BREAST IMPLANT SIZING 101

whippetmom · May 2017

Stix: The capsule starts forming right after surgery, and continues to do so for weeks or months. Ditto to whatCarla said about settling. I don't use the term drop and fluff, because plastic surgeons do not use that term.

whippetmom · May 2017

Fat grafting will not address the projection issue. Stix - my right implant has bottomed out. No big deal. I wear bras all day and a shelf bra camisole atnight. I do not plan to get it fixed, unless something else goes wrong and I need to replace the implants.

whippetmom · May 2017

Vicky: hank you for the tip about editing.

EDIT: Sometimes a letter just automatically drops and there is no retrieving it!

Stix · May 2017

whippet mom

thanks for the comment on fat grafting. Re removing the implants- mine has always bottomed out.It looks ridiculously assymetrical when it bottoms out- mainly due to the flat upper pole. I cannot even fin. the nip reconstruction due to it. presnelty It feels heavy compared to the other side- time will tell as with everything. I guess I need to concentrate on something else in the meantime.

Shocked

Nanpop · May 2017

Hi,

I had a bilateral mx. I was a 34 f I now have Natrelle style 133 TE. REF NUMBER 133 MV-15-t. They can fill to 600 cc but are only filled to 450 cc. The doctor filled them up during the initial surgery. Never had anything added.

I am 110 pounds. Rib cage is 30. I am 5'3.

I want to remain small. Like 34 b.

They were placed on October 5 2016.

My right breast has deflated.

I was thinking of a diep flap procedure after my body heals. I don't want inserts.

I am doing radiation now for the left chest wall.

The doctor used alloderm and will need to fix the right breast even though I'm undergoing radiation.

The original TE was too large. What size and type should I get?

Does deflation happen offen?

Thank you.

whippetmom · May 2017

Nanpop:

I am confused by two statements:

"I was thinking of a diep flap procedure after my body heals. I don't want inserts."

"The original TE was too large. What size and type should I get?"

Do you mean you are getting NEW tissue expanders bilaterally? Or, did you have even larger TEs before the MV-15's? What did you have originally, because the MV-15's are pretty large for your frame. 15 cm is a pretty wide implant for a petite gal. I presume he needed to fill up the skin envelope, in light of your previous breast size. But none of this would matter, if you plan to have a DIEP.

Your PS would need to do considerable pocket revisions to narrow the pocket and provide a smaller envelope. I think the ideal size of TEs would be MV-400 ccs, but can it be done? I do not know. It depends on how much skin can be excised.

But overall, I am not sure which way you want to go with reconstruction. If you do not want "inserts" (implants), it does not matter what size of TEs are used. I think you need to discuss all of this with your PS.

Deflation of the TEs is rare, and typically occurs because of physician or nurse error in finding the port during fills. The TE gets punctured and deflates

whippetmom · May 2017

Nanpop: Just found your post to me from 6 months ago. At the time you said you had a 450 cc tissue expander. What happened to THAT TE

whippetmom · May 2017

Nanpop:

This is my response to you in December of 2916. I wonder if you saw it? I think it answers your questions currently

Nanpop:

"Your tissue expanders are pretty wide for your frame. I feel that your PS should narrow the pocket and use nothing wider than a 14,0 cm wide implant. You should have discussed a DIEP with your PS previously. Does your PS know that you are considering a DIEP? That said, based on your height/weight, it does not sound as though you would have sufficient tissue for a DIEP. You can get a perfectly natural look with implants. You are going to need pocket revisions....perhaps an Inspira SRF or SRM. Something in the 450 cc to 500 cc range. Or a moderate height Allergan Style 15 in the mid 400 cc range I just am concerned that you and your PS are not on the same page, based on the size of the tissue expander he chose for you. Please discuss your desires to remain on the smaller side with your PS. Do the TEs seem wide on your chest wall? I"

Nanpop · May 2017

Thank you for replying so quickly. My PS originally put in TE's that were large because I had a lot of extra skin after the mastectomy. The TE's are way too big. You can see the plastic sticking out under my arms. I did lose 25 pounds after Masectomy. He knew I was considering a DIEP Flap and put in TE's because I wasn't sure what I definitely wanted. I wasn't sure I wanted to undergo an 11 hour surgery.

Are there any newer surgeries that don't take that long?

As of today I noticed that the right breast leaked out. So I believe I need a new TE. We may try to refill the TE to see what happens. This is the third surgery. The first TE after masectomy caused a hematoma. So I went in two days later to get a new TE. Now it's 7 months later and it's deflated. I just had my ovaries out three weeks ago. I am 2 months post chemo. I just started radiation for chest wall. I'm not sure what to do

Any suggestions?

whippetmom · May 2017

Nanpop:

You really should not do anything until well after radiation is completed. Then you can decide which way to go. You need to talk to your PS about the various options he feels might be appropriate for you.

noodlesmom · May 2017

Whippetmom-

I did finally choose a PS and am scheduled for BMX May 31. He initially showed me a 400cc expander and I was shocked as I think it would have to wrap around my rib cage. He said it was the smallest they made, but when I pressed, he pulled out the catalog and found that they could get a 300 from Allergan (I think). Does that sound right to you? Should I ask about a smaller one from Mentor? When he measured me, it was 13cm, but 2 other PS I met with measured 11cm so I'd say I'll split the difference and say 12?

whippetmom · May 2017

Noodlesmom: Allergan's tissue expanders: show these to your PS!

noodlesmom · May 2017

thank you! Calling over there to check. How do I know whether short height or moderate height is right for me?

buffyjc · May 2017

Hi all! I'm looking for suggestions. I definitely would like to have much fuller, larger breasts then I previously had. I have NEVER been proportionate with small breasts. I had a SMX so I'll be having a "matching" implants, as best my PS can do, to my opposite breast. Here is my profile:

Height & weight: 5'8" 157 lbs

Rib cage circumference: 34.5"

TE: Mentor Smooth Round Spectrum (350-1490)

Currently filled to 500cc (300 at surgery and 200 at first fill this week). Next fill is not until June and PS said we should get it to 700cc then.

I think my PS carries both Mentor and Natrelle as I've seen both posters and display implants. Initially I was leaning towards saline implants as I just assumed they were the more natural than silicone but in talking to the PS's nurse this week, she said most breast cancer patients typically get silicone. I'm okay with this if it helps with the best cosmetic outcome. Although, I'm not sure if he offers the gummy gear style.

ETA: PRE-surgery, I wore 36C bras but all of them were extreme padded, push up. I've never had a proper bra fitting so I'm not sure if I am/was a true B or C cup

Any suggestions would be helpful!

MinusTwo · May 2017

noodlesmom - I may have missed it, but I don't see where you listed all your specifications. Please do read the header and list everything that is requested for Whippetmom to give you an opinion.

Also when you get a minute, do go to My Profile and add your diagnosis & treatment specifications so we will be better able to comment on your questions.

whippetmom · May 2017

MinusTwo: noodlesmom gave me everything a few pages back.....

whippetmom · May 2017

noodlesmom: Based on your preference to be small, either should be fine. It all depends on which style - which HEIGHT - actually, your PS feels would work best for your frame.

whippetmom · May 2017

buffyjc:

I feel that the Mentor or Allergan smooth silicone round, high profile, might work best for you. Probably 700 ccs on the MX side and whatever size the PS needs to use to augment the native side. Another option is the Allergan Inspira implant, which is the newest silicone implant available. The HP (SRF) style there also, in the 700 cc range.

buffyjc · May 2017

Thanks so much, whippetmom! I appreciate your insight!

Tracy123 · May 2017

I am not sure if I am doing this right but I had a bmx on 4/18 with te placement. I previously wore a 34c bra but they were always extra padded pushups leading me to believe that without all that padding I would have been a 34b. I would like to go a size bigger and I am currently at 290 ccs in allergen 133mv-13 400 cc expanders. I have Dr. Pusic at MSK. She suggests that filling me to 500 should get me the full/perky C that I would like. I am 5'2" and 120 pounds with 28.5 measurement for rib cage. I have read a lot about not being able to get projection and that reconstructed breasts look like pancakes and that worries me. What fill volume/implants should I be shooting for ?

I forgot to add I had skin sparing and nipple sparing for diagnoses of Stage 0 DCIS in left breast.

Thanks in advance. I'm so confused as I never thought I'd be picking my own breast size and there is a sea of information (most of it scary) on the internet !

whippetmom · May 2017

Tracy: Dr. Pusic is great! I would go with smooth silicone rounds. The standard Allergan Style 20, 500 ccs, is a choice. For more projection, it would be Allergan Inspira, 545 ccs, Style SRX. Inspira is the newest implant available, and has a higher fill ratio. So you could also go with Style SRF in 485 ccs or 520 ccs and get the width you need, but with not as much projection. The SRX has 6.2 cm projection and the SRF has 5.4 cm projection. The key here though is that the PS needs good skin closure over the implant, so we will have to see how much skin availability you have after fills. Oft times it is not even known until you are in the OR, what size/projection implant will fit the best. So just discuss with Dr. Pusic your desire for projection and discuss the style options I mentioned above.

Tara17 · May 2017

dear whippet mom --i dont know if this question is appropriate for you , so forgive me if this isnt the right forum. I will be undergoing unileteral mastectomy in two weeks .my PS is planning tissue expander and implant. After doing some more reading, i am reading about direct to implant surgery -- ( i am 5'2" , 115 pounds, i am a 32C naturally ). The direct to implant surgery wasn't mentioned to me at all. Is this something worth askign the surgeon about or is it better to to go with the tissue expander and implant process ?

Tracy123 · May 2017

I do love Dr. Pusic ! Thank you for the info ! I will definitely be discussing allthis with her at my next appt.

whippetmom · May 2017

Tara17: If your PS did not mention this or offer direct to implant as an option for you, he may have felt that he could not gain symmetry without tissue expansion. A direct to implant requires much more precision and predictability with size and if you are a unilateral, that further limits your candidacy for a one-stage, direct to implant procedure. Symmetry is very important for a single MX. So a tissue expander will allow the PS to better control the size and shape so that he can come as close as possible to matching the native breast.

Tara17 · May 2017

thank you Whippetmom for the detailed reply! All that makes so much sense. You are a wonderful human being by helping women out like this. I will be back with more questions as i go through the process.

Maui-Jen · May 2017

Hi there! This is my first time posting. I had my last chemo treatment on 3/13/17 and a BMX with TE's on 5/8/17. My 4 drains were removed on 5/19 by the PS nurse. She told me she can do my first fill also. I was a little hesitant because she wasn't my PS. But then I had her do 50cc in each. I regretted it on my way home thinking I should have just waited for my PS to do the fill. That night and for the next 2 weeks I was in so much pain I had to take percocet 3 times a day. Yesterday was the first day of relief as I had more discomfort rather than actual pain. This was a surprise as I normally have a high tolerance for pain. Although she put the same amount in each side, the right side looks considerably smaller than the left. Is it normal for them to look completely different? Today I see my PS for my next fill, and I'm thinking I will ask for less than 50cc in each.

Whippetmom- In your opening post you ask for some details in order to help determine the appropriate implant type for each individual. Here is my info. Thank you so much for your time and helping so many women going through this journey.

Height: 5'5", Weight: 142 (need to get back to 135). Ribcage circ: 31.5", TE: Allergen Natrelle 133 mv, 300cc, Implant Type PS uses: Mentor, Pre MX size: 36 A/B

whippetmom · June 2017

Maui-Jen

50 ccs is really not a huge volume to start out with. Personally, I prefer that the doctor do the fills. Sorry, but that is just my preference. My PS felt it was her responsibility to manage the fills. As far as sizing, I think you should gradually get your fills every two weeks and perhaps get a bit of overfill so that you could get an implant in the 450 cc range at least. A Mentor smooth silicone round HP or moderate plus profile implant.

Robins_Mess · June 2017

Hello WhippetMom!

I had bilateral mastectomy March 2015. The right side was pre-emptive as I have BRCA 1 gene. I had lat flap surgery with TE on my left (radiated) and TE under the pectoral on the right 3 weeks ago. I have Sientra Full height, smooth, 14 cm, fillable 480-575. I am 5'5", 130 pounds, 32" ribcage. Previously I was a 34A. I have had one fill of 80 cc's in the right and 50 on the lat flap side. The lat flap side is already about the size I felt I was before, but I think I still have some post-surgery swelling there causing some of the size. I would love to be a bit fuller to actually fill out the tops of dresses after all of this. What are your thoughts on implants for me - I guess using the non-lat flap size so it's easier to judge size on that.

Thanks for your help!

Maui-Jen · June 2017

Whippetmom - Thank you so much for your response.

BTW, When I saw my PS he said he would take over all my fills from now on. I wish I had known that in the beginning. And I found out that nurse is longer working there.

whippetmom · June 2017

Maui-Jen:

BREAST IMPLANT SIZING 101

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