Has anyone had micro fat grafting?
Comments
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Thank you alexandra and jseda-I will call his office again. I would have thought that if there was a PS in my area someone in Dr. Khouri's office would have suggested them to me when they told me my insurance wouldn't cover it...
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Hi Kitchenwitch,
Have you seen the mastectomy reconstruction pics on Dr. Khouri's site - http://www.miamibreastcenter.com/breast-reconstruction-before-after.html ? The ladies at the bottom of the page look pretty large. I don't know if they would be bigger than a D or DD (measuring at at even an A and B has been new to me, lol!), but they do look pretty big.
Hope that helped.
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Makingway,
Sorry, I misunderstood. I didn't know you had called his office and that's how you found out about the insurance. But it couldn't hurt to ask anyway. There do seem to be quite a lot of surgeons observing his procedure. There were seven there on the day I had mine.
(I did want to add - someone mentioned having a pretty bad experience at the hospital Dr. Khouri did their surgery at. He did mine at Kendall Regional Medical Center. The hospital itself seemed pretty state of the art and also pretty organized. However, my compression garment never made it there, but that was a miscommunication between the office and the hospital. There is a bit of a language barrier at Kendall as well, but I believe that's going to be the case in any hospital in Miami.)
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jseda,
That will only provide you with physicians who are authorized to sell the BRAVA system - it is also used for augmentation independent of surgery. Those physicians are not surgeons who are performing the fat grafting procedure. (Well, I guess some of them could have attended Dr. Khouri's workshops, but those doctors names have been there for years as BRAVA providers.)
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makingway, I haven't talked with my insurance company about this specifically but I have a hunch I'm in the same boat... I've already decided, I WILL be doing this if I get a mastectomy... like someone else said, I'm willing to be boobless for a while if it means being able to do this. The biggest thing to me is sensation... but the fact that this minimizes the whole football-shaped huge scars all over your boob is even better!!
Really hoping they get their FDA approval SOON and it doesn't take 5 years or something ridiculous!!!
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PSF-I am terrible at these forums and not sure about how to exchange email info. But, let me try it this way...my email is: kimmejayATmacDOTcom
Erica, I am with you on the odd "feeling" about the office. I think I am used to it, being that my surgeries/treatments all took place in S. FLA and his office is like so many others. Yes, the office is ridiculously crowded & after my post-op visit this past Monday, I realize-you better keep track of everything he says and suggest, b/c the staff/nurses do NOT. Unfortunately, this has been my experience with practically every Dr. I've had there. And yes, I will def. request the next procedure be done anywhere other than Palmetto. Although, he does alot of them there:( I don't know anything about Kendall Medical-don't think it's much better, though. I had a surgery at Baptist and received great care. I know that he does have privileges there.
Crunchy Poodle:)
Contact Khouri's office. When I was there Monday, he was actually telling me that he had recently done a Dr. training in ATL.Makingway: He told me of a lady (and showed me pics) who was so mutilated from botched surgeries/mast/radiation....she had no money & showed up at a presentation he was doing in Peru (where she lived). He met w/her and is doing her surgery. I don't know the details of this, but he travels all of the States & maybe it would be worth finding out where he is & meeting w/him. Alot of his trainings are posted on his website & he travels everywhere. Keep your chin up:)
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Forgot to give the update on my post-op appt Monday (chemo brain kicking in): Looking back, I would say I had maybe 1-2 days of pain. One side more than the other and after a couple of days I was just really sore. Again, my donor sites were from below both breast, abdomen, flanks, inner thighs & knees....so maybe I was so uncomfortable b/c it was such a large area. I will say this-if this works on me, it will work on anyone! I have had bad luck thus far. I have really dark, thin radiated skin that is so sunken in, w/a very small area where I have a lat flap. Well, as mutilated as I look right now, I am happy:) Happy b/c the tissue expander is out. As I mentioned, he was unable to use all of my fat b/c my skin was like "cardboard" and just wouldn't take it. So, he plumped up the lat flap area, and put very small droplets of fat all around it. It sort of looks "quilted." Very small bits of fat. I am also happy w/the fat he injected in my upper chest area up to my collar bone. I had all tissue removed & my chest looked paper thin, you could see my ribs. Very noticeable, since the other side was normal. So now, it is actually a little more fat than the unaffected side:) He revised my surgical scar under my arm. All of my lymph nodes were removed & 1 was cancerous. I had a big chunk of scar tissue under my arm & had that (forgot the name) problem where the "cord" or tendon or whatever it is, kind of sticks out down your arm. It was always tight. All of that is gone. He took some underarm fat-the fat that sticks out of your bra, and distributed it under my arm where the scar tissue was. Before, it felt strange-that feeling of no sensation, sort of tingly all of the time....now it feels, well, normal-good.
Gameplan: He wants me to start wearing the brava in one month. Then in Oct., I will have the second procedure. He will take fat from my sides and back (top of buttocks, muffin top area). He says that will bring me to a large B. Now, this is from completely flat in most areas. In fact, concave. He said then I wear the brava until about the end of Dec. and have the third procedure, which should do it.
One thing I did NOT know. I have very good insurance. Thus far, they have covered every procedure, trial drug, everything (Thank you God). Insurance does NOT cover the actual Brava device. He said NO insurance company covers it. He wrote me a prescription for it & said I could try to submit it. I have to pull out the paper work, but I think he prescribed a large/XL one & that it will be about $700?? This was sort of a blow....and I do feel like they should tell you this up front.
I have emailed him about one other concern. I am majorly concerned about the suction and my skin. He said it would be okay and would NOT further damage my delicate, radiated skin. But, I was just on the Brava site and there is a chart, and under the section "who should not use the Brave system" it says anyone who has had radiation to there chest area should not use it.
Always something:( I truly hope my poor skin/tissue can take it.
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What would be the ideal way to go about using Dr Khouri's method after a mastectomy? Would I have partial reconstruction (longer surgery but would certainly be nice to wake up with some sort of breast, even a half-way-there one)? Or no reconstruction and then just use Dr. Khouri? I know someone said he does not do that but his website indicates that he does.
I don't know if it is possible but I am hoping to have nipple- and skin-sparing mastectomy on one side. My breasts are 34DDD and I def. have some fat around my midsection that could be very useful somewhere else, haha.
I am planning an appt with Dr. Khouri and looking around for the right breast surgeon in NYC. Any advice at all would be greatly appreciated.
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Elizabeth McCarthy, vice pres of Sales for Brava system, says best way to get providers list is to call Dr. Khouri's office.
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Hi Kitchenwitch: My gut call is that you will have the mastectomy and after healing, start the Brava system several months post op. Are you not having immediate reconstruction ie DIEP? As for the nipple/skin sparing mx., that'll depend on your cancer location. If not near the skin/nipple, you will most likely have that choice. My CA was too near the nipple so didn't have the nipple sparing part. I'm glad to see you've made an appt with Dr. KHouri. Write down all those questions now and take with you to your appt. Good luck!
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Jaeda, thanks for your help. I think the location of the lesion is not an issue but my breast size might be. I've heard that nipple-sparing is more possible with smaller breasts. But a lot I think depends on the skill and willingness of a surgeon to try it.
I think the DIEP sounds like a terrific procedure. But if I did that... why would I need Khouri's procedure? That is what I am having a hard time understanding. I guess when I first heard about it (just a few days ago!) I thought it was instead of other reconstruction types. Does it work in tandem with them, and you get better appearance and some sensation? Or...? thank you again for helping me understand this.
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kitchenwitch-
hello. not sure about whether to have full reconstruction with Dr Khouri or not but Dr Christina Ahn in NYC is fabulous. I believe she has worked with Dr Khouri and I know she has recommended the Brava System to a patient..... She is at NYU MEdical
please keep us posted
good luck
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Happy29, thanks. I saw an earlier mention of Dr. Ahn by you (I think) and I checked but I don't think she takes my insurance. I will call her office Monday though to check that. Do you know any other New YOrk City doctors who use the Brava system? I am willing to go to Dr. Khouri (and he sounds really nice) but I certainly wouldn't mind staying local if possible.
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Hi Kitchenwitch:) Yes, you would do the DIEP OR the fat grafting. I looked into the DIEP & was going to do it, until I found Dr. Khouri. I actually live in Charleston, SC where there are top-notch Drs that do this procedure. I decided to try Dr. Khouri b/c the DIEP surgery is fairly long, like 7-8hrs. and I've already had the TRAM (lat. muscle) flap at the time of my mastectomy last year. I'm just not up to another big surgery right now. But, the DIEP gives awesome results, all natural. If you are having the mastectomy, you could opt for immediate recontruction-have the diep done at the same time. That's would I would have done, if I'd have known about it:(
You wouldn't have a need for Dr. Khouri's services. But, on the flip side....you could have the mastectomy & then start w/Dr. Khouri. I don't see how it could all be done at the same time as the mastectomy.....since it normally requires wearing the Brava for several weeks, to stretch out that mastectomy skin. The up side to his procedure is that it is NOT surgery, rather small "needle sticks" to obtain the fat. For me, the down side to the DIEP is that it is an extensive surgery, it's a micro surgery where they take the fat/tissue/blood supply from your abdomen & re-attach it all to your breast. Then it has it's own blood supply & not the same risk of the tissue dying, as with other flap procedures. But, since the blood vessels are meticulously severed & then reattached, it is a very lengthy procedure. But, when it's done, it's done! Beautiful boobies! Dr. Khouri's is lengthy in that it takes months & more than one "session." So, just some aspects of both to ponder! Isn't it wonderful that we now have these options?
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Kitchenwitch:
Don't feel bad; its all confusing. The Brava system can be in addition to the DIEP procedure if needed. I, for example, had the DIEP on the left side. I had a lot of necrotic tissue that eventually dissolved, leaving a smaller than expected outcome. Because of that, I will be using the Brava system to re-expand the tissue (as opposed to using tissue expanders) which will in turn give us more room to put the fat injections into. Hopefully, a couple of sessions of this, will re-gain breast size. Once that is done and settled, then I will have revision of the good side to make the 2 more equal in size, as well as the nipple made on the affected side. Hope this makes sense!!
The Brava system is still very new so as to all the possible applications, I couldn't tell you. Dr. Khouri will be the one to answer to this.
Later
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Hi Kimmie:
The DIEP isn't a perfect procedure either. I had it done. You still lose some of the size post op as the fast tissue re-absorbs. That's why I'm getting ready to start the Brava system, to stretch out the smaller DIEP breast for upcoming lipid/fat injections. The lipo suctioning is an operation that can require about 3-4 hours in length. Generally, you are under anesthesia for this procedure as well.The fat is harvested from wherever they can find it, then washed and prepared for re-injection with a small cannula in which they intricately layer the fat cells throughout the breast. Once done, approx 3-6 months later, you will be able to see how much you retained and if necessary, do it again or stop if reached goal. I haven't gotten my Brava Bra yet (on its way) so don't have any details to share with you in regards to this and how long you have to wear post op etc. Maybe someone else out there in the process could educated us.
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hi Jseda
I had a similar situation. I had a TUG and due to some complications, lost volume. The recommendation was to use the BRAVA system and do the fat transfers. I have decided to use the BRAVA alone for 10-12 weeks to try and avoid the fat transfer procedure. I am about 8 weeks into the process. The system itself is a pain, but not painful. It is hard for me to use (between work and other obligations) more than 10 hours a day. It does interfere with sleep. There is a definite volume increase. I don't know what will be permanent, but right now I am somewhat optimistic that this alone will be enough for me.
Jean
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Hi Jseda-yes, I forgot that you also risk the loss of some of the fat/tissue w/a diep flap. Well, I think it's a great option to be able to use Dr. Khouri's services afterwards.
I wrote my experience a few posts up. I actually had the fat transfer done w/Dr. Khouri about 1 1/2 wks. ago. It seems to be "settling" in and filling out a little. My breast did look very "quilted", now a little smoother. The surgery took 4++ hours, but I was at a different starting point and had to have the TE removed, along w/some scar tissue. I will reiterate, it is not a simple procedure. I have "needle sticks" from below my breast, abdomen, inner thighs...all the way to my knees. Had lots of bruising & swelling, which is beginning to resolve itself.
Of course, it's very soon, but I lost some of the fat he placed in my upper chest. Specifically, right below my collar bone, where my port scar is. But, so far, it's holding up elsewhere:)
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Kimme,
I have an appointment with Dr. Khouri on Monday..Would you do this procedure again?
Any other advice you can offer would be utilized by many.
Thanks for sharing
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Grrr, I talked with Cindy in Dr. Khouri's office and apparently there aren't any doctors in Atlanta trained to do this yet (although she said one will be doing training with Dr. Khouri; she didn't know when though). Darn darn darn.
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Yes! I am excited to be one of the recipients of this innovative type of brest reconstruction...Dr. Khouri is the originator and world's most experienced (does it here and in Europe). I had a left mastectomy in Dec. 07 and wasn't going to do reconstruction as I had just started a new job and didn't want to take six weeks off. Also the choices seemed less than ideal and so painful! In April 08 my husband just happened to hear a new story on a local health spot about this Miami MD doing a new kind of less invasive breast reconstruction. He called the station and got his name and got in contact with Rosie. That was the beginning of a very exciting journey. I only had to be off work for three days at a time (I had four graftings two months apart). It's an outpatient procedure (you do get put under) I thought there was very little pain ( a little discomfort from the lipo, they don't take huge amounts, so maybe that makes it less painful??). It is so sweet to get fat redistribution though!! At 57, I have a better shape than I had as a teen! I went frum an 34 ! to 34C and the tummy from our five kids is flat now. I feel like it's a very sweet gift from God to be so naturally restored and rejuvenated. On the other side, it takes time and patience. The Brava is a hoot! Not too conducive to social life as you need to wear it ten hours a day and it's like Dolly Parton times three. The other down side is that Dr. Khouri is so busy. He is very wonderful to work with and gives great service when you are on the radar with imminent pre or post procedure, but hoping he gets more office crew as it can take a long time to get answers in between. This is a less invasive, low risk, low pain, quick recovery, wonderful result option. Check out miamibreastcenter.com (think I have that right).
with care to you all,
wisconsin randi.
p.s. reading up a few notes...yes there are expenses...the Brava you get a discount, but still is expensive and might need another set before you're done. I think Dr. Khouri is the only one who really does this procedure. Heard about one women in VA whose MD is starting to do them. He does lots of trainings but not too many are doing them. It's an art and science. Hoping more will start though!! We actually got to have some done by Khouri at a symposium in Milwaukee, WI, but then had billing problems because WI doesn't have a code for this procdure...would have been cheaper to go to Miami. No problems with billing there.
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Thanks for the info! My PS is doing the lipid injections at the U of Washington Med Cntr.The brava system is just an apparatus/step of helping get better results and not necessarily the basis for looking up PS doing lipid injections. I think it would help you ladies more if you were to research PS doing lipid injections. The brava system can be ordered by any PS to be used prior to lipo suction/lipid injections. Look at your state university medical centers for potential PS doing this procedure. Just remember, it hasn't been accepted by the AMA/medical coding body yet so most insurances won't be covering it without a lot of extra paperwork/letters from your PS and no guarantee. You're better off paying for it out of pocket and keeping receipt and submitting later, after they've received their medical codes for the Brava system. I know 1 gal who tried to get coverage for the Brava system prior to her liposuction/reconstruction and her insurance denied everything, including her reconstruction. She'll probably get it turned around but it'll take many letters and lots of effort to do so.
Keep on posting ladies, great information coming in from everyone.
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The Brava is an extremely important part of fat retention. It helps provide a matrrix of blood supply that the fat is embedded in.and becomes part of your body. Results are estimated at 85% retention and that seems about right to my case 1 1/2 yrs after my last grafting (Jan 08). Most of the change happens in the first few months after.
I don't mean to be too know it all though as there definitely might be more out there than I am aware of. Wishing you very well with what you are having done. Is this able to be done after a mastecomy or is it more for after a lumpectomy?
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I emailed Dr. Khouri's office and was told there are two doctors in New York City that do this procedure Dr.Christine Ahn(who I think was trained by Dr. Allen to do flap surgery) and a Dr.Sydney Coleman. I am definitely going to talk to Dr. Ahn's office about this tomorrow.
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Pandazankar,
I would be interested in hearing. I want to apologize. Everyone has been very nice in welcoming me to this site and being interested and I think I have been a bit rude. Sorry....really don't mean to be.
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Maybe I've hit the jackpot? I have an appt with Dr. Christina Ahn in earlyl September. I was told by her receptionist that she does nipple-sparing mastectomy which I am very interested in. It would be awesome if she could also do the microfat grafting and spare me the trips to Florida (though I am willing to do that if necessary).
I know i'll be asking more questions as they come up but I want to thank everyone who has so generously shared experiences and information.
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Kitchenwitch...
I had called Dr. Ahn's office before I went to see Dr. Khouri...think it was in May sometime. At that time her staff said that she did not take insurance for the procedure (fat grafting), so it was off my table immediately. I'll be interested to hear what she has to tell you.
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Kitchenwitch...
I meant the fat grafting reconstruction procedure, not the mastectomy! Also, sorry about misspelling your Discussion Board name in my previous post!
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PSF, Dr. Ahn doesn't take my insurance anyway - so I'll have to use her as an out-of-network provider. I have to hit a deductible of $2300 first (have already done some of that, apparently). I am not happy about that, and maybe it will be cheaper to go through Dr. Khouri, but I'm taking a long view: a few months of wearing a weird device and some procedures... a bit of money ... and the result is (I hope) a more natural-feeling breast. If Dr. Khouri does take my insurance I would still have to calculate the cost of a few plane trips to and from Miami.
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