Anyone who has had fat-grafting, I have some questions...

aquilegia

The PS told me that a fat graft will only last if it is within a few millimeters of tissue with a blood supply. So it makes sense that the fat used to plump up my breast lasted (it was injected into the DIEP flap fat), while most of the fat used to fill in divots was resorbed.

weety

If I just look at my chest (radiated back in 2010) my recent fat graft doesn't seem to have kept much of the fat. But when I feel the skin, it feels more supple and less close to the bones (before there was almost no give--it seemed like it was very tight against my chest bones.) So I guess it is still successful in terms of rejuvenating the skin. I go in for a 2nd fat graft April 5th. This time he will use inner thighs. I am going to ask him about my outer thigh dents, but I'm pretty sure I will just have to live with it. It's like I had to trade one deformity for another...

ItsStillMe

Weety- I am in the same situation, about to loose my tissue expander due to infection. But my PS has said i can only have flap surgery now. She did not give me the option of sparing my skin and fat grafting at later point after rads. Did you do rads after TE was removed? When the surgeon removed the TE did he save your skin and nipple? Did the skin fuse to your chest? Sorry for all the questions but this thread has given me hope of avoiding flapSurgery and saving my own breast skin and nipple.

TWills

ItsStillMe, so sorry you're in this situation. I lost my TE due to infection half way through rads. I was devastated. So far it was the worst feeling during this whole ordeal, maybe not diagnosis. My skin did somewhat stick to my ribs probably because I had to continue with rads for another 3 weeks after it was removed. I had skin and nip sparing BMX and they left all of that during the removal. I could have found a Dr to “try" implants but I eventually went for a consult with a surgeon in Orlando that does a lot of sucessful DIEP's and I loved him and his staff. I left there knowing I wanted to proceed. It's such a difficult situation and I'm sorry, I know exactly how's you feel. I was adimate in the beginning that I did not want DIEP but considered Lat flap. I'm now 3 weeks and 3 days out from DIEP and I'm actually sitting outside eating lunch at the Mall so I'm doing great. I love the feel of my breasts and my flat tummy so far. I'm not one of those people on this board that is a cheerleader for only the procedure I had but i wanted to share what i went through and my choices. Good luck as you make your decisions:)

ItsStillMe

Twills- thank you so much for sharing your experience. I have been in such despair at the thought of what’s to come but hearing your story gives me hope that I can move forward. Did you have DIEP on both breast? Will you be having nipple reconstruction or tattoo? I live in South Florida. May I ask your doctor’s name?

TWills

I had bilateral DIEP, and I'm not sure what I'll do about the nip. I think I'm waiting to see how the other nip looks when I'm all healed. I thought for sure I'd want reconstruction but now I'm not sure. I'm loving not wearing a bra so I'm now afraid if I have reconstruction I would have to wear one for vanity reasons. Not a big deal but something to consider. Dr Klein was my surgeon Dr Lee is also a micro surgeon and he assisted. It's Orlando Aesthetic and Reconstructive Surgery Institute. They are with Orlando Health Hospital which is wear I had the surgery and they were awesome. No doubt it’s a big surgery but so far this has been easier than my BMX.

SajeScents

I also have a question: Can minor fat grafting after lumpectomies (yes, bilateral) be done under local anesthesia? I'm not looking for augmentation, just smoothing out the indentations, puckering and creases which developed after seromas drained and tissue healed in creases. Before the seromas, the surgical scars were smooth and tissue wasn't puckered, One breast looks like a hacky sack (like it's partly adhered to chest wall, yet doctor tells me it's not adhered)!

I'd love to have it smoothed out, (I can live with the slight indentation and crease in the other boob), yet I don't relish undergoing a general anesthetic for medically unnecessary procedure for the hacky sack. Am I just being vain? Hubby says it's up to me, but I think he's just being "sensitive".

I will see the surgeon in about 2 weeks for an initial consult. If it can't be done under a local, I'm wondering if I should simply cancel the consult. Anyone know?

Thanks in advance,

smwusaf

sajescents - I'm not sure because they have to do liposuction to get the fat to fill in. I think you would have to go under for that at least? I'm with you though, I'm still on the fence but thankfully I have 6 months to make a final decision since my PS won't do anything until 6 mos after radiation. Gives me time to mull it over.

I would keep the consult, see what they say. I say it's best to be fully informed. Let us know.

ABeautifulSunset

it’sstillme. If you are in south Fla then it’s worth a. Visit to see Dr Khouri at the Miami Breast Center in Key Biscayne, if you havent already.

Sunse

TWills

For those that have had fat grafting, where is the least and most painful harvesting area?

SpecialK

twills - I have had flanks, hips, and abdomen - in five separate surgeries - and found the abdomen to be the most painful - I think due to core muscles being used for everything like standing and sitting upright and generally moving around. That said, I had the largest amount of fat taken from there so it may also be due to the volume harvested, but I have had the abdomen used by two different PS. So happy you had your DIEP with the guys from UF Orlando, they have a great rep - sounds like it all went very well.

TWills

SpecialK, thanks, so far so good:) Not sure if I’ll need any fat grafting but I thought I’d get some opinions. I’m thinking mine would have to come from my thighs but I’ve heard that’s very painful but I’m not sure. I’m not quite 4 weeks out from surgery so I’m not looking forward to anymore discomfort.

VegGal

I've had inner and outer thighs and abdomen. Abdomen was the worst.

Flmom66

I just had abdominal fat grafting with Dr Lee in Orlando. It's uncomfortable but not terrible. He had a lot to work with, if you know what I mean! Good luck!

TWills

I just had DIEP with Dr Klein and Dr Lee in a Orlando, small world, so I’ll need to harvest from a site other than my belly if I end up needing fat grafting.

weety

I'm scheduled for my second fat grafting procedure this Thursday. I'm really feeling kind of depressed about the whole thing because the only place I left to use is my inner thighs and there really isn't much there. I kind of feel like it's almost a pointless surgery to have for the little bit we will get. But I don't think my PS will move forward with trying to expand again if I don't do this surgery because he said my skin is still quite thin.

I'm starting to get worried, too, about the toll of all these surgeries are having in my body, specifically my immune system. Is this going to allow my cancer to come back because my immune system can't keep up

wallan

Hi weety:

Hugs to you. I understand what you mean. I wondered if my immunity would be affected myself when I had all my reconstruction surgeries, including the fat grafting. My fat was harvested from my inner thighs too and I was told I didn't have much. (I thought they were out of their mind when they said that because I think I have lots LOL). And then my PS kept telling me my skin was too thin for expansion without the fat grafting and it might not work. I might need more fat grafting and maybe I wouldn't have fat to harvest. It was discouraging and scary and frustrating.

But now I am finished with the reconstruction now, and I am glad I did it after all. Mine worked out. I am grateful to have foobs that will fill out a bathing suit and tanktop in the summer without prosthesis.

So hang in there.

wallan

SpecialK

weety - I have had a boatload of surgeries - some in rapid succession, and I have had five fat grafts - a total of 17 surgeries between 2010 and 2016. Our diagnosis also has similar receptors, I am barely PR+, strongly ER+ and Her2+. I found that really taking care of myself post-surgery to be helpful - eat 100g of protein daily to help with healing - good sources are Greek yogurt, meat/fish/poultry, quinoa, fortified cereal, dairy, eggs. I took zinc, bromelaine, and arnica to assist with healing also. Taking a probiotic can help with gut flora and immune health, and if you are taking a prophy antibiotic for surgery eat yogurt to help your GI system. Thankfully I think we are coming to the end of flu season, but wash hands often, minimize forays into the outside world right after surgery if you can, and watch the hospital staff carefully for sterile process, hand washing and gloves, etc. Hoping all goes smoothly for you - I don't regret a single fat graft - they all contributed to recon success for me.

trhbfc2017

Hello All,

I am glad this group is actively posting and would like to ask a question. I am 8 months post op, left mx with DIEP reconstruction. The reconstructed breast is coming along great and I have no issues - would have been perfect if I had not had healing issues and scar tissue along the bottom below the flap but even that is smoothing out.

The only difference you can notice is that my natural right breast is a bit more shallow at the top (due to the normal aging breast). I am a D cup. When I wear a bra, no matter what top I am wearing, I really only have a slight difference but you have to really inspect me to see it. Obviously without a bra you can tell the breasts aren't the same but I am not really one of those people that go around bra-less in the world anyway. My husband likes me just the way I am and has no issue how I look. I meet with the plastic surgeon on Monday to talk about any second stage touch ups. I just wonder if any possibly complications from fat-grafting are worth having some added to the upper part of my right breast to make the two completely symmetrical. I have been exercising like crazy and have lost a total of 20 pounds since the initial dx and go to the gym regularly but I have saddlebags on my hips which means I would have a decent donor site. LOL

Any thoughts would be appreciated. From reading past posts here, it seems overall a few of you have been really happy with your results.

Thanks!

SpecialK

trhbfc2017 - placing fat in the upper pole is one of the best uses of fat grafting, so I think you could have good symmetry by doing that. That was the object of my first fat graft, bi-laterally above two implants, and it made all the difference. I went from a coconut under the skin look to a really natural upper pole afterward. What I would caution is that if you are in a weight loss process don't do the fat graft until you reach your goal. Because this is transplanted fat it can disappear with weight loss just like any other part of the body. The biggest complications from fat grafting are reabsorption, pain at the donor site, bruising/dimpling/firmness at the donor site. My grafts have been very successful - I have obedient fat apparently, lol! I did not have problems with reabsorption, the discomfort for me was not that bad and faded quickly as did any bruising, and I was a faithful compression wearer which was important for the aesthetic results at the donor site.

trhbfc2017

Thank you SpecialK!!! I so appreciate your reply. This helps going in to the visit.

All these decisions we must make are sometimes scary but it really helps having someone who has been there.

VegGal

My upper pole grafting worked really well, too, especially the second round. My PS said subsequent rounds do better as the fat has a surface to which to cling. The first round had the recovery room nurses plonking down ice packs on my newly revised boobs. Later I read that wasn't a good idea. I made sure to keep my boobs really warm and covered the second time, just to make sure to give those little fatties the best chance possible..

aquilegia

TWills - for me, the side of the abdomen/hip (outside of the DIEP scar) was the most painful donor site by far. For the first few weeks, just sitting down was enough to make me scream. Because any compression also presses on the hip-bones, it's painful to compress the area, and it took months until I could go without padding under my clothes. Inner thighs were no problem - a little sore for a few weeks.

SajeScents - My PS said the next time I do fat grafting he could use sedation rather than general anesthesia. I doubt local would work - the area to be harvested is too large.

weety

Thank you Wallen and SpecialK. I am really at a low point in this journey right now, mostly because I am feeling defeated. Wallen, my PS is telling me the same things: I might not have enough fat; my skin is too thin; it might not work; I might have to relook at the latissimus surgery. Ugh! I just want to scream!

If you look at a few of my previous posts, you'll see that I ended up with some pretty deep dents on the sides of my thighs. My PS is willing to fix it (I was worried Kaiser wouldn't be up to fixing things for cosmetic reasons) but he said he's kind of stuck between a rock and a hard place because the real fix for it is to fat graft fat back into the dent. But if we use my fat that he harvests from my inner thigh, then there is no fat left to fat graft onto the breast area. And I don't think he is willing to move forward at this point with an expander if I don't go through with tomorrow's surgery and get some more fat into the breast area. What he proposed he could do is do a little more liposuctioning around the dent to make the valley of the dent less shallow. He didn't liposuction the area on the lateral side of the dent, so I guess it definitely would get rid of the small mound to the back of the dent and look somewhat less deep, but I really just want to go back presurgery and put my saddlebag fat back on! I'm petite and only 110 pounds, so there wasn't much there to begin with. My butt and thighs are definitely my biggest fat reserve area and my "problem" area, but at 110 pounds, even a "problem" area is not really that pronounced.

I'm just at such a loss as to what to do. I want to just tell him to put the fat back on the thighs and fill the dent back up, but then I know I will not be getting a second breast. I lost the initial implant to a severe infection about 2 years ago after probably the last surgery I was going to need to be finished. It was so heartbreaking. I don't want the latissimus dorsi procedure due to ongoing shoulder issues, and I don't have enough fat to consider the DIEP. The TE and implant is really my last hope. I don't want to give up, but I know this is really my last chance.

Meow13

weety, sorry to hear. I was 125lbs 5'3" so I did have some fat. My ps was really reluctant to take inner thigh fat. He thought it would be more painful. They managed to get 800cc from me. I need to have it done again, now I carry more weight. I want to wait till after summer to do it.

SpecialK

weety - bummer, and I totally get it - have lost both a TE and an implant and was facing a recommended lat flap, which I can't do because of the history of skin cancer on my upper back. I also have lymphedema in the other arm and didn't want to compromise any strength in the remaining "good" arm. Other flap surgery was too scary for me as I don't heal well on the side with so many issues and the thought of that major a manipulation of that area didn't look promising. Fortunately, fat grafting to my flat side allowed for successful new TE and expansion even though my skin is very thin there after so much surgery. If I were in your shoes I might do the graft to the chest in hopes that it helped with recon and maybe wait and address the thigh dent down the line. How long ago was the harvest from that location? Has your PS mentioned any possibility of improvement over time, or it is looking the way it will remain? I wish there was such a thing as fat donation like blood donation, I would help you in a New York minute! I weigh about 12 lbs. more than you do, but it seems to be ALL FAT, lol! As soon as I figure out how to bank people's donated fat I will make millions! It would solve a lot of problems, right?

weety

Thanks for the kind words. SpecialK, I remember you way back from my initial breast cancer journey in 2009/2010. I think you were just a bit behind me. I remember crossing paths on some of the old chemo threads, etc.

You are right in that I should just worry about the fat going to the breast tomorrow. I guess I need to decide, though, whether to have him lipo around the dent like he suggested or just leave it alone for now. If he does do a light lipo in that area, he'd have a little more fat to use, though. But I worry that it might just make things worse since I already think too much fat was removed from that area of the outer thigh.

SpecialK

Yes ma'am - we are old timers! And happy to be so! It is a hard decision between wanting to fix one thing or the other - I wonder if you can split the difference or if your PS feel like there is only enough fat to do one thing for sure - such a dilemma. I have not had this happen even though I have grafted so many times - I have been very fortunate that I have not had any permanent issues at donor sites, but I have never used thighs. Both of my plastic surgeons have avoided them for this very reason, but I know if you don't have fat anywhere else, you have to use what you've got, right? If I can imagine what is in your head it is that "what if the fat doesn't fix the breast skin and I missed the opportunity to fix the thigh dent", ugh! Can you take one more opportunity to discuss in pre-op tomorrow? I know that is not the ideal time, but I have done it with both PS - just to clarify.

weety

So, I had the surgery on Thursday, and my PS's plan changed at the last minute. He decided not to use the inner thigh, stating that he was afraid that the same dents could happen there that happened on my outer thighs. He did say he could avoid it by taking just a tiny bit, but then it wouldn't be worth it because the net amount he would get would be so small. So he ended up getting more off my flanks--last time he had focused on the area near my hip bones--this time he focused more on the area of my upper butt/lower back. He was only able to harvest 100cc from each side though. That didn't give him much to inject into the breast area. He also ended up taking 5cc from each area on my thigh around the dents and re-inject it back into the dented areas.

ItsStillMe

abeautifulsunset thank you, I will contact Dr Khouri. I have read and heard a lot of positive things about him. He invented the Brava system right? Did you use him