ANYONE DONE THIS? Explant then Fat Transfer Reconstruction

SLJKT

Long time breast cancer survivor, but first time poster.

DX in 2002 at age 32 and have had implants since initial reconstruction (with a couple ruptures and replacements and tweaks along the way of course!). I would LOVE to get these implants out of my body, but I really don't want to have nothing. I'm looking for people who've done this procedure, and would love to hear about your experience and insight. Also, where? I'm struggling to find surgeons in my area (Kansas City) who have experience in this.

Thanks in advance!!

Sara

Yuuki

Hi, Sara.

Our stories have some similarities. I was dx in 2000 at age 34. I had silicone implant reconstruction that served me fairly well - only intracapsular ruptures - until 2016 when I had a local recurrence requiring radiation. The implant hardened, migrated, cut down my shoulder ROM, and I had axillary cording.

I talked to more than one surgeon about implant exchange, but concluded autologous tissue was the way to go. I am 7 months out from Stage I and almost two months out from Stage II DIEP. For me it was a very good decision, but my implant-related problems were significant.

DIEP is major surgery, with significant recovery and downtime. At this point I can say the breasts feel like they’re my own (they are still numb over the graft, but the motion and the warmth feel very real). I am extremely pleased with the cosmetic results over implant recon despite the new scars.

If you go this route, plan on investing several months and more than one procedure. For me, it was absolutely worth it - but it shouldn’t be taken lightly. Talk to several surgeons and find one you trust completely. Best of luck to you,

Yuuk

Shoregirl

SLJKT, I am wanting to do this too. I have had nothing but problems, on my 3rd set of implants since April 2017. Additionally, all kinds of joint pain, fatigue, dry eyes, inflammation really too many symptoms to list here. I have been to countless specialists, Rheumatologist, Endocrinologist, Podiatrist, nerve conduction studies. Everything negative. Blood work is perfect.

I would like to invite you to 2 different Facebook groups I have joined. You will find TONS of info there. And yes, women that had msx with implants, had them removed and reconstructed with just fat!!

https://www.facebook.com/groups/1976983342582108/ This one is the Fat Transfer (No Flap) to the Breast After Mastectomy/Lumpectomy group. It is a small group, under 2000 members but it is where I started. From there I found this next group called Breast Implant Illness and Healing by Nicole. It has grown quickly to over 90,000 members!!! Here is the link https://www.facebook.com/groups/Healingbreastimplantillness/?multi_permalinks=2552177218334534&notif_id=1567909884437278&notif_t=group_highlights

I hope this helps!!

monkeymom

Hi SLJKT,

I'm about to start this process. Diagnosed 2013, bilateral mastectomy and textured silicone implant put in. Fast forward 6 years and the implants are being recalled. I'm having them removed next month and both breasts reconstructed with fat. DIEP/TRAM were not options for me because of the long recovery (I have 2 kids). Fat transfer is a long process, spaced out over 3-4 each time, but hopefully the end results will be worth it! Best of luck to you!

Yogatyme

My sister is hoping to have this surgery and has a consultation tomorrow w a surgeon at Duke. There are only 2 surgeons in NC who do this surgery and she is anxious to hear what he has to say. She is having prophylactic BMX bc we both have BRCA1 mutation and I was recently dx & treated for stage 1. I elected to go flat and use prosthesis primarily bc I didn’t want to have more surgery but am completely supportive of my sisters decision. We all have to do what is right for us. We have both also had prophylactic oophorectomy. I will let you know what she finds out. Good luck to all of you courageous women!! BTW, I know others are well meaning when they tell us what they would do or what they think we should do, but really......do they think we care what they would do? Besides, no one really knows until they are facing it.

Yogatyme

My sister met w the PS at Duke on Tues and he indicated he would use fat from each side of her abdomen. He said The mastectomy and reconstruction could be done at the same time but she would be in surgery 13-16 hrs, so she elected to have mastectomy ASAP and do the reconstruction in the early part of next year. He didn’t discuss risks and she didn’t ask....both a bit worrisome but maybe that conversation will take place at her next appointment.

Shoregirl

SLJKT, how are you doing? Did you find a doctor near you that can do the procedure?

Yogatyme, 13-16 hours for msx and ft does not sound correct. I just wonder if she had 13-16 hours quoted for a different procedure involving a flap. I am no expert and I may stand corrected lol but I can share my experience. I had bilat msx and tissue expanders placed in 4 hours. My subsequent implant removal, exchange for smaller implants and fat grafting took only 2 hours. So for msx and ft, I would *think* it really shouldn't take any longer than 5 hours, if that! 13-16 hours is more in line with an SGAP flap reconstruction. I know because I consulted for SGAP at Johns Hopkins and when I was told how long it would take I said no thanks!! For reconstruction involving fat grafting, the surgeon performs the lipo 1st. This shouldn't take more than 30-45 min. While the fat is being spun down and processed, the ps goes on with the other part of the surgery. Then at the end, the purified fat is injected into the desired areas. If she does want fat grafted in the future, it would be ideal for her to get a small amt grafted at the time of msx so that future fat has that base layer to integrate with. FT is great, but it usually takes 3-4 sessions to get the volume desired as much of it can be reabsorbed by the body when transferred. Prayers your sister does well with her surgery!

I am having my consult Monday for explant and ft. I am so ready to get rid of these implants!!

Yogatyme

shoregirl, thanks so much for the info. It was very helpful. I hope your consult was positive today. Good luck going forward!!

HopeWins

shoregirl - hi, we're sort of neighbors. I'm also on eastern shore. Curious how your consult went. I had DIEP and need quite a bit of FT because I didn't have quite enough tissue. Maybe once the divots are filled in, I'll be satisfied with smaller breasts but I don't right now.

Shoregirl

Hi ladies! My consult went great!! Dr Vander Kolk in Baltimore. He BELIEVES in breast implant illness so much that he doesn't put implants in anymore. He told me he has done waaaaayyyy more explants than implants over the last 25 years (since the 1st time silicone implants were taken off the market for cosmetic surgery in 1992). He is doing an Enbloc capsulectomy, and a procedure like a reverse tummy tuck of sorts where tissue from upper torso (beneath bra line) is pulled up and formed into an IMF and fat grafting. He has me in the OR approx 3 hours. I will have drains and a pain pump. Surgery scheduled for Nov 5!! I have learned that we must be very, very careful choosing surgeon for this type of reconstruction. You want someone that has done a LOT of high volume fat grafting....whether it be breast aug/recon or Brazillian butt lifts. They know how to inject the fat in thin layers to minimize chance of fat necrosis and other complications. The 1st ps I consulted with said he could do what I wanted, but in talking with him I could tell A) he doesn't believe in BII, told me my symptoms were likely "psycosomatic" and "in my head" even though he admitted he knows of all these women online reporting getting well after implants removed. He said he would "try" to get all the capsule out. Getting the capsule out in its ENTIRETY is crucial to healing. Preferably removed "enbloc" which means all together with the implant intact inside it in case the implant is ruptured, removing the capsule without tearing it will keep the ruptured implant material contained and not leaking out into the chest cavity. When he said that, I knew he was not the surgeon for me. The Facebook group I referenced in my earlier post, the Breast Implant Illness & Healing by Nicole one, has a file that has a list of doctors in various states and Canada that are skilled in the Enbloc method of explant surgery.

HopeWins

shoregirl - so glad your consult went well! I'm at the same practice with Dr Chang. They are a super experienced group. Best of luck and congrats on getting in so quickly!

BTW - not sure if you've been to Mercy before, but they're top notch. I had fantastic care there.

Shoregirl

HopeWins, thank you! I was amazed how quickly they got me scheduled!! I haven't been to Mercy but I sure could have saved myself a lot of heartache and time off my life dealing with some of the places I have been had I gone there 1st!! I live on the Eastern shore so didn't want to travel to Baltimore. Big mistake!! Dr. V told me if I am not happy with the fg results he would recommend his colleages Dr Chang & Dr Collins do an SGAP flap. Hopefully all goes well. Its so nice to actually have a sympathetic surgeon!! I did consult at Hopkins last fall and another ps in Columbia....not so sympathetic!!

Di2012

I had two different sets of implants....first pair migrated toward my arm pits, and the second set were the recalled and they were so BIG I was having backaches all the time time and I could not raise my arms without pain....they were removed last Nov. And replaced with just my skin....building a "skin sling" for each side!

The end of Feb I had fat from my thighs transferred to give my "foobs" more volume, small but fit my 5' frame.....I am very pleased!

Di

Shoregirl

Di2012 that is so interesting! I am happy to hear you are happy with your results! Was the fat from thighs removed via lipo or was it an actual tissue transfer? I ask because a ps from Hopkins said that was really my only option, creating breasts from my thighs and I think it was called a TUG flap. I kept searching for a ps that would do actual lipo and transfer the lipoed fat. I am so happy with my results too!

I just had my 3rd round of fg June 23. The 1st round was immediately after my implants were removed (in the same procedure) Last Nov. Not going to lie, the enbloc explant was a very rough procedure. I was out of commission for a good month so I would say on par with a msx! But I absolutely have zero regrets in explanting. My health has improved significantly. The 1st round of fg was minimal. The excess skin from my upper abdomen was pulled up and tucked in to create the IMF. Just 200cc of fat was placed on each side. I probably only retained 40%. 2nd fg was 3 months later in Feb. Again, only a small amt was grafted and again, I didn't retain much but did retain some. This time at our consult, Dr Vander Kolk said he would do things differently. He used a smaller cannula. He placed the fat in a centrifuge. (I thought that was standard procedure?) And he took fat from my more stubborn areas, ie places I have trouble losing fat from which was my back and flanks. It is early, just 5 days out, but I really think I will have much better retention this time. I am really enjoying how the girls look now!! They are warm, soft and jiggly. I apply DMSO 4x per day to help improve vascularity.

HopeWins ~ how are you doing? Did you have more fg to fill in divots? You are right about Mercy. Its a bit of a trek for us but wow what a fabulous hospital and staff!! I left a gold star review.

macb04

I tried, but had an inexperienced PS who wasted my fat. Had 5 Fat grafting procedures, had 2 huge infections, lost all the grafted fat both times.

Also I had severe Rad Fibrosis screwing up the healing process as well.

Had to switch back to implants, Prepectoral instead of Subpectoral . I started getting Hyperbaric Oxygen Therapy HBOT. Had HBOT about 50 times., following surgery to finally succeed with even Prepectoral Reconstruction

All together I had 15 Reconstruction surgeries. I am still lopsided. Not loving it when nude, but have cleavage and full motion without IRON BRA.

Would have preferred Fat Grafted Breasts. I was cursed by bad doctors, just unlucky.

Good luck to yo you all.

Shoregirl

macb04, I'm glad you chimed in here. People need to know the importance of having a doctor with a lot of experience in fat grafting. You and I have shared our experiences on your thread about prepec implants. It is so darn frustrating dealing with incompetent ps!! Remember I had 3 sets of (prepec) implants with 3 different ps. Each one left me botched. The 4th ps did just a bit of fg but when I decided I wanted to explant I discovered he was not sympathetic to breast implant illness and didn't have any experience in enbloc explant so I moved on. I wound up with ps#5 who is very sympathetic but it hasn't been total smooth sailing. With my grafted fat, I would say the 1st two rounds I only kept about 30% total. I was so worried I wouldn't have enough to spare for the next two rounds and so thankful he was willing to try a different approach this last time! This process isn't easy. I do have areas of lumpy fat necrosis. I have started light massage to try to get the areas to absorb but its been just over 2 weeks so have to be careful. Fat graft is so tricky because there is very little blood supply when msx has been done.

I have had 8 reconstructive surgeries so far so just half what you endured. My ps told me if I am unhappy with my fg results his colleagues could do an SGAP. At this point, I just turned 56 and I had lumbar surgery 2 years ago in the midst of my reconstructions. I can get through a couple more fat grafts but that's all I am willing to do. I get so discouraged that I am coming up on 4 yrs since dx and still messing with this crap!!! I am happy you have cleavage and full motion without IRON BRA!! Prayers we and all our sisters can get our lives back after all we have been through!!

macb04

I know you have been through the ringer as well Shoregirl. We shouldn’t have to go through so much but this is the way it is, real hard really unfortunate for most of us.

I think it can be a crap shoot regarding Recon, there is such inconsistency in doctors.

Di2012

Shoregirl,

I had lipo from my thighs, entry points of the lipo cannula were top of inner thighs on each leg, but I know it went down to just above my knees joints and my doctor & the docs (THREE very cute doctors interning).....I don't know how it got to my chest to make my small "boobs"......the part I love about them, is that they are WARM......unlike my multiple cold implants.

Di

Coffeeholic

Hello,

I explanted last year and have no regrets about that. My Allergan textured implants caused me nothing but problems from the very beginning - BII, pain, swelling. All symptoms disappeared after explant, so all good there. I had 2 fat grafting procedures, the first one right after my explant and the 2nd was done three months after that. I also had the Goldilocks done where they fold the skin to create a small ridge. After the 1st transfer, the middle part of my affected breast had sunken in with adhesions that needed to be released in surgery to proceed with the 2nd fat transfer. Unfortunately, soon after the 2nd transfer, I ended up with fat necrosis, so I canceled the 3rd fat transfer.

I have a smooth and symmetrical "breast" area that is more like fat pads than mounds, and honestly I'm okay with how it looks. BUT I am bothered by the multiple areas of fat necrosis - some that grew several months after my last surgery. I've had MRI, US and biopsies to check the lumps, and even though my doc says don't worry, I can't help but worry. I'm scheduled for a follow up in the next month or two to see if these areas have grown. I'd like to have surgery to remove all the fat necrosis and excess skin and just go flat. However, with Covid in the mix, I'm more likely to lay low until we get this under control. Plus the thought of more surgery just leaves me cold. Looking back, I wish I would have gone flat. So glad that it has worked for others, though. I think this is an exciting option for women who don't want implants!