Reconstruction after RADIATION

patriciahurtado

good morning!!! Been so MIA cause of work ... Ok so it's been 4 months without LF TE... Saw 4PS ... One said I can place a new TE on radiated skin cause he says I have enough tissue and he can slowly but very slowly expand the tissue I'm confused will my Rediated tissue stretch ... Has anyone done this? Help I'm still lost and do not trust any PS any more!!!... I don't want DIEP or FLAP

quiltrunner

You may consider finding a PS experienced with fat grafting BEFORE tissue expanders.  That's what I'm doing with the hopes tissue expanders will work with the radiated tissue.  Just had second fat graft last Friday.  Waiting 3 months between grafts for the stem cells to do their thing.  Time will tell but there has been pretty positive results recently with this method.  Slow and steady is the key! Good luck. 

babs6287

I had 1 fat grafting done- hoping this helps my radiated skin so I can eventually do a small implant. I think I'm seeing a change already!!!!

Babs

patriciahurtado

I'll ask my PS he didn't mention fat grafting at all... I went to see another PS and he said we can try TE but he wants to wait till August he said radiated tissue needs at least a year to start to reconstruct ... Why can I find the right PS so many different opinions 

4sewwhat

Patricia,

You will find someone!  I hate "Doc Shopping".  I love my PS but he is dragging his feet commiting to reconstruction after my recent deconstruction.  So yestereday I made appointments with 3 new docs for consults.  In the mean time I am going to minor surgery Friday for a drain and scar revision.  I feel like I am cheating on my PS because he knows these people I am consulting with.  Maybe it will light a fire under his butt!  If I come back and say that Dr. so n so says this!  Either way, a girl's gotta do what a girl's gotta do!!

Hugs and luck!  Contact WhippetMom too and see if she has a suggestion for a Dr in your area.  She has lists from previous people she has helped.  It's worth a try!

Lojo

Hi All - 

I just saw this article about some potential problems with fat stem cells in the fat grafting procedure. Not sure what to make of it yet

http://www.plosone.org/article/info%3Adoi%2F10.137...

4sewwhat

That;s really hard to read!  I can't tell if they used autologous fat?  It sounds like they used donor fat.  It also sounds like it was not MX patients and there was still breast tissue?

Maybe I need more coffee and it will read better!

Lojo

I read the article again - 

Essentially they co-cultured (in the same petri dish) fat stem cells derived from healthy human subjects (via liposuction) along with an established triple negative cancer cell line. The fat stem cells (adipose stem cells ASC) were at "passage 1" which means fresh from the donors, and hadn't been allowed to grow in a dish, scraped up, and put into another dish (a passage). The co-culture in vitro (in petri dishes) didn't seem to trigger metastatic changes. But...

More concerning -- They also injected the fat stem cells and the triple negative cell line cells into mice, and compared to the mice that just got the cancer cell line cells, the ones that also got the fat stem cells grew (more?) tumors and had metastases. 

Interestingly they note that only some of the donor fat stimulated metastasis in the mice - those with lower BMI  - the higher BMI fat did not. (If I'm reading this correctly - but it also cites another paper that found the opposite effect on Er+ cell lines.)

My take away is : they don't know how fat stem cells will affect breast cancer cells when injected in close proximity, but evidence suggests it might be a problem.

Here is the conclusion (the MDA-MB-231 is a triple negative cell line)

"In summary, the present study demonstrated that human ASCs markedly increased migration and metastasis of human MDA-MB-231 cancer cells in a xenograft model that was likely due to facilitation of the early steps of the metastatic process. These data, along with several recent reports demonstrating that ASCs induced EMT in tumor cells and alterations in tumor stroma consistent with metastatic progression [34], [35], [37], suggest that caution is warranted in applied use of ASCs in close proximity to breast cancer cells that have a greater propensity to metastasize."

http://www.plosone.org/article/info%3Adoi%2F10.137...

4sewwhat

Hey Babs, how is it going since your fat graft??

Anybody have anything new going on?  I am trying to stop draining from my removal and trying to be patient until I can move forward!!  Think my PS is coming around to the fat grafting and I have 3 other consults scheduled soon.

Have a great weekend ladies!

babs6287

4sewwhat

I'm doing well post fat grafting.  My skin is feeling softer and more supple (to me).  I see the PS in May and then the PS and I will figure out what's next for me.  Find yourself a PS that is your partner in this journey-one who listens to you-it makes a world of difference!

Babs

quiltrunner

Hello fat graft aficionado friends.  I had graft #2 almost a week ago and it was even easier than the first time.  No bruising and minimal soreness. I ran 3 miles the following day.  I was suppose to have my follow up appointment yesterday but convinced my cute PS surgeon into just calling me for a phone appointment rather than me driving 5 hours (round trip) for a 10 minute peek to tell me all looks good.  He told my hubby while I was I recovery that he thinks 2 grafts will do the trick. During our phone visit today he said we would let it cook some more and then in May we will put in the TE.  He's brand new to Montana and right out of his residency.  I'm only his 3rd patient for this procedure (2 during his residency in Oklahoma) and I am the first woman ever in Montana to have this done!!  His partner has a fabulous reputation and I initially was seeing him. I was referred to him from both my oncologist and the surgeon that did my BMX.  He called me in August and said he'd heard of the graft method pre-TE from a colleague in Seattle and thought I would be a good candidate but he'd never done it personally, although he has done tons of post-TE fat graft for decades.  He told me he was hiring a new young surgeon that has done this a few times with success while in residency so when the young PS got to Montana I transferred to him.  Initially the young Dr said the pre-TE grafting is still new and not the 'preferred' method but has since backed down on that statement saying research and good results are moving toward pre-grafting being the preferred method. He made that statement again today.  Time will tell if I get through the TE and exchange successfully but for me, I'll take the gamble.   

Good luck rads ladies exploring this option.  If we don't try it, how will those after us know their options?  I'm not saying be a martyr or sacrificing our bodies for all sorts of experimental testing.  I'm just saying, after having failed implants immediately after the BMX and then rads doing the damage it does, trying this before moving to flaps is worth it to me.  Considering how easy this has been thus far, the only thing it's costing me is a few months and with the increased chance of better results and TE success it was a no brainer for me! 

Raelan

quilt runner -  I've had two fat grafting sessions with a 3 month recovery period in between (last one was in December) and am scheduled for T.E.s tomorrow morning at 7:30 am.  Am I nervous?  Hell yes!  But I'm also really ready for this next stage and I so hope it works.  Interestingly enough, my PS is in Seattle.  Wonder if there's any chance your PS heard about this approach from my PS?  Wouldn't that be totally ironic!

I think it's great you have a PS that's willing to do his research and give this a try with you.  My PS has about 4-5 women in his practice currently using this approach...all at different stages.  He said we really won't know how well this works until about 2 years out.  It's at this point that capsular contracture, etc, can become a problem.  Like you, I'm willing to be a bit of an experiment.  Someone has to be a trailblazer, right?

Wish me luck tomorrow

quiltrunner

Raelan, I do wish you luck and am saying a big ole prayer for you too!!! Keep us all updated on your recovery.  The Dr. is Stephen Hardy in Missoula.  What is your PS's name! 

babs6287

Quiltrunner and raelan

I had TE's first and lost my left (radiated side) TE a few months ago.  That's why I'm doing the fat grafting.  I do NOT want to do LD surgery which I was told was my ONLY other option.  My PS suggested we try this now as he's heard of good results.  I did end up with a case of cellulitis after the first graft.  But he felt it was because we didn't wait long enough after the TE was removed (I couldn't wait to start something again)  We're thinking of 2 grafts (he says I don't have enough fat for more than that) and maybe going from that directly to a small implant.  I hope this works and like you, I feel it is good to be a trailblazer if it can help others.

Babs

4sewwhat

Raelan,

I hope you are resting and comfortable!  I'm so excited you made it to this step and can't wait to hear from you!!  You give me hope that I will be back there soon too!

Raelan

Ladies -  I'm pleased to report I made it to the other side.  Very sore and tired, but I can already tell that my pec muscles are settling down a bit.  Taking Percocet and Valium every 4 hours around the clock and sleeping a lot.

It's so cool having "mounds" again after being flat for 2 years.  My PS said I'd come out of surgery looking like a 13 year old girl and he was right.  Not sure how much he put in, but will find out at my next appointment on Thursday.  We both agreed with a low and slow approach.

He also told me he has 3 other patients currently going through the T.E. process and one whose had implants for 4 months.  All are doing well so far.

I'll try to post pictures on the picture forum in the next day or two.

Thanks for all your support.....us FG gals need to share all we can with one another since this is such a new approach with so much potential!

Raelan

quilt runner - By the way, my PS is Dr. Drew Welk from the Polyclinic in Seattle.

quiltrunner

Raelan you are our hero!!!  I'm glad you feeling better all the time.  Rest and take care of yourself.  I am praying for your health, recovery and lessened pain.  

My dear friend in the Seattle (kind of) area had her exchange 6 weeks ago and has developed a complication on the radiated side this week.  Got stapled closed and ordered to rest yesterday.  She did not have the pre-TE FG.  He did some grafting at the time of the exchange however, but I suspect that isn't soon enough.  I'm concerned for her and my heart breaks thinking she may lose the implant.  

Also, I've heard that muscle relaxers help with the pain, tightness of the expansion.  Makes sense to me.  Anyone know anything about that?

Another question I have is, in the early part of the expansion - the 13 year old girl phase - does anyone 'supplement' the mound when going out in public.  I work in a professional office and hope to wear my same wardrobe so I don't want my tops to hang.  Thoughts, experiences, ideas all welcome.

Hang in there Raelan.  If I were closer to you I'd bring you some chicken soup!  

My husband just came in and I told him about you, Raelan.  He said he could see the encouragement on the look of my face and in my eyes.  You are an inspiration to so many of us ladies who have felt hopelessness with this horrible disease and the battle scars left behind.  I am encouraged but still feel so much anger toward the local, sloppy and ignorant-by-choice PS that did the majority of the damage that didn't have to happen in the first place. 

4sewwhat

We are all going to get there girls!!!

QuiltRunner, I think whether you "stuff" or not is up to you   

I am in an awkward position right now because, I have my left C+/D side and I just took the bandage off my CONCAVE in the middle, pouching out on the bottom left side.  I knew it wasn't going to be pretty, but damn!  it looks like a cantelope somebody sucked the innards out of and it collapsed in on itself.  Good news is all that dimpled/shriveled skin is there to stretch back out.

Have a great weekend Girls!!!  We have quite the exclusive little club here and I am glad to have found you girls!!

quiltrunner

4sewwhat, 

Dimpled, shriveled, sagging skin is good.  Saggy breast tissue?? Who would have ever guessed that would be something to strive for?!! BaaaHaaaa!  

4sewwhat

Too Funny!!  I do feel pretty good about it actually because he admitted that my rads damage is minimal.  He said about 4 on a 1-10 scale.  Saw my LE therapist Friday and she said I came through amazingly well considering I had like 6 rads fields and strong ones at that.

I am really comfortable with my PS.  He is very humble for a PS.  Not at all like what it sounds your original jackass doc was.  So sorry you went through that.

We are all on this ride together girls!!!  Even if it is Mr. Toad's Wild Ride!!!

I did get access to pic forum but have not logged on yet.  I will try to figure out how to start posting there.

Raelan

just posted pictures of my T.E.s if you want to jump over there and take a look.

By the way I'll definitely be "stuffing" for awhile until I can get to what my PS calls the "prom stage"...ha ha.

4sewwhat

Ladies,

I got the most comfortably micro fiber bras at WM for $6 each.  They came in hot pink, silver gray, white and I think Black.  Maybe beige too.  They have the pad inserts in them.  Well I took the pad out of the left and out of a second bra and "stacked" them in the right pocket.  Evened me right out!!!  Much cheaper and lighter than a cutlet from med supply.  figured I am not going to need it long.  I usually go out lopsided but when I am doing something other than running kids or groceries, I strap the boob on.

Of course I have been know when someone is staring to FLASH them.    YOu know they want to know what it looks like!  Did it to my friend right after MX.  She was staring!  So, I flashed her and said, "you know that's what you were wondering!"

quiltrunner

Prom stage? That makes me belly laugh!  

I'm popping over to the other side to take a peek.  I've tried to post photos over there and can't figure out how to reduce the file size enough. 

4sewwhat, funny you should mention the arrogance in PS.  Dr. Hardy told me that he has looked for years for a partner but it's hard to find a good PS that isn't already full of themselves.  He said PS in particular seem to develop the 'God complex' early.  I don't find his young partner to be obnoxiously arrogant at all (I do find him exceptionally gorgeous however).  The 'butcher' PS was a professor at the university of Ohio med school in plastic surg. before moving to our resort community to start his private practice.  You know the old saying 'those who teach, can't do' ? - that was him personified!! When this whole reconstruction thing first went 'tits up' and I mention FG and he poo-poo'd it.  However, he admitted he was getting closer to retirement and wasn't interested in learning anything new at that point.  My dear friend who was worked with him for years in the OR tried to warn me BUT I thought I would be fine.  I would do so many things differently now, but wouldn't we all at some point? 

Ok, enuff of this and time to clean house.  All you lovely ladies enjoy your day and work on being healthy! 

quiltrunner

4sewwhat, would you mind posting the style number of the bras. 

4sewwhat

I will try to find the tags.  They are pullover and super stretchy!!  If I can't figure it out today I am going back soon and will get the info!!   Oh, and they come small, med, large, etc...not by number and cup.

Dr. Woods credits his ability to God, he doesn't think he IS God!!  He is acutally very humble and kind of shy.  I consulted with a lady however that should not have been able to walk through the door for the size of her head!

quiltrunner

Are they similar to the Genie bra?  They are comfortable too.  But, if you are concave (I am) and don't have anything to keep them down (like a weighted prothesis) I find they crawl up to my neck. 

Our other PS (we have 2 in town) was a very skilled and artistic PS - until she got a bit too deep in the coke and alcohol.  Has had 2 failed trips to rehab and no longer has hospital privileges but still has her medical license.  She still does surgeries in her office!!  Scary and just wrong that she is still can cut on people.  

4sewwhat

Good Morning Ladies!

To be honest I have only tried the bra once since they put the drain in.  It didn't ride up but maybe that's because I have one boob?  Like my new avatar!  A big left one and a tiny right one!!!

Maybe if you got it a size larger it would just hang like a camisol instead of ride up and not go back down.  Plus the pads are soft but hold their shape really well so they don't bunch up.  For $6 it's worth a try!!  They are similar to a genie bra but the elastic is not as strong, if that makes sense!

Bummer on the drunk stoned PS.  That stuff ruins so many good talented people.

Raelan, hope you are feeling better every hour!!

Hope everyone has a great rest of the weekend!!

Raelan

Good morning ladies.  I continue to recover well, and have been diligent about staying on top of my pain pills.  While I'm typically not a pill popper, I'm also not a martyr.  So far so good.  My little mounds are staying the right shade of pink/tan and aren't warm at all to the touch.  So happy to be at this point.  It will be interesting to see how much he put in the TE's when I see him on Wednesday.  

It's really hard for me to lay around and do nothing, but I know it's 100% necessary.  Just keep reminding me to take care of myself.   With a husband, 12 year old twins, and 3 cats at home it's easy to forget who comes first.

Thanks for all your continued support.

4sewwhat

It really is hard to sit still!  I feel like I have been on my ass since new years!!  Wait, I pretty much have!  Time will fly though!

I'm guessing from your pics he put between 100-150cc in.  I only say that because mine was initially filled to 200 at my MX on the invaded side!  The prophy side was at 250 plus had a thicker layer left behind.

Glad you are feeling good!  I don't do pain pills unless I am really in a bad way.  So far I haven't had to take any for any of my boob jobs!  My ankle, well that was a different story!

Have a great day ladies!