Fat grafting-- enough liposuction to make a difference?

Every situation is different, but I should qualify that my five fat grafts were done for a variety of reasons and I retained almost all fat every time. My initial and largest graft was to soften the upper poles a year after exchange. I had implants that were relatively large for my frame and had a “coconut under the skin" look - I looked significantly more natural after that graft. That surgery was more than six years ago and that fat remains. I subsequently lost my left implant a couple of years later after a repair to my allograft, which was perforating. I had two grafts, about six months apart, to the left flat side to improve the skin integrity, so I could have a new expander placed. My last two grafts were at the time of exchange when the new left expander was swapped, with the last one done about six months later to improve shape. I've been very happy with each fat graft, they have made all the difference with my very complex reconstruction. I know others have not been as fortunate with fat retention - it can be frustrating.

CBK - the 15 surgeries were in addition to the BMX and ALND surgeries, and spanned six years. None of my surgeries have been for improvement of the way things look aesthetically, aside from the first fat graft. I have been unlucky to have abnormally thin pectoral muscles, and due to the thoroughness of my mastectomies, also very thin skin with virtually nothing between the skin and thin muscle. My surgeries have been for removal, and later replacement of my initial left expander, multiple skin tears and repairs, loss of implant due to failure to heal, and 18 months later a new expander to implant with downsize bi-laterally due to loss of skin. At the time of my first surgery in 2010 surgeons were not doing pre-pec placement, only sub-pec. Pre-pec has regained popularity lately (it is actually the way recon was done years ago) because of the complaints about the distortion and animation, and pain from sub-pec placement. Pre-pec is not an option for me due tothe skin issues I have had and because allograft doesn't incorporate as well for me as an individual - it would be disastrous for me. At this point, due to the extensive tears/repairs, I'm long past the way my recon looks - but I totally get how important it is. I pursued the final attempt at reconstruction because I was uncomfortable with wearing a prosthetic and wanted to look normal in clothes. My last surgery was in late 2016, things have been quiet since then and I hope they stay that way, lol! I wish you the best, and will keep my fingers crossed for continued pleasing results for you!

hapa - that may be one reason I’ve retained fat as well as I have, I am slender, particularly upper body. My docs (two different plastic surgeons) have been careful in their selection of lipo donor location and have avoided thighs because there is a greater possibility of creating a new problem using that site. There are people here on BCO who have successfully used thighs, and they have been happy with the result. It’s pretty individualized and it is good to have an experienced PS.The lower addomen and hip area is more forgiving. I highly recommend wearing compression on the donor site, I wore it for 8 weeks - the lipo cannula creates tunnels when harvesting fat and those can fill with fluid if not compressed. The fluid can harden or create a seroma. My first PS also restricted the gym for 4 weeks, second one did as well but not as long. Both allowed as much walking as desired though.

cbk - I have actually been pretty pragmatic about all of this surgery, I was able to compartmentalize it and separate it from the cancer diagnosis as a separate issue, and I’m not an overly emotional personality. I was mostly frustrated. I think one of the hard things for cancer patients is a lack of experience with illness or surgery prior to diagnosis. I had some previous experience with surgery over the course of my life, and actually had an initially very scary tumor removed from my right calf at an NCI center 18 months before breast cancer. It was thankfully benign, but it helped frame my breast cancer experience. I feel like I was just unlucky, my docs were dealing with a situation that was partly circumstance and partly Murphy’s Law. I’m also a complicated patient - allergic to adhesive and most antibiotics - that means custom hypoallergenic dressings and they even have to swap out the irrigant used in the operating room. I’m actually allergic to the detergent used on the linens in pre-op. It’s ridiculous, lol I changed doctors after the first eleven surgeries because I felt my first surgeon was leaning strongly toward a lat flap and I didn’t feel I could do that because of extensive skin cancer on my upper back, but not because I wasn’t confident in his surgical skills. My current PS has been great and is meticulous and picked up where the previous doc left off. Thanks for your good wishes - I’m hanging in and doing fine! Hope all goes smoothly for you from here on out as well!