Fat Grafting, pros and cons
Comments
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OK, oh wise ones who've gone before. I need some advice. Yesterday I started feeling little "zaps" of quick stings at both the donor sites and the grafting sites. I'm guessing that the ones in the lipo area are because the nerves in the damaged tissue are waking up, much like many of experience on our chests in the early weeks after mastectomy. Not sure what the grafting site stinging is though. The very minor bruising is just about gone. I'm 1.5 weeks out. The stings are not at every injection site or lipo site, just a few.
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Sandra - I have not had this happen, but the same logic would apply I would think. In order for fat grafting to "take" it has to vascularize and integrate with the existing fat/tissue - I would assume this involves potential nerve regeneration. There are some who report increased skin sensation after fat grafting, so it would make sense if it was nerves.
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Sandra - had fat grafting two times. I had the zaps both times. Not sure what caused it, but I had no issues with any of my procedures.
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Oh thank you SpecialK and BayouBabe. I feel better now.
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Sandra - I, too, had 'the zaps' but only after my last (more extensive) fat grafting procedure. (The one where I turned every color of the rainbow...) Anyway, they didn't last very long and weren't nearly as intense or as frequent as the ones after my BMX. My PS said that the zaps and the burning sensation are pretty much par for the course with fat grafting.
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I started to say, "good" but I'm not glad you had these little stings too. I guess what I mean is its good to know what I'm experiencing is normal.
Another thing I realized, is that I had 1,000 cc's of fat taken as opposed to some others who had 100 cc's. That's bound to make a difference in the internal turmoil those cannulas caused.
Last night the top little incision (about 5-6 inches above my navel) was really complaining. I opened the binder and felt relief so I left it off and didn't even sleep in it. This morning my belly was quite sore in that area. As soon as I showered and put the binder back on, the pain went away and my whole abdomen felt better. Do you suppose I'm doing any harm by once in awhile going without the binder? I had it on 24/7 the first week, but have slept without it twice now in the second week. Sometimes it drives me crazy as I'm falling asleep and I think I can't stand it another minute. It's not too tight. The PS showed me how tight he wanted it and I'm following directions...99% of the time.
If I need a scolding, please give me one.
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Sandra, maybe he'll let you wear spanks instead? Do you have a post op soon? Also I'm curious. If he took out 1000cc, how much did he inject up top after he spun the fat in the machine? I'm going for my saddlebags and I hope I will see a difference. It's weird that I'm thinking more about my thighs than I am about the ripples in my foobs.
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sandra - since the purpose of the compression is not for pain relief, but rather to keep fluid from collecting in the cannula tracks or a seroma from forming, and the instruction is to wear it 24/7 - I'm here to scold you!
Julie - I am thinking sandra had a significantly larger amount of fat removed because of the correction on her side - it is pretty unlikely you will see much of a difference if what you are having corrected is some rippling. I am also not sure how strict her doc was in following the "only remove the amount you are using" rule because her procedure was performed in a military facility. In my first FG I had a considerable amount injected in the hollows above the implants - there was a pretty significant divot - and I really did not see much difference in the donor site (abdomen).
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The1,000 cc was all usable fat after the aspirated tissue went through the centrifuge to spin out the blood products, epinephrine and lidocaine solution. I've read that those byproducts can be up to 1/4th of the amount they remove. My discharge documents show the fat itself was measured after processing so that's how I know it was 1,000 cc's.
All of it did not go on my chest. A percentage was used to repair and restore the soft tissue lost on my left side after the infection. He also re-used the tissue from the oversized left mud flap.The "skin and bones" areas are all nice and plump now both on my chest and on my side.
I don't see any difference - my abdomen looks the same. Bummer. I've read that when PS do contouring, they take 3,000-4,000 cc's (3-4 liters.) More than 4 liters of processed fat is connected to sometimes dire consequences so other than Hollywood types, I imagine most people don't really get enough taken out to notice a difference in the donor area. As painful as the donor site is, you'd think it would look smaller afterwards.
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Thanks, SpecialK. My pre op is on 1/15 and I'll ask her how much she anticipates removing. Even 100 on each side would be nice
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I have had lipo/fatgrafting twice with fat from my abdomen. I have definitely seen a change in the donor site. It takes a while for the swelling to go away.
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Thanks Julie. I'm just 2 weeks out today so maybe in a couple of months I'll have a nice slim body! A girl can hope.
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i am devastated I cannot continue with fat grafting as I need so many procedures and simply cannot afford the cost. Had I not had the serious infection it would be different, I would be almost finished by now........but that left so much fibrosis I can only have small transfers each time........
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SpecialK, could you please describe the fat grafting process? If i remember correctly it's done in two stages. Always? If so are either done under anesthesia?
I have a divot on the upper pole towards the center of one breast . (After immediate implants, Not TE's) Also, have a slight one on the other side but it's only noticeable when I raise my arm. Want that one done at the same time because I work out at a gym and want to be able to raise my arms without a divot showing.
You have excellent experience with this process (and lots of other processes as well...)Too many and am hoping your next TE surgery will go off without a hitch.
I know you had fat grafting to beef up your thin skin and make it more viable for your next surgery but I'm assuming fat grafting I'm speaking of is the same process that you experienced?
Btw, was anyone given guidelines for when it's safe to work out with upper arms on weight machines at a gym?
Best...
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ocean - I have had fat grafting twice. Initially I had it about a year after exchange and it was done to fill pretty large divots above the implants and below the clavicle. I have a pretty bony chest and the excavation of breast tissue in the area above that which was filled by the implant left large dents. I did not have any fat placed over the implants themselves, only above them to fill the divots and soften the step-off. Doing this type of graft made the slope look much more natural. I had fat harvested from the abdomen - upper and lower - and injected from two entries in the cleavage aimed upwards above the implants. This process was done as an outpatient under anesthetic. It was not done in stages, other than the fat is taken, centrifuged, and reinjected - but this is all done in one surgery. I woke up in a compression binder around the abdomen only - the area where the fat is placed is not compressed. I wore compression 24/7 for 8 weeks, no physical exercise during that time other than walking, and I had lifting restrictions. I could drive as soon as I was not taking pain meds - which was almost immediately. This is the type of grafting that would be used for your correction of a divot on the front of the breast, but some docs use a drop by drop method to try to prevent fat necrosis.
The type of fat grafting I had done recently to aid my skin is for a different reason, but the harvesting process is the same, as are the restrictions afterward. I had much less fat taken from the donor site, and the fat was injected in small amounts under the entire area of skin which would be occupied by an implant or expander. The purpose of this is not aesthetic, but rather it is to increase vascularization and flexibility of the skin to help it accept the stress an expander or implant will cause.
Any type of fat grafting procedure is subject to reabsorption of the fat. This happens often, but I have been fortunate to not have it happen discernibly. Some folks have grafting done and all the fat is absorbed, some have a percentage, and grafting is often a procedure that has to be repeated, sometimes multiple times, to achieve the goal. It is important to know this in advance and be prepared for multiple procedures, or complete failure of grafting as a method for fixing a defect. Also important to note is the fat necrosis I mentioned above. This can present as a lump or nodule after grafting. So, your divot might be fixed but now you may have a lump, which may, or may not, need to be biopsied. These are considerations to think about before you do a fat graft, as well as typical surgical complications - like infection, seroma, or other problems. I am not trying to dissuade anyone from fat grafting - it has been great for me - but it is always good to know the risks.
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Excellent overview of fat grating and details of your two procedures, SpecialK. Before I had it, I had no idea what it was actually like so your words are helpful to those coming up. I might add that there are different ways of harvesting the fat (liposuction) but I don't know why one procedure is used over the other. I'm guessing that it could have something to do with how much fat they need to remove in order to fix the problem. I had lipo to get rid of a large "mud flap" under one arm six months ago. The traditional method was used and at least for me, it left some rather spectacular bruising which took more than a month to reduce in size and ultimately fade. For the fat grafting I had 2+ weeks ago, the same plastic surgeon used the tumescent procedure to remove 1,000 cc's of fat and there has never been one tiny bit of discoloration, much less bruising. I have 6 openings, about 1/2" to 1/2" long incisions on my belly, two on the sides of the upper abdomen , one about four inches above my navel, and three others across the lower abdomen. My restrictions are just like SpecialK's. Wear the firm Velcro binder on my abdomen 24/7 for 8 weeks, no exercise, and no lifting anything over 10 lbs for three weeks. There are no drains involved. I'm not to raise my arms above my shoulder either. My surgery also included scar revision and removal of the remaining mud flap so I have about a 4" incision towards my back. The surgery was 3 hours.
There are seven small injection points across my chest and two under my arm, closed with one very fine absorbable stitch. In the second week of recovery there were minor small nickel and quarter-sized yellowish spots at the incision points where the fat was injected but they are gone now. I wear a soft bra 24/7 as well because it just feels better, not because I was told to.
The first two days my chest and abdomen felt like they were burning, which is from the nerve damage I suppose. Tylenol worked fine. After that there was no pain as long as I was sitting down. When standing, the donor areas are painful for 5-10 seconds, but as you stand straight it goes away and you stop shouting "OUCH." Even at my stage now, gravity is not my friend. My abdomen is sore - just not even close to as sore as it was two weeks ago. My chest is tender to the touch but not painful. The donor site incision areas are healing fine with no redness but they are still tender to the touch. The discomfort improves greatly when the Velcro binder goes back on after showers.
This is an easy recovery and well worth the donor site pain. I drove in my neighborhood at 2 weeks but turning the wheel was uncomfortable and the swelling on my chest was the problem. There's not a lot of it, but I can feel it if I twist or reach across my body...so I don't.
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Special K and Sandra, than you for sharing your experiences. 16 more days for me!
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Hi everyone! I have a question about recovery. I am a manicurist. In April the plan is to lift my natural breast and fat grafting from my upper abdomen to my flap. I'm a pretty tough cookie when it comes to pain meds and recovery. How long do you think I should allow for time off work? I was thinking a Wed. or Thurs. surgery and back to work the following Tues. or Wed. Is that too optimistic? After being off so long for the flap surgery I really can't afford to take off too long and my job is pretty sedentary.
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sacnail - I used to live in Sacramento! For the FG piece the greater area of discomfort is the donor site - and your return to work may be more dependent on what that site is. So, if your upper abdomen is used sitting upright and engaging your core to do so may not hurt at the beginning of the day, but may at the end of the day. It is also dependent on how much fat is taken. I had quite a bit more in the first FG I did and was uncomfortable longer than this last time, but not more than a week or two. The skin is uncomfortable for a longer period at the donor site - a burning stinging kind of pain - but usually for me just when I took the compression on and off. I had abdominal lipo also and quickly found that having the snap opening on the Spanx panty was genius - that way I didn't have to take the whole thing off. I think the more problematic issue may be the lift - that is a more invasive procedure and may interfere with you reaching forward and keeping your arm above waist level.. You might peruse the uni threads to ask some of those who did a lift to match their reconstructed uni how they did with pain and return to work.
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Hi! I'm having a lift and FG on January 16th. Earlier someone posted that they were on antibiotics after the procedure. Did anyone else have to take antibiotics? I'm concerned as I was on very strong antibiotics in March after a post-op infection and then on them for a month after my MX and flap reconstruction in May. Since then my system is not the same and I am trying to heal my gut and strengthen my immune system. Unless absolutely necessary, I don't want to take any more antibiotics. How vulnerable do you think you are to infections post op? The incisions seem so small and couldn't you just use a topical for protection?
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My PS had me take a course of antibiotics after both of my fat grafting procedures. However, one FG was during exchange, and the other was part of a revision surgery. Maybe that's why
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Rubyiat,
You must not take a chance! Take it from someone who got an infection after my BMX which took 5 more surgeries over 15 months to repair the damage. Although I had little prior experience with antibiotics, the infection was not even slowed down by three kinds of IV antibiotics in the hospital during the first three days. They finally put me on what they call, "the antibiotic of last resort, IV Vancomycin" and I stayed on it for 5 weeks, through another surgery and even at home with a visiting nurse. After every 3rd dose I had to have my blood tested to check for liver damage. If an antibiotic was going to set me up for problems in the future, this experience should have done it. It didn't. For all the rest of the surgeries including #6 three weeks ago, I had IV Vancomycin with no problems...and no infections!! For surgery #5 in October, the PS did not send me home with it for the first time. We took a bit of a chance and went with an oral antibiotic, Cephalexin (Keflex) for 10 days. No problems.
After the fat grafting three weeks ago, I again had IV Vanc in the hospital (I got out on day 2) but came home with Keflex for 10 days. Again no problems.
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Thanks Bayou and Sandra!
What a horrific experience Sandra! I hope this last surgery corrected all the problems and you are pleased with the outcome. That is a lot to go through! I got a staph infection after my third lumpectomy that led to another surgery and I definitely don't want to go through that again. You are right, I shouldn't take any chances.
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Do not risk it without antibiotics, it is a fairly high chance you will get an infection and you only need them for one week but if you get an infection you lose all the graft and more tissues too, not worth the risk..............I can no longer continue with FG due to a massive infection a year ago that has left me with so much fibrosis despite detailed attention to try and prevent that..............
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So sorry Lily55. You tried your best to not get an infection but got it anyway. No one on this thread thinks infection is no big deal, but some of the comments I've read on other threads just floor me. I wonder if people knew how serious an infection can be? Perhaps they think it's like a cut that gets infected...a little Neosporin and a Band-Aid will fix it. Even a painful infection like strep throat can be cured by some oral antibiotics in a few days, usually without any complications.
I read people saying they have too much to do so there's no time to rest and are not concerned. They say, "Oh, I don't have to worry, I'm on antibiotics." That's not good enough! Lot's of us were on antibiotics and ended up with an awful infection. Too much activity leads to increased fluid output which can lead to a seroma and perhaps an infection. Sometimes in spite of taking all precautions, something goes wrong and people don't want to give the symptom the concern it deserves. I've read comments like, "I don't want to bother my doctor. It's just a low grade fever. I'll wait and see what happens. I'll just call his office on Monday."
Those of us who've been through it might seem overly worried, but we KNOW how bad it can be. It's not worth taking any kind of chance.
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I was on antibiotics and got an infection, and it was so bad it took all previous fat grafting and more tissue besides, and to give you an idea over 500ml of pus came out of that one area.........sorry to be graphic.......it was horrendous
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It sounds horrendous! What an ordeal Lily - I am so sorry you had to go through that. As much as I dislike the idea of taking antibiotics again, I think the risk without is more than I want to take. Thanks for sharing your story.
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At 3.5 wks I've noticed another step toward healing. All of the sudden the swelling on the left side of my chest went down. Now I can touch my right shoulder with my left hand without discomfort. The other side never has been a problem but then again, less fat was needed there. The little marks where the fat was injected are shrinking and going away. Three still have the dissolvable stitch but the others are gone. There is no tenderness in my chest any more. All but one of the donor sites are pretty much healed. It's the one above my navel and has always been more tender than the rest.
Standing up still gets my attention by hurting briefly. I'm losing patience with the discomfort in my belly. There's nothing I can do about it but wait. Hopefully it will be gone this time next month when I get "released" from compression binder prison at 8 weeks.
I was getting up from the recliner today and pushed up with only my left arm without thinking and OUCH. Dummy.
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It is good to celebrate these little steps. I'm glad to hear the swelling has gone down and the incisions are almost all healed. I bet being released from the binder will make a big difference in the discomfort in your stomach. One step at at time....
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I'm wondering if anyone was not told to wear a compression garment after FG? I'm having fat taken from my thighs for my breast, but I also have a large indentation at the tissue donor site on my right thigh that will be filled in. If I can't compress my inner thigh where they are injecting fat, then how will I compress my outer thigh where they are taking fat?? Too much fat transferring:)
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