjustable implants in both breasts. 525 cc. I am current filled to 625 cc in my left breast, and 550 cc in my right breast. I have almost nothing below my breast fold and the implant sets high on my chest. The implants are uncomfortable, too high and what I have looks like a 14 year old's breast, but wide. I believe he has overfilled due to my complaining of how by breast look like I only have the top, but no bottom.

I finally saw today. He has given me “man” breasts! I look like an overweight man that has fatty breasts! I could just die

Please help!

prm

also, I live in South Florida. Can you provide list of good reconstruction plastic surgeons

2ndbase2021

Hi Whippetmom,

I am hoping you can assist with a recommendation regarding implant size as I feel very lost. I am 5'6" and weigh 140lbs with a 30" rib cage. I was fit with pre pec Allergan 133S-MX-11-T 300cc fill volume TEs in November 2021. I am currently filled to 350cc which was my final fill before planned exchange surgery in August. My PS is planning on Allergan SCX implants in the 350-450 range. I have a bony chest and carry most of my weight from the hips down. I was an A cup pre mastectomy and am hoping to look like a small C cup following the exchange (I know we don't go by cup size but wanted to give an idea of what I am striving for). I am worried that I did not go large enough with the expansions or that the 350-450 SCX implants will not result in my desired outcome. Any advice you can provide would be very appreciated! Thank you so much for all the time and knowledge you have dedicated to this site! You are a gift

DYSchneider

I’m hoping for some assistance with implant sizing please. I’m 5’4” 230lbs with a rib cage circumference of 42”. I had a bilateral mastectomy on 4/7/22 and had my expanders immediately filled to 600ccs which felt very small for my size. I have since been filled to 700ccs but I have the option to fill to 800ccs and I’m just not sure what’s right for my body size. I do plan to lose weight once this is all behind me but maybe I’m just used to seeing myself with DDD breasts. This is all so challenging. I believe my PS prefers to use Natrelle implants. Thanks in advance

MinusTwo

I noticed Whippetmom hasn't been on in awhile. There have been so many challenges with the BCO format, but I sure hope she can still check in maybe once a month or so. Hang in there ladies, because her advice is the gold standard.

Moderators

dyslca_637 - Just in case Whippetmom doesn't see your post, we suggest sending her a private message to see if she is still around. Click on her profile name, and under the information at the top, you'll see the option to send a private message. Meanwhile, we hope you can get some advice from other ladies here too!

Hope this helps. Please let us know if we can be of any assistance!

The Mods

jennik78

1. 5'5" 160 lbs (about 20 pounds up from before chemo- hoping to get back there). Rib cage 31.5" I had nerve grafting which he said that we don't want to push on it with the implant- and would want to stay a moderate size- which I am fine with.

2. Over the muscle allox2-fh11se expanders with volume of 230-280 with a projection of 5.7 and 11" width

3. PS uses mentor and mentor boost has not been approved yet for purchase by the hospital

4. I was an "A" meaning I wore anywhere between 30c-32b-34a bras. I am pear shaped and carry most of my weight low.

5. PS is suggesting Mentor moderate plus implants filled at 350 12" width I think that because of my overall medium build that is going to be too little projection (4.1). I do not want to be flat like before but I'd like to have moderate sized breasts. I suggested MemoryGel® XTRA Smooth Round High Profile plants SHPX450 and he said I might be too busty.

Thoughts?

MinusTwo

jennik - I hope Whippetmom checks in since she is the absolute guru & 'breast whisperer'. However she hasn't posted here since May and may be frustrated with the site changes & problems. Wishing you the best.

whippetmom

I see questions dating back to May. If you still need an answer to your question, please letme know!

Deborah

whippetmom

Jennick78

Huh? You ABSOLUTELY will not be too busty! In fact, you will not be happy with anything less. It is impossible for you to be “too busty” with a 450 cc implant. Don’t settle for less!

Debora

MinusTwo

Deborah - GREAT to see you. Thanks for popping in. You are absolutely "the breast whisperer". Hope you're doing OK.

2ndbase2021

Hi Deborah. Glad to see you back. I had posted in May regarding a recommendation on implant size. I was previously fit with bilateral pre pec Allergan 133S-MX-11-T 300cc fill volume TEs. We ultimately filled to 400cc. I am 5’6” and weigh 140 with a 30” rib cage. I just had my exchange surgery on 8/1 with Natrelle Inspira 485cc SCF implants. I am not necessarily unhappy with the way things look but it is soon after surgery and I am not sure if the look will change with healing. I have some slight rippling on the right (mostly with bending forward) and it seems as though I can feel the upper edge rubbing on my skin on the right. I am not sure if I will eventually need fat grafting for the rippling or if a revision will be needed. Do you feel that the 485cc implants are appropriate for my frame or would you have suggested another size? Also, do pre-pec implants go through a drop and fluff period like sub-pec or is what I see pretty much what I am gonna get? I am trying to decide if the SCX would have been better than my SCF or if that would create more rippling or a step off. Not sure if you can have it all or if it’s a trade off. So many questions…

2ndbase2021

Hi Deborah. Glad to see you back. I had posted in May regarding a recommendation on implant size. I was previously fit with bilateral pre pec Allergan 133S-MX-11-T 300cc fill volume TEs. We ultimately filled to 400cc. I am 5'6" and weigh 140 with a 30" rib cage. I just had my exchange surgery on 8/1 with Natrelle Inspira 485cc SCF implants. I am not necessarily unhappy with the way things look but it is soon after surgery and I am not sure if the look will change with healing. I have some slight rippling on the right (mostly with bending forward) and it seems as though I can feel the upper edge rubbing on my skin on the right. I am not sure if I will eventually need fat grafting for the rippling or if a revision will be needed. Do you feel that the 485cc implants are appropriate for my frame or would you have suggested another size? Also, do pre-pec implants go through a drop and fluff period like sub-pec or is what I see pretty much what I am gonna get? I am trying to decide if the SCX would have been better than my SCF or if that would create more rippling or a step off. Not sure if you can have it all or if it's a trade off. So many questions…

jennik78

Hi Whippetmom, The PS and I met again for my final expansion and he now thinks the Mentor Xtra 375 moderate plus is best but will also have the 400 moderate and the 450 high profile in the OR. We will be doing fat grafting as well to smooth things out. He says 450 will probably be too big/tight. He said he is willing to work with other brands that might have a better combination of projection and my width but he likes Mentor the best. My TEs are now fully expanded to 280 - I do like how they project and fill a 34b my bra. I know probably unimpressive to others but pretty curvy to me!