Lipofilling/Fat Grafting after Lumpectomy

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Curlykat
Curlykat Member Posts: 85
edited August 2016 in Breast Reconstruction

During my lumpectomy, my surgeon took out a significant amount of tissue. He told an interning med student on one of my post-op visits that he took out half, but I'd say more like a third. Anyway, I'm left with a natural DD on the left and what is probably about a C with a large dent on the left side. I have an appointment on September 19th to talk to the plastic surgeon about getting balanced back out.

In the meantime, I'd love to hear your stories about your lipofilling/fat grafting post lumpectomy. How was the surgery? What was the recovery like? Are you happy with results? Have you had to go back for more due to reabsorption?

Thanks!

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  • lane4
    lane4 Member Posts: 175
    edited August 2016

    Hi, Curlykat - I had a partial mastectomy which removed a large amount of tissue followed by radiation therapy. My treated breast ended up a cup or so smaller than the other. At first, I decided to take the simplest route and have the healthy breast reduced. While that improved symmetry, the treated breast continued to shrink. So a year later, we grafted fat in order to even them up. Because I still had a dented area, we did one more round of fat grafting to fill in that spot. I am extremely pleased with the results! The fat grafting sessions were very easy day surgeries. The worst part was the soreness from the liposuction. In my opinion, fat grafting is definitely the way to go.

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  • Curlykat
    Curlykat Member Posts: 85
    edited August 2016

    Thanks for sharing your story, Lane! What was your recovery like for the different surgeries?

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  • arissasmom
    arissasmom Member Posts: 17
    edited August 2016

    I've had fat grafting done six times with no results whatsoever. None. Last week I had the (preexisting) implant on the non-cancerous side replaced/reduced, and on the cancerous side replaced/enlarged. Once the PS got in there, she said it was absolutely horrible due to the huge amount of scar tissue from radiation. The fat needs a healthy blood supply to take, and that can't happen with scar tissue. Strangely, I had no outward sign of excessive scar tissue formation, such as capsular contraction, so it was kind of an ugly surprise, but also explains why the fat grafting never took. As far as the FG procedure itself, the donor site was quite bruised and painful for a few days, but not too bad. Good luck with whatever you decide!

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  • lane4
    lane4 Member Posts: 175
    edited August 2016

    Curlykat - Recovery from the first surgery was very easy. I had a small reduction and a crescent lift done on the healthy breast and I don't remember having pain or soreness at all. I wore the surgical bras they gave me for about a month, I think. When I had the fat grafting, there was soreness and bruising from the liposuction, but that improved rapidly. My breast had some swelling and bruising, but no pain or soreness.

    arissasmom - My PS broke up scar tissue before he grafted the fat. In fact, in the OR report, he stated that he used a "pickle fork" to break up the scar tissue. Maybe that contributed to the success of my fat grafting.

    Be sure to choose a PS who has a lot of experience with fat grafting. The results are very dependent on the surgeon's technique.

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  • simsoka
    simsoka Member Posts: 42
    edited August 2016

    Curlykat, what was a significant amount of tissue for you? I just had a lumpectomy on Monday. Going in, the surgeon expected to take about 4 cm of tissue, but she ended up taking 9.3 cm. I had a 7mm invasive tumor plus DCIS, which was 6.5 cm in size, and a total surprise. MRIs and mammograms measured it at about 3.5 cm. And now I have to go back in because margins weren't clear on one edge, so she may be taking another cm of tissue. This is tough news for me. I have D-sized breasts, but expect my left to be pretty disfigured when all the tissue settles. Fat grafting seems like a good option, based on what I've read. But is there a size limit? Wondering if it's only for smaller areas that need to be filled in.

    Guess I have more questions than answers. For those of you who have fully recovered from the lumpectomy, how long before you know what your breast will look like?

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  • lane4
    lane4 Member Posts: 175
    edited August 2016

    simsoka - Although your questions were for Curlykat, I'll chime in here if you don't mind. My surgeon took a chunk of tissue that was 10X4X2 cm plus six cavity margins, for a total of almost 100cc's. I was a 34D and that amount of tissue loss was definitely noticeable. Radiation therapy also added to the shrinkage. I had the opposite breast reduced one year after radiation, but the treated breast continued to contract. So after waiting another year, I had the first round of fat grafting, actually two years after completing radiation. I think some doctors would say a year is enough time to let the radiated breast settle, but I waited two years before I had any work done on the treated breast.

    I don't think there is a size limit on fat grafting, but if you need a large amount grafted, it might be better to do it in more than one session. My PS did not want to graft too much at one time because the grafted fat needs to quickly establish a blood supply in order to survive. Packing it in too tightly can cause the fat cells to die and reabsorb. The great thing about fat grafting is that it can be used to fill in a divot or it can be placed all around to increase the total size of the breast (or both).

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  • Curlykat
    Curlykat Member Posts: 85
    edited August 2016

    Thanks, arisasmom. That gives me some questions to ask. I have what I call a dent or divot, maybe that is capsular contraction - I'll have to check. Funny thing is, it goes in the opposite direction of my excision.

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  • Curlykat
    Curlykat Member Posts: 85
    edited August 2016

    Thanks, again, lane4! That doesn't sound bad at all!

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  • Curlykat
    Curlykat Member Posts: 85
    edited August 2016

    simsoka, my excision are was 10x9.7x3cm. I went from a very full D to what I imagine is a C (my left breast is DD). Sorry that you have to have another surgery. There was a pathologist on my surgical team. The first excision didn't have clear margins, so they went right back in. I have "narrow" margins, but I haven't looked back at my pathology report to see if they were to the current 2mm guideline.

    My breast doesn't look "horrible," but I do find myself thinking of it as disfigured. If I wear a triangle top bikini, the scar/contraction is visible. The worst thing for me, though, is that clothes don't seem to fit right. If I wear an unpadded bra, I have to pad it or it's very obvious (at least to anyone who is looking) that I'm unbalanced. I bought some cotton nursing pads after my surgery and they work well as filler.


    Thanks, lane4, for addressing her other questions!

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  • arissasmom
    arissasmom Member Posts: 17
    edited August 2016

    I had a total of 600 cc's of fat transferred. I don't think there's a limit to the amount, but as a PP mentioned, it can only be done in small increments so the fat can establish a blood supply.

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