Reconstruction

How to Prepare for Breast Reconstruction and Fat Grafting Surgery

Breast reconstruction can be a never ending process. While the results will never be perfect or the take you back to the breasts you had before cancer, I can now share after 5 surgeries how to approach your breast reconstruction with fat grafting and implants feeling confident. Education & confidence are the keys to long-term acceptance of your reconstructed body.

breast-reconstruction-with-fate-grafting-and-implants-_header

Breast Reconstruction with Fat Grafting and Implants

Before cancer, my breasts were one of my favorite parts of my body. Sure they were huge (36DD) and quite saggy for 27 (thanks to gravity and aging), but I loved them. They were a part of me and made me sexy and womanly. Going through chemotherapy and a double mastectomy, I felt my femininity was stripped from me. I couldn't wait for the reconstruction stage so that I could begin to feel whole again. I saw reconstruction as the answer to my insecurities and sadness about my newly changed body. If you haven't been following me since the beginning you can read more about my previous breast cancer surgeries  and reconstruction posts here. In today's post I will share my reflections on the journey and lessons learned about how to approach breast reconstruction & fat grafting with confidence.

Breast Reconstruction

Just like with many things in life, the things we see as the solution for our unhappiness rarely work out as planned. I started with a single mastectomy on the cancer side, then after chemo I did a prophylactic mastectomy, added expanders and later swapped the expanders for implants. Each surgery left me with new disappointments, added recovery time and new complications to face.

Now, looking back the road through breast reconstruction was part of my healing but  there was a lot more self-love and acceptance work I had to do in parallel. Ultimately it was blogging, reflection, and lots of self-love practice that helped me find love for my body again.

breast reconstruction with fate grafting and implants _Perfectly imperfect quote

Why I Chose to Have Breast Reconstruction Revisions & Fat Grafting

Two year's after my first mastectomy on my cancer side, I had a surgery to complete reconstructive revisions and fat grafting (also called fat transfer). The revisions were done to remove extra skin and tissue that made my foobs (fake boobs) look disproportionate. The fat grafting was also done to improve the natural appearance of the foobs by adding fat taken from my stomach and hips to my chest. The goal was a more rounded, natural shape of the breast reconstruction.

For reference my implants are under the muscle Natrelle Inspira Overfilled Round in 750CC (Silicone)

fat grafting breast reconstruction _Natrelle Inspira Implant

How Does Fat Grafting Work on Reconstructed Breasts?

When going into a fat grafting experience it's important to understand the specifics of how it works so you can have realistic expectations.

The average survival rate for fat grafting is about 60%. You are born with a set number of fat cells and that number never changes. The reason you may gain or lose weight is because those cells grow or shrink. When moving fat around during a fat grafting surgery, the surgeon will go in with a scraping tool (yes that's why it's painful) and remove cells from areas where you have a large concentration. They then run those fat cells through a processing machine to "purify" them and then they inject those fat cells into the new location.

The injected fat cells need enough oxygen and blood flow to survive in the new area. If too many new fat cells are injected at once there is a higher chance the fat cells will die. It takes time to determine what amount of the injected fat cells were survive.

After the fat grafting procedure, you will be expected to wait up to 3 months to see the full results. After the waiting period you can determine if you plan to do another session. Most patients will go through 2-3 sessions to achieve the desired result with fat grafting.

Fat Grafting Breast Reconstruction Recovery

Fat grafing Breast Reconstruction Results_Brusing & Compression

I am sharing my own experience recovering from the fat grafting procedure, keep in mind that each person's healing time and pain tolerance is different.

Fat Grafting Pain & Bruising

When I came out of my surgery I had zero pain on my chest (where the fat was injected and where the skin revisions were done. The locations where the fat was removed from my hips and abdomen were extremely painful though and sore to the touch for about 30 days following. As you will see in the photos below my bruising was quite bad for the first few days but subsided quickly. The tender soreness similar to a bad bruise remained for the full 4 weeks of recovery, but I was able to fully function and was not on pain medication aside from Tylenol. I even started a new job 7 days later.

Compression Garments

One of the most important part of the recovery is the medical grade compression you will wear on the fat harvesting sides to help with healing and the blood cell recover (read more on that here). This is the compression girdle I wore 24 hours a day for 4 weeks! My nurse had the fabulous advice to plan the surgery towards the end of the summer/beginning of fall because the compression garments are super hot and sweaty.

Healing Restrictions

Another aspect to the recovery in my particular case was that I did have the typical 5lb weight limitations due to the skin revisions. If you are just having fat grafting done without other revisions, the recovery is normally only 7 days. .

Mastectomy & Breast Reconstruction Results

Breast Reconstruction Timeline

Fat Grafting Before & After

Fat Grafting Breast Reconstruction Before & After
Breast Reconstruction_Fat Grafting

Fat Grafting Breast Reconstruction Reflections

So you may be thinking... was it worth it? My honest answer is, for the most part yes. While the appearance of my reconstructed breasts is improved, not all of the fat was accepted by my body. The fat grafting and revision helped me have a more natural appearance and fullness to my breast reconstruction.

While I will need more sessions of fat grafting eventually to achieve my desired results, I am tired and done with surgery for the time being. I am preparing to take a break for family planning and hope to someday come back to the reconstruction process in the future.

My plastic surgeon and I will revisit the topic after children and may at that time, assuming my body has changed even more, I may go through additional fat grafting sessions. Maybe in the future, it will become a priority again, but for now I am sticking with this body I have and I am celebrating my reconstructed breasts.  Sure there are imperfections but they are all part of my story. I choose to celebrate my strength, my determination and my amazing body that has gotten me through so much.

Breast Reconstruction_Fat Grafting _Survivor in Mirror

Breast Reconstruction & Fat Grafting Lessons

When the plastic surgeon first told me the reconstruction process could take up to 2 years, I didn't really understand the weight of her remarks. I thought after the first surgery I would be satisfied and it wouldn't matter that there would be "touch up surgeries" down the line. Now, many years later I reflect and share these lessons with you so that you may have more peace and confidence throughout your breast reconstruction journey.

  • Be your own advocate

    Do your research before reconstruction. Look into a variety of approaches (expanders, immediate reconstruction). Research implant types, sizes, materials, surgery specifics like under the muscle or over the muscle.  The more you know, the more questions you can ask and the more satisfied you will be with the results of your surgery. Make sure you are the driving force in the decision making.

  • Be patient

    This is the hardest part. Expanders take time, recovery takes time and waiting in between surgeries takes time. Immediately after each surgery my world revolved around my recovery, my feelings about my results and ultimately my disappointment. The more I learned to be patient and let me body heal, the less I stressed about the results. In time, I was able to reach a healthy level of acceptance.

  • Take progress photos

    Just like with weight loss, it's hard to see growth when you are looking at yourself everyday. I am so glad that I started taking progress photos at the very beginning of my cancer journey. Those photos help me see how far I have come and how strong I am. They help me celebrate my strength, my beauty and my growth both physically and emotionally.

  • Live your life

  • Sitting around waiting for your reconstruction to be perfect can keep  you from living your life. When I finally let go of obsessing over my reconstruction I found I had much more time, energy and interest in living life, trying new things and connecting with others. Our disappointment and self-doubt can hold us back from joy

Wherever you are in the reconstruction process, I hope you find peace and love for your body. No surgery will take back the changes cancer caused, but you deserve to keep going until you have found peace and self-love.

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44 Comments

    Melisande Balleste

    January 4, 2018
    Reply

    Great post as always. I cannot wait to hear more about the family planning. ❤️

    Patricia W Leary

    January 4, 2018
    Reply

    Another awesome post, Anna. Your reflections and willingness to share so others may learn is truly inspiring. Thank you for being you! Lots of love….

    KANIKA

    January 5, 2018
    Reply

    Anna, I think you look absolutely beautiful and you do not need to go through anymore surgery. I had my nipple reconstruction about a two weeks ago. The left side( cancer side) doesn’t look like my right…..color is not pink because of the blood flow etc. I felt a little sad before Christmas but then I realized that no matter how many surgery I will have to correct the problem, I might just end up with other problems. So, I made up my mind that I am done with surgery all together. Like you said, our Foobs does not define who we are. I pray that God will bless you and your husband with either a princess or a prince in this New Year. God bless and always remember that you are a BEAUTY!!!

      Anna

      January 5, 2018
      Reply

      That is kind of where I am at now too. No matter how many surgeries I have, nothing will be perfect. I am working on acceptance. Thank you for reading and commenting.

    Tish Z

    January 5, 2018
    Reply

    You have been an inspiration to me. I just had my reconstructive and grafting surgery last week. I’ve been following you since I got diagnosed at the end of 2016. I can’t believe a year has passed. It flew by. Mastectomy in January, my Mom passed ( from cancer) early March. She passed 2 days after my first chemo treatment. Last chemotherapy was September 5. Next, hopefully February, I get to have my ovaries removed! Thank you for sharing your journey. It has really helped me get through the past year. Many blessings to you and your husband. Hopefully, we will hear that the next chapter in your story is Motherhood. God Bless you and good luck.

      Ambrosia

      January 5, 2018
      Reply

      Anna. Another great post on the realities of cancer survivorship.
      Thank you for your honesty and willingness to share such personal insights with others so others may learn.
      You are truly inspiring. Thank you for being you! Wishing you many Blessing in 2018!!

      Anna

      January 5, 2018
      Reply

      I am so sorry for your loss. I can’t imagine the pain and struggle you have gone through this year and will continue to face. I am sending you love and comfort. Thank you for reading and supporting me.

    Amy

    January 5, 2018
    Reply

    Really admire you for sharing. Spoken so well especially bec I feel so many of the same things post recon.❤️❤️❤️ I put so much weight into the recon surgery and thought it would b the answer to all my insecurities and happiness too. No one tells you how long of a process it is. You’re a freaking warrior!

      Anna

      January 5, 2018
      Reply

      Thank you so much for your input. I am glad to know I am not alone but I hate that you too had to go through this. Sending you love, light and leave with your recovery.

    Mac

    January 5, 2018
    Reply

    To any co-survivors out there it’s critical that throughout the entire process (from diagnosis through reconstruction completion) its her body and 100% of the decision making process is hers.

    As a co-survivor your responsibility is to help remember information received from the doctors and help her weigh the pros/cons of each decision.

    Even when she asks you specifically for you opinion it’s important that you do not try to convince her of any specific decision. Give your opinion as it relates to facts received from doctors and other experts, but remember that it’s her body and you have no right to tell her what she should do with her body. Not only will that cause insecurities it will also make her second guess all other decisions and take away the only control she has over the cancer. It will also turn you into the target of anger/frustration that is part of the process and will slow her ability to accept her body and love it again.

    Cancer care is more than just surgery and medicine, the mental treatment is present in every decision throughout the process.

    Love you hunny and I’m so proud of you,
    Hubby

      Anna

      January 5, 2018
      Reply

      Mac your insight as a caregiver is invaluable. You have truly been my rock, my biggest supportive and my guidance during the toughest times. Thank you for always supporting me in my journey to self-love

        Angie

        June 27, 2021
        Reply

        Anna, you are so lucky to have a supportive husband. Mac, this was amazing advice! I was diagnosed with breast cancer in February after having my first mammogram. After genetic testing that indicated I had a higher chance for recurrence, I decided to have a bilateral mastectomy on April 15. My husband has been just like Mac! So supportive and always left the decision up to me. I worried that I would make the wrong treatment decision. He always told me there isn’t a wrong decision. The genetic testing results made my decision for me. I am currently in the expander stage but with only 375cc in each side. Don’t think I will be able to go much larger because my skin is getting thin. I had a skin sparring surgery, so they removed a lot of skin given the location of the cancer. My husband was, and continues to be my rock. During one of my post-op appointments, I mentioned to him that I hope all women are blessed with a supportive partner or family to help them through the breast cancer journey.
        Thank you for sharing your story!

    Amber Bergeron

    January 5, 2018
    Reply

    You are an inspiration, Anna. I am 5 years from DX date and I’ve struggled for years with my post bilateral mastectomy foobs for so long. Seeing your pictures and hearing about the struggles you’ve gone through makes me realize I’m not alone in these things. You are amazing!

    Courtney

    January 5, 2018
    Reply

    Thanks for sharing! Next on my list is fat grafting…I might reconsider, not sure I want to go through that within a year of the mastectomy. I want a break from surgeries for at least a year. So I’m with you! Good luck in family planning, I love following you!

      Anna

      January 8, 2018
      Reply

      Hello Courtney, I completely understand. Take some time to live and not focus on your surgery. Maybe in a little while your priorities will change or you’ll decide your satisfied and don’t want any fat grafting. Either way time will help you get clear.

    Coreena Malburg

    January 8, 2018
    Reply

    Good morning, I am so brand new to this. I am probably much older then most of you but any feedback I could get I would be so grateful. First of all Anna, what a beautiful person you are inside and out you truly amaze me. I was diagnosed in Feb 2017 had my mastectomy in July and getting ready for my reconstruction on( Feb 16, 2018) exactly one year to the day I found out I had breast cancer. Not sure how I feel about this date!! Can someone PLEASE offer advice on how to mentally make your way thru this? There hasn’t been a day I have not sobbed since starting what I do not like to call a journey. I am looking for advice on how to live again and having recurrence always lingering in the background. I have never posted to anything and yet I find this site soothing and you are all so beautiful.

    Coreena

      Anna

      January 8, 2018
      Reply

      Coreen, I completely understand. I went through that as well. Unfortunately there is not a magic pill but I think self-reflection, journaling, starting new exercise routines and getting involved in the breast cancer community really helped me. Setting boundaries was also really important for me to help with the fear of recurrence. Knowing every situation is unique and trusting I am doing all I can to live a healthy life. You can also search emotional, fear, depression or recovery on my blog to read some of my more emotionally focused posts.

    Kara

    March 7, 2018Reply

    Anna,
    I just had my reconstruction surgery last month. I too like the idea of the fat grafting (lipo suction) 🙂 However, can you tell me what hurt worst? The mastectomy or the fat grafting. Because honestly the mastectomy was the worst pain I’ve ever experienced in my life. And I’ve given birth to two kids! I love reading your blog and Insta stories 🙂
    Thanks for all you do!

      Anna

      March 7, 2018
      Reply

      That is so hard to say because the pain was so different. The mastectomy was bad but pain pills helped me manage that pain. With the fat grafting I was in so much pain that the same pain pills didn’t manage it and I was tender to the touch of the grafted from areas for at least 4-6 weeks. So glad we have connected!

    Elyssa B

    May 30, 2018
    Reply

    Hi, I’m 54 yr old (13 day) post op prophylactic BLM. I wish I would have found your blog before my BLM –
    Although it was prophylactic due to risk, it turned out had lobular in situ in Rt breast making my risk even higher, so I felt even better about doing it after the biopsy came back with that.
    I had NO idea what I was in for with pain r/t drains or expanders and the way the scars looked after surgery are still mind boggling to me… and I am a nurse who does home care and has seen many mastectomy wounds- although I see them
    When they have had trouble and I’m using doing wound care such as a wound vac for patients at home. Never imagined the scars to be very similar, just minus the infections or other issues I saw them for. The rippling and bunchiness- for lack of a word to describe the lines where they are sewn was shocking. I guess it makes sense as of it were a smooth flat scar the skin would risk ripping w expansion.
    I’m only 13 days post surgery and still dealing with painful drains so that’s been hard. Getting them out tomorrow and praying that will be the end of the pain which has still prevented me from getting around except in my home aside from dr appts and one time trip to the salon to get my hair washed out of desperation.
    Even 13 days out there were so many items you suggested to get prior to surgery that I just ordered – bras as they all hurt me from the wounds under my breastline where the dr sutured muscle to the rib to form a pocket… it doesn’t look to me like you had these… and I haven’t been able to find anyone else on line w those type of scars or pain from it. If someone’s reading this who does have them, I’d love to hear from you as again I was shocked by what this actually turned out to be (big looking dimples under and along the breast line) as compared to what the PS explained … and again, I’m a nurse who cares for people w problematic wounds (how crazy is that?!).
    Thank you, for all you documented!!! I just don’t even know how you were able to while going through all of this especially when you had cancer to begin with. Can’t even imagine adding that into the equation. Women like you who do are truly amazingly strong! 🙏🏻
    Lastly, reading all of this is making me reconsider the fat grafting too. The way it’s explained by the PS it sounds so simple and like it’s a no biggy surgery… like the swap is explained… actually it’s all kind of been explained that way. I’m still taking 10mg oxycodone every 6 hours and my dr has been hesitant (to say the least) to even give it to me for 5mg every 8hrs…. which is not realistic for me at this point. I’ve found the pain management to be the hardest part. I’m hoping the drains are causing most of it and it will be relieved after I get them out tomorrow.
    Sorry I’m so long winded, I’m just so thankful for all you have documented and the pictures were SO helpful to be able to see!
    You’re an inspiration!! Thank you!

      Anna

      May 31, 2018
      Reply

      I truly understand. I struggled to find others to relate to at the beginning as well. It can be so hard to grapple with the reality as compared to how the doctors described it. Being on the other side is completely different. I will be sending you lots of love during the healing process and it makes me unbelievably happy to know my blog and words helped you in some way!

    Susie Stamey (@SusieStamey)

    July 11, 2018Reply

    I found your page by googling how to try to manage this hair of mine that is coming back from chemo. In small ways, I just want to feel like me again, but after reading this post I am realizing there will never be a me again that I knew before and the way to move forward is accepting the new me. Thanks for the support and encouragement. It feels like someone really understands this journey.

      Anna

      July 11, 2018
      Reply

      That makes so so happy to hear. I couldn’t find anything when I was diagnosed and it was really scary feeling so alone. I hate you have to go through with this but I am sending you love and support! You are not alone.

    gggeekyhot

    May 7, 2019
    Reply

    Hi

    Thank you for so bravely sharing your stories and especially pictures. Looks just like me actually.

    If you have latest pictures of your results can you link me to them here? This is the latest post I could find on your site.

    I am about to start radiation, and then filling/exchanging. I am about your build and I was a size A/B and will increase to a C. So I would really love to see what I can actually expect once all settled in a year or 2.

    Thank you!

    gggeekyhot

    May 7, 2019
    Reply

    I love that you were focused on your beauty and exciting outcome afterwards. I feel the same way. But I keep feeling like I have to explain it to people for fear of sounding shallow or out of touch with my real illness. I am trying to focus on the rewards at the end of all of this. I have never had large breasts and I am so looking forward to being even sexier than before. And it’s covered by insurance!

    So far cancer has been a good thing for me, oddly. I have lost 40 pounds and have started taking care of myself again. I had lost motivation and was really letting myself go. Now people keep telling me how different I look. I am very blessed. I look more like I’ve gone on a workout kick rather than a chemo binge. LOL

    From reading your blog I am braced for post-treatment depression, and possibly disappointment with my new breasts. (I hope not!) I can prepare now and take steps to keep myself in good spirits. Maybe I’ll go on a real workout kick!

    It’s good to hear from someone who seems to share many of my same experiences.

    Thanks again.

    Stacy

    September 17, 2019
    Reply

    Thank you so much for sharing your experience. I was 35 the first time I was diagnosed and had a lumpectomy and radiation that left me VERY lopsided. I lived with it for 13 years but was always so self conscious. I wore a filler in my bra on the cancer side to try and even out the appearance. Then, after 13 years of being cancer free, I was diagnosed with a recurrence. Suddenly being lopsided didn’t seem like a big deal. It was caught early enough that I have been able to avoid chemo and since that breast had already been radiated had to have a mastectomy. I decided to go ahead and have a double mastectomy and be done with it. I had tissue expanders placed immediately and I’ve finished all my fills. The exchange is scheduled for the middle of November. Friends and family have tried to comfort me with the “free boob job” and “now you can be even” comments. Looking at myself in the mirror I see this is far from true. This is no regular boob job and it seems hard to believe these crazy lumps of skin with deformed turtle shells jutting out will ever look “normal”. I am wishing now I had accepted myself lopsided and goofy looking. At least then I had nipples and feeling. 🙂 I love your comment about accepting where you are. I am trying so hard to accept where I am. -and I am so nervous about the exchange. More from an emotional recovery standpoint than physical. I want to feel happy in my own skin again. I am reading every one of your posts! Each one makes me feel a little better. What a blessing!

      Anna

      September 17, 2019
      Reply

      I completely understand your feelings and can totally relate! It is a process of acceptance and self-love. Sending you all the support.

    Tracy Clason

    October 30, 2019
    Reply

    I’m scheduled for fat graphing in a few weeks. I had a double mastectomy in Feb due to triple neg stage 4 breast cancer. I had Chemo first to shrink the tumors, the the mastectomy and reconstruction (at the same time) then radiation. The radiation on my left side (cancer side) left that breast very hard, while the right side feels more natural. However the left side is much higher than the right so I opted for fat graphing on the right side to have a more even looking chest. Did you go through radiation and did it harden your implants? I’ve been very inspired by your blog and refer to it often. I’m so happy that you’re Mom, it’s so rewarding. Thank you for your post and sharing your story.

      Anna

      October 30, 2019
      Reply

      Thanks for your comment. I did not have radiation but still needed fat grafting for more natural appearance. I need more sessions post baby

    Irene

    March 19, 2020
    Reply

    Thanks so much for your post and blog, I’m 33 and I was diagnosed with breast cancer last august, went through 5 months of chemo and just have a double mastectomy last week… It’s being a little different since I had immediate reconstruction so I won’t be needing other surgeries, also my doc says I’m too thin for fat drafting so at least I hope this it… now I’m struggling with disappointment too and thinking what to do with nipples… I don’t know if I want reconstruction or a tattoo…. reading your story has give me a lot of support. I hope I could be a mother some day too… THANKS!!

      Anna

      March 19, 2020
      Reply

      Sending tons of support your way. I know that navigating the disappointment throughout reconstruction can be bewildering.

    Carla

    March 31, 2020
    Reply

    Thank you so much for your posts.. I’m in the beginning stages of all of this now.. I went and had breast reduction surgery at the end of Jan.. At my week post op I found out I have breast cancer.. I now have been told that I have the breast cancer gene.. I was told I am needing a bilateral mastectomy.. I’m not sure about doing reconstruction as of yet.. But if I can have it done at the same time.. I want to send many prayers and good vibes your way.. May God bless you in all ways possible..

    Judy

    July 28, 2020
    Reply

    I have a question for you. After my double mastectomy my stomach has been very extended. Bloated, and tender. Did this happen to you or anybody you know? It has been 8 months out from initial surgery, had another surgery in March and probably one more coming in September. I too had them under muscle and was not a good look at all!!! I had boobs way up high and the bottom had nothing, they dropped like a 80 yr old woman with nothing in them. I cried for days… in March he changed them out on top of muscle, look better but still have WAY to much skin.. Hopefully after talking and trying to explain what I would like to accomplish, I feel he understands and assured me that he will do his best. And tighten me up and do fat grafting. I am hoping and praying for the best. You look beautiful and your foobs look nice and firm and perky. I hope the same for me..
    Thank you for all your information!
    Judy