Personal Experiences Submission Form Thank you for considering contributing your story and/or photos to the Visitors' Experiences section! If you have already had breast augmentation, breast reduction, breast lift or any kind of breast surgery, you know how important it was to read the stories of women who had gone through the difficult decision to undergo this surgery and who had experienced recovery first hand. (IMPORTANT NOTE: If you are only submitting a short testimonial for your doctor, go here!) Fill out the information below. Then, click on the submit button. If you want to submit your photos, you'll find instructions after you hit the submit button. About You (I will only display your first name or the word "anonymous," depending on YOUR preferences. However, you must provide this information to me in order to have your photos posted. Click here for my Privacy Policy. Your First Name: Your Last Name: Name You Want Us to Display to others on the Web: (e.g. "MK", "Mary", "Anon" Street Address: City or Town: State/Province: - Choose One - UK AU (specify in comments) Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Brunswick New Foundland New Hampshire New Jersey New Mexico New York Nevada North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Is. Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennesee Texas Utah Vermont Virginia Washington (state) West Virginia Wisconsin Wyoming Yukon Territory Zip/Postal Code*: Home Phone #: Your E-Mail: Valid email address required About Your Surgery (Give as much info as possible. If you're not sure, leave it blank and/or let me know in comments at the bottom): Your Surgery Date: (e.g. 11/05/2004) Procedures you underwent (check all that apply): Breast Augmentation Breast Lift Breast Reconstruction Tummy Tuck Liposuction Other (use comments) Breast Reduction Incision Type (choose one) (for breast surgeries): Areola Belly Button Armpit Breast Crease Benelli / Donut / Pursestring (lift) Vertical / Lollipop (lift) Anchor Implant Manufacturer & Style # Manufacturer Inamed Mentor Silimed Eurosilicone Other (please specify below) Implant Placement Below the Muscle Above the Muscle Implant Fill Type: Implant Fill Saline Silicone Cohesive Gel (Gummy Bear) Other (specify below) What size implant in cc's? Implant Size (cc's) 80 85 90 95 100 105 110 115 120 125 130 135 140 145 150 155 160 165 170 175 180 185 190 195 200 205 210 215 220 225 230 235 240 245 250 255 260 265 270 275 280 285 290 295 300 305 310 315 320 325 330 335 340 345 350 355 360 365 370 375 380 385 390 395 400 405 410 415 420 425 430 435 440 445 450 455 460 465 470 475 480 485 490 495 500 505 510 515 520 525 530 535 540 545 550 555 560 565 570 575 580 585 590 595 600 605 610 615 620 625 630 635 640 650 655 660 665 670 675 680 685 690 695 700 705 710 715 720 725 730 735 740 745 750 755 760 765 770 775 780 785 790 795 800 825 850 900 950 1000 or more What did your surgeon fill your implant to in cc's (if saline)? Implant Fill Volume (cc's) 80 85 90 95 100 105 110 115 120 125 130 135 140 145 150 155 160 165 170 175 180 185 190 195 200 205 210 215 220 225 230 235 240 245 250 255 260 265 270 275 280 285 290 295 300 305 310 315 320 325 330 335 340 345 350 355 360 365 370 375 380 385 390 395 400 405 410 415 420 425 430 435 440 445 450 455 460 465 470 475 480 485 490 495 500 505 510 515 520 525 530 535 540 545 550 555 560 565 570 575 580 585 590 595 600 605 610 615 620 625 630 635 640 650 655 660 665 670 675 680 685 690 695 700 705 710 715 720 725 730 735 740 745 750 755 760 765 770 775 780 785 790 795 800 825 850 900 950 1000 or more (For saline only - Silicone is pre-filled) Implant Surface: Smooth Textured Implant Shape: Round Anatomical Implant Profile: Regular High Profile Low Profile Age: Age? 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 Height: Height? 4'8" 4'9" 4'10" 4'11" 5'0" 5'1" 5'2" 5'3" 5'4" 5'5" 5'6" 5'7" 5'8" 5'9" 5'10" 5'11" 6'0" 6'1" 6'2" 6'3" 6'4" Weight: Weight? 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 or more Before Cup Size: AA A B C D DD After Cup Size: AA A B C D DD Number of children you had before surgery (delivered by you): # Kids None 1 2 3 4 5 or more Number of children you breastfed: # Kids Breastfed None 1 2 3 4 5 or more What is your race / skin color / ethnicity? Race American Indian Asian Black Caucasian Hispanic Other About Your Plastic Surgeon: Plastic Surgeon Name: Plastic Surgeon City: State/Province of Plastic Surgeon: - Choose One - UK AU (specify in comments) Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Brunswick New Foundland New Hampshire New Jersey New Mexico New York Nevada North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Is. Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennesee Texas Utah Vermont Virginia Washington (state) West Virginia Wisconsin Wyoming Yukon Territory Did ImplantInfo.com help you find your doctor? Yes No (tell me more in the comments section!) Would you recommend your plastic surgeon to others? Yes No (tell me more in the comments section!) Paragraph 1 of your experience Use as many paragraphs as you need. Please do NOT type with your CAPS LOCK KEY ON! Please note that each box will hold only 1000 characters so be sure to break up your text into paragraphs :) Paragraph 2 of your experience Paragraph 3 of your experience Paragraph 4 of your experience Paragraph 5 of your experience Paragraph 6 of your experience Paragraph 7 of your experience Paragraph 8 of your experience Paragraph 9 of your experience Paragraph 10 of your experience By checking the box at left, I am agreeing to the terms of the ImplantInfo by Nicole Consent Form (click to read). Can we improve this form? Please send an email to nicole@implantinfo.com
Personal Experiences Submission Form
Thank you for considering contributing your story and/or photos to the Visitors' Experiences section! If you have already had breast augmentation, breast reduction, breast lift or any kind of breast surgery, you know how important it was to read the stories of women who had gone through the difficult decision to undergo this surgery and who had experienced recovery first hand.
(IMPORTANT NOTE: If you are only submitting a short testimonial for your doctor, go here!)
Fill out the information below. Then, click on the submit button. If you want to submit your photos, you'll find instructions after you hit the submit button.
About Your Plastic Surgeon:
Use as many paragraphs as you need.
Paragraph 10 of your experience