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Choosing implants

Saline versus silicone? Teardrop or round? Will high profile give enough projection? Choosing implants has been a popular topic in the Prophylactic Mastectomy Facebook group this week. While reviewing feedback of some of the other Ladies, I found myself questioning the choices I’ve made. After looking over my little list yet again, I reaffirmed that I have made the best decision for me. Here are the winners upvote and the losers downvote.

QuestionDisclaimer: Each person may give different levels of importance to the factors I list below and should discuss their options with their plastic surgeon. It is not my intention to convey that choosing anything different than what I chose is wrong. I am just presenting my logic. Right, wrong, or just plain stupid. 🙂 As always, I welcome your feedback!

Implant type

Factor Saline Silicone
Durability downvote upvote
Incision size upvote downvote
Chance of rippling downvote upvote
Natural feel downvote upvote
Sloshing downvote upvote
Leak detection upvote downvote

All the hoopla about the link between silicone implants and connective tissue disease, breast cancer, or reproductive issues is just that .. hoopla and unproven. It still caused the moratorium on use of silicone implants in the US in 1992, though. Because of this, breast implants are the most tested medical device out there. The moratorium was lifted in 2006. See FDA’s Update on the Safety of Silicone Gel-Filled Breast Implants for more details.

BreastReconstructionGuidebookTab6_1In any case, both types of implants are encased in a silicone shell. The one encasing the silicone implant is solid, but the saline one has a port (salines are inserted deflated and filled with fluid; silicones are pre-filled). Also, salines are more prone to ripple, causing folds in the shell. These two vulnerabilities are the causes of higher failure rates of saline implants. Although they come out on the bottom here, problems with silicone implants are more difficult to detect. Regular MRI screenings for “silent ruptures” are recommended for patients with these types of implants.

On the aesthetic side of the equation, the incisions needed for salines are smaller, but they are firmer and have been reported to produce a “sloshing” noise.

Implant shape

Factor Round Anatomical
Natural appearance downvote upvote
Natural feel/motion upvote downvote
Higher projection upvote downvote
Complication due to turning upvote downvote

From the various photos I have seen, I am not convinced that there is much difference in the aesthetic outcome, but in my head it makes more sense that anatomical (teardrop) implants have a more natural shape, so I gave them the upvote. While both shapes are filled with cohesive gel, the degree of viscosity varies between the round and teardrop versions. Teardrops may look better, but they are firmer due to the gel being more form-stable (read: solid). This consistency is what gives the implants the “gummy bear” moniker.

Whether saline or silicone, implants come not only in different shapes, but also either smooth or textured surfaces, as well as different projections. Due to the distribution of the gel within the implant shell, the same volume of silicone produces a higher projection in a round implant versus a teardrop one. The higher the projection, the narrower the base. With a 29″ rib cage, I need narrow implants and the round version offers the highest projection: ultra high.

And lastly, the fact that corrective surgery is required if the implant turns is a big one for me. When a round implant turns, you can’t tell, but if a teardrop is loose within its pocket, it is obvious. With the current state of my expanders (one sits higher than the other), I am nervous about this possible issue and want to avoid it.

So there you have it: I chose round silicone implants.

Check out this awesome video showing the difference between regular round silicone implants and their anatomical counterparts.

This is a video of me playing with a round implant that has been ruptured. You can see that this type of implant is also cohesive enough to not leak outside of the shell. It retracts just as the anatomical implant in the above video.

Source of Table 6.1: Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.

So what size are you?

It’s strange how often I have heard this question. Yes, I had a prophylactic bilateral mastectomy, and yes, my boobs seem to be growing right before your eyes, but this question is not appropriate for watercooler chat. We’re not that chummy! How would you like it if I asked your wife her bra size? Kind of weird, no? Apparently not. If I had a Dollar …

Quest markerThe times I actually did answer this question, the only measurement I had was the volume in ccs. Unless you’re one of “us,” this don’t mean jack, so after yet another time I fielded this question, I decided to go on a quest and figure out exactly what the magic number was.

How I measured my cup size

A lot of women make an appointment for a fitting by someone who knows what they’re doing (usually Nordstrom lingerie department). I have not yet taken this step, because I’m not completely finished. Off to Google and the FaceBook groups I went. There seem to be a few different ways to do this. One of the ladies in a FB group, who is familiar with the topic, was happy to assist.

Bust measurement

Source: Jason Lee, RealSimple.com

Without a top, I first measured the underbust, which is the lower yellow line in the graphic = 29″.

Traditional sizing says to add 4″ if even number or 5″ if odd number.  Modern sizing rounds up to the next even number. We went with modern sizing, so that brought me to 30.

Then I measured at the top yellow line, which is the widest part of the bust = 36″.

The math: subtract the underbust from the bust. The difference is what determines size, with each inch representing one cup size. 1 = A, 2 = B, 3 = C, etc.

Ladies and gentlemen, we have our verdict: 30 DDD. Yes, that’s right D D D. I was shocked when we came to this conclusion. I still am. I was not expecting this at all. Having been wearing an A cup bra pre-op, triple Ds just seem ridiculous to me. I never had a number or letter in mind when thinking about reconstruction. I was of the mindset that I would keep expanding until things seemed just right. I hit that point at about 400ccs. Having read a lot of feedback of women feeling that they should’ve gone bigger, I told my plastic surgeon that the sweet spot was 450ccs. Since I’m getting round implants, we overfilled by 100 for a total of 550ccs. It’s at the overfill point that I measure a DDD, so this isn’t the final FINAL verdict. I will get a professional fitting a couple of months after my exchange, once things settle down. Stay tuned!

Here’s an interesting graphic related to cup size. A 30F on me is a 38C on someone with a larger ribcage/underbust. It’s all about body size and proportion.

Cup size and proportion

Done, DONE, D O N E – ninth expansion

WARNING: NSFW / graphic content below.

I am officially finished with the expansions! YES! We added the final 25ccs to each expander, for a total of 550ccs/side. I am so ecstatic to have reached this milestone. I was really hoping to be completely done late Spring/early Summer, but my rebel nipple Dusky and his pal necrosis had other plans. Six months after my prophylactic bilateral mastectomy on January 22, 2013, I am finally done with fills! This is what I’m doing right now:

What’s next?

  • 7/31: follow up to make sure I haven’t decided that I want to go bigger
  • 8/19: pre-op appointment
  • 9/03: the long-awaited exchange surgery!!!

That’s a lot of fills!

2013_7_19 fills

100 + 50 +75 +75 + 50 + 50 + 50 + 50 + 25 + 25 = 550ccs

Eighth expansion

WARNING: NSFW / graphic content below.

I can almost smell it: the end of the expansion process. This was supposed to be my final expansion, however I wimped out and we only added 25ccs to each expander, for a total of 525ccs/side. The goal is 550ccs, so I have another appointment for the final FINAL expansion in one week.

GravityThe reason for halving the volume is pain. The last expansion brought on a lot of pain. Not that I thought it was going to get more pleasant, but it was pretty bad. As usual, the worst of it come early in the morning. I’ve never dreaded getting out of bed so much. As soon as I sat up, gravity would work its magic. Talk about grumpy mornings.

The pressure was intense and I was on ibuprofen for about three days after. It didn’t help that we spent that weekend camping, so I was not sleeping in my own comfy bed. I really thought if someone poked me, a foob would pop. I even had a dream that my cat sat on my chest and the thing just blew up under her. Not like a slow deflation, but a violent explosion! I woke up in a sweat and immediately groped my chest to make sure everything was still there. Whew!

Enjoy the pics. It’s getting crowded down there!

2013_7_12 Fills

100 + 50 +75 +75 + 50 + 50 + 50 + 50 + 25 = 525ccs

Melons!

There is nothing simple about a mastectomy operation and following breast reconstruction, but this still made me LOL.

If life gives you lemons, a simple operation can give you melons

Extra! Extra! Seventh expansion

WARNING: NSFW / graphic content below.

The Virginian-PilotThe story I mentioned in my last post, has been published in Sunday’s edition of The Virginian-Pilot. “At-risk local women take the fight to breast cancer” features stories of the two local FORCE coordinators and mentions this very blog. Check it out.

In other news, I am definitely over the hill with the expansions. I reached the size I’d like to be after the exchange surgery with my last expansion that brought me to 450ccs and am now in the overfilling stage. My seventh expansion added 50ccs to each expander, for a total of 500ccs/sideThere is one more 50cc fill left. I don’t  know how that’s going to go. I feel like any minute now, these foobs are going to pop!

No surprise that this was the most painful expansion thus far. After previous fills I usually had a shitty Saturday morning, but did not really think about it by Sunday afternoon. Today is Monday and I did not have a pleasant morning. I slept fine, but I was feeling pain as soon as I sat up in bed after waking up. Gravity … I hate your face right now! I am both looking forward to and dreading the final expansion in three weeks.

2013_6_21 Fills

100 + 50 +75 +75 + 50 + 50 + 50 + 50 = 500ccs

For those of you just joining us …

HELLOI’d like to take a minute to say welcome to new visitors and subscribers! Thanks for stopping by and checking out my blog. (I know you’re really here for the topless pics 😀 – see: My Photos)

I was recently contacted by a reporter who is writing a story about BRCA and hereditary breast and ovarian cancer (HBOC). I was more than happy to share my story, feedback, and reaction to Angelina Jolie’s New York Times op-ed. I thought adding that here is a great way to give the new readers a summary of my story, so here goes …

Recap

I’m 32, married, no kids (more: About Me). Neither I nor any of my family members carry any of the known BRCA mutations; however breast and ovarian cancer are prevalent in our family. My sister was 28 when she was diagnosed with breast cancer and died a year later. My other sister has a breast biopsy scheduled for next week. My mother is currently undergoing treatment for ovarian cancer.

I said NOPE to Breast CancerEven though I am BRCA mutation negative, I have an increased risk of developing both cancers based on my family history and was faced with the same decision regarding my breast health: choose surveillance, chemoprevention, or surgery. For the past 10 years I chose bi-annual screenings via mammograms, ultrasounds, and a few MRIs. I made a different decision and started planning for a prophylactic bilateral mastectomy when screenings discovered some issues (see: But why?) in March and then June of last year. I underwent the mastectomy in January 2013 and am currently going through the breast reconstruction process, which will end with the second surgery (see: We’re getting there) in September. I have consulted with my doctors about having my ovaries removed and will most likely be seriously considering an oophorectomy in about five years.

When I was preparing for my mastectomy, I spent many hours online looking for first-person accounts of the process and following recovery. I wanted to know every little detail related to the options and decisions I had to make: from which doctors to choose, to what type of reconstruction is available, to how to handle insurance coverage complications. I didn’t find many back then, so I started my blog, sharing my story and photos. I write my blog to give women facing HBOC insight into the experience of a prophylactic mastectomy if they choose to undergo one.

The “Jolie mastectomy”

I was immediately very excited when I read Angelina Jolie’s New York Times op-ed. I could relate to her story, as I had undergone my mastectomy just weeks before she had hers. More importantly, her name is known by millions of people around the world and now her story is too. She accomplished with one op-ed what many organizations have been striving to do for years – bring global awareness to BRCA and HBOC.

The essay described her very personal journey and reasons for making the decision she did. I echo her feeling that choosing to have a mastectomy was not easy, but I have no regrets. Although the decision to have surgery was right for me, Jolie, and countless other women, it is not the right decision for every woman and one that shouldn’t be taken lightly or made without research, consulting with experts/doctors, considering alternative options (screening, chemoprevention, holistic approaches, lifestyle changes), and understanding the consequences. I think it’s important to note that Jolie’s experience is unique. She was fortunate enough to have a relatively complication-free recovery, but there are many women who experience severe complications following their mastectomy.

After her op-ed came the multitude of reactions, commentary, articles, blog posts. Many expressed their support of her decision, but others condemned her. Having made the same decision, it was difficult to not take it all personally. What they were saying about her and the choice she made, they were essentially saying about any woman that made the same decision. I have (thankfully) had support and encouragement from those around me.

Then came the pieces referring to BRCA as the “Angie gene” or the procedure as the “Jolie mastectomy.” I do agree with the post I recently reblogged (see: Semantics) – in a way yes, this trivializes other women, their experiences, their struggles. Women (and men) all over the world deal with the realities of carrying a BRCA mutation every day. The decisions, uncertainty, major life changes, and disruption are a huge part of their lives. For some, not a day goes by that BRCA and cancer aren’t on their mind. Most have watched a loved one deal with cancer and worse. Majority don’t have a famous name or a famous face. Some publicly share their stories via articles, blogs, support groups, and other venues. Jolie hasn’t done anything extraordinary. The “Angie gene?” She’s no pioneer. I have nothing against her and reiterate that I’m ecstatic that she decided to share her story, but she made the same decision thousands of women have made before her and will make after her. Hearing someone say “oh, you had the Jolie mastectomy” makes me cringe and smile at the same time. While I’m peeved by the categorization and potential assumption that I chose this option because she did, I understand that this is the only point of reference some people have and welcome the opportunity to talk about HBOC and BRCA.

3/7/14 update: A few things have changed since I wrote this post in June 2013: mom’s treatment was not effective (or rather TOO effective) and she died in November, my sister’s biopsy results were clear, but she is now prepping for an oophorectomy, my September surgery was NOT my last one,

Sixth expansion

WARNING: NSFW / graphic content below.

Yup, I’m done size-wise. I wasn’t 100% sure after the fifth expansion, but I’m 200% sure now. 50ccs have been added to each expander, for a total of 450ccs/side.

After the last expansion brought me to 400ccs, I was quite happy with the result and declared that this is what size I’d like to be after the exchange. However, the feedback on pre versus post-exchange size has been pretty consistent: when you think you’re done, do a little extra; implants sit different and will be a bit smaller than the expanders. So here we are, at 450ccs.

What’s next? Two more expansions are in my future. My PS overfills by 100ccs in order to overstretch the skin and muscle. This ultimately gives a more natural result post-exchange surgery.

Here they are after six expansions.

2013_6_7 fills

100 + 50 +75 +75 + 50 + 50 + 50 = 450ccs

Help change or save a life

The My Destiny Foundation needs your help!

Do you want to make a difference? Want to help someone who is at high risk for breast cancer. Join the fight by making a donation to My Destiny, an amazing non-profit organization that was previously highlighted as one of my favorite resources (see: Resource highlight).

My Destiny’s mission is to educate, support and most importantly, empower women of all ages who are at high risk for developing breast cancer and who are choosing to have a prophylactic mastectomy to reduce that risk!  We are dedicated to providing information, resources and financial assistance to this high risk community.  We provide a safe haven for women so they may gain knowledge about their options, share their journey, and to support and inspire each other.  Our online community (breast sisters as we like to be called) will inspire each other to be in charge of their health and more importantly, their destiny.

Help make a difference! This could be your mom, sister, daughter, friend, neighbor, colleague, or a complete stranger. Any gift, no matter how small, will help offset the costs for genetic testing or healthcare for a woman in need.

Your gift will help change and SAVE lives! Click here to visit the My Destiny website and make a donation.