Has anyone had micro fat grafting?

Hi jseda,

Actually, I live in NJ - I only got "Miami" expenses because I flew down there. As I mentioned before, there is a surgeon in NY who has done fat grafting for years. While it would have been far more convenient for me be there (only 50 miles from me), his fees were astronomical. Also, it seemed like his experience wias more in augmentation (and fat grafting to other parts of the body), while Dr. Khouri's was both augmentation and reconstruction. Also, since Dr. Khouri is the inventor of BRAVA (originally designed for augmentation on its own, many years prior to being used as part of the fat transfer procedure), and the pioneer of this procedure, I wanted to go directly to him.

From pictures I've seen of other lumpectomies, mine wasn't as drastic and damaging as most, but worse than many others. 

Something else that might be of interest to you all, that I never thought to ask him exactly how he did it, was that he "de-tethered" (I have no idea what the correct terminology should be) the flesh that was down to the bone, also with no incisions. It was done strictly thru the needle injection sites. Except for the scar of the lumpectomy incision/stitches (which the appearance of is improving still), you would never know there was any deformity there. 

(I was just reading earlier pages of this thread that I hadn't seen before. Someone mentioned stitches at the lipo sites. Dr. Khouri does not stitch them closed. It was explained to me that by leaving them open, they drain better and it reduces swelling. It is kind of messy for a day or two, but you can't really see any of those sites on my legs, thighs and knees anymore.)

The man who invented the new procedure for microfat transfers to the breast is in Miami. His partner in the project is in Verona, Italy.  Unfortunately for me I found out about him too late (after I had implants put in).  But now I am telling the world about what he does.  He is Dr. Roger Khouri at the Miami Breast Center.  He rebuilds entire breasts from fat...WITHOUT cutting you open. No more scars or major surgeries. It's amazing.  He does removing of fat as an outpatient procedure then injects tiny bits of it into the breast area to create the breasts.  I've met some of his patients and they worship the ground he walks on.  They keep sensation in their breasts with this process. AMAZING.   From what I understand the reason this is so breakthrough is because in the past, fat in the breast died.  But he used this external expander (instead of the one I had which was inside the breast).  It's called Brava and it used to be used for breast augmentations, but now he uses it to expand the skin, tissue, etc...from the outside for a few weeks...THEN he injects fat and it lives!    Check out his site: www.MiamiBreastCenter.com

Glad I stumbled across this post. I am going for my touch-up planning appt soon. I too have a small divot on rt breast...I had a SIEA flap procedure.  I am glad to know it can be filled in. 

Jupmm:  I TOTALLY get it about the big breasts thing!  I had 34 FFs or something like that, it was ridiculous!!!  I am probably in the tiny minority of women here who went down, WAY down in size after my bilateral mastectomy.  I am now around a C cup  or so!! I LOVE it.  However, I had my exchange surgery two summers ago and I have had some REALLY ugly folds and dimples, so I asked for a revision which brings me to my post (there is a point here!)  I just had my surgery two days ago and I am guessing this is what I had?  They sucked out some tummy fat (OUCH!!) and used it to fill in all the places that needed help.  I looked at it today and it looks great!  I am so pleased.  I can finally get those tatoo nipples and feel completed.  I am in a fair amount of pain, but mostly in the abdomen area.  I will let you all know how it looks once all the bruising, etc goes away but I gotta tell you, at this point, I am quite pleased!

Thanks, Anne and Erica.  I realize that this is a reconstruction forum.  And, I certainly haven't decided against having one done, ultimately, nor do I object to any decision that any woman makes about her own breasts.  But, I feel that, for all well intended reasons, I have not been told about all the alternatives and the personal costs involved with the expanders, extra recovery time, the additional damage to healthy tissue, etc..  I also didn't like them not listening to what I said that I wanted.  I said, "I want a reduction."  He said, "They'll be about the same size as they are now.  They'll just be 'higher and facing forward'."  That was "cute", but, didn't indicate that he had "heard me".

I think that what we've ALL gone through or, in my case about to go through, has been ugly enough and that we ALL deserve to have the outcome that we want.  Not just what the "average woman" (whoever she is) wants.  I plan to take my time with my decision, until I make the choice and find the doctor that will give me what I ask for. 

 I wish for the best outcomes possible for everyone here.  This is just such a personal decision.

Okay, I've finally combed through the entire thread and I think I understand it now. Can someone correct any of this if I have it wrong (summarizing what I've picked up on this thread)?

• Dr. Khouri's procedure uses your own breast tissue (what little is left after mx) + the Brava device to suction it for several months + fat that is liposuctioned from another part of your body.
• It doesn't require implants, tissue expanders, cutting into muscle, or taking muscle tissue from another part of your body.
• It allows your breast to retain sensation.
• It can be done with nipple-sparing mastectomy.
• It can be done after your mx, without coordination with your breast surgeon.
• The fat transfer is done in 2-3 procedures (is that right? and over how long of a period of time?)

Did I get any of that wrong? I honestly can't see a down side of this. The whole reason I've dreaded mastectomy is the loss of sensation. This procedure would make all the difference. I don't need a big cup size (a good full B is plenty for me) and I have PLENTY of thigh/butt fat he could use (LOL!). I haven't had radiation so that wouldn't be an issue. I don't mind sleeping in bizarre contraptions. 

Is there a down side for someone in my situation??

Well, other than the fact that I'm in Atlanta and would need to fly to Miami however many times (unless someone at Emory University has latched onto this procedure and is now doing it).

Thank you so much, Barbara/Erica! Your posts on the rest of this thread have been very helpful too and I can understand the concern about having breast tissue left (I personally would mainly want to make sure they got all the ducts, at least, even if there is necessarily a bit of breast tissue remaining). No one procedure is right for everybody, certainly... I'm excited to realize that it sounds like exactly what I've been waiting for! Thank you again for your thoughts!

Just had a bilateral mastectomy 6/28. Found I had DCIS in left breast where 17 years ago I had stage I infiltrating ductal CA.  This time, learned I am BRCA2, so had the right breast removed too.  All lymph nodes under my left arm were removed and I had radiation during my first cancer. 

 Prior to surgery, researched my reconstruction options.  Went to Johns Hopkins and Georgetown to check out flap possibilities.  I had already been told I would be a good implant candidate since I am petite and do not have a lot of fat.  I rejected this option because I didn't want any foreign bodies and did not want to face any potential problems that some have with implants.  At JH and Georgetown, found that I could have flap surgery, but it would have to be from two different donor sites.  The surgeries and the potential for flap failure seemed very unappealing.  I checked out the BreastFree website (thanks, Erica), too.  I really liked what I saw there. 

During my research I did come across Dr. Khouri's website.  Sounded too good to be true.  Did some further research and found the clinical trial, but no results were posted yet.  While at JH and Georgetown, I mentioned Dr. Khouri and his approach, both were familiar with his procedure and both said this would be an option.  This made me feel more confident that it was a legitimate procedure.  At any rate, I was almost going to settle for being breast free, but then my husband suggested that I make an appointment with Dr. Khouri.  We flew to Miami (I live in the mid-Atlantic).  He spent about 2 hours with us explaining everything and answering all of our questions...he has a very busy practice and I felt privileged to receive this much time from him.  He is a very compassionate person and really encouraged me.  Before I left his office, I was able to meet a woman who had her first grafting session a few days prior.  She looked great and had two nicely shaped mounds or breasts already!  I then talked with 3 other women who had either completed their reconstruction or were in the process and I was encouraged by their comments.

I  decided to to have my mastectomies by the surgeon I used 17 years ago..he had done a wonderful job on my lumpectomy.  I mentioned Dr. K's work to him and he was not familiar with it.  He wanted to talk with him.  They did talk and discussed the best approach for the mastectomies (as far as skin looseness...etc...left the skin slightly loose).  My surgeon also ran Dr. K's name by a few of his PS friends and there were no red flags.  I was delighted after my surgery to find my surgeon preserved the cleavage line and also the breast fold (under the breast).  With the post-op swelling it looked like I had a bit of cleavage and breast, but he assured me all the breast tissue was removed!. 

I have just started wearing the BRAVAs...they pair you up with a coach who walks you through the wear and care, etc.  I admit, looking at the BRAVAs (I am using a med./wide...Dr. Khouri wants as much area as possible to be expanded), I was intimidated!  But Dr. Khouri said start wearing for a couple of hours...to get used to them.  I wore them 2 hours yesterday and it wasn't bad.  The left side was a bit uncomfortable, since I did have radiation on that side and all nodes removed, leaving nothing but skin and bones.  But I found that by adjusting the soft silicone lip, I could find a comfortable spot.  When I took them off, the breast area looked a bit purple....but that all went away in a half hour or so.  This is probably due to the blood supply being pulled forward.  Dr. Khouri told me also, that after fat grafting there would probably be a return of sensation/feeling where it is still numb from the previous cancer treatment.  There is another clinical trial that I came across, where they are treating irradiated breasts with fat prior to implants...as this is thought to rejuvenate the skin and tissue.  At any rate, I will see if I notice any difference after I have my first fat graft.  All in all....this type of reconstruction does take some time and dedication from the patient, but when I was looking at the flap surgery, I would have had to spend several weeks recuperating after each surgery and I was going to have at least two surgeries.  So, from my perspective, this process is better...I don't have to have a foreign body implanted, when I reach standard BRAVA wear time, I will have 12-14 hours a day where I don't have to wear it, and the downtime after the fat grafts will be MUCH shorter than after a flap surgery. 

If anyone is interested, I will continue to post my progress.  Good luck to all of you out there who are facing reconstruction or are in the process...whichever type you choose.  And...if you choose to go breastfree...enjoy this too....I think it is so great that we are alive and that we have so many options to choose from! 

Hi Kim...

 So sorry to hear about your experiences towards full reconstruction. Really appreciated hearing about your surgery and experience with Dr. Khouri.  I had heard about the punctures and drainage..apparently they inject some kind of fluid as they are collecting the fat and this has to drain out..leaving the holes open with some compression helps to drain faster and then you apparently have a faster recovery, from what I have read on the internet.  My surgery is going to be at Kendall Regional, but thanks for the tips about the other hospital.  I would love to talk with you off line if you want.  I was trying to find out how we can exchange e-mail info or phone numbers privately.  Do you know?  psf

Hi Kim,

Thanks so much for posting your story. It really helps to read about experiences like yours. I hope your appointment today with Dr. Khouri goes well. Please let us know what happens.

I also had the same impression as you about Dr. Khouri's office and staff. I had a 6 p.m. appointment. No one was in the reception area, either upstairs or downstairs, so I had no idea where to even wait. When I finally found someone, they seemed kind of confused. I had to wait almost an hour. Once I met Dr. Khouri, I felt somewhat reassured. He seemed compassionate and knowledgeable. But the examining rooms and other areas were disorganized and the staff, while pleasant enough, seemed clueless. 

Those impressions are part of the reason why I decided not to go forward with the Brava technique. I do believe that Dr. Khouri may be something of a genius and that he's really on the cutting edge of reconstruction techniques. But his support system falls short. I'm sorry you had such a bad hospital experience. I spend time in Miami and I know there are lots of Miami hospitals where treatment would be better than what you described.

Thanks again, Erica, and jseda, I'm excited to follow your progress! When I first read about this, it seemed clear to me too that this is the future of reconstruction... just being able to preserve sensation alone is a biggie, plus not having to take tissue from other areas of the body, not having a foreign object, etc.

I asked this via their website and one of their staff is supposed to get back to me (haven't heard back yet), but does anyone know of any Atlanta area doctors that Dr. Khouri has worked with on this technique?

To CrunchyPoodleMama...I live in Virginia, so it is a trip for me each time.  It will be interesting to see how it goes with my first surgery in Sept.  I've never had out of town surgery.  I have met 3 or 4 others who have done the procedure and they are from out of town.  He tries to do the surgeries on a Friday or Sat, so it cuts down on the time (days off from work). 

 jseda:  When I talked with Dr. K, he is referring to regaining sensitivity in the breast without the nipple.  Just like  you would feel touch on other parts of your body.  Good luck!  I'll be interested in hearing how it goes with your Brava wear.  I'm still trying to get used to them, but am doing better each day.

Another heads up that I learned about the Brava bra at this point in time, in regards to insurance coverage. In the state of Wash., they are denying the bra at this time and I feel that this is only until they get their FDA/AMA acceptance. PS is highly recommending not submitting the bra to your insurance at this time, but hanging onto the receipt and submitting after they achieve their acceptance. I know of a gal in Wash St who submitted a preapproval for her Brava Bra, which was denied and shut down her liposuction/lipid injections as well. What a game!

Hi makingway,

Did you ask Dr. Khouri if there might be anyone else in your county who has trained with him? On an implant forum I posted about this in, one of the ladies said she lives in San Diego and couldn't go to Miaimi. She said that Dr. Khouri gave her the name of someone in SD who is doing this. I looked at that dr's site tho, and there wasn't anything on it about it. At any rate, maybe he can recommend someone in your county....? Just a thought... 

I agree with Alexandra. Contact Dr. Khouri or Brava bra systems. Tell him your situation and maybe he'll or his company will be able to help you. You can always order the bra from them and the cost is around $1000. with extra domes. If it were me, I'd look for someone else. There is someone out there, you just have to keep looking and not give up.