BREAST IMPLANT SIZING 101

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited October 2016

    Carla - just wanted to clarify that having skin and nipple sparing with TE does not guarantee that you are any further ahead in the process that leads to exchange to implants. You can only be filled to the tolerance of your remaining skin. I had skin/nip sparing BMX, natural breasts were a full B/small C cup, with 550cc expanders and was filled to less than 150ccs because that was as much as my skin could handle and not impair blood flow. Your PS has to look for the sweet spot that is large enough to start the process but not too large that you end up with necrosis due to lack of circulation/inhibition of new blood vessels. I know quite a few others who had skin/nip sparing and also were filled with a modest amount at the time of surgery and did gradual fills until they were ready for exchange, just as if their nipples had been removed. I believe your experience is actually the exception. A 450cc surgical fill is quite large, which means that you most likely had a larger skin flap than others might.

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  • elise24601
    elise24601 Member Posts: 155
    edited October 2016

    Thanks whippetmom & others - I assume the suture tabs are not visible after the TEs are placed?

    Another thing I keep seeing on here (and the pic forum) is about the "pockets" being the right size - I assume this is just all about the skill of the surgeon, so is there anything I should ask or tell my PS about this ahead of time?

    I realize the need for revisions is common (perhaps inevitable) with recon, but I WOULD like things to look as good as possible on this first run, as it will be several months before they can change anything.

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited October 2016

    Carla:Ditto to what Special K said....

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited October 2016

    Elise: PM me the name of your surgeon. I am in LA county also.

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited October 2016

    Sorry beanybaby.....you have been in and out by now. What did you find out?

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  • Bird-of-light
    Bird-of-light Member Posts: 167
    edited October 2016

    Whippetmom,

    I am approaching my exchange and am ready for your help. I currently weigh 150. Before cancer (March), I weighed 160. I dropped to 143 by June, but seemed to have leveled off at 150 over the last few months. My rib cage under my TEs is 30.5. Style of TE - Natrelle 133 MX-13-T. Height - 5' 7". I had a nipple sparing mastectomy, and I have a little bit of loose skin, but I am filled to 420 and have the option of another fill before surgery. I am unsure if going a tad bigger will help with the skin and if I want to go any bigger. I am lucky with how things look so far. I plan to ask for a pocket revision on the right side because the TE is closer to my armpit and seems to have rotated a little. Ideally, I would love the 45/55 pole ratio (with cleavage), but I don't know what is possible. My PS offers Mentor, Allergan, and Sientra.

    Thank you for your service to so many women. You are a blessing.

    Bird-of-light

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  • Bird-of-light
    Bird-of-light Member Posts: 167
    edited October 2016

    Tampa - what kind of scar cream? My PS said I wouldn't need it, and so I have done nothing. I also had a nipple sparing BMX, but the top ofmy right nipple died off. It is half the size of my left :(. You are lucky!

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited October 2016

    bird-of-light

    Allergan Natrelle "Inspira" implants - SRX - 545 ccs, 560 ccs or 580 ccs. It all depends on which implant will best give you as snug a pocket as possible. Your TEs pretty accurately correspond with 545 ccs or 560 ccs, but given that loose skin, three sizes in the OR would be nice.

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  • Bird-of-light
    Bird-of-light Member Posts: 167
    edited October 2016

    You rock! Is the last fill necessary?

    Bird

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  • beanybaby
    beanybaby Member Posts: 6
    edited October 2016

    PS is recommending 300cc anatomical implant with fat grafting. I questioned him about rotation issues and he says he does not have them. I told him I did not want the "fake boob(foob)" look and that I wanted them to look similar to the originals. What do you think

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  • Sweetbea
    Sweetbea Member Posts: 4
    edited October 2016

    Whippetmom - thanks for the input. Had last fill so MZ-12 TEs have about 460cc in each. Seem huge but sitting very high so hard to judge. She first said anatomical but now is thinking Inspira, didn't mention size or projection. So tired of the TEs, very uncomforable and too wide so my arms brush against them. I'm 5'1", 130 lbs with ribcage of 31". Pre cancer was 34C. Recommendation on the Inspiras? Also, how long is typical to wait for exchange? Skin is healing well so originally was told 8 weeks but now may be able to do 6. I don't want to rush it but very anxious to get these rock hard expanders out. Plus I'll still need to have one fipple constructed so assume that will be a couple more months of waiting. Is it common to get fat grafting? PS hasn't mentioned yet. I had the alloderm netting so maybe it won't be necessary? Wouldn't mind losing a couple of saddlebags to fill things in. :-)

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited October 2016
    Bird-of-light: I cannot tell you that. Only your PS can tell you what is needed in this regard. But if you have sufficient skin, it might be that no further filling is required.
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  • whippetmom
    whippetmom Member Posts: 6,920
    edited October 2016

    Sweetbea:

    If Inspira: SRF 415 ccs or 450 ccs or SRX 445 ccs or possibly 470 ccs. It depends on the availability of your skin flaps for closure over the extra full projection option - if the SRX style is used. Fat graft transfer is not used unless necessary, and then some plastic surgeons do not do it at all. It is up to your PS.

    Personally, I would wait at least 8 weeks after the last fill for the exchange

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  • mom2allboys
    mom2allboys Member Posts: 26
    edited October 2016

    I am just about done with fills, and I am meeting with my PS on Thursday to discuss implant sizing and type. I would appreciate your opinion.

    Here's my info:

    I'm 5'1", 120 lb, 29-30" ribcage circumference.

    I currently have Natrelle/Allergan 133MV-12-T TEs, recommended max volume is 300 ccs (I currently have them filled to 350 ccs).

    Prior to my mastectomy, I was wearing a 32B, but I was hoping/planning to be a little larger after the implants (like 1 cup size bigger).

    My PS prefers the anatomical/gummy bear implants (so do I). I do have a slightly concaved chest wall and a large space between my breasts and was hoping to have some cleavage with the implants. I assume there will be some "movement" once I have the permanent implants (as opposed to the expanders which don't move at all. If so, I can achieve some cleavage with a bra.

    Thanks!

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  • meg2016
    meg2016 Member Posts: 287
    edited October 2016

    whippetmom I talked to my PS about your recommendation of Allergan Natrelle Inspira implants - SRX - 650 ccs. She said we can see how the skin does through radiation. She said it's not in as good of shape as we need, she would recommend going to the one with full projection rather than extra full, and then there is another one down from that one which would be the last resort if my skin is in poor shape. Does this seem like the right approach if my skin isn't able to withstand the extra full? Or should I consider a different implant? My surgeon says has been doing many of this particular implant in the full-projection style recently and people have been quite happy with them. Thanks again for your help!

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  • coachvicky
    coachvicky Member Posts: 1,057
    edited October 2016

    I hope you can help me.  I am lost about my expansion and what size implants I want.   I am 5 feet tall and weigh 135 pounds.  My rib cage is 30 inches.  I have Mentor CPX4 with Suture Tabs, Medium Height, Style 9200 expanders.  Currently I am expanded to 525cc.  I was a 38G bra size before my bi lateral mastectomy on 12 July 2016.  I do not want to be that large ever again.  At this point, my implants will be Mentor or Allergan but I don't knw any more information than that.  I will not have my implants until I finish my Herceptin, Texotere, Carboplatin  chemotherapy in late December 2016 and start only the Herceptin chemotherapy.  I have search the Internet to research what a D cup would be and cannot find an answer. I think I want to be a D cup.  My Plastic Surgeon reminds me that I petite and not to be too big.  Thank you for any help you can render.  Coach Vicky

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited October 2016
    Mom2allboys:

    Personally, I would prefer the Allergan Natrelle Inspira implants for you. I think with your chest wall anomaly (might be pectus excavatum?) you need an implant with a higher fill level and you need the additional projection. If you go with the anatomicals, they are pretty rigid and immovable - considering what you want to achieve with some enhanced cleavage. If you do go with anatomicals, you need a MX style, so that you can gain the needed projection. This would be a 410-MX - 325 or 370 gms. In the Inspira, SRX - 445 ccs or SRF - 385 ccs. In round implants - it generally (nearly always with Allergan MV style) takes 100 plus ccs to approximate what you have in dimensions with the TEs.
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  • Moderators
    Moderators Member Posts: 25,912
    edited October 2016

    Hi Coachvicky!

    Someone will be by shortly to weigh in on your post, but we just wanted to stop by to say hi and welcome to our incredible Community. We hope you find our boards a very helpful, supportive resource!

    Let us know if you need anything at all.

    --The Mods

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited October 2016

    meg2016: The SRF style in Inspira is absolutely fine. I agree about the skin coverage issue.

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited October 2016

    coachvicky:

    What is the volume of your TEs?

    Catalog #Vol.WidthHeightProj.
    3549211275 cc10.7 cm9.3 cm6.2 cm
    3549212350 cc11.7 cm10 cm6.6 cm
    3549213450 cc12.7 cm10.8 cm7 cm
    3549214550 cc13.5 cm11.7 cm7.4 cm
    3549215650 cc14.6 cm12.6 cm7.6 cm
    3549216800 cc15.6 cm
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  • whippetmom
    whippetmom Member Posts: 6,920
    edited October 2016



    imageOkay, well that was one hot mess.

    Here are your volume choices coachvicky:


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  • coachvicky
    coachvicky Member Posts: 1,057
    edited October 2016

    My expanders are 550.  I am 525 right now. I can overfill my sugeon's office said I could go to 625. What say you?

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited October 2016

    coachvicky:

    I would go with Allergan Inspira, quite honestly. SRX - 615 ccs. Here is the question though: With a 30 inch ribcage you were wearing a 38 band bra? You should have been in a 34 band size with a 30 inch ribcage. So I think you also could use 650 ccs in the SRX Inspira. You would likely not need any extra fill. Tell your PS you do not want droopy breasts! If you have large skin flaps, you need to sufficiently fill up the skin envelope.

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  • coachvicky
    coachvicky Member Posts: 1,057
    edited October 2016

    Thank you. I now feel empowered for the conversation with my Plastic Surgeon!

    Coach Vicky

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  • coachvicky
    coachvicky Member Posts: 1,057
    edited October 2016

    I forgot to share that I have lost 40 pounds thus the difference in my rib cage dimensions.

    Thank you, again.

    Coach Vicky

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited October 2016

    coachvicky: Well that explains the former bra size!! 👍

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  • Yaniza
    Yaniza Member Posts: 140
    edited October 2016

    Maybe in the light of the last few posts I could ask again how the rib cage measurement relates to the diameter of the implant if the rib cage measurement does actually change with weight gain and weight loss?

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  • Yaniza
    Yaniza Member Posts: 140
    edited October 2016

    Maybe in the light of the last few posts I could ask again how the rib cage measurement relates to the diameter of the implant if the rib cage measurement does actually change with weight gain and weight loss?

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited October 2016

    Yaniza: As you lose weight, your ribcage decreases and your adipose tissue decreases. The implants do not decrease in volume - you do not lose any fat because there is no longer connective tissue or fat - like your native breasts would have) and so the implants appear larger on the chest wall with weight loss. I just do not know how to explain it any better than this. I lost weight and went from a 34 DD to a 32 F.

    But when I ask for ribcage measurements, I have in my head a picture of which implant width would be appropriate for that ribcage measurement. If you have a 35 inch ribcage circumference, a 12.0 cm width/circumference implant would be too narrow. But it would not be too narrow for a 28 inch to 30inch ribcage circumference.

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  • whippetmom
    whippetmom Member Posts: 6,920
    edited October 2016

    By the way....those bra sizes sound huge, I know. But these are European bras and European bras are sized differently. Also, the reconstructed/augmented breast is a different shape than a native breast and so it typically always requires a larger cup size - more so with round implants, not anatomicals.In clothing, I look like a "D" cup.

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