Reconstruction after RADIATION

quiltrunner

Oh my gosh ladies!!! Where have you been all my (BC) life??!!! I've been looking for this kind of information and other's experiences for the past year - since I lost both of my implants from infection 10 days apart!!! I had immediate reconstruction at same time as my BMX - before chemo and rads. I'm 5 ft even and 120 lbs. and was a 34D before BC. I asked the PS to stay the same size or even a bit smaller. I was so naive and uneducated... Not to mention overwhelmed with all the decisions to be made. You all know that feeling. Anyway, he shoved in 600cc (if I remember correctly - maybe even larger ) implants into my chest. At the time I didn't know the stage of cancer or that chemo and rads were ahead. So I've been boobless since I lost the implants - exactly one year ago. Not gonna lie, it has been the most difficult part of this whole crazy mess for me!! Pretty depressed. I've just found a new PS 140 milesaway and am scheduled for 1st fat grad on Dec 7th. Wait about a month and then 2 more fat grafts, TE and then exchange. If all goes without a hitch I may have boobs by summer. I'm super excited.

My questions for those of you that have gone before me are as follows: Will I see any of my muffin top disappear after the lipo host area has been sucked? That has got to be the bonus for all this pain surely??? Does the grafting soften the rads side enough to accept TE and maybe make the fills less painful?? Those of you that have finished this method (since I don't see any updates after some of you have completed process) how are you feeling about the final outcome?

I am so excited to find this topic!!! Thank you to those brave ladies that are going ahead and risking this process post-rad. I do not want to be a flapper until I've run out of other options.

patriciahurtado

quiltrunner I hope you can find some answers here I'm still doing my research too... I'll keep in posting

quiltrunner

I had my first fat graft / stem cell transplant on Thursday!!! I am positively on a 'spiritual' high. I don't have the words to explain how I feel God has truly blessed me / us by even having the opportunity for this procedure available. I live in a relatively small Montana community and am traveling to Missoula Montana to have this done. While fat grafting isn't new at all, the successes reported from grafting / stem cell transplants BEFORE TE and AFTER radiation is what I am so giddy with excitement about. As I understand it, in a very simplistic terms, the stem cells actually help repair the radiated tissue and thickens the skin, makes it more pliable, softer and better accepts the TE. This improves the rather dismal success rate of TE / implants after rads!!! After losing my implants like so many of us have, I've had several PS tell me the only real option after radiation is flaps. I didn't want that at all and was very depressed (clinically depressed) with this news. This really opens some doors for us ladies!!!

It's a long boring story about how I fired my original PS that did the immediate reconstruction after BMX that went 'tits up,'. My oncologist's wife had a facelift from the PS in Missoula and referred me to his office. You know that if the physicians and their families are going 140 miles out of town for their plastic surgeries it speaks volumes about the local PS. They suck - both of them!!! So, to have found this new young PS right out of his residency specializing in reconstruction and with the newest info on this procedure is just so exciting!!

The procedure itself was very simple. I'm feeling sore - kind of like I'd worked out really hard at the gym. So far I have had very little bruising but I suspect that will come in a few more days as everything comes to the surface. PS said after 24 hrs I can do whatever I feel like doing, I went to a Christmas party tonight, did some house cleaning today, and may go to the gym tomorrow and use the elliptical machine for a while. I am amazed at how good I feel!! And, the best part is I am actually seeing a little bit of puffiness on my radiated concave side. He injected the fat /stem cells directly into the scar tissue so I'm not sure of its puffiness from 'trauma' or from the cells doing their thing. I literally have 8 band aids covering 8 little sutures - 1 on each side of my hips (2) and 3 on each breast for a total 8.

I was pretty wrapped up in wanting to have to all - boobs and a trimmer waist. I'm greedy I know. Still a bit early to tell, but I think I might have SCORED both and my muffin top may have been transferred to the boobs!! It may be just wishful thinking at this point but I do think I look a bit less fluffy around the belly.

Patriciahurtado, I'm considering documenting my progress on the photo site if I can figure out how to size the pics to upload. You are almost in the same situation I'm in except I finished radiation before you started and I've never had TE. Like you, after the implants failure I needed to finish the cancer treatment before reconstruction could start up again. You probably already know TE after rads has a pretty low success rate. This technique really opens some doors for us !!!

My prayer as I was being put under Thursday is that I can use this experience to give other women hope. I've felt so low, mutilated and butchered through all this crazy mess and for the first time in about a year exactly I feel like I've got s good chance of being made whole again!!! And, made whole without sacrificing my trap muscles, tissue, and long recovery!

Girlstrong

quilt runner...what an amazing story. Your a fighter and I'm so glad your doing great!!! You give me hope. I'm supposed to have surgery in January but am not sure about reconstruction, I will be having a BMX . I know I don't want the lat flap and I'm not a candidate for DIEP or TRAM so that leaves implants or SGAP or IGAP procedure. I guess I now need to research some other things too. If you have any websites or links that would be great. Thanks!

quiltrunner

I'm a pretty cynical and when Suzanne Somers came out with her breast regrowing story I chalked it up to her being a nut job. That crazy woman may have been on to something. While re-growing isn't probably accurate, there is some real hopeful work going on. Not just for breast reconstruction but all sorts of other diseases. If you google some key words like fat graft and stem cells with reconstruction there is quite a bit of information to weed through. Of course it's your job to weed through what are reputable and credible reports. Ladies, I'm super excited about this!!! A year ago I was so depressed with thinking I would either be mutilated for the rest of my life or have to sacrifice another part of my body's muscles and tissue to have what would still be scarred up ugly breasts. And with that, possibly another flawed screwed up trap, butt muscle, etc. I wasn't happy with those choices. This new journey to build me some boobs is worth it to me. I don't feel like I have much to lose. IMHO I think stem cells is where it's at!!!

quiltrunner

Girlstrong, here's a good start to the research.

http://www.plasticsurgery.org/news-and-resources/press-release-archives/2012-press-release-archives/technique-provides-new-option-for-breast-reconstruction-after-radiation-therapy.html

Girlstrong

thank you.....I've started my new research project

cledora

quiltrunner-

This is my third go with bc.. I had my right breast radiated twice. Last year after my left mastectomy and latissimus dorsi (back skin) my ps put in te. I did ask him about doing this because of radiated breast. He said it would be okay. Well, they since have been removed after infections. I don't want to try this way again. My breast doctor referred me to a ps that does fat grafting. I was to have surgery done in Sept, but he had to fix the infected breast from my prior ps. Now I will have it done the end of December. I too look forward to nice boobs instead of what I have to deal with now. My ps said I will have 4-8 surgeries. I too want to use my stomach area for the lipo. I have been trying to find out how lipo felt and healing time. I am not using Brava. I don't know what "size" my breast will be after all of the fg is done. My left breast is flatter than my right side. Thank you for any information. I am so happy that you are not depressed anymore. This is a very emotional experience. My twin sister went thru bc three times too. Her bc spread and she passed. I have had 15 surgeries in the last 11 years dealing with bc. I like that these blogs allow us to express how we feel. Merry Christmas to all if I am not back on before then. God bless to all. Cledora

quiltrunner

Cledora, I think 4-8 surgeries is a reasonable estimation from my understanding. However, they are relatively simple out-patient surgeries as opposed to more complicated invasive surgeries. I look at it now as just one more surgery behind me. I'm not using the Brava nor do I know what size I will be upon completion (are we ever really completed?), but the new PS told me a C is not unreasonable. From my experience 4 days ago, the lipo procedure is pretty easy. Not completely painless, but more annoying and very manageable. They gave me an Rx for some narcotic pain killers but I haven't needed it. I'm still not bruising! Sore though - mostly moving from sitting to standing and visa-vera. It hasn't prevented me from doing anything I want to do however. I hope you can rest easy that the FG part is so easy. I have no idea what to expect with the TE since I've never done that part. BMX, implant failure, necrosis and infection I know something about. I'm so excited about the getting the future FG done now since I know what to expect. The anxiety level has been almost non-existent. Time will tell about final results but I feel things are really looking very promising.

The only thing I'm not completely sure on is how long to wear this compression wrap. I have a check-up on Thursday and I'll learn more then. In the meantime I'm wearing it unless I'm showering. I also think taking the herbal supplements arnica, bromolain and one that starts with a 'Q' may be why I haven't bruised yet.

Good luck to you with your upcoming fg. It's so easy! I hope you have a fabulous outcome.

cledora

quiltrunner

Thank you so much for answering me so quickly. I don't plan on doing the TE or implants. I know that is what caused so much issues this past year and infection. However, on the bright side it brought me to my new ps who does the fat grafting. So I look at it as new doctor, new boobs, new me and right before the New Year. I bought a compression garment besides the one they will give me after surgery. Thank you for mentioning the herbal supplements. I didn't know about them. I will want to take them if it helps in anyway with bruising. If it doesn't that's fine too. I will let you know how it goes and yes I look forward to an awesome outcome. I saw that you had taken taxotere for chemo. I know that is behind you, however, I wanted to know how that did for you. I took it the second go around with bc and it wore me out. I was out of work for a year because it made me so sick and then they had to stop it because of the neuropathy damage it was doing to my hands and legs/feet. I still have the neuropathy. Thank God the chemo days are over with.

cledora

quiltrunner

After I read your post, I looked up the supplements to help prevent bruising. The "Q" name is quercetin. I saw that you can order bromelain and quercetin in a combined pill. Walmart and Walgreens you can only order thru online is what I have found. I still have to check the wholesale store. Just wanted you to know since you helped me. Thank you again. I do appreciate it.

quiltrunner

UPDATE about the lack of bruising.... Spoke too soon. I suddenly am pretty bruised around both the future home of breasts and my pelvic area just above the pubic hair line is black and blue!!! I'm sure the blood has just pooled there. Still doesn't hurt. I worked out at the gym tonight for an hour on the elliptical and lifted some weights. This FG hasn't slowed me down past the first 24 hours.

Taxotere is of the devil! Of all the women that I know that have had such horrible side effects mine were really mild in comparison. Still thought it as beyond vile. I lost one toenail and believe it or not I have another one I'm getting ready to lose at this late date. My hands had horrible itching and burning rashes. But, my hair actually started growing back while I was on taxotere. I had very mild neuropathy.

So you are doing to do FG only and no implants at all? What kind of compression did they give you and what did you buy? They put me in what looks like to me a back brace. It's a wrap around and Velcro it together job. I must say not having to pull it up and down to go to the bathroom is really handy. I wore spanx to a party Saturday night instead of the wrap thing and it hurt to pull it up and down. Of course I'd been drinking water like crazy to flush and prevent swelling and I had to go to the bathroom nonstop. I wore the wrap under my workout clothes tonight too. I'll be anxious to find out at my appointment Thursday what the compression protocol is after this week.

What date do you have your first FG?

I'm curious as to how your first and second round with BC was staged IV without positive nodes?

cledora

I still am going to take the supplements to prevent as much bruising as possible. Yes, I am only doing FG. The implants route I don't want to try since I had so much complications with the expanders. I haven't gotten a compression from the doctor office yet. The other one I ordered online. It was a full body one with opening to use bathroom. I did buy spanx. I read on here that you wear the compression garment based on age. So for every ten years of age is a week. If true, then I should have to wear it 5 weeks. Dec 27 is my first FG. In answering my dx I might not have put in all the info right. I know my doctor told me I had aggressive bc and the letter I got from my disability insurance when I was out for a year stated I had stage 4 bc. I questioned it with my doctor and he said the second bc they found while doing reconstruction surgery was in nodes in middle of chest between breasts.

quiltrunner

That would explain the Stage IV. I guess in your 'signature' it doesn't show the node positive. This is all still so confusing to me - all the different kinds, grades, invasive, aggressive - blah blah blah. It is just all nasty at the end of the day!!

Back on the supplement wagon. Bruising is much better today. I'm like you if the week per age decade formula is the deal but I'll be pushing the 6 week mark, sadly. My appointment for Thursday got moved until next week for a surgery scheduled in my slot since I'm doing so well. I asked the nurse if I still need to be in compression and she said yes. Fortunately it's not terribly uncomfortable and it's cold outside so that helps. I can imagine it would be very hot in the summer.

How many grafts do you anticipate? Maybe because I'm so new to learning out about the grafts is why I'm so crazy excited about this amazing option and it's not really that new after all. I'm sure my previous PS kept me uninformed since he doesn't do them. I did have a brief discussion with him about FG about 6 months ago but he poo-pooed it. Would you believe this idiot was a professor of plastics at univ of Ohio med school!!! Anyway, I'm grateful he's In my past and feel so very blessed to have this FG option- especially since he didn't help the landscape possibilities with his pathetic, sloppy and corner cutting 'techniques.'

God has sure been good to me and I've felt His presence throughout this. Not sure why I got dealt this hand, but it has had some good come from it for me. I've learned how much I'm loved, appreciate my husband so much, found out who my real friends are, and who are crazy people I have no time for (like the co-worker that complained to our fiirm's managing partner and other co-workers that I consider friends, that I was exposing everyone to chemo toxins. She would literally clean every surface I came in contact with Lysol wipes. Not sending that insane individual a Christmas card ): This whole thing sucks completely and I am still in shock that I had this disease! I went from running 1/2 marathons to being diagnosed with stage III almost overnight. Still can't wrap my head around iit. But, I see so many people that are far far worse positions that most of us on this forum contend with. That has put life I perspective.

I am very interested in how your FG works for you. Keep me posted and I hope your results exceed your expectations!

patriciahurtado

hello my ladies!!!! Yes thank you!!!! Been doing so much research!!!!that I'm tired.... Quiltrunner thank you so much for that info....so a saw few PS . Well I had an appt with the pioneer of fat grafting dr. Khouri .. But one of the PS said all this FG is very experimental and also would make the radiated side recurrence because it's like reliving the cancers cells .. Then another said it creates lumps on the skin...I really happy that we do have a choice and that I'm looking forward for OUR out come I'm going to continue to do my research but for now I'm putting it on hold till next February cause I had to have hysterectomy it's been 6 days... Feeling great.. But I am looking into also FG and no BRAVA... Yes please need pictures, we can exchange via private messages, please do post all you process... And as I come closer to that date I will keep posting too!!!! Thank you!!!! I hope for the best fir all of us that don't other options

(Edited by Mods to remove member's personal email address. If you want to reach this member you can use the Private Messages feature).

Girlstrong

Hi Patriciahurtado...so glad you saw Dr. Khourani.  I was just looking at his website the other day along with anothe PS out of Washington who uses the BRAVA etc.  I too am worried about FG and recurrence.  Interesting to know that a PS gave you this advise too.  Of course I dont want that to happen.  I have appointments with 2 PS next week (still dont know the date of my BMS..LOL!).  1 PS will give me recommendations for implants with radiation etc. and the other is supposedly an expert microsurgeon and so I will get info on the SGAP and IGAP procedures.  I think it is great that you dont have to make a decision right away.  That is the best.  I will keep posting too.....

peepgirl

Greetings ladies. Thanks to you all for the very helpful information.  I will be talking with my PS about BRAVA and fat grafting in January.  I had implants placed to both breasts (cancer in both) following radiation to both breasts.  The right side succeeded and the left failed (my PS thinks its because that side had radiation to two quadrants).  We are considering BRAVA and fat grafting as I really don't want have to have a flap surgery.  My understanding is that with the BRAVA system she can move more fat at one time so I'd only need 2 or 3 procedures as opposed to 5 or 6.  Call me crazy, but since I have to be put under again, I am considering asking her to remove the one implant that remains (I am cold all the time and I think it's part of the problem) and replace that with fat as well.  My main concern is what Patricia mentioned above...by stimulating the growth of cells in the breast and/or placing fat in the breast, am I creating a breeding ground for recurrence?  I'm planning on asking my Breast Surgeon, Oncologist and Plastic Surgeon all to weigh in on this one.  If you other ladies have any info on this I'd surely appreciate it.

I hope you all have a blessed holiday season with your families!

cledora

wow, I never heard about the recurrence. I was told the FG is good for a radiated breast and it softens the area. I had a double mastectomy (different times for mastectomy in each breast). So how does this play a factor. I will ask my ps. When my last ps filled my expander on my radiated breast, the breast looked the best I ever had seen in years. However, it got real red around the radiated damage area and with a week got infected. I asked him when he first suggested implants if I should since my right breast had been radiated two different times. He said yes. I should have researched about it. I thought he knew and since it had been 8 years since last bc dx I thought things improved with implants. My husband kept questioning the knowledge the ps knew. He felt like the ps was not sure what to do with me. I finally decided to see another ps. I love my breast doctor. I went and talked to her and she said that was the best thing to do. That's when she suggested my new ps that does fg. I really am excited about my surgery coming up towards end of Dec. I do believe God truly put me to this doctor. The peace I have with him and his dedication to my needs.

cledora

quiltrunner.

I will fix my "signature". I don't want to be misleading to anyone. I to don't understand everything. My latest breast doctor talked about triple negative breast cancer. Then this latest bc was estrogen fed. I was confused between my first two bc dx was aggressive. So when I got dx I didn't research things like I do know. I didn't understand much and just did what I was told. The second time I found out was after my reconstruction/mastectomy surgery to my right breast using skin from my stomach. The doc removed a rib and that when they found it in nodes in middle of chest. He said if they didn't find it, it would have spread thru my body. I had a harder time dealing the second time. I think I was trying to support everyone else and didn't deal like I should have. It was also hard since my twin and I both were dealing. My twin and I are called "mirror image" twins. Even though we are identical we are opposite. I am left handed, she right. I am taller, she shorter. So, when we had the bc. Hers was on left, and mine the right. My twin and I were like night and day. She did do drugs the majority of her adult live. I say this because when she got bc, she thought she deserved it. When I got it, she didn't understand why I did. (she always thought I was the goody two shoe one). Actually, she was somewhat glad we were both dealing with bc. I know she didn't mean it in a mean way, she just couldn't deal with it by herself. She was very angry. She did have a baby between the 2nd dx and 3rd. She was so happy having him and she was determined to get better. She passed 2 months after he turned one. I saw her the most happiest the last year. Even though we had to go thru this bc journey, I watched God put the "puzzle pieces" together before she died. Not only did I get to be by her side and saw her die peacefully. She also gave her life to Jesus 4 months prior. I know it might sound confusing, but I saw a bad situation turn to good and I am so greatful to God for this. I too had a bad experience with my last ps. I had dealt with so many infections and hives while having the expander in my left breast. Then when he put one in the right breast months later, I had hives and infection again. Hives was happening after each surgery. I was put on steroids for a month. This didn't help with my healing. It has been from June 2012 to July 2013 I was dealing with all of this. Sept 2013 thru Oct 2013 my new ps has had to repair the wound with my right breast. The stitches wouldn't stay and I had to pack the breast. It finally healed after he stitches inside and out of the breast. He said 4-8 FG, he said it will take about 1 1/2 years to get where I will be done. I know a lot has to do with waiting 3 months in between grafting. I will keep you informed.

patriciahurtado

Cledora... You been through a lot good times and bad times... I'm really happy that you are on your way to reconstruction we are here for you and yes please let's keep posting to help other sisters here... I will posting soon as I find out more about frat grafting..

Girlstrong I didn't get to see him ... I cancelled because my PS scared me about being "Experimental" but that's for now ... I'm going to see what I really want...

patriciahurtado

did you guys check this forum:

http://community.breastcancer.org/forum/70/topic/744891

Toastiecat

I don't understand why some surgeons are saying FG would contribute to a recurrence. Is there any data on that? 

I had a consult with Dr Ahn in NYC, and I felt she was pushing me more toward a flap. I just plain don't want to do one. She also said she wouldn't want me to start Brava until Sept 2014 (because of my history of infections) and then would want to wait the maximum time between surgeries (6 months) and have four surgeries. Which would put me a finishing recon sometime in 2016-17! That seems crazy. I felt torn because I know she's very respected and loved, but I also felt like she was playing up the easiness of a flap, compared to the time and difficulty of Brava. I'm going to see some other dr's who do Brava in the city.

quiltrunner

Do you still have the TEs?

I just saw my PS yesterday for a follow-up after my first fat graft.  He emphasized again that the preferred and recommended standard for radiated recon is a flap.  We are going to try the fat grafting first - I have really nothing to lose if it fails.  I'm just determined it's not going to fail.  We discussed time frame for completion yesterday and if all goes without complication and as planned hopefully breasts by fall 2014.  I'm not using brava - just grafts followed by TE, followed by implants.  It's a long process.  Thus far, with one graft out of the way, I'm impressed and it's been very very easy.  Plan to do a second graft the end of Jan- 1st part of Feb. and may only do 2 grafts.  

PS has not mentioned increased risk of recurrence but sometimes the fat takes on the appearance of a lump which can be frighteningly similar to the feel of a tumor.  I have a few little lumps now - fat lumps.  He said they should soften over the next few weeks.  They are only felt - not visible.  

Toastiecat

No, sorry, I just hadn't updated my signature in a while. Now it has everything! I have a permanent saline implant in the right and nothing in the left.

I like your mindset, and it's similar to what my PS said, about no harm no foul (physically speaking) if AFT doesn't work. You end up with more robust skin at the end, if nothing else. I know flaps aren't for me. Having foobs alone isn't important enoughg to me. With Brava and AFT there's some regained sensation. That's hugely important to me -- way more so than what the boobs look like. 

How are you doing now after the first surgery?

quiltrunner

WOW - regained sensation would be fabulous!  I haven't heard that before.

I feel great after the first surgery.  Really IMO the term 'surgery' is an overstatement.  'Procedure' is more accurate IMO.  For me it was so easy - especially after BMX, chemo, rads, implants In and out after infections, etc etc!  I had dental work today I found to be more painful than the fat graft!  

What I know so little about and I'm curious to see what they look like under the muscle are the TE.  I've snooped around a little in the photo section but haven't seen much.  Even around the internet I haven't seen any photos of actual TE In place, just the photos of the TE itself.  I think that's the one procedure I dread because it seems like it is constant discomfort, annoyance and pain.  What do you wear to fill in the space in bras  etc during the process?  I guess I have more of an issue of that since I went from a D+ to a D-  LOL. 

sciencegal

Hi Quiltrunner, The TE was okay, not real painful for me- just HUGE! And they ride high, it is like they are up under your chin. I only had one, so had to boost the other side up to match. If you are balanced it would be much better. 

Under the skin it just looks like an implant- a big one!

Thanks for all of your info about the fat grafting, very interesting.

Happy Holidays

Raelan

I'm using the same approach as quiltrunner.  Fat grafting followed by TE's then implants.  I'm also hoping to have everything completed (except for nips) by Fall of 2014.  My PS said the same thing about the procedure.  It might not work and I may still end up with a lat flap, but it's worth a try.  Plus, I get the added benefit of softer more pliable skin as well as liposuction in those "problem areas".  He has about 6 women in his practice currently utilizing this approach, so doesn't have any long-term experience with it, but he's hopeful.  Only time will tell if this approach will provide a viable alternative to radiated patients in the future.  I'd love to see another option outside of an invasive flap surgery.   

Toastiecat

Has anyone been to a dermatologist to discuss possibilities for healing the skin? For some reason this just occurred to me, 10 months after the fact . 

4sewwhat

bumping for updates!

Lojo

I'm also interested in people's experience with this procedure - fat grafting + BRAVA or no BRAVA. I'm not interested in implants or flap surgery, and am strongly leaning toward not reconstructing, but the fat grafting is the only thing that holds any appeal and the pictures from Dr. Khouri are pretty impressive (although I know those are the "best" outcomes). My investigations suggest the procedure hasn't been around long enough to really evaluate risks of recurrence. Hoping to keep this topic alive to hear experiences