Fat Grafting After Lumpectomy

Go for it! I had fat grafting done for different reasons......it has a good history of success but choose your surgeon - you will know when you find the right one

I had fat grafting also, but after a BMX. Three weeks out today. SO GLAD I did it! Hurts like crazy for a while after, but did wonders to soften the edges of my implants. It has, at least in my mind, did wonders for my rads boob. The skin looks better, I see new little veins in one section beneath the skin, and the portion under my arm that used to be SO painful, feels many times better! Best of luck to you!

I think fat grafting is the way to go.

My experience - I had a partial mastectomy and radiation and ended up a cup size smaller, maybe more. My surgeon recommended that I wait until a year after radiation to have the other breast reduced to match. I did wait a year and had a small reduction and crescent lift. Initially, symmetry was much improved, but I'm sure I experienced more shrinkage of the radiated breast during the 2nd year. In addition, I developed an area of fat necrosis that pulled a dimple in above the scar line. (Had to have that biopsied to rule out recurrence.) So the following year, my plastic surgeon broke up the scar tissue and fat necrosis and grafted some fat into the scar area. I have also had fat grafted throughout the breast to increase the overall size (2 grafting sessions). Be sure your PS has had a lot of experience with fat grafting. Mine said if you graft too much fat at one time, it's more difficult for the fat to find a blood supply, resulting in more fat loss.

The only discomfort I really felt was in the donor site, and that was more soreness than pain. In fact, after the PS broke up the scar tissue and fat necrosis, all of the tightness and pulling I felt when I raised my arm was gone (tumor was at 12 o'clock). And I did notice what appeared to be new blood vessels under the skin, even under the areola, that I did not see through the thickened radiated skin.

Regarding unnecessary biopsies, I had to have an "unnecessary" biopsy due to the effects of partial mastectomy and radiation. Of course, I was glad it was benign, but it was clearly due to treatment. As of now, I've not had a call back since before I had fat grafting done.

Wishing you the best!

I know what you mean about not wanting to reduce the other breast. I didn't really want a reduction, but I desperately wanted to be even again. I was a 34D (average, not full figure), which is actually pretty small. At first I didn't want anything else done to the treated breast because it looked pretty good. But in that 2nd year post-treatment, I continued to see changes such as the dimpling I mentioned above and even more retraction. That's when my plastic surgeon suggested breaking up the scar tissue and fat grafting. Also around that time, some studies had come out that alleviated some of the concerns the medical community had about grafting fat into breast tissue. Radiologists now say they can distinguish calcifications caused by fat grafting from malignant calcifications.

The reduction I had on the opposite breast really only reduced me by about 1/2 cup size, I think. The fat grafting on the radiated breast brought me up about 1/2 cup size, so I am very even now. I started as a 34D and now I think I'm 34D-. I bought a 34C, but the cups are a bit too small. The same bras I wore before still fit; I just don't fill them out as well.

Hi MichelleLee,

I also had a lumpectomy in Oct. 2011 and rads in April-May 2012 that resulted in a dent in my right breast at the 3 o'clock position.  My former BS and current BS both advised against fat grafting because there aren't any good long-term studies yet, and it can result in necrosis or calcifications, which may lead to the need for more imaging and biopsies.  However, my MO, internist and PS say that it is safe.  Although no one can see the defect, like you, I don't want a daily reminder of BC.  I am scheduled to have the fat grafting in NYC on Nov. 1.  With the exception of Zard, I haven't heard from many lumpectomy patients who have had it done, whereas it's pretty common post-masectomy.  I hope we hear from more women who have had a good experience.  Good luck and please let us know if you learn anything new.

All the best,

Susanella

Lily55 - I am one of the women who developed fat necrosis post rads, although the radiologist thought it was a recurrence because of the way it enhanced on MRI.

susanella - I had a suspicious area of enhancement on an MRI about a year and a half after partial mastectomy and radiation. The area in question caused a very firm lump that pulled a dimple toward my chest wall. Of course, a biopsy was done and it was fat necrosis; clearly the result of treatment (it was in the boost area). This was before I had any fat grafting done. I have not had any callbacks for biopsies since I had fat grafted into my radiated breast. I am extremely happy with the results. Wishing you the best!

MichelleLee - I think you should have your mammo/MRI done before you have fat grafting done, on the remote chance that there is something of concern in that breast. It would be a shame to do the procedure then later find out you have to have a mastectomy. Also, I would think your BS and certainly the PS would want to know where you stand before proceeding with fat grafting. Good luck! 

So glad to find others who have had or are considering fat grafting after lumpectomy! I consulted with the first PS last week and will interview a second later this week. I didn't know fat grafting was an option until the PS recommended it. He said my own stem cells could be implanted as well as fat cells. When measured, my affected breast was over 3 cm "shorter" from base of throat to nipple than my other breast. (He also recommended a lift for the unaffected breast).

I had a re-excision lumpectomy in February to correct a large, persistent seroma. The seroma has returned and now occasionally drains out through my nipple.

I'm anxious to see what the second PS recommends.

Hi,

Lane4 -- Thanks for the information.  In 4 weeks, it will be 2 years since my lumpectomy.  I am scheduled to have a mammo and sono next week, followed by a breast MRI, and then, if all goes well, will have the fat grafting on Nov.1.

ThriverInGA -- What was the opinion of your BS and MO regarding the fat grafting??   I went to 3 PSs in NYC.  The first would not do fat grafting for post-lumpectomies.  The other 2 would.  My former BS and current BS both advise against it because there are no long-term studies.  However, my MO says she has no problem with it.  Some mainstream institutions are now doing it, i.e. Washington University (Barnes Jewish) in St. Louis, NYU, and I heard from a woman in Albany (posts under the name Zard) who had it done and is happy.  If anyone else out there has had post-lumpectomy fat grafting, please give us feedback.

Susanella in Long Island, NY

 I am so confused about this issue. I'm 5 years post Rads and my divot has sunken in more on my already small breast. I went to a plastic surgeon who said I could do implants or fat grafting, and then saw my breast surgeon who recommended against fat grafting, stating that I would have better results and less problems with implants. But I've been reading a lot about how implants don't take well to a radiated breast. My next step is to consult with another plastic surgeon for their opinion.  Then I'll ask the advice of Radiology docs. 

Pandabear, I had a reduction on my "good" side and they used some fat from under my arm for my transfer.  Yes, my health insurance covered it and the reduction looks beautiful 8 months post op.  Still have a little bit of pink scar on the underside but you can't see the scar around the nipple AT ALL and the line that runs from the nipple to the under boob is fading quickly too.  I was very happy with the results from it.  The fat transfer... not so much.  Will be discussing it with my breast surgeon next week at my 6 mo checkup and then I see my PS in another few weeks.  

I had a lumpectomy and radiation to my right breast almost 8 years ago.  I have a vertical divot that runs up from my nipple.  I have had numberous consultations with plastic surgeons regarding what can be done.  Implants under or over the muscle, lifts, and fat transfer.  I have only found one plastic surgeon in the Buffalo NY area that has done fat transfer, and I am going back to see him December 18th.  It makes me a little nervous that only ONE doctor would be performing fat transfer in the city where I live.  Is there anyone else in the Western NY area that has looked into this type of surgery? 

I'm wondering myself about all this and have been wanting to do fat grafting. Then became afraid after speaking with breast surgeon, who convinced me that I should get implants instead. She stated that I would be much happier with them and would have less problems than with the fat grafting. But I feel like she had an agenda,wanted to refer me to her plastic surgeon friend, who is more pro implant. With everything I'm reading here about the damage from rads and how it affects an implant, the more convinced I am that fat grafting would be a better idea, My lumpectomy was almost 7 years ago. Don't know if that makes a difference as far as healing of tissue from radiation damage. I probably should just go for a consult with a couple of plastic surgeons and see what they have to say about the whole thing.

I just found this thread and am wondering about others' experiences with fat grafting after lumpectomy and radiation. I'm almost 3 weeks out from my lumpectomy (DCIS, wound up with a total tumor size of 2.4 cm, more than twice as large as originally estimated after first biopsy). No problems with the surgery, clean margins and no invasive cancer found. I'm scheduled to have my planning appointment for rads in a couple of weeks and then start my 4 weeks of rads around the beginning of March. My tumor was at 6 o'clock, so I now have an incision of over 2 inches that runs from the edge of my nipple all the way down to what little is left of the "fold" below my breast—I have very small breasts to start with, so losing 2.4 cm has left a significant dent or more of a crater on the underside of my breast where it used to be rounded, at least (and a slightly downward-pointing nipple). I was okay with it, really, until the swelling really started to go down in the last couple of days, but now, more than ever, not so happy with it. I would like to investigate improving the looks and symmetry with fat grafting. I'm really not interested in implants or flaps or anything more major like that, not looking to get especially larger breasts, but would like a more normal contour and more of a match between the two, which would probably involve some fat grafting to my opposite breast, too, since it was the smaller one prior to surgery.

I have heard conflicting advice on whether fat grafting after lumpectomy can or should be done after radiation is completed. On the one hand, I've been told that irradiated tissue doesn't heal well, but on the other hand, it seems likely that radiation would not be good for the newly grafted fat tissue to survive if the grafting procedure were done prior to radiation, right? So is it okay to wait until after I complete radiation and then at least 6 months to a year to allow everything to "settle in" before considering fat grafting? My radiation oncology team said I should definitely wait & look into fat grafting later, so that's what I've been planning to do, but now I'm wondering. My treatment is being done at Johns Hopkins, so I do have access to breast plastic surgeons experienced in fat grafting reconstruction. I'm pretty anxious about the upcoming radiation and further shrinkage of what's left of my breast, I have to say. And wondering if I should get a PS consult before starting rads.