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Topic: Fat Necrosis / Monitoring and Fat Grafting questions

Forum: Breast Reconstruction —

Talk with others facing decisions about whether or not to have breast reconstruction, and if so, what type and when.

Posted on: Mar 24, 2021 02:49PM

abigailj wrote:

I'm looking to get a better understanding of how a fat necrosis site may affect an upcoming fat grating I am planning. I had a skin sparing BMX with immediate DIEP flap recon June 2020. I had some healing complications, one of which included an infection with a good sized lump of fat necrosis involved too near the bottom of one recon breast about 2 months after my initial surgery - it left a divot. Anyway, I'm all healed and been massaging the recon breasts and scars to soften everything up and am ready to get the divot filled and contours smoothed with some fat grafting. However, a few weeks ago I felt a small round lump, around 1 cm, a little to the side of one nipple. Got examined, PS said fat necrosis very likely, it's sitting on the flap, but ordered imaging just in case. So, I had ultrasound and mammo (never thought I had one of those again!) on that side, radiology doctor said "does not appear to be anything concerning, likely fat necrosis but I am very conservative and want you back in 6 months to look at it again. I asked her two questions: (1) do you recommend I defer any fat grafting until after my next scan in 6 months? (2) should I go ahead with the planned grafting in May and ask the PS to remove this lump as part of what is done? To both she said "that's between you and your surgeon". So basically no guidance provided by her.

Has anyone been in a similar situation and could share their experiences? I will be speaking to the PS next week but in the meantime would welcome hearing from anyone that had grafting with a fat necrosis situation going on (or deferred it or whatever). Thanks in advance.

Abigail

Dx 1/2020, ILC/IDC, Both breasts, 2cm, Stage IB, 0/4 nodes, ER+/PR+, HER2- Surgery 6/23/2020 Mastectomy: Left, Right; Reconstruction (left): DIEP flap, SIEA flap; Reconstruction (right): DIEP flap, SIEA flap
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Apr 20, 2021 12:47PM LAstar wrote:

I had a SGAP that ended up having a plum-sized spot of necrosis deep in the breast. I expressed concern about it when I came back for my phase 2 surgery (fat grafting, etc.), and my PS said he'd deal with the necrosis. He didn't and left it there. Over the next 2.5 years my breast shrunk 2 sizes. My understanding is that the necrosis was the result of reduced blood flow to the flap. The PS had even grafted larger blood vessels during the initial surgery (without ever telling me) but the necrosis still occurred. I had to have the side redone with a DIEP 3 years later, and that came out fine. Based on my experience, I would at least have the necrosis removed so that the monitoring is not needed and any underlying issue causing the necrosis can be dealt with. My fat grafting surgery was ultimately pointless.

Also, soooo many women in my flap cohort had fat necrosis in other areas 8-12 months after surgery. It occurs when there is any injury to the breast. We all worried a lot but none of us had any serious issues. Of course, we always need to get it checked. Even 6 years out from my DIEP, I just had a lump of fat necrosis removed from my upper chest last week. Always nice to hear the word "benign" but I'd love to stop seeing my BS.

Best wishes to you! These decisions are tough!

Dx 3/5/2012, DCIS, 6cm+, Stage 0, Grade 3, 0/3 nodes, ER+/PR- Surgery 4/6/2012 Lumpectomy: Left Surgery 5/4/2012 Lumpectomy: Left Surgery 6/19/2012 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): SGAP flap/hip flap; Reconstruction (right): SGAP flap/hip flap Surgery 10/5/2012 Reconstruction (left): SGAP flap/hip flap; Reconstruction (right): SGAP flap/hip flap Surgery 1/26/2015 Reconstruction (left): DIEP flap
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Apr 20, 2021 01:31PM abigailj wrote:

LAstar, thanks so much for the helpful info. I decided to defer the fat grafting for a few months (mostly to lose a little weight/ shrink down the fat cells in my bottom half before trying the grafting) but will now be able to discuss the necrosis situation a lot more knowledgeably with the PS when I see him again in July thanks to what you shared with me.

Dx 1/2020, ILC/IDC, Both breasts, 2cm, Stage IB, 0/4 nodes, ER+/PR+, HER2- Surgery 6/23/2020 Mastectomy: Left, Right; Reconstruction (left): DIEP flap, SIEA flap; Reconstruction (right): DIEP flap, SIEA flap

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