Fat Grafting, pros and cons
Comments
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Thanks, SpecialK! I think I'll email both my PS and his PA and see if they're sure one week is enough. Better to have more than I need.
It's frustrating how unpredictable the results are with FG--it might reabsorb, it might not; it might come back, it might not. Stupid cancer!
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E - and stupid fat!
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I had FG done 3 months ago and it went well. (about 6 months after the bmx and immediate implants.) I'm having another FG surgery in a month to completely fill in the upper pole area where there was an area that looked hollow after the pec muscle relaxed and the implant settled.
The PS I see does nothing but breast reconstruction and every type of breast recon. He does NOT recommend wearing a binder after FG surgery.
My FG was from my abdomen and the amount of bruising was shocking. The pain is significant but it only lasted about a week. Very easy compared to the other surgeries.
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Oceansky, glad to hear your FG went well. I am scheduled in October. How long did you take off of work? I work 10-12 hour shifts as a recovery room nurse. How long should I take off for recovery? Also, how much of the fat did you retain? And do you think FG would fix an incision that contracts inward? Good luck next month. It must not be too bad if you are doing it again:)
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Good morning! I've been following these discussion boards for months now and am so thankful for all of the information you women have shared. I am 33 and was diagnosed with stage 1, her2+++ breast cancer last Nov. I had a double mastectomy on January 15, did 12 rounds of taxol and Herceptin (am still doing Herceptin), and had my reconstruction on June 24 (I got 420cc anatomical gummies). I love them and think they look great but as most people have shared, they feel quite firm. I know it's still early and they'll soften up more but I'm curious as to how fat grafting has improved the feel of your implants. I love the anatomicals but I'm considering fat grafting to increase my upper pole fullness a bit and am really hoping that it will also improve the "squishiness" of them. It sounds like they have pretty much ruled out the theory about fat grafting increasing recurrence risk so my only big worry is developing lumps from fat necrosis. So my questions are: 1) did fat grafting improve the feel of your implants? 2) did fat grafting make a big difference on the appearance of your implants? 3) Any major problems with new lumps from fat necrosis? 4) I've read that some women report gaining sensation back in their breast after fat grafting...any truth to that?
Thank you all for your willingness to share! This is a dreadful journey but being able to share in forums like this makes it so much better! Fight on breast cancer sisters!
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Kingster, I don't work but for me it took only one week before I felt back to normal. There was residual pain, but I think one week is enough time. Of course, you should ask your PS what he suggests, but that was my experience. Some people told me the surgery was 'worse' than the BMX but I disagree.
I retained a very good amount of the grafted fat. It was an aggressive amount of filling. Not a minor amount of fat grafted.
Special K explained how the pec muscles relax and the implants settle in a post on another thread and that was exactly what happened to me. So after the immediate implants went in they looked pretty perfect. After a few months though the cancer breast/foob side developed a fairly wide (about four inches) indentation above the breast...The pec muscle relaxed to the point where the implant settled slightly lower. So there was a sunken look on the upper side near the cleavage, not on top of the implant buy directly above it.
The first FG filled it in completely but after a while there was still a slight dip. A huge improvement and I could get away without doing another FG, but it does show slightly with V neck shirts, etc...and I want to finish the process and have it look like a completely natural breast.
PS's who are very experienced with FGing can do 'smoothing' techniques with FG, and I expect that as well. They explained that after just one FG the area will be slightly lumpy/bumpy but the subsequent FGing will fix that. So I'm having the second FG to not only fill the very shallow dip but to smooth that area. Not sure if I explained that right, but that's my understanding.
As for how FG will affect an incision that is contracted inwards I have no way of knowing. Much of it has to do with your PS and his experience with FG. What did he/she say he could do for it?
Sboese, I'm sorry you're having this experience. I don't have gummies so I can't respond to the firmness issue. I have Mentor 500 round implants and they feel 'normal' in terms of squishiness. Mine feel like real breasts.
As for your question about FG improving the look and feel of the implants...I can say that it didn't change the feel at all, and the look I'm achieving is an improvement in the area directly above the implant. My FG is not actually over the implant itself but in the area above it. Yes, it has very significantly improved that.
Good luck with your decision process. I would look to your PS to help with your concerns. Also, if you're able to get more than one opinion I would recommend it. I'd try and find a PS with a lot of experience with FGing.
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Oceansky, I'm so glad to hear about your results. It's great that you retained so much of the fat. I really wish we knew how to make it stay put! : )
It's also fascinating to me how different each PS is. The no-binder recommendation is really interesting. Mine said it was very important. Of course that sort of thing has been true all along--every step of the way there are PSs that do things one way and some another.
The only way it makes sense to me is a comparison with gardening. I start lots of plants from seed, and if I tell someone else how I do it, they don't get the same results. I've worked out over time what works best for me in my little basement area. I suppose the same is true for cooking--my oven, my stirring, kneading, etc. techniques are going to be slightly different. Over time you find what works for you. A PS with a lot of experience presumably is developing what works for him or her. I'd love to have one set of rules--follow them and get perfect results. But we all know that's not how real life works.
Sboese, my first FG is scheduled for Sept 11th, so I don't have results. I have seen women post who have felt improved squishiness (not to mention warmth, which would be nice). I've also heard reports of increased sensation--which would also be very nice. However, I think those are somewhat unpredictable factors. Well, just retaining the fat where you want it is unpredictable enough! I've got big ripples (maybe you'd even call them dents), and my PS gives it about a 50/50 chance of fixing them for good in one surgery. I am of course hoping for everything good to happen, but I'd be satisfied with no (or even much smaller) ripples. In addition to the ripples I can see, I've got a ripply texture I can feel all across the upper pole area, and I'd love to improve that as well.
I did ask my PS about fat necrosis, and he said that in the last 5 years, with about a dozen FG per week (he has started including FG in almost all exchanges), he's had two patients have lumps that were significant. He's also had two divots in the donor site that had to be corrected.
I agree that having this forum is immensely helpful. Everyone is so kind and helpful.
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Thank you for the comments Oceansky, I'm glad to hear it improved your implants! Good luck with your upcoming procedure Elizabethaw! I completely trust my PS but don't see him again until December so have plenty of time to keep learning from you ladies! Please keep sharing how your results are!
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I don't see how fat grafting can affect sensation since that comes from nerves that were cut in the initial surgery. Fat wouldn't help nerve regeneration. (It does affect coldness, however.) I had extensive fat grafting (over a quart) eight months ago and have noticed no difference in sensation. As to firmness, it depends on the kind of implant of course, but also on the pocket created by the plastic surgeon. I can tell a difference because of pocket revision done to limit migration. The size of the implant vs the size of the pocket can create a firmer feel. Time also affects the feel after the pectoral muscles relax. What I've noticed is that my chest feels soft now that's there's more than skin and bone there. Was it worth it? Yes. Would I do it again? Probably not. The recovery from a large fat withdrawal is pretty painful in the donor sites.
Most women have fat injected into the upper pole above the implants rather than between the skin and the implant so that wouldn't affect the feel of the implants.
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Sandra, as I understand it, the tiny chance of increased sensation is from stem cells that are transferred along with the fat. It is possible for them to help reconnect nerves.
My FG (coming up on the 11th!) is to fix rippling, so it will have to be between the skin and the implant to fill in those ripples. I'm cautiously optimistic, but the PS gives it about a 50/50 chance of success...
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Had FG done on 31st as part of revision. Had the fat removed from abdomen n under arm of one breast. Not sure yet how much was removed or reinserted but I don't think they would have gotten more than 100-200 cc on me. Absolutely no pain in abdomen but am sore under arm. Came home in a binder so that could explain why my abdomen doesn't bother me. Had the tumescent method so have 2 Tiny incisions in bikini line thathave a steri strip on them. Finally got a sponge bath today as I can't shower until drains come out. Surprised no bruising anywhere in t am also taking vitamin c n arnica forte so maybe that's why. One thing I was not forewarned about is how much you will have to pee the first day. Definitely did not rest the first day as I was going to the bathroom every hour but I do have a pea size bladder so that may be a reason too. Put spanx on after bath so binder could be washed...definitely a 2 person job.
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Can some of you who have had fat grafting at least 6 months ago talk about your final outcomes? Does anyone have issues with lumps? I saw my surgical oncologist this week and he was supportive of fat grafting once I'm done with herceptin and a little farther out from my cancer...but he made it sound like it would absolutely be lumpy. True
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sboese - I had FG done for aesthetic purposes (to fill out and soften the upper poles bi-laterally) in Jan 2013 and had a significant amount of fat lipo-ed and grafted. No lumps at the donor site or graft sites. I have had two more grafts, Nov 2014 and May of this year, for skin strengthening after loss of my left implant. No lumps after either procedure
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So glad to hear that SpecialK! I would really like to fill outy upper poles a bit but not at the risk of being paranoid of new lumps. Did you accomplish what you wanted with your upper poles? I love my anatomicals but they are a tad flat on the top and I'd like a bit more cleavage.
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Sbose, no lumps in the donor area or grafted areas for me either after extensive fat grafting in December. I had almost no fat under the skin from clavicle to the top of my implants due to a very "thorough" double mastectomy. Nearly a quart of fat was grafted into that area and under my left arm where infection and many repair surgeries had left mostly skin and bone. Most of the fat grafting was successful. I did lose a little under my arm but my nice plump chest has stayed. No lumps, no flat areas or uneven areas anywhere.
Good luck!
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Thank you for the feedback Sandra and I'm so glad to hear it worked well for you! I'll be done with herceptin in Feb so have lots of time to decide! Did those of you who had fat grafting think it made a significant improvement in how your breasts look and feel
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sboese,
Unfortunately I wasn't as lucky as Special K and Sandra. I do have lumps in my breast now do to the fat grafting. I have had to have my breast ultrasound and tissue and fluid removed to test for cancer cells. Luckily it came back negative but yes now I am paranoid, once again because I can now feel lumps in my breast. How am I to know if the are cancerous or not?! I have one spot that is sensitive to touch, a limp about the size of a grape and itchy. Not sure if I shooukd contact breast surgeon again or not. They just did ultrasound like s month ago or so. I go back for my regular follow up in October but not sure that I can hold off that long. I feel like u could seriously be calling the doctor weekly to have these checked to keep my sanity! My breast surgeon said it is fairly normal after fat frafting to have lumps but my plastic surgeon never tells anyone. My breast surgeon and plastic surgeon work together.
Any advice from you ladies on whether I should wait until October to have it checked out since I just had a "biopsy" a month ago and an ultrasound? Gosh seems like the worry will never go away!!! I thought that's why I chose the bmx?!?!
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Mommy, I would be paranoid too, but that's just me. I would call. I have my exchange in 3 weeks and have 2 big, what I call, gullies at the top of the right expander. I have a pre op appointment with my PS on Wednesday. Is this something to be concerned about? Or, do implants plump this out? Did you have gullies or divots before exchange? Should I discuss this with PS? I am starting to get nervous.......already
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sunshine,
Speak to ps about it. I had divots above my implant that's why I chose fat frafting to fill it in and make it more natural looking. It does look better but now I have the damn lumps. Good luck with your exchange!!
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Can anyone tell me how tight the compression garment should be? I was going to buy a spanx-type thing as a backup for the one the hospital gives me. (They only want to give me one, and I'm thinking it would be nice to have two.) I tried on a couple, but they weren't uncomfortably tight. That would be nice (comfortable is good), but do they need to be uncomfortably tight in order to work? I suppose you swell up so much after surgery that comfortable now might equal uncomfortably tight later?
Any advice??
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mysunshine - ask your PS how much FG work they do, and how they do it for filling in the upper pole. Yes, my divots were there after exchange just like they were prior because they have excavated that area of breast tissue in the BMX and the implant didn't reach as high up. My FG was done by layering in the fat under the muscle and over - you want an experienced person doing this. Even with an experienced PS you may end up with lumps - that is just the nature of fat grafting, but you should ask your PS how often it happen in his/her practice.
Elizabeth - I aimed for tighter than I would wear for regular purposes, but not uncomfortable. And, yes, you will have swelling so what feels moderately tight will be tighter, at least initially. Depending on where your donor site(s) will be - if they are abdominal you can get a binder that you can adjust - like this linked below. I could not use these because I am short waisted, and have a small waist, and the binder kept riding up and chafing. I did better in a high waist panty with a snap crotch. If you go with a panty type I highly recommend the snap opening - saves pulling the garment over your tender skin.
http://www.amazon.com/ITA-MED-Womens-Breathable-El...=sr_1_9?s=hpc&ie=UTF8&qid=1441556267&sr=1-9&keywords=surgical+abdominal+binder
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The nice thing about buying a garment especially made for post-ops is what it's made of. I had no idea until I looked into it. Manufacturers make fabrics for medical use that stretch to specific percentages. They mix these strengths when constructing an abdominal binder to provide optimum compression in the right areas. There are lots of different sizes to accommodate all sizes of people and to compress certain parts of the anatomy. The hospital gave me two abdominal binders by Dale. They are available in several widths, lengths, and sizes on Amazon for $20.
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Where do you get a panty with a snap crotch? And, if I need fat grafting, can it be done the same day as the exchange? And, how long do you wear the binder or panty? And, I thought this exchange would be easy and Inwould be done. Ohhhhhhh
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And, if you need fat grafting later, is it a long surgery? Recovery again? Compare it to the exchange surgery. The only surgery I can relate to now is the BMX and none of this is making me feel very good.
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mysunshine - I purchased a high waisted snap crotch panty at both Dillard's and Macy's. I had FG done a year after exchange and wore the compression garments 24 hours a day for 8 weeks and was restricted to walking only, could not go to the gym. I had a couple of weeks acute discomfort only when getting up and down, or taking the garment on and off - but for the most part was just a bit sore. I could drive within the week. This surgery is not comparable to a BMX, and mine was about 90 minutes. Some of the surgical time is for centrifuging the fat and preparing it for re-introduction. Some plastic surgeons will do FG with exchange, mine did not. He felt that we needed to wait for the swelling from exchange to go down to see where fat would be needed, but I have seen other docs do it with exchange - you will have to check with your own doc.
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Special, Thank you for all your answers.
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Thanks, Sandra and SpecialK! Unfortunately, I will have multiple donor sites--belly and inner and outer thighs. So I need a more complete garment. I hate to buy something too expensive, but maybe it's worth it. I'm hoping I can talk to PS's office into giving me two garments!
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my PS provided garments It was a long line "girdle" with zippers on both sides. No pulling up over skin. Was crotchless. So did not have to take it down.
I'd recommend asking Ps.
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Elizabethaw - you probably won't find a usable snap crotch shorts type product but here is an affordable possibility that has the right configuration of compression.
http://m.target.com/p/assets-by-sara-blakely-a-spa...
I have one like this, with an open bust so as not to compress the chest. When I wore it I had to take it completely off to go to the bathroom though. It was a better choice later in the process when I didn't have as much skin sensitivity
http://m.spanx.com/products/38-MSSS5615
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Hi ladies
I will be having FG done Sept 18th along with Botox injections into pec muscles for this animation!
Robin
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