BREAST IMPLANT SIZING 101

BleuJay · November 2016

Hi Whippetmom

I'm new to the forum and trying to navigate the world of reconstruction after mastectomy. I had a Bilateral NSM in October, after diagnosis with invasive lobular carcinoma. I wished I'd had more courage to join the forum before my surgery, but I joined now. Before my surgery I was a 34-36 A, and athletic, and told my PS that I didn't want to be too large, but larger than my current "A".

Now on the other side of my surgery and healing well, I am worried that I won't even be a large "A". My PS used 250 cc Natrelle 133 TE under the muscle, and I am currently filled to 200 cc, and I am barely where I was before surgery. Can the TEs be filled beyond 250, but by how much usually? My ideal would to be a solid b-cup, and I'm wondering if the 250 TEs are going to get me there and what size implant would get me the look I am hoping for? I guess I'm worried that with 50ccs to go on each side that it won't make a huge jump to a "B".

Perhaps I can get some feedback on whether I will get close to a B? Thank you for all of your expertise in this area.

My stats

TE: Natrelle133, 250 cc, the little wallet card doesn't tell me anything but the catalog number for each side ( let me know if that is useful information).

Height: 5ft 4"

Weight: 120 lbs

Ribcage just under TEs: 30"

Previous bra size: 34-36 A

PS uses Allergan implants, I haven't asked if he overfills TEs

whippetmom · November 2016

BleuJay:

Yes, your TEs can be overfilled. I think they can be safely overfilled to whatever the tolerance is with your skin envelope. So if you take expansions gradually, it is likely you could get another 100 ccs or 150 ccs in your TEs. I think you need implants in the 400 cc range. Is it possible to get there? Yes. Again, your skin integrity dictates how far you can expand. You need good skin closure over the implants. But many gals who had Allergan 250 cc TEs ended up with 425 ccs in a smooth round high profile implant. I think you would stand a better chance of going larger with rounds than with anatomicals, because the anatomical is rigid and fixed and you can "fudge" a bit more with the softer silicone rounds.

Another important point would be the STYLE of your TEs. Are they MV or MX or SV or SX? That would tell me a bit more about the dimensions of your TEs.

Deborah

layle · November 2016

Hi Whippetmom,

I have changed surgeon and am back to square one on choosing implants. This surgeon is more flexible on what I want. My question is, which BRAND of implant would give me the best projection? I currently have Allegan expanders 133-mx-11 and I'm filled at 380cc. My rib is 29", I'm 5'2 tall, 106 lb. I'm hoping to achieve a full C cup. I was looking at getting the 410 anatomical at 370 cc because it seems to have higher projection than the rounds and the width of 12.5 seems to fit me. Do you know if the other brands other than Allergan are good to use if I'm seeking good projection? I'm open to both shapes. I appreciate your help.

whippetmom · November 2016

layle: Where did you come up with the 370 gm Allergan 410? Your PS is probably not going to go that large, especially with an anatomical implant. There is no use speculating on the size, unless your PS is willing to do this. I think that unless you have a very lax skin envelope, 12.0 cm would likely be the largest (12 cm width) and you would have 5.7 cm projection. The volume of the TE does not correspond with the volume of the implant. The Allergan Inspira actually would be better, and there is more "wiggle room" in terms of volume. The 400 cc extra full projection Inspira (SRX) has 5.8 cm projection and is 11.5 cm wide - much closer to what you have with your TEs. That still might be larger than your PS has in mind, and so 375 ccs would be another option - 5.6 cm projection

BleuJay · November 2016

Hi Whippetmom

Thank you for your thoughtful reply. I need to contact my PS office to see if they can give me the additional info on my expanders. It is reassuring to hear that the expanders can be somewhat overfilled. Is there a general rule on how much can be overfilled, assuming the skin/body can handle it?

I am still healing on one of my nipples, where there was a small amount of necrosis, so my PS is wanting to go slowly with the fills, which I think makes sense. I will be back with the additional info, but in the meantime....thank you very much!

-bleuja

Anonymous · November 2016

BleuJay, Another option for getting the TE information is to contact medical records at the hospital where you had surgery and ask for the surgical notes. Typically you have to fill out/sign a release of information, which can sometimes be found on line, but if you call medical records, they can walk you through the process.

whippetmom · November 2016

BleuJay: Please read #6 in the thread header

Nanpop · November 2016

Hi,

I am normally very careful and investigate all procedures. My fear of my breast cancer made me lose any rational thought I had.

I had a bilateral mx on October 5, with tissue expanders placed with alloderm. I just found out what alloderm is and am very upset that it was not explained prior to surgery.

I do not know what type of tissue expander were put in. My PS said because my breasts were large he used larger TE's. I have a tightness under my breast that feels like a wire cage. He filled up the TE all the way. So I never had them filled again.

Do all TE Feel the same?

Are all TEs sewn in underneath the breast?

Is alloderm safe?

Is the tightness normal?

Will I ever feel comfortable?

What can I do during the next reconstruction to fix all of this?

Thank you.

MinusTwo · November 2016

Nanpop - Please go back & read the header in detail and then list all your measurements & specs. The PS is required to give you a card with the info about your tissue expanders. And you can also get it from the hospital. Have you started chemo? When do you plan to have your exchange?

In answer to your other questions, every one if us is different, just like every PS has different preferences. There are numbers of different ways for the incisions to be made. There are two good threads called 1) Exchange City, and 2) TE trouble, that should answer most of your questions. I think you'll find that very few of us were comfortable with TEs. Mine felt like a hard turtle shell or coconut shells and I could hardly wait the 3 months after final fill that my PS required to get them out. You can search for Alloderm on BCO to get more info about that. I didn't have it so I can't say much.

Nanpop · November 2016

I found out that my tissue expanders are

Natrelle style number 133

Filled up to 450cc at time of surgery.

I am 5'3 112 lbs. petite frame

My breast size was 34 f European bras

I just started chemo. This TE has metal so I don't know if that affect MRI and radiation.

Should I remove the alloderm

LuckyLady17 · November 2016

Good evening Whippet Mom.

I would appreciate your help and opinion on sizing for my implant exchange. I had a bilateral mastectomy the first week of October with my plastic surgeon placing Mentor Artoura High Profile 375cc expanders along with Alloderm. I had my last fill last week, which put me at 400cc. I will not be having chemo or radiation. I am scheduled for my exchange the last week of December. She is leaving it up to me to decide how big I want to be but from our conversations and what she has gleaned from me she suggested Style 20 500cc. She told me to try on clothes and everything and decide if where I am with the expanders is where I want to be and she will try to go with whatever I decide.

I am 46 years old and 5'8" at 150 lbs with a ribcage of 32" and absolutely no upper body fat (meaning you can see my ribcage and breast bone, etc). Pre-mastectomy I was droopy and wearing a 36B or 34C depending on the bra.

I want a more natural look and don't want to look like I have balloons or cantaloupes on my chest and with these expanders they do have a slope to them with more projection at the base. I have tried on some clothes and I like the size of the expanders but I am kind of thinking slightly bigger than where I am right now would be nice as when I tried on a 36C bra there was just a little extra material ripple. Would going up to 550cc in Style 20 make any difference with that or do you have any other suggestions? I am not sure if she uses any brands exclusively.

Thanks for your help!

Kattis894 · November 2016

I am very confused regarding my upcoming surgery Dec 21st. My cancer is very aggressive and I am mostly concerned about that at the moment so reconstructions is so far away from my mind.

They suggested to have an immediate expander placed during the removal of my breast. I have large breast and my tumor size is 6,5 x 4 cm and has grown that size during 2 years It has not noticeably shrunk during the neoadjuvant treatment so they are planing to remove the entire breast. I will start radiation beginning January, every day for 2 months as well as hormonal treatment, which kind I am not sure as of yet. I have a friend of a friend whom is a professor of breast cancer, she strongly advice me against placing the expander and using silicon at this point and instead just focus on getting rid of the cancer. She also said chances of complications of the implant might make the breast very hard and not comfortable at all. I will have the opportunity to speak with her on the phone tonight to ask more questions. I am more interested in reducing the size of my healthy breast, keeping the nipple to just make it more bearable for the years I have to wait for reconstruction, they said approx. 2 years since my treatment herceptin ends next September.

Any thoughts here would be very appreciated. I understand it would be great to immediately get a breast even if hard but I am more worried about the cancer spreading and complications with the silicon. From what I understand now a flap is softer and more comfortable in the long run.

layle · November 2016

Hi Whippetmom,

I'm trying to decide how long after final expansion to have exchange surgery. Do you know if there are any benefits to waiting a long time? How long do you suggest waiting?

Also, do you typically see much over expansion for anatomicals being necessary? Just thinking if implant needs a snug fit, then over expanding would loosen the pocket more, thus higher chance of rotation.

Newgirls · December 2016

hi lucky lady.

I am 5'9 and 140. I have Mentor medium profile implants and don't have that melon look. That comes more with high profile. As the implant contents shift downward once it's inside your chest the profile is quite natural. I like mine.. I have a few ripples if I slouch but with a bra and clothes who knows

MinusTwo · December 2016

Layle - every PS specifies a different wait time. Mine required 3 months after final fill. I have Allergan 410 anatomicals. I'm very happy with the shape & the feel and I've had then 3 years now. It's my understanding that the fit has to be pretty exact to avoid possible rotation problems. So you need a PS who has lots of experience with anatomicals.

MinusTwo · December 2016

Katie - I think this is your first post to this thread? If you will read the header and provide the details requested Whippetmom will be better able to address your questions. If you're talking about reconstruction, I believe that putting in the expander before radiation is preferred, and then doing the exchange later. Someone else will have a definitive answer. Also Whippetmom will probably talk about fat grafting for radiated breasts.

I too was HER2+ when the cancer came back as IDC, so I understand your concern about focusing on the cancer. I did not have a complete response with neoadjuvant chemo. I had more chemo after surgery and then radiation, and then Herceptin for the year - with implants in place from 2 years before. Luckily there was no damage to the implant from the 2nd surgery & no problems with rads except a tightening up of muscles & skin. So far I have been NED for 3 years.

MinusTwo · December 2016

LuckyLady - the boards are very quiet because of the holidays but Whippetmom will be around soon. Thanks for providing all the details in your post. She should be able to answer your question.

whippetmom · December 2016

Sorry for going AWOL on you guys! I was on vacation last week and so busy with grandkids! I will start reading tonight and get to my private messages tomorrow

whippetmom · December 2016

Nanpop:

A tissue expander with 450 ccs sounds perfectly fine for your frame. Tissue expanders can feel very uncomfortable for some people. You were filled to full capacity all at once, rather than gradually, so I can imagine that you might be feeling more uncomfortable than if you had gone through fills over two months time. It is not uncommon to do this though, with large breasted women who have ample skin flaps.

Alloderm is used quite often in reconstruction. I have Alloderm and many gals on these forums have Alloderm or some other dermal matrix as a supportive function after mastectomy. It has not bothered me in the 8 years since my surgery.

whippetmom · December 2016

LuckyLady: Yes, I would vote for 550 ccs in an Allergan Style 20. It sounds like a good size for your frame. You should be able to get there just fine with your 375 cc TEs and your overfill.

whippetmom · December 2016

Layle: It all depends on the patient, when determining how long to wait for the exchange post-last fill. If your skin has responded well to expansion, perhaps a month to two months. It is up to your PS. I do not see the need to overfill much if any at all if anatomicals are to be used. That is, unless there is a larger jump in volume anticipated by your PS.

whippetmom · December 2016

Kattis894:

I think it is a matter of choosing the option which will make you feel less stressful and anxious about your treatment. If it means that you will be worried or wonder what is going on with the implant during your aggressive treatment protocol, then delayed reconstruction will remove that stressor for this part of the journey. It is a journey - all of it - and removing stressors from your life is paramount to your healing and recovery. For some women, having a "mound" after mastectomy is very important and for them, THAT helps them cope more with the treatment issues. It sounds like you are talking about having only the cancerous breast removed. Am I correct? If so, and if you have immediate placement of an implant (not a tissue expander) it may not fare as well as a tissue expander. I have had gals go through rads with implants in place and they did fine, in terms of no rupture to the implant. You are at higher risk for capsular contracture with radiation, and this is why many women opt for a flap procedure. If you have ample tissue, and you are otherwise healthy, I have seen beautiful results with autologous flap breast reconstruction. I am not sure why Herceptin would delay reconstruction though. Many, if not most gals, here on bc.org have taken Herceptin during or after reconstruction. I know you need to wait a considerable length of time after rads, but why Herceptin? That is just not my area of understanding and perhaps one of the Her2+ threads would have more information to share in that regard.

Please keep me apprised of how things are going for you and what you decide to do.

Keiki · December 2016

Bird-of-Light

Where are you with your expansion/exchange? I have same 133MX-13T awaiting exchange on Dec 15. I am only 5'2" but at 600cc, What is your plan? I would love to know how you are doing

Kattis894 · December 2016

Thank you so much for your reply Whippetmom,

I agree with you; it is all about what makes you feel less stressed and more comfortable in the end. There are many aspects to consider for each individual. As I am 55, I am not worried about breastfeeding nor other issues that a younger person might understandably have. I have been working in the fashion industry my hole life so being flat chested (like most models) is actually something I am looking forward too at this point. I will ask for a breast reduction on my healthy breast but not sure when that surgery can be performed due to risks for infections prior to radiation. I hope they can do it immediately.

Yes, I did have a chat with the professor, she was all with me on not having the expander put in at this point and she told me to ask the surgeon for another option than silicon. Her experience is that they can get very hard especially considering my age. I am trying to read up about flaps (will read up on autologous flaps) and was wondering if they need to save some skin in order to be able to do reconstruction further along while doing removing the breast?

I am just glad I am questioning the "standard" protocol here in Sweden. The nurse seemed very surprised I did not want the expander so I think I need to stand my ground and feel certain about my decision. The professor told me that most plastic surgeons mostly just wants to use silicon over here since it seems faster and easier at first glance.

Thanks again, I will be reading up about flaps.

LuckyLady17 · December 2016

whippetmom

Thanks for your opinion. It's so hard trying to figure out what's going to end up looking right. I did more reading as I was waiting for your response and found that you say comparing the measurements of the expander to the implants to be most telling.

The 550cc of style 20 is 1.5 cm wider but .8 cm smaller in projection than the dimensions of my expanders. I know I said I don't want cantaloupes but I also like the projection of the expanders right now.

So I'm wondering if the Style 45 or Inspira SRX would be a better choice. I don't even know if she offers that implant but I thought I should ask you what other implants and sizes you think would suit me before I talk to her.

Thanks

whippetmom · December 2016

Kattis - Flaps can mean a number of things, but here we are speaking of latissimus dorsi, DIEP, SGAP, and other procedures where your own tissue *(autologous meaning self-donating) is used to create a mound. I know very little or next to nothing, actually,about these procedures, so you would need to go to the various forums where these procedures are discussed.

Now when you talk about a "tissue expander", I just want to make sure you realize that the TE is not silicone. It is a firm shell with a port and saline is added to the device to create volume. You could keep this in for 6 months while you undergo treatment. Thereafter you could thave the exchange to silicone implants. There is nothing wrong with silicone implants. Most of us have them.

whippetmom · December 2016

LuckyLady: Certainly you can talk to your PS about Style 45 or the Inspira ultra full projection style implant. Find out what she is willing to do to get you to the size you desire. But .8 cm is not much you know. It is 5/16 of an inch.

whippetmom · December 2016

Here is the Inspira SRX sizing chart:

Marimucho · December 2016

Hi whippetmom! On January 7 I will be having a bilateral mastectomy. I have opted for tissue expanders with Alloderm and silicone implants and potential autologous fat grafting at the final reconstruction surgery. I am now a full B cup, but I was always an A. With age, almost 52, I have gained some weight and they are a big B. I am 5'1 and am a 34 when in shape and a 36 when not. What I think I am trying to say is my weight fluctuates. My frame is small. My plastic surgeon suggested a B cup for the implants. I feel that as an A cup I was so comfortable. He then suggested a small B and said we would have the advantage of living with each size before the exchange surgery. Do you think an A cup would be too small. I have been told that A cup implants don't look very good. What is your opinion?

Kattis894 · December 2016

Thank you for your reply whippetmom,

Yes I understand the expander eventually gets exchange and there are normally no complications with it. I also know many woman with silicon that are very happy with their breasts.

However I have made up my mind pretty firmly at this point not to go ahead with the expander and will discuss with the surgeon on the 8 th of Dec if they can suggest any other alternatives, like the flaps. I have also decided to do a breast reduction on my healthy breast moving forward and go ahead with life pretty "flat chested". If anything positive will come of this, it would be that I will get a smaller chest. My boobs are very large and I would be happy with them being much smaller. I am aware I might have to wait 2 years for my reconstruction not doing the expander at this point but I am ready to wait as well. Dealing with this type of triple positive aggressive cancer makes my decision also easier since I just like to focus on getting rid of the cancer at this point. I do not have to wait that long for the breast reduction and they might be able to do that in-between my herceptin shoots.

Still this is such a scary ride and I am very worried about everything.

BREAST IMPLANT SIZING 101

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