autologous fat transfer - poor result
last week I had liposuction and fat transferred to the breast area where I had a mastectomy. I also had a lift and reduction on the other side. I was a D on that side and now it's probably a small B.
The fat transfer doesn't show any noticeable increase in the volume of the breast. I understand there are limits to what the doctor can do and that some of the fat is likely to dissipate in time. but there seems to be no result from this painful procedure.
I have a post surgery visit scheduled but when I confirmed I found it it is with a nurse. I've asked if I can get an appointment with the doctor. I'd like to talk to him about this. I expect he will say something like I tried but this is what we got.
I understand a lot of women who do this procedure do multiple injections. So is this normal - to basically see no improvement after one fat injection?
I'm glad I had the lift as at least I have something to show for the pain and inconvenience. Now if I do nothing more I will have a skin mound and a small breast rather than a skin mound and a large saggy one.
thanks for any advice
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@mary9999, it may be too soon to see noticeable results, especially as you may still be experiencing swelling from your surgery last week. Are you wearing any compression garments? Compression garments are often recommended for at least a few weeks post-surgery and fat-grafting, and the stability from that compression plus this recovery time period is also needed to allow the transferred fat to "take". After several weeks' time, your team can then assess the results.
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I hope you're right but I saw a nurse today for post op visit. she said it won't get bigger. and my understanding is that if anything the fat dissipates
Nurse had no explanation for the lack of a difference in the "breast"…..I asked where the fat went
Yes I have to wear a compression garment and bra 24/7 for 6 weeks
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Please allow your body some time to recover, and see how things are after 6 weeks, @mary9999! A single session of fat-grafting will typically provide subtle results. It will not offer significant volume increases in breast size, however it should offer visible improvement in the appearance of ripples or divots, and should help soften the appearance of the post-mastectomy reconstructed breast. Typically patients report noticing a gradual dissipation of about half of the fat transferred, in which case repeat fat-grafting sessions may be needed.
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thank you
I don't have an implant….the fat is the only reconstruction I have. and the lift and reduction on the surviving breast.
I didn't expect an excellent result with one fat transfer but I did hope to see something.
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Hi @mary9999 -
Sorry your procedure didn't go as hoped.
My situation was slightly different, but since you haven't gotten many replies, I thought I would respond.
My latest mastectomy was with a lat flap. The lat flap is usually done with an implant. However, I didn't want an implant. So, my ps recommended the lat flap with fat transfer. Just doing the fat transfer without either a lat flap or an implant (as you have had) is a newer procedure. I've heard of it, but it is pretty rare. Actually, I haven't heard of anyone doing the procedure I had done either.
In my case, I had the lat flap at the same time as my mx. This did not include any fat transfer and was more to build the 'base'. I had 2 more surgeries that did the fat transfer. The first one added some depth to the breast, but I felt I really wanted the 2nd additional surgery to add to it. I think it is slightly smaller than the other breast which was a tram flap from an earlier dx. However, I am now happy with it as it is.
In your case, (I'm just guessing here), it almost seems like the surgery you had would have been more to build the 'base'. My guess is you would need additional surgeries to build that up. How many surgeries did your ps indicate you would need when you had the initial consultation? If I were you, I would also want to discuss it with the ps . Will they allow you to make an appointment directly with the ps? Did the nurse recommend future procedures or what?
Sorry this has been such a frustrating experience for you. It is a lot to go through if you aren't seeing the results you expect.
Best of luck as you pursue this.
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I asked for the post op appointment to be with the doctor rather than a nurse but they didn't have a time available that was convenient for me so I saw the nurse. she really didn't have any answer as to why my result was what it was. not surprising since she works for the doctor. she isn't going to criticize him.
What the doctor said at my initial visit with him was he would do the tissue expander at the time of the mastectomy. then a couple of months later do an implant with fat transfer to give better result. but he wasn't able to do the tissue expander, I guess because of my circulation being inadequate.
so at subsequent office visits he said if I waited long enough he could do implant or fat injection without tissue expander. I wanted to avoid the tissue expander as I had heard it was uncomfortable.
He was somewhat inconsistent in what he said but I guess I hung onto him saying he could maybe get me to a small B with just the fat transfer.
I asked the nurse what she thought about more surgery. She said the thought I could get a good result with just an implant - no more fat injection. She said if she had to make this decision and she didn't want an implant she would go flat.
When I had asked him right before this last surgery what result he could get with just an implant he said it would be ripply. So I will see him in a couple of weeks. If he says the fat didn't take and and implant would still result in ripples, I'm done. If he says he can match the lifted breast with just an implant and recovery from that would be easy I may consider it.
I have a feeling he is done with me. and I'm done with the pain and inconvenience. I'm 74 - how vain do I need to be? With the way I dress, a prosthetic partial breast form will look fine in clothes.
thank you for talking to me. I appreciate it.
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Hi @mary9999
It's always a lot of decisions isn't it? It sounds like you have your head around your options and that's really the most important thing. Treatment and recon after dx is one time when you can truly say "It's ALL about ME!" because it really is. As long as you feel good (or accepting) about things, that's all that counts.
Your other option is another opinion, but it sounds like you have had about enough and I can certainly understand that.
Take care.
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@mandy23 I haven't gone through as much as you have but it feels like a lot. as of yesterday I discovered some blood apparently oozing from my incision onto my bra. doctor said I should buy some meds and apply with gauze. It's not much blood but of course an infection is the last thing I need.
Hopefully drain is coming off tuesday. that will release me from prison of not driving and not wanting to be seen in public wearing it.
I have thought about a second opinion but the doctor I'd want to go to is very busy and his office is pretty far from me.
I'd ask my breast surgeon who did the mastectomy for another name but she likes the one I have and she never answers her own messages. I always hear from her nurse.
thanks for your thoughtful advice
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@mandy23 finally after about eight weeks the incision below my lifted and reduced breast has closed. I saw the nurse at my plastic surgeon's office yesterday. she said it looks great and I can stop using ointment and gauze. I have an appointment with the doctor in a few weeks. I don't think I want any more reconstruction. I'm tired of feeling numb, stiff, pain. I can go talk to him. He will probably say if I want, he can do an implant with more fat injection to make it look better. I'm tempted to just cancel the appointment. He may say I've been through enough but if he suggests more surgery it may confuse me.
He isn't pushy or salesy but it's his job to do these things and he has a tendency to minimize the potential risks - like implants needing to be removed.
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Hi @mary9999
Really sorry to hear about your issues with your incision. I missed your post from 2/22. I think I was traveling at the time, so I didn't see it. What a pain that must have been! I'm glad to hear that it has closed and has healed.
You have been through a lot. As you stated earlier, it might be time to just be done. I'd say hold the appointment for now and just think on it for a few days. Now that you are healed, if you are comfortable where you are at, then cancel in a few days. It's always an option to change your mind later too if you find you don't like where you are at. If that happens, you might want to find a different ps as it does sound like there was some communication lacking on his part.
Sorry for all that you have been through. Maybe it's time to put it all in the rear-view mirror and enjoy life, for as we all know so well, each day is a gift.
Best of luck to you. 😊
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@mandy23 I did go for the visit with the PS. He said he can't do an implant on the left side (where the fat injection basically did nothing) - said it would be too large compared to the right side where it was lifted and reduced. I don't want any more surgery. I'm glad I had the reduction though. Better to have one side with basically skin and the other with a small breast, than to have the right side with a saggy D cup.
Yesterday I saw a friend. This woman is very inquisitive. wanted to know all about my most recent visits, my future visits, etc. What doctor follows me now. When I told her the PS said he couldn't do an implant as it would be asymmetrical, she said "so have another implant on the the other side"
I pretty much went off on her. I"m pretty old. I just want to heal. I think it's best that in spite of what may be genuine concern on her part, I don't talk with her on this subject again.
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Hi @mary9999 -
Good for you. Doing that last visit sounds like it reinforced your decision to just be 'done' with recon. I think we all reach that point. I'm with you on the reduction. Probably the one positive from getting bc in my 1st dx was getting the 'good' breast (at the time) reduced as I never cared for the saggy Ds anyway. 🙂
People who haven't been on this journey really don't get it. You get the ones like your friend who think it should be easy to have surgery after surgery to chase 'perfection'. Then you also get the ones who don't understand why you need to have breasts at all and claim they would never do the surgeries. It's a whole lot easier to say what you think you would do when you've never been the one to go through it. Add health journeys to religion and politics as off-llimit topics in some circles…
I hope you can now just heal and move on with your life. Put bc in the rearview mirror.
WIshing you all the best.
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thank you @mandy23
yes, I hope I can put cancer in the rearview mirror but it worries me more now that I've had it twice. After the first one (in situ with just lumpectomy), I wasn't really worried when I would go for a mammogram or ultrasound. Now it's different. I'm not freaked out but I am much more concerned. I had an ultrasound recently and the doctor came into the room. she said they found lumps but they are probably post surgical. she wants me to have another ultrasound in six months. hopefully that one will come out better.
As far as my friend, she is super inquisitive. She wanted to know the result of my ultrasound. then she wanted to know who orders the next one, who gets the results. when am I going back to the surgeon.
As far as her suggestion that I just get two implants - one on the flat side and one on the reduced side - I don't know where she is coming from on that. She herself is skin and bones with (as far as I can tell) small breasts.
I guess I should be glad someone is concerned but it feels so much better to talk to someone who has been through cancer. There is one woman I know casually who had triple negative. she had chemo, mastectomy, hysterectomy, the works. such a brave woman.
thank you for listening and supporting me
mary ann
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It is common for fat necrosis to develop when you have fat transfer (either through DIEP recon or fat grafting - I had both). The initial fat necrosis lump developed within 6 months after my initial surgery, then I had another one like a year after my second and final fat grafting. The first one was absorbed by my body around 6 months after it was found. The second one has been very slowly going away - it's become smaller and softer over time. In both cases had mammo and sono to make sure that's what it was. Hopefully yours will reabsorb as well. As for your 'friend', I really hope she will listen to you and respect your wishes when you tell her that talking about details of your health situation causes a lot of stress and anxiety and that you'd appreciate it if she didn't bring it up.
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@abigailj in addition to having lumpiness (necrosis?) on the left side where fat was injected, I have it on the right breast which was lifted and reduced. the radiology doctor came into the room and talked to me. she said when the surgeon moves the fat around it can create these lumps which hopefully will go away. I'm trying not to worry about it as I have to wait six months for more screening. so nothing to do now.
When I was in active treatment I had told my friend somewhat sharply "you don't need to know about all my appointments"
I think partly it's concern on her part and partly she is just an inquisitive person. I really don't get her level of curiosity. How she comes up with all these questions - like when my ultrasound or other test results are in, which doctor gets them? I gave her the courtesy of answering all of her questions. For now, there is nothing more for her to inquire about other than my visits to the chiropractor.
I appreciate your response. On the necrosis - sometimes they remove it surgically? but usually not? only if it's painful or cosmetically bothersome?
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@mary9999 yes, I’ve heard moving fat around can cause necrosis granules and lumps. I haven’t heard of fat necrosis being surgically removed - don’t know if it’s ever done but personally never heard it. I never had discomfort from it (well, other than mentally) and can’t recall reading a post that mentioned it causing physical discomfort. As long as your friend respects your boundaries now that’s all good. I personally am not comfortable discussing details about my BC with someone that hasn’t been through it so what you wrote struck a chord with me. Hopefully your necrosis will also be reabsorbed by your next scan.
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@abigailj I'm not delving too much into the necrosis thing right now….hoping doctor is right and it's just post surgical. I gather one concern could be if they can't be sure what the lumps are by looking at ultrasound images and they have to do a biopsy. but that isn't surgery.
I'm sure my friend will irritate me again at some time with her questions. she has her own health issues but pretty much avoids talking about them because she isn't doing anything about them. and she's good at evading questions. funny. as a man I knew many years ago would say "the bell goes ding but doesn't go dong"
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