Has anyone had micro fat grafting?

alexandra-aaa, I'm really grateful that you posted about the Brava system and Dr. Khouri. It is not an option for me right now since I had reconstruction with an implant last year but I think it's so promising...I'm glad that there are doctors trying new and less invasive procedures, I can't help but think of my grandaunt who had a halsted mastectomy without reconstruction 60 years ago, I'm glad that doctors tried and created techniques to "reconstruct" a breast (of course I'd be happier if they had found a cure for cancer instead of having to mutilate patients and pray for NED...).

Your posts in my opinion have been very informative and I hope you continue to join us.

Best wishes.

This has been a happening place for the last couple of days. I guess it's time I jump in with my two cents. I'm not even going to try to keep track of who said what. But first, if there is someone here posting from Dr. Khouri's office - will you please let us know who you are so we can ask some real questions? I'm constantly tempted to call his office and try to get through with my questions, but then I tell myself to be patient and wait for my ps to learn all the details. Not so cool to do it anonymously, but if your bias is clearly stated, I don't think there's a problem?

Also, I guess I'm guilty of being one of those who has mostly just posted on this thread. I did join this site a year ago when I was diagnosed, and did a lot of reading, but only posted maybe twice.  I'm not sure why, except that I was overwhelmed and didn't feel like it. This procedure is the first exciting thing I've come across since finding that horrible lump a year ago. If my enthusiasm has comes across as an advertisement, well that's just because I'm enthusiastic. 

AAA - okay, I did remember you. You're very welcome here. I'm grateful for all your research and information. I do want to add that I felt defensive from the ominous tone of some of the posts as well, and was tempted to just back away. I'm real big on surrounding myself with good feelings while trying to heal. Not that I think we want keep blinders on, but I hope this can remain a happy place to visit. 

Reconstruction is a very personal decision, and any decision needs to be respected. I join those that are pleased to be pioneers, and respect those who aren't comfortable with it. But in my mind the possibility of problems in the future really pales in the face of the problems caused by the other options of the day.

My surgeon raised the same concerns listed here about this being new, the only study being small (though he did call it legitimate and impressive), and the fact that most of the information out there is in the form of advertisement. But he offered to look into it from a scientific point of view if I was interested. I gave him the go-ahead - and he found information that satisfied him. That was enough for me. 

Finally, I think it's fair to say that plastic surgeons are a unique group. They're half artists, half scientists, and usually come with an ego. I haven't named my doctor because he doesn't advertise himself and I cringe at the thought of him being maligned like some have. (For instance, if you do a search for Dr. Coleman you'll find a whole bunch of negative info, which was apparently concocted by one dissatisfied patient.)  I would recommend that as a general rule it's a good idea to find a doctor we trust and rely on his advice more than the range of inaccuracies that can be found online. 

BUT with that said - CrunchyPoodle - I applaud your decision to go ahead with the doctor willing to do it, even if it's not his first choice. I suspect there's some ego issues going on there, but if he can do fat grafting, he ought to be able to handle this, as long as you keep up with wearing the BRAVA device. Sometimes we're faced with less than ideal choices, and we just have to pick the one that feels best for us.

 Okay, enough of my soap box. I appreciate you all!  

alexandra-aaa:

You're right in noting that I'm protective of the forum and it's members, and when you first started it was I who said "You are a new member here and your post does sort of come off as an advertisement for Dr. Khouri and his Brava System."  

I have found a welcome and supportive home here these past years, and have been helped through some of the most challenging days and nights of my life, including the loss of my sister this year to BC.  No one, and I mean NO ONE else understands us like each other. 

You've made a good case for why you post here, and you are as welcome as any other member who follows the rules.  Those who should not be here know who they are, and are usually gone in short order.

Be well, all of us.

Maria

Beesie,

I totally hear where your'e coming from, but I have to ask for some clarification. In your post you mention the fact that this method may increase recurrence rates. That was a key point for me and my decision. I found some pretty strong evidence to lead me to think there was no reason to expect an increase in recurrence (I wish I had time to track it all down, but it was over the course of several days of research, and came from at least one prestigise (sp?) doctor not affiliated with Dr. Khouri.) I realize nothing is certain without long-term studies, but are you basing that statement on something specific? I'd really like to be pointed in that direction before making the final decision.  Thanks so much for your input!

NNT2G,

No, the good news is that I'm not basing my comment on anything specific.  In my earlier post in this thread, I asked this question: Are there any potential problems with the system in that it may spur the growth of the tiny amounts of breast tissue that remain after a mastectomy.... does this create an increased recurrence or new primary BC risk?   I think it's a reasonable question and I wondered if any testing has been done to determine whether an increase in recurrence risk is a possibility and/or real concern or not.  From what I can gather, no testing has been done.  Julia, in her response to my post, indicated that she's made the decision to go ahead with this reconstruction method and is okay "(e)ven if it's found to double or even triple the risk of recurrence from 2% to 4 or 6%".  So my most recent comments were simply a continuation of this earlier discussion.

I have found information on the internet that suggests that for women who use this method for breast enhancement, the new breast tissue that develops is at no greater risk of BC than any other breast tissue.  But I have found no information on testing done with women who've had mastectomies.  So the bad news is that it appears that we just don't know whether there is an increased risk of recurrence or not.  What we do know is that no matter how good our surgeons are, there always will be tiny amounts of breast tissue left after a mastectomy. This is why it's possible to have a recurrence after a mastectomy. In women who use the BRAVA system for breast augmentation, the system seems to spur the growth of breast tissue. Therefore does that mean that women who've had mastectomies may end up with more breast tissue after using this  reconstruction method?  And if there is more breast tissue, is there is a greater risk of recurrence and/or the development of a new BC?  Or, in spurring the growth of breast tissue, if there are a few rogue cancer cells left in the breast tissue after the mastectomy, might this system of reconstruction encourage the growth of these cells?  Could that lead to a greater risk of recurrence?

I think these are reasonable and logical questions.  Without any testing having been done, there seems to be no way to know if this is a real concern or not.  Hopefully it's not, but from what I can gather, it's going to be the women who are pioneers who will be the ones who test this out and answer these questions for the rest of us.

As I said in my original post, if anyone has information on this, please share.

aaa,

Thanks for the link.  I have read that information before.  Everything discussed there has to do with whether the Brava system may cause cancer or promote the development of cancer.  It seems not to, which is great.  This is important information for those who are undergoing breast enhancement. 

From my understanding/interpretation however, the information provided has no bearing on what the Brava system may do to someone who has had breast cancer and who may have rogue cancer cells still left in her breast.  Nowhere on the Brava site can I find anything about safety for reconstruction patients.  To me, the absence of this information is glaring.  That's what I find worrisome.  That's not to say that there is a problem but it seems to me to be a pretty obvious question and a pretty obvious topic for them to cover off, and the fact that they don't suggests that they have no information at all about this.

Here's the webpage with info on the clinical trial:

http://www.clinicaltrialssearch.org/breast-reconstruction-and-augmentation-with-brava-enhanced-autologous-fat-micro-grafting-nct00466765.html

It's only 50 women and it appears that they are being followed for only 1 year.  While the trial was started in November 2004 and was supposed to end in November 2008, the website indicates that they are still recruiting.

On the clinical trial page,it does say they are still recruiting,but they don't update those pages very often.If there were 50 women,how many had reconstruction and how many augmentation?I think the concern with the cancer growth is that from what I have read(and someone please correct me if I am wrong)most are very slow growing,so it would need several years of follow up to be sure.I guess part of what I do not understand is if this has had the clinical trial and been approved, why is the Brava system not covered by insurance?

I'm going to take Beesie's concerns to my ps. Based on our conversation in the past, I think I know what his answer will be, but I'll refrain from posting it until I talk to him. I'm hoping to hear some feedback from others as well.

But before I talk to him, I'm wondering if those of you who have done this can answer a question for me - was your first procedure done in a hospital? Was it outpatient? And how long were you in the surgical room?

The reason I ask is that I'm anxious to get started as soon as I can, especially since I have expanders in and apparently won't need to start with the BRAVA device until after the first surgery. But my surgeon isn't getting the training until the end of October, and he schedules two months out for surgery. So I called his assistant to see if I could get on his schedule, and she said she has no idea what kind of room he'll need or how long he'll need it, and he won't know till he gets back. Which means waiting probably until the end of December (and that means probably January). So if I can figure out how to get a room scheduled now I'd be really happy. I'm crossing my fingers it's something he can just do in his office, but that's probably a bit too optimistic.

Finally, I think I can address the question of why the BRAVA isn't paid for by insurance. I know from my experience with lymphedema that manufacturers have to jump through a bunch of hoops to get any device approved to where it's considered a "medical device" and approved by insurance companies. I tried to for many months to get my insurance to pay for a pump that does lympathic drainage. It was recommended by my doctor and my therapist, and has all kinds of studies proving it works, but it hasn't passed through the approval maze and my insurance wouldn't budge. So I don't find it so odd that they won't pay for a boob suction cup device.  

pandazankar:  I started wearing it about 4-6 weeks after the BX and I was concerned about it too, but for the most part...on my body, it rested on the perimeters of the mastectomy and actually felt good in the middle part that was being suctioned out.   Except for an area on my left side where I had a lumpectomy about 18 years ago, and virtually nothing but skin and bones was left....the Brava on that side rested on a nerve, I think, but after a while, I was able to adjust the positioning....it would be interesting to find out if they would provide a refund if you can't wear them, though. 

NotMyTime2Go:  My procedure was done in a hospital....outpatient....I think my surgery was around 3 or so hours under general anesthesia and several hours recovery....but every case will vary depending on the situation.

I'm hoping to talk a different plastic surgeon in metro ATL into trying this technique. One thing he didn't understand was what is the point in doing an initial fat graft at the time of the mastectomy (before there is breast tissue structure to support it). He thought the fat would just drain right out via the drains.

Does the initial fat graft (if done the same day as mx) "take" at all, or is that really just so the patient has a breast mound and it isn't so shocking after the mx? This plastic surgeon tried several times to call Dr. Khouri but got a busy signal every time.

BTW, if anyone has a direct phone number for Dr. Khouri that my doctor could try, I would appreciate if you could PM it to me... thanks so much!

whippetmom, that does sound alarming on first read, but actually it just sounds like an overly cautious plastic surgeon who has no interest in (or possibly doesn't even know about) the applications for mastectomy patients. He's speaking for his own practice's policies, not the safety of the device for those applications. 

The pregnancy exclusion alarmed me, but since he's only treating non-mastectomy patients, of course that makes sense.

pearlcap:  Fat graft transfer can be used to fill in defects after lumpectomy - especially as you describe, "slight indentations."  I would personally want a plastic surgeon who is experienced with FGT for breast reconstruction.  It might take two or even three separate FGT procedures to accomplish this....it might take only one.  The "100%" guarantee though....I don't think you will find any plastic surgeon to make such a promise.

Thank you Whippetmom and lago.  I'm having surgery in two weeks and maybe a fat transfer sometimes next year.  I'll let the board know my experience with fat grafting if that helps anyone.  Thanks for your responses.

What, I never heard that?!

I know my surgeon is planning on doing some fat transfer with my implants. He knows I'm doing chemo and might do rads. I would get a 2nd opinion on this. I would also ask your oncologist what s/he thinks about this.

I have a life science/medical background (not in breast research) and have been reading some research on fat grafting since I've been thinking of doing this post lumpectomy surgery.  This is what I found out.  Although fat grafting/transfer has been done for many years in Europe, its use in reconstructive surgery is still controversial in the US.  There are two main issues.  First, there has been fear that some of the fat transferred will die (necrosis), causing calcification and interfering with accurate detection of cancer.  Both my physicians at Memorial Sloan and references to studies I looked at indicated (Plastic Surgeon Societies continue to be against fat grafting for breast augmentation) that radiologists are able to distinguish between calcification from fat necrosis (cell death) and breast cancer.  As far as I am concerned, this is not an issue for good radiologists.  The second issue is whether stem cells from fat grafting will induce growth of tumor cells.  This is the more important issue and we still need more data; but thus far, the data suggest that the transferred fat cells may promote active tumor cells but not dormant cancer cells (see link below).  This is a personal decision but what one should consider is whether there is a risk that there may be unknown cancer cells left behind that may induce tumor growth through the fat grafting/transfer.  The perfect situation is to wait a few years of cancer free diagnosis before getting a fat graft.  Personally, I am going to reassess my situation after surgery.  I have to see what my breast look like and read more research.   If I get a fat transfer, I will let the board know the outcome.

(http://www.upmc.com/MediaRelations/NewsReleases/2010/Pages/Fat-Stem-Cells-Breast-Reconstruction-Dormant-Cancer.aspx)