Cup Size After Mastectomy with Saline Implants?

Question

I will be having a right simple mastectomy. I'm a "A" cup, and I'd like to have an idea about the cup size I would have after mastectomy, with 450 to 500cc of saline injected into my tissue expander? I will then have two implants placed on both sides.

Otto Joseph Placik, MD · Answer

You've have provided us with alot of information and I wish you the best of luck in your subsequent treatment.
Remember that the overall goal is to treat the primary and chemotherapy, if necessary, may delay or effect the reconstruction timeline.
Having said that, it has become increasingly difficult to pin down an exact size at this time.
Also the final size of the expander does not directly equate to the size of the implant. In fact, many surgeons "overexpand" for a prolonged period in order to create stretched skin that may mimic a real breast when a smaller implant is placed and has some "jiggle" room.
In addition, there are combination expander implants that act as the expander and have a separate port through which they are filled. This is commonly placed in the armpit area. When the right size or overexpansion has been achieved the fill tube is removed  via a small 1 inch incision in one simple operation and the expander is left in place as the "permanent" implant. Now this is the ideal circumstance and frequently I find that I have to change the implant position/size/shape necessesitating a larger operation. However, I would discuss this option with your surgeon. It allows you to give your input as you proceed with the expansion process.
In regards to shape, there are round and "anatomic" also descriibed as anatomic expanders.  Anatomic saline implants are available but to the best of my knowledge at the writing of this comment, anatomic silicone implants are not currently available.

Asif Pirani, MD, FRCS(C) · Answer

There is no way to guarantee a particular bra size. Bra sizing varies greatly between bra manufacturers and a C in one bra will be a D in another. What matters more than the assigned bra size is the way the implant looks on you. The best option for your body and aesthetic goals can be determined in a thorough implant sizing session.Implant sizing depends on several factors. One of the most important factors is your breast width. Generally, your surgeon will measure your breast width, and then provide you with a range of implant sizes appropriate for your native breast size. There are more nuances to it than just what I've described, but this approach works for most women.I usually have my patients bring in a large bra and a tight t-shirt to do sizing. I'll then choose 3-4 implants that I feel are appropriate, and have my patients place them in the bra under the tight t-shirt. My patients can then look in the mirror and get a good sense of what they will look like with the provided implant sizes. My patients like this approach and get a great idea of how they will look.By using this technique, your surgeon can outline a range of appropriate implant sizes that will be aesthetically pleasing, and you make the final decision.I hope this helps. Good luck!

Lewis Albert Andres, MD · Answer

The volume needed to achieve this result will differ amongst each woman. You must take into account body habitus, height, weight, as well as the projection-type of implant used. A smaller woman will require much less volume (cc's) than a much larger and taller woman would. The chest girth in inches (36, 38, etc.) will not change as this is a measure of the chest circumference beneath the breasts. The cup size (B, C, D, etc.) is measured by the projection from the chest. Also, this is always variable, as not all bras are made standard and one brand may give a different cup size from another. Determining this value during your expansion process, if you are having tissue expanders placed initially, may be the easiest way, as you could see the size as it expands and determine for yourself when you are happy with the size in clothing. It sounds as if this is a larger volume, given your stated preoperative sup size. However, since you will likely be going larger in size on the unaffected side, more volume must be placed to compensate for this. It is difficult to answer your question without seeing you or knowing any additional information as that stated above, but certainly looking at your appearance during the expansion process and trying on different bras during may help.

Mytien Goldberg, MD, FACS · Answer

A tissue expander is thicker than a regular implant due to the medal valve and thicker shell. The tissue expander alone carries approximately 75 to 90 cc in volume. With 450 to 500cc saline injected into a tissue expander, you are looking at the final volume of 600cc implant. Without any breast tissue, a 600cc implant would give you a C to D cup depending on your height and chest circumference. I recommend that you seek consultation with board certified plastic surgeon who specializes in breast reconstructions.

Robert Whitfield, MD · Answer

Breast size after reconstruction is a challenge.  I currently use the Jockey Bra system for this.  I have found this system the most effective in establishing a bra size.  Each 200cc or grams roughly represents a cup size.  Please find an experienced Board Certified Plastic Surgeon
and member of the Aesthetic Society using the Smart Beauty Guide.  These Plastic Surgeons can guide you on all
aspects of facial surgery, breast augmentation and body procedures including
tummy tucks or mommy makeovers!

Steven Wallach, MD · Answer

As I am filling up the expander, I ask my patients at what point do they like the size. Once we reach that level, I usually overexpand the tissue expander and then replace it with an implant that matched the patient's volume preference (of course, the shape as well).

David A. Robinson, MD · Answer

It is difficult to determine the final cup size at the time a mastectomy is performed.  Although weighing the amount of tissue removed is used as a guide by some plastic surgeons, several other factors must be considered.  Among these are the amount of tissue remaining following the mastectomy, the amount of skin laxity you posess and the size and amount of saline used to fill your expander.
I explain to my patients and their families that size is determined during the expansion process.  A patient s desires, amount of skin elasticity and  saline placed in expanders, gives the most accurate determination of ta patients final cup size.

Hisham Seify, MD, PhD, FACS · Answer

It is always a pleasure to spend time with my patients on the pre op day trying to get to the best possible breast shape and volume following reconstruction.I will try to be as simple as possible in telling what I would do in my consultation:1-Your actual breast tissue volume now is giving you a 32A size. This volume will be confirmed immediately after the mastectomy when the specimen is weighted. This is very valuable information that helps the surgeon to fine tune his choice of expander.2-The first question I ask my patients are how big (if any) they would like to be? A general rule of thumb is that very cup size is another 150-250 cc of volume. This is not an exact science since there is a major difference between height, weight and chest diameter.3-It is very helpful to know the breast diameter as I would choose an implant diameter within these measurements.4-Now my choice of expander is a volume range that I would bring to the OR with me. Once the breast volume is measured intraoperatively, i add the desired volume difference and fine tune my choice. It is important to point out all these small details pre-operatively to my patients. The truth is that at the end most of my patients would leave me some choices to make. I have to point out that the using new 3D devices could help in the future to make this choice easier. We published a paper few years ago on the validation of the 3D technique in measuring breast volume. It is very promising.I hope this will help

Peter E. Johnson, MD · Answer

Reconstruction of the breast after simple mastectomy has so many variables that determine your eventual cup size. The most important  consideration is the thickness and amount of skin available to cover the implant, and will the nipple be spared. Another is your expectation of the size of the eventual reconstructed breast. If you are currently an A-cup it might be best to discuss with your plastic surgeon your expectation and often photos will help guide you.
The amount of saline in the tissue expander is a poor guide to eventual breast size as some will overexpand the skin before placing the permanent implant. Also the size of the expander and fill are influenced by your height and weight.
The best approach is to sit down with your plastic surgeon with photos of what you find are a pleasant cup size, augmantation photos will do fine, and ask your surgeon how expansion has progressed and what size options will work best, or implant type will work best for you.

Francisco Canales, MD · Answer

Cup size is one of those intangibles that do not have a simple answer.  It depends on  a great number of vriables.  A 450 cc or 500 cc implant will yield a different cup size on a woman who is 5 feet tall and has a narrow chest than it will on a woman who is 5'10" and has a broad chest. The diameter of your present breast is an important parameter.
When you say you are an A cup, that size varies with a woman who is a 32 A or a 38 A cup so it would be helpful to know how tall you are and whehter you wear a 32, 34 ,36 or other bra.  As all women know, a C cup at Victoria's Secret is different than a C cup at Sears. Most women who fill a C cup can also wear a D cup depending on the bra manufacturer.
I would have a long conversation about dimensions, volume and size with your plastic surgeon. He/she will be able to guide you because they have examined you and done specific measurements. Good luck with your surgery.

Cup Size After Mastectomy with Saline Implants?

Answers (13)

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