Fat Grafting BEFORE TE’s

My story is long and complex, but the short version is BMX with TE with dermal matrix, loss of left (non-cancer) TE after multiple surgical tries to save it due to necrotic skin. Chemo, then TE replaced. Did not need rads, but skin is similar - fragile and thin. Slow fills, then successful exchange. One aesthetic fat graft to add fullness in the upper poles. Failure of dermal matrix (very unusual) and injury to skin of left side during repair surgery, more surgical tries to save implant, but ultimately it was removed. Flat on left for 18 months, but had two fat grafts to improve the integrity and vascularity of skin during that time. Successful TE placement, slow fills, successful exchange to smaller implants bi-laterally. I really feel that those two fat grafts to the flat side prior to trying the TE again were what made the difference! Totally worth a try if your PS thinks the skin may be improved by this process prior to trying a TE again. I know how frustrating this is and I wish you the best!

Reconstruction problems can be frustrating for sure, but hang in there! The thought on fat grafting for this purpose is that there should be separation between graftings of at least 90 days. This is due to wanting to leave the grafted area alone and undisturbed so the newly grafted fat can establish a good vascular supply and chance to remain. I ended up with six months between grafts because I switched plastic surgeons also. Here is a link to some info - doesn’t apply directly because this is your non-radiated side, but there is some useful info.

https://community.breastcancer.org/forum/70/topics/744891?page=7#post_5209248

Hello - I did not need radiation so the condition of my skin was not quite the same as if radiated, but the problems were very similar. I started with typical recon, tissue expander placed under the pectoral muscle with a surgical fill taut enough to occupy the skin flap, but not so taut that the vascularity was impaired. I have unusually thin pectoral muscles and thin skin, my mastectomies were very, very thorough. This is a recipe for skin necrosis and this is what did occur. I had areas of necrotic and dead, black and scabbed skin over the front of both reconstructed breasts. Fast forward to the grafts - it was the opinion that additional grafts, beyond the two six months apart, would not improve the skin integrity so we might as well try to place an expander. Fortunately everything after that went very smoothly. Dermal matrix is mandatory for me, my muscle (now largely absent) and skin are not strong enough to support an implant. My skin looks ok, but my left side is a bit of a road map after so much surgery, I have a lot of scarring from the necrotic areas.

You are welcome, and yes it can! I think that probably many would have given up had they been in my shoes, but after the two time periods of half-flatness (7 months without TE during chemo, then 18 months without implant from removal two years later) I knew I wanted reconstruction. I was about out of options with an implant and looking at a flap, which I really didn't want due to the concern that I would introduce a new wound healing issue at another location on my body or on the breast, but making a switch to a new surgeon was the key to success. While what I have now is far from perfect, it is enough for me. I look fine in clothing and I wear modest workout gear and bathing suits - I am content and pleased, very happy that I was able to persevere. I think when one has had challenges with recon it is important to manage expectations about what is possible and probable, and really consider what will make you feel whole, and what you are willing to endure to achieve that. I have hope that fat-grafting will be the key to success for your daughter as well, it was the best thing for me. I will say that the grafting is relatively easy in terms of difficulty of the procedure - the smaller grafts are different from aesthetic grafts in that far less fat is harvested and the process is shorter. The hardest part for me was indeed the length of time to be flat. The expander that was placed after the grafts was able to be filled a little more rapidly than my first expander, and it was in place, fully filled, for a relatively short period of time before exchange. You are so sweet to ask about this process for your daughter, I wish her the best as she goes through this. If you have any questions don't hesitate to ask, or PM me - I fortunately happened upon this thread again and saw your query!