Fat Transfer using Liposuction
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I did not have Brava, but had expanders exchanged for implants nov 15th and had fat/lipo from abdomen transferred to fill in upper poles and soften overall look of implants (had nipples done at same time), it looks good and seems to have turned out very well so far. The area of abdomen it was taken from actually looks tighter now then before (my ps said he would do a little contouring while harvesting it, yea), I had to wear a spanx for 3 weeks after which was not fun but stomach looks tighter and better now, Surgery for everything took 5 hours but all seems very good right now hopefully will not lose any of the fat. The abdomen area the fat was taken from was somewhat sore for a week or so but not terrible and I did not have any bruising to speak of. All in all I'm very happy with the results.
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I just wanted to share my experience. Fat grafting to create a "natural looking breast" is gaining traction in Europe but not so much in the US. In Europe a study was conducted to examine the 5 year survival and recurrence rates of breast cancer in women that had fat grafting to create a breast vs those who had a different reconstruction procedure (using implants for example) the study concluded that there was no difference. However, the arguments against this procedure center around stem cells. If actual fat is transferred in large amounts to take the place of an implant for instance, there will be stem cells there and the million dollar question is "can these stem cells cause cancerous cells to grow again?" this is especially relevant for those who had a lumpectomy versus a mastectomy. Other related issues include fat necrosis as specified in earlier posts. Fat necrosis can be mistaken for a tumor on mammograms but ultrasounds would probably be better at diagnosing it. In any case, the fat needs good blood supply to live and several sessions are needed to achieve the desired size. One way to overcome that is to use a LD flap or another type of flap that will give the fat a "better" chance of surviving. The uptake issue is also very relevant here, fat may be re-absorbed by the body and the individual differences in this case are huge..it can be anywhere from 1-2% to 40 or 50% or even more...and there is no way to know in advance so if you opt for this option you just have to wait and see. I am 4 weeks post op, I had LD flap with lipo filling from my thighs. Right after the procedure it was extremely lumpy and then very slowly it started to become softer but some of the lumps have not softened yet. Doctors have the technology to separate the stem cells and that helps greatly with the fat uptake but in the US they are very concerned about what this will do to the cancer cells that might be still there...even with mastectomy patients some breast cells might be left behind..would these stem cells add fuel to the fire and revive the cancer...that's the debate right now..also all the issues with the fat donor site are also relevant, you will see "dents" through your skin where the fat was extracted...my surgeon said it could take up to 3 months to resolve - we will see.
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becmb... I'm so happy it worked out well for you. I wish that's what I had done. My doc said he could do fat grafting or fat grafting/small implant with TEs and I unfortunately thought the BRAVA would be a quicker process. I was certainly wrong on that!
Quasi.... very interesting. I have read some on that. I guess I can be a test subject since I have one DIEP flap breast and one fat-grafted breast! The DIEP flap definitely looked more natural immediately, It will be a full year for me to (hopefully) have a natural looking fat-grafted breast. Did you use BRAVA?
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I think I have heard of Brava being used with a flap.
A full cup size without Brava via fat grafting only? My guess would be yes, but it probably would take several surgeries (even with Brava it probably would take 2 surgeries is my guess - more if you have had radiation on that side).
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Hi Deb...yeah...it sucked ROYALLY. So glad all that craziness is behind me! Still working on recon, but all the other crap is done...and I hope for good!
Awesome you have an appt for a consult - yay! I started with Dr. Khouri (the guru himself) in Miami and then switched to Dr. Ahn in NYC for a multitude of reasons. Both are excellent, excellent plastic surgeons...but Dr. Ahn has won my heart! She is just so skilled, meticulous, and caring. I sound like a commercial but I don't care, lol! Keep us posted on your appt and good luck!
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Hi Plimsolls
I was wondering how you got on with your reconstruction.?? I had a mastectomy last year and whilst I want reconstruction I am not thrilled with the options out there. I have read about the Brava and AFT (autologous fat transfer) system that some ps' s are using in the US, where you reconstruct your breast using your own body fat. This is enormously appealing but I don't know who is doing it in the UK. Does anyone know more??
Confused and unsure. Fansan
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As someone who has done fat transfer my take on it is that the fat stem cells are there anyway, they just move location. Plus I have less overall fat for oestrogen to thrive in........so I am not sure about increased risk, maybe different risk, but local recurrence is better than a distant one......the things we have to consider in this position are amazing really, talk about emotionally challenging!
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Good point Lily 55. From what I'm reading here, everyone seems to be using brava or AFT after a diep or implant. What I would love to know is if anyone has had just brava and AFT alone to reconstruct their breast post mastectomy and if so, has anyone had it done here in the UK (or Europe) and if so, by whom??? I totally get the worry about cancer recurrence due to the fat cells being transferred - I assume everyone saw the skirt size issue in the Telegraph yesterday? - but I just feel this method has so much potential and I am loathe to carve up my body further or put in an implant when this method may be just about to become mainstream. It seems crazy that I can't find more about this method and whilst I would love to pop over to Florida and have it done, I have no insurance to cover those sort of prices! Would really appreciate hearing from someone who has actually done this. !
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I am AFT and BRAVA alone. The bigger surgeries generate more inflammation so
I think also increase risk and of course transfer fat and tissue when its a flap.......
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I am AFT and Brava alone after BMX. Still in the process, have had 3 surgeries so far. (I had radiation so my course is more complicated.)
I did not have surgery in the UK but I know there are fat grafting after MX only surgeons in Europe. Check out Dr. Gino Rigotti in Italy - he is actually one of the pioneers of this type of reconstruction and has written research articles on it. He and Dr. Khouri have collaborated on fat grafting. Also, other docs from the USA have studied under him.
Even if you can't go to him, perhaps he can direct you to someone in your area who has trained under him. I don't know his contact info but if you google search enough I bet you can figure it out eventually.
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Well, just so happened my search page listed this page next:
Even has his email!
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Fansan...I just finished (yeah!) a fully fat-grafted breast. I originally had a DIEP flap done on both breasts, but lost the left reconstructed breast to a staph infection. After recovery, we did fat grafting (with BRAVA at the beginning, something I would NOT do again) 6 times and just finished up.
You cannot see -- or feel -- the difference between my DIEP flap breast and my AFT breast.
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If you do fat grafting only, he is correct, it will take several procedures, even with using Brava. If your flap has been radiated it will take even more procedures. Brava allows you to have > 150 cc of fat grafted during one surgery - but you need a doc who really knows what he is doing to graft > 150 cc without creating excessive fat necrosis and also to guide you through the Brava process. I would ask your PS what his experience is with grafting large volumes of fat in one surgery. It needs to be done in a specific manner to avoid excessive fat necrosis.
Alternatively, you could have many more small (< 150 cc) fat grafts and get increased volume.
And the other alternative of course is implants.
I just finished my 4th fat grafting for my radiated side, using Brava. It is a slow process with multiple surgeries and lots of Brava time - it's certainly not for everyone. But I am forever thankful it is available to me and am thrilled with my current surgeon. My results are small but IMO very pretty so far!
My bet is you wouldn't need too many grafts if you are supplementing a flap, which gives you more volume to start with.
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I am done with fat grafting. I would do it again (without Brava), but it is a long process. I too was told it would take two, maybe three, procedures. It took six and I could probably use another. I'm not going to, though. Afterall, no one is born with two perfectly even breasts anyway!
My first three grafts were done with BRAVA and the last three without. I found the retention of fat was exactly the same, but I had more complications (hematoma and infection) with BRAVA.
The other thing to keep in mind is that I've found it takes 3-4 months for everyting to even out and swelling to go down after each lipo. Don't sweat it if you look a bit lumpy before
They feel very natural and my only issue is that I'm afraid to lose weight! I got in the habit of gaining weight for each procedure so now -- with no more procedures -- I could use to lose 10 pounds, but I'm afraid it might come out of my breast! Fortunatley, my doc says that the extra 10 lbs just puts me on the cusp of normal and overweight BMI wise and I should sweat it. Instead I'm concentrating on working out to build more muscle.
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Excited for you BosumBlues - so glad you have options now!!! Yay!
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I just had my PBMX on January 21st and had small implants placed immediately and immediate fat grafting. I will be using BRAVA in several months for 3 weeks 6 hours/day and will hopefully finish off my breasts with one more major fat grafting procedure. I am curious how uncomfortable the BRAVA domes are to wear?
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it depends who you ask. I wouldn't do BRAVA again if you paid me! I believe it caused more problems that it solved, it's expensive, and painful.
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Hi,
I am considering using fat transfers with my implant. However, I want a smaller implant with more fat to try to make it feel more natural. How many CC's of fat did you use? Has your liposuction donor sites improved? Were you in a lot of pain?
I had my implants for a 15 months now....
Thanks!
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Only 2 weeks I had to wear my garmet for over a month but I had no lumpiness so it was worth it.
I had fat grafting 4 years ago after my DIEP, I need a touch up. I will never do it in the summer again.
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I had four fat transfer procedure and found all of them to be very complex and painful. I currently have small implants surrounded by fat. My non radiated side looks and feels really good...soft and squishy. My radiated side looks and feels as bad as it did with the large implant. I would like to have it removed completely on that side but for numerous reasons I have to wait. One, the drug I take causes low WBCs. Two, I have mild lymph edema on that side that I don't want to exacerbate. Three, I don't have any fat left and would have to eat a lot of donuts (well, maybe that's no so bad. Lol) Lastly, expense and pain. And yet, if some of these conditions corrected themselves, I would still do it.
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I didn't find the brava painful. Uncomfortable ..a little. But it is a pain. I've have five procedures so far (radiated side). Sixth is scheduled next month.
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I am curious if your lumpiness ever smoothed out. I am a month post surgery and had fat taken from stomach in front and around my sides to be transferred around implants to make look more natural. I have lots of hard lumps. PS said over time they will go away.
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I never had hard lumps -- I was told to massage lotion in twice a day and I always have -- but I never really "smoothed." I can't wear anything tight fitting without a bra because you can see my breasts aren't smooth. I don't consider this a major problem worth having more surgery over.
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Some of the harder lumps have smoothed. There are a few that haven't. Smoothness is not a thing anymore. I wear a padded bra to hide the deformity And I look great as long as I have a bra on. Without it, not so much. I've had four surgeries..may have a 5th to try to do some corrections.... may not. It's never going to look or feel like I want it to in my head, anyway
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I agree. I like perfect in a padded bra!
I went through a total of 10 surgeries from mastectomy to my final fat transfer. I am done. My only regret, ironically, is that I should have gone smaller! I didn't need my breasts to be as large as before and I would have been done quicker.
Anyway, we are alive and cancer-free
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I am looking into having my current silicon implants explanted and reconstructing with aft. Can you tell me who your surgeon is?
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Hi Everyone, I also posted the message below on another thread about fat grafting, hoping to get multiple answers!
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I developed keloid scars following a biopsy (28yrs ago), my bilateral mastectomy, and less so with my TE to implant surgery 8/2016 due to excellent skills of my PS who did scar revision. Have any of you developed keloid scars at the fat donor site or where fat was injected in the breast areas?
And,if your fat grafting PS is also very experienced in doing repair/pocket revision with the use of Alloderm and Strattice, please share his or her name! My capsular contraction seems to be rapidly worsening in spite of massage and Vitamin E and I need work on the other breast that has dropped and migrated. I will most likely have to travel to get with the right PS.
Thank you!
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