Fat Necrosis after DIEP

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dah0123
dah0123 Member Posts: 115
edited June 2014 in Breast Reconstruction

Hi all,

I had Stage 1 Delayed Bilateral DIEP on 3/8.  Stage 2 is scheduled for 6/10.  Anyway, here is my question . . . I have 2 areas at the top of each breast (toward the center) that are hard and sore.  I know it is fat necrosis.  I assume that they will take these areas out during Stage 2 and try to fill the areas with fat from lipo.  But I am concerned since these areas are rather large that they won't be able to fill in enough w/lipo to get a permanent and symmetrical result.  Has anyone else had fat necrosis and if yes, what did they do about it?  Did it have a negative impact on the overall result or where they able to "fix" it?   Thanks!!!

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  • ck55
    ck55 Member Posts: 346
    edited May 2010

    I would love to hear a reply to this as well. I had a unilateral delayed DIEP last October which partially failed and have some hard areas of what I assume to be fat necrosis under my new foob. I don't want to lose any more of the tissue ( it is already a bit smaller than the natural breast) but I  wonder what can be done about these areas? Anyone out there with this experience?

     Cyndi

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  • Dejaboo
    Dejaboo Member Posts: 2,916
    edited May 2010

    I Just bumped up a Thread Called Does Massage Really Work for Fat Necrosis.

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  • dah0123
    dah0123 Member Posts: 115
    edited May 2010

    Thanks Dejaboo.  Massage has not worked for me.  And I really don't understand how it would (?) since if the tissue is dead, I wouldn't expect that it would be able to "come back to life"?  If it has worked for some, I'd sure like to know it!  Assuming it doesn't though (like I said, it hasn't for me), what does or can the PS do???

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  • robink
    robink Member Posts: 336
    edited May 2010

    In my case massage seemed to make the breast swell, become more tender and eventually harder.  May 6 the entire dead flap was removed (with great difficulty) and an implant inserted.

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  • neversurrender
    neversurrender Member Posts: 508
    edited May 2010

    dah0123,

    Has your PS actually told you it is fat necrosis?  My diep was done on January 25, I had one hard spot on my rt breast until mid-April.  My PS told me all along it was not necrosis, but swelling and that once the swelling was gone, the hard spot would be gone.  He was right.  At just under 3 months, the hard spot went away. 

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  • dah0123
    dah0123 Member Posts: 115
    edited May 2010

    Robink,

    That is so depressing . . . I'm so sorry for you.

    Neversurrender,

    I actually said to my PS that I thought it was fat necrosis and he felt it and didn't correct me.  He told me to massage the areas.  He said the areas "weren't that big" but I beg to differ.  On my left breast I would say it is a 1.5" x 3" area and on my right (which is smaller to begin with), it is a good 3" x 2.5".  How big was your hard spot?  There was a lot of swelling and bruising in these areas right after surgery but I am 9 weeks out now and there doesn't seem to be any swelling in the traditional sense.  These hard areas didn't seem to be there right away --- I just noticed them after about 2 weeks or so.  Maybe I just didn't notice right away, not sure.  But I am concerned that this is a flap failure . . . I wonder if they count this when they say less than 1% failure?  And I wonder how common this is?  I'd love to know how big your "hard spot" was . . .

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  • NancyD
    NancyD Member Posts: 3,562
    edited May 2010

    I actually had fat necrosis, before my delayed DIEP, from the radiation treatment. During my DIEP recon, my PS removed as much as he could. What he left, which is on the lower, outer side has softened a bit since my DIEP in January. I thought small areas of fat necrosis could be broken up and absorbed by our bodies...no?

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  • Del11
    Del11 Member Posts: 944
    edited May 2010

    I'm 6 months out and I have the same hard areas at the top center, I've always assumed it was because that area of the flap bears the most weight. I've also been told by my PS, who I saw in person a month ago, that it's swelling and it will continue to go down. And it has. Very slowly, but it's going down.  I do believe that most of the firmness I'm feeling is swelling, especially since it gets a little less firm when I do lymphatic massage. There are probably some small areas of fat necrosis in there, but I'm hoping my body will just absorb them over time.  Whatever isn't absorbed my PS will break up, as Nancy said. Unfortunately I don't think any doctor can give you a definitive diagnosis of fat necrosis until they get in there for stage 2.

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  • neversurrender
    neversurrender Member Posts: 508
    edited May 2010

    dah,

    My spot was approx 3.5 cm long and 3 cm wide.  By the time had phase 2 at 12 weeks the spot was completely gaone.  I have another spot now, after phase 2, but again he says it is swelling.  I never noticed the swelling either, but it must be interior.  I hope this is what yours is and it will resolve itself.

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  • dah0123
    dah0123 Member Posts: 115
    edited May 2010

    My main concern is the size of these "hard" areas (I wouldn't call them "spots" because of their size).  I'd love to think that they are swelling or would break up over time (but I just can't imagine that these are "swelling" because the areas are hard as rocks).  But why wouldn't the necrosis have been discovered in the hospital when all is monitored so closely for warmth and with the doppler?  Supposedly the incidence of failure after 5 days is practically nil and I was in the hospital for 6 days.  After having implants for 14 years, I would be very depressed if these flaps fail and I have to go back to implants.  Question:  Were the areas that were described as "swelling" as hard as rocks?  And tender?  These are also the only areas on my new breasts that are tender (and massaging these areas hurts - how hard are you supposed to massage them?). Has anyone had these areas removed and filled with lipo fat???? Thanks everyone!!!!!! 

    Debbie

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  • shadow2356
    shadow2356 Member Posts: 393
    edited May 2010

    My DIEP breast was hard as a stone for a long time. It is now 6 months later and it is very soft except for a tiny spot. Maybe yours will soften up too.

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  • dah0123
    dah0123 Member Posts: 115
    edited May 2010

    Thanks Shadow.  I hope so too!  I have Stage II scheduled in a month.  I'm not sure how the PS will decide whether to remove or leave as is for now hoping massage will work over time.  Also, just noticed that you have the same diagnosis as me . . . and I'm 15 years out now. :)

    Debbie

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  • lovetosail
    lovetosail Member Posts: 544
    edited May 2010

    dah0123 - I am 10 days out from my unilateral DIEP and have a portion of the new breast that sounds like your description - a hard area that is tender.  I saw the BS on day 8 and she said there would still be hard areas due to swelling right now, I see the PS next Tues.  Has your tenderness resolved itself? I have no evidence of infection.  Anyone else have tenderness around a harder spot on their DIEP?

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  • dah0123
    dah0123 Member Posts: 115
    edited May 2010

    Hi Lovetosail,

    The tenderness is gone but the "hard areas" are still there.  I just can't believe mine is swelling - wouldn't swelling be soft?  And these weren't hard initially - I noticed it after about 2 weeks.  But they may have been there before and the area was so bruised and tender at that time that maybe I didn't notice (I don't think so though).  My PS just told me to massage the areas but it doesn't seem to be making a difference.  I think they are too big to "break up" with massaging.  I am curious to see what the PS does regarding these areas during Stage 2.  Both areas are at the top of my new breasts (think maybe the blood flow didn't make it that far?).  Anyway, I'll let you know what the PS does about it during Stage 2 since it is only 2 weeks away.  I can't believe that I had so little response when I asked others on this forum about these "hard areas" (which I believe to be fat necrosis).  Is it really that uncommon?  Of course, I do tend to always be on the wrong side of the odds. :)

    Debbie

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  • ebann
    ebann Member Posts: 3,026
    edited May 2010

    I have fat necrosis in my abdomin. I have massaged it and have started to exercise. This has made a  big difference for me. It has  taken awhile. It was really big and hard. Still can feel it but they are getting smaller. Yes they. I keep massaging it and believe in what my doctor says cause so far everything he has  told has been correct. If you are so uncertain I would recommend a second opinion.

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  • lovetosail
    lovetosail Member Posts: 544
    edited May 2010

    Thanks Elizabeth and Debbie.  My surgery was just 2 weeks ago and when I saw my PS last Tues she said it was too early to tell if I had necrosis, but to start gentle massage anyway.  It feels strange!  It's probably a good idea for me to do anyway to get aquainted with the new breast, it still seems like an alien to me.

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  • fightinhrd123
    fightinhrd123 Member Posts: 633
    edited May 2010

    I had mine done 3/31 and had some hard spots too, they are totally softening up already, i have been doing gentle massage too.

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  • lovetosail
    lovetosail Member Posts: 544
    edited May 2010

    Hi Laura - about how many times a day are you doing the massage?  I think Dr. Lipa told me 2x a day - but I am spacing a bit ;-)  Glad to hear that yours are softening up!!  How are you doing otherwise, are you back at work and all?\

    Sue

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  • fightinhrd123
    fightinhrd123 Member Posts: 633
    edited May 2010

    I have to say im not that consistant with the massagaing,so  i think its softening up by itself. Im doing good, my incision is finally healed, still have a couple of stiches.  I dont work, except for the three kids i have ;) and I'm starting to feel like im getting back to normal :)  I just cant wait for stage 2!!!!

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  • navygirl
    navygirl Member Posts: 886
    edited May 2010

    I've had two issues with fat necrosis in my diep, both on the same side - one of which was rather large (about 4cm), each time continued daily massage broke it up and it was reabsorbed with no problems. The areas filled in on their own - I don't know with what but I don't have any divots from it so? My PS told me to massage it 3x's/day and I did that if not more. It took about 3 months the first time and about 6 weeks for the smaller second one. It's been over a year now since I had any issues, and the breast has softened up a great deal (it's been 2 years since surgery). I hope this helps...if you have doubts or concerns have it checked out or maybe have a referral to physical therapy to help with breaking it up.

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  • lovetosail
    lovetosail Member Posts: 544
    edited May 2010

    Glad to hear you're finally getting back to normal, Laura.  navygirl, thanks for the input, it was helpful! and I love your motto (life is short, play hard).

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  • Gee
    Gee Member Posts: 10
    edited October 2010

    HI MA, 

    I am three week out from my DIEP and have exactly what you have described. My PS said it might be necrosis but could be sure until some of the swelling went done. I am also very worried if it will be something that can be "fixed". But that is the only sensitivity/pain I am having in my breasts. It is really annoying. I go back in two weeks, I will keep you posted if I hear anything new.  

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  • dah0123
    dah0123 Member Posts: 115
    edited October 2010

    Hi Gee,

    During Phase 2, my PS removed the hard areas (sucked them out using a lipo candula I believe) and added more fat to those areas using fat that he lipo'd out of my hip area.  Still had hard areas after that and had that process repeated in Phase 3.  Much better now though there are some different hard areas that I do believe will soften up with massage.  Keeping my fingers crossed.

    Debbie 

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  • lovetosail
    lovetosail Member Posts: 544
    edited October 2010

    Hi Gee and dah0123 - I had my DIEP in mid-May and with twice daily massage most of my hard areas have broken up.  I have one small spot remaining that is slowly decreasing in size.  I have stage 2 on 20 Oct, I'll let y'all know how that goes ...

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  • brendaclee3
    brendaclee3 Member Posts: 119
    edited May 2013

    I had my DIEP over a year ago and had some rather large necrosis near the cleavage area.  It has taken a year, but after massaging,  (which I've only been doing for a few weeks) the necrosis on the right side is totally gone, and the necrosis on the left is greatly reduced. I don't know how it works, but it worked for me.

    Brenda

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  • jcbis1
    jcbis1 Member Posts: 6
    edited December 2013

    I would be so grateful to hear about the massage techniques-- my PS hasn't mentioned massage, but it makes sense that it might help.  I'm 4 weeks out and 1/3 of the foob is like concrete, and seems to only be getting worse.  Can anyone describe what lymphatic massage entails?  Or what else you're doing that seems to help?  Or maybe there's a you tube link. . .  anyway, very good to hear that it's not a done deal yet, I was starting to feel like I'd have been better off with an implant than a bag of rocks sewn on to my chest.

    Thanks,

    Jessica

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  • LAstar
    LAstar Member Posts: 1,574
    edited December 2013

    Brenda, did your breast get smaller after the hard areas softened?

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  • Del11
    Del11 Member Posts: 944
    edited January 2014

    Necrotic tissue is dead tissue. Massage won't bring it back to life. It may encourage liquefaction though, where the necrotic tissue becomes fluid and is absorbed. You will lose volume if that happens, although whether it's noticeable or not depends on how much necrotic tissue is liquefying.

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  • LAstar
    LAstar Member Posts: 1,574
    edited January 2014

    My docs say there is no negative health effects of having necrosis. It's hard to believe that dead tissue liquifying in my body doesn't have some adverse effect!  Had anyone read or experienced adverse effects?

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  • Del11
    Del11 Member Posts: 944
    edited January 2014

    From personal experience there can sometimes be pain from soft (live) tissue getting pressed up against the hard tissue. I think you can also sometimes have an inflammatory response around the necrosis. There may also be encapsulating scar tissue, not sure about that though. 

    I had 2/3 of a flap liquefy, no adverse physical ramifications. Most of it came out of a fresh incision, and it came out as liquid fat, not anything infected. It never got infected in the course of draining either. 

    Edited to add: most liquefies without exiting the body :)  I just happened to have a convenient exit point at the time so it took it.

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