BIG difference between augmentation and reconstruction. I really don't think that you can compare them at all.

Have you asked your PS about fat grafting? How often do they do that? Do they think they can harvest enough fat if needed?

I had prepectoral reconstruction. I have not had any fat grafting. My PS would love to do it, but I'm hesitant. It's another surgery and I worry if I'll be happy with the donor area as well as the breast area.

Soon after the swelling from the surgery went down, I was worried about the rippling. Now - I don't notice much at all. I was able to save my skin and nipples and my scars have faded so everything actually looks pretty good.

Hi ComeOn2019. I have a Prepectoral Thread, come on over and post. Several women used to be on the thread who were quite slim and athletic.

Topic: TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

https://community.breastcancer.org/forum/44/topics/835911?page=58#idx_1718

Unless you are extremely emaciated, there is fat. My BMI was 19 and I had two generous rounds of fat grafting. 

I had reconstruction (prepectoral gummy bear implants with alloderm) with fat grafting and my surgeon was laughing about how little fat I had to give. She said, "I want you to show me where you have an ounce of fat for me to use." I showed her a roll of skin on my belly and she said, "Yeah, let me see your thighs." She even told em to eat as much as possible in the two weeks before surgery. I'm a hair under 5'4" and weigh about 100 pounds if that gives you an idea. Ultimately, they took what tiny bit I had in my belly and a little from my inner thighs. She said we might need to do a second round down the road but I'm thinking I might not bother. I will tell you that the sites where they did the liposuction for the fat grafting are still sore a month later. Not terribly but I can feel it. For the first couple of weeks it hurt to sit on anything hard because of my thighs and the puncture site in my belly button really hurt. But it's all getting better and I'm glad to be done.

I have prepecs andhave not had fat grafting. I am pretty small - 5’5 and currently about 105. I know my PS was generous with the alloderm as he thought getting any fat for a revision would be difficult. I struggled to keep my BMI above 17 during chemo. I have small implants that are the same size as my real breasts were and I don’t really notice any ripples. I had skin/nipple sparing if that matters. These decision should are never easy

Come on, I honestly don't know! I would guess if I ran around all the time with no bra that over time I would see changes over the years. I am pre pec. Maybe others that have had their implants in for years will chime in and let us know.

Hapa, i agree I'm sure most have enough for fat grafting. I do believe the recovery would vary depending on how thin the person is and where they were able to get the fat from. My PS did not hit my lower belly at all. He chooses to leave it for plan B down the road if there are implant issues. Practices certainly vary from PS to PS

Trmtab -Mine is a C cup. But I have such a small frame that it was only a 400 cc implant to make me a C.

Bra sizes are weird. I went from a 36B (probably should have been a 34C) to now a 32DDD or 32E, depending on brand. Most of the size increase is in the diameter of the implant and not the projection.

And I wanted to stay about the same ...

you can not compare recon with augmentation.

I have pre-pec and also didn’t do fat grafting since there wasn’t a lot to give. I see some rippling but it’s not very obvious. For now I’m not planning to do it

Comeon2019, I don't think you need to worry about enough fat to cover the entire implant unless that is what you are seeking. Typically, they only graft fat around the edges and upper pole to soften the look. Before my fg, my implants jutted out abruptly from my chest and I was self concious of it. FG last November, about 30cc per side really helped it look more natural. I am one though that DOES want fat over the entire implant to make them feel warm and softer. Was in the midst of a staged revision to remove my implants and put smaller ones in and fill the difference with fat but my ps stopped par with my insurance. I am in revision limbo for now but I have a consult coming up Oct 3.

Trmtab, we are of similar build. I am 5' 71/2" and was a 38DD before msx, my current pre-pec 440 Sientra smooth rounds give me about a 38D.

On the subject of gaining weight for fg, I am confused. My old ps advised me to gain or at least not to lose any before my fg. But I have been researching like crazy and read somewhere that you should go in for fg at your normal weight. Reason being if you gain just for fg, and don't maintain that weight, once you go back to your normal weight the fat shrinks and you're back to square one. Sorry I don't have the link to where I read that but it does make sense to me. I found this thread while searching for threads on revision. Wishing you all the best!!

Your regular body weight is exactly right. I just had this conversation with my plastic surgeon . The number of fat cells you have is number of fat cells you have... so it doesn't take much figuring out to understand that the best weight to do this at is whatever your normal weight is.