Has anyone had micro fat grafting?

Oh Kitchenwitch, that's disappointing... and I hear you about the weeping... I figure I'll be one-breasted for at least a few months while I heal from the mx then wear the Brava, and that makes me weepy too.

I'm not sure how the sensation/feel of DIEP can be similar to fat grafting since DIEP uses transplanted tissue... wouldn't you have sensation loss with that? I don't know, though, maybe not. I personally can't do DIEP since I plan to have a pregnancy after all this is over and they won't take abdominal tissue because of that.

How do they already know that you'll need radiation?

Kitchenwitch -

I'm so sorry - you have every right to be disappointed and angry.  I agree with Crunchypoodle about the feeling/sensation.  I don't know how that would be possible with the transplanted tissue.  However, a friend (fellow BC sister from here) had the DIEP on one breast (didn't take on other and had to get implant) and she is very happy.  It definately looks much more natural than the implant she has on the other side.

Hang in there.  Things will get better.

I had my long-awaited consultation with my ps yesterday, and promised some of you that I'd report. He went to Florida for the BRAVA training last weekend, so I was very anxious to see what he thought. He started out by telling me - very gravely - that he was a huge skeptic when he left for Florida. He was intrigued by the process, but was put off by what he called a "used car salesman" feel. He said his intent was to spend the weekend finding the "problems" with the process. And he did find problems. The BRAVA cups can cause problems with the skin, take dedication, and certainly aren't for everyone. BUT, despite all that, by the middle of the day he began to be impressed, and by the end of the day he was sold, and very enthusiastic. He's started the process of getting the hospital equipped with all the things he'll need (bigger syringes was the only thing I understood). 

One of the things he was most impressed with was the description of all the dozen or so women of a restoration of feeling. He discounted Dr. Khouri's explanation of why they have normal sensation, but he couldn't deny that what the women described was way more significant than any of his diep-flap patients have ever described.

So, then I asked about this process of just using the internal expanders, since I already have those. He said he's familiar with the doctors who are attempting that, and he is open to trying it on me. My first step in this process will be to do a session of fat grafting and either remove the expanders or just deflate them, depending on what I decide. He did say however that from what he knows of anatomy, the external expanders make more sense and should achieve a better result. Using external expanders means pulling the skin to form an envelope that has a bed of new tissue, and working from the bottom up. With internal expanders, the fat is going in at the top and pushing downwards. He doesn't think the sensation of touch will be the same, or that it will have the same healing to radiated skin and mastectomy scars, there will be a higher absorption rate etc. But he said if I want to just deflate the expander in the first session, I'll have an idea of whether it is working and I can decide after that. The only thing I'll be out is one extra time under anesthesia and more delay in the overall process.

So that's where I am. I've been reading about the BRAVA and am pretty convinced that it'll be miserable. Oh (I'm rambling now, there's just so much info) I did ask about the suction issue, and he said that they said sometimes mastectomy scars make it hard to keep suction, but they fill those with a little fat and it usually takes care of it. He also acknowledged that this all hinges on how dreadful the BRAVA really is.  But most of the experiences I've read of BRAVA are women who just want to have a bigger cup size. I want a cup. period. And since I'm not a candidate for diep-flap or implants, I expect I'll be a lot more tolerant than some. But I still don't know...

I do have a date - December 9. He'd like to know in the next week or so which way I'm going - taking out the expanders or just draining them a little. If it weren't for my lymphedema I think I'd definitely try to just drain them. But I really, really like the idea of a natural feel and healing stem cells and getting rid of these expanders. So I'll report when I've made a decision, in the meantime I hope that info help some of you with your decisions!

(Oh I wish I still lived in a world where I my biggest decisions were picking out new furniture and maybe helping the kids decide on a college. This how to get your body back business is the pits.) 

SDSTARFISH:  I had the same experience at Palmetto!  I am a patient of Dr. K's and had my first fat grafting the end of July.  Palmetto, by far, was the worst hospital...with the worst staff.  I hate to be that negative, but I have had several surgeries (haven't we all)....all in Broward county, and, boy, what a difference:(  

I actually recently spoke to Cindy in Dr. K's office about where the next surgery would be.  Since they moved they're office to Key Biscayne, they will be using the hospital there, which I have only heard good things about.  I told her I would never go back to Palmetto:( 

NotMyTime2Go...what a great posting!  So informative. 

 I'm preparing for my 2nd fat grafting surgery...December 3 with Dr. K.  I'm really happy with the results from the first round.  I think he got me to about a small B.  The left is still firmer and higher than the right...left had CA 17 years ago with lumpectomy and radiation, then DCIS recently, thus the BX.  I really didn't want to wear the BRAVAs initially and several times early on I thought maybe I would quit, but it was definitely worth any inconvenience.  I have very sensitive skin, so I was very worried about rashes, blisters, etc.  I found that by taking very good care of my skin and moisturizing it, and then treating any sore areas as soon as possible, my skin is holding up very well. 

About the comment on the BRAVAs not keeping their suction...prior to my first fat graft, I had that issue before I started to use the extra bulb pressure.  When I started with that, I found that if I just gave it a slight squeeze beyond the sports box pressure, the BRAVAs "stuck" more firmly.  At first, I felt like a little kid in a tight snowsuit ....and didn't do much with them on, but then I somehow became more used to them.  Prior to my surgery, I even wore them out to dinner and to the store (had to wear them 24/7 for 2 days just before surgery).  I also had thought I could not stand to wear them 24/7 at all, but that went ok too.  I think it's a lot about motivation.  I just kept telling myself that soon it would all be behind me and I'd have breasts again.  After having the first surgery, it was much easier to wear the BRAVAs...Dr. K placed fat in some of the areas where I was basically just skin and bone and the BRAVAs are much more comfortable now.  Every time I look down and see my breasts I am SO glad I hung in there and am looking forward to my second round!    

 Pandazankar...I was really worried about sleeping too, but for the most part, that hasn't been the issue I thought it would be.  I can really understand your apprehension.  I think at first, I felt quite awkward in them and they felt huge!  But I just kept with it and like I said, you do seem to get used to them. 

I decided to share this so all of you could make an informed decison should you decide to go to Palmetto. My desire is not to rain on anyone's parade...if you still want to go ahead with things, I wish you an easy surgery, a peaceful hospital stay, and beautiful results.

Peace, Lisa

Excerpt from my letter to Patient Advocacy:

My first event of concern was that when I came in for my pre-op clearance, some of these staff members actually had to go get someone else to speak to me because their English was not satisfactory enough to help me. I realize (now) that Hialeah has a heavy Hispanic population. However, I have the right to expect that your staff would speak to me and fully comprehend my concerns in English first. In hindsight based on my overall experience, I am not confident that anyone to whom I spoke - even in English - truly comprehended the questions I was asking them regarding my health and my pending procedure.

Another disturbing thing about my pre-op visit was that no one could give me a time for my procedure. As a cancer survivor, I have had many surgeries in other hospitals. Not once - before my experience at your hospital, that is - have I ever been told that I could not be told my surgery time until the day before the surgery. This is ridiculous. From a logical standpoint, the patient can't drive his/herself home. In order to coordinate a ride, they need a time. From an emotional standpoint, the patient is already worried about the upcoming event. They don't need the extra anxiety of unknown information.

My surgery was scheduled for 6:30 a.m. Eventually, I found out that I was not even scheduled for my procedure until 8:30 a.m. Two hours is a very long time to be sitting around doing nothing...particularly for my sister-in-law, who had changed her whole schedule to drive me to and from surgery. (My 12-year-old daughter was also with her, as she is home-schooled). Then, when 8:30 finally came, I was told that my doctor was ‘notoriously late'. By the time 9:30 rolled around, I was told that my surgery had been pushed to 10:30. All this time while I was waiting on the gurney, several more staff members spoke to me first in Spanish. All this time - about 4 hours - my chart was left out for anyone to see. In fact my sister-in-law even mentioned that my chart was still out. But none of the staff was concerned. This violates HIPAA compliance as well as JCAHO compliance.

In hindsight, maybe I should have seen these red flags as a sign of your level of patient care, and refused to have this procedure done. And I truly wish I had. But again, a patient is stressed and anxious, and is not necessarily thinking level-headedly. This is particularly true for a breast cancer survivor, because each new surgery is another trauma that brings the whole cancer crisis back to her in a way that is emotionally staggering. In addition, it was extremely loud in your outpatient center. You, however, as the health professionals, are the ones who are supposed to be making the level-headed decisions. It's your job.

When the doctor finally arrived, he had a friend with him. For a lengthy period of time, I was marked for my procedure with several different colors as the two doctors talked to each other - not to me - about my procedure. I was so confused and stressed by this point that I was not sure what was up or down. All I really knew was what was discussed at my pre-op with the doctor - a fairly simple, minimally invasive outpatient procedure to fix a few defects in my breast reconstruction. A two-hour procedure. Taking fat from only one small area of my body. Back to doing light yoga in 5 days.

And I honestly believed that's what was still happening. I even attempted to verify this with staff to be sure I was still getting it right. But looking back, it is highly possible that they had no idea what I was saying. They just nodded their heads and put me under.

One thing I did not realize until the next day that should be of major concern to you is this - I never even had an i.d. bracelet on me during that procedure. It took your staff until 9:00 a.m. the following day to put an i.d. bracelet on me. I'm sure I don't have to tell you how completely unsafe and unprofessional this was. This is a gigantic HIPAA violation, as well as a gigantic JCAHO violation. My God, what if I had been confused with another patient??? Had the wrong surgery? Been given medication that I may have been allergic to?
Are you starting to get the picture of how traumatizing this experience was for me??? But unfortunately, it got much worse.

Two hours passed, then 3....4... and no one came out to update my sister-in-law. She was the one who was forced to constantly hunt people down and ask them what was going on. She's not even really sure how long altogether I was under - but it was at least 6 hours. And no one came to talk to her and explain what was going on. Do you have any idea what that must have been like for her and my daughter??? Or for my husband, who was commuting home from a business trip and just had to wait and wait for his wife to get out of a procedure that should have been done hours before???

When my sister-in-law did hunt people down to ask them how I was doing - and even where I was - she was treated very rudely with broken English: "Nothing! You wait!" She finally found out that I was in recovery at 11:00 p.m. that night. No explanation of when I had gotten there. She found me herself, only by insisting that she be let in.

She was told that I had just been given a shot of Demerol because I "screamed for 5 minutes" when I woke up. She was also told that I'd had fat removed from several different locations on my body (arms, legs, back, and hips). She was also given the vague explanation that it was a more complicated procedure than they had originally thought. But keep in mind - it was an elective procedure, not a life-saving one. By continuing such a long surgery, your staff robbed me of the chance to make the choice myself as to whether it was actually worth it. What they should have done is stopped the procedure, then talked to me about it when I was lucid. And I can tell you right now, had I known that I would be under anesthesia that long, and that I would be coming out with surgical drains, there is no way I would have given my consent to go on.

So my outpatient procedure turned into an overnight nightmare. I asked for pain meds during the night because I was in agony. I was told that the only thing I could have was another shot of Demerol. I asked them to call the doctor or his substitute and ask for something else, because the Demerol had given me a migraine. This is a normal hospital procedure. But your staff refused. They said there was nothing they could do. Effective pain control is another JCAHO violation.

My bedside phone was not working. Apparently it was not plugged in (as I was told later. Fortunately, my roommate - who was also a patient of my doctor, and had also been treated horribly by your staff - was kind enough to call for me, asking for an icepack. Each time, the person on the phone did not understand English. It is completely unacceptable to have staff in a hospital who cannot understand the needs of their patients. Patients are obviously not there for a good time - they are there because they are suffering. So this isn't rocket science - there needs to be someone on the other end of that phone who can understand them.

And - there needs to be a working bedside phone! Doesn't anyone check these things ahead of time before a patient is admitted to that room? Do you realize how serious that is?

And still on the topic of the bedside phone - why is it that every time a patient called the nursing station, the announcement came through the speaker on my phone (as well as my roommate's phone)? How is a patient supposed to get any rest with blaring announcements all night long? Even if this is something that can be adjusted, why have phones that do that at all?

In addition, for a good portion of the night, my tray - which held my water - was out of my reach. On top of that, I was never provided with an incentive spirometer. After an extended surgery such as I had, this device should have been within my reach.

Please keep in mind - I had just had surgery, so my mobility was limited. And since I had no phone, I had to wait until staff happened to come in to check on me to ask for them to move my water to where I could actually reach it. On one of these occasions, I was rudely asked by an irritated staff member: "What do you mean, you ‘can't move your arms?'

On to your staff. During the entire night, your staff carried on personal conversations in my room, very loudly. And they seemed to have no awareness that perhaps this was disrespectful of the patient's privacy, not to mention their physical need for sleep. This happened not just one time - but several times, throughout the entire night and the whole next day while I was there.

Now on to the two dangerous, mentally ill patients on my floor. The first one was there during the night. He threw things, banged on walls, screamed, and cussed - for 1 ½ hours. My roommate and I were terrified. Our door was wide open all night. If that man came in our room and tried to hurt us or throw something, we would not even be able to move in order to protect ourselves. How is it possible that this man was allowed to behave this way, without either being subdued or removed to a psychiatric facility? And do you realize how this added to the stress of every patient on that floor? The next morning, a different mentally ill individual behaved in the same manner. But this time, the nursing assistant actually screamed in fear, because this man threw something at her when she was restraining him. Later, she told us that this was ‘typical' at your hospital. Why in the world would you keep psychiatric patients on the same floor as patients recovering from surgery?

When it was finally time for me to be released, my husband came to pick me up. Bear in mind that he'd been up all night, and had driven 45 minutes to get there. But there were no post-op instructions anywhere to be found. I was told by staff that "I should know" what to do. How should I know??? I'm not a doctor. Then I was told that I'd have to wait around until my doctor called them back with instructions. For almost an hour, no one knew where he was. Finally they realized that he was right there at Palmetto, doing surgery. So my choices were given to me: either go home and call us later to find out how to take care of yourself, or, wait here for however many hours it takes the doctor to come out of surgery so he can answer your questions. But finally, the doctor's assistant left surgery to explain things to me. There was no written explanation at all...just him explaining it to me. Seriously? This is how you run your post-op discharge?
There are probably a multitude of other things that happened which I am too overwhelmed to recall as I write this. But this should give you a very clear picture of my ‘healthcare' experience at Palmetto General.

A word about my roommate: Like me, the patient next to me was a breast cancer survivor. Like me, she was put under anesthesia for much longer than she was told she'd be. Like me, she had also had fat taken from several areas of her body, rather than just one. And like me, her procedure was supposed to be outpatient. She was equally horrified not only at her physical condition upon waking, but also the lack of staff that were knowledgeable, respectful, and English-speaking. Like me, she was also extremely frightened by the two mentally ill patients on our floor.

She also feels that the staff did not understand her questions throughout her stay, which may have led to her shocked feeling upon waking. And like me, she was also unnerved by the fact that no doctor checked on either her or me the next day. I am not sure at this point whether she will move forward with contacting you. But on her behalf, I would highly suggest that you contact her and attempt to make amends in some way for the trauma that you have unduly caused her and her loved ones.

As for myself, I will avoid willingly stepping foot in your hospital ever again; and I plan to advise everyone I know that they should do the same. I am in a state of shock as I try to get over this traumatic experience - while also trying to help my family members move past the horror of waiting and wondering what on earth was happening to me....and please keep in mind, this was not for the first time they've had to do this. You've reopened wounds for them, without just cause. And this alone causes me more stress than you can imagine.
I truly believe that I am lucky to be alive after my stay at your hospital. I sincerely hope that you realize that - and choose to make some drastic changes in patient care.

The hospital replied with a very condescending letter, denying everything - despite the fact that I have witnesses to everything.

sdstarfish:

 Wow, sounds awful.  So sorry this happened to you.  I was at Palmetto, too.  I was a bit worried about the language issue when I learned it was in a heavily Hispanic area, but everyone I dealt with spoke English and I felt they did understand me.  I didn't have to spend the night there, so I can't comment on that part.  Everyone pre and post op were very kind and attentive to me - but there was no pain control effort after surgery, except for the prescription that my husband had filled while I was in recovery.  I do recall that my surgery took longer than my husband thought it would, but not too much longer.  Anyway, I just wish you had a better experience. 

Besides your bad experience at the hospital, what do you think of your actual surgical results? 

sdstarfish: OMG, Lisa!! I am so ANGRY reading all that!! What an absolute nightmare. I would be tempted to report them for these HIPAA violations -- have you? Seriously, like you said in your letter, they are endangering people's lives!! So sorry you went through such a traumatic experience!

pandazankar, re: what you said here:

Has anyone here had the fat grafting at time of mastectomy? I admit,I am having some emotions about having no breasts at all.I would love to wake up with little mounds,it would be like Christmas morning!

I've wondered and thought the same thing, and in reading the posts about how hard it is to maintain suction at first, a light bulb just went off. An initial fat graft at the time of the mastectomy would help maintain suction right off the bat! I know Dr. K. does sometimes do initial fat grafts at the time of mx, but I thought it was just for psychological reasons. Actually it seems there is a very good logical reason if it would help the Brava attain suction better.

I've heard some back-and-forth on the potential for problems with micro-fat transfer in terms of calcifications or tumor growth. But how is it really that different from something like the DIEP? I mean basically they're rebuilding a new breast with fat from the abdomen or thighs, right? They put the fat there in a different way, but isn't it kind of the same thing?

I wish I had asked my BS that, because he brought up the issue of how new fat-grafting is and how there could be some future danger - which is totally the last thing I'm worried about. The only reason I'm having such a hard time with this is that I don't want to be without a breast for so long. My PS was dismissive of the difference in feeling/sensation between fat grafting and DIEP.  

Still gathering info... still agonizing over what to do in a couple of weeks.  

Kitchenwitch,they have done microfat grafting to the breast in Europe for many years.My understanding is that some of the fat dies off when it is grafted and it shows up as suspicious.This is why you have a baseline MRI done.I have also read that a good radiologist can tell the difference between fat necrosis and possible cancer.The reason why there is more sensitivity in the microfat breast is because when they use a flap, nerves are severed.With the fat graft,you still have the sensation of the skin that is there,not skin that has been cut off from another body part..I emailed Dr.Khouri this morning.You can have the fat grafting at the time of mastectomy,you do NOT have to be without a breast.On the other hand,I have been without a breast for two years and there are worse things to face.When my cancer was discovered, I did not care,wanted it out of there.And while I was undergoing treatment,I was too sick to care if I had one boob or three.When I started getting active and in pain from being so lopsided,I started looking into recon.I loved my breasts,even at 55,they were lush and firm.I  look at the before and after pictures on the plastic surgeons websites and think how much prettier my breasts were than most of the ones I see.I do think if I had had immediate recon I would have been dissapointed as it is doubtful they could have duplicated what I had.And the one plastic surgeon I saw agreed with me.Anyway,do not rush into the recon,take your time and be sure what you are doing is right for you.I have been researching this for close to a year and have just now decided I want the prophylactic mastectomy with immediate fat grafting.Now to find a surgeon closer than Florida to do it! But I truly believe if I persevere,it will happen.I would rather wait than  have a surgery I am not comfortable with.

Crunchypoodle I hear ya about the bra/camisole/whatever! I was just saying that to my husband last night, that if I did decide to wait on recon, I would likely always be wearing something "during." : )

Pandazankar, Thank you for all the info. Dr. Ahn's office was definitely pro-fat grafting on the phone call, and she was pro fat grafting (mostly) before my last lumpectomy. The game changer seems to be at the moment, that my post-mastectomy treatment might require radiation.

I don't get the feeling that Dr. Ahn has done full fat-grafting at time of mastectomy... I don't know if she'll be willing to call Dr. K. to discuss but I will certainly ask that she do this. I am VERY on board w/ less surgery time. So much so that I am very much considering living w/ .... sigh.. less breast than I would like, for a while, because it would be far less time under anesthesia. Not to mention shorter recovery time.

So... that will definitely be on the questions list. I think i will start putting that together and then post it back here and see if you or Crunchypoodlemama or anyone else has other questions t suggest. And thank you, thank you again.

Hello Ladies.

Thank you all for the above detailed information.  Has anybody had their grafts/procedure done at Dr.Khour's new facility.  Maybe that has some promising care.  Also has anybody used Coral Gables Hospital near Miami for their procedure.  Just can't make up my mind!!!!!

Have a great day!

Hope

sent you a pm

Crunchypoodle mine is Thursday! Will you have a netbook or anything in the hospital? Ill have something for emails and instant messages as soon as I'm able... it would be great to be in touch while we're recovering! How are you coping with the next week or so? I feel.. well, I feel very very nervous even though Dr. Ahn's patient was so generous and encouraging. 

 Jill