Non-Implant and Non-Flap Reconstruction Options

apenelope

Hi there!

I am currently in treatment for a recurrence and will be doing radiation. After my first diagnosis I had bilateral mastectomy w recon, TE to saline UTM. They never felt right. They are tight, I have animation, and they cause me pain. Additionally, I developed Sjogren's after recon and I can't help but wonder if it's because of the implants/related materials.

Now that I am facing radiation, I'm told having the implants removed (at least the one on the non-radiated side) would actually be ideal. I'm not sure I'm ready to go flat. And I would like to have a long-term game plan before going in to radiation (in case it makes sense to keep an implant on the side that will be radiated to see if we can keep the skin stretched). I'm not totally into the idea of having a very big surgery (like a Flap). My natural breasts were a size C and I was never attached to them. A size "B" would be fantastic but I'd be pretty happy with anything between that and ballerina "A's". I found a paper from a surgeon in Poland doing TE with fat grafting and heard from plastic surgeons in Chicago that there are plastic surgeons in Italy doing something similar. The other option I learned about is the BRAVA+AFG procedure, but it seems the device has been discontinued and there are several complaints about Dr. Khouri which make me concerned about his ethics.

Have any of you tried other options? Or know information about other options? Anyone know of plastic surgeons in the United States that do the TE with fat grafting? Maybe fat grafting just enough to create a small mound?

SoulShine1969

Hi apenelope

I’m so sorry to hear about your recurrence. Hopefully you can put it all behind you soon.

I had my mastectomy and revisions at Northwestern in Chicago but recently decided to consult a Plastic Surgeon in Milwaukee. I’m really glad I did. He’s had great success using the upper inner thigh to create new small breasts. I like the sound of no more implants.

I hope this is helpful.

apenelope

Thank you. I hope so too.

I also had mine at NW! What’s the name of this surgery? Is it the PAP?

HopeWins

I'm just throwing this out there based on my personal experience. I had DIEP flap last August - bilateral. I didnt really have enough tissue to recreate my original size. I was a small C / large B and after DIEP I was an A. I had two rounds of fat grafting. The first put around 150cc in each and that got me up to a small B. I just had another round of fat grafting this week, so my healed size is TBD. He put around 250cc in each this time. You probably know this but just in case - you lose about 45% of the fat injected. Some women have better results than that. Some have worse.

I'm just going to say it - liposuction is barbaric. My first round of fat grafting was not a difficult recovery, but I was really sore for a few days. Tender for a couple weeks. Swollen for about a month. I still had large numb spots 3 months after surgery. They took fat from my flanks primarily. This time they took a lot more fat. It was out of my outer thighs and a bit more from my flank. The recovery is definitely harder this time and I think it's because they took so much more fat. The bruising is something you would see in crime photos. It's not easy on the body and there's no way I would be willing to do three or four rounds of this. I've had pretty good luck, but some folks have unexpected cosmetic results at the donor sites. Some folks have unexpected results at the receiving sites.

I'm just sharing this to say - making breasts entirely out of fat grafting may not be as easy and may not end up being less traumatic than other recon options. The fat needs to develop a blood supply from the tissue around it in order to survive. I'm not sure how that works when there's very little surrounding tissue. Also know, it's very difficult for surgeons to produce volume at the upper and inner areas of the breast. After my first surgery, I was skin on ribs in that area. The fat grafting helped a little, but I'll never have cleavage the way I used to.

I can totally understand being opposed to implants, but if you're looking to minimize trauma, down time, etc. Could you consider silicon implants over the muscle? I understand animation is a non-issue, there's usually no pain with these, the surgery should be a relatively easy one and implants are definitely more predictable from a cosmetic standpoint. Idk, just reading what you're looking for, that's what I would consider. Best of luck to you through your treatment and surgery!

SoulShine1969

apenelope

I’m not sure what the procedure is called. From what I understand he’ll take skin, vascular supply and fat all at once from each upper inner thigh. I had a ct scan of the upper legs so he could “see” the vascular structure of the area and a MRI of the breast in preparation for the surgery. Unfortunately, the MRI showed enhancement and vascular development behind my left nipple (I had NPS). So, now a second MRI, ultrasound, biopsy with nipple removal later I’m waiting with bated breath for biopsy results. According to my BS, I should still be able to go forward with the original plan. Yay