What were you told about safety of fat-grafting after recon?

Nolton9

Hi,

I would be very interested to hear what others have been told about the safety of fat-grafting (lipofilling) after a breast reconstruction?

My breast surgeon has recommended a 2 year wait between my last cancer surgery and having it, as there is, apparently, some 'thought' and/or evidence to suggest that women who have had DCIS, especially extensive DCIS at a young age may be slightly more likely to experience a recurrence afterwards.

I've read up a little and it seems that there is some evidence in the lab and possibly one or 2 studies that support this view but small numbers and possibly other related factors that caused the recurrence in the in-situ DCIS groups

My story is: I had a mastectomy and immediate DIEP almost two years ago, unfortunately I found some residual, superficial DCIS just a few months after the DIEP operation. So 2 lumpectomies/ WLEs were needed to clear that. Consequently my rather lovely DIEP now looks far less lovely and I need further reconstruction this year. Fat grafting has been recommended but not for 2 years.

Many thanks for reading and I look forward to any help/advice.

jbdayton

Safety was not a major concern for me. I think there is no more risk with this procedure than most other standard surgeries. All surgeries carry some risk.

I needed 6 sessions of fat grafting to fix my breasts due to losing about half of one flap to complications.

I had a PS that was very conservative with how much he would transfer at a time. Too much at one time can cause other complications such as fat necrosis. I felt very safe doing these procedures.

I think lipofilling is very common now. It is not the same as liposuction for weight loss. I am very pleased with my final looks and most people I meet are just as pleased with theirs. It is the icing on the cake.

My case is just the opposite of you. I had my mastectomy then radiation. I had to wait before doing my flap recoconstruction. If you had radiation your surgeon wants all the tissue changes to be stable before doing the final lipofilling. Sounds perfectly normal to me.

Nolton9

Hi,

Thanks for your reply and for the encouraging comments re your outcomes with lipofilling after reconstruction - sounds good!.

I'm very comfortable re the risks of the procedure/recovery etc but I am being advised to wait for 2 years from an oncological safety point of view before having lipofilling. I think my history is, now a little 'unconventional' (if there is such as thing as a conventional one); as you point out most women probably have the opposite procession through treatment to me.

many thanks

Elizabethaw

I believe the concern is that stem cells (which are going to be an automatic part of the fat transferred) have the ability to promote growth of any remaining cancer cells. At one time the American Academy of Plastic Surgeons disapproved of any fat grafting for reconstruction, but now they feel that it's safe for mastectomy patients. There is possibly a little concern for lumpectomies (according to one site I saw). I'm thinking that your situation is closer to that since you've had remaining DCIS. (Which sucks! I'm sorry you had that experience!)

My PS told me that fat grafting is exploding in popularity, but there's still plenty that's not known. I had it done to fix rippling in Sept of 2014 and am very happy with the outcome. I suppose your doctor is being conservative because you had the residual DCIS. There's probably not enough data out there to know how that situation would be affected by fat grafting!

ual0307

my oncologist told me to leave my port in for two years because reoccurrence was most likely in the first two years.

I had it removed 11 days after my last chemo.

I think oncologists are very conservative.

Mel2328

Hi jbdayton; could you tell me the difference between fat grafting and lipofilling? Also do they put you to sleep for the procedure? Thank you!

swimmersmom94

Sorry you had to go through all of that. I am scheduled for surgery for the lipofilling March 22nd and both my breast surgeon and plastic surgeon have told me that if the cancer were to come back, it wouldn't be from the lipo but that if there were residual cancer that remained, it could attach to the fat. I had DCIS in SITU, stage 0 and have a less than 1 percent of it coming back, so I feel pretty safe, but I still second guess if I should even have this done. I had a bilateral nipple sparing mastectomy Sept. 18, 2015, exchange Dec. 15th.

Nolton9

Thanks everyone....

I think like all treatments nothing is 100% guaranteed in the case of the preventative steps we have to make decisions on such as tamoxifen etc and likewise some of the treatments have risks; even if they are small.

Swimmersmom - I think my situation is quite unique in creating my surgeon's discomfort with rushing into lipofilling. My initial hospital couldn't have done worse really; at every stage. Sadly it's me that is learning from their mistakes.. I also think having such a vivid reminder of their rubbish approach doesn't help hence why I 'm keen to repair what I can...

thanks!

swimmersmom94

Did you have a mastectomy and a lumpectomy? My PS said some people wait 1 year to see if you have a reoccurrence but with me having less than 1 percent, I may just go through with it. It's a tough decision. I personally don't feel enough research has been done as most cancer patients situations are all different, but I guess life is about taking risks...

Nolton9

Hi,

I had a skin sparing mastectomy and immediate DIEP. I was DX with extensive DCIS over a 6cm area, then after further ops PLCIS was added in.

I found residual disease just a few months after my MX, I have 2 expert opinions that it was residual... actually I didn't really need those it was in the same place; of the same type and presented in the same way. I thought I was just really unlucky at first but digging into my medical notes; showed that the original breast surgeon noted that I had superficial breast tissue; he just didn't inform me of that. I therefore had opportunity to make an informed decision re whether I need further surgery or PMRT or scarily the fact that I was at a very high risk level of recurrence of residual issues....

I had a further 4cm of DCIS; but that was 14 months ago and all seems quite at the moment; but they have trashed my reconstruction..... not happy re any of it but you have to keep moving forwards

Still hoping to go for lipofilling later in the year...

wintersocks

http://www.hopkinsbreastcenter.org/artemis/201603/...

There is an article here, that might be interesting....