LD flap recon with liposuction!!

LD flap recon with liposuction!!

LD flap recon with liposuction!! Hello everyone,

I went to see my Plastic Surgeon yesterday to discuss delayed reconstruction following my mastectomy last June.

What I have decided is best for me, for many reasons that I won’t bore you all with is this - LD flap to get muscle and good tissue as I’ve had rads and therefore damaged tissue. This will be followed 3 months later with liposuction to my hips and the fat injected into my new boob to increase the size and a reduction on my good boob to make them even. I could have more than 1 liposuction to increase my new boob by 1 cup size each time but I have opted for a nice new pair of 32C’s instead of the 32E I presently have.

I know this is a fairly new procedure and I’m delighted to have been offered it. Has anyone out there had this done and can you offer me any advice please?

Carla x

lipo-filling - for Carle Hi Carla

I was having a browse and came across your post…I have been offered the lipo-filling treatment and am now on the waiting list. My consultant talked about it as my best option but I coudnt find anyone who had had the op…but eventually I found the best info on the procedure here on the website.

If you go into the older threads (still on the reconstruction thread) there is a posting headed ‘Liposuction by SuperSue’. Its an oldie - dated 20.04.06 but because its a really new procedure the info is still good. Supersue has a couple of other postings giving updates etc. I hope you’ll find them as helpful as I did.

I have had all the tests - mammogram, MRI, the ‘before’ photos (- hope it wont be too long till I get the ‘after’ ones taken!!) but was told there is a 16 week waiting list - which she says is optimistic - I’m now at 19/20 weeks and waiting for the postie every day.

Sounds great - boobs sorted with the extra benefit of a slimmed down tummy / hips. I was told I didnt have enough tummy but my shanks (!!!) would proveide enough blubber. Needless to say the diet has gone out the window for the last 4 months…

Hope you find what youre looking for…take care…

Alimo x x

Thanks Alimo for that, I’ll have a look. I too have ditched the diet as I didn’t even have enough fat for the LD flap last year when I originally saw the Plastic Surgeon so I want to hang onto my extra bits!
The earliest I can have it done is September due to radiotherapy only finishing in March so effectively I’ll be at the top of the list by the time I’m able to have it. Seeing her again in Sept to discuss dates. I see you are in Scotland too. Who is your surgeon? I’m seeing Eva Mithoff - she has a fantastic reputation - I know people to work with her who also say she is wonderful.
Please let me know how you get on,
Carla x

to carla Hi

I am under Ms Mithoff too…she seems to be the one forging ahead with this new kind of reconstruction. She was involved in the original tests in France and really knows her stuff.
I was impressed with her thoroughness on my last visit and cant wait for the go ahead now.
I mentioned to her that she had been given ‘a good write-up’ on this site and she was most intrigued!

Take care

Keep posting

Alimo

LD+LIPO LD+LIPO

Hi Carla and Alimo,

Yes the procedure is fantastic. I’ve copied old details below and put a new update at the bottom.

Ms Eva Weilor-Mithoff knows that I’m willing to talk to anyone about to embark on LD+LIPO. I can’t put my full name here but have a word with her and ask if you can speak to Sue M.

Okay here are the details…

INTRODUCTION

As people may know I was diagnosed with BC in April 2003 but unfortunately I’d had a twelve month delay in diagnosis. As a result of the considerable delay I was advised to have a mastectomy without reconstruction because a simple mastectomy was less likely to have complications which could delay chemotherapy.

After meetings with my NHS Trust I insisted on having a reconstruction as soon as possible. In this part of Scotland the waiting list is five years and so the Trust decided to send me to have the reconstruction done privately at their own expense.

I discussed different reconstruction techniques with the private surgeon. She couldn’t carry out a diep (abdominal flap) privately because the private hospital couldn’t provide the necessary emergency backup but she could carry out an LD (back) flap which is a less complicated operation.

I’m not a large woman and it was clear that an LD flap on its own wouldn’t supply enough volume for the reconstructed breast to match the natural one. At a 34B cup size I didn’t want a breast reduction on my natural breast.

My surgeon suggested using a new technique which has been developed in France. Rather than using an LD flap plus an implant she recommended an LD flap plus one or two sessions of liposuction. This new technique would removed fat cells from my abdomen and put them (guess where) in my reconstructed breast. After the fat cells are put in place they don’t die because the body develops new blood vessels to support them. The advantages of the technique would be no risk of rejection (they are my own fat cells), a low risk operation, a natural feeling breast that would change size if I lost or gained weight, no future operations to replace an old implant, and a flatter tummy.

JULY 2005

I had the LD operation in May.

The surgery went well. It’s a big operation but not as big as the diep (abdomenal) flap. It took 4-5 hours and I spent 12 hours (as a matter of routine) in the higher dependency ward – the medics like to check you carefully and frequently after any major operation.
The muscle was removed from my back and placed in the chest area complete with its blood and nerve supply.

As I had previously had radiotherapy the skin over my chest area was not very stretchy so the surgeon cut a strip of skin from my back and sewed it onto the breast as part of the reconstruction so that there was enough room for the muscle in its new position.

My arm and back were stiff when I woke up. I was given painkillers, intravenously at first and then later in tablet form. I had several wound drains which were removed five days later and I was immediately allowed home.

My arm was very stiff at first but got better with the exercises I was given to do. I regained full movement within three months. Occasionally my arm gets a bit stiff but the stiffness disappears if I go swimming.

My back is now fine and I can lift everything as usual. I used to get away with having terribly bad posture but now I have to sit up straight so that I don’t get backache. My surgeon tells me that the operation will mean that I will never be an olympic cross country skier but for everything else it will be okay. My skin is numb in a patch below the scar on my back. This has slowly improved.

Aesthetically speaking, the breast itself is such an improvement on a simple mastectomy. I am very pleased. The surgeon who carried out the reconstruction did a very good job. She even removed the old ugly scars under my arm and replaced them with nice neat ones. The scars are flat and are gradually fading. They will never be invisible but already they are nowhere near as prominent or as red as are often seen in medical photos. This improvement is likely to continue for a few months yet.

The breast itself is made of back muscle and still has its nerves and blood supply. At first, after the operation, when I touched it, it felt like I was prodding myself in my back. Weird. The breast also contracted when I pushed down on the bed when trying to sit up because my brain still thought it was a back muscle. The surgeon told my husband that he had to rub cream into my back and new breast and that this would help nerve endings to recover and would persuade my brain that the muscle was now at the front. This has proved helpful, as well as pleasurable, and these odd effects have gradually diminished but haven’t entirely gone yet.

In my case the new breast is nice but smaller than my natural one. Sometime in 2006 I’m going to have the size of new one increased using liposuction - this technique is being used as an alternative to implants by French surgeons so my surgeon keeps going to France to practice . Once this is done I shall have a nipple reconstruction. This will make me more symmetrical and will make the scars less noticeable.

APRIL 2006

Earlier this month I underwent the first liposuction operation. It took about 90 minutes. Fat was taken from my abdomen, centrifuged and put into my reconstructed breast in layers. The surgeon could only put a certain amount in because due to radiotherapy the skin is less stretchy than it used to be and also because if too much fat is put in at one time the new blood vessels won’t be able to support it.

I came round with the usual groggy effects of the anaesthetic but was sufficiently recovered to go home the next day. The bruising was pretty spectacular - I looked like I had been in an explosion in a powder paint factory. I was black and blue and green and yellow. It was sore and I had pain killers so I don’t recommend liposuction as an alternative to dieting. The soreness wasn’t deep and didn’t affect my muscles so I had no problems sitting up, laughing or coughing. There was also swelling (oedema) in both the reconstructed breast and my abdomen.

Scarring. On my abdomen there are four small scars cleverly hidden inside my belly button. On my reconstructed breast there are no additional scars because the fat cells were injected along my already present scarring.

I have to wear a supportive garment for the next month or so. I’m wearing an M & S one piece garment that is basically like a playtex girdle. It has a bra part attached to an elasticated body part. I also have to wear knee high surgical support stockings - not very sexy - for a while.

Two weeks on and the bruising has almost disappeared. I’m still swollen but my stomach is definitely flatter. The surgeon says that the reconstructed breast will reduce in size to about two thirds of what it is now but still considerably larger than it was and so I may need a second liposuction operation. We’ll have to wait and see.

I’m back to work, I can drive and I’ve been swimming and walking. Next week I’ll be going out cycling.

UPDATE AUGUST 2006

In September I will be going into hospital for my second and last liposuction operation. This will ensure that my reconstructed breast is the same size as my natural one.

Some time after that I will have a nipple reconstruction under local anaesthetic.

I have had no complications from the first liposuction operation. The hidden scars inside my belly button can’t even be felt. The swelling and bruising completely disappeared quite a while ago.

The breast itself is not only good cosmetically but feels very natural being of a similar firmness to my natural breast. The LD muscle underneath has retained its nerve supply. This was odd at first because if I prodded my reconstructed breast firmly it felt as though someone had just prodded me on the back. However, over time the brain adapts and now it just feels as though I am prodding the breast that was removed. Does this make sense? Basically it just feels as though it is part of me rather than something stuck on.

UPDATE MAY 2007

I had the second liposuction operation in September 2006. It was much easier than the first because less fat had to be taken from my abdomen and placed into my breast compared with the last lipsuction operation. Again some bruising but not as extensive as last time. I was back to driving within two weeks but probably could have driven earlier. Again no complications - the bruising and swelling went down quickly. Because, as before, fat was injected along the LD scar line there was no increase in scarring. More tiny scars hidden in my belly button. Surgical stockings to wear again. The breast was slightly higher than my natural breast just after the operation but has since responded well to gravity and symmetry has been resumed.

I had a nipple construction in March 2007. The surgeon injected anaesthetic into my reconstructed breast and then took a small amount of fat and skin from the side of my reconstructed breast, made a cut in the nipple area and inserted the fat. This was covered with the skin (essentially a skin graft). A button shaped pad was put on the skin graft and then padding and a large waterproof plaster was put on top. There was no pain at all but I had to be careful not to get the skin graft wet so no showers for a week. The pads were removed at the end of the first week . I had to wear The skin graft crusted over (they always do) and the crust didn’t fall off until about 5 weeks later revealing a small but convincing nipple.

I had an areola tattoo at the end of April 2007. This was done in daylight so that the tattoo colouring could be matched accurately with the areola from my natural breast. I was given anaesthetic cream to put on an hour before the tattooing began. The tattoo equipment is state-of-the-art stuff rather than 'Terry’s Tattoo Parlour ’ stuff and the result is remarkably good. The tattooing should have been painless because it took place on skin that had originally been on my back but it was a little painful because I had new nerve growth in the piece of skin that was originally taken from my back during the LD operation . This is a very interesting and unexpected side effect of the lipsuction. In amongst the fat cells are stem cells and under the right conditions the stem cells help regenerate (or perhaps even turn into) nerve cells. This means that the reconstructed breast is continuing to feel even more like my natural breast as time goes on. I think the surgeon plans to check other women for this effect and use injected anaesthetic rather than cream on other occasions.

SO, WHAT IS THE FINAL EFFECT OF ALL THIS?
Negative effects: my back is scarred (faint white scar across half of it) and slightly rippled where the muscle has been removed; this is true of any LD operation. At first the muscle part of my reconstruction would contract when I moved my arm. This gradually stopped and now it only contracts if I have a cough.
I had radiotherapy before reconstruction sothere is a slight colour mismatch between the skin from my back and the breast skin but hey, I’m not grumbling.
Positive effects: the breast’s appearance is excellent. The reconstructed breast is a tiny bit slightly smaller than my natural breast but I don’t anyone else would notice. My new breast feels natural and part of me. The symmetry is very good. I have had no back problems. And, guess what, I won’t need to have any more operations. Hurrah

SURGEON DETAILS AND OTHER COMMENTS

My surgeon is Mrs Eva Weiler-Mithoff. She works at the (NHS) Canniesburn Hospital and the (private) Nuffield Hospital in Glasgow. Clearly it would be very difficult if lots of people contacted her directly - she is a very busy lady - but it may be useful to ask your plastic surgeon to contact her for further details about this type of operation and to find out who else in the UK is using liposuction as part of breast reconstruction

Liposuction is definitely the way forward. My surgeon says that it will devastate the breast implant industry because the operation is relatively simple and unlike with implants there is no risk of rejection.

She says that it is possible to use liposuction in situations where conventional reconstruction has left a hollow or where a mastectomy has left a dent. These can be filled with the person’s own fat cells very successfully.

There is a five year trial in France at the moment to find out whether it is possible to use liposuction in cases where women have had a lumpectomy to reconstruct the missing part of their breasts. The scientists need to be sure that there are no adverse effects of mixing fat cells with normal breast tissue.

There is also a trial to see whether LD+LIPO can be carried out before radiotherapy so that no extra skin is needed from the back.

On the subject of stem cells: stem cells from abdomenal fat have been used recently to repair heart tissue damaged in heart attacks - the stem cells turn into new heart muscle cells.

Does anyone know of any surgeons in the South that performs this procedure?

thanks Sue - alimo Sue
Thanks for the update - I was wondering how you had got on.
It was your info I had mentioned to Ms Mithoff during my appointment, but obviously I dont know your full name…but if requests for her epertise increase we’ll know why!!

I will be going in for the op in the very near future (got everything crossed that I’ll have a new boob for summer) but I’ll have to take some time off work. How long do you reckon that’ll be…and I also play badminton 2 to 3 times a week…and I was wondering how long I’ll be away from that. i do a bit of running too and I dont suppose jigging up and down will be too good for a while. I read that you do sports which is why i’m asking your expert opinion.

Ms mithoff mentioned 2 ops to me - sounds like your second op was a quicker recovery time (?).

This is the last of my cancer ‘stuff’ (d.v.) and I’ve probably waited too long before asking my gp about recon - was just glad to have it a behind me and be ‘normal’ again.

Hope you are ‘sorted’, thanks again for all the info - I for one really appreciate it,

Take care

Alimo

Hi Squeaky and Alimo Hi Squeaky and Alimo,

Squeaky, I don’t know who else does the LD+LIPO but it is worth writing to Ms Weilor-Mithoff herself or asking your plastic surgeon (if you’ve got one) to contact her. I’m sure she’ll know of other people carrying out the operation.

Alimo, I wish I was more sporty at the moment but I’ve been very busy with work. As far as exercise is concerned ask Eva Weillor-Mithoff for advice. It was my right breast which was reconstructed but I’m left handed so lifting my left arm for badminton wasn’t a problem. I don’t think I played for quite a while after the LD but ask Eva for advice. My real frustration was not being able to swim until the LD op scars had healed, and then not being able to swim after the liposuction ops, the nipple reconstruction and the tattooing.

You are right in thinking that the recovery time for the second LIPO op was shorter. I went and had the op at 2pm on one day and was out by 10am the following morning. My husband came to visit me and found me with case packed sitting on the bed waiting to go. Total recovery took a bit longer but a lot of that was due to the the general anaesthetic (which takes a while to get rid of totally). I took it very easy for a week and then got back to normal pretty quickly.

One thing I forgot to mention in my previous long message is that my armpit and an area of back above and below my scar were completely numb after the LD op. These areas have got smaller and recovered somewhat over the last two years but haven’t disappeared entirely. I can feel a firm touch but not the very lightest of touches.

Hope that this is helpful.

Best of luck,

Sue

P.S. I had my six monthly check-up yesterday and oncologist admired the reconstruction and was very interested in the fact that nerves have regenerated and that the breast actually feels like a breast rather than something ‘stuck on’.

SuperSue Hi Sue,

Thanks so much for all your info! I’m just back my hols and see that there was a flurry of activity on my thread. I’d be very keen to talk with you about the procedure; I’m not due back to see Mrs Mithoff til September but I’ll contact my BCN to organise things. Or, are you on the ‘other site’ where you can send personal emails and therefore exchange details? I am, under the same name.
Hope to speak to you soon then,
Carla

Hi Sue Hi - I have just read through your excellent post and it was amazing. You have really helped me in so many ways. I had a mastectomy in Nov 06 followed by radiotherapy. In September i will be having a LD reconstruction and your detailed account has really put my mind at ease and answered so many of my questions.

Thanks again so much.

Sue (abcde)x

Hi Carla and Sue Hi Carla and Sue (abcde),

Carla, I’m not on the other site but feel free to get in contact with me through Mrs Mithoff or your BCN. Mrs Mithoff knows I’m willing to talk to people about the operations. Just ask to contact Sue M.

Sue, glad to be of use.

Good luck with your operations.

With very best wishes,

Sue

Hi Sue,

I spoke to my BCN at the beginning of the week and asked her to track you down! Hopefully she’ll get back to me soon; looking forward to chatting to you.

Carla

Hi,

I guess I’m asking SuperSue this question predominantly because you’ve had it done and know the surgeon well; I was wondering ‘if’ you knew or anyone could ask Doctor Mithoff, whether a person who has implants (me) can have them removed and the at then lipo’d and injected? I’d be really keen to get rid of my implants due to Immunological reasons and because capsular contracture is making the side of my chest and arm VERY painful, this is progressively getting worse.

I now wish I was within the area in Scotland required to see Dr Mithoff!!

Hope someone can answer my question.

Thanks

Yessie

Hi Yessie,

I’m not sure I can answer this question. You could ask your plastic surgeon to contact Mrs Weillor-Mithoff to find out whether lipo is a possibility. Or you could try to contact her yourself.

It’s worth a go especially if you are in considerable discomfort.

Good luck and best wishes,

Sue

Hi Carla,

I’ve sent you a private message with my name.

Best wishes,

Sue

Hi Supersue
Can I ask what size your reconstructed breast is? is this proceedure ok for 34B/C? Did they get all the fat they needed from your tummy or did they go elsewhere for the 2nd top up?
Thanks
fantan

Hi Fantan,

I’m a similar breast size to you. Both times Ms Weillor-Mithoff took the fat from my stomach. Each time it wasn’t huge amounts, about a tenth of what would be taken in a serious liposuction operation. Although heavier than I used to be (thanks to tamoxifen) I’m not a huge woman; 5’3" and nine and a half stone. Had there been any problem with the amount of fat Ms W-M would have looked to have taken it from my hips, thighs or buttocks.

Best of luck.

Sue

I had a mastectomy and immediate DIEP in Sept 05. During my ‘tidy-up’ ops (I had 2) I had lipo from hips to transfer to 2 dents left in my breast, very successfully. Since then my London PS says he believes this is the way breast recon will go in future, with the ensuing collapse of the implant industry!
Helen

Question for Helen

Can I ask where you had your lipo from hips op and do you know if they can do the same from stomach area.
Had mastectomy with LD reconstruction about 18mths ago but reconstructed breast is slightly smaller -do not have implant and not too keen on having the other one reduced so was wondering if lipo could be an option for me?I live on the south coast.
Thanks