Fat Grafting, pros and cons
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jnccobb - I am not sure if I would do fat grafting and nips at the same time since you have the potential of having your grafted fat reabsorb and change the placement of your new nips. If it were me I would wait to see whether the fat takes and then do nips after six months or so, particularly if you are attempting to add volume with the graft. Most don't report a great deal of difference in size at the donor site - your PS has to be sure they are taking basically only as much as they need so that your insurance doesn't deny payment for what they consider to be a cosmetic procedure rather than a breast revision.
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jnccobb, I will be having nipple reconstruction with skin graft from groin and fat grafting too at the same time on Monday 5/4, this note from my PS when I asked if I was rushing him by doing both things on Monday and if I needed boy shorts along with shapewear: "The shape wear alone will be OK, this will hold the dressings in place. I think the fat grafting at the same time makes sense, should not add to the recovery appreciably."
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I'm a very confused sister that needs advice. I have been following this thread but not posting yet as I haven't had FG done I have been on three consults with PS which they told me I would need FG (among other things). So, of course, armed with all the knowlege I gained from this thread I asked them if I would have to wear a binder, spanx, etc. They each told me no. Of couse, I asked the last PS if he ever had FG done and he said no. I know that you should always follow your dr order and each dr is different but I obviously do not want to create divots or channels in my donor sites. Does anyone know if having to wear a compression garment depend on how much fat they take?? I just don't know why 3 drs told me no when most of my fellow sisters that have had it wore something. Any thoughts?
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mjh1
Every PS is different. I'm on week 2 recovery after FG. When I saw my PS on Monday, he said 4 weeks. I've read where others are told 8 weeks. I've yet to read no binder at all.
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MJH -- My PS doesn't advise to use compression or a binder. I've had fat grafting twice -- first time from the abdo and second from inner thighs and sides. I also had diep surgery and had no compression or binder, and I know a lot of women do for that surgery as well. My PS is the head of surgical oncology at our largest academic hospital, and only does reconstructive surgery for cancer, so I trust him -- haven't had any issues with not using compression so far, but from I've read here, most seem to recommend it.
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jkfinnigan good luck onMonday. Let me know how you make out. I see ps again in June trying to make a list of questions.
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You are going to feel a hell of a lot better with compression if you have anything close to as much fat grafted as I did. If it's only a couple of hundred cc's, it might not make a difference.
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My surgery went well on Monday. PS did the nipple reconstruction with skin graft and did fat grafting from inner thighs, although there are little bandages on back of thighs too. I see him in the morning for a dressing change. Have the Madonna cone, gauze and plastic over left breast, will get a peek tmw! Skin graft is uncomfortable but not too bad. Thighs are bruised, buts haven't needed anything for pain since yesterday morning.
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OMG, the Madonna cone...my DH would love that!
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kfinnigan - glad surgery went well and you're on the mend. I hope this journey will finally be over for you. Speaking of Madonna cones, I'm going to see her at the Barclay center in September.
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when my PS said Madonna cone, the nurse giggled! Mjh1, her concert will be fabulous, she is in terrific shape
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Ack!! I'm seeing some hollowness on my chest that wasn't there a month ago. Damn. Reabsorbed some of the fat. I'm 4.5 post op.
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oh Sandra I'm sorry!! I also think some of my day re absorbed. It soooo sucks! I was wondering just last night if I'd do it again... Hm not sure. I low people say sometimes it takes more than 1 fat grafting session.
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I need help please
I had my exchange with fat grafting on April 1st and have a question.....the donor sites on flanks have long since healed even though they were very bruised. However the donor sites on tummy thru the umbilical are very strange and painful!
Was told by PS to massage them. But there are two very large bumps size of a fist on my tummy between breasts and waist.
They are very sore.... Any ideas?!?!
My physical therapist said they might be hernias *?!*
Have call into PS...but his nurse is on vacation and they are "very busy"......
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Hi Everyone - I'm new to this thread but thought I'd pop in and introduce myself and tell a bit about me.
But first....
bbbun - I'm sorry you are having issues. I've had a number or recon surgeries but other than weird nerve pain and hot spots I've never had mysterious bumps as you've described. I do have a bit of a tennis ball sized bulge above my belly button but it is natural fat that has been pushed here from the last surgery I had. I hope that you hear back from your PS's office soon.
I have had a very lengthy recon since single MAST (left side only in 2009). I really can't believe how long I've been at this now and it seems I'm not quite done yet.
Since my MAST in 2009 I've had TX and then started recon with TE (Sept 2010) along with natural breast reduction & lipo (underarm), then exchange to Gummy implant (early 2011) with natural breast reduction again, then a round of fat grafting (May 2013 from lower abdomen), and then another round of fat grafting (Feb 2014 from lower abdomen & flanks) + tummy tuck and lipo.
My first fat grafting was to improve the thin radiated stretched skin and alloderm showing through the bottom half of my recon breast. It was very successful.
The second fat grafting was to continue to improve the thin skin areas and soften my revised MAST scar. Again very pleased with the results.
All of my recon has been covered by health insurance except for the tummy tuck (I paid for that myself because I thought it would be my last surgery).
I saw my PS yesterday (Monday) and he suggests another round of fat grafting (from upper abdomen - tennis ball area) to be done this Sept.
I have mixed feelings about having another surgery but I do agree that I still have a slight depression with a bit of a dog ear and some purplish skin on the left side (close to my underarm) that will be improved with more fat grafting.
My MAST incision was closed with staples and since starting my recon I have seen vast improvements in the overall look of my recon breast "mound". Where I have already had fat grafting the scar is practically gone and just a faint white hairline is visible. My recon side is plump and I have cleavage.
Based on my personal experience I do recommend fat grafting to anyone who has the opportunity to have it done.
But I also have to question at what point do you stop?
I'm not complaining about my PS or the work he has done for me so far or even the FREE lipo but at some point I"m going to have resolve myself to the fact that this is as good as it will get for me. My breasts will never look or feel the same...so why bother?
On the other hand when I look back at what I started out with I'm very fortunate to have a PS that is working with me for this long and also approaching my recon in a cautious and conservative way. I think that is why I have had so much success with my recon so far.
Anyway that's my story but I'd love to hear from others on their opinions of when to stop fat grafting or recon altogether.
Marie
ps. I will read through back posts and get to know this group better!
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marieK - welcome and wow!!! You certainly have had quite a long journey. When do you stop?? When you know you can live with the result and be happy looking in the mirror. if you've had great results so far yet notice still some areas that could be improved, I would definitely try one more.
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Thanks mjh1! I think you are right - when you feel you can live with what you have facing you in the mirror is the time to stop.
I should add that after reading some of the posts here that I feel sooooo lucky not to have had any complications of set backs on my recon journey. It's just taken me a long time because I don't want to do more than 1 surgery a year and my PS is very conservative.
Thanks EnElle for posting the list of foods and sharing all of your success strategies! I do normally eat a lot of pineapple because I read that it's good for fighting inflammation both post surgery and pre-TM marker blood work. But I'll keep in mind the list after my next FG surgery and see if it makes a difference. Also I swear by 25 green grapes for helping with constipation post chemo and surgery.
For me, FG was recommended to fix rippling, a divot at my cleavage, visible alloderm and flattening of implant due to tight MAST scar. It has tremendously helped with my skin appearance and texture after radiation left it tight and dry looking.
I had chemo followed by radiation after my MAST but had to wait 3 months post rads before my PS would even start my recon. Throughout my recon I have been on Tamoxifen and since my FG I have been on AI with no skin issues.
I'll also add here that my first FG was taken from my c-section scar site but after that I was left with a lot of hanging abdominal skin - like an apron. I did NOT wear any compression garment and my PS did not advise me to wear anything. However for my personal comfort when I wore something a bit clingy I did wear panties with a front compression panel - I think they are WARNER brand and I got them in a 3 pack at Costco.
Because I needed more FG and because of the "mudslide" look of my abdomen I decided to go for a full tummy tuck at my second FG procedure. After that procedure I wore a binder (woke up with it in hospital). I wore that for 3 months!! I did give myself some breaks and wore a full spanx (from under breast to thighs - with pee hole) to several events after 2 1/2 months.
During FG I also had fat deposited on top of my implant around my MAST scar and around my implant (top and sides) to improve and soften the overall appearance.
In each case I also woke up with a surgical front closure bra like the one I wore after my TE and exchange surgeries. My PS did recommend wearing that for 2 weeks.
Thanks to everyone for posting their success strategies and suggestions (and photos) here for others like me who need reminders and encouragement on this recon journey.
Marie
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bbbbun
I also have a fist sized bump in the lower abdomen after fG. I thought it may be scar tissue. If you find anything out from your ps please post!!
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Hey guys, did anyone figure out what those abdominal lumps are? Just curious.
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I had my left breast revision and fat grafting last Wed-I will say I am definitely glad those first 4 days are over. Was a bit tough. I think the worst continuing problem is the drain site but hopefully tomorrow morning that will be out! The donor was abdomen-looks like truck ran over it. Lots of bruising and quite colorful. 99% put around left implant (top) and small amount top of rt implant. Think I will wait several months before considering having another graft done-kind of like having babies-you forget the worst of it and enjoy the end event!?? Char0 -
Char - good luck with your healing. It is amazing the colours you see after lipo bruising. You mention waiting "months" before doing FG again.
I'm wondering - from you and others who have had multiple FG - how much time (normally) between FG procedures?
I'm having my 3rd FG in sept but have waited longer between procedures (1st may 2013, 2nd February 2014). I feel like my FG is staying pretty much where it was put but I just follow my PSs recommendations.
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My, ladies! You have all been through so much!!! One never hears about the pain, time spent healing, and overall emotional toll BC recon takes on a woman. I am so lucky to not have needed it...at least not this round...and praying for never. Before knowing my type of BC, my doc went over all possibilities and since my mom and her mom both had it, thinking there may be a genetic component, the doc told me about mastectomy with immediate recon. After researching it, I thought no way in heck would I do that; possibly only if they could do a nipple-sparing one...but also because pain-killers don't work on me, either...only make me sick. Kudos and blessings to all of you brave enough to endure everything you have gone through. Women are so amazingly strong!!!
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Hi ladies~ I am so sorry I did not post more timely about lumps in the tummy! My PS kind of blew it off...grabbed hold of the fist sized lump and squeezed and kneaded it....ow ow ow.....said it was fat and to just keep massaging. So I will continue massage now that my PS thinks that it will help to do so. He didn't explain and I didn't ask as to HOW the fat got there.
I believe I am losing the fat grafting little by little...I must stop checking and fretting. ( FG and EX was 4-1-15)
One thing I did not know until my meeting with PS last week is that FG is a onetime deal in the US according to insurance so if I have another FG, it will be out-of-pocket!!!! Bummer!!!
On a good note: I am CANCER-FREE!!! Yippee!!! and the implants are very soft and squishy (small..... Sientra 435cc high profile which is fine for me) ... soooo.... 6 weeks out and I'm feeling fine and ready to go to Oklahoma and enjoy my 6 year old granddaughter's Ballet Recital!!!!!!! And can assure her 3 year old brother that "Bunnie's boobies aren't broken anymore" !
With love and hugs, Valorie
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Just got back from 7d Fat graft and revision post op apt w PS-drain removed! Yahoo!!!! That was the biggest obstacle! Now on to massage-am to use "rolling pin" twice a day on abdomen - and I thought they were only for rolling pie crusts! Who would have thought! Am to continue with compression on donor site and bra for support 24/7. My question is how much compression does one need? Right now am using the surgical abd binder I got after surgery and rib high to thigh like a spanx. I am just concerned that it is enough pressure. How do I know how much is right? Any suggestions on brands or types would be appreciated. Back to rolling! :-) Char
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bbbbun - glad you're healing well. try not to fret just yet. I was surprised to hear you say that insurnce will only cover one session of FG. I'm still trying to plan my revision which will include FG so I haven't checked on that but I thought that by law since it's considered part of breast reconstruction they must cover it. I would double check on that.
char66 - glad you got the drain out. I hope you are able to roll out that lump. it painted such a funny picture in my mind that I just had to bust out laughing. I wonder if insurnace will cover the rolling pin...lol.
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I am having the third FG, insurance approval not a problem, and I will probably do a 4th. It is coded as a breast revision, so this may be an individual insurance thing. Reconstruction is covered by federal law if your insurance covered mastectomy, but revisions are an iffy area.
bbbun - keep in mind you also had swelling, so you may be having less swelling, which is not the same as fat re-absorption.
mariek - some docs like to wait about 6 months between FG so they know how much of the fat is staying from previous FG procedures.
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I had my fat grafting January 22nd and kept nearly all of it. It made such an improvement and I'm glad I did it. I met with my PS yesterday and we both agree that I'm done! I'm really relieved because it was somewhat painful and I did bruise a lot. Good luck to all of you!
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Congrats Julie. I know that is a relief. I can't wait to be at that point. This has been a really long journey. Glad to have been able to travel this road with you from 3/10/14 until now. Do you or did you do nipples? I can't remember right now. Hope to hear from you down the road.
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Hi jbdayton! I want to get 3d nipple tattoos. I just need to think about when and where!
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I too had 2 FG which insurance totally covered. For me FG was the best thing I could have done. It improved the integrity of my skin so much so that I was able to go direct to implant on my bc side. My PS says my skin on that side is like that of an LD flap!!! And before the FG I had major skin issues and had to have my TE removed!!! Wishing you all similar results!!!!!!!
Bab
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