Fat augmentation/necrosis

Amanda875

Hi there. I had DCIS over 3 years ago now. I had a mastectomy of the left breast and immediate DIEP flap reconstruction. Unfortunately this failed. I have Raynaud's and my poor circulation meant it didn't take. About two thirds of it was removed in 3 subsequent operations. I then had two lots of fat augmentation to build up the breast. On the third lot of fat augmentation I began to develop necrosis. Everywhere fat was put in the fat has died but instead of being absorbed my body is expelling it through the skin. I first get a hard lump then skin goes red then black. It then develops a head which bursts and fat etc seeps out. I currently have several open sores some 5 months after the op. I see my consultant regularly. He has a look squeezes some more stuff out. Says it's my t cells getting rid of my own fat. Says it's unusual but all we can do is watch and wait. Anyone else had anything like this happen?

Moderators

Amanda875, we are so sorry to hear what you are going through. We wonder if you have considered a second opinion from another plastic surgeon. Have they discussed aspiration or surgery as options?

Amanda875

Thank you for your reply. No not mentioned either. Because lumps are small they burst and empty themselves so don't think aspiration is viable. Surgery is not some thing I want to do again as I think I already have more scar tissue than reconstructed breast. I also find myself in a difficult situation as my surgeon is always available to see me and has done all of my operations. Not sure whether to ask for another surgeon as I feel he is doing everything he can. What I really want to know is if this has happened to anyone else and what they did? If there is hope it will stop eventually.

Trishyla

Not to frighten you, but have they done a punch biopsy to rule out skin metastases? What you are describing doesn't sound at all like fat necrosis. Unless your skin is extremely taut and fragile, there's no mechanism for fat to push through the skin. It normally stays as hard lumps under the skin.

I'm with the moderators. I'd go for a second opinion, preferably your MO or a dermatologist. Plastic surgeons are not trained to spot cancer. You need a qualified set of eyes on those wounds.

Good luck! Please keep us posted.

Trish

MinusTwo

I agree - a second opinion with a dermatologist AND an MO. You don't say if you've had chemo, but if not I'd sure get an MO involved too.

Amanda875

Ok. Thanks ladies. I didn't have chemo or radiotherapy as it was DCIS and they said there was.no need with a mastectomy as my sentinel lymph node was clear too. I'm in the UK so will ring my breast care nurse this morning and see where we go from there. I never even considered it could be anything other than a result of the fat transfer. Better to get it checked as you say.

Amanda875

Just to update. UK breast care team said they couldn't help as I was no longer 'in their care' and was now under my plastic surgeon. That was quite upsetting! I have therefore seen my GP today who has referred me for a second opinion with the breast team in a different hospital. Hopefully I won't have to wait too long.