Has anyone had micro fat grafting?

Anonymous

Maybe those that used the BRAVA, who are MX patients, can chime in as far as how much the device actually costs because I haven't heard any dollar amounts mentioned.  I thought I had read somewhere that Brava will discount it if you are using it for reconstruction but haven't confirmed this.  It would be worth looking into, though.  Even if it's out of pocket, average over a lifetime, it doesn't seem as though it would be that much.  I didn't have to do the Brava but the cost of the FG surgery was worth every penny.  I wish this was offered to every woman, with full insurance coverage, and I'm sure we'll get there someday.  Unfortunately, we're on the cusp of this and it can be frustrating when you know there's something out there that could help you or be better than what you have, and you feel it is out of reach.  I'm sure women before us felt the same way about skin saving MX, nipple sparing MX, and the various recon methods out there.  Someone, sometime, had to be the first one to try it while others waited on the sidelines for it to be approved.  It's just the way things work.  Unfortunately, in the U.S., the pace is excruciatingly slow.  Just look at how long it's taking to get the anatomical shaped implants fully approved.  They have been used in Europe and Canada for over a decade, with no issues, yet are still going through clinical trials here.  In this global environment all that time, money and research should be shared.

Anonymous

Kate and Pandazankar,

Yes, in many cases the approval process is much shorter in Europe. I has asked in my post several weeks ago whether Brava was approved for reconstruction in Europe, because that would make a difference to me. I plan to ask Dr K next week.

Clinical trials often have different endpoints, ie. What is the study trying to prove? It seems to me that the current Brava study is trying to show whether the device+fat grafting is effective. Long term safety, which is what the FDA would likely require in addition, does not seem to be an endpoint. Any type of fat grafting suffers from the same shortcoming, but, in fairness, is being done all over the place, including Johns Hopkins.

leeinfl

Kate - Very well said! Thanks for posting the update.

I do have to add that if it weren't for doctors such as Dr. Khouri, who strive for a better, less invasive and above all more patient friendly way of doing things, where would we be? So many surgeons are perfectly content to do things the same way they've done them without the desire to learn different and cutting edge procedures despite the potential benefit to their patients. Dr. Khouri is not one of those doctors. He could have been perfectly content to continue to perform flap surgeries but he felt there had to be a better way. He not only professes concern and care for his patients, he lives it and has proven it by what he has done for them.  Not just his own patients but the many women who will continue to benefit from his work in the years to come.  Above all, he is a surgeon and not a lobbyist.  His skills are best used in the OR - all of us can help bring about change by asking questions and pushing our medical professionals to offer new techniques that benefit all of us. 

tedwilliams

My cost was $750. I used both domes until they would stick no more...replacement domes were $300.



I have not had the same results as others....wearing the domes did not release the skin from my chest wall as hoped. I did wear the BRAVA after the first grafting and there has not been a loss of tissue. As to whether there is a necessity for wearing BRAVA prior to the grafting or even after I can not say. For me the issue is the damage done by radiation. I do believe technique for injecting the fat is vital....but Dr. Khouri is not the only one with that skill or technique.



In the UK fat grafting is being done without the BRAVA with success.



Jana

alexandra-aaa

Jana, can I ask, when you wore the domes pre-op, did you use them with only smart-box suction, or did your surgeon have you use additional pressure (hand bulb pump)? That is used not only for stubborn "stuck" areas, but also in the immediate days/week pre-op for maximum expansion. That said, I know other ladies have had more issues with the tissue releasing when they'd had previous radiation. (You had one grafting already, right?)

The ladies I've spoken with have experienced an improvement in areas with previous radiation, and in general to all the tissue that had fat grafting (usually noticed about 2-3 months post-op). Whether it's the fat itself, the stem cells naturally in fat, who knows, but what typically happens is that subsequent BRAVA use is also more productive/successful in terms of expansion as well as pulling out the more stubborn adhered areas. It also ends up more comfortable to wear (if you can ever call them "comfortable"!!) after the initial grafting. I hope this happens for you for your with your next graftings. (Was pretty sure you said you already had one, and will be having further graftings - sorry if I screwed that up, lol!!)

mtks

Dr. Khouri sounds like a very compassionate and caring doctor. I wish there was a away to find  doctors who have trained under him or has started his technique of microFG in the state I live in.Kate and Leeinfl, I am so happy for your amazing results!

You are right Kate- in due time there will be more PS performing Dr. Khouri technique. Patience!

GointoCarolina

I started several posts and deleted them all,I did not want anyone to take them the wrong way.Please be assured I am not maligning Dr.Khouri's skill.I have no idea about his kindness or compassion,I have never met or spoken to him.The point made here is that the US is slow with FDA approval.So that makes it even worse that the process for the Brava is not even started.Not only for insurance coverage but to ensure at least some degree of safety when used with those who have had mastectomy.And Dr.Khouri is not the only doctor who is doing successful fat grafting,he is simply the best known because he makes a point of advertising.Which is a good thing,the more who know about this,the better.I am truly happy for those of you who have had successful recon,but it hurts my feelings that I am breastless and you are urging me to be patient.It has been three years this week that I found my lump.You have no idea how my patience has been tried over the last three years.Maybe that is making me more sensitive,it is an emotional time,especially since I had hoped to have started my recon by now.

Anonymous

Pandazankar,

I am so sorry for all you have been through. I am coming up on 1 year since finding my lump. It has been 7 months since I had mastectomy. I did not imagine how difficult this would be. All along through chemo, which I had before surgery, I thought I was going to have lumpectomy. It didn't hit me til well after my MX how I would feel about being breastless. As all of us know, it is devastating. 3 years is a long time. I pray that you will find a solution that brings you peace.

A word on the fat grafting...it's success is highly dependent on experience and technique. This is evident from reading the European studies. The same centers had increasing success rates over time. I haven't met Dr K yet either, but I think it's fair to say that his technique is very successful.

Fwiw, I am not too interested in using the brava, for all the reasons being discussed. I am hoping he can still help me. I will post after my visit next week.

Wishing all peace and blessings.

GointoCarolina

Thank you,pinkbutterfly.There are lots of women on this forum that have been struggling to get back to "normal" longer than I have.I am seeing a doctor on Monday who went to a training of Dr.Khouri's.I am hoping he can work with what little stretch I have from the TE's that were in for three weeks.I do have another doctor in the wings who does not use the Brava,she is the one who I had the TE surgery for,but she is farther away and travel is hard right now.I really thought with all my confidence I would be fine being flat....but I have learned different. I remind myself that if I had done recon sooner,I would not have known about the fat grafting,so I keep looking at the wait as a blessing.It is just hard to have it within reach and then have stumbling blocks like finances and fear.I will almost have myself convinced that it is safe,then I think  why do they say  "do not to use if you have had mastectomy"?I hope your appointment goes well,do be sure and post.

Anonymous

Pandazankar,

I share your struggles. Once bitten, twice shy.

mtks

I'm VERY SORRY for not making my message clear. Patience was intended for me, not for anyone else. I feel badly it was taken wrong-I am so sorry!

This is a very emotional journey for all women and I sure don't want to make anyone feel bad. I will be more careful in how I word things. Again, I am sorry!

tedwilliams

alexandra---aaa:



I wear only one dome and have used both the smart box and the bulb. There has been improvement in both the color and softness to my skin and I beleve it is all the factors you mentioned. My next fat grafting is Aug. 5 in New Orleans.



Jana

mradf

pandazankar ~ if you read my posts from last year, you are - more or less - echoing the concerns me and my PS had when discussing the BRAVA. 

This is not the panacea of breast reconstruction, but a good partnership between you and a qualified, experienced PS is. 

For the record, I am fully, successfully reconstructed using implants, flap, allograft, and fat transfers.  I faced some challenges, but they are lovely and natural looking. No domes or trips to Miami necessary.  All fully approved procedures, all covered by insurance.   

Be well,

Maria

bher

Pandazankar - I feel for you having spent the last three years after your mx and still being "breast-less".  It has been one year for me since my dx and I am still going through reconstruction and it has been a rough road.  I think we all just want to feel "normal' again. 

mtks - You are right about Dr. K. being a compassionate and caring doctor.  He is very hands on. I have faith that he can fix me, however it will require much patience on my part.

tedwilliams - That is encouraging that the color and softness of your skin has improved.  The damage rads caused is my major problem too.  My skin is driving me crazy.  I am hoping the fat grafting will help it heal.  Good luck with your next round of fat grafting.

Pinkbutterfly- Good luck with your appointment next week.  I hope you find the right solution for your reconstruction.

mradf-  I am happy for you that your reconstruction is a success.  That is the goal for all of us.  In my case the damage from rads made it impossible for the implant reconstruction to work so I am going the fat grafting route because I am trying to avoid a flap procedure as my first PS suggested during my last visit. If I had not had rads, implants would most likely have worked for me and I would be done now.

leeinfl

bher - yes, this will require patience but it will be well worth it!  I never thought my reconstruction would end up taking over a year, but the implant "detour" turned my journey into a 5 surgery, 15 month adventure.  As far as implants....it's shocking to me how many reconstruction patients are unhappy with the results.  Myself included, but I didn't know that back then - figured it was pretty much a "boob job" - even joked about how I'd be the grandma in the nursing home with the perky boobs.

tedwilliams - I love the way my skin looks now and I did NOT have radiation, so I'm thrilled that you and the other ladies who did, have seen such a marked improvement!  An unexpected and beautiful bonus to this procedure!  Good luck on the next round!

mtks - I'm sure everyone understood the intent of your post.  I'm not blessed with a lot of patience, yet I've had to learn that this journey requires it.  It's frustrating, heartbreaking, truly maddening at times, but those emotions won't help us get through it - I've always believed that a good sense of humor helps where our patience lacks.  Like most of us, there were soooo many times where I just wanted to slump into a pile of despair.  I'm still not a patient person, but I've gotten better......(some would argue with that - LOL!)

mradf - I'm glad that you are done and happy with the results.  Have you posted your pictures?  I'm sure all of us would love to see your outcome, especially since you had a combination of reconstruction procedures.  What flap procedure did you have?  I was only offered the lat flap and couldn't imagine the thought of a second surgery site (especially since I live in Florida and am constantly in bathing suits).  Look forward to seeing what your surgeons have done!

Pinkbutterfly - Can't wait to hear how your appointment goes!  

kareenie

Jana (Tedwilliams) My first fatgraft is Aug 5 as well but in Miami.  We would love to hear from you over at the other site and hear about your experience in New Orleans. Who is your PS? We would love to have patients over there from other docs.

GointoCarolina

mtks,please,do not feel the need to apologize.I am going through a super sensitive time right now and the recon is adding to it.It is so easy to take a posted comment wrong..I need to lighten up a bit!!!  mradf,I am so happy for women whose recon goes well.I unfortunately am not one who could have implants..even if I chose to.I had tissue expanders and Alloderm placed to stretch my skin for fat grafting and had to have everything removed only three weeks later due to severe pain and immobility.The only flap I am eligible for would be bilateral SGAP, and I was advised against it due to a low back injury and sciatica.I know the fat grafting is right for me and I also know that when the time is right,it will all come together.I am excited about my appointment tomorrow,this will be the fourth PS I have seen.leeinfl,I can't tell you how helpful you are with your posts,they are full of easy to understand info and you are always so positive..a good example!!!

Anonymous

Pandazankar,

I am so happy to hear you say that you know it will all come together for you. I am sure it will!!! We all have our down days (and weeks), and it's awful we have to go through this. But we WILL get through it, and that's what counts!

I'm sorry if I missed it, but are you going to see Dr. K in CT? I talked with her on the phone and through email, and she was so nice, compassionate, down to earth. She seems very knowledgeable and does a variety of recon procedures, which I think is a great advantage as far as getting an opinion on what is best for you.

GointoCarolina

I saw Dr.K in CT several months ago.She is the doctor that I had the TEs placed for.She is wonderful,and from the photos she showed me,a true artist.She says she can still do the grafting even though I was unable to continue with the expanders.The doctor I am going to see tomorrow is Dr.Loomis in Middletown NY.The consult is free and he is an hour and a half closer than CT.I want to cover all the bases,so I will probably have a consult with Dr.Julie Vasile, in CT,too.I  talked with her several times on the phone when I was thinking of flap surgery and she is super .After hearing what they all have to say,I figure I will at least  be well informed !I know I am lucky to have so many options,I just have to keep a positive attitude and be patient(~!!) and more accepting that  the universe knows best.

Anonymous

Sounds like you've got the bases covered, Pandazankar. Good luck!

middlechild

I had this done in May.  It is painless, except for the area around the belly button where the fat is taken.

middlechild

I am not satisfied with my results and I'm wondering how many "fat transfers" some of you have had before you felt like it was right. 

geewhiz

I had one grafting already in January. Not all of it "took". I have had radiation, but it seems to be the side without the rads that caved in a bit? I also got a whopping bill from my insurance company, so this has been 6 months of financial hassles, back and forth with insurance and Khouri's office. I do love the man, he loves what he does and we need more doctors like him who really care.

If I was a lower stage patient, I would probably do it again, also with thoughts to stimulate the rads skin some more to make sure I keep my implant. But anesthesia suppresses the immune system too much for me to make another go right now. So, for now...I am quite happy to be here...slightly lopsided and all!!

Anonymous

I thought they could do this with a lower state of anesthesia? Rosie mentioned it was something to ask the anesthesiologist about, being asleep but not "under"...

geewhiz

I think I was told someone literally sat up during the procedure, and since then Dr K only uses general. If the twilight was an option, Id be interested!

Anonymous

If anyone is considering fat grafting using Dr. Khouri's method this article is the most in depth explanation of how it works that I've seen so far.  I'll try to post a link-

http://www.aesthetictrends.com/monthly_updates/Summer2010/Summer2010PlasticSurgeryBreastFINAL.pdf 

tedwilliams

Sitting here in Scotland with lots of time on my hands since I can not drive and shift on the opposite side of the road.  Was trying to find more information about fat grafting and found these sites:

 http://www.liebertonline.com/doi/pdfplus/10.1089/ten.teb.2010.0352

http://rlbatesmd.blogspot.com/2011/03/fat-grafting-to-breast-and-oncologic.html

She has listed many resources and articles in regard to fat grafting.  I kept going and going with the links she provided.

http://clinicaltrials.gov/archive/NCT00466765/2011_04_06 

This is a link to the current clinical trial Dr. Khouri is conducting with the BRAVA and fat grafting.

Hope this gives some answers to the questions that have been asked.  Sorry I don't know how to make them clickable links...my tech support is at work.

Jana 

GointoCarolina

My appointment did not go as I had hoped.Dr.Loomis was wonderful,very kind and caring and best of all,honest.He told me that he will be sending info to Dr.Khouri about any patients he does fat grafting on and the results will be used to get FDA approval for the Brava.However,even if you are a guinea pig patient  providing info for this clinical trial, you still must pay for the Brava out of pocket. Dr.Loomis said he would accept whatever my insurance company chose to pay him as he was doing this for research,so I would have no additional costs to him.I told Dr.Loomis that I had read a post on this site about a woman who tried the Brava in her doctors office and could not wear it even for a few minutes.(Thanks Erica!)He was glad I shared this with him and expressed concern about me being able to use the Brava with my fibromyalgia and he immediately sent an email to Dr.Khouri asking if it had been used by any other patients with fibro.His office will call me when he gets a reply.Dr.Loomis said he asked at the training if he could have a test model Brava in his office for patients to try and he was told he would have to buy the unit.He asked why I wanted fat grafting and I told him I did not want the long surgery and recovery times from flap surgery.After examining me,he told me that if he tried grafting without the Brava,the best he could do would be a very small A,barely a mound and even with the Brava,perhaps a small B and that would take a minimum of three sessions.I have very little skin on my cancer side,even after being stretched with the tissue expanders for a brief time.He also wanted to remove the lumps and bumps on my chest as he said the scar tissue would impede the grafting.This would be done before starting any grafting in a separate operation.He stressed that I would have a minimum of four surgeries.He again expressed concern about my being able to use the Brava especially since I seem to have an extremely sensitive chest given that I could not tolerate the tissue expanders.I told him there was a device similar to the Brava that was much cheaper called the Noogleberry.He was intrigued and felt it might be money well spent to see if I could wear it before investing in the Brava.I also told him about my concerns that the Brava site says not to use if you have a mastectomy,etc.He said this is due to FDA,but there is no way to know without further testing.He did say what the links tedwilliams posted indicate,that if cancer sells are dormant,there is less risk.That possibly delayed recon is safer.His nurse was also great,she told me that if I had any surgery,she would set it up as a 23 hour,so I would be able to stay overnight,but would only have the copay for ambulatory surgery.I will be seeing one more surgeon,but I am not hopeful at this point that fat grafting will work for me.

alexandra-aaa

Hi Pandazankar,

It certainly does sound like Dr. Loomis is a great doctor - so for that I am happy for you. As for what he had to say not being what you had hoped for, I just wanted to share a few thoughts.

"....However,even if you are a guinea pig patient providing info for this clinical trial, you still must pay for the Brava out of pocket...."

While it's still pretty expensive, it's about half the price that it is sold for when used as an expansion device only (w/no fat grafting).

And definitely great that he will accept whatever your insurance company pays. That at least must be a relief.

"....I had read a post on this site about a woman who tried the Brava in her doctors office and could not wear it even for a few minutes....and expressed concern about me being able to use the Brava with my fibromyalgia....he asked at the training if he could have a test model Brava in his office for patients to try and he was told he would have to buy the unit...."

"....After examining me,he told me that if he tried grafting without the Brava,the best he could do would be a very small A,barely a mound and even with the Brava,perhaps a small B and that would take a minimum of three sessions...."

Sorry, I don't know anyone w/fibro who has used it, but I can say that I had very little (any) natural breast tissue (thus the "aaa" in my name!) and where the lumpectomy was the skin was flat to the ribs. I know that one few inch area is very minimal compared to an entire removed breast, but I wanted to relate two things. Overall there was pretty much nothing between the dome rims and my chest wall (same for some of the augmentation ladies on my forum, who were completely flat chested - one in particular who has not posted pics, tho has emailed them in the past to those who have pm'd her (she was honestly nipples on ribs, with zero "cushioning" for the domes)). The domes do begin to pull away that "adhered" skin, making them a bit more comfortable over time.

But if that ended up not being the case for you, I can say that if you did the first graft without BRAVA and did end up with a small A cup, then that padding from the fat would make subsequent use of the domes much, much more tolerable, if not comfortable. And that increase, from nothing to an A or B after one or two graftings is pretty much in line with the final result for some of the truly flat-chested women who've had this done for augmentation. The one I mentioned above went from nothing at all to a small B. Another went from nothing to a full A/small B. I, who had a tiny bit more tissue than those two ladies, went to a small B after the first grafting, and now fluctuate between a full B/small C (depending on weight fluctuations and yep, at 51 still, time of the month - ugh!). So I would say that his size estimate for one or two procedures is pretty realistic. And a third if you wanted to be larger and/or for any additional tweaking to even them out, release constricted tissue, etc.

"...He stressed that I would have a minimum of four surgeries...."

While that may sound daunting, remember, the procedures that involve just the lipo and fat grafting are incision-less. They are non-invasive, and the toughest part of the recovery is the soreness from lipo - which is annoying at best, but still involves no cutting and little tissue injury - mostly soreness/bruising.

"...He again expressed concern about my being able to use the Brava especially since I seem to have an extremely sensitive chest given that I could not tolerate the tissue expanders...."

Comparing BRAVA to tissue expanders is truly apples to oranges. TE's are inserted sub-pectorally. I cannot even imagine the pain from that (in the 90's when I first consulted w/PS's after my lumpectomy, I couldn't run out the door fast enough when the words "detach your pecs from your ribcage" were spoken!). BRAVA is a gentle vacuum device worn outside of the body, and could be removed the moment you feel discomfort. I cannot imagine being literally "trapped" with TE's or implants in place when they are causing you pain.

As for Noogleberry....a few thoughts. For one, they have no cushioned rim attached to them. I cannot imagine putting them on my body! The have however, designed a foam rim that you could attach to them, but they still look anything but comfortable. Definitely not the thick, soft silicone gel rim like BRAVA. Also, they were not designed for the extended use that BRAVA was. If you read any of the forums on Noogleberry, the people who use them are doing so at intense suction, for just about an hour max/day. Also, I would almost guarantee that Dr. Khouri wouldn't accept a patient into the study who is not using BRAVA. Aside from whether Noogleberry is a viable alternative, the purpose of the study is to gain FDA approval for BRAVA


Pandazankar, I had remembered seeing NY under your name in your posts and "google mapped" Oxford from where I live in Central NJ - it's 201 miles/3.5 hours! I was going to say I'd be happy to meet you and let you try a pair of mine on for a couple of hours. Are you ever in the city? My daughter lives there and I'm often by to see her (only about an hour from me). If there's a way we could arrange it, I'd be happy to let you try them.

GointoCarolina

Thanks, Alexandra-aa, especially for the offer to try the Brava out! I am rarely away from home,yesterday was a big day out for me.Dr.Loomis did not want me to use the Noogleberry long term or as a replacement for the Brava.He thought I could try it to see if the suction and/or domes bothered me.I am extremely sensitive from the fibro,have been for years.My chest still hurts to touch and my last surgery was 3 months ago.I tried to wear a slightly tight tank top today and could not stand it pressing on my chest.And it was not that tight.There are many days that I can barely stand to have a loose tee shirt touch my chest or the bed sheet.Sometimes the shower hurts.The pain I had from the tissue expanders was abnormal and the only thing any of my doctors have been able to attribute it to is the fibro. Plus the surgeon used Alloderm which has shown to cause less pain,that was the main reason he used it with me.Dr.Loomis wasn't comparing TEs to the Brava,just assessing my pain tolerance which is extremely low.He was the kind of doctor who did not want to give me false hopes,he was very honest about what he felt  I should expect.I am going to see one more doctor who does fat grafting. It may be that fat grafting is just not in the cards for me.