Fat grafting for radiation fibrosis and scarring! Help!

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dpms
dpms Member Posts: 26
edited June 2014 in Breast Reconstruction

My mother finished going through her complete breast cancer treatment as of July 18, 2013. This included a Mastectomy with 10 lymphnodes removed, chemo (ACT), and 6 weeks of radiation. Around the middle of her radiation she started to feel extreme tightness on her chestwall and as the radiation completed, and following it, and additional symptom of feeling her rib bones rubbing against her under arm, or a sensation of them poking started. Both of these symptoms have gotten worse. After seeing many doctors, surgeons, and pain management clinics, we have concluded that the tightness is and the "bone poking" is from scar tissue, and fibrotic tissues that have formed post her mastectomy and post radiation effects. She also says it feels like her armhole is shorter and tighter - feels like the bones are clasping around her armhole, and that everything is just pressed up against her chestwall and stuck. Doctors say the pull force is the scaring and fibrotic tissues which have contracted her pec and other surrounding muscles, causing her shoulder to be pulled down, and hence the feeling of her ribs poking and rubbing against her underarm

These issues have just gotten exponentially worse over the last 9 months. She has also been in Physical Therapy throughout this whole duration. (she already had full range of motion - that was never a problem). They have tried breaking the scar tissue through massage, and strengthening excercises, but this has also not helped.

We have met with two great plastic surgeons just recently. One at Stanford and one at Mayo Clinic. The stanford one has suggested reconstructive surgery, and that it should help her problem issues, by going in and physically removing scar tissue, and doing a tissue transfer from the abdomen.

The mayo one has suggested Fat Grafting. We are told this procedure has been used for breast cancer patients in only the last 5 years.

**My question today is if anyone has gotten Fat grafting done to resolve issues similar to my mothers.

Does it in fact help with tightness and pulling in the chest wall?

Does it create a padding on the chestwall?

Do you feel like it has revascularized the area? giving is blood circulation?

Can you feel a difference? An improvement? How long after the procedure did you start to see the affect of fat grafting?

Did it break up scar tissues?

If you got it done, who was your surgeon and from which hospital?

What was your recovery from it like, and how many sessions did it require? We are not looking to get a complete reconstruction done through fat grafting. Just for it to help with her problem issues.

Thank you so much for your responses and any help you can offer. We are really struggling trying to figure out what to do, as doctors are giving different approaches and opinions that are so different. We hope other patients like ourselves will be able to shed some light on this. 

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  • Raelan
    Raelan Member Posts: 200
    edited April 2014

    dpms - I don't have much time to respond, but did want to at least let you know that I've read your post and wanted to provide you with a quick summary of my situation.  I had a bi-lateral masectomy 2 years ago along with chemo and radiation.  I delayed my reconstruction for a year and a half, and just had tissue expanders placed a month ago.  Prior to this I had 2 fat grafting sessions (3 months apart) to help repair some of the tissue damage from radiation so I can have a successful implant outcome.  I noticed a significant improvement in my skin after the fat grafting sessions;  my "tan" square faded and my skin developed a pink undertone, my masectomy scar (where I received several boosts) lost some of it's firmness, and I started to develop some feeling in certain areas of my chest.  The fat also provided a nice layer of insulation between my skin and my chest wall.

    For me, the recovery from the two lipo sessions was easy-peasy.  A few days taking it easy, after which I was back to work and my life. 

    I would strongly recommend trying this approach first.  Honestly, what does your mom have to lose (except possibly some unwanted fat...boo hoo!)?  This is still considered "experimental" in the world of Plastic Surgeons, but there's good anecdotal evidence that the stem cells from the fat have "healing" power on tissue damaged by radiation.

    The one caveat I would throw in is if your mom decides to go down this path, make sure the PS takes fat from areas other than her stomach so she has a fall-back plan in the event she doesn't get the level of relief she's seeking and wants a DIEP.

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  • dpms
    dpms Member Posts: 26
    edited April 2014

    Raelan - thank you so much for your response! It was extremely helpful. I'm glad to hear fat grafting proved to be beneficial for you. I was wondering what symptoms did you experience prior to the procedure and how did you decide on going through with fat grafting?

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  • SophiaMarie
    SophiaMarie Member Posts: 352
    edited April 2014

    dpms - I just had surgery yesterday - fat grafting after a disfiguring lumpectomy.  The initial cancer surgery created a large dent, and the incision as also pulled in - all with extensive internal scarring.  I saw an occupational therapist who did myofacial release - and after many many sessions the scar had softened considerably.  It was still adhered to the chest wall though.  So yesterday Dr Hijjawi in Milwaukee cut to release the scar and did a fat transfer to fill it in.  He said he will have to do it again though.  I see that there is still a bit of a dent.  He is really really good though so I'm confident that it will still look way better than it had!

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  • Raelan
    Raelan Member Posts: 200
    edited April 2014

    dpms - My reasons for fat grafting are different from your moms.  I did not experience any pain after I healed from my masectomy and radiation treatment, however, it was always my plan to have reconstruction.  I don't have enough stomach fat for a diep, so that limits my flap options.  I'm hoping to avoid a larger flap surgery by doing the fat grafting instead, followed by TE's and implants.  Only time will tell if my skin will stretch enough to allow for an implant.  I may ultimately end up with a lat flap, but figured I'd give this a try first.  I decided it was worth the extra surgeries and additional 6 month delay in getting TE's.  

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  • 4sewwhat
    4sewwhat Member Posts: 2,093
    edited May 2014

    Hi Dpms!

    I am late getting to this conversation but I wanted to tell you I am scheduled for a fat grafting on 5/21.  I am doing it because I lost my recon on my radiated side through a series of stupid coincidences.  Long story!!

    However in the search to find an answer to fix my recon I have met with multiple docs in the Metro Atlanta area and wanted to mention something one of them suggested to me.  I do not have bad rad damage and I don't have the pain your mom does.  I'm sorry you are both suffering through this.

    Hyperbaric.  Yes as in oxygen chamber.  The doctor told me he has used it for several patients with radiation complications and had good success with it because it brings so much oxygen and increased blood flow to all the tissues.  He rattled off a bunch of numbers and that they raise O2 levels to very high numbers and some other specifics I don't quite recall now.  He happens to be a PS but is also in charge of wound care at Piedmont Hospital here.  He basically said radiated tissue is a wound of sorts and the blood flow has been restricted.  

    I think fat grafting couldn't hurt at all either but you might want to look up or ask about the hyperbaric too.  It is a big time commitment but if it truly helps it's worth it.  He had told me it would be 90 minutes a day 5 days a week and in my case it would be 4 weeks then they would place a TE then another 4 weeks.  I don't know how it could work in your mom's case.

    Best of luck to you ladies.  I hope they figure something out to get her some relief very soon.

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