Fat Grafting and Phase 2 of Breast Reconstruction

[@blueclover9918]

Im so grateful to have the reconstruction with my own tissue - admittedly the first surgery by taking adipose tissue from the abdomen was brutal - not the incision, but under the abdominal skin and 3 drain sites. However the results compared to conventional mastectomies is wonderful, and I don't regret it in the slightest despite the pain. The second surgery to fill in the concave area above my breast was a breeze.

[@tmathews1001]

Hi - I can totally relate. I just had a DM with DIep flap reconstruction and yes, it was a very tough recovery. Not so much with my abdomen, even though that hurt very much too, but in the hospital I was sat in a manual recliner on day two and I had to keep using the bathroom and instead of calling the nurses to get me out, I used the manual lever and ended up with a hematoma and a very swollen right breast. Also, on the left my nipple did not survive because the general surgeon cut too deep I was told. Thankfully my plastic surgeon saw that and left some skin so he could fix that three weeks later along with removing the hematoma and liposuctioning out some of the tissue. But going in for surgery three weeks later set me back. I now have rippling on my right breast in the upper inner area so wearing anything low cut will not work right now. Not that I do much anyway, but things such as a bathing suit top I can wear but it won't look that great in that area. I go for stage 2 May 15th. Whether you call it stage 2 or 3. I am afraid of the lipo part of things, but this video did help. I also have a concave area above my left breast and it is nice to know that this can be filled in. I hope the rippling can be fixed too in May or sometime after.

[@carolinecampbell39]

This is so encouraging! I am 63 years old and had Allergen implants places in 2016 following bi-lateral mastectomy follow breast cancer diagnosis. I want them removed due to the recall and my surgeons don't think I have enough stomach tissue for DIEP. I'm not ready to go "flat". Are you procedures "cutting edge"? No one has given me the option of fat grafting to "supplement" my own tissue. It makes so much sense to me. Is my age an issue?

[@DiepCFoundation]

Caroline, the DIEP flap procedure surgeons talk about on this KZbin channel is considered by many to be the "gold standard" in breast reconstruction. So if that is what "cutting edge" means to you then yes. Fat grafting is done at the second stage of DIEP flap breast reconstruction. Phase 1 is the transfer of tissue and blood vessels. This is the longer surgery. There is a video here entitled, "The surgical stages of breast reconstruction" you may want to watch. To answer your question regarding age, your overall health is a stronger factor in consideration of having DIEP flap. A video you may want to check out is "Is Age a Factor in Breast Reconstruction?" Hope this helps and best wishes. The key is finding a microsurgeon who has successfully and routine performed a number of DIEP flaps if you choose that type of reconstruction.

[@carolinecampbell39]

Thank you so much! @@DiepCFoundation

[@TheArthouseOasis]

Amazing video thank you.

[@sarikandel6466]

another amazing, informative video. THANK YOU.

[@DiepCFoundation]

You are most welcome Sari.

[@terrynashhartmann8419]

Thank you! Very informative. Info that I didn't find anywhere else.

[@DiepCFoundation]

I’m very pleased to hear this Terry.

[@deenawaddell5631]

This was very helpful. I have my expanders in right now, I got my last fill last week. I will be having my expanders out and implants put in, in a month and also will be having fat grafting which I am a little nervous about. And I am not going to lie, all of the pain I have gone through I kind of got my hopes up a little when they said they were going to take fat from my stomach. 😁😁

[@DiepCFoundation]

I hope it all goes well for you Deena.

[@wem-c9f]

Hi Terri, could you advise what sort of bra and underwear should a patient bring to the hospital for the DIEP flap surgery? I can't seem to find any information in the videos that I watched. Do they have to be front closure bra? Since there will be surgery cuts to the chest and abdomen, should a patient get a whole suit that goes from chest to abdomen, or is there other options? Thank you.

[@DiepCFoundation]

All my post surgical garments were provided to my by the hospital 🏥

[@DiepCFoundation]

The bra in this blog was the same for phase 1&2. The longer garment was for phase 2. It is really surgeon and hospital dependent.

[@DiepCFoundation]

diepcjourney.com/surgical-compression-garments-diep-flap-breast-reconstruction-revision-phase/

[@wem-c9f]

@@DiepCFoundation Thank you Terri 💞💞💞

[@schellywagoner8264]

Does the liposuction leave valleys in the donor sites? Is there any way to smooth out the donor site after the canula goes through and sucks out strips of fat?

[@DiepCFoundation]

Schelly, generally speaking it should not. The canula is a small device and the goal of plastic surgery is to make it as aesthetically pleasing and functionable as possible. To this end, the techniques used by highly skilled plastic surgeons should not leave "valleys in the donor sites" from the canula used to extract the fat.

[@schellywagoner8264]

@@DiepCFoundation thank you so much!

[@shannonholmes6674]

Why doesn't anyone talk about what happens to large women when they have a lumpectomy and there their breast is mostly fat & there isn't enough connective tissue in the breast to reapproximate the breast and close the gap made by the lumpectomy. This leave a large area (perhaps the size of a lime or a lemon) for scar tissue to form into a very hard lump. This scar tissue coupled with the radiation that lumpectomy patients receive leave a great deal of fibrous tissue and the scar tissue becomes as hard as a pink school eraser. It also leave a dip in the skin because the scar tissue is pulling the skin in. What can be done besides scar reduction massage. Are there reconstruction options for lumpectomy patients who have this happen ( I have met several like myself already) but all the internet talks about is reapproximation at the time of surgery. Are there reconstruction choices for this problem like surgery to take out large chucks of scar tissue and perhaps replace it with fat from the abdomen. It seems as though the plastic surgeons don't think that a lumpectomy is anything to be bother about

[@DiepCFoundation]

Shannon, radiation has the potential of unpleasant side affects like the ones you mention. I suffered from fibrous tissue. The DIEP flap I had made a huge improvement. My surgeon removed the scar tissue and replaced it with new, soft, tummy tissue during my DIEP flap. Perhaps in a similar manner, after lumpectomy and surgeon could remove the scarring, fibrotic tissue, and inject fat to replace volume. I would ask about this.

[@wem-c9f]

Isn’t fats collection from all over the body for grafting done under GA? It sounds so scary the pain he was describing?

[@DiepCFoundation]

Fat grafting for breast reconstruction is taken from optimal sites determined by the plastic surgeon. Not all areas of the body provide the optimal fat used for symmetry in this instance. The pain is more what I would call "soreness" and dissipates quickly for most after a few days. Walking frequently and wearing compression garments for a short period of time during recovery helps with this. Hope this helps.

[@wem-c9f]

@@DiepCFoundation Thank you so much x

[@nancyfelstein3148]

I enjoyed the podcast very much however I was uncertain about if you were having a tissue transplant if you would use if you would use that grafting, I felt it was more about implants. Thank you.

[@DiepCFoundation]

Thank you for your comment Nancy. Fat grafting is used for both implant and tissue reconstruction. On the DiepCFoundation channel, using the search engine, type in the words, "fat grafting" or "phase two" and you will come up with a number of other videos that will discuss the benefits of fat grafting in both instances of breast reconstruction. Let me know if you need further help.

[@amycuaresma]

I heard the timeframe of 6 weeks as a starting point to meet with the pt and review options phase 2. However what is the timeline as for when the actual second procedure happens?

[@DiepCFoundation]

Hi Amy. There really is not "timeline" for the actual phase 2 procedure. Check out another video where Dr. C talks about it in "Breast Reconstruction Questions Answered". Hope this helps and you are healing well from phase 1.

[@amycuaresma]

You are the best my friend ❤️ thank you 😘

[@jonahmaysam3207]

Try two years of recovery after a flap reconstruction, double mastectomy.I still have major scar tissue that causes my thighs, where the graft came from to feel like I have duck tape on my thighs. Also tightness in my chest.

[@jonahmaysam3207]

Six surgeries, two years. I’m just saying

[@dottiecrow5255]

I have a history of dvts so I can't have lipo what other options do I have...Thank you

[@deenawaddell5631]

I have my surgery on April 1st to get the expanders out, implants in & fat grafting. I am pretty nervous about this, about the pain because this has already been a pretty painful situation.They will be taking from my stomach. If I’m a size 8 will I go down in size?

[@DiepCFoundation]

Deena, if you are a size 8 now and the fat grafting will be taken from your stomach, you may notice a difference in your pant size. I did. My pant size went down after my fat grafting by a size. It doesn't mean it will for you but that was my experience. As far as the pain, I'm not sure what your surgeon uses for recovery and pain but thought I would offer this video for you to watch on the channel about ERAS (Enhanced Recovery after Surgery) protocol. kzbin.info/www/bejne/a3vOhaiYmLWfi5Y

[@deenawaddell5631]

@@DiepCFoundation thank you,that was very helpful.

[@KimTyler-z6k]

I did have phase 2 , before DMX I was a size F, after DIEP I was DD size, my desire was to be a C. 3 months post Phase 2 I believe with swelling gone and setting I am a B/C I am okay with but the setting has left me with the large concave again on my left side non-cancerous side , it was I believed filled but is now concaved again, is there an option for a 3rd phase to fill with fat grafting or will this fat keep disappearing and concave upper chest ?

[@karensiegel8738]

You can definitely have more rounds of fat grafting. I just had my third round after a PAP flap that I had about 3 years ago. What is most important is to find a surgeon who has done this procedure a lot and is a true artist. If they take too much fat & inject that, you can have fat necrosis. If they take too little fat you won't have good esthetic results over all. It is a gradual procedure though so you have to prepare for that. I am also 69, almost 70 so age does not matter as much as health. Also everyone is different in terms of how the fat stays in their body. The average is about 50% stays. But there's definitely things that you can do to help with that and one of them is not disturbing the breast at all for at least two weeks. I heard a surgeon on Terri's site here say that it's important to leave the breast alone for at least two weeks for the fat to set in place and take, before you start moving them around. Surgeons don't normally tell you these things which is unfortunate. Also things like not smoking and exercising too much during the first 2 weeks will also help with keeping the fat.

[@melissadd7597]

After mastectomy do you need to a capsule in order to fat graft intp? So fat cells domt just go anywhere? So they stay in a capsule? My Dr is saying i need to keep tissue expander in me before fat grafting to stretch skin and allow body to build a capsule. Is that true??... fyi i am opting for no implant. Im just trying to have a sm A cup to match other healthy boob. I also had explant surgery, so i could not just go flat; i wouldve been concaved.

[@Melanin_Move]

Is it possible for nipple reconstruction start in phase 2? But then again fat grafting happens then.

[@DiepCFoundation]

Hello, yes, nipple reconstruction is generally part of phase 2 of breast reconstruction. Ask the plastic surgeon you are going to. There are various techniques used to reconstruct the nipple. You can also have a 3D tattoo done. Check out our videos done with tattoo artists. It may help.

[@Melanin_Move]

@@DiepCFoundation Thanks for responding. I will definitely do so.

[@DiepCFoundation]

@@Melanin_Move You are very welcome. Best of luck to you.

[@wem-c9f]

My surgeon told me nipple recon can be same time as fat grafting at phase 2.

[@donnabaldwin8091]

You referred to fat necrosis..., can or should the area of necrosis be removed? Indeed, it feels like a cancer lump, however, not necessarily, unsightly. Will additional fat grafting over a site of necrosis adhere or likely fail?

[@DiepCFoundation]

Donna, this is a good discussion to have with your surgeon. In my case, we left one area as my surgeon told me it would leave too big of a divot. I had no problem with that. I trusted his skill and expertise. I know it's there and told the radiologist when I had my post #DIEPflap MRI for a baseline. Some fat necrosis can be removed. It is best to let your surgeon make this determination. Hope this helps.

[@donnabaldwin8091]

Thanks, probably more fat graft over the area would work. I never thought to ask if it should or could be removed. These discussions stimulate questions. Appreciate you, Donna

[@samanthadavis1862]

Can I have symmetry surgery if I have a pacemaker

[@DiepCFoundation]

Samantha, this is a medical question that needs to be addressed with a microsurgeon who performs surgery for breast reconstruction.

[@wem-c9f]

For a woman who has small breasts and wants to do nipple and skin sparing mastectomy then tissue expander, I am imagining using a silicone implant would make the final breast look very fake? In this case, can liposuction and fats transfer help to improve things to give a natural look?

[@DiepCFoundation]

Fat grafting (transfers) can have great benefit with implants to hide rippling smooth things out. It would also add a bit more volume.

[@sherriclark1290]

No way 😳 to not have pain meds . No way .