Fat Graft Transfer and the Radiated Breast
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I so hope this will also benefit me. I waited two years to be sure I was ready.
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I plan to reread this entire thread as I am now scheduled for my surgery. I am also curious how many had OT or PT ahead?0 -
Well, after many complications with my insurance over the plan my doctors and I put together, I have decided to postpone my fat graft surgery.
What my doc and I wanted was for me to attend to 8-10 weeks of PT/OT for breast and chest wall lymphadema drainage, (something that takes 3-6 months to even get into the cue), then to have a clear imaging, a three weeks ahead of surgery pre-op appointment, then after the surgery, a 2 day, a 6 week, and up to 6 months of followup as post surgery doesn't always go as quickly as we'd all like it to and I have a history of needing up to four times the usual in recovery time from surgery, radiation, or invasive procedures. I also deeply wanted to plan for this with at least 2 or 6 months of an exercise program ahead so I was at my strongest and thinnest ahead of surgery and not go into it in any stressful ways.It was all planned in advance, conservatively, and with my best health and results in mind.
My insurance however decided because I cannot tolerate AI's (the government dictates what drugs and procedures you MUST take whether you can tolerate them or not) that they would drop my coverage effective immediately, August 31st.
My insurance pulled out for the two months I was to have the lymph drainage therapy and did not guarantee the surgery. I was denied my pre-op appointment (Oct 22) ahead of a scheduled Nov. 12 surgery date. I had to push forward my imaging from early Oct to Nov. Then the insurance jumped back in on Nov. 1st and said if I get it (imaging/surgery/pre-op appt. and post op appts.) (but skip the drainage therapy) ALL done in eight weeks starting November 1st and ending December 31st, they would pay for the surgery alone.
Well. by now, I was completely stressed out for the two months of being in limbo, so I was in no state for surgery. The only way to have it was to have the pre-op the morning of the surgery (finding that option was being made available for me under these insurance circumstances only hours before the surgery time) and then to be let loose from post surgery care before the recovery time I might require and to go into this during the holidays (a stressful time), without prepping up my strength (I lost my motivation) and serenity ahead.
So, my docs, my husband, and I all decided it was too out of order, too rushed, too stressful, too close to the holidays and just too dangerous to go into surgery in such an unorderly manner that is not a life threatening issue. I called the whole rest of it off for now. It just doesn't make good common or medical sense.
I settled with getting my imaging done. But then I couldn't proceed in such a short time frame with no preparation.
The insurance can either get behind me and my doc's idea of the right ducks in a row or my husband and I will budget for it for a future time. I can have it in a year, six months, 18 months and save for it. But I don't want wam-bam surgery. I was a freaking wreck trying to see if I could go through with it (unprepped and no notice and no lymph work ahead and no extended follow-up possible at Christmas) or not. But in the end, it just felt so wrong to do it that way.
Sometimes, we have no choices. But sometimes it seems we are bullied by insurance to do things the wrong way. It is important to take charge of our own health, medicines, procedures.0 -
I am a third time breast cancer survivor. My twin went thru it 3 times as well, but passed away when it spread to other parts of her body. Last year my ps said he would do implants. I was told before no due to my radiated breast. He put in t.e. and they got infected. I was then referred to a ps that does fat grafting. My surgery is now scheduled in Dec 2013. It got postponed twice due to a wound that didn't heal properly and also a seroma. I am excited and looking forward to this procedure. My radiated breast is so hard feeling. How long is most people out of work is what I have been trying to find out.0 -
Hi Cle,
I am soooooo sorry about your troubles and your sister. BIG HUGS!
I don't know about others, but my PS said that the injection to the breast would be quicker healing than the liposuctioned part and that that would be at least six weeks. It can be months though. You have to take into consideration your strength, age, fitness, etc.
My own history is that when they say x amount of recovery time, mine is at least four times that. I have to plan a LOT of time for myself ahead to prepare and for afterward too. I was a whole year recovering from radiation and then I am still only at 80% and have no "cushion" for overdoing or else I once again lose my energy for up to four months, so I have learned to pace myself.0 -
Cledora,
Are you trying to reconstruct a complete breast from fat grafting? If so, there are additional threads you may find helpful.
You should be up and about pretty quickly. The lipo is more painful than the breast injections. Most only need to take about 4 or 5 days of recovery before going back to work. That said, you will still be sore from lipo for several weeks, but in general it does not limit most people significantly.
My radiated side is rock hard. It has taken 4 months for the fat graft to start softening things (my 3rd procedure was July 2013). I am still pink in areas and hard - it is still healing. But it is healing, and softening! Getting there. Still need one maybe two more procedures to get my radiated side matching my nonrads side.0 -
Dancetrancer,
Thank you for responding to my questions. I was told by my ps that I will have between 4-8 surgeries for the fat grafting. My left breast is flat after the expander was removed and my right breast is the radiated breast. My ps said he would be able to do all with fat grafting and not have to use skin from my inner thighs. My stomach was used the first time I had bc and my back was used for my left side the third time I had bc. I see my ps in about 2 weeks and my surgery is in 3 weeks. I will be asking him how he will handle both sides since their is a difference in sizes at my next appointment. I know the radiated side will take longer to soften up. I went thru radiation twice and it is very hard and had more damage after my other ps filled the expander and then it got infected. Won't walking be the best to help with the lipo healing or will that have to be limited. Thank you again, I truly appreciate the blogs. It truly helps in finding out answers and information.0 -
truebff,
Thanks for your HUGS, I do sincerely feel the love. I am looking forward to my fat grafting surgery. Last year when they found bc in my left breast, my prayer was not to have to do chemo a third time. HE truly answered that prayer. However, I didn't expect almost over a year and a half of being sick with all I dealt with the expanders, infections, hives and being anemic. I to had to rest more than I was use to. At least when I took the chemo I knew when I would be sick and for how long.(trust me I wouldn't want anyone to have to take chemo). I am just saying that being sick for a year and a half takes a lot out of someone. I am not complaining, because I was thankful that I am alive and all is and will be well with me. I am looking forward to this surgery in 3 weeks so I feel like I am getting back to some normalness. Did you wear spanx or just the compression garment from the hospital? Thank you again, Cledora0 -
I'm glad that you guys are finding ways to deal with radiated skin.. Dr khouri is here in Miami but my onco said he just does experimental stuff so I chicken out and cancelled my appt ... I only have one radiated side with no TE on the other side I have seen 4 ps and they all say I should have DIEP done .. I don't want to so I stop searching for now but please keep on posting ...and let us know your out come please... Please I live in Miami you would think they know a lot about fat grafting ...DIEP is not an option0 -
dont listen to your oncologist. often drs poohpooh what they do not know or understand. fat grafting is not experimental and khouri is a rrespected ps in miami.
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HI All. I postponed my fat grafting. My breasts are very close in size (small breast/small lump) so it is not that big of a deal cosmetically, but I was hoping for it to help soften the tissue that pulls from the scaring inside the lumpectomy site.
But, warning:
Please only read this next part with warning and do NOT read if you have already had the fat grafting:
However, I was somewhat dismayed that my plastic surgeon called me and said, after consulting with his partners that he was not willing to do the fat grafting on my radiated breast until more evidence came in down the road. He is the chief of the PS department at U of M and one of his partners will NOT use fat grafting ever on a radiated breast and the other only on a case by case basis. Their mutual worry is that the fat grafting may backfire and turn into cancer! Yikes! So we both agreed to not only schedule it with all the solid prep in front of it, but to also wait until more evidence was in on how this might change the cells of the breast. He was worried that it might cause a possible recurrence because there hasn't been enough study on how the cells react over time inside the breast at the site of previous cancer and radiation. However, when the all clear comes in -hopefully- it can still be done much later, even years. So I was greatly surprised because previously he had been willing and ready to do the surgery. In the meantime, I am using some compression for the lymph chest swelling and massaging the scar tissue inside and hoping that that will also help me over time.
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truebff: That is interesting, because MSU has been testing the use of fat grafting (in previously irradiated patients as well} since 2010 and they report favorable results and do not question whether there will be untoward sequelae. So I am perplexed. It has been used with previously irradiated patients for over five years....and I never have read any reports which suggest that there is a concern as mentioned by your doctor.
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Fat cells contain stem cells. That is the concern, as some worry that the stem cells could help any residual cancer cells grow. However, they have been doing flaps like DIEP for years and years and years with no incidence of increased recurrence rates of cancer. Flaps are chunks of fat with skin, etc. and yes indeed they do contain stem cells. With fat grafting the fat is injected vs transfered whole as a flap - so the procedure of transfer is different. While that may change the process/risk in some way, I logically cannot see how the risk is any different between the two procedures. And as whippetmom said there are indeed studies showing no increased risk of recurrence with fat grafting. Most of these studies are on using fat grafting to supplement other reconstructions like flaps or implants. However there are a few from overseas that show no increased risk when fat grafting is used to reconstruct an entire breast.
Now, anyone who CONCENTRATES stem cells via a special procedure after removal and then reinjects those cells for fat grafting is indeed taking a much higher unknown risk. This is what Suzanne Somers had done. She had it done in a clinical trial, and in that trial, you must have been cancer-free for at least 5 years before you could be included. She also had it done after lumpectomy - and I don't think there are many studies on this at all that I am aware of - perhaps the unknown risk jumps up further with this since there of course is much more breast tissue left after a lumpectomy vs a mastecomy (very minimal).
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Hi. Well, it puzzles me too. But my doctor called me personally and heartfeltly after consulting with his two closest colleages and I was certainly put on alert that "their" procedures -which may differ from others, I don't know as it is the only one I've addressed- is "under review until further evidence that it will 'do no harm' is substantial..." At any rate, it kind of put me at peace. It's not off the table for the future and I'm actually relieved to be excepting that my one breast has a bite out of it and grateful it is still so close as the other one, just not that "perfect" breast shape, but luckily, only very slightly off in shape and not at all off in size.
I am staying tuned.
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I had fat grafting yesterday to help my radiated skin on my left side so it (hopefully) will accept a small implant. My left TE was removed due to infections on my left side and I didn't want to try again with TEs. I am sore but not in pain. Time will tell to see if it works. I hope so!!!
Babs
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I hope so too, Babs. Speedy recovery. And joy for all the procedures that help us reclaim our beauty and wholeness!
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bumping for newbies
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Babs.....please keep me posted on how you are doing after this procedure!
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Bump
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Thanks for the bump! This gives me some hope!
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Whippetmom!
I have been in such a better mood since you pointed me in this direction! I have been wearing out my printer and hi-lighter. I have a thick file to take to my Doctor on Tuesday and he doesn't stand a chance!!!
I do have a couple of questions? My infection seems pretty well cleared up and I am still taking my antiB's. It itches like crazy! I have also picked back up on my supplements. I have felt so good I had slacked off on them.
How long after the infection is cleared until I could have the first grafting procedure? My doctor said to wait 4 months to let everything settle before moving on, but he was thinking DIEP when he said that. I am wondering if I can do the fat transfer during that 4 months? Also, he said my tissue was in really good shape except the small spot that popped open. He didn't see any other thin spots. Radiation really had minimal impact, all things considered.
My other question would be if I had to have a second grafting, how far apart should they be? Also, could a TE be placed in conjunction with a fat transfer as long as it was not too inflated when it was placed?
Thanks again for all the help you provide to all of us. You are a true Angel!!!
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4sewwhat: I think I answered these questions in a private message....yes?
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Yes you did, Thank You!
I am researching too and will forward or post anything I come across!
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Bumping for the Exchange City Girls!!!
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I think I've had it ALL done, lol. I had exchange before rads and did ok. I started with Dr Khouri, REMOVED my 550's went to something WAY smaller to fill in with fat grafting. While I truly believe it helped my skin, it was too involved for me to keep schlepping to Miami. I'm going to shoot you a PM : )
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good morning!!! Been so MIA cause of work ... Ok so it's been 4 months without LF TE... Saw 3PS ... One said I can place a new TE on radiated skin cause he says I have tissue and he can slowly but very slowly expand the tissue I'm confuse will my Rediated tissue stretch ... Has anyone done this? Help I'm still lost and do not trust ant PS any more!!!
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I had a TE placed in radiated tissue, after lots of fat grafting, and did just fine.
I do think it was all the fatgrafting that made the tissue healthier. My skin went, over the course of a year+, from dark suntanned color to pink again. I do know its really dependent on the condition of your skin. I would make sure your PS does LOTS of these types of surgeries, as the complication rate can be quite high.
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It's been so long I forgot to ask about fat grafting... I'll ask him when I go back on the second .. He didn't mention anything about it...just straight TE... I'm going to see a new PS today so will se what he says thanks for reminding me of that fat grafting ... How many sessions have you had? I had 27
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Has anyone here done fat grafting prior to their exchange surgery?? I see my PS today to discuss if I am ready for the exchange - it has been 6 months since surgery and 4 months since my last fill. My left side was radiated 12 years ago and due to this it is tighter and has what I would describe as a divot at the top. My PS stopped my fill at 400 cc because he did not want to overdo it. Whippetmom told me about the fat grafting pre-exchange versus the usually done post exchange fat grafting and I plan to discuss with my PS today but wondered if anyone has actually done this and can tell me about their experience. Thanks!!
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