Remedial fat graft surgery following mastectomy and radio therapy - To Do or not To Do?

Hi -your breast surgeon feels your pain is due to  your implant becoming very tight and hard - this is due to capsular contracture  around the implant. See reference below . Fat transfer will not alter this.

I would opt for removal of the painful and now unsatisfactory implant and let everything settle down. You may decide you don’t want further treatment and like lots of people are happy with no reconstruction. Or you may opt for further surgery in the future.

No personal experience of fat transfer but know the results are unpredictable appearance wise as the fat does not always remain. I know of someone who had 3 operations for fat transfer post breast construction as she lost the fat each time including the third procedure . Not what you want to go through after everything else that has gone before.

Reference From breastcancer.org

Capsular contracture 

“Once a breast implant is in place, fibrous scar tissue forms around it, creating a tissue capsule. The body forms a protective capsule like this around any object it recognizes as foreign. The tissue capsule is usually soft or slightly firm, not noticeable, and helps to keep the implant in place. In some women, a tissue capsule forms that is unusually hard and dense. The capsule tightens around and squeezes the implant. This condition, called capsular contracture, can cause chronic pain and distortion in the shape of the breast, and it can make the breast rise higher on the chest.

Who is at risk of capsular contracture?

If you’ve had radiation therapy at any time in the past — and particularly if you had it after your initial breast reconstruction surgery — that can greatly increase your risk of developing capsular contracture. But overall, the reasons that some individuals develop capsular contracture while others do not are not well understood.”

I hope you are able to get relief from your pain and if your surgeon does not appear to be addressing your concerns I would see another plastic/breast surgeon .

Dear Moppers,

Thank you so much for your reply.  You seem to understand so well.  It looks as if I have capsular contracture - text book version, my implant has risen on my chest, the breast is very distorted and feels so tight and sore all the time. I had a large amount of RT following my surgery resulting in some very bad effects. In fact I think my surgeon mentioned it to the nurse when I saw him.  He didn't really address my concerns either the first time I saw him, or when I went back when he had me sign the papers for the fat graft, which I was still unsure about.  When I questioned hm, he didn't really answer any of my questions and when I asked him how helpful the surgery he was suggesting was he said that he offered it to pretty well all his patients who had had radio-therapy following reconstruction, most of whom were happy to take it up without a murmur.  He also made jokes about all my questions to the BC nurses who were there with me, so I felt that my concerns were not taken seriously.

I would like to talk to another breast surgeon, really to discuss the option of removing the implant, which my surgeon didn't want to discuss at all.  How do I go about doing that.  I rather thought that you got the surgeon you got, in the clinic you went to and made the best of it.

Thank you so much though Moppers, you have really given me hope that I can address this issue with someone who will take the pain and discomfort seriously, and look at the real options available.  Thank you.

If anyone else has any experience I would be grateful.

Thanks again.

Pollydog