Private Parts: Breast Recon Without Surgery

Well, I must say it’s been nice. By the time I submit my beleaguered breasts for inspection in a few weeks, it will have been six months since I’ve had to expose any private parts to physicians. I had a sinus infection recently that required my primary care doc to look down my throat and in my ears, but that doesn’t really count. If disrobing is not involved, you can at least maintain some sort of dignity.

In two weeks, I will be interviewing a plastic surgeon about lipotransfer. I say ‘interviewing’ as if I were researching a magazine article. I wish. I do plan to mention to her that I write a blog about breast cancer and that I will be taking careful note of all her answers so that I might share them here. But this interview will involve exposing my breasts for the umpteenth time, to yet another stranger, and possibly having them photographed, which is a thing plastic surgeons do. The requisite ‘Before’ photo. She will probably also have to poke, prod and squish, and read the dimensions of the surgically-excised tissue formally known as my right breast from the copy of the path report which I will provide. Those dimensions are etched in my brain: 10.5 cm x 5.5 cm x 2.5 cm. Also known as my ‘slabectomy.’ Shortly after my surgery, I made some comparison measurements to other objects just to help me conceptualize how much breast I’d lost. Of course I’m not quite sure if my slabectomy was a perfect rectangle or more of a lopsided wedge. But the dimensions about equal my cell phone, if I had two of them stacked one on top of the other. Or a fresh bar of French bath soap. Or a couple of packages of chewing gum, in the economy size.

I’ve eschewed serious consideration of flaps, grafts and implants thus far, for many reasons, chief among them being all the damage caused by radiation. But apparently, there might be another option that doesn’t involve scars or 14-hour surgery. It might not even involve a hospital. Seems that plastic surgeons have been getting quite good at removing adipose tissue via liposuction from one part of one’s body and re-injecting it into breasts that have had slabs removed from them. In other words, recon by lipotransfer. One of its advantages is that prior radiation is not as problematic. In fact, this seems to help soften up adhesions from radiation. Another point in its favor is that breasts end up looking more natural, still possessed of their normal droop, which doctors insist on calling ‘ptosis.’ Personally, I prefer a little droop. I just don’t see myself as the ‘perky’ type.

There is a clinical trial being conducted by Dr. Joel Aronowitz, of the Breast Preservation Foundation in California, of a slightly more complex lipotransfer technique. This involves separating some of the adipose stem cells from the fat that is liposuctioned from the donor site — yes, adipose tissue has its own stem cells — then concentrating it, and injecting it with regular adipose tissue into the breast. The idea here is that the stem cells will help preserve the transferred fatty tissue to help create blood vessels nearby that will help the transferred tissue survive. Even without this stem-cell boost, there are stem cells in all ‘good quality’ fat, which can in turn help keep the transferred tissue healthy, but the extra boost may improve that outcome. This stem-cell boost technique has been used successfully in Europe and Japan for some time now. Most of the research findings have been published by a Dr. Yoshimura. But the technique has not yet been approved in the U.S. Hence, Dr. Aronowitz’s clinical trial.

In any event, I did some research on plastic surgeons in my area who specialize in breast reconstruction and checked out their web pages. The woman I made the appointment with made the semi-finals for the simple reason that she did not have one of those noisome ‘aesthetic’ websites that some plastic surgeons are wont to have. You know what I’m talking about. Those sites splashed with ‘tasteful’ soft-lit photos of perfect female bodies, artfully arranged in semi-erotic poses, that are certainly Photoshopped and thus do not resemble any body I’ve ever seen nor would especially want to have. Dented, divoted and tattooed though my right breast may be; a body that’s certainly not as buff as it once was, and carrying a few more pounds than it did before I started down this miserable road; still and all I actually like my body. Which is a startling revelation at this juncture. I’ve gotten rather used to my morphology over the years, even fond of it. I’ve learned, through trial and error, how to dress it up or down, and what assets I’ve ever possessed have never involved cleavage anyway, but have tended to attract admirers of legs and long hair. Which is just fine. Not a thing wrong with looking good in a short skirt and high heels now and then, nonchalantly swishing my locks over my shoulder.

So, really, it’s quite encouraging to hear myself say that I still like my body, after all this. And I’m not interested in consulting any plastic surgeon with an agenda, shall we say. I have no desire to look younger than I am. I look ‘young’ enough already, thank you very much, thanks to keeping out of the sun, my mother’s genes, and the judicious application of hair color now and then. Restoration I’m open to. Correction of my so-called deficits and imperfections, as defined by some knife-wielder making payments on his BMW, I’m not.

Thus I was pleased to find a surgeon with a website that was business-like, medically-oriented and informative. The one I’m seeing made the finals based on the person who answered her phone. I do not suffer front-office morons. I deal with enough of them in my job, which often requires me to call doctors about my patients. And I certainly don’t want to consult a doctor who doesn’t have the wherewithal to hire someone with adequate brain cells to serve as her gate-keeper.

When I called this particular office and asked if the good doctor performed lipotransfer for breast recon, it was quite refreshing to be told, “Hang on a second, I’ll ask her right now.” Which was done, with dispatch, and I wasn’t even placed on hold. The answer was, “Yes,” whereupon we booked an appointment.

So, dear readers, I’m asking for some help here. I have a few logical questions in mind, but there is that haze that comes over me when I have any doctor’s appointment involving breast cancer. I get a little fuzzy. I forget to look at whatever list I’ve brought with me. I’ll take a Provigil that day — if I remember to — which might help. But tell me, those who’ve never had recon and those who have, what would you like to know about lipotransfer? If you help give me an assignment, I’ll do a better job. Thanks in advance.

If I do this, I admit I might miss my prosthesis. It’s been an endless source of amusement over the last few years. But I can still wave it around in public now and then. Just for fun.


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This entry was written by Kathi, posted on Wednesday, May 30, 2012 at 01:05 pm, filed under Surgery & Reconstruction and tagged , , . Bookmark the permalink . Post a comment below or leave a trackback: Trackback URL.

43 Responses to “Private Parts: Breast Recon Without Surgery”

  1. You should TOTALLY keep that prosthesis–you may want to go as the 3-boobed chick from Total Recall to your next Halloween party. ๐Ÿ˜‰

    This sounds like a kind of awesome procedure. I can’t think of a single question to ask, because I’m still wrapping my brain around it. Also, the hotness of you in those heels is distracting me. Hello, hottie.

  2. LOL on the Halloween idea!! I’m telling you, Wendy…I’ll come & give you a personal lymphedema treatment! You deserve one. Hugs. ๐Ÿ™‚

  3. Hi Kathi – here’s hoping your appointment goes well. I’m glad you’ve found a procedure you want to consider. I have heard of one woman here who had this type of recon, and she had a comprehensive page on her blog about it. The link is here:
    http://julieshort.wordpress.com/2011/05/06/lipofilling-breast-reconstruction-the-patients-quest-for-more-information/

    What I do know about lipofill (although I’ve not had any myself, but flap transfer), is that in all transfers some of the fat can die, and go hard. As I understand this can mean you might have the procedure more than once to get a successful result.

    Good luck Amazon! Best to you, Sarah

  4. Thanks, Sarah. I’ve talked to a few folks who’ve had some lipofill, but not for the whole job. They’ve had very few problems with it. Depends on the surgeon and the donor site, I’d think. And I don’t mind if I need a tune-up now & then. Thanks for that link! We’ll see…

  5. Like, even love your body, we all need to more. And you look great, too. Love the prosthesis pinned on front, nice touch, like a wonky corsage. There is a joke about a woman with 3 boobs, great to dance with, unusual appearance. (sorry if that offends), Groovy shoes too.

    As for q’s, I suppose I’d like to know about the impact on the donor site – what are the possibilities, will there be pain, changing shape, impact on function? As far as the procedure itself, what are the stats on the procedure overall, will the fill shift, how often might you need tuneups. What’s the recovery time? Are there particular stages of recovery? And the all important question in the US, is this covered by insurance?

    Best of luck with the appointment.

  6. Hahahahah, Elaine! You & Wendy are on the same page regarding the 3 boob wonder woman! Yes, I am wondering about the donor site myself, etc. The procedure is covered in the US — we actually have a law that entitles us to lifelong recon procedures if we’ve ever had breast cancer. All these thoughts & questions are so helpful. I am really appreciating everyone’s contribution.

  7. Let’s see, there’s an awful lot I would want to know and would look at in interviewing physicians. Since my mind will move faster than my typing fingers I’ll start listing some questions/thoughts that have come to mind:

    1) Check with Sue Friedman of F.O.R.C.E. She’s on FB as Sue Friedman. She told me that FORCE usually has this topic on their annual conference agenda. She also might be able to direct you to women who have had the procedure. Itโ€™s big in Florida, which should tell you something.

    2) I operate under the assumption that the proposed procedure does not work; thus allowing the doctor to either support or challenge that assumption based on his/her answers. So if the doctor says, I’ve done 500 of these procedures and I havenโ€™t had any problem with tissue necrosis….then that would be pretty awesome. If the doctor says I’m just starting to learn about this procedure, or I haven’t reconstructed this MUCH breast before, then I would say thank you I’ll return when you have the kinks out. Is the doctor writing and teaching the procedure? Personally I’d feel a lot more comfortable with a doctor who is doing both.

    3) How is the procedure done? How much fat can be injected at one time? enough from one procedure? And wouldn’t you need to have skin grated from another site or do you have enough that can be stretched? Have you had physical therapy tot your skin moving across the radiated tissue? That took some work for me. In the end, the majority of my radiated skin was discarded and newer skin from my abdomen added from the flap transfer.

    To me this is one of those procedures that sounds better than it is. Is surgery really not involved? I donโ€™t think it could be as simple as injecting botox or alloderm into your face. The beauty with elective surgery though, is you can take your own sweet time to check it out. Right now you haven’t given me enough to go on to sign on myself. So ask the big questions and take a friend with you. It will help you with your decision.

    Hugs,
    Jms

  8. Great input, Elaine & Jody.

    This stem cell boosted thing is for partial breast recon, not for total breast recon, so I’m not sure that F.O.R.C.E.’s info or the Florida thing is really relevant. The Florida thing is BRAVA, I think it’s called, which is for total masts where skin is removed. I have all my skin. And my nipple. Whole nuther deal. Good thing, as you’ve pointed out, Jode, is that I don’t need to do this, nor would I lose sleep over it if it never happened. The appeal for me is almost more to do with the possibility of softening up the adhesions I have from radiation. Love that. Symmetry? Be nice, but not a big deal for me really.

  9. I would also be concerned about tissue necrosis. Jody’s questions are perfect.

  10. OK, I risked doing the math captcha again to say this:

    You are one AWESOME writer. Love the way you use humor in this. Good luck with the doctor’s appointment, and good for you for interviewing them!

  11. Thank you, Beth!! Can’t seem to help being snarky. Must be genetic. ๐Ÿ˜‰

  12. Hi Kathi,

    In February I had a double Mx with immediate recon (free TRAM and DIEP). Lefty had issues due to disruption of the blood supply during an MRI-guided biopsy; poor frankenboob is pieced together and there wasn’t enough skin to allow padding of the upper chest, so I was almost skin on bone there, and very uncomfortable. I had lipotransfer/fat grafting 13 days ago. My donor site was my hips.

    I was told that grafts usually need to be done up to four times, generally 6 weeks apart. I can’t tell how well this one did yet as it’s way too soon, but I can say that I was bruised and lumpy at first. Things change daily, and the tenderness is largely gone. I’m still rather lumpy, but the lumps aren’t noticeable, and seem to be softening.

    I had more fat than needed for the transfer lipo’d out of my hips, as the flap procedures had left me with a flat tummy but I still had muffin top and it made pants almost impossible to find. I woke up from surgery with a compression garment that went from just under my bust to my hips, and my hips and sides HURT. 13 days out, I’ve switched (per doc’s permission) to a Spanx-like garment and while the pain has lessened, I’m still decidedly uncomfortable. The pain is enough to amaze me that people do this voluntarily – had I not needed the fat for my chest, there’s no way I’d have done it, and in fact if I had known how much it would hurt, I may have chosen to live with the chest discomfort.

    Please let me know if you have other questions that I might be able to answer about my procedure!

  13. And speaking of snark, well, I just know we’ll be instant friends, Melissa, as your blog name is the Snarky Llama. You’re so right about llamas. They are rather snarky, aren’t they? But they do have lovely eyelashes. Too bad they can’t blog for themselves. ๐Ÿ˜‰

    One of my friends had a similar fat graft on her upper chest. Just one booster shot, so to speak, and it’s been fine for the last three years, I think. Looks great, too! Her skin there looks beautifully smooth!

    It’s quite an involved type of thing that you’ve gone through, though. I don’t have the heart for it. Plus, I’m a physical therapist & have seen too many post-op horrors & could not/would not sacrifice a millimeter of muscle tissue or deal with scars across my belly or back or wherever. No thank you. I need my trunk intact to haul my patients & my equipment. So I can work & pay the bills & eat!!

    I hope you will be all right in the long run & happy with your results & have no complications of any sort. Hugs to you.

  14. Kathi – I can totally appreciate why you’d eschew the type of recon I had. My options were implants, flaps or no recon, and I just couldn’t fathom looking in the mirror and seeing… nothing. I always loved my rack (well, since my reduction when I was 20), and the idea was too much. I didn’t want implants because I have other health issues that made the idea of something artificial (not to mention high-maintenance) seem like a bad idea for me.

    That said – yes. It’s been a lot. Too much, some days – I’ve developed Axillary Web Syndrome and will be starting PT when I’m healed from the most recent surgery. I call cancer (snarkily, of course) “the gift that keeps on giving.”

    Do you know how long it took your friend’s graft to settle down and look similar to how it does now? I know it’s too soon for mine – I find it so hard to have much patience with my own healing.

    Ah, Llamas. Snarky ones! My son called me the Mama Llama, and it stuck, so here I am – sans amazing eyelashes. But then, I don’t spit on anyone, so it all evens out.

  15. Melissa, I think my friend told me that the first fat graft lasted about a year, then there were a few valleys & divots. So she got a second one, and that one is the one that has looked good for at least 3 years since. I think the latter one settled right away. It sounds like they may need to fix a few spots for you, to smooth things out.

    Honestly, it’s easy for me to say all this about recon, but I don’t know what I would have done if I had had to face a full mast or a bilateral mast. Probably implants, but maybe not. I don’t know. I’ve never liked the idea that implants are inserted under the pectoral muscles. Knowing what I do now, I suppose I would at least have checked out having a skin-sparing/nipple-sparing mast. What I had amounted to that, except for the partial mast I ended up with. It was done through a circum-aureolar incision, too, which hurt like a son-of-a-gun for months & I cursed my surgeon heartily. But after it healed, the scar is virtually invisible, although the nipple looks like a squashed cherry on a collapsed meringue.

    I had a little bit of UE lymphedema at first — I had no chemo or node removal, mind you. The LE appeared after radiation. That resolved but I developed axillary cording like you. It comes & goes. I had PT on it as well, which helped, but it comes back. And I have chronic adhesive capsulitis in that shoulder & I have to keep working with theraband exercises or my whole right arm hurts like hell when I try to move it. I finished acute treatment in October, 2008, mind you. I hardly ever get it stretched out enough to reach my right arm all the way over my head — close though, but it hurts. I also occasionally get the most hideous spasms all the way down my chest & trunk if I bend over or reach down too quickly. Like a charly horse. Awful!! I call radiation “the gift that keeps on giving.” It all is, let’s face it. Sigh.

    Good luck to you. xoxo

  16. Hi Kathi – first of all, kudos to you for doing such great investigative work to find your doc, and I hope the consultation goes as well as the initial phone call. Regarding the procedure, there’s limited experience by a handful of plastic surgeons but this does seem to be very promising. I don’t have personal experience with the procedure but have a few comments:
    – Several have made important points above – this is not a one shot deal, and multiple sessions may be required. There is no way that I know of to predict the amount of fat necrosis (when the fat loses it’s blood supply and forms firm sometimes painful masses – happens sometimes after flap procedures as well) and I think you always have to keep in the back of your mind that surgical revision may be required. And Jody’s points regarding radiated tissue not stretching are excellent – as you well know, radiation can do some nasty things to tissue and the true extent of the damage is not always known until you start messing with things…

    – As with any newer procedure, a certain amount of trust in the doctor is needed as we don’t have long-term results. As someone who is involved with a few innovative procedures myself, I don’t necessarily need 50-year follow up on a new technique, but I would certainly seek out some of the pioneers in the field. Ask the doc about her personal experience with the procedure.

    – If you’re not at all comfortable, just walk away and research some more.

    Best of luck whatever you decide; I know you’ll keep us posted!

  17. Thanks, Deanna. Your input is always appreciated. As you can tell, aesthetic plastic surgeons are not my favorite people. I know too much about surgery and about the history of breast augmentation, which is hardly a sterling one.

    Yes, I’m going to end up with a long list here. We’ll see. There has to be the right chemistry, I think, for any doctor-patient relationship to work, so mainly, I’ll have to feel comfortable with this woman. I consulted another woman a few years ago who does plastic surgery at Faulkner and Newton-Wellesley Hospital, both great places to have any surgery. I liked her a lot and she was very candid with me about surgery and about avoiding flaps & scars because of the work I do. I thought this time I’d try to check out someone closer to me than Boston, but Boston is not impossible either. The woman I’m seeing has privileges at this triad of hospitals in Providence, which has a relationship with Brown U Med School. That was one of the criteria on my list, to have that affiliation. I’ll probably know within ten minutes if I can get all my concerns addressed and speak frankly with this woman. So, I’m going into this with no expectations really, just starting down the road to reconsider this whole thing. I do like the whole notion of this, though. It sounds like a promising avenue altogether. I did search for clinical trials of the stem-cell boosted fat grafts, but couldn’t find any close enough to me, although I would think that New York or Boston might start something in the not-to-distant future, being the medical meccas that they are.

    I think mostly, I’m regarding my willingness to investigate this as a sign that I’ve turned some kind of corner physically and mentally, which is a good thing. Whether I have any procedure or not is almost not the point, if you know what I mean. Just being willing to check it out, after feeling for so long that if I had to see yet another doctor about my breasts, I’d go completely round the bend, is a healthy sign.

  18. Kathi, as always, an entertaining and informative post!

    Everything I could think of to ask has already been mentioned above. Good job ladies!!

    Be sure to ask what types of things can specifically go WRONG with the procedure and how many of those wrongs this doctor has personally experienced โ€” and fixed. And don’t be afraid to ask more questions if any answer is nebulous!

    Good luck and keep us posted!

  19. Kathi, I so love your positive outlook. If only you could bottle it and send some this way. Using your blog to get advice is really smart, as are the responses you’ve gotten. I wish I’d taken more time for research before my reconstruction, but it seemed the best option at the time. I had tissue expanders, then implants. Good luck meeting the doc. Looking forward to hearing about it. xoxo

  20. Very interesting (and I love the photos!). I needed a mastectomy (one of the two tumours had developed near and become enmeshed w/some pectoral muscle, so I needed a slab of this removed too). My surgeon recommended a skin/nipple-sparing mastectomy with recon via implant – he also inserted mesh in place of the removed muscle – and said his aim was that ‘no one need ever know’ about my mastectomy when I was in a bikini top. At the time the cosmetic outcome was minimally important to me, but I must say that I really appreciate now that he achieved his cosmetic goal, as it’s great (living in the tropics, for starters) feeling unselfconscious in swimwear. Most importantly, though, the margins were clear first go. My surgeon is a rock star in my eyes – well worth travelling to the big smoke for. I’m now nervous about the limited lifespan of the implant (another thing I didn’t focus on at the time), but can’t think of an approach that would have been better in my particular circumstances. Seems the options all have significant downsides. I will be intrigued to hear about your consultation – I’ve never heard of this technique.

  21. PS I will always think of that scene from Holy Grail now when stripping off at the doctor’s!!

  22. Lots of good points already. I would add asking pointed questions about how the doc defines success & failure. You know what your idea of success is – make sure you understand what the doc’s is. And also for failure. Always important to know what the doc’s definitions really mean. What does failure mean, what does it look like, what does it feel like, & most importantly, what is the remedy.

  23. Kathi,
    This is fascinating. You look so adorable in that picture. I wish I could say I love my body… I appreciate it, but love it, not so much. And since cancer, things have gone seriously gone down hill…

    My number one question to ask the doc would be how many times have you done this procedure and what has the success rate been? I would also double check on insurance covering it, cause sometimes things get “sticky.” I would also ask to talk to one of her patients who has had the procedure done.

    Like Stacey mentioned, I wish I had investigated all my options further. That is a regret I do have, so in some ways you are “lucky” to be dealing with this now if that makes sense.

    Regardless of what you decide, I know you’ll keep investigating. I know you’ll keep us all informed too. Good luck!

  24. Thanks, everyone! Poor surgeon isn’t going to know what hit her!!

    Nancy, I can’t say that I ‘love’ my body, but I like it and I appreciate it. And I’ve had a lot of fun with it in my life. And I don’t take it for granted anymore. It took a while for me to come to terms with feeling like it betrayed me for letting this cancer thing happen. But I’m not holding that against it anymore. Now, I just feel sorry for the poor ol’ bod. So, I’m trying to let it have a little fun now and then. Bought a hula hoop recently and even kept it going for a whole minute the other day!! LOL. My big achievement for the week. And it was fun so I’m going to keep at it.

    Laura, it was so therapeutic to take that photo, which I took on my patio around my first birthday after the initial folderol was over. The tattoo was my birthday present to myself. I just had to make fun of the whole ‘breast cancer is sexy’ baloney. After the hula hoop and I get better acquainted, I have plans to take a few more goofy self-portraits…stay tuned for that!!

    If it weren’t for attitude and not taking myself too seriously, I’d be in a rubber room for sure. xoxoxoxo to you all.

  25. I have nothing to offer as far as an opinion on your conundrum but I just wanted to say that I absolutely LOVE your picture!!!! You rock!

  26. Kathi,
    You are going to be loving that hula hoop! I also have one and it is so damn fun! I can’t help but smile and be silly when I use it. As a matter of fact I am going to get it out and use it tomorrow just because of you. I will be thinking about you when I am “hula-ing” my booty around for all to see. I will fit right in here in Portlandia ๐Ÿ™‚ Oh yeah, and it is great exercise too…BONUS! I have always been curious about your tattoo. Do you have a larger picture of it? I would love to see what it is. I have 5 hours of credit at my tattoo parlor and I really want to incorporate my “Cancer Assassin” experience into it somehow, looking for inspiration ๐Ÿ™‚

  27. Laura, I deliberately picked a non-pink, non-cancer symbol. I have a lot of Celtic heritage, so I picked a Celtic knot in one of my favorite colors — purple! I picked a place where I could hide it if I needed to (for work) but show it easily, and also where I figured there was a good chance it wouldn’t get flabby or have a surgical scar through it anytime soon. LOL. This is the drawing I brought with me. It’s more shaded on my leg and a little smaller:

    You’ll have to write a post about your next tattoo!! ๐Ÿ˜‰

  28. I’ve had lipotransfer twice to fill in the flat areas at the top of my DIEP foobs. Both were done outpatient, in a surgical center not a hospital, which made me happy bc there’s less risk of infection–a must for me! The first transfer was taken from my hips, to rid me of the fat sacks resulting from the ab incision from the DIEP. The second one was from the saddlebag area. I have several puncture holes in the hips & thighs but they’re small. The bruising was significant the second time, but kinesio tape & massage from my Lymphedema specialist helped tremendously.

    The results of the transfer were visible immediately; smooth and round, and I don’t recall a lot of pain. I felt awful from the prophylactic antibiotics that are required for a girl with a post-mastectomy infection, though.

    Unfortunately, I had a significant amount of necrosis, and the roundness is pretty much gone. It’s not easy to predict the success rate, and of course everyone is different in terms of healing. One thing that worked against me was losing weight after the transfer. You want to be at your ideal weight, whatever that may be, before the transfer bc losing weight will make the new fat die. Maybe it’s different with stem cells; I can’t speak to that bc I didn’t have that done (but it sounds very promising).

    You should def plan on more than one transfer, and my insurance did cover everything. I’m sure there are some issues with how to code the procedure so that it’s def reconstruction & not cosmetic.

    Good luck!

  29. Nancy, I was thinking about the weight thing myself, so I’m glad you mentioned that. I want to tone up a bit first anyway & see if I can get rid of this last 5-8 lbs. that have been hanging around, mostly due to fatigue. So, it did seem to me that it would be better to do that before I had anything done.

    You’ve all been so wonderful with your advice and sharing your experiences. I really appreciate this enormously & I’ll keep you all posted. xoxo

  30. Hi you do indeed look fabulous so it’s important to do what works for you. I recently opted for lipofill to avoid direct surgery to an irradiated breast from 16 year previously. My surgery last year tipped the balance too far and I hate the prosthesis I had. I have had one lot of lipofill and a breast reduction on the other breast. The lipofill has had moderate success but I believe the next top up ( see earlier blog on this!) will be more successful as its building on more healthy tissue now. It is a procedure that needs more than one top up. It is bruising and painful, but it felt like the best option for me. Good luck and happy to answer any questions if I can. All best Audrey

  31. Audrey, thank you so much! This is so helpful, and I’ll definitely be in touch if I go through with it.

  32. Hey Kathi — sorry I’m slow to chime in on this. I’ve had two fat grafts (one after my original implants and a second when I had my nipple reconstruction done — which obviously followed the new implants, but that’s another thread).

    As others have noted, fat grafting isn’t without its downside. It is quite painful, particularly the harvesting from the donor site. I cannot imagine anyone voluntarily undergoing a lipo procedure! But that said, I would do it again.

    The first graft was uneventful, though my outer thighs were quite sore. I work out a lot and I’m in relatively decent shape, but it was a good 6 to 8 months before the discomfort was entirely gone. It wasn’t the type of pain that needed constant medication, but there was a soreness that was always there. My PS filled in around the implants (first ones were the horribly named ‘gummy bears’. Ugh) Have to say the injection sites were pretty tender for a while too. But nothing you can’t live with. Of course they want you to restrict lifting and other strenuous activities for a few weeks so that the grafts can settle. I had a small crease near my cleavage from the bilateral that bothered me and this fixed it and softened the edges around the implants and they looked very natural.

    Ultimately, I was displeased with the implants as they lacked projection, heavy, and didn’t pass the hug-factor. After discussing this with my PS, he felt I would have a better result with round silicone and was on board to exchange them. I was very lucky that he was able to go slightly larger and they did not ripple, but as he predicted, I would need another fat graft to perfect them. I wasn’t thrilled about it as the thigh pain had finally settled down, but I was all about the result.

    My PS originally wanted to use my inner thigh, but I’d heard that was excruciating. Since he was taking a graft for my areola from my bikini line, he said he thought he could take fat from there — bonus, for sure in my mind, as it would be like a tiny tummy-tuck.

    I assure you that seven months later, all is fine — however, there was an initial problem with the second graft. Within a few days of my surgery, the fat graft above my right implant appeared to ‘bubble’ under the surface and was uneven and lumpy. It was extremely upsetting since I’d never had a complication in 4 past surgeries. I was a basket case until my follow-up visit the following week. Within a few days, the lumpiness absorbed and by the time I saw my PS it was substantially better. We’re not quite sure if it was the quality of fat from my abdomen vs the thigh which was the issue, but that is definitely a complication that can happen. I was just lucky that it resolved itself.

    The pain factor wasn’t quite as bad but it took about a month before jeans were comfortable again.

    To summarize, while fat grafting might be considered ‘less invasive’ than surgery, it is equally painful. The choice of donor site appears to play a role in the procedure’s success and lumpiness (like cottage cheese) is definitely a risk. My oncologist was fine with the procedure, but I have read articles that suggest there could be risks involved with fat transfer due to the estrogen involved (which may or may not be an issue for some women). I was ER+ so I found that somewhat disturbing, but there are no long range studies to date. But the little secret that nobody discusses is whether the fat taken from a donor site will return. The answer is that it likely won’t — but that doesn’t mean it won’t colonize elsewhere and in surprising places, such as your upper arms, back, waist, etc. So that’s been a big motivating factor for staying fit.

    I hope this helps and I’m anxious to learn what you decide to do. XO

  33. BlondeAmbition, thank you SO MUCH for sharing your story. It’s important to be reminded that any invasive procedure is not without pain or risk. (I’ve written posts about the lovely colonoscopy I had in January, not to mention the wire localization just prior to my breast surgery — quite nasty.) It is interesting about the donor site, isn’t it? You wonder if there’s some way that they could tell beforehand which donor site might yield better fat tissue or if they could tell by just extracting a little & analyzing it somehow. Hmm. Again, these are things I will definitely ask about. Frankly, I don’t even know if it’s possible for a surgeon to do what I’m inquiring about, which is to fill in the half my breast that’s missing. But nothing ventured, nothing gained. LOL on keeping fit!!! My chief motivation for keeping fit over the years is so that I can keep eating like a long shoreman! ๐Ÿ˜‰

  34. Kathi,

    I am having my second lipofill in 2 months. The surgery is outpatient and is basically this in a nutshell:

    1. liposuction of ________(fill in blank). For me it was stomach. PS only took 500cc’s.
    2. Run cells (all during surgery) through some machine to process before injection.
    3. Inject into site.

    My first go round I had no problems. My breast looked and felt great for 2 years, actually still does. I am in the process of my second recon on L side (long, boring story) and will get it done again on both sides this time for some reshaping. I had no necrosis and I actually had a lot of feeling where the fat was injected that I had lost with my original recon.

    I will say that it does HURT like crazy (VERY sore and VERY tender at injection and site of liposuction) for a few weeks after the surgery. Liposuction is a pretty brutal process in my opinion. Think of a long saw shoved into your abdomen pulling out and in getting the fat out. I have no scars. It took my stomach a good 6 weeks to flatten out. You have to rub it a lot to work out the scar tissue.

    Wishing you the best in whatever decision you make.

    Hugs

  35. Great summary, Diane. Very much appreciated. They do make it sound like you just walk in and walk out, but knowing what I know about surgery as a PT, I know it cannot possibly be that simple!! And that, given my job, I will probably have to take some time off to recover. I can put up with a lot of soreness, though, and the worst pain in my life has to what I had down my whole left leg after a herniated disk that had to be surgically removed. Gawd…

    I’ll tell ya, there’s nothing like a group of sistahs who’ve been through to give you the real scoop on things. I’m so glad I asked you all for info. Hugs back.

  36. This sassy post really speaks volumes. I love how you love your body the way it is. Because that’s how I feel, too. Like you, I play up the assets I still have, and go from there.

    Since I didn’t opt for recon, I know next to nothing about lipotransfer. Other than infection and risk of worsening lymphedema, what are the things to watch out for if you are considering that route?

    xx

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