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Was fat grafting worth it?

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Hello, seeking feedback from those who had fat grafting with their exchange from TEs to implants. All input appreciated, with particular interest in results on those carrying a moderate/lower amount of fat. Was the resultant appearance of your breasts worth the extra procedure and recovery? How did the sites from which the fat was taken look afterwards? Anyone have grafts primarily from their sides vs front of abdomen? If so, any issues with asymmetry or odd contours? Feels a bit frivolous to be a concern amid everything, but might as well try for the best-possible experience and outcome. Thank you.

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  • nns121317
    nns121317 Member Posts: 115
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    I had a direct to implant reconstruction, so no TEs, then had fat grafting about 18 months later (after chemo/rads). For me, the fat grafting was worth it. More natural appearance up top, and they used my love handles/flanks because I wanted to preserve my abdominal fat for a possible DIEP. I did end up doing the DIEP because implants weren't for me, and I am considering doing fat grafting again depending on how my DIEP looks (just had it done 2/20). My surgeon, whom I adore, made things very equal during fat grafting - no issues with contours or divots.

  • wishinguswell
    wishinguswell Member Posts: 9
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    @nns121317 Thank you very much for sharing your experience and addressing my questions—extremely helpful! Wishing you the best with your DIEP recovery and outcome.

  • needs.a.nap
    needs.a.nap Member Posts: 195
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    Hello @wishinguswell. I read your post the night before I was to have my exchange surgery with fat grafting and a reduction of my other side (my surgery was yesterday) and all I could think was, Wow! These are great questions to ask, I wish I had thought to ask them. I can’t provide any answers because everything is too soon to tell, but I went ahead with the fat grafting. I understand how it feels almost frivolous! And it does add a little more to the healing process which I struggled to justify but I reasoned that it’s one surgery, one recovery, and if I didn’t do it now, I don’t know if I ever would. My surgeon used my “love handles” and I’m now in a tight binder. I took pain meds last night and just did Tylenol and Advil during the day. If I sat still I felt fine but moving around is pretty tender. I haven’t looked at myself in a mirror yet, I’m not ready.

  • wishinguswell
    wishinguswell Member Posts: 9
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    @needs.a.nap Thanks so much for taking the time to reply right after your surgery. I hope your recovery goes well and I’m glad you’ve been able to manage your pain. I think I’m going to go ahead with the love-handle grafting with a similar mindset to yours: go for the best long-term outcome in one shot despite the extra healing. If you are so inclined, I would love to hear how you progress. I hear to expect pretty significant bruising and that pineapple and arnica may help. I’m scheduled for exchange in a few weeks. Kinda can’t wait; also kinda sighing as I’m finally unrestricted again physically with full range of motion and thinking about needing to re-rehab everything.

  • needs.a.nap
    needs.a.nap Member Posts: 195
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    Hi @wishinguswell. Those were my exact feelings … I was finally feeling almost normal again and able to use my arm mostly without pain … I was having some annoying shoulder issues in recent weeks and a little restriction that might have been from cording that was persisting in my chest. But the thought of having to be limited for several weeks again was making me second guess my decision to even have this surgery. I was stressing over if it would make my shoulder issue worse (I tried getting in to physical therapy but the earliest available appointment was around the same time as my scheduled surgery) so I’ve got PT lined up for next month and some massage therapy with a lymphatic massage therapist lined up for May. I’m determined to get back to as normal as I possibly can since it’s my dominant side and I do very physical work (gardening) and I’d like to be able to work this growing season. Sorry for all this detail. Just that I can relate to your apprehension.

    Interestingly enough, my arm and shoulder feel fine. Is it from taking pain relievers? Or limiting my motion? I’m curious if the surgeon was able to remove or break up some of the scar tissue and cording. It sounded like he was going to.

    I’m feeling pretty good today, I think the residual effects of anesthesia have worn off and I took the Norco pain meds in the night again but am just doing Tylenol and Advil during the day today. It’s uncomfortable but I’ve had way worse pain with other things so it’s fine. In fact, the pain is helping me remember to not use my arms too vigorously so that’s good in a way.

    So far, from what I’ve looked at, the bruising isn’t too hideous. I have one area that I think is a hematoma (it’s deep purple and is extra tender) … I had one from my biopsy that turned 2/3rds of my breast purple and it was super tender for a while so I’m not freaking out over this one. I do have pineapple and arnica so I’m trying that.

    I think at the moment, I’m glad we did the fat grafting. I can see that it has given a softer look to the implant instead of the weird hollowed out space I had above my tissue expander. I won’t particularly miss my love handles either. But I’m not sure how keen I’d be to doing any more fat grafting down the road (between paying a high deductible and subjecting myself to an additional surgery) … so we shall see what I look like once swelling subsides and the incisions heal.

    I never would have imagined I’d be discussing this, or having any of this … it’s still so surreal, that I had cancer! I’ll try to keep you updated and feel free to ask me specific questions (you could always private message me). Take care of yourself and try boosting your body before your surgery if you can (getting well hydrated is a big one)!

  • wishinguswell
    wishinguswell Member Posts: 9
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    @needs.a.nap - I’ve had cording issues, too, both arm and trunk. So glad I asked for PT and really lucked out getting in right away. Huge difference quickly in my range of motion and comfort. Lymphatic massage is the BEST. I’m hoping I can start up again with at least that part of PT ASAP after the exchange.

    Hope that if it is a hematoma that it resolves quickly. I have not had that thus far, knock on wood. I had my TEs placed after the mastectomy (skin issues) and I was thinking maybe they used some Alloderm to fill the part that looked kicked in under my clavicle on one side because it looked a lot better after TE placement; I forgot to ask about that.


    I really hope the grafting turns out well worth it for you (and for me)! I so hear you about the weirdness of all this, so thanks for the weirdly lovely conversation, lol, and looking forward to updates. I’ll let you know how I move forward, too

  • mtks
    mtks Member Posts: 61
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    I had a DIEP flap after explant. My breast area looks like the flap reconstructed the lower half only. Is this how most look?I haven’t seen my PS yet but I was expecting more of a full breast.

  • needs.a.nap
    needs.a.nap Member Posts: 195
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    Hello @wishinguswell. How are you? I’m thinking you must have recently had your exchange surgery … I hope you’re doing well!?

    I finally made it to the 6 week mark post surgery and all restrictions are lifted. Yippee! I’m sorry I forgot to update you. I’m so forgetful these days (I’m only at age 50, so I’m feeling worried about the rest of my life and my brain function, but I’m trying to let that be Future Me’s problem).

    I am SO glad I did fat grafting !!!!!!!!!

    My breast skin had been super thin and now it’s got a little pudge to it. Like the difference between the skin on the back of my hand, where you can see and feel everything right through it, compared to the skin further up my arm where it’s more fleshy. My sides where the fat was harvested from have been fine. They were pretty bruised but not really sore initially and I’m still wearing a compression binder during the day because it seems to help keep swelling down. But since my hot flashes have returned (thanks to resuming Tamoxifen) I’ve stopped wearing it at night so I can feel more comfortable. The fat grafting was totally worth it! What did you think?

  • wishinguswell
    wishinguswell Member Posts: 9
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    Thank you for checking in, @needs.a.nap, and hooray for lifted restrictions for you! I am through the exchange and my post-surgery pain level was pretty mild, really more discomfort than pain, both breasts and abdomen. What a difference from the mastectomies recovery. Bruising and swelling also pretty mild (I ate my pineapple every day). I did backslide a little on range of motion and have had a smidge of cording again, but working it out at PT. Didn’t need much time off from work. I’ve just been permitted to do shapewear in place of the binder and am really glad for a less bulky option during the day, but I still do the binder at night. I have hot flashes (in my 50s and on an AI), but they’re mostly just hot, not sweaty. Hoping I’ll be released from compression at next follow up since weather is getting warmer. Allowed to exercise moderately with upper body restrictions; I feel MUCH better when I can stretch and work out the joint and muscle (and scar tissue) stiffness. I love your description of the difference fat grafting made for you and that you’re pleased with the results. I’m also glad I did it although I can’t fully judge the difference it may have made since I went from TEs to implants. The implants are definitely better than the TEs and I look nice in clothes, but no one seeing them bare would be hoodwinked into wondering whether they were real breasts! I already feel less plumped than newly after surgery, which may be fat graft absorption or maybe just reduced swelling. Who knows. PS says typical to retain about half. In any case, I feel like some edges are a little visible, but no real surface rippling. I’m on the leaner side these days and the implants are small but high-profile, so that outcome would seem fair. In any case, the fat placed is supposed to help healing, too, right? And my abdomen looks good. I don’t think that much was harvested, but I feel like my sides are less love handle-y. So even though that wasn’t the point, I’ll take it! All considered, worth it. Hoping we both move forward now happily and uneventfully. I appreciate being able to chat!