Revision and fat grafting after lumpectomy results?

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HopefulJenn
HopefulJenn Member Posts: 34
edited July 2017 in Breast Reconstruction

Hi! I'm not certain if this is the right spot to post this but please let me know if I should try some other spot.

I'm considering scar revision with fat grafting surgery and trying to get as much information as I can before I decide either way. I had a lumpectomy just over 2 years ago (yay!!) and radiation afterward. A few months after radiation, I started to develop hard lumps beside and under the lumpectomy scar. All the scans say it is scar tissue that has formed and they haven't changed in about a year. I still have all over breast pain from the radiation (the muscle tightens up and just aches) and the scar and surgical site gives me pain on a daily basis. If I roll over onto that side in my sleep (my surgery was at 9 o'clock on the right side), when I wake up and sit up it hurts an awful lot for quite a while. If I put pressure on the scar tissue, it hurts. I have a divot on the side but I'm not too worried about that, I see it as a kind of battle scar! But the pain is what gets to me.

My plastic surgeon recommended scar revision with fat grafting. He figures that removing the underlying scar tissue will loosen stuff up but can make no guarantees about the pain. He says pain is subjective and all he can say is he "hopes the surgery would help" with the pain I'm having. I can totally respect that but as the pain is the whole reason I'm thinking about another surgery, I'm trying to figure out if the surgery will help me or not. The surgeon says the recovery is not too bad, the worst pain will be from the small amount of lipo he will have to do but I just am not looking forward to another surgery.

Has anyone had a similar situation and what have been your results from this kind of surgery? Have you had pain from scar tissue that has gone away after the scar tissue was removed?

Thanks very much! Wishing everyone gentle hugs and beautiful summer days!

Jenn

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  • Meow13
    Meow13 Member Posts: 4,859
    edited June 2017

    My situation is different but might be helpful I had mastectomy and after a DIEP reconstruction. I had a painful lump on abdomen from scar tissue. It hurt when doing yoga, my ps took the lump out and it felt better. The lipo and fat grafting I had made me sore. It help to wear the compression garment. I had 2 garments keeping one clean all the time so I could take off sweaty one shower and put the clean one on. That helped the itching.

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  • AmusingSoprano
    AmusingSoprano Member Posts: 114
    edited June 2017

    Hi HopefulJen

    My surgeon recently went to a conference and told me that it seems that fat grafting actually helps with the pain. They are not yet sure why but he was quite excited about it. There may some research on the net.

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  • HopefulJenn
    HopefulJenn Member Posts: 34
    edited June 2017

    Thanks Meow13! That does sound fairly similar, scar tissue that hurts when there's pressure applied. I'm glad it worked for you and I hope you're happy with your reconstruction! My surgeon actually hasn't mentioned compression garments, other than recommending a couple different bras. I think because he doesn't expect to do a lot of lipo on me, that shouldn't be too much of an issue for me. Thanks for the info!


    Hi AmusingSoprano! Thanks for the tip, I was able to find a couple journal articles about it from the last couple of years. They have found fat grafting seems to help some people with nerve pain especially. I guess gives it a cushion or sorts? I'll look for more info in regard to that specifically, I was mostly looking for info about scar revision online before. Thanks very much!

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  • BCGirl1
    BCGirl1 Member Posts: 9
    edited July 2017

    I finished radiation 3 years ago and wanted my breast reconstructed in some way after my lumpectomy and radiation but the surgeon here will not do anything. He says radiated breasts do not heal well because the tissue is dead and the blood flow is not best as well as the radiated skin is a risk factor for slow healing and infections. He said If he injects fat it may not take. I was sad and disappointment that after all this nothing can be done. I have seen him twice now and he still says no to any procedures. I have to live with what I have now after being promised the option of cosmetic surgery by my oncologist and other women who say it is our right after what we have been through. I'd like to get a second opinion and it is a 2 year wait to see anyone.

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  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited July 2017

    BCGirl - by all means - you need a second opinion. I don't understand why it is a two year wait to go see another plastic surgeon. Even if you have to drive some, I'd make an appointment. Maybe the plans are different if you're not in the US?

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  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited July 2017

    HopefulJenn - Has your surgeon discussed treatment with Trental and Vit. E? This is quite commonly used for radiation fibrosis and may help in your situation. I've been using it for a number of months without any side effects whatsoever and it has definitely helped both soften the sore spots inside the treated breast and has had a pronounced effect on the pain and soreness. I'll go on using it for at least a couple of months longer to see if I can get rid of the last, lingering effects of sx. and radiation.

    It's a lot easier (in my opinion) than surgery and much less expensive, too. It can take a while to get results but that's about the worst you can say about it. In my case, I started feeling results pretty quickly.

    Good luck with any and all tx.

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  • BCGirl1
    BCGirl1 Member Posts: 9
    edited July 2017

    We have a doctor shortage here. I was lucky to get in here in less then 2 years but the other bigger city closer to me is a little longer wait then here I heard. I don't think the surgeons here have enough experience with my type of issue. Most people who I know that had breast cancer have had mastectomy's or are older. He even down played it and said to me that he has seen worse then what I have and people just live with it. I get that there are worse however every breast cancer survivor is entitled to have cosmetic surgery after surviving breast cancer if they so choice, it is a right that we have which is covered medically. I am young and want to do as much as I can to fix my breasts up again. My clothes will fit better too.

    What gets me is every time I am in the surgeons office there is always some young girl there who has nothign wrong with her and she just wants bigger breasts and gets them and yet someone like me who had an illness (out of my control) that wrecked my breasts can not get any help. How frustrating.

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  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited July 2017

    BCGirl - you didn't say if you are in the US, in which case, YES your reconstruction should be covered if the initial problem was caused by breast cancer. What city are you in? There is a lady on the boards who has kept a list of really good surgeons in every state.

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  • HopefulJenn
    HopefulJenn Member Posts: 34
    edited July 2017

    Hi Hopeful82014,

    No, I've never heard of that before. I'll definitely look into that. I'm very glad you're getting relief from the treatment you're on! Thanks for the info!

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  • HopefulJenn
    HopefulJenn Member Posts: 34
    edited July 2017

    Hi BCGirl1,

    I'm very sorry to hear you've been having so much trouble with healthcare. I assume you're in BC? I'm in Alberta and was lucky, I had to ask for a referral from my family doctor back to my general surgeon (who did my lumpectomy), saw my general surgeon within 2 months I think, then he referred me to a plastic surgeon who has done reconstructions after both mastectomies and lumpectomies. I had an appointment with him within 3 months. And, at this point, if I wanted a second opinion, I would go back to my general surgeon and he would refer me to someone else. That would probably take another couple of months, of course, but it is absolutely my right to get multiple opinions. I have heard things are backed up in BC health care but I agree, it doesn't make sense that someone have elective cosmetic surgery is getting in ahead of someone requesting breast reconstruction. I don't know which city you're closest to but I did find this website:

    http://breastreconstruction.vch.ca/

    They look like they're based out of the lower Mainland and look like they may have some good resources. I know it says it's for reconstruction after a mastectomy but they may be able to at least give you some information. I have found through all this it never hurts to pick up a phone and ask some people some questions. Most of the time they're very happy to help or direct you to someone who can. They also have a FAQs page on the website that says:

    "What is the cost of breast reconstruction?

    The Medical Services Plan (MSP) covers breast reconstruction including the first and second stage surgical procedures, hospital stay, and follow-up treatment for women with breast cancer. Balancing surgery on the opposite breast to match the size and shape of the breasts is also typically covered by MSP."

    My understanding is that that is very similar to the coverage in Alberta, essentially they will cover what is medically necessary to help you achieve symmetry.

    The plastic surgeon I saw did mention that my general surgical risks are increased due to the skin being radiated but not significantly so. My skin is still supple and seems fairly healthy so I'm sure that would factor into his thinking.

    And, honestly, just from what that surgeon told you (that he's seen worse and people just live with it), I would request a new referral. That is a load of BS if I've ever heard it! Everyone is different, everyone is a special case and we should all be treated as such, not dismissed and told to live with it. I've told my Mom when she's struggled with her doctor to be her normal, polite, Canadian self, but to bug the hell out of them! Keep on asking questions and get on every cancellation list you can.

    Wow, sorry for the long post! I hope it was some help and I hope you're able to get the information and help you need! Keep us updated on how things go!

    Gentle hugs and best wishes!

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  • Wildflower2015
    Wildflower2015 Member Posts: 279
    edited July 2017

    HopefulJenn,

    My treatment time frame was similar to yours - lumpectomy a couple years ago followed by chemo and radiation. I also had really hard scar tissue that formed along the incision site.

    I had my first fat grafting done about a year following the lumpectomy. I was told at the outset that it might take 2 fat grafting procedures to get the best results; in my case the first one kind of set the stage for success for the second one. I just had my second fat grafting done about 6 weeks ago and I'm very happy with the outcome! The plastic surgeon said I had a lot of internal scarring from the lumpectomy and he actually used ultrasound to help break up some of the scar tissue during the second surgery. I had some pain and hardness at the scar site which diminished after the first fat grafting. After the second one, I don't have any pain and the scar tissue is much more softer and flexible, plus the shape of the breast is much more natural. I consider the two surgeries absolutely worth it!

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  • TarheelMichelle
    TarheelMichelle Member Posts: 871
    edited July 2017

    In my experience, surgeons who primarily do cancer surgeries have very little knowledge about fat grafting. I went two states away to see a plastic surgeon who specializes in cosmetic surgery. He had much more experience in fat grafting. He averaged 2-3 fat grafts a day. He understood my fragile ego and my desire simply to have symmetry. In smaller towns, women who have lumpectomies are having them done by general surgeons, not breast specialists. If you find a fat-grafting specialist, you have a better chance of a perfect outcome. The American Cancer Society helped me find a hotel to stay in after my surgery and I only had to pay $12 a night. My plastic surgeon also removed some skin mets under my arm, at the same time, leaving a barely detectable scar. I'm so happy with my fat grafting and I waited 6 years to do it. It's never too late; insurance still covered it. (And ye, the lipo area is pretty sore for a couple of days!)

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  • HopefulJenn
    HopefulJenn Member Posts: 34
    edited July 2017

    Hi Wildflower2015,

    Your situation does sound very similar to mine. Thanks very much for telling me how your experience has gone, I'm glad you're happy with your results It's wonderful to hear of success stories!

    Take care and all the best!

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  • HopefulJenn
    HopefulJenn Member Posts: 34
    edited July 2017

    Hi TarheelMichelle!

    I agree, it is definitely better to get someone who specialises as opposed someone with very little experience. I live in a smaller town but was sent to a larger center for my original lumpectomy. My surgeon is a general surgeon but all he does is breast cancer cases. The plastic surgeon I saw was highly recommended by my original surgeon and, while he doesn't specialise in fat grafting, the majority of his practice is made up of reconstruction cases.

    I'm very happy to hear you're so pleased with your results from your fat grafting! I agree, it's never too late to decide to get scars fixed. And, yes, if I decided to wait 20 years, insurance would still cover it, which is pretty cool. I have heard that the lipo site is pretty sore for a while but I'm thinking if it gets me the results I am looking for, I could definitely put up with some more pain for a while.

    Thanks very much for the info, I appreciate it!

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