Fat graft entire breast
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Misstic, How are you doing with your fat grafting/transfer surgeries? Did you finish up all three? I do hope it went well for you. Did they shrink considerably?
Beblev, Did you find a PS in/near Maryland? I'm in Delaware and may start looking in surrounding states.
Adrielle, If you don't mind me asking, how is your fat grafting holding up? Did much of the fat reabsorb, or did it stay in your breasts?
I find the whole breast autologous fat transfer with lipo so interesting! I am a candidate for nipple sparring mastectomy (bilateral for me) and have not had radiation. I also currently have implants that were put in years ago for cosmetic reasons. So, I'm thinking I may be good candidate for whole breast fat transfer. I no longer want implants. My PS suggested extended DIEP with PAP (thigh), because I'm 5' 6" and 130lbs, but I don't like the idea of thigh and stomach donor sites. Lipo fat transfer is looking very appealing to me.If anyone else has had lipo fat grafting to create a whole breast, please let us know how you're doing. Thank you!
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Outdoorsy, my all-natural replacement breasts are doing fine. I can't imagine having implants or having slabs of skin/fat moved from other parts of my body. My body feels perfectly normal. The grafted fat is staying put -- it's been almost a year since the last round of grafting, and everything that was still there a month or so after the graft is still there now. With each round of grafting, about half of what goes in doesn't stick, but at least for me, that all happened in the very short term. As long as you're not looking for more than a A cup, I think fat graft-only is a no-brainer, unless you have general healing problems that might increase the risk of complications from the multiple harvest sites.
However, not all insurance covers fat graft-only reconstruction. No clue why not -- probably just that it's fairly new, but as far as I know, they all cover fat grafting for filling in after lumpectomies, filling out around implants, etc. I was a bit concerned because I had to change insurance after I'd starting fat grafting. Aetna stopped selling individual policies in my state, and my only real option was BCBS which says it doesn't cover fat graft-only reconstruction. I didn't have any issues with BCBS, but that may have been because the fat grafting had already been started before I had to switch to them. Even if your insurer doesn't officially cover this, since you mentioned you've had some other health issues that make implants seem like a bad idea, you might be able to get an exception if your PS is willing to argue that it's medically indicated.
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Yes-completed 4 years ago. I recommend that you check out the fat graft website-contact Dr. Khouri in Florida-I used Dr. Christina Ahn in New York-fabulous results-minimal down time. Wishing you the best, Eilee
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Thank you, EileenKaye1 and Adrielle. I'm so glad to hear that your procedures were successful. And thanks for the physician names. I'll check them out.
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Eileen, I read your whole journey on fatgraftpatients.com. I was really drawn in and riveted to read it because you didn't sugarcoat it. I appreciate how real you are. And I admire you immensly for your resolve to continue to try in spite of the difficulty, and ultimately your persistence paid off!! I am so happy for you. I can't imagine the feeling of living with chronic pain for 16 years with implants and then finally getting pain relief AND soft, bouncy, warm breasts with fat!! Your story is the only one I have read so far, but it has greatly encouraged me to give more weight to this option for myself.
I do have a question, I know you gave me your email and thank you so much for that but I thought it would be good to ask it here so others could get the answer if they are also wondering. With implant based reconstruction, my understanding is that cancer screening is just clinical exams every 6 months, then yearly. An MRI would be ordered only if the dr feels it is warranted. This makes me a bit nervous. I am nervous because an implant would make it harder to see a tumor on the chest wall anyway, and obviously would not be felt w/clinical exam as it would be behind the implant.
So with AFT reconstruction, how are cancer screenings done, and how often?
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Hi everyone and thank you for posting your stories. I've come to this thread because of a meeting I had with a third reconstructive surgeon who gave me yet ANOTHER recommendation for my reconstruction and I'm now more confused than ever. This time it involves fat grafting. (Sorry this got so long!!!)....
Briefly my story: Cancer in my left breast 2005. mastectomy on the left, (w/chemo and rads). In 2007 my onc. had me get prophylactic mastectomy on right with immediate recon. Went into surgery that day believing I was getting a bilateral DIEP flap. Instead, somehow, my PS had me slated for a Lat Flap with an implant on the right and nothing on my left side. I did not know this until I was laying on the gurney with my shower cap thing on my head. I probably should have gotten up and gotten dressed and left but through all kinds of tears and emotions, I let him talk me into it. I ended up hating the Lat flap and hated the implant. Got a staph infection from my back wound to my breast requiring another surgery. It was all so traumatic that I didn't go back or do anything else for over 10 years.
I'm now ready...tired of looking at this body So I met with three surgeons. All three agree that I need a DIEP on my left, radiated side.
Surgeon #1, who did my original reconstruction says I cannot do a double DIEP because I don't have enough fat. (I'm 5'2" and weigh 130-I have PLENTY of fat). Besides the DIEP flap on left, he wants to use a silicone implant in my right (I have a saline implant there now). I told him I was fine being a "B" cup but he says I won't be happy with that and that i'll be too small. I ask about fat grafting, to give me volume above the implant but he said he doesn't believe in fat grafting because the body just re-absorbs it and it never stays. He is the head of surgery st a major cancer hospital here in Los Angeles and mostly all he does is breast reconstruction.
Surgeon 2: says I have plenty of fat for a bilateral DIEP. I have one more meeting with him tomorrow, I actually have a surgical date of Feb. 21st set up with him. That gives me 8 weeks of recovery before I go back to work. I have not discussed fat grafting yet. (Dr. Tseng at UCLA).
Surgeon 3: Wants to do fat grafting on right, with or without an implant. He said because I already HAVE a flap on that side (my lat flap), he doesn't want to give me another flap but will use the muscle that is there from my Lat Flap. HOWEVER....he wants to do the DIEP flap ONLY during the first surgery. Wait until we do Stsge 2 and THEN start working on building right breast with my fat. After thinking about this, I have several questions and problems with this.
1. I'm already going to be sedated and in pain from the DIEP surgery. Wouldn't it be better to start the grafting while I'm under and recovering anyway? (He says the DIEP surgery is a big surgery and enough for one day).I know I still have Stage Two corrections on the DIEP side, so woukn't that be a better time to do the second fat grafting?
2. I've been wearing a prosthetic on my left to match my right. So how will I appear even after having a DIEP, (which would end up to be about a B Cup), and my "C" implant?
3. I know the fat doesn't hold right away.. How long does it take for your body to re-absorb the fat to know how much more fat you need to inject?
I'm so stressed out having three totally different recommendations. I REALLY love Surgeon 3 (Dr. Leif Rogers) and I would choose him in a second, but the more I think about only doing one side and waking up from surgery lopsided again, I may not be able to go with him.
Plus, I have BCBS insurance. Not sure what they will cover.l as far as fat grafting.
I'm terrified to go through this again. Wondering if I should wait until next year?
Would love to hear your thoughts on this and sorry again for such along message!!
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maybe call surgeon 2 and ask what they will do with the existing lat flap on the left. Perhaps he plans to use it plus some tissue from DIEP to build that side and use just DIEP tissue on left to get the volume you need on both sides. If not, starting from scratch may not be a bad thing especially when it comes to symmetry. Don’t know if it could be done but I’d ask if he’s not using the lay flap can he reconnect it where it was prior. Surgeon 1 cracks me up saying he knows what you’ll be happy with. Um, I’d have to say no to him. Somewhat also reminds me of the personality you describe of your original PS.
Fat grafting is known to reabsorb. There is no way to predict how much or how little your body would reabsorb though and it can differ grafting session to grafting session. As long as it’s coded right BCBS will pay for multiple fat grafting procedures. Odds are surgeon 2 will use fat grafting during stage 2 to fill upper poles and symmetry if needed. From what you’ve written and what I know I’d go with surgeon 2’s plan.
A dr can have great skill but no bedside manner (thinks/assumes/insists they know what a patient will and won’t be happy with even when the patient tells them what they will/won’t be happy with and it’s in opposition). A surgeon can have great bedside manner and lack skill or the confidence to get the procedure done as perfect as possible in as few surgeries as possible without compromising patient wellbeing and outcome. It’s a rare surgeon who has the combination of both skill and bedside manner.
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surgeon 2 seems the most reasonable. I had both breasts fat grafted. No DIEP. It took five, yes five, surgeries for enough fat to hold without any implants. The radiated side was difficult. I’m a B now.
Also, if you feel like shlepping to Torrance, dr lisa Jewell has great bedside and is very skilled. She only did my last surgery but I loved her!
Any surgery is difficult, but I’m really happy with my outcome..
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I like surgeon 2 as well. I was 5'3" and about 125 to 130 pounds. I have ample fat in abdomen to do a left side DIEP also had plenty of extra skin. When I ask if they used everything they said yes. The second surgery they managed to get fat out of my thighs for grafting. No implant after 5 years Im thinking of another fat grafting I'll see. I am losing the extra weight AI drugs packed on. I really need a tattoo that doesn't disappear the 2 times I had this were a failure. Still haven't brought myself to call a tatto parlor.
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meow- on the tattoos, have you looked into going to Vinnie Meyers? His work is amazing.
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Mitzi, I would lean toward #2 or #3. If you really like # 3, I don't think his plan is unreasonable at all. A diep IS a big surgery. A bilater diep even more so. You will likely need revisions anyway, so I don't think if you went with #2 you would be "one and done", but I could be wrong. IMHO, Dr #3 is probably being cautious and not wanting to subject you to fat graft on day of diep because they are BOTH big procedures. The areas that the fat is harvested from will be quite sore. Also, there will be a lot of post op swelling. He may want to wait for that to subside so he can guage just how much fat needs to be grafted. I am assuming since the diep tissue will go to one breast, the fat for other side will have to come from another donor site. I myself am 3 months out from implant downsize w/fg. I want more fg done and implants downsized more, but my ps wants me to wait a few more months because it is hard to work on "a moving target" as the areas continue to settle as swelling subsides. At any rate, I agree w/the other ladies...eliminate #1!! And press the others for more info before deciding.
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