Delayed recon after rads - fat grafting first?

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beeline
beeline Member Posts: 308
edited March 2020 in Breast Reconstruction

Hi, it's been a while since I've been here regularly, but I'm hoping someone has some experience or insight they can share. I am just about a year post-treatment (UMX, chemo, rads, the whole shebang) and looking into delayed recon. I am not a candidate for DIEP or anything abdominal, and not interested at this point in GAP procedures (which I would have to travel internationally for). I would ideally just do implants but it is complicated by having rads.

My question is this -- the PS says he can start with fat grafting which can help the radiated tissues heal enough to enable enough stretching for a small implant. Has anyone had this done? What were your results like? How was the recovery? I am also trying to imagine how it is going to look with some weird blob of fat injected into my currently very flat chest.... any input appreciated!


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  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited February 2020

    beeline - there are a couple of threads that discuss fat grafting. Probably under 'reconstruction' or maybe even better to use the search section. I think Whippetmom created one of them. You can always post a question for her at Breast Recon 101

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  • beeline
    beeline Member Posts: 308
    edited February 2020

    Thanks MinusTwo! I did a search but mostly turned up fat grafting as a second stage or for revisions. Will try again and also ask Whippetmom!


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  • M_and_G
    M_and_G Member Posts: 10
    edited February 2020

    Hello Beeline,

    My PS at MD Anderson recommends fat grafting a few weeks post radiation to help the skin heal for exchange surgery. I am currently doing radiation so cannot comment on the cosmetic aspect at this time.

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  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited February 2020

    Wish I could be more useful. I know there were some good threads about fat grafting after rads, but it wasn't something that related to me so my brain didn't save the data. If I recall there were some docs that said pooh-pooh, and others who were having great success.

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  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited February 2020

    Beeline - here's the thread I was thinking about.

    https://community.breastcancer.org/forum/70/topics...

    I searched 'fat grafting' with just Whippetmom's name


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  • beeline
    beeline Member Posts: 308
    edited February 2020

    Thanks MinusTwo! Great link, but your replies were useful to me even without it :)

    M_and_G - thanks for weighing in. It's god to know MD Anderson recommends it. Good luck with radiation, hope it's not too tough on you!


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  • SpecialK
    SpecialK Member Posts: 16,486
    edited February 2020

    beeline - I did not have rads but did have fat grafting done as if it was being used to improve radiated skin. I had necrotic skin bi-laterally after BMX and after several skin repair surgeries I lost my expander, which remained out for the 7 months of chemo. I was able to have a new expander, fill slowly, and successfully exchanged to implants. After two years my allograft material started to perforate and during the repair surgery my skin shredded so the implant was eventually removed, again after multiple skin repair surgeries. My PS suggested fat grafting to the flat side to improve vascularity and skin integrity, so I could try a new expander again. I had three grafts done, small amounts several months apart - no lumps, but rather a softness, and it made all the difference! Afterward I was able to proceed with recon again and have had no issues since. It is worth discussing with your PS, and I would encourage asking questions about methodology and results in other patients.

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  • Cpeachymom
    Cpeachymom Member Posts: 518
    edited February 2020

    beeline- I did delayed recon about a year after rads. I actually requested FG before to soften the skin first, but was told no by my ps. (Turns out this was the right call for the wrong reason) Expansion was brutal towards the end, skin just wouldn’t stretch! Skin held up well, had FG with my exchange surgery, and he was barely able to get 30ccs. I don’t have any for a second round of FG. I stayed small, about a b cup. The rads side is high & tight, but not painful or uncomfortable, just sits higher than my natural side. Can’t really notice in a good bra. I have prepectoral with alloderm, Ideal brand saline.

    Hope this helps!


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  • beeline
    beeline Member Posts: 308
    edited February 2020

    Thanks SpecialK and Cpeachymom!

    SpecialK, wow, you really went through the wringer! Thank you so much for sharing your story. I'm so glad the fat grafting worked in the end -- kind of amazing, really! That gives me hope it will work for me, too.

    Cpeachy - your response on the "itty bitty" thread made me think it might be possible to do implants after rads. I am also looking to return to my former glory of a B cup :) Everything else I have read and been told said no, so thank you again! Can I ask why no FG up front was the right call?

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  • Cpeachymom
    Cpeachymom Member Posts: 518
    edited February 2020

    My PS originally said no because “there wasn’t a pocket yet to put it in” or some bs like that. That just injecting it under the skin would just have it floating around or something. But if he had agreed, there would have been nothing left to cushion the implant with. He told me he’d never worked so hard for so little fat, and another round of FG wasn’t gonna happen unless I gain some weight. BUT, that’s mostly because he only wanted to harvest from my abdomen since it was already wrinkly from having kids. He might’ve been able to get some from my thighs and butt if needed, I think. ?

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  • beeline
    beeline Member Posts: 308
    edited February 2020

    Thanks Cpeachy -- sounds like we may be built similarly!

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  • RimRoc
    RimRoc Member Posts: 32
    edited February 2020

    I'm in Sarasota FL and have had one PS tell me 'no-way to do an implant' on my side that received partial breast radiation 6 years ago (and is now post-mastectomy flat). -- the rate of complications is something like 60%.

    A different PS said it can be done, just will take longer because the filing has to be very slow, like 30cc/week. She also wants to do a fat grafting either before or after to add a layer of cushioning over the pocket for the implant. Plus she would have to modify my non-mastectomy side because there is no other way to get symmetric. So she's talking about four surgeries over the course of a year.

    it's good to hear it "can" be done...but I'm really unsure if I want to subject myself to four different surgeries. I'm now 68 and in good health but I'm a hesitant to start on such a big production. At the same time, I'm really tired of being flat on one side and am much more bothered by it than I anticipated when I had the mastectomy done. So I'm really perplexed.

    Any thoughts for women who have chosen to go through delayed reconstruction???

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  • beeline
    beeline Member Posts: 308
    edited March 2020

    Hi RimRoc, I can relate! I have decided to go for delayed recon, though if you had told me after my mastectomy that I would voluntarily agree to 3-4 more surgeries, I'd have said you must be joking!! Like you, I am also much more bothered by being half flat that I imagined I would be. Though I also thought I'd be able to wear a prosthetic which it turns out is too uncomfortable after ALND, rads, etc. I really don't mind at home, but it makes me feel very vulnerable out in the world somehow.

    The way I look at it is that fat grafting as a first step is pretty low stakes so I can always pull the plug after that. I am pretty sure I'll go through with all of it, but who knows. I am only 43 and planning to be around for a long time. I'd rather not spend all that time hating being flat. Good luck with your decision!


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  • Sunshine-Lady
    Sunshine-Lady Member Posts: 8
    edited March 2020

    Beeline,

    I did have fat grafting, just not for the same purpose. I had an infection on my non-cancer, non-radiated side. I was prepped for possibly doing it twice to rebuild the tissue enough to attempt the tissue expander again. However only needed one round, which was great news. I had 60cc’s inserted and opted for inner thighs as a donation site. Although some is absorbed I’d say 50-60% stayed. And it worked- as a result I had a successful tissue expansion process. So one FG session isn’t enough to look like you have a real boob. It really just gave me a bit more than needed to get rid of the concaveness I had. I think men can use it alone to rebuild, but it’s not enough for a woman.

    I have a desk job and took three days off work before the weekend. So 5 days before returning to work. For me the donation site was really sore- really sore! When I went back to work I was still in pain although not intolerable or requiring anything other than Tylenol or IBUPROFEN. The location was not ideal for sitting all day and my skin on my upper legs is still a little loose from the removal of the fat. But I wanted to conserve the tummy fat in case I had to abandon the implants and do a DIEP.

    Also for recovery I had to wear Spanx for 3 weeks afterwards (except in the shower). It helps the donation site look better afterwards. But ugh,that got pretty old.

    I hope you are able to get the information you need to make the right decision for you.

    I should also mention that almost a year later, I’m really pleased to have that fat taken out of my thighs. That was a very nice cosmetic consequence 😁

    Love,

    Sunshine-lady

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  • beeline
    beeline Member Posts: 308
    edited March 2020

    Hi Sunshine-lady, thanks for sharing! So glad you had a positive experience! It is really helpful to know the likely aesthetic outcome of fat grafting. I am also hoping for a side benefit of less thigh fat :D


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