We are 144,967 members in 73 forums discussing 114,787 topics.

Help with Abbreviations

All TopicsForum: Breast Reconstruction → Topic: Fat Necrosis after DIEP

Topic: Fat Necrosis after DIEP

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

Posted on: May 12, 2010 06:19AM

dah0123 wrote:

Hi all,

I had Stage 1 Delayed Bilateral DIEP on 3/8.  Stage 2 is scheduled for 6/10.  Anyway, here is my question . . . I have 2 areas at the top of each breast (toward the center) that are hard and sore.  I know it is fat necrosis.  I assume that they will take these areas out during Stage 2 and try to fill the areas with fat from lipo.  But I am concerned since these areas are rather large that they won't be able to fill in enough w/lipo to get a permanent and symmetrical result.  Has anyone else had fat necrosis and if yes, what did they do about it?  Did it have a negative impact on the overall result or where they able to "fix" it?   Thanks!!!

Log in to post a reply

Page 1 of 2 (34 results)

Posts 1 - 30 (34 total)

Log in to post a reply

May 12, 2010 10:25AM ck55 wrote:

I would love to hear a reply to this as well. I had a unilateral delayed DIEP last October which partially failed and have some hard areas of what I assume to be fat necrosis under my new foob. I don't want to lose any more of the tissue ( it is already a bit smaller than the natural breast) but I  wonder what can be done about these areas? Anyone out there with this experience?

 Cyndi

DX 11/9/06 9cm ILC Stage 3A Mastectomy ER+ PR+ HR- 2/16 Nodes DD AC/Taxol Radiation

Log in to post a reply

May 12, 2010 10:45AM Dejaboo wrote:

I Just bumped up a Thread Called Does Massage Really Work for Fat Necrosis.

Dx 3/7/2008,DCIS, IDC-1.2mm, Stage tIA, Grade 1, 0/1 nodes, ER+/PR-,HER2+,Lump/SNB-4/1/08, Bilat 5/22/08, EX 9/22/08, PFO & ASA heart Closure 12/29/08, 7/09-RAVH, 11/09-NOLA-SGAP-to fix Symmastia! Stage2 4/2010, Stage2B 11/2010, Truncal & Arm LE

Log in to post a reply

May 12, 2010 10:48AM dah0123 wrote:

Thanks Dejaboo.  Massage has not worked for me.  And I really don't understand how it would (?) since if the tissue is dead, I wouldn't expect that it would be able to "come back to life"?  If it has worked for some, I'd sure like to know it!  Assuming it doesn't though (like I said, it hasn't for me), what does or can the PS do???

Dx 10/10/1994, IDC, 1cm, Stage I, Grade 3, 0/11 nodes, ER-/PR-
Log in to post a reply

May 12, 2010 01:51PM robink wrote:

In my case massage seemed to make the breast swell, become more tender and eventually harder.  May 6 the entire dead flap was removed (with great difficulty) and an implant inserted.

Robin K.

Dx 2/7/2008, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR-, HER2-
Log in to post a reply

May 12, 2010 03:27PM neversurrender wrote:

dah0123,

Has your PS actually told you it is fat necrosis?  My diep was done on January 25, I had one hard spot on my rt breast until mid-April.  My PS told me all along it was not necrosis, but swelling and that once the swelling was gone, the hard spot would be gone.  He was right.  At just under 3 months, the hard spot went away. 

Sally dx Nov 12@40yrs DCIS,grade 3.stage 0. 0/7nodes. bmx 1-25-10 with diep recon.

Log in to post a reply

May 13, 2010 01:37AM dah0123 wrote:

Robink,

That is so depressing . . . I'm so sorry for you.

Neversurrender,

I actually said to my PS that I thought it was fat necrosis and he felt it and didn't correct me.  He told me to massage the areas.  He said the areas "weren't that big" but I beg to differ.  On my left breast I would say it is a 1.5" x 3" area and on my right (which is smaller to begin with), it is a good 3" x 2.5".  How big was your hard spot?  There was a lot of swelling and bruising in these areas right after surgery but I am 9 weeks out now and there doesn't seem to be any swelling in the traditional sense.  These hard areas didn't seem to be there right away --- I just noticed them after about 2 weeks or so.  Maybe I just didn't notice right away, not sure.  But I am concerned that this is a flap failure . . . I wonder if they count this when they say less than 1% failure?  And I wonder how common this is?  I'd love to know how big your "hard spot" was . . .

Dx 10/10/1994, IDC, 1cm, Stage I, Grade 3, 0/11 nodes, ER-/PR-
Log in to post a reply

May 13, 2010 01:46AM NancyD wrote:

I actually had fat necrosis, before my delayed DIEP, from the radiation treatment. During my DIEP recon, my PS removed as much as he could. What he left, which is on the lower, outer side has softened a bit since my DIEP in January. I thought small areas of fat necrosis could be broken up and absorbed by our bodies...no?

I'm not a complete idiot. Some parts are missing.

Dx 2/22/2008, IDC, Stage IIIa, Grade 2, 4/10 nodes, ER+/PR+, HER2-Chemotherapy 03/22/2008 Adriamycin, Cytoxan, Taxotere
Log in to post a reply

May 13, 2010 09:52AM jeskachi wrote:

I'm 6 months out and I have the same hard areas at the top center, I've always assumed it was because that area of the flap bears the most weight. I've also been told by my PS, who I saw in person a month ago, that it's swelling and it will continue to go down. And it has. Very slowly, but it's going down.  I do believe that most of the firmness I'm feeling is swelling, especially since it gets a little less firm when I do lymphatic massage. There are probably some small areas of fat necrosis in there, but I'm hoping my body will just absorb them over time.  Whatever isn't absorbed my PS will break up, as Nancy said. Unfortunately I don't think any doctor can give you a definitive diagnosis of fat necrosis until they get in there for stage 2.

Log in to post a reply

May 13, 2010 01:01PM neversurrender wrote:

dah,

My spot was approx 3.5 cm long and 3 cm wide.  By the time had phase 2 at 12 weeks the spot was completely gaone.  I have another spot now, after phase 2, but again he says it is swelling.  I never noticed the swelling either, but it must be interior.  I hope this is what yours is and it will resolve itself.

Sally dx Nov 12@40yrs DCIS,grade 3.stage 0. 0/7nodes. bmx 1-25-10 with diep recon.

Log in to post a reply

May 13, 2010 03:45PM dah0123 wrote:

My main concern is the size of these "hard" areas (I wouldn't call them "spots" because of their size).  I'd love to think that they are swelling or would break up over time (but I just can't imagine that these are "swelling" because the areas are hard as rocks).  But why wouldn't the necrosis have been discovered in the hospital when all is monitored so closely for warmth and with the doppler?  Supposedly the incidence of failure after 5 days is practically nil and I was in the hospital for 6 days.  After having implants for 14 years, I would be very depressed if these flaps fail and I have to go back to implants.  Question:  Were the areas that were described as "swelling" as hard as rocks?  And tender?  These are also the only areas on my new breasts that are tender (and massaging these areas hurts - how hard are you supposed to massage them?). Has anyone had these areas removed and filled with lipo fat???? Thanks everyone!!!!!! 

Debbie

Dx 10/10/1994, IDC, 1cm, Stage I, Grade 3, 0/11 nodes, ER-/PR-
Log in to post a reply

May 14, 2010 02:09AM shadow2356 wrote:

My DIEP breast was hard as a stone for a long time. It is now 6 months later and it is very soft except for a tiny spot. Maybe yours will soften up too.

MaryEllen, 44, Mom to Julianna, 2 years, bilateral mastectomy with immediate DIEP, BRCA-, 10/09/09 maryellenandjulianna.blogspot.... taxotere, carboplatin and herceptin X6, herceptin will be for a year

Dx 8/14/2009, IDC, 1cm, Stage I, Grade 3, 0/4 nodes, ER-/PR-, HER2+Surgery 10/09/2009 Mastectomy (Both); Reconstruction: DIEP flap (Both)Chemotherapy 12/07/2009 carboplatin, TaxotereTargeted Therapy 12/07/2009 Herceptin
Log in to post a reply

May 14, 2010 11:13AM dah0123 wrote:

Thanks Shadow.  I hope so too!  I have Stage II scheduled in a month.  I'm not sure how the PS will decide whether to remove or leave as is for now hoping massage will work over time.  Also, just noticed that you have the same diagnosis as me . . . and I'm 15 years out now. :)

Debbie

Dx 10/10/1994, IDC, 1cm, Stage I, Grade 3, 0/11 nodes, ER-/PR-
Log in to post a reply

May 23, 2010 03:07AM lovetosail wrote:

dah0123 - I am 10 days out from my unilateral DIEP and have a portion of the new breast that sounds like your description - a hard area that is tender.  I saw the BS on day 8 and she said there would still be hard areas due to swelling right now, I see the PS next Tues.  Has your tenderness resolved itself? I have no evidence of infection.  Anyone else have tenderness around a harder spot on their DIEP?

Dx 10/19/2009, IDC, 2cm, Stage IIa, Grade 3, 0/5 nodes, ER+/PR-, HER2+
Log in to post a reply

May 27, 2010 03:41PM dah0123 wrote:

Hi Lovetosail,

The tenderness is gone but the "hard areas" are still there.  I just can't believe mine is swelling - wouldn't swelling be soft?  And these weren't hard initially - I noticed it after about 2 weeks.  But they may have been there before and the area was so bruised and tender at that time that maybe I didn't notice (I don't think so though).  My PS just told me to massage the areas but it doesn't seem to be making a difference.  I think they are too big to "break up" with massaging.  I am curious to see what the PS does regarding these areas during Stage 2.  Both areas are at the top of my new breasts (think maybe the blood flow didn't make it that far?).  Anyway, I'll let you know what the PS does about it during Stage 2 since it is only 2 weeks away.  I can't believe that I had so little response when I asked others on this forum about these "hard areas" (which I believe to be fat necrosis).  Is it really that uncommon?  Of course, I do tend to always be on the wrong side of the odds. :)

Debbie

Dx 10/10/1994, IDC, 1cm, Stage I, Grade 3, 0/11 nodes, ER-/PR-
Log in to post a reply

May 27, 2010 04:16PM ebann wrote:

I have fat necrosis in my abdomin. I have massaged it and have started to exercise. This has made a  big difference for me. It has  taken awhile. It was really big and hard. Still can feel it but they are getting smaller. Yes they. I keep massaging it and believe in what my doctor says cause so far everything he has  told has been correct. If you are so uncertain I would recommend a second opinion.

Elizabeth (EB Ann)

Dx 4/10/2008, IBC, 6cm+, Stage IV, Grade 3, 3/16 nodes, mets, ER-/PR-, HER2-
Log in to post a reply

May 28, 2010 04:52AM lovetosail wrote:

Thanks Elizabeth and Debbie.  My surgery was just 2 weeks ago and when I saw my PS last Tues she said it was too early to tell if I had necrosis, but to start gentle massage anyway.  It feels strange!  It's probably a good idea for me to do anyway to get aquainted with the new breast, it still seems like an alien to me.

Dx 10/19/2009, IDC, 2cm, Stage IIa, Grade 3, 0/5 nodes, ER+/PR-, HER2+
Log in to post a reply

May 28, 2010 05:43AM fightinhrd123 wrote:

I had mine done 3/31 and had some hard spots too, they are totally softening up already, i have been doing gentle massage too.

Dx 5/29/2008, IDC, 2cm, Stage IIb, Grade 2, 2/14 nodes, ER-/PR-, HER2+
Log in to post a reply

May 28, 2010 08:12AM lovetosail wrote:

Hi Laura - about how many times a day are you doing the massage?  I think Dr. Lipa told me 2x a day - but I am spacing a bit ;-)  Glad to hear that yours are softening up!!  How are you doing otherwise, are you back at work and all?\

Sue

Dx 10/19/2009, IDC, 2cm, Stage IIa, Grade 3, 0/5 nodes, ER+/PR-, HER2+
Log in to post a reply

May 28, 2010 09:40AM fightinhrd123 wrote:

I have to say im not that consistant with the massagaing,so  i think its softening up by itself. Im doing good, my incision is finally healed, still have a couple of stiches.  I dont work, except for the three kids i have ;) and I'm starting to feel like im getting back to normal :)  I just cant wait for stage 2!!!!

Dx 5/29/2008, IDC, 2cm, Stage IIb, Grade 2, 2/14 nodes, ER-/PR-, HER2+
Log in to post a reply

May 28, 2010 12:04PM navygirl wrote:

I've had two issues with fat necrosis in my diep, both on the same side - one of which was rather large (about 4cm), each time continued daily massage broke it up and it was reabsorbed with no problems. The areas filled in on their own - I don't know with what but I don't have any divots from it so? My PS told me to massage it 3x's/day and I did that if not more. It took about 3 months the first time and about 6 weeks for the smaller second one. It's been over a year now since I had any issues, and the breast has softened up a great deal (it's been 2 years since surgery). I hope this helps...if you have doubts or concerns have it checked out or maybe have a referral to physical therapy to help with breaking it up.

life is short, play hard

Log in to post a reply

May 28, 2010 12:06PM lovetosail wrote:

Glad to hear you're finally getting back to normal, Laura.  navygirl, thanks for the input, it was helpful! and I love your motto (life is short, play hard).

Dx 10/19/2009, IDC, 2cm, Stage IIa, Grade 3, 0/5 nodes, ER+/PR-, HER2+
Log in to post a reply

Oct 17, 2010 10:00PM Gee wrote:

HI MA, 

I am three week out from my DIEP and have exactly what you have described. My PS said it might be necrosis but could be sure until some of the swelling went done. I am also very worried if it will be something that can be "fixed". But that is the only sensitivity/pain I am having in my breasts. It is really annoying. I go back in two weeks, I will keep you posted if I hear anything new.  

Gee

Log in to post a reply

Oct 18, 2010 09:28AM dah0123 wrote:

Hi Gee,

During Phase 2, my PS removed the hard areas (sucked them out using a lipo candula I believe) and added more fat to those areas using fat that he lipo'd out of my hip area.  Still had hard areas after that and had that process repeated in Phase 3.  Much better now though there are some different hard areas that I do believe will soften up with massage.  Keeping my fingers crossed.

Debbie 

Dx 10/10/1994, IDC, 1cm, Stage I, Grade 3, 0/11 nodes, ER-/PR-
Log in to post a reply

Oct 18, 2010 04:05PM lovetosail wrote:

Hi Gee and dah0123 - I had my DIEP in mid-May and with twice daily massage most of my hard areas have broken up.  I have one small spot remaining that is slowly decreasing in size.  I have stage 2 on 20 Oct, I'll let y'all know how that goes ...

Dx 10/19/2009, IDC, 2cm, Stage IIa, Grade 3, 0/5 nodes, ER+/PR-, HER2+
Log in to post a reply

May 14, 2013 11:15PM brendaclee3 wrote:

I had my DIEP over a year ago and had some rather large necrosis near the cleavage area.  It has taken a year, but after massaging,  (which I've only been doing for a few weeks) the necrosis on the right side is totally gone, and the necrosis on the left is greatly reduced. I don't know how it works, but it worked for me.

Brenda

Log in to post a reply

Dec 20, 2013 04:42PM jcbis1 wrote:

I would be so grateful to hear about the massage techniques-- my PS hasn't mentioned massage, but it makes sense that it might help.  I'm 4 weeks out and 1/3 of the foob is like concrete, and seems to only be getting worse.  Can anyone describe what lymphatic massage entails?  Or what else you're doing that seems to help?  Or maybe there's a you tube link. . .  anyway, very good to hear that it's not a done deal yet, I was starting to feel like I'd have been better off with an implant than a bag of rocks sewn on to my chest.

Thanks,

Jessica

Dx 5/15/2013, IDC, <1cm, Stage Ib, Grade 2, 1/3 nodes, ER+/PR+Surgery 06/10/2013 Lumpectomy (Right)Surgery 06/21/2013 Lumpectomy (Right)Surgery 07/31/2013 Lumpectomy (Right)Surgery 11/20/2013 Mastectomy (Right); Lymph Node Removal: Sentinel Lymph Node Dissection (Right); Reconstruction: DIEP flap (Right)Hormonal Therapy 12/15/2013 Tamoxifen
Log in to post a reply

Dec 20, 2013 07:34PM LAstar wrote:

Brenda, did your breast get smaller after the hard areas softened?

Dx 3/5/2012, DCIS, Stage 0, Grade 3, 0/2 nodes, ER+/PR-Surgery 04/06/2012 Lumpectomy (Left)Surgery 05/04/2012 Lumpectomy (Left)Surgery 06/19/2012 Mastectomy (Left); Prophylactic Mastectomy (Right); Reconstruction: GAP flap (Both)Surgery 10/05/2012 Reconstruction: GAP flap (Both)
Log in to post a reply

Jan 10, 2014 04:43AM jeskachi wrote:

Necrotic tissue is dead tissue. Massage won't bring it back to life. It may encourage liquefaction though, where the necrotic tissue becomes fluid and is absorbed. You will lose volume if that happens, although whether it's noticeable or not depends on how much necrotic tissue is liquefying.

Log in to post a reply

Jan 10, 2014 07:05AM LAstar wrote:

My docs say there is no negative health effects of having necrosis. It's hard to believe that dead tissue liquifying in my body doesn't have some adverse effect!  Had anyone read or experienced adverse effects?

Dx 3/5/2012, DCIS, Stage 0, Grade 3, 0/2 nodes, ER+/PR-Surgery 04/06/2012 Lumpectomy (Left)Surgery 05/04/2012 Lumpectomy (Left)Surgery 06/19/2012 Mastectomy (Left); Prophylactic Mastectomy (Right); Reconstruction: GAP flap (Both)Surgery 10/05/2012 Reconstruction: GAP flap (Both)
Log in to post a reply

Jan 10, 2014 07:49AM, edited Jan 10, 2014 07:50AM by jeskachi

From personal experience there can sometimes be pain from soft (live) tissue getting pressed up against the hard tissue. I think you can also sometimes have an inflammatory response around the necrosis. There may also be encapsulating scar tissue, not sure about that though. 

I had 2/3 of a flap liquefy, no adverse physical ramifications. Most of it came out of a fresh incision, and it came out as liquid fat, not anything infected. It never got infected in the course of draining either. 

Edited to add: most liquefies without exiting the body :)  I just happened to have a convenient exit point at the time so it took it.

Page 1 of 2 (34 results)