Is fat graphing after expanders are in place and before the actual implants are placed a normal thing to do?

I had stage 2b dcis and had 2lumpecto Ives and margins weren't clear so after chemo I had a double masectomy with expander placement. Then 31 radiation treatments . And I wanted to have some fat graphing along with my exchange which I couldn't do for six months , my dr. Referred me to a diff. PS, in a different state he insisted on doing the graphing first after one treatment I now have a hard lump where my port use to be he says it's fine but it's sore and itches , I don't want anymore graphing.

Doctor Answers 4

Fat Grafting Timing?

In general, fat grafting is not done until the final implants are in place and settled for 3-6 months. Fat grafting before the exchange of the expanders makes little sense since you really do not know how things will look until the implants are in.  The implants sit differently than the expanders to a degree so the expanders themselves are often not quite what the implants will look like.

Fat grafting and expanders

if I am going to perform fat grafting, I usually do it either at the time of implant exchange or delay it until after the implant exchange has healed.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Fat grafting in breast reconstruction

Many of us will perform fat grafting at the time of the implant exchange for the permanent implants.  However, there is research showing that fat grafting may help reverse some of the damage caused by radiation to the tissues and perhaps your plastic surgeon is trying to improve the health of the skin and tissue before performing the final procedure.  Unfortunately, there is a much higher risk of capsular contracture (firming of the implant capsule and distortion of the breast) when your breasts have previously received radiation.  Fat grafting may also help uneven contour issues and make the reconstructed breast appear more healthy and natural.  Unfortunately, we never get 100% of the fat grafting to live and sometimes a chunk of it can die (fat necrosis) where we place it.  It can feel like a firm spot.  With help from massage, your body can 'dissolve' that fat necrosis over time.  If not, then at some point that area can be removed surgically if needed. 

Talk with your plastic surgeon about the issues you are having and your thoughts about the future plans for the reconstruction.  If further fat grafting will not serve you well and you are against it, then your plastic surgeon can simply move forward with the remaining stages of your reconstruction.

Best of luck to you!

Timing of fat grafting

There are lots of opinions on timing of the different stages in implant based reconstruction.  Although not wrong, I typically do not use expanders or graft prior to expander swap for permanent implant.  The firm lump you are feeling is probably fat necrosis.  Sometimes if the lump is small, it will resolve with time.  You certainly do not have to do further grafting, but understand that it can improve the overall quality of the tissue in a radiated breast.  If you are not comfortable with the plan given by your current plastic surgeon, seek additional opinions.  There are lots of us out there.  

Kelly Killeen, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 5 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.