Has anyone had micro fat grafting?

Eileen, I'm meeting her next Friday. Am going to ask about this course of action. Is she going to use the Brava at all? Or will you not need it because of the implant?

 (Sorry if I've asked this question before, I can't keep all the threads straight.)

Hello Ladies... I had a bmx April 2011 and implant reconstruction. I had my first exchange in August to a mod+ profile 400cc implant.  I didn't like the profile shape and had 2 largish divots on the top left side. In November I had another exchange to the HP 500 implant and a fat graft using fat from my stomach. Three weeks out from the surgery I noticed that the divots, although better, were starting to come back. At 6 weeks out, I noticed that the divots looked less pronounced, but this was because the entire left top (directly above the implant) had started sinking in. This seems to be only happening on the left side. Now it looks so ugly. I feel like I can actually see the implant through my skin. I can even see the ripples of the implant a bit.... I'm bummed out.

Is is normal to have to repeat the fat grafts? Also, the area on the stomach where he took the fat is not healing flat. Is seems still "lumpy". (I'm now 8 weeks out.)Is this normal? Will it fix itself or is this permanent? Yikes, these surgeries seem endless... any advice?

Brett

Brett-  Not sure, but it sounds like maybe some of your fat was reabsorped.  There are different techniques for fat grafting- some with higher rates of fat retention afterwards.  If the PS is just injecting the fat directly into the breast in clumps about 50% is usually lost.  Some, like my PS, inject the fat drop by drop and I think more is retained with this method.  You may want to attempt it again it order to cover up the implant.  As far as the lumps on the stomach, did you wear compression garments (like Spanx) afterwards?  It's recommended that you wear them 24/7 for several weeks after lipo to help everything heal smoothly.  Even doing that I still had some lumps which are almost entirely gone now but it did take 6-9 months.

chrissilini- I think fat grafting is definitely worth it.  The problem with implants being directly under the skin (as opposed to under breast tissue with augmentation) is often you can see the edges of the implant, rippling is very common, there can be a big "step off", the cleavage area can appear kind of boney and the skin over the implants can feel colder than the rest of your skin.  Fat grafting can fix all of these things.  Is your PS recommending doing the fat grafting at the time of exchange or later to see if you will actually need it?  I'm surprised your insurance won't cover it as a lot of them are these days.  You could try to appeal it and see what happens.  Personally, I think it should be covered for all BC patients as I think fat grafting gives us the most natural appearance and restores what we have lost due to lumpectomy and MX. 

Kate33.. thanks, that's pretty much what I figured. My ps and I haven't talked much about it yet but we will next appointment. I think he recommends it but won't come out and say I should have it. He's strange that way but I love him. He is very particular and takes the outcomes personally so I know he would do whatever he needed to get the best results. As far as the insurance, they used to cover it but have been able to extrapolate some wording in policy to their favor. My ps said it is under review again and he has gotten the National Board of PS or something like that after them. Might be settled in patient's favor soon. Hope so.

I had fat grafting and nipple reconstruction on a Thursday and was back to work (my job is part time and not physical) on Monday.  My tummy was sore (think 500 sit ups), but I managed just fine.  I am scheduled for a second round in March and will plan the same recovery period.  Just mad a my PS as I wanted to add a small cosmetic procedure while I was "under" and he does not want to, grr.

Katee33--thanks for your concern.

She recommends that the second graft be at least 6 months after the first.

I will be waiting longer--as it works better for my job.  I think it is better for me to loose out on deductibles, and co-pays, rather than risk an employment situtation.

Dr. Ahn is certainly willing to work with me--whatever I decide.

Finding Dr. Ahn and her office staff to be extremely receptive to all of my concerns.  Eileen

Kate33 -  Thanks for the information. Yes, it does seem that the fat was re-absorbed. I'll have to ask my PS about the grafting technique. As for the lumpy belly where the fat graft was, yes, I did wear the compression garment (spanx) almost 24/7 for the first 3 weeks or so. I go to see the PS next week for a follow-up. I'm glad you mentioned it could take 6-9 before settled. I'll ask & see what he says. Probably will need another fat graft, so I'd like to know what to expect.

regarding lumps and compression ... how many weeks out would you say it's safe to wear lycra cycling shorts again? (Not that it's ever safe, ha ha.) I'm a big cyclist, so that might affect how I scheduled this proceedure during the year. I don't want to go out in public and look too strange.

Christine, the eyes were no big deal at all but my ps had me taking all sorts of supplements two weeks prior to surgery and I had minimal bruising and swelling. I think his concoction worked! I could have gone back to work one week after the eyes with just a but of makeup. But my doctor had me out for two weeks for exchange.

Mina- The member who saw Dr. Aronowitz was beacher4209.  I'm sure if you PM'd her she'd be happy to answer some questions.

Hi Kate,

Your replies have been incredibly helpful - thanks so much!  I just got home yesterday from Miami (live in California) where I did the implant swap and fat grafting with Dr. Khouri.  I was not prepared for the pain, having been through bi-lat mx and DIEP, I thought this would be a breeze.  Hah!  My core strength is good, I am not as weak as the other surgeries, but the pain is really severe.  What did other folks experience?  What to do?  I am having major buyer's remorse and thinking I should have lived with my ripples, divots, etc.  Though I talked Khouri into using my existing incisions, I have very restricted mobility in both arms, extreme pain in underarms and lower back, and then there's my chest, inner thighs, oy!  Made lots of bargains with god to get through the plane ride home, I hope I won't have to follow through on :-).  Also, he no longer suggests compression garments.  Have some nice new spanx for sale ;-).

Hurtin' in Berkeley 

Hopefulhealing I feel for you.  I've only been at this 6 months, and I am feeling so worn and drained...crying much more often as well.  I had my left areola spared, only to have to have it removed b/c the cancer was found to be too close to the margin of it.  I understand that feeling of grief, and I think we all can feel for you on the never feeling "normal" again.  

Cancer sucks and has taken so much from me, from all of us.  I'm determined to do everything, though, to keep it from taking my life...even though that means radiation to my newly fat grafted breast.     

Thanks Geewhiz - you are absolutely right.  I have my down days, but overall, holding up better than I would have ever expected.  Gotta keep slamming this beast with all I've got. 

mmscullen- I found the pain was minimized a lot by wearing the Spanx.  I would try to not wear them after a few weeks but after an hour had to put them back on.  I wore them 24/7 for 3-4 weeks.  Frankly, I'm a little surprised Khouri isn't advising you use them.  PS's almost always advise compression garments after lipo to help everything heal smoothly with no lumps.  Even with the Spanx I ended up with some lumps on my stomach that took forever to go away.  One thing that helps with the pain is try and be as active as possible with walking.  It will make a big difference.

geewhiz- I detest my armpit incisions, too, and will never understand why he insisted on doing it that way.  The whole point of doing fat grafting is to improve things aesthetically so he puts 2 big scars where everyone can see?  It makes absolutely no sense.  I live in Arizona but now sleeveless tops are out of the question and am not looking forward to swim suit season.  

EileenKaye- I think it has been discussed a lot about the post-op pain.  Some only have what they would call the soreness of a really hard work out and some (like me) have the worst pain they've ever felt.  Not sure what the difference is but some theories are the pain is worse the thinner you are, or it's worse if you have multiple areas that receive the lipo or it just varies from doctor to doctor.  The good news is the pain is usually pretty short lived.  The first day can be excrutiating, the second day is bad, the third day is bearable, etc.  Each day gets progressively better than the day before so it's not like you will be in unbelievable pain for weeks.  I found the recovery, though more painful, much shorter than recovering from MX.  I think for me the worst pain was when I woke up in Recovery and that should have been handled right then and there but it wasn't.  I would address your concerns with your PS and see what they say about their plan for pain control in Recovery and at home. 

For anyone having fat grafting I would ask your PS if they personally will be doing the lipo.  I assumed this would be the case with Khouri but found out 15 minutes before my surgery that another doctor does it.  (Only found out when I was introduced to the other PS who I had never met or layed eyes on prior.)  You want to find someone who is experienced at fat grafting but having someone experienced at lipo is just as important. 

faithhopenluv--

I will not be having any armpit scars--Dr. Ahn is using the same incision from prior surgeries.

She is quite experienced with liposuction--and I certainly have excess fat.  I do expect discomfort--but was disappointed with some of the recent comments--extreme pain, difficult recovery, disappointments.  Hope others will clarify the situation--as I have quite high hopes.

Thanks, Eileen