fat graft for implant revisiton/nipple reconstruction

msarcich

hello to you all,

i first wanted to thank this community. this was the group that got me through my fears at diagnosis back in august 2016. when i could barely breath i was so overcome with fear. i happened to find you with a google search right after i was diagnosed. i posted my fears and you responded so quickly and beautifully. you helped me feel not quite so afraid and not alone. and you helped me strategize my search for my medical team, whom i love. for all that you did for me, thank you. i'm deeply grateful.

i'm now on 'the other side.' i'm cancer free they tell me -- still trying to believe it. i've had a mastectomy with implant placement, nipple removal and in january implant surgery. my treatment now is tamoxifen.

here's my question -- what is your experience with fat grafting? actually, also with nipple reconstruction? at my follow up, my plastic surgeon said she wants to do a fat grafting to cover my ribs and make my implant a more natural slope. right now, it starts about 2 inches or so off center and also very abruptly. it makes my breast look off center. she can reconstruct my nipple at the same time.

i'm very torn. i really hate surgery. i don't want another one. even driving by my hospital still brings me to tears. however, i do want the results she's talking about. has anyone done this? would you mind sharing your experience with me? does it look natural -- smooth and gently sloped up like a real breast? isn't there risk that the fat could not take? is that necrosis? and isn't there a risk the fat could be reabosorbed? does it last over time? do you know of other risks i should be considering? i wish there was a non-surgical option.

and does the nipple reconstruction last? i've heard they flatten out over time. and how real do they look?

any help thinking this through ...well, i'd be so grateful. i told dr. wu i'd like time to think it over and maybe in the fall we'd do it. so, i see her again in july to follow up.

thank you so much. and i hope today is a good day for each of you.

-- marianne

IrishEyes39

I didn't have fat grafting, but I did have skin taken from my lower abdomen to reconstruct nipples. I regret doing it 100%.

I will tell you the details of my experience, but keep in mind that your experience may be very very different.

First, my recovery from this surgery was considerably longer and more painful than even my mastectomy recovery. My breasts were fine, pain was minimal and seemed to go away completely after a few days, although I had to keep the nipples covered with wound care dressings for several weeks. However, the abdominal incision (which is about 8 inches, very crooked, and very ugly) made it impossible to walk for weeks in an upright position. The swelling prevented me from wearing any of my clothing for at least a month, and now 3+ months after my surgery, I still can't wear everything I wore before, even though my stomach should be flatter.

I developed a hematoma on the right side of my stomach that needed to be drained twice, and that side is still more swollen than the left (and there is a bit of loose skin there, over my incision, that looks horrible. I still have pain where it was located, which may or may not be from a trapped nerve in the capsule (or something) of the hematoma... or be unrelated to the hematoma.

As for the nipples, they look better than I expected, and they did flatten considerably. However, the flattening made them look better, not worse.

Having said that, they are not even, and as my implants continue to settle, they are becoming less even. What this means is that I cannot go without a bra, because they are very obvious and very obviously crooked. Oh, and covered with abdominal hair, which insurance won't pay to remove. So, I have started plucking it.

My husband loves the nipples and says it makes my foobs look more real. But if I could go back and skip this surgery, I would in a heartbeat. Between the ugly, crooked abdominal scar and the uneven, hairy nipples, I do NOT feel more normal... I hate looking at myself in the mirror. At some point, I will insist on a correction of my incision line, and maybe one day if I can afford it, I will have the hair removed.

And I should say that I have a good PS and was very pleased with my previous scarring and other surgery results. So, this was totally unexpected.

I hope all goes much better for you if you decide to do the reconstruction.

I am not sure if there's a way to send a photo through direct messages here, but if so, I am happy to send one.

Sandra