Fat Grafting after BMX with direct-to-implant reconstruction

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Vermonster
Vermonster Member Posts: 44
edited September 2018 in Breast Reconstruction

I am 7 weeks out from BMX with DTI reconstruction (teardrop shape gummies) and my plastic surgeon has recommended fat-grafting at the end of this year to fill in the hollow area above the implant below my collarbones. I can't find any discussions or threads from anyone that has had similar surgery (what I can find is about fat grafting done at time of TE exchange). Anyone have fat-grafting as a "stand-alone" procedure willing to share what it was like, what type of anesthesia (so I can compare), how much pain in donor area and grafted site, how was recovery? You know, all the firsthand stuff that you forget to ask... Thank you!!

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  • DebAL
    DebAL Member Posts: 877
    edited September 2018

    hi vermonster. I did have fat grafting at time of exchange 4 weeks ago. I knew from the start I may need a second round so I am schedule for just fat grafting in December. I expect it to be no different except no exchange incisions and arm restrictions. First time fat was taken from belly and I wont lie I was more sore from that part of the surgery. Belly super bruised and very sore. Wearing compression garments/ spanx helps. If we go forward in Dec I believe its inner thigh next time. I'm relatively thin and he warned it would be tough to get what he needed. Very happy with the outcome so far. Best wishes to you!

  • Vermonster
    Vermonster Member Posts: 44
    edited September 2018

    Thank you DebAl - I have one more visit with the PS between now and when the grafting is scheduled and so I'll have that opportunity to ask more questions - when I got home yesterday and looked at the paperwork it says "General Anesthesia" and I guess I hadn't realized it would be GA, which kind of worries me for something that is cosmetic only for a "hollow" that I don't even know yet if it bothers me and I've heard that not all grafted fat "sticks" and I worry about "what if it makes it uneven" ... would welcome anyone else chiming in with their experience...

  • SpecialK
    SpecialK Member Posts: 16,486
    edited September 2018

    I had a stand alone fat graft procedure a year after exchange to add fullness to the upper pole. I have a bony chest and had an abrupt step off that needed some softening. I retained the fat very well and it was a great decision. I did have GA, and I think many do as lipo is a pretty aggressive process. My abdomen was used as the donor site, and was sore and bruised - it felt like I had done 1,000 sit ups, but was only sore when I moved - no pain when at rest, and not enough pain to require any medication. I wore compression (tight Spanx) for 8 weeks and could not exercise other than walking. I would do it again in a heartbeat.

  • DebAL
    DebAL Member Posts: 877
    edited September 2018

    I'm sure its general in the sense you are "out" which you would want to be! The PA in the office said up to 50% of the fat can be reabsorbed into the vascular system and that is why a second graft may be needed. Like you said it is a choice too. I just got 2nd surgery on the books for end of the year for insurance reasons. He said it's enough time in between so the timing worked out. I didn't have a alot of bruising till later around the breast area but belly was pretty bad. I can technically lose the spanx today ..4 weeks out... but they give support when I'm up. I had a suture above each nipple, 3 lower and 1 upper belly and they were removed at 10 days. I ate a lot of pineapple to help with bruising! I will check back to hear how your appt went!

  • VegGal
    VegGal Member Posts: 507
    edited September 2018

    I had stand alone grafting last December. You would want GA!  I also kept the fat and after about 3 days felt pretty good. I've had harvesting from inner/outer thighs, hips and belly. 

    During recovery I made sure to keep things nice and warm, kind of like the DIEP ladies do. Whether that helped or not I'm not sure, but it did feel comforting. 

  • NotVeryBrave
    NotVeryBrave Member Posts: 1,287
    edited September 2018

    I have not had any fat grafting. My PS has seemed pretty pro grafting - as he says, to "make things pretty" and basically finish the process. According to him, something like 2/3 of his patients have it done and about 1/3 of those need a second round.

    I've been hesitant for many of your same concerns - more surgery with risks, more anesthesia, possible worse outcome, etc. We've also been watching this weird lump that is under the areola on the cancer side and originally thought to be fat necrosis but has changed with palpation and not seen on imaging. My BS would prefer no fat grafting for at least a couple of years - so as to not worry about more possible lumps and bumps.

    Interestingly - I noticed more of a step off and more rippling earlier in this process. I'm not sure if it's really improved or I've just gotten used to it! At this point - it's not concerning enough to me to bother with fixing it. Maybe down the road if everything else in life is calm! Perhaps in conjunction with changing implants or something. IDK.


  • mountainmama406
    mountainmama406 Member Posts: 99
    edited September 2018

    I did BMX DTI in feb, also teardrop shaped. Did a first round of fat grafting in May. Scheduled for another next month. Per my PS there’s not much to graft to the first time around so not is much was done, but still noticeable. Did see some reabsorb but happy that I took the extra step in reconstruction process. PS never pressured to do it and has been very helpful with getting it all scheduled in the same year.

    Donor site the first time was from my stomach. It’s VERY sore after. Nearly 2 weeks before moving didn’t feel tender, bruising lingered a little longer. Lived in my sweat pants/jeans were too tight and not a comfortable option. Seeing results from that area (bc yay getting rid of some stubborn belly fat!) wasn’t immediate as it needs to heal but I could tell later that there’s a difference. Compared to BMX, the grafted area was a cake walk with recovery.

    Going into surgery was weirdly calming for me. It was my third (had biopsy done surgically, then bmx). It was good to feel restored rather than destroyed being there. A lot of my nurses/anesthesiologist were repeat, it was all just less stress.

  • Vermonster
    Vermonster Member Posts: 44
    edited September 2018

    Thank you all for responding - as is often the case, now I have more questions!! What about the donor site - I know it'll be sore & bruised for a while - but how does that area look after (smooth, lumpy, uneven, can you tell something got removed???) Due to the timing in my case, I don't think there's a chance they could squeeze in a second fat-grafting procedure this calendar year (bmx was 7/16, 1st fat grafting will be early December if I go ahead with it) - anyone know how far apart they have to plan to do the grafting to see if it "worked"??? I guess I'm glad it's not super hot summer any more - it would add insult to injury to have to wear spanx in the heat we just had (compression bra was bad enough)! anyway, thank you for responding and for letting me bug you all for more info!

  • mountainmama406
    mountainmama406 Member Posts: 99
    edited September 2018

    3 months between each thing is what my PS recommended. Had it not been so busy this summer for us I would have done second time in Aug rather than Oct.

    unfortunately you don’t get as much as you might like removed during liposuction. My PS took as much as he could without it being considered the primary reason for doing it 🤣 because I know what area it was taken from I can tell, but no one else would notice, I wore a bikini all summer without any fear that I had an uneven belly area. A good PS isn’t gonna leave you looking lumpy ;) I didn’t wear any type of compression other than my workout leggings

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