Fat Grafting, pros and cons
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Kingster, he said maybe give it a month for the cardio. But he also said that no one really knows how exercise affects fat retention, so...
As to "overfilling," he said he put as much fat as he could in--without crowding it too much. If you crowd it too tightly it can't attach to a blood supply and will die and be reabsorbed or form fat necrosis. The overfilling part was that he put enough fat in to the cover the ripples, and then added as much as possible on top of that--in the hopes that as some fat is reabsorbed enough remains to cover the ripples. He doesn't think I have enough fat to do a second session, so we're really hoping this does it.
I think there are few known facts about fat grafting. My PS did say that lots of research is going on right now, but there's little in the way of answers. It is clear that surgical technique makes a difference (how they layer in the fat and how much) and how they filter it. Whether or not exercise, supportive vs compressive bras, diet (more/less fat or angiogenic) make a difference in retention is all unknown. Surely some of it depends on genetics--your body will do what it wants to do with its fat!
MJH1, I'm glad you're doing well! I hope everything stays as you want it!
I wouldn't hesitate to do fat grafting again as well. I was really sore for about 4 days, and the pain was pretty much only when I got in or out of bed. Sleeping was a pain though, it was hard to get comfortable. The anesthesia was the roughest part of recovering for me. At three weeks (and 2 days, but who's counting? : ) ) I feel pretty much completely fine. I suspect what really helped me was that I didn't lose a huge amount from any one area--400 ccs total fat removed from a bunch of different spots.
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Elizabeth, what fat processing system did your ps use? Mine uses the "revolve" system. I am one week out from FG #1 and am getting around better. I still look as if the whole front of me was beat up or in a car wreck. That is mentally tough for me. Can't wait for my bruising to go away. My ps recommended another FG session in 3 months. I do believe that would be way too soon for me. I really don't like that the whole process of breast reconstruction seems to have a never ending series of surgery. Since not much is proven regarding exercise and fat retention, is maybe why he had no opinion one way or the other. I think I will gradually get back into the swing of things when I feel and look less beat up;) I, on the other hand, seem to have plenty of fat stores:/ How do we come to the place where we can look in the mirror and say...good enough? Also, my chest is still sore more than I expected. Is that bad?
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I had fat grafting done in June and I've had some fat necrosis and the doctor actually had to biopsy a couple spots couple months back and today for my 6 month follow-up I noticed a pretty large lump in my breast and it actually was a fluid pocket due to the fat grafting as well has anyone experienced either of these issues from fat grafting; lumps of necrotic fat/tissue or fluid pockets
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Mommyathome, what do they plan to do with the fluid pocket? Sorry to hear about this. I am only 1 week out from FG, and still trying to overcome the soreness and bruising. Will they aspirate it or just leave your body reabsorbed it? Are you to massage it?
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Kingster
Since it was so large and it was actually causing discomfort and anxiety because I could feel it she aspirated it. I had a few other fluid pockets too but they were smaller so she left them
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Mommyathome--I'm so sorry you've had such a bad experience! Finding lumps has got to be very scary.
KIngster--I can't imagine going in for another surgery in three months! Ugh. I had no problem with an iv for my first two surgeries, but it took them 2 tries on the third and 4 tries on the fourth. The nurse told me that veins take a year to recover. Surely your whole body needs time to recover! I'm sorry you're so bruised. I actually like bruises--I know, I'm weird!
but I didn't bruise that much. I had basically no bruising from my biopsies, and most people I know had tons. I don't bruise easily, so I'm sure it varies a lot person to person.My chest is still sore and sort of tight. I'm surprised at how long it's taking. I think soreness is not a bad sign--red, swollen and increasingly painful would be bad!
My PS told me what system he used to centrifuge, but I've forgotten.
I don't know when you get to the time when you look in the mirror say things are good enough. I suppose you either just get sick of surgery or love what you see in the mirror--or a combination of both. It's not like I loved what I saw in the mirror before BC! My family is really not into me having more surgeries--they think I should just be done. I'm alive and (presumably) cancer-free, so why keep going? I really dislike the ripples and dents and flat spots. I don't like looking fake and strange. So I'll continue until I feel like I look sort of normal...
Hoping everyone is happy looking in the mirror soon!
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Elizabeth, I told them that I can't even fathom another surgery right now...I'm only 1week out. Maybe he just offered that as hope because he could not fix all the problems this time. Anyway, now my skin in the upper foobs area seems ultra sensitive now. I hope that goes away with time. I also have bad veins to pick from since I had a total of 4 surgeries in the last 15 months. I kinda have a feeling that I will be sick of surgery before I am pleased with my reconstruction results. I had 165 ml of fat placed per side, and I have 700 ml implants...so my chest also feels full. I appreciate all my doctors and their efforts on my behalf;) I knew that I would bruise badly because I have always bruised easily. It is getting better everyday. Is this skin sensitivity normal? And how long should it last? Thanks for your input ladies;)
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You all sound like you are doing well. Someday these docs will get together and come up with a plan to recommend that works most of the time. Until then, we get different advice from different plastic surgeons. (sigh) All you can do is read anecdotal stories from those of us who've had fat grafting, research different methods, ask a million questions, and cross your fingers. Unfortunately, we are all different.
By my experience, it's a more painful surgery than you would expect. I took absolutely no pain medication in the hospital or at home except Tylenol since I'm allergic. My chest was tender but my abdomen was SUPER sore for several weeks whenever I moved. I had a large amount of fat harvested by the tumescent procedure and can really recommend it. The donor areas did not bruise. On my chest, only a few of the grafted spots had quarter-sized yellow marks for several days. I wore hospital grade abdominal compression binders for over 6 weeks and did not exercise during that time either. I had no fat necrosis, lumps, or problems whatsoever and have kept the fat on my chest. My PS said NO massage of donor areas and NO compression of any kind on the grafted areas.
To have more surgery or stop??? You will know when it's time to stop. All of us have our limits. Many are after perfection and have surgery after surgery in pursuit of it. Others say good enough is good enough at some point. Anesthesia experiences, family issues, and your age play a role in your decision. I'm 66 and after 6 surgeries in 15 months, I knew it was time to stop and live with the remaining imperfections. Perhaps if I was a young single woman, I'd be more inclined to seek more surgery.
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kingster - hang in there. You r not alone in this winding journey. There were many day when I thought I would never see the light at the end of the tunnel and/or look in the mirror without cringing. Of course most of this time I had no idea that my pec muscle was over dissected n retracted n so I really only had skin covering my implant until I started going on numerous consults after.revision 1. I knew when 3 surgeons told me u can't reattach a pec muscle n it was going to b " challenging" to get me symmetrical n ripple free that this would b my last surgery. Th e one thing that bothered me the most since my exchange has always been the rippling medially n i knew that i would not stop until i could get that resolved. Luckily i found the PS who had the right tricks in her magic hat (still keeping fingers crossed). Whippetmom was instrumental in helping me find her for which I am so grateful.
Maybe we should start a revision, revision, revision thread since unfortunately there r so many of us that need fine tuning.
Sandra - 66 is still very young 😉.
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I'm 4 months out of fat grafting and I have a walnut sized lump of necrosis. Is there any chance this will be absorbed so late out from surgery? Or would it have to be surgically removed?
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philomene, have you tried some firm massage of the lump? I found that it was a good way of breaking it down and allowing it to be absorbed
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MJH am I remembering correctly that you had significant reabsorption?
Kingster, I don't know if my skin is ultra-sensitive or I'm just ultra-sensitive to it! I'm so afraid of anything pressing on my fat that I'm very protective. I'm having a hard time letting the seatbelt touch my chest because it seems like too much pressure. Maybe I'm just ultra-sensitive!
I do know that liposuction can cause temporary nerve issues--especially numbness, and I am feeling that in my flank area. Presumably that's temporary...
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Well ladies, looks like I am up for fat grafting scheduled for Nov 24th, a little worried as I am thin 5'4" and 129lbs. Going to try an add a few pounds between now and then but I walk 10-12 miles a day delivering mail. A little nervous also about how quickly I will be able to return to work, especially right at the holiday season.
Interested in what other ladies my size and their experience with fat grafting have to say
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Catey, how much fat is the PS planning to take? If it's only 100-200 cc's, it shouldn't be much of a problem. Also do you know what procedure the doctor will use? Tumescent minimizes bruising.
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Sandra not sure, I go for my pre-op on the 11th and need to ask then. Any other questions I should ask?
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catey - I am about your size, an inch shorter, and fluctuate a few pounds lighter. I am fairly slender but I had some fat available due to 7 surgeries in the preceding 24 months and the steroids from chemo - I was not in shape even though I was fairly light. I have had fat grafting three times - the first time I had the most fat removed with the abdomen and hips as the donor site - for the purpose of filling the hollows above my implants. In this surgery I had the largest quantity of fat removed, 1.25L, because it was filling fairly large divots, and I think my PS was aggressive with the removal (Merry Christmas to me!) and was not sure how much he would need, so he erred on the side of being generous I had no fat placed anywhere over the implant. I was uncomfortable for about a week - but with compression on the abdomen I could walk around comfortably and drive, and I was instructed to wear the compression for 8 weeks, 24 hours a day. I did not wear a binder because I am short-waisted and it would not stay around my abdomen - kept riding up - so I wore tight Spanx. I had an 8 week exercise restriction, and was not allowed to lift more than milk jug. If you are similarly restricted, carrying mail may be an issue - but I was allowed to walk. One thing to consider is that walking that far daily may cause increased re-absorption of the grafted fat - not sure, nobody really knows why it absorbs for some and not others. Are you carrying a cross-body mail bag that presses on your chest? That could also be a problem. The next two fat grafts were done after the loss of my left implant. I have had a host of skin issues and these were smaller grafts to improve the quality of the skin which normally covered the implant, like some PS are now doing for those with rads damage. I did not have rads but had extensive necrosis that left my skin very fragile and thin in spots. The fat beefs it up and provides increased vascularity. The first of these I had 500ml of fat harvested, and less than 50ml grafted. My PS had the same restrictions even though it was considerably less volume that was harvested. The third fat graft was with a different surgeon, but the procedure was the same - grafting to the flat skin to improve the integrity, with the same volumes. The harvest area was toward the back of the hip and had a similar amount taken, graft site the same. This PS only had a two week activity/lifting restriction, with no insistence on compression, but I wore it anyway, just not as long. I did develop some lumpiness at the donor site but it disappeared with aggressive massage. I will most likely have FG again since I will have an expander placed in Dec., and go through the process of expansion and exchange again. I will wear compression longer this time to avoid the lumpiness. I had tumescent with all three procedures - my first two the bruising went completely away within a couple of weeks, and I had none at the graft site. This last one I had a lot more bruising and it took months to go away at the donor site. I could not have worn a bathing suit - it was pretty severe.
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I had FG with my exchange, and my PS gave me the ok to do any exercise I would like except high-impact two weeks after surgery. I've noticed in the last few weeks that the fat is being reabsorbed some, especially on my dominant side (left). I do believe that I've overdone the exercise. I have more FG scheduled with my nipple reconstruction and I'll stick with very light upper-body exercise for a while after that, see if I can get my body to hold on to the fat better!
I never bound the donor site (inner thighs), and while I did have a bit of lumpiness for a couple of weeks, it's now completely gone and back to normal. I didn't massage or anything.
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elizebeth - nope not me. I'm sure I had some absorption but its so hard to tell since I had a lot of pocket work done. I'm still not quite sure how much she took out and grafted as far as ml because I keep forgetting to ask but I know she did say she didn't put a lot in. My donor sight was abdomen and I'm very slender so not sure that there was a whole lot to take. For this reason I specifically asked her not to use multiple donor sights because I was having a lot of pocket work n wanted to save what little fat I have just in case I needed another FG session. I'm 2 months post op n the rippling medially is gone n have some mild rippling in one breast in The upper pole but really only visible when I bend over. Looks great in a bra or bikini so keeping my fingers crossed that it stays this way.
Catey - my restrictions were the same as specialk so my only concern would be carrying a mail bag. I would also ask your PS about the gaining weight b4 FG. I was told to specifically not do that as your fat is better at your normal body weight. I personally consider specialk the FG guru n followed all her recommendations. Each PS is so different in their instructions but who better to ask than someone who has had it multiple times. One thing I can say is that if u r going to wear spanx get the snap crotch. You'll b so glad u did.
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My wife's reconstruction surgery is coming up on Dec 8th. Right now she has her expanders in after her double mastectomy. I believe through all the fills she is roughly 480-500ccs. she is 5'4 140 pounds and has finished her last chemo on the 7th of October.
One of her main concerns is the FG. She is worried that the fat will become hard, create lumps etc that will be hard to detect if there is something more in her breast than just "hard fat" if that makes sense. Is this a concern for anyone else? Ways that you have dealt with it if you have had FG done. I have seen/read in the discussion boards that the are some who have had to have biopsies already on those areas to just make sure.
Is FG worth it?
thanks
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Amstar, that is so sweet to write on your wife's behalf:) I just had FG almost 2 weeks ago. 165 ml of fat was placed on each side. So far, it feels softer and warmer, and my ripples are gone! But, I was told it takes 6 months before you can tell the final results. Some fat is usually reabsorbed. I have a hard lump above my umbilical site that I have been massaging. There was extensive bruising on my abdomen and mild bruising on my chest. One of the ladies here has had fluid pockets aspirated and biopsy done due to FG problems. FG seems unpredictable and is a leap of faith. Good results have been obtained and made it well worth it. While others have had a lot of fat reabsorbed and not worth it. I have to wait about 5 1/2 more months to see if it was worth it for me.
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Catey, I'm 5'4 and less than 120 pounds. My PS was really concerned about being able to harvest enough fat, but he ended up getting more than he needed! He did use multiple donor sites, and we're really hoping this round is enough because it's unlikely I can do it again. He took 400cc of fat. I would also suggest not trying to gain weight--when you lose it and go back to your normal weight, the grafted fat loses weight too. I think you want to be at a stable weight. I had rippling, a bit of a step-off and a rib showing like a lump in my cleavage. I'm only 4 weeks out, so I still have plenty of time for the fat to reabsorb, but so far FG has solved all of my issues.
I second SpecialK's concern about carrying a bag. At four weeks out I still hate the feeling of the seat belt across my chest, and I had a really hard time with a purse (even just hanging off my shoulder) for at least two weeks.
SummerAngel, I'm really struggling with how much to exercise and when. My PS and I talked about it, and he told me that they really just don't know how exercise effects fat retention. Initially he had told me not to run or do yoga or Pilates for 3 weeks. When I saw him at a follow-up at 3 weeks, he said he was so happy with the results that he'd suggest being ultra careful and not running (or other cardio; he mentioned no spinning) for a while longer. He said Pilates was ok, and I only do very gentle stretching yoga (Yin, for anyone wondering). I did one Pilates class, but I was careful not to do any exercise that involved weight on my arms/chest. In my past surgeries I've been walking for long distances pretty soon afterwards, but this time I've been more cautious.
I was planning to walk instead of running for somewhere in the 6- to 8-week range, and I plan to avoid weight-bearing on my upper body (no planks, downward dogs, etc.) for that long--maybe longer.
Summer, you're at about 2 months post-FG, right? Would you wait until then to do more? I think it's tricky because when you see the loss of fat it may be the result of something weeks before that. It takes time for the fat to be absorbed. And maybe it's not related to anything you did or didn't do--I think fat does what it wants to do!
Off topic, but fat related: When I was pregnant the first time, I ate very carefully and exercized a ton. I still gained lots of weight. My firstborn was premature by 5 weeks--although we were both fine--so I decided to do things differently the second time. I ate anything I felt like and quit exercising. I gained pretty much the same amount of weight and lost it pretty much the same way as well! The baby was only 2 weeks early, but who knows if that was a result of the exercise/diet change or something else. I think I'd gain that amount of weight with a pregnancy unless I starved myself! So perhaps your body's reaction to fat grafting is genetically pre-determined, like your body's response to other major changes.
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Successful fat grafters--my PS told me I could start wearing a "sports bra" at this point (4 weeks out). My regular sports bras are very compressive, so I bought a lightweight bralet thingy in a larger size than I would usually wear. Do y'all think this is a safe time? I had been wearing a post-surgery vest thingy (same as after exchange and BMX, only one size larger). I'll admit that I wore the bralet thing yesterday and then got nervous about it and went back to the post-surgery vest thing today. It's not uncomfortable, but it's impossible to hide under clothes! My PS did not like the braless idea, he thought that some support was good but not compression.
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elizabethaw - where are your grafts again?
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The grafts are upper pole and cleavage--covering rippling, step-off and rib-bump between cleavage. I would think that pressure on the sides and bottom of each breast would be ok, but top and center not. You'd think an outright push-up bra would be fine! : ) The bralet thing left the very tiniest little line (barely visible) across the upper pole area.
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elizabethaw - hmmm, I wore Genie or Coobie - generously sized after the FG I had for the upper pole and those applied virtually no pressure to the graft site. The last two have been directly on the front, right by the nipple, but I have no implant there, so without a prosthesis the bra applies no pressure either, since it is big enough to accommodate my 650cc right implant. I think something supportive that doesn't really press on that area is what you need, but I would think as demi a cup on the bra as you can get would be the best - not easy to find, right?
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I suppose I don't know exactly the extent of the graft. I know my PS tries to "feather" the fat smoothly into the surrounding area, so it's probably more extensive than I think. I can see the incision mark--and it's right by the nipple on each side. I suppose I need a supportive bra that only covers the lower pole area and not the nipple. Hate to say it, but I'd bet you could find such a thing online. My poor PS would die of embarrassment if I email him a photo! : )
Thanks for your advice, SpecialK! You are so very helpful!
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Elizabethaw, yep, I'm about two months out. I started running on an elliptical and doing weights two weeks after my exchange. I didn't start back with the lightest weights I used when I had the BMX, but instead started at 10 pound free weights for most exercises and "cheater" pushups off of a bench (as well as hanging body lifts for my abs). My body tends to be thinner on top, anyway, so part of me thinks that maybe my body is just doing what it normally would do. I am planning to go about 8 weeks next time before I do any weight lifting with my upper body, though, just to try to help in any way I can. I'm not sure that would make a difference, I keep thinking it will just shed the fat once I start working the area again.
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elizabethaw - if you really want no pressure over the surface of the breast just google "cupless bra" to see what is out there - you can even get one from Amazon
I also just looked at what comes up if you google demi cup bra, or balconette cup bra there are lots of options - both cover up less of the top of the breast and provide support from the lower portion.0 -
SummerAngel and SpecialK, thanks so much for your responses! Don't you wish there was some way to know how much exercise and bra type after FG even mattered? As much as I hate to go for long without exercising, I'm thinking I may stick with the most conservative 8 weeks before doing serious cardio (running) or any weight-bearing exercise on my arms/chest. I'm going to the gym and walking on the treadmill and going to Pilates and skipping anything chest/arm-related.
As much as I love my surgeon, I wonder if a bra that supports but leaves the upper pole uncovered/uncompressed might make more sense. There would certainly be no harm in it that I can see. I do think I'd feel pretty weird wearing a "cupless bra" to work! : )
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E - a cupless bra is kind of a why-bother bra, but I think something unconstricting, with support, is fine - as I said I wore generously sized Genie ones - it worked for me. Cupless at work, while potentially entertaining, is probably not a good idea....lol!
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