BREAST IMPLANT SIZING 101

whippetmom!

My heart skipped a beat seeing you posted about capsular contracture and fat grafting. I have such faith in your expertise, I wanted to ask you first for guidance. Your blog provided such reassurance during my early difficulty - reading others comments and questions and your answers.

I have developed capsular contracture over the last 4-6 weeks on my left, and my right implant has migrated toward my armpit. Oh my gosh! Who ever thinks these things will happen?

1) Do you know of an excellent surgeon who specializes in capsular contracture repair or a place on this site to find other women's reviews?

2) Research on recurrence and/or failure of fat grafting and of capsilectomy with implant replacement is incredibly hard to find. Do you have any references and/or can you refer me to another excellent blog topic/blogger like yourself here? I love my small C foobs and want to keep the same size and like every woman, I hope my next surgery is my last!

3) Is there an approach that more often fixes these issues without repetitive subsequent surgeries?

Also, why don't surgeons start out using Alloderm or other means of creating a sling or internal bra when there seems to be evidence these can reduce implant migration, capsular contraction and infection rates?

Since I last posted, here is the update:

I had exchange surgery in August with a new PS - I finally changed with encouragement and the original surgeon was very upset, according to my wonderful breast surgeon. I was initially so happy with the results - because of a hematoma and the original PS not being able to get the expander up under my pectoralis muscle on the right, I knew there would be a little difference in fullness on top, but the PS was able to make my spared nipples pretty even horizontally. He also revised keyloid (sp?) scars which are significantly improved, but still occurred.By October, I began feeling my new foobs were really my breasts! The PS released me to return in 6 months. Then almost immediately, I felt changes in both breasts.

Just wanted to update that I had my exchange on Weds and except for the nausea that has followed me the last couple of days I am happy that this is finally done. My plastic surgeon ended up using Inspira SRF 560 and even though I am still swollen because of pocket work done on both sides I know she helped me make the right choice for me by using the SRF and not the SRX. She was also able to decrease the major space between the implants and I am sure I will be happy with the final outcome. Thanks again for all the info to help prepare me for this stage!

Hi Whippetmom,

Thank you for providing the support that you do. It is greatly appreciated. My TE's are too wide. The PS put them in because I had so much extra breast tissue. He knew I wanted to be small and wanted a Diep. I did not want inserts. I like the idea of having my own skin and fat in my breasts. I lost about thirty pounds from stress since surgery.

So, I have a lot of extra skin by my abdomin but not a lot of fat. My skin was stretched out from pregnancy 19 years ago. Do you think it's possible to have a diep or something similar now that I lost all that weight?

I will be having radiation so I do not know how that will affect future surgeries. My understanding is that radiation continually shrinks the skin. Is this still true?

Thank you.

SeattleBound - I'm sorry I wasn't able to be of more help. I don't know the policy guidelines of posting specific recommendations but Whippetmom should be able to help soon. I understand the feeling of wanting to make sure you get an experienced recon/revision PS. My original PS thru my HMO was not experienced in recon. I lived with a less than satisfactory outcome for 5 yrs. until I developed cap. contracture. By a huge stroke of luck my HMO referred me to a great recon/revision PS! Before my appt. I did go online & researched specialists in my area but once I met her I knew I was in experienced hands. She convinced me to go thru expansion again both sides (which I didn't want to do) in order to get the best possible result. She is a perfectionist & my final outcome (surgery 9/15/16) is better than I could possibly have imagined. She used alloderm & Mentor anatomical implants for their textured surface which is reputed to have some effect in reducing cap. contracture although I don't think it's clinically significant. Also visit the Exchange City thread on this site & see if you receive additional advice there. I don't think you are unrealistic in any way. You want the best possible outcome just like the rest of us! Best wishes for a wonderful 2017!

Thank you, MrsB88! I have found many specific names since last posting. Would you share your PS's name

Whippetmom and others

What is the procedure to remove TE without implants? Does the muscle reattach?

Can the expanded skin be used with tummy tissue? Sounds like this could be plan B for failed implants

Thank you, Orcaporkka

whippetmom,

Wow! What an incredible set of articles and links with a wealth of information. Thank you so much!! With all the time and effort you have given to so many of us for so many years, I hope it is rewarding to know how helpful you are and what a difference you can make in lessening the sometimes overwhelming sense of helplessness that I, for one, feel.

I wish there was an easy way for every woman facing decisions at every point to find all the information in one place. It seems one set of information leads to others. It is a process of following trails to an end point, then back-tracking to follow another! The same with researching plastic surgeons. My questions after the most recent researching are listed below. I am certainly not asking you to do any work for me nor do I expect all the answers from you. If you know where I might find any of the information, that would be great. Taking this route will be costly for me, so I need to do my best to narrow the field!

1) From the different types of fat grafting, which types/methods are preferred or known to be most effective with the least problems? (The Brava stretching sounds unworkable to me 😳 with the number of hours required to wear the cones and multiple treatments - out of town, for me, over several months.)

2) Would I be correct in thinking that problems following a mastectomy (such as capsular contraction) would be best handled by a PS who does a lot of post mastectomy reconstruction work?

3) Is there any resource that can give statistics re: the success rates of a given procedure, or a particular surgeon's success rates? For example, it would be helpful to see if certain doctors have better outcomes in treating and preventing future capsular contracture through fat grafting - with or without implant replacement.

4) Is there a list of doctors who members of this site have used that have been successful in pocket revisions, treating capsular contractions and using fat grafting when indicated? In one topic thread, a member posted a list, primarily related (I think) to doctors who will do prepectoral implant placement.

Finally, on a personal note, have you heard of a situation like mine in which the PS could not get the TE fully up under the pectoralis muscle, so the pocket developed differently from the other side, but a subsequent PS was able to modify the pocket to achieve a similar result on both sides?

Again, thank you very much. It is a real comfort knowing you are thete

Hi everyone!

I continue to read and research everything I can since my capsular contraction and my other implant migration are now becoming noticeable in clothing. Does anyone have feedback about Dr Richard Baxter who is north of Seattle, Dr. Lisa Cassileth in CA, Dr Hilton Becker in Boca Raton, Florida, or Dr Lewis Albert Andres in Scottsdale? I have focused my search specifically on doctors who specialize in, or list and have photos related to, reconstruction after mastectomy.

I cannot find any complaints or malpractice claims on Dr. Baxter and I am impressed with what he has written on his own website blog as well as answers he has written on realself.com. Baxter, Cassileth and Andres seem genuine and humble which appeals to me. Dr. Becker gets a lot of good reviews but also some complaints, as does Cassileth. Becker has invented a number of products and tools related to reconstruction which can be great, but I also worry a bit about that.

Thanks to all who share their experience and knowledge! All comments are welcome

Thank you, Whippetmom.

Is there a place I can share surgeon information to help other women? For example, I am specifically identifying reconstructive plastic surgeons who

-Specialize in breast reconstruction and revision (versus augmentation revision surgery)

-Are skilled in using ADMs (Acellular Dermal Matrix such as Alloderm)

-Perform "pocket revisions"

-Do "prepectoral" implant placement as well as under the pectoralis, when indicated for the patient

-Use fat grafting to augment/fill in areas, as needed (versus moving/transplanting flaps with or without muscle)

I would love to help other women seeking the same skill sets. There seem to be a lot of PSs who primarily do DIEP, TRAM, SGAPand other flaps, especially at teaching and research centers.

Whippetmom

I posted on the main breast reconstruction page but I thought I'd also directly ask your opinion of what you think might be causing major rippling all around the implants at only 2.5 weeks post exchange. I can see deep rippling on the outside of both implants when I'm just sitting or standing. If I bend over the deep ripples are everywhere, top, insides, outsides, and if I feel the bottom it seems like they are there as well.

I thought I ask if you thought maybe this could be an implant size issue? Maybe she should have used the SRX instead of SRF. I don't know but I just hate this.

As a reminder, I had Mentor Artoura High Profile 375cc expanders filled to 400cc and then exchanged those for Inspira SRF 560cc implants. My chest measurement below implants is 32".

Thanks for your input or anyone else who has dealt with this issue.