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Topic: anybody with fat necrosis after surgery?

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

Posted on: Oct 24, 2007 02:36PM - edited Oct 24, 2007 02:36PM by sharebear

sharebear wrote:

I had a large fat necrosis removed on the left side of my breast that occurred right after tram flap surgery. 2 1/2 weeks later, it has swelled back out like an egg and is sore again. Like the original necrosis. I called the ps and I'm going in on Friday. It doesn't seemed infected.

Has anybody else had a fat necrosis removed and then had another appear in its place? I know the body absorbs some of it but not all of this.

Sharon

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Oct 25, 2007 11:35AM - edited Oct 25, 2007 11:35AM by cbl

I had a large amount of the fat necrosis removed but I have not had it return.  It would really disappointment if I had to deal with it a second time! I would be very interested to hear what your plastic surgeon has to say about why it happened and what can be done to make sure it doesn't keep happening.

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Oct 25, 2007 11:52AM bbmom wrote:

cbl,

Can you tell where the necrosis was removed or did they fill it in after?

"The Will of God will never take you where the Grace of God will not protect you." Dx 11/25/2009, ILC, Stage IV, Grade 2, 14/17 nodes, mets, ER+/PR+, HER2-
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Oct 25, 2007 10:15PM sharebear wrote:

I'm going in tomorrow to see the ps. hopefully he'll have an answer for me. It's like I now have an egg shaped boob growing out under my arm.

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Oct 26, 2007 07:22AM Naomi wrote:

Hi, could it be that it might be a collection of fluid, such as a seroma or maybe a hematoma? If so, they probably will just drain the fluid out. I had problems with both. They felt pretty hard to the touch even though they were fluid filled.

Dx 5/16/2005, IDC, 5cm, Stage IIIC, Grade 2, 10/17 nodes, ER+/PR+, HER2-
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Oct 26, 2007 01:34PM sharebear wrote:

Naomi,

You are correct. I'm just back from the PS. He drained to syringes full of fluid and what he called old blood. It didn't hurt to drain but I didn't watch. I'm not afraid of needles but don't like to watch the process. He then bound me with an ace bandage for 72 hours he said if I can stand it. If it fills up again he told me to come back in.

Did you have to have it drained more than once? Were you wrapped after?

Sharon

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Oct 26, 2007 05:50PM EyesOTex wrote:

Sharon, I'm so glad you were able to have it drained, and I hope to h**l it doesn't recur.  But I would love to hear from others who had fat necrosis, either removed or not.  I have a large area in my left reconstructed breast of fat necrosis that was actually just biopsied (go figure; I thought mastectomy would take care of THAT) but it seems to me it is conjoined with an area that has recently lost a lot of tissue (that ripply effect).  SO...I hate to have it removed, as it will make my "breast" even more saggy and flat on top, but it IS very hard and uncomfortable...  and anyway, I don't want to have any more surgery, I have gone over the top on that issue. Or maybe I'm just having a bad day.  Anyway, I hope people with fat necrosis will chime in; I really need some input here from some folks who are in the know.        help??

Dx 5/1/06 2.1 cm Grade 3 1/15 nodes IIb ER-/PR-/Her2- Bilateral Mast, TAC x 6 Dx 4/24/2008, Grade 3, mets, ER-/PR-, HER2-
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Oct 27, 2007 10:35AM SandyinSoCal wrote:

I have an area of necrosis that has swelling around it, and it does ache at times.  It is at the lower cleavage area.  My ps said it could take a year or two to "liquefy" and be reabsorbed by my body.  He said it's better to leave it than remove it and leave an even larger void.   I haven't had stage II yet (DIEP) so I will see what can be done then.  I may end up with small implants because there is a low area at the top of the other breast that needs to be taken care of.

I am wonderfully made to do ExtraOrdinary things! (www.girleo.com) Dx 5/22/2007, IDC, <1cm, Stage I, Grade 3, 0/1 nodes, ER+/PR+, HER2-
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Oct 27, 2007 02:39PM sharebear wrote:

I had the fat necrosis removed, but they can fill in with fat injections if it leaves a large void. My necrosis had been there for 7 mos. already and they even biopsied it a couple mos earlier because they were concerned. This necrosis literally was there right after my tram surgergy like within a day. I'm O.K. with it not being perfect as long as it was comfortable and I can wear a bra or bathing suit. The way it was, I couldn't. Mine was right where the cup of you bra comes up under the arm. An awful place even if you don't wear an underwire.

Sharon

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Oct 30, 2007 09:22AM melody wrote:

HI

  I have a few areas of necrosis in my left breast from the mid clevage area down to almost the bottom (6 o clock) of my breast. Though it is not visable I can feel it and it is uncomfortable when I sleep on my stomach.( one area feels golf ball sized) My ps wants o to wait it out. I haven't had stage two yet. he feels it may soften up and if we try to remove it it may leave a divet in my beautiful reconstrution.  I'm not sure yet what I want to do.

Melody Dx 5/2/2007, IDC, <1cm, Stage I, Grade 3, 0/3 nodes, ER+/PR+, HER2-
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Oct 30, 2007 10:48AM - edited Nov 20, 2007 11:17AM by cbl

Alaina13:

Most of the necrosis I had was along the side closest to my arm and a little across the top.  The part closest to my arm was about 2.5 inches by 1.0 inch and made it difficult for me to comfortably have my arm at my side.  I always felt like my clothing was bunched up under my arm pit.  Massage definitely helped soften the area but after a year it still was uncomfortable.  The PS didn't remove all of the necrosis because I would have been significantly smaller that I wanted to be.  He removed enough to keep the general size and shape that he created originally and I am a lot more comfortable than I was.  The area was not filled in afterward.  I am not sure how or why but it seems to have filled itself in. 

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Oct 31, 2007 02:44PM EyesOTex wrote:

sharebear, do you know if the fat injections are done everywhere or if that's a pretty specialized thing?  Somewhere, sometime, somehow, (chemobrain) I followed a link that made me think that only a few places (or Drs) did this.  I'm still putting off going back to the PS...  Thanks for all the info, sisters!

Dx 5/1/06 2.1 cm Grade 3 1/15 nodes IIb ER-/PR-/Her2- Bilateral Mast, TAC x 6 Dx 4/24/2008, Grade 3, mets, ER-/PR-, HER2-
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Oct 31, 2007 07:12PM sharebear wrote:

My PS offerred this to me when he knew we would be removing a large necrosis. Mine was also in an area that my arm couldn't rest comfortably like cbl's above. He didn't want to ruin the shape or make it noticeable smaller. I don't know how common this is or isn't. It has worked. I did have to go back in and have some fluid drained. Two syringes full. I might have to go in one more time as I have a little more fluid build up. But it all seems much better now.

Sharon

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Nov 10, 2007 07:40PM kiki wrote:

Hi I too have a large area of fat necrosis on my right breast the side that had cancer.  Now the skin around it has turned red over the last few days.  Does anyone know what this could be?  My surgery was July 6th so I didn't think it could be infection.  Anyone had this?

Laugh today do housework tomorrow! Dx 6/4/2007, IDC, 1cm, Stage I, Grade 3, 0/1 nodes, ER+/PR+, HER2-
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Nov 10, 2007 08:00PM SandyinSoCal wrote:

I just had revision of my DIEP breasts, and my surgeon broke up the necrosis with some lipo and the area is soft now.

I am wonderfully made to do ExtraOrdinary things! (www.girleo.com) Dx 5/22/2007, IDC, <1cm, Stage I, Grade 3, 0/1 nodes, ER+/PR+, HER2-
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Nov 16, 2007 07:03AM hopefor30 wrote:

How do you know if you have necrosis?   I am 3 weeks out -- had a large hematoma, so I am still draining, but my breast is feeling much tighter and more painful than it did after surgery.   My PS said there is still a lot of fluid and swelling, but I am concerned because it seems to be getting worse rather than better and it is more painful -- no redness, no temp -- so I don't think it is infected.

M.

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Nov 16, 2007 12:02PM sharebear wrote:

Mine was a hard solid piece. My surgeon actually biopsied it to make sure. Then when he did my nipples, he removed a big chunk. I still have some but he didn't want to remove too much and have me not be symetrical. We're hoping what he left will soften up with time.

Sharon

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Nov 17, 2007 08:48AM MaryGirl wrote:

This is a really interesting topic that hasn't been discussed in depth on this board in the year+ that I've been here.

I'm a year+ post bilat diep.  The cancer side definitely has a hard, uncomfortable area at the bottom around the incision.  My breast surgeon did an ultrasound and said he didn't THINK it was necrosis, only a build-up of scar tissue.

I've also wondered how much of this is lymphedema related.  I haven't had any problems with arm lymphedema (2 nodes removed), but it seems like the hardness varies throughout the day, being worse at the end of the day and generally not too bad at the beginning.  Maybe it's my imagination, but that seems to be the pattern.

I also have a couple hollow spots at the top of my breasts that seemed to develop months after my Stage 1 surgery.  Could that be related to fat necrosis dissolving?  I wouldn't mind having those spots filled in, but am worried about the fat injection idea.  Are they just injecting fat that's going to be dead and hard?  What's the success rate of the fat injections?

I'm having my Stage 2 surgery on Monday and will discuss this with the ps and let you all know what he says.

Mary

dx 8/06, bilat mast w/DIEP 9/06
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Nov 20, 2007 08:54AM kiki wrote:

I'm going to see my surgeon on Tuesday to find out what is going on.  The redness has gone after a week of antibiotics but now I have thickening and swelling around the incision.  MaryGirl, I am interested in hearing what your ps says about lymphedema.  I only had 2 nodes removed as well but some days my shoulder and arm ache.  I wonder??  Let me know what the ps says about the hollow areas as I have developed these as well.  I just don't like seeing any changes 4 months post surgery.  Makes me nervous, every little thing now makes me think that the c is back.

Laugh today do housework tomorrow! Dx 6/4/2007, IDC, 1cm, Stage I, Grade 3, 0/1 nodes, ER+/PR+, HER2-
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Nov 20, 2007 11:49AM SandyinSoCal wrote:

I just had my second stage DIEP at NOLA, and Dr. DellaCroce said that my flaps had slipped down. (First surgery was done elsewhere.)  I had never heard of that before, but after looking at my post-op photos at several stages, it's clear that they did shift downward.   He completely redid the flaps inside, and I have fullness now where there were hollows on my chest.  Not only that, but my former hamburger buns are now round and full!

I am wonderfully made to do ExtraOrdinary things! (www.girleo.com) Dx 5/22/2007, IDC, <1cm, Stage I, Grade 3, 0/1 nodes, ER+/PR+, HER2-
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Nov 20, 2007 02:26PM Nichola wrote:

Ultrasound showed 2 areas of fat necrosis in my reconstructed breast.  Radiologist biopsied one - just to be on the safe side.  Proved malignent for IDC again.  Both lumps have now been removed and I am awaiting pathology and results from CT and Bone scans.  I only had stage 1, grade 1 small tumours originally.  Any one else have similar experience?

Original DX Stage 1, Grade 1 multifocal IDC 2004. Multiple nodule recurrence in skin of reconstruction, Nov 2007 and reconstruction removed. DIEP/tram replacement reconstruction Dec 2008. May 2010 DX chest wall recurrence. Dx 11/27/2007, 1cm, 0/10 nodes, ER+/PR+, HER2-
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Nov 20, 2007 04:15PM acarr wrote:

Hi Mary,

I had GAP surgery with Dr. D in NOLA 2 years ago.  I didn't develop fat necrosis, but I have had fat injections on 2 separate occasions.  I had radiation on my cancer side and the fat injections didn't take very well there.  I think my body just reabsorbed most of it.  My injections were done to help with projection.  The injected fat did not become hardened.  My body just absorbed it.  I'm sure Dr. D will be able to fix the hollow areas at the top of your breasts.

I haven't experienced lymphedema in my arms, but I do sometimes notice that my breasts become fuller, and sometimes uncomfortable, toward the middle of the day. At times it is painful to wear a bra.  I suppose this could be lymphedema since I had 14 lymph nodes removed. 

Hope your surgery goes well on Monday.  I'm sure Dr. D will be able to give you fantastic results.  -- Amy

Delayed bilateral S-GAP in NOLA with Drs. Dellacroce and Sullivan in March 2005. Stage 2a 6/2005 & 2b 12/2005. Wonderful doctors; wonderful results! Dx 6/24/1990, IDC, 6cm+, Stage II, Grade 3, 0/17 nodes, ER-/PR-
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Nov 20, 2007 09:01PM kiki wrote:

Nichola, how long ago did you have your first mast & recon?  How long did it take for the fat necrosis to show up?  Mine has been there since 1 week post op. but the thickening just started.  Good luck with your scans, I'll pray that they are clear. 

Kiki

Laugh today do housework tomorrow! Dx 6/4/2007, IDC, 1cm, Stage I, Grade 3, 0/1 nodes, ER+/PR+, HER2-
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Nov 21, 2007 02:06AM hi5 wrote:

What exactly is fat necrosis?  I had bilateral mast. with expanders.  The side that had the tumour and was radiated has a line of 'fat' that is somewhat tender.  The other side doesn't have this.  The ps says it's fat.... and it would cost me to have it removed or to lose weight...I don't think so...so ultrasounds can be done? 

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Nov 21, 2007 07:21PM MaryGirl wrote:

Hi All-

I had my stage 2 done with Dr D in NOLA on Monday.  He didn't think there was any fat necrosis.  Said that the scar tissue is just tight and that can be alleviated by stretching as you're healing.  He didn't really address the lymphdema theory.  I've brought it up with several doctors but they all seem to kind of shrug it off.

I did have some fat injections to fill in the hollow spots and to help with the symmetry issues.  Things are still pretty swollen right now, so I can't tell how it will all come out.  But so far I think the shape and symmetry of my breasts have improved.

I'll be glad when these things heal up though...ouch!

Mary

dx 8/06, bilat mast w/DIEP 9/06
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Dec 22, 2007 04:27PM hopefor30 wrote:

What did your fat necrosis feel like?   Mine is not a lump -- there is one whole side of my breast that is hard and PS said it was fat necrosis and scar tissue -- he also said it would not soften up --  so what happens?    My breast looks pretty good, but is uncomfortable and I don't see how the hard area could be removed -- it seems too large --- can this all be necrosis?  

It is very disappointing....I am still waiting for the hole in my breast (from draining an infection) to close up -- don't go back to PS for another month --   I hope something can be done to improve the feeling...

M.

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Jan 24, 2008 12:21PM Binney4 wrote:

To the top for M. Thanks to all those who contributed to this thread, as it's an important topic and hard to find information about.

Be well!

Binney 

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Jan 24, 2008 04:48PM MinAZ wrote:

Thanks Binney! I have this problem on my lifted breast, not the implant one. I had the surgery about 6 weeks ago and became aware of this problem about 3 weeks ago. There is a dent or divot on the outer side of the incision around the areola, and there are a couple of lumps at the bottom of that incision. The PS is treating it by pulling out the dead fat weekly and I'm doing an antibiotic cream and gauze/pad covering twice a day. There are twinges now and then but it's not painful. It's a nuisance, though, and it sure is ugly!

This morning I had a sudden flow of blood from one of the areas and it scared me. I put pressure on with a gauze pad and it stopped and is OK now. But there is a kind of hole and I can see the yellowy fatty tissue inside - ARGH! But the PS says it's OK as long as it's regular red blood, and probbly means there is healing going on.

Believe me - I have done a lot of Googling on this and I finally found something that is quite informative. The link is pretty long - hope itworks for you:

http://books.google.com/books?id=58Cz0x03OakC&pg=PA157&lpg=PA157&dq=surgery
+%22fat+necrosis%22&source=web&ots=gCxGw-XM50&sig=3j_izyCIGQNLr9ihhEoftsXpyUk
#PPA157,M1


Minz 

Dx 10/15/2006, IDC, 1cm, Stage I, Grade 2, 0/2 nodes, ER+/PR+, HER2-
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Jan 24, 2008 07:08PM hopefor30 wrote:

Thanks for the  link -- I understand what fat necrosis is, am I just not sure that I have it...I did see the PS again this week and there is a small area near the top of the breast that he said was probably fat necrosis -- it does not bother me.   The other area that is hard is on the side and it causes the breast to look deformed -- now he is saying that is scar tissue and can be improved with stage II -- so I am now scheduled for stage II  -- not looking forward to more surgery, but I am not happy with the way things look and feel right now, so there's  no choice.....I hope it can be fixed.

M.

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Jan 24, 2008 09:19PM sharebear wrote:

M.

Mine was very large. It also was on the side of my breast. They actually biopsied it and it was fat necrosis. The PS removed a large chunk of it, not all of it because he did not want to make the breast appear smaller. Taking out what he did made it much more comfortable and what was left did soften up and the body is starting to absorb. He also did some liposuction on my fat pad under the breast and injected it where he took out the necrosis. It filled right in and the breast looks completely normal.

It does get better.

Sharon

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Jan 25, 2008 07:45AM hopefor30 wrote:

Thanks Sharon -- I hope I end up looking completely normal as well -- I am not there yet.   Did you have any lymph nodes removed?   I had 6 in my sentinel node biopsy and I am nervous about further surgery, even though the PS said he won't be near any nodes.

M.

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