Fat grafting feeding your dcis???

bluewillowskys · January 2014

Just came from seeing my BS. I asked about fat grafting and she says that she doesnt recommend it with my prior DCIS as there is reason to believe that it could FEED any remaining cancer cells not eliminated by my radiation. She says they (drs.) just started doing fat grafting to boobs without there having been any studies, especially long term ones.Has anyone heard about this before form their doctor or read a study?

Also she feels a mastectomy would be difficult with my having had radiation...not that it couldnt be done but may be pretty difficult. SHe suggest I try a small implant to fill in my "dent" instead. SO I have appt in about 10 days to see a PS. In the meantime if anyone else has heard about fat grafting possibly feeding a cancer i would like to hear about that and/or if anyone knows about any studies i could read on it. Thanks

bluewillowskys · January 2014

I just came across this link while looking for info.... to say im shocked would be an understatement. Has anyone else had an MRI after DCIS?

http://mammogramsanddcis.blogspot.com/

lane4 · January 2014

bluewillowskys - Here is a link to a study that addresses the risk of recurrence after lipofilling (fat grafting). The authors conclude that fat grafting appears to be safe. In this study, the dcis group had a higher recurrence rate, but the sample size is very small. My breast surgeon reviewed this study when I was considering fat grafting and he felt it would be safe for me. I had the fat grafts done, am very pleased with the results, and have not had to have any biopsies since. I did ask about an implant to correct my asymmetry, but my plastic surgeon said there was a 50% chance of complications with an implant in a radiated breast. Please let us know what you and your plastic surgeon decide to do. Best wishes!

http://annonc.oxfordjournals.org/content/early/201...

bluewillowskys · January 2014

Lane: thank you ! I dont understand why i wasnt told that radiation could leave me without future implants option to fix the lumpectomy dent. I know women are getting BMX and having recon after they have had a recurrence following lump./rads

Had i been told i might not be able to have an implant in the future i might have chosen MX in the first place. How can women get TEs and then have radiation if its such a bad thing to do?

Beesie · January 2014

bluewillowskys, I just finished replying to your other post in the lumpectomy vs mastectomy - why did you choose your route? thread, where you included this same url about DCIS and mammograms. The website you are referencing is a blog, not an article or a
research study; in other words, it's just the personal opinion and
anecdotal experience of one patient. And that particular blog has a lot
of misinformation in it. It's not a reliable source at all.

MRIs appear to be better at 'seeing' high grade, comedo-type DCIS (the
most aggressive DCIs) but they aren't particularly accurate in spotting
less aggressive DCIS. Personally I think it's a good idea for anyone
diagnosed with DCIS to have an MRI prior to surgery, to help the surgeon
get as complete a picture as possible prior to operating. And certainly
MRIs have proved to be valuable for women who have dense breast
tissue. But mammograms have a role to play too, since they are the most
effective at spotting the calcifications which can be a sign of DCIS.

As for having implants after rads, certainly it's more complicated, but lots of women do it. There is lots of discussion about this in the reconstruction forum.

bluewillowskys · January 2014

yes i know its a blog, however she cited all her resources for the information she wrote about The fact that her doctors couldnt deny the facts she posed to them was good enough for me. Im usuing it as one of MANY tools to make my decision.

sunshinegal · January 2014

My plastic surgeon doesn't do fat grafting because he says there is not enough research (yet) proving its safety to make him comfortable with doing it. He told me that since fat cells contain estrogen, there's a real question mark in his mind about putting such cells in the region of an estrogen-fed tumor - even if the tumor was excised.

Lily55 · January 2014

my understanding is that you already have the fat cells, the hormones, and circulating tumour cells, like anyone who has had cancer, so you can therefore grow a tumour anywhere......there is no evidence its higher risk in an area where you previously had cancer. Mets are more common than local recurrences when you look at statistics, and no study has been done relating mets to fat transfer

ziggypop · January 2014

I read something about that but other PSs reply that all the flap surgeries put body fat near the location of the removed tumor - can't see as the two things are very different.

Lily55 · January 2014

also with flap surgeries there is a lot more inflammation and that is also a feeding ground for cancer cells .

lisagwa · January 2014

Choosing the type of recon was a harder choice for me than choosing BMX. I believe there are 2 choices for fat grafting (fg), one that solely uses fat to create a breast, and the other that uses fat after recon to help the breast appear fuller or symmetrical, or get rid of dents.

I don't know anything about the latter recon choice. Re- solely fg, after talking to several doctors, there wasn't enough research or long term studies. There was concern about lumps developing after procedure which might cause confusion as to if it was medical concern or superficial. The 1 doctor where I live that does the procedure said that I would have a lot of fg procedures to get to a B cup. They're not sure how much fat stayed in breast. It would have taken more time and maybe pain in areas where the fat was taken from.

There is a doctor in florida who does the BRAVA system and there is a thread for this.

ziggypop · January 2014

Lily - there is a potential that someone who has had cancer has cancer cells in other locations in their body - that risk with DCIS is very, very, very low.

Bluewillowskys - PS's are divided on their thoughts regarding fat grafting. My PS did it & she is a very well respected PS and works at the Cleveland Clinic which is an excellent facility. Using fat to fill in a divot is probably the 'easiest' solution. You were probably not told that you couldn't have implants following rads because it's not true so it's not something that they should have told you. What they should have told you (and likely did at some point although we are all hit with so much info that we 'delete' that which isn't relevant at the specific time that we hear it - or maybe you had a team that was REALLY negligent, at a minimum you should have receive a booklet or written materials that discussed risks etc. ), is that radiated skin and tissue can be much more fragile and does not tend to heal as well, scarring (internal) is less predictable, etc. and this means that future surgery of any type can be really difficult. Implants CAN be placed in irradiated tissue, but the failure rate is much higher than in normal skin.

Your PS sounds like she is quite conservative regarding treatment options, there are many PSs who will do fat transfer (I just had it done) and there are many PSs who will do implants. If those are options you want to consider, then you might want to try a different PS.

bluewillowskys · January 2014

thank you ladies for chiming in with your info....any info i get is very helpful:)

Fat grafting feeding your dcis???

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