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Fat Graft Transfer and the Radiated Breast

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  • Imkopy2
    Imkopy2 Member Posts: 214
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    Dancetrancer thank you so much for sharing your experience with me. I will certainly take all advice into consideration. I’m not looking for a ton of volume it’s a somewhat small flaw I’m looking to have fixed but considering how long the implants have taken to settle and soften, my thought was that the FG process would be the same. I know there’s a risk of how much survives, etc. My new Ps is well respected and does conferences all over the country about his research. Hindsight, had I known about him when all of this started I would’ve went with him to begin with given his vast knowledge of recon with rad tissue. Trying to get my ducks in a row for when I meet with him again prior to surgery.

    What type of process did you use for nip recon recovery? So thankful for all of the wonderful advice I’ve received from this site.

  • dancetrancer
    dancetrancer Member Posts: 2,461
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    My plastic surgeon used skin from my breast (locally) to make the nipple. She left the nipple recon open (no stitches on the top flap) because she said radiated skin does not heal well, and if she closely it completely there would be a greater chance of swelling and it possibly necrosing and dying. So, it took longer to heal.

    She sewed a plastic ring into my skin around the nipple. I had to do a daily dressing change where I packed a special dressing carefully all around the edges of the ring (and underneath) and then on top of the nipple in the center, then covered it with a tegaderm. This was after carefully irrigating the wound with sterile saline spray.

    I forget how long I had the plastic ring sewed into my skin. Maybe 6 weeks? And the nipple care continued after that for a while, too. It worked, though! I had some shrinkage and flattening, BUT, she had made it larger than the other side to account for that.

    For a detailed description of the process, I did document my whole story on fatgraftpatients.com. My memory is fading, so reading there will be more accurate.

    It's a long story chronicled over the 5 years I had multiple surgeries to completely reconstruct my breasts from fat. If you go to around April 2016, that is when I had my last surgery with nipple recon - start reading from there.

    http://www.fatgraftpatients.com/forums/viewtopic.p...

  • anothernycgirl
    anothernycgirl Member Posts: 821
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    Imkopy, - I, too, had nipple recon after radiation, but my ps used skin from my upper thigh (along the panty line). As dancertrancer had, the followup days were quite involved re dressings and care, but the results are amazing.

    Good luck with your decision!

  • Imkopy2
    Imkopy2 Member Posts: 214
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    dancetrancer I will def look up your story. NYCgirl thank you so much...akin from your bikini area also sounds interesting. How painful was the recovery in your bikini area and how much of a scar did it leave? I have heard of this process before ...so many things to decide

  • anothernycgirl
    anothernycgirl Member Posts: 821
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    Imkopy, - pantyline skin graft healed quickly and scar is not noticeable really. The bandage and tape in that area were annoying, but it didnt have to be on long. My ps used only the left pantyline so as not to interfere in driving even those first days.

    Good luck with your decision!

  • Suz-Q
    Suz-Q Member Posts: 110
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    Imkopy2, Sorry I didn't get back with you! Looks like you got some good responses.

    I've been on Pentoxifilne and vitamin E for 1.5 years to soften up my radiation damage. I had another round of FG in December. I found out too late in the process that the Pentoxifilne is strongly antiangeogenic. My fat take has always been way lower than most people. However, Last summer, my plastic surgeon did comment that I had the softest radiated breast that he had seen. I think it's due to the fat grafting and the Pentoxifilne + vitamin E. even though the fat didn't take very well the fat that was transfered healed some of the radiation damage. Good luck

  • Imkopy2
    Imkopy2 Member Posts: 214
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    SuzQ-

    Yes the info on this thread has been amazing. I have a list of questions for my surgeon on his intentions thru this part of my journey.

    The one thing people don’t realize about the whole recon journey is that it is truly longer than the treatment part. Thank you ladies for all of your wonderful info and I hope this action helps out others who are going thru similar situations. I will post once I meet with my surgeon. Cyber hugs to al

  • OCDAmy
    OCDAmy Member Posts: 289
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    I am getting all sorts of differing opinions about implants and the radiated breasts. My PS is suggesting the lattisimus dorsi flap on the radiated breast but I am afraid of a big surgery like that. Whippetmom suggested I look into having fat grafting while I have my TEs in and then get the exchange for implants. Has anyone done this? I am not sure how many PS do this.

  • anothernycgirl
    anothernycgirl Member Posts: 821
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    Amy, - My radiated side was unable to heal 100% after the switch from TE to implant. It looked fine to me, but with a careful eye, my PS was able to see that it was not fully healed. He tried very hard to save it, but had to remove the implant after almost 2 months to avoid the risk of infection. A few months later, I had the LD on that side, with fat grafting later on, too. I am small , and had small implants, but I cant help but wonder if an even smaller implant on the radiated side would have been able to heal completely so I could have avoided the LD, but I'll never know.

    Good luck with your decision!


  • Imkopy2
    Imkopy2 Member Posts: 214
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    Amy- You will always have a difference of opinion when it comes to recon after having radiation. I had TE at the time of my BMX, underwent 28 rounds of rads and 3 months after had implants put in. At first I was happy because they appeared symmetrical even though my radiated side was a smaller implant. About 4 months after I was so upset because the radiated side was def higher and my original PS said it looked fine. He also refused to do my nip recon even tho my skin looked really good. I went out and found a new PS after a great deal of research I found my guy. Almost a year post exchange my implants are even again WITHOUT having a revision surgery. However, my new PS is going to do FG on both breasts but is confident that FG will improve the integrity of my radiated side. The FG will also help the success rate of the nip recon. My advice to you is to do your homework and find a surgeon who is VERY SKILLED in recon of radiated breasts. They do exist, maybe ask whippetmom who she recommends in your area. Check in with SpecialK she has a ton of experience with the many facets of the BC journey. If you are near Chicago I can help, my surgeon travels and does conferences based on his research. This is a great board and the ladies her can be of great help. Check the link http://www.fatgraftpatients.com/forums/viewtopic.php?f=141&t=1609

    Best of luck to you!

    Michelle


  • 08172016
    08172016 Member Posts: 2
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    Hi all,

    I wanted to share that I had my first fat graft procedure done today. This is the first step of my delayed reconstruction. I am going this route to improve the radiated area in preparation for an implant. This option was more appealing to me than a lat flap + implant.

    Prior to the tissue expander, I will have 2 more graft procedures, each 3 months apart.

    I will report my future progress for anyone that may be considering this option.

    Thanks to all of you wonderful ladies for the information you share on this site. I have learned so much and feel that this is a great place to find options for our continued journey

    Hugs!

    Lorraine

  • klvans
    klvans Member Posts: 199
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    I'm interested in fat grafting as my radiated breast is smaller than the non radiated breast. My biggest fear is that fat grafting will make it harder to read my mammograms. Have women who have had this done experience problems with this?

  • dancetrancer
    dancetrancer Member Posts: 2,461
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    Yes, I have had multiple areas of fat necrosis after grafting (I had 6 fat grafts done total) - but this happens after flaps, too. All they have to do is an ultrasound - it can usually easily be seen that it is benign that way.

    FYI, I found most of my episodes of small lumps after fat grafting presented about 6 months post the grafting. After about a year just about all of them have gone away.

    Most seasoned radiologists by this time are familiar with fat grafting and reading mammo's. It's way better than a few years ago, in my experience, since fat grafting is becoming more common. However, there are still some radiologists that are old school and do not have as much experience reading mammo's after fat grafting.


  • minustwo
    minustwo Member Posts: 13,116
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    I have the opposite issue. I like my smaller & tighter radiated breast. Looking at surgery to lift tighten up the implant on the other side - or exchange for smaller. I'm 7 years out from initial implant placements & 4 years out from rads, so i don't expect any more gradual changes

  • klvans
    klvans Member Posts: 199
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    Dancetrance, thank you for your response. It must be emotionally trying to be called back for an ultrasound, but good to know radiologists are becoming more familiar with the benign after affects of fat grafting. It would make me feel better about considering it.

    MinusTwo Preferring your smaller breast is probably the healthier option! I'm not going to rush into anything. I want my body to just "be" for awhile. I too want to be beyond any more "gradual changes." I'm not going to pressure myself to be cosmetically perfect; other things are more important. :-)

  • whippetmom
    whippetmom Member Posts: 6,028
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    imkopy2:

    Did you have your April FGT procedur? Eager to hear how you are doing.

  • Imkopy2
    Imkopy2 Member Posts: 214
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    Whippetmom- Yes I had my surgery April 25th... my surgeon went ABOVE my expectations by like 1000% percent. At my pre op appointment he had a plan, ( he was swapping out my original implants and moving down my imf on my radiated side) the day of surgery he came in to mark me and asked, would you like to be fuller? More cleavage? I said I would love all of that but if I can just have 2 breasts match in size and shape that look feminine I’d be happy. I also pointed out a scar on my left side from my original exchange that was supposed to be in my imf but was off by a lot, I requested if he could tuck it into my imf for real. He said he would do what he could. Soooo he released my scar tissue on my rads side (it’s so much softer), put bigger implants in (L) was 450 now is 560.. (R) was 435 now it matches her sister, he FG upper pole and medial oh yeah and that scar GONE. My breasts are warm and no longer cold like a waterbed mattress. They went from neighbors to being twins , I see his nurse on the 30th for a check and I see him in August. I’ll def have another round of FG before I get nip recon I see a few areas now and know by August there will be more. LOVE LOVE LOVE my surgeon. Oh yeah and even with all of that I was able to go back to work 5 days later... he’s truly magical. Thanks for checking in.

    Dancetrancer thank you for your guidance through my process...

    Michelle

  • dancetrancer
    dancetrancer Member Posts: 2,461
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    Imkopy2, you are so welcome - so happy for you!!!!! Your surgeon sounds amazing!!!!

  • Samnjb
    Samnjb Member Posts: 5
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    this description is helping me tonight. Thanks

  • hapa
    hapa Member Posts: 613
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    whippetmom - thanks for another great thread! I had implants swapped out in May and while my new foobs are much better than the old ones, I do think I would benefit from some fat grafting. I had the PS put the same sized implants on both sides with the idea that I would fix any difference with fat grafting rather than have her put in two different sized implants and run the risk of looking lopsided. I also had CC after rads, and the skin on the rads side is kind of tight. The only thing I can't decide at this point is if I want fat grafting this Christmas, or if I want to put it off for a while. The upside of doing it this year is that I've already hit my out of pocket max. The downside is that I could really use a vacation, and Christmas is the only time we have available so I have to pick one or the other.