Phase 2 of DIEP reconstruction made my boob too small. Is there a fix? (photos)

Question

I had a unilateral mastectomy and DIEP and just had Phase 2 (fat grafting in a dent, reshaping, nipple reconstruction). I went into the surgery with a size C original breast and a size D DIEP breast. I'm only a week out and I'm already so upset with the results -- my DIEP breast is now noticeably smaller than my original breast. I won't see my surgeon for some time and I'm so upset. Is there any way to correct this -- a lift on my original breast, fat grafting, anything?

Allen Gabriel, MD, FACS · Answer

Thank you for the pic and the question. Don't be disappointed, you have a great result with a nice contour and the most difficult part of the surgery is over.  You have a healthy flap and now multiple sessions of fat grafting can tremendously help. Some adjustments on the natural side may also have to be done.  Follow up with your plastic surgeon and discuss your concerns. Best of luck.

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!  Fat grafting has become a popular procedure to improve aesthetic outcome following breast reconstruction or for improvement of contour after lumpectomy. Much of the newest research has investigated the properties of fat, in terms of its stem cell properties and associated advantages.	It has significantly ameliorated radiation damage by increasing vascularity. Also, it adds additional "fatty tissue" atop the reconstructed breast mound to further contour any concavities or deformities, while also masking implant visibility with rippling and such.The decision to have the procedure performed once again will be on you - if you are happy with the results thus far.  It is true that some of the fat does resorb (survival rate of fat grafting is 50-80%).  At our Breast Reconstruction Center, we have utilizing this technique almost routinely to maximize the aesthetic outcomes after lumpectomy or mastectomy. We have utilized the micro-fat grafting technique, and have been obtaining maximal fat graft survival into the breast. After harvesting of the fat from areas with excess fat, usually the belly, hips, or thighs, the fat is processed and injected back into the breast using the aforementioned techniques. Our patients have been very happy with the results as well as the areas where the liposuction was performed. Contour has been much improved using the micro-fat grafting technique, and the downtime is minimal.Fat grafting has become a mainstay in breast reconstruction and has added another edge to breast reconstruction for aesthetics with minimal morbidity and complications.  It typically takes up to a year to see vascularization of the area, which will ameliorate some of the radiation damage present.  Hope that this helps!  Best wishes!

Robert Whitfield, MD · Answer

Don't allow yourself to get more upset.  You are doing well and your photo shows it.  The shape of your right breast can be slightly change to help match the left reconstruction.  In any reconstruction where one side is being reconstructed to match the other it is rare that at one time there is a perfect match.The side without any treatment normally  has to be adjusted either with a lift, reduction or augmentation.  You are doing well so please concentrate on your recovery!

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