BREAST IMPLANT SIZING 101

AnnHB · June 2016

also I had skin and nipple sparing mastectomy and my ps likes to use round rather than teardrop shaped implants

whippetmom · June 2016

Ringelle. I would get "hung up on numbers". I would want to know the range he is considering and the style he is considering. Plastic surgeons always write down the style and volume of the implants Lakeland to try out in surgery and this is recorded in the patient's chart. So you could call the nurse and ask her what is recorded in the chart. This might not even be entered until a few weeks before surgery or even at the time of the preop. But you have a right to know.

whippetmom · June 2016

Alex276

Yes, 800 ccs in a high profile or even extra full projection style implant. Allergan or Mentor. Natrelle Inspira TSX would be a good option also. You might only need 750 ccs in that brand/style. It has the most projection over anything else.

whippetmom · June 2016

AnnHB:

I would suggest at least 400 ccs and up to 475 ccs in a high profile, smooth round silicone implant. Yes, your tissue expanders can get you there

whippetmom · June 2016

Blessings:

Thank you for sharing your experience and expertise on this subject!

BethL · June 2016

Ringelle- I can't imagine losing my ps before exchange. Ugh! But sounds like you're in good hands. My exchange surgery is August 2nd. Had oopherectomy last Friday, not fun. My gyn onc was originally going to do it at the same time as exchange but she called and told me she was leaving the organization in a few weeks. So I know how you feel ! I went ahead and had it done now while she was still here. It's hard to get to know a doctor and then have then leave. Glad you're doing well

TrmTab · June 2016

Just 3 weeks today post L-MX. At time of surgery had fill of 300 cc. Two weeks later +50 and yesterday +100. I think I need a break, this is going to fast.

My specs: 54 y.o., 5'8", 200 lbs, ribcage 40

TE: AlloX2-FH15E, Low Pole Plus-Full Height Profile, 600-720cc

15 x 13.8 x 6.4 cm

At first consult PS gave me handouts from Mentor, but hasn't since mentioned any preferences.

Before surgery I was wearing a 40D...and will have some reduction/lift on R to balance at some point

TrmTab · June 2016

sorry for fast update...I actually have handouts from the PS for both Mentor and Allergan products

whippetmom · June 2016

TrmTab:

Symmetry trumps size for a single MX. It all depends on the size of your reduced native breast, and also how much ptosis (droop) remains after the lift. You will be in the 700 cc range I believe, high profile smooth round implants - Allergan or Mentor - they are similar. It depends also on how your skin responds to expansion. But again, achieving symmetry with the native breast is the primaryfocus.

TrmTab · June 2016

Okay, thanks.

I feel like I am in a cart and horse discussion...my PS has said from day 1 that there is no way to make me as large as my natural R breast. I have taken that to mean we will do all that is necessary with my Left side and then after all surgery and swellings have gone down etc...judge how much to reduce the R to match the L.

Your comment makes me think this is the reverse logic...

whippetmom · June 2016

TrmTab:

A lot of large breasted gals have had one breast removed and have been expanded sufficiently to gain symmetry with the native breast, which is either lifted, reduced or both. Do you have access to the picture forum? Where are you located

TrmTab · June 2016

Given my age/size/droop I am expecting a reduction and lift on the R to try to match the reconstruction. While the doc is never willing to say a size, he is consistent in "I can't get you as large as you are" and I am a D...so my hope, but again without any confirmation, is a C, but from these discussion boards, a C sounds optimistic.

I am happier to be lopsided for a while to see the final outcome of the reconstruction than to overdue on the natural side, so maybe I am the one pushing to wait for reduction/life more than the doc...???

I am in Newport News, VA (between Richmond and Norfolk) and I do not have access to the picture forum.

HuskerFan · June 2016

whippetmom, do you have any experience with OVER the muscle implants? I had my BMX on May 26 and have Allergan 133FX-15-T tissue expanders with 800cc recommended volume. I am 5'5", 160lbs, with rib cage circumference of 33". Before my BMX I wore a 36DD and would like to be a little bit smaller than that after my exchange. I'm already filled to 540cc and feel like I definitely don't want to be filled any more. Do you have any knowledge of going over the muscle and if you need to overfill just as you do with under the muscle?

Thanks

Andraxo · June 2016

I also have a question about OVER muscle implants. I am not a candidate for (per my surgeon), nor want, under muscle because I am far too athletic and active....my job is also active as a physical therapist. I had B nipple sparing mastectomy in September 2015, then chemo, then radiation L. I'm now 5 days s/p fat grafting B to bring in some stem cells to the radiated tissue area to help with healing and allow for more flexibility later. My surgeon does not typically use TEs or implants in radiated tissue due to high complication rates, but has been going that route after early fat grafting first because it helps the tissue. Initially my recon plan was BRAVA and fat grafting but I simply don't have enough fat. He already took what little I had for this fat grafting round which was not to make breasts or change my appearance. I'm lean/muscular and I don't want to gain weight at this age for more fat grafting. It's simply too hard to lose weight over 40 and it affects my athletic performance to be heavier.

Wondering about the possibility of implants (very small ones) without needing tissue expanders. I'd be happy with an A cup. I was an A+ to B- before cancer/surgery. I swear my PS said this might be an option later (using gummy bears) during my pre-op a few days ago - I will ask him again this week. Anyone else have this?? (small gummy bear implants over muscle without expanders)

I'm 46 yrs old, 5'5", approx 125#, muscular. ribcage circumference approx. 31"

Was most often a 34B bra before, but sometimes As fit, sometimes I needed a 36.

Hoping to avoid multiple surgeries and TEs. My scars are mobile, as is my skin. My surgeon was excited for how well my tissue is and thinks it will be even better after this fat grafting and give me more options. If I'll need TEs though, I may just avoid recon and stay flat and fabulous.

Thanks for any opinion/input!! xo

whippetmom · July 2016

TrmTab: Contact Lilah and ask for admission to the pictures forum. Lilah is the gatekeeper's screen name.

whippetmom · July 2016

Huskerfan:

If you feel you are large enough, perhaps consider the Natrelle Inspira, SSX, 695 gms or 745 gms, or the SSF style - 675 grams. The former is an ultra full projection style and the latter is a full projection style. It depends on how much extra skin you have that needs to be taken up by implant. I cannot see why you would need further fills for either style/volume implant, with your prior breast size, unless you had a lot of skin excised at the time of the MX. I don't think that being over vs under is an issue.

whippetmom · July 2016

Andraxo:

I am hearing from a number of gals recently who are going to have over the muscle TE and/or implant placement. Certainly in the past, since I have been on this forum, most renowned plastic surgeons have strongly advised against this, for various reasons, which you can read here

https://www.realself.com/question/over-muscle-breast-augmentation-mastectomy

And here

https://www.realself.com/question/the-benefits-anatomical-breast-implants-round-counterparts

I presume reasons for wanting OTM placement primary hinge on your desire to avoid implant animation and the distortion associated with implants placed under the muscle. Honestly, whether they are under or over, I would not recommend anatomical implants to a woman who is very athletic and intends to incorporate a great deal of pectoral movement in her exercise regime or profession. The risk of displacing the anatomical implant and causing it to rotate in the pocket would appear to me to be too great to waste my time doing it. A small, silicone round would be my choice.

That said, IF your PS could incorporate the "allobra" approach, which is surrounding the implant with an acellular dermal graft such as Strattice or Alloderm, that might mitigate rotational concerns as well as provide a better cosmetic result. I know Deborah Bash, MD out of Mayo Clinic Scottsdale pioneered that approach and she created some beautiful results. She did this as a one step direct to implant procedure. Ask your PS about it.

The FGT was a great idea by the way - for a bevy of reasons.

HuskerFan · July 2016

whippetmom, thanks for the info. I do feel like I have quite a bit of skin. I have some "dimples" that I assume would fill out more if I did more fills. I keep reading about the implants being smaller than the TEs. Is that the case with over the muscle as well?

whippetmom · July 2016

Huskerfan

Implants do not have to be smaller than the TEs. Mine are not smaller. If you have a sufficient skin envelope, you should be able to exchange to implants 100 ccs or so larger than the TEs. Look at the dimensions of the TEs as compared to the dimensions of the prospective implants.

I have no idea whether over the muscle placement would impact size for you personally. If you have thin skin, implant size might be an issue.

Mariangel43 · July 2016

I am confused. I have to see for the first time the PS. I only know that I have to see him and receive my expansor so that the radiologist can begin radiotherapy. My skin hurts and I don't know how can I tolerate any work in the mastectomy area. I hope the PS is gentle cause I will cry the whole procedure because it really hurts.

Stix · July 2016

I still have not gotten my revision yet. I have a cc on one side grade 2 to 3. And bottomed out on the other I am noting that I an having a bit of pain when lying on my stomach with the bottomed out side. Does anyone know why I would be having pain in the bottomed out side ? Thx.

whippetmom · July 2016

Stix: I would not advise sleeping on your stomach. Picture in your mind what this does to your already bottomed out breast. I am a reformed stomach sleeper.

Andraxo · July 2016

Thanks for the info whippetmom! I will ask about technique because I would like anatomic cohesive implants (assuming I move forward and my radiated skin can handle the process/surgery). I am very lean and muscular and can't see how round implants would look natural on/in me based on pictures I've seen.

Madison4568 · July 2016

Hello Whippetmom,

I had a lat dorsi flap surgery 5/2/16. I have 550cc Mentor TE's(I do not know the style or type he used). I am currently filled to 650ccs on the good side and 550ccs on the lat side. He is filling the good side to 700ccs and Lat size to match looks wise. He said heis using Mentor round gel implants either high profile or ultra high profile. I like how I look now but want more projection with less underarm boob. I am 5'7", 170lbs. 34" around rib cage, 34C prior to BC. What is your opinion on style and size? Also my last fill is 2 1/2 weeks before my exchange, is that ok?

Madison

CeCegbp · July 2016

I just wanted to say thank you, Whippetmom. You did a magnificent job of estimating what I would need. When I showed the PS he said that was very close to what he had in mind. I have only been posting sporadically but realized I never said thank you after the exchange surgery & wanted to do that. You do an awesome job taking the time & effort to give advice to women who often get blindsided by a diagnosis & have no idea what they need to do.

Frill · July 2016

Hi, Whippetmom. You talked to me a million years ago back in Nov./Dec. back when I was cheerful, optimistic, and just knew everything was going to be okay. Oh, and I trusted my doctors . . . implicitly. I looked back on my posts in this thread and it made me sort of sad.

I'm coming back for some different advice. I had a MX back in Nov. No reconstruction, nothing because of BP issues at the time. Now I'm supposed to have radiation. I'm scared shitless about what I'm going to look like, to the point I won't have rads, especially because even though I had skin sparing MX, I've lost 20+ pounds and there's NO SKIN.

My PS is on maternity leave. Trying to get in with anyone - a PA - whatever - to just discuss what happened since surgery - my tumor wasn't 1 cm, it was 10cm and 1cm, we didn't do TEs, rads wasn't really on the horizon, how does a lat flap fit into all of this, is ALMOST IMPOSSIBLE. On top of that they almost act like I'm nuts. (rereading that, I do sound nuts. They've turned me into a nutjob. Or cancer has. Or both.)

Plus the hospital JUST CALLED with the phone right in front of me and the phone didn't ring and they didn't leave a message. It's like I'm cursed.

So - and I know you're not a doctor, but maybe - and even if it's just to give me some more questions to add to my OUTLINE of questions for when I do get to talk to someone - help me.

Shouldn't I have TEs before rads? Is that a hospital procedure preference, or do they just shove those implants right on in if they want? Or am I going to be stuck with smaller boobs? (sorry breasts, w/e) What exactly do they mean when they say that rads ruins your skin for recon? I registered for the photo portion of the website way too early, didn't get on, and am having a little trouble reregistering (totally my fault), I just wasn't read to look at recon pictures and didn't need to then. Now I'm like desperate to figure out what I'm going to look like.

But then, I'm reading that implants are bad with radiated skin and I should have fat transfer, which I never wanted - all those scars. The idea of a tummy tuck doesn't make me go YAY. And my dr doesn't do thigh fat, which is the only thing that would. (Ok, I have a tiny bit of laughter left.)

Back then, my magic number 700 implants. That won't change with my weight loss, will it? (sad, sad face) I'm so worked up about this. Any advice that you can make out to provide of this will be helpful.

Madison4568 · July 2016

Hi Frill,

Whippetmom is definitely the expert and I am sure she will give you great advice!

Speaking from my experience...I am 24 years old and I had a double mx along with radiation. They took as much skin as possible during my mx because I had inflammatory BC which was in my skin and lymph nodes (my breast was purple at time of dx). They left only enough skin to close me. I too struggled with what to do after radiation (which wasn't horrible just inconvenient). I wanted just implants but was told by 3 ps that was not an option for me. Another gal in my support group did not opt for the Lat flap and did the fat grafting to improve the radiated skin and then implants. She has had nothing but problems. She is very susceptible to infections and was told she can not get nipples only tattoos. I wanted this over and done with. I did the lat flap surgery with TE's. So far even with just the TE's I am so pleased with the outcome. I go for my last fill in a week and then exchange at the end of August (I am currently filled to 550 on the Lat side and 650 on the other side). I do not notice one bit of difference in my back muscle since my Lat flap surgery. I can do everything I did before. I would just make sure your surgeon is very experienced with Lat flaps if you go that route. It never hurts to get a few opinions.

Anonymous · July 2016

Frill, I agree with everything Madison said. I had a BMX, then chemo, then rads. My skin held up well, but everyone is different. If you do rads, but sure to be diligent about whatever your Dr wants you to use on your skin. My rads Dr suggested Aquafor. I was told I had to wait a min of 6 mo after rads before reconstruction, and I had the LD flap, and so far so good!

Madison, good to hear all is well with you!

whippetmom · July 2016

Madison: You could go either way. The deciding factor is your skin integrity. The ultra full projection does take more tissue coverage than the high profile, but something in the 650 to 750 cc range sounds about right.

whippetmom · July 2016

Frill:

First of all, where did you hear you have scars with fat graft transfer? Teeny tiny little needle and the scar is a pinprick in size. I am a huge proponent of FGT after radiation. What I have read and actually would prefer MYSELF, would be 1. TE placement and one round of fat graft transfer to the side which will have radiation during that procedure. Expand to as much as possible (if the TE is a 500 cc TE, expand to something around 400 ccs). 2. Go through rads. 3. After rads, wait a month and then continue expansion as tolerated. Wait at leastthree months for the exchange. 4. Exchange to implants and one more round of FGT to radiated breast at time of exchange.

That said, some doctors and hospitals want to do radiation first. In your case, it might be a timing issue - they want to get started right away? Do you have time to get a second opinion on TEs during vs after? I will send you some articles on the topic tonight.

Radiation can indeed impact your skin integrity and increase your risk of complications with reconstruction. HOWEVER, everything I have read suggests that FGT can be the mitigating factor and can reduce the risk of complications significantly. The proof is out there. Read my thread "Fat Graft Transfer and the Radiated Breast."

I do not know about sizing after rads. It will depend on your skin integrity, but if the skin integrity can be improved, the chances of getting to a 700 cc implant will be reachable. However, if you have lost 20 pounds, do you really need 700 ccs?

BREAST IMPLANT SIZING 101

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