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Fat Grafting, pros and cons

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Smaarty
Smaarty Member Posts: 2,618
edited April 2017 in Breast Reconstruction

I'm looking for answers. If you have had fat grafting, why and how did it go? Would you do it again? Any experience with this topic would be greatly appreciated.

I will be getting the upper pole areas done in the next couple of months. I've lost weight so it's very noticeable in my upper chest. I was wondering if it can be done along the bottom edge of the implants without puncturing the implants? I have very sharp edges that can be felt like I have crinkled plastic balls in there. Oh wait, I do!

Again, appreciate any info or help on this subject. Thanks

Update: asked my new PS about fat grafting after next sx. She thinks I might not need any once the new anatomicals are in On December 5. So now it's a wait and see. I think it looks hollow but the new foobs may change everything.

Thanks to everybody who has posted.

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Comments

  • sarahjane7374
    sarahjane7374 Member Posts: 23
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    I had fat grafting at my exchange to smooth out the transition between the implant and my chest on my right side.  It went fine - I was a little sore at the donor site (belly), but otherwise ok.  I'm planning to ask about doing some more to fix some rippling that has become more noticeable lately. 

  • sas-schatzi
    sas-schatzi Member Posts: 15,879
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    Smarrty, i have a shelf on both foobs. Noticeable without a bra. DBF doesn't care-THANK OMD for that. I am conscious of it. Whatever your decision on a fix.  Suggest contact with SpecialK :)

    BTW you look fabulous on the pic on the other thread. Totally jealous of your curves i.e all in the right places.  Lookin good gal!

  • cfk
    cfk Member Posts: 5
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    I will be getting fat grafting in the next few weeks.  I was wondering if your insurance paid for it.  

  • Smaarty
    Smaarty Member Posts: 2,618
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    yes, it's part of the recon process. I didn't realized how good our insurance was until BC. 

  • Dogsneverlie
    Dogsneverlie Member Posts: 164
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    Hi,

    I have my consult tomorrow with PS and looking at FG.  I will try to remember to post out here how that went!

  • Tricia59
    Tricia59 Member Posts: 3
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    I had fat grafting in July to top area of breast after partial mastectomy and radiation 9 yrs ago. I was so excited and optimistic but it failed...prob due to poor blood supply in radiated tissue. Am going for another go next month. Fingers crossed. Some women seem to get excellent results. If not will consider LD flap altho that is mega scary as risk of creating problems just for aesthetics of having 2 boobs the similar size. So helpful reading all the threads and posts. Just to add.....the fat grafting procedure was under GA and except for some bruising from the lipo.....easy recovery....altho' the anaesthetic made me feel like I had alzheimers for about a month after which was actually quite scary! As results with fat grafting seem to be so variable you have to be open minded and be prepared for 'the journey'. What a bugger radiated tissue is. Annoying that I recall no discussion or information about the impacts of radiation on future reconstruction at the time of diagnosis.  Mind you....when you are just dealing with the ca diagnosis It's not easy to process all the other stuff. Looking forward positively and feel very lucky to be offered reconstruction on the Public System (NZ) after 9yrs. Interestingly no doctor even mentioned the topic until I asked about it! 

  • jane1971
    jane1971 Member Posts: 6
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    Hi ladies:  Does anyone know whether it matters where the fat is harvested from?  It seems like everyone talks about fat coming from their belly/stomach.  Ideally, it would come from my back though.  I will ask PS but was wondering about your experiences.  Thanks!

    Jane

  • MartyJ
    MartyJ Member Posts: 819
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    Jane, my fat came from a variety of areas since my PS stages things.  First from the flanks (back above waist), then outer thighs, and inner thighs.  Last little bit came from just above the hips in the front.

  • Lily55
    Lily55 Member Posts: 1,748
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    they dont like taking fat from your back as they have to keep turning you over, i had fat taken from outer thigh, belly, flank and inner thigh

  • jane1971
    jane1971 Member Posts: 6
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    Thanks MartyJ and Lily55!  I'd love PS to take some from my flanks/back and so I will have to discuss with him. 

    Lilly55- I've heard the same thing with PS' not wanting to turn you back and forth but you would think they would do so for a preferred cosmetic outcome. 

    Have you both been happy with FG result?  What is a reasonable amount of thickness to expect with the FG?  For example, can they build up upper pole to an inch or more?  I understand 40 percent may be lost over time but was wondering whether it is possible to just get a thin layer of fat or a thicker layer that fills more than divots and alters shape. 

  • bostonnorthwest
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    I had PBMX in April 2014 with TEs, silicone Mentor 550s placed in August.  I have some divots from gauze I had on the sides of my breasts.  PS mentioned fat graphing to fill in areas.  I was wondering how long the FG lasts, does it need to be replaced or added to?  Will the FG look like pockets of fat (unnatural look)?  I wish I had known about revisions, etc when deciding to do the PBMX, I was dx with IDC in 6/2005, had lumpectomy, SNB clean, chemo then Herceptin for 10 months (had to stop before 1 year due to heart issues) and radiation.

    Will the radiated skin not take the fat graphing well?  

    So many questions and nervous about yet another procedure is terrifying.

  • DiveCat
    DiveCat Member Posts: 290
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    Boston:

    Fat grafting is actually often used in radiation patients before implants are placed, as there is some evidence that it improves outcomes for radiation patients who have much higher failure rates when it comes to implants. I am curious as to your statement that gauze caused divots though? That would have to be some awfully strong, and long-adhered gauze! And since you just had exchange in August, it seems like, as with most divots and ripples, it is a result more of thin tissues....fat grafting is sometimes used to try and thicken up this tissue to hide rippling and other contour deformities.

    As mentioned above, fat grafting does not always take (and even where it does, some may lose 40-50% of it), so sometimes yes it needs to be added too. It will not look unnatural though, as it is kind of "liquified" and injected to smooth out areas. It is possible to develop areas of fat necrosis, like hard lumps of fat, but these are not harmful and sometimes dissolve on their own in time.

  • claireinaz
    claireinaz Member Posts: 693
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    I had fat grafting to fill out my small silicone implants (I was lucky and didn't need expanders for the original reconstructive surgery) last May.

    All went well.  I may need a bit more later, but right now all is good and I'm happy; I had no complications. Recovery took about a week because I had general anethesia which always robs me of my high energy level; my hips (donor site) and stomach (second donor site) were terribly bruised for a while, but I didn't care. Not much soreness at all: it only lasted a few weeks overall.

    Claire

  • specialk
    specialk Member Posts: 9,237
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    My FG experience was much like Claire's - I had divots above my implants in the upper pole, and a fairly bony chest.  I had excellent results, and the FG made things look much more natural.  I had little to no reabsorption of the fat and would have needed only one FG.  My post-surgical experience was very good, minimal soreness.  The biggest issue was having to wear compression garments for 8 weeks, 24 hours a day, and a restriction on exercise - I was allowed to walk only, no gym.

  • KBeee
    KBeee Member Posts: 695
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    I had fat grafting in April.  The results look really good, so from that perspective, I am pleased.  I would not however do it if I had to do it over again.  I developed several lumps after the fat grafting process.  Usually these are the result of fat necrosis, but mine simply came back as inflammation after the biopsy.  Obviously finding the lump, finding more lumps, waiting 2 weeks to see if they go away, waiting 3 more weeks to see if they go away, waiting for biopsy results was very stressful.  The fact that the lumps are still there makes it very hard when assessing for recurrence because it is hard to tell what's new.  That in and of itself creates stress!  I knew lumps were a risk, but PS said that it is very rare.  After the face, he told BS that lumps are very common.  So...just don't underestimate the risk of this not dangerous, but very stress-inducing complication.

  • EnELLE
    EnELLE Member Posts: 31
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    Hello- I had fat grafting about 2 weeks ago on 9/11...my PS  took fat from the saddlebag area and the back of hips-love handles. I am a unilateral but he also put some fat on my native breast as well. The brusing on my legs was fierce and painful, but I used Arniflora (arnica gel) several times a day as well as taking emergen-c and now I have about 15% of the bruising left on my legs. Oh and the bruising travels down to the knees as it heals.

    They can put fat anywhere- for the bottom edge they would just move the implant out of the way to put the fat in-they are sculptors. I have holes all over the place from where they took fat out and fat in. I have 11 holes fom the cannulas (donor and transfer sites) and I also have lots of little needle marks on the donor areas- I am  assuming to even me out and leave a nice contour...will have to ask PS at my 3 week follow up.

    As of now- I have a natural upper pole slope that matches my native breast and the rippling is gone. For a unilateral I have a nicely matched pair of breasts. My PS said preop that he only needed 100-150cc of fat to transfer. They used to require compression garments but  stopped as it was hard to fit due to individualized post lipo swelling etc. Kinda like the lymphadema sleeves-a wrong fit is worse than no garment. So I haven't had to wear one, but I have been wearing a spanx that doesn't fit too crazy tight for a couple of hours a few times a weeks starting after my one week post op.

    Also besides surgical technique, the survivial of the grafted fat depends on angiogenisis- create new blood vessels-so the fat can survive. So all of the anti angiogenic foods that help retard the growth of cancer can inhibit the "take" of the fat transfered. So no green tea, broccoli sprouts, artichokes, etc etc a list of 40 antiangeogenic foods to avoid .for a bit. It's also recommended to keep insulin higher (feeds fat) so I am eating additonal pieces of fruit and a few more (non gluten) carbs. I also have been eating grass fed butter, grass fed cream, almonds, pepitas, range eggs/chicken etc etc  in moderation along with lots of carrot juice, water, decaf coffee, etc....of course all organic. All to help me retain the fat and heal quickly. Also alcohol can cause angiogenisis-but red wine is an anti angeogenic. I was taking vitamins sourced from foods -many if not most antiangeogenic (Seeking Health- Optimal Multivitamin),  but now just taking Now Multi Vit for the next couple of weeks. I have also read that the older you are the lower percentage of fat takes :(

    One more thing- I asked my surgeon for a list of plastic surgeons for fat transfer (post breast reconstruction) and they gave me a list of 4 and I asked who did the most fat transfer procedures and I went  with the surgeon who had done the most.

    So far the only lumps I have are under my armpit scars where some fat was put in to level them out-surgeon said to massage them daily-so far it has helped to soften them so I will continue to do daily massage.

    Since this was my 5th surgery in less than 2 yrs due to cancer/recon, I decided to do a little something for myself and had just a little  fat put into my upper lip to get rid of the vertical lines. I looked like a smurf last week, but it has settled down. It is still a bit swollen, but will settle soon. I figured why not since they are harvesting fat anyway, and it lasts much much longer than injectables. 

    Will keep you updated as to what percent took and results....they say Iit can take months and months to see final results...

  • EnELLE
    EnELLE Member Posts: 31
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    To BostonNorthWest ... to ease your mind a bit....there were lots of changes to my new breast once the implant was put in last July. I regularly took photographs and as time went by a few of the irregularities settled and they improved on their own. I had a weird dent, funky lower fold and a blue window that resolved by 10-12 months after exchange from TE to implant. I had my fat transfer done 14 months after my switch out from tissue expander to implant. It may be to your overall benefit to wait a bit longer....also you will give you  more time for research and to find the best fat transfer PS for you. 

  • bethq
    bethq Member Posts: 177
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    Hmm, am considering fat grafting in a few months if my implants don't even out. My PS used two different sizes and we figured they would drop and be similar in size appearance wise. They are but the difference is the upper poles. One breast sticks out above a bra and the other does not so it's pretty obvious. I can probably live with that but if fat grafting can fix it why not? I do worry about more lumps and biopsies, oh my I don't want to go through THAT again. PLUS my Vinnies will have to wait until 6 months after fat grafting. 

    My PS said no compression garments or restrictions and I hope that holds true.

  • bobogirl
    bobogirl Member Posts: 2,083
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    Special K, my sweetie!  Was just wanting to PM you!  How are you doing?  You still have an sx coming up?  I believe we have one at same time?  I am going to send you a prezzie, so PM address..

    No gym for eight weeks?  Have been through one FG and they said compression for two weeks @ 24 hours, then 4 weeks @ 12 hours.  Zut!  No gym for first two weeks, walking for second two weeks.  I begged for yoga and pilates, at least, and was given lecture.  What do you think?  No yoga for eight weeks?

    They say if you exercise then blood flow blah blah blah, I cannot remember.  I have been talked at so much.  I do not feel in control of my body and am in worst shape of life.

    EnELLE, I found your discussion of angiogenesis highly interesting.  Does that mean you restrict green tea after FG?  And for how long?  My PS made me restrict it two weeks before, but said nothing about after.  So interesting.  I cannot have dairy, but I am going to try to think about this more.  Do not know much about what's anti-angiogenic.

    This thread is a big help to me.  Thanks you guys!

  • specialk
    specialk Member Posts: 9,237
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    bobo - I have an upcoming appt with my PS to set the first surgery - should be mid-Oct.  My PS is pretty restrictive on the compression and exercise, but having done this once before and seen the donor site result, I will follow his instructions.  It is just that Spanx and pajamas is such a weird combo, lol!  I am in better physical shape for these upcoming FG surgeries than I was for the first one.  Here is a list of anti-angiogenesis foods, so I assume these would be foods to avoid in the short term.  I had been following this from an anti-cancer perspective, but will slow down on it:

    http://blog.ted.com/2010/02/10/dr_william_lis/

    How are you doing?  I like the step-down approach of your doc, still a long time but not at 24 hours a day.  I took some very long showers as that was the only time I was not in compression!  My PS was mostly concerned about fluid accumulation in the tunnels created by the cannula, and a resulting seroma.

  • bobogirl
    bobogirl Member Posts: 2,083
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    I'm okay!  Feeling a little 'not in control of my situation,' but okay.  Yes we have to avoid seromas with you!  No seromas for you!  :)

    Okay... we avoid the food on the list?  For the two weeks before sx, and for how many weeks after?  Keep in mind I have one more of these sx at least after this one.. what are you going to do?

  • bobogirl
    bobogirl Member Posts: 2,083
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    Um.  OMG.  That list is, like, everything I eat.  What will I eat now?  Yikes!

  • specialk
    specialk Member Posts: 9,237
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    bobo - Lol!  Talk to your PS and see if they think anti-angiogenic food is an issue they feel strongly about.  Those foods are anti-cancer so they are good, but apparently bad for the newly infused fat?  I did not follow any specific diet, only increased protein, although I did add pineapple when trying to heal the open skin in the spring (for the bromelain), alas, while super delicious, it did not help, :(  I think that I will do what I was doing (which is not avoiding foods on the list) because I have very obedient and well-behaved fat, it is very hard to get rid of even when you move it to another location!  I had excellent fat retention when I did FG the first time.

  • bobogirl
    bobogirl Member Posts: 2,083
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    I am told I had excellent retention as well.  It's just strange since I have this smoothie recipe from another PS (not mine, he would never deign to give out smoothie recipes) that contains many of the foods on that list.  But that smoothie is for healing and immunity, not fat retention.

    I hesitate to do things to get fatter (i.e., eat more high-fat foods) since I am already feeling so out of shape!  What I eat a lot:  nutmeg, green tea, dark chocolate, kale, turmeric... lots of what's on the list!  

    :)

    I only like pineapple when it is room temperature.

  • specialk
    specialk Member Posts: 9,237
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    bobo - you're a pineapple diva, lol!

  • bobogirl
    bobogirl Member Posts: 2,083
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    You don't know the half of it.  My DLLP is a saint.

    p.s.  I am putting things in my amazon queue with which to possibly treat myself when I am stoned on pain meds!  Granted, they are useful things, like China gel, so it is not excessive.  But sometimes I feel anything I do not buy for the eight-year-olds is a splurge:)

  • EnELLE
    EnELLE Member Posts: 31
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    well I'm sure it's good to ask a DR about angiogenesis etc, but I wouldn't be surprised if they say it's not important. When I was in HS I had an internship for nutrition at a hospital and time and time again the Dr would cross off the certified Dietitian's diet recommendations. That was in 1980.

    Anyway, I stopped the antiangeogenic foods about a week prior to surgery and plan to continue for 4 weeks post op. 

    There are lots of other foods that are healthy and anti cancer....beans-especially garbanzos (hummus) lentils, and fava beans, macadamia nuts, carrots, millet, buckwheat, celery, onions (white-red are antiangeogenic) kiwi, salmon, white mushrooms, etc.

    If the changes in my diet for a few weeks could possibly help save more fat cells-I am going to give it a try-anything to help my plastic surgeon's expertise.

    I am a big proponent of diet and health-don't know if anyone else had this happen, but I had hives where my alloderm was put in with my TE and started an anti-histamine diet. Turns out during surgery I would swell up too according to my PS in Houston (not life threatening reaction) so when I started an anti histamine diet the swelling went away rapidly and I lost lots of water weight. 

    That was last year-when I moved to ATL for my ALND I told the anesthesiologist that I get a histamine reaction from surgery-she said immediately that it was probably from the morphine and not general anesthesia. I was given delotid (sp?) instead if morphine and no swelling after surgery other than my incision) -I had cankles post surgery before.

    For the fat transfer surgery I had delotid again and no additional swelling except at donor and transfer sites-so if you swell and gain lots of water from previous surgeries-you may want to discuss with Dr and/or anesthesiologist prior to fat grafting.

    I also am following an antihistamine diet  (as after all of my surgeries) now to reduce swelling at donor and transfer sites and it has helped tremendously-at 2 weeks to the day post fat graft all swelling and bruises are gone-do t know if it is typical -but I feel great now :)

    I have also read that there is a connection between histamine and lymphadema and since I've had ALND I have to be careful.

    Good luck to everyone to keep the fat (graft) :)

  • Dogsneverlie
    Dogsneverlie Member Posts: 164
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    Great info on FG - had my consult about a month ago and meeting with PS again on October 14 to lay everything our for a November procedure.  Thanks so much for sharing your experiences with FG - I have lost a lot of volume on the left and hope that it can be filled in and then some shaping done!  MAM MIA!  :)

  • EnELLE
    EnELLE Member Posts: 31
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    Hello all fat grafters :)

    I had another follow-up with my PS yesterday....I asked when will I see the final result of the fat grafting. He said at 3 months. We got into a discussion about fat and angiogenesis. With all of his expertise on fat transfer, etc. he pretty much said that they really don't know what makes the fat cells "take".

    I guess that throws out my experiment about avoiding anti-angiogenic foods...sigh. I will say that so far at 1 month that I have retained most all of the fat around my new breast and some fat that was put around my native breast. I don't have any lumps. I am, thankfully, very even and very happy....finally.

    I am going to slowly be adding back my anti-angiogenic foods. At least my food experiment added some variety and new choices to my diet. 

    Will post at 3 month mark with % retained...


  • AZ85048
    AZ85048 Member Posts: 1,467
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    I really struggled with my decision to have a bilateral revision with fat grafting back in June of this year.  But looking back, it was one of the best decisions I've ever made.  I was a little leery of the FG procedure but both my PS and whippetmom are huge proponents, so I decided to give it a try.  (Heck, I was already going to be out.)  I was warned that as much as 50% can be reabsorbed into your body, but I was lucky and had a really good result with the little amount that he used and it's stayed pretty much intact for the last four months.  However, as the implants dropped a little and the swelling went down, I have a distinctive crease across the inferior medial quadrant that is now quite apparent. I'm not wild about going under anesthesia again (is anybody?), but I'm going to do it one more time so my PS can do a substantial amount of FG to plump up my skin above and between the implants.  

    The first time I woke up to find two stitches in my belly button.  I was sore - like I'd done way too many sit ups - for a couple of days.  The bruising takes the longest to go away, but then I didn't really have a lot of that either.  This time, I expect to be really sore for a few days and a lot more bruised.  I had my pre-op yesterday and my PS said he's like me to wear some kind of compression garment for about a month because he's going to harvest from the flank area this time.  I'll let you all know how it goes...

    Shocked