Has anyone had micro fat grafting?

Kitchenwitch Don't listen to a resident. I remember over 25 years ago I ended up with an ulcer in my throat from doxicycline. I lost a lot of weight because it was painful to eat. Anyway I was in the hospital for one of those throat cams. The resident started accusing me of being anorexic. I explained to him that it was a SE from the drug and he should check the physicians desk reference. He still sent up a nutritionist to tell me I should weigh 133 lbs. (120-119 was my norm weight at age 20… and back then I ate everything when I didn't have an ulcer in my throat.)

Oh,Kitchenwitch,I am glad you are home and so sorry you are not feeling up to par. Thank you so much for your honesty and sharing.I am sending you lots of postive healing energy!!!Wonder how CrunchyPoodleMom is doing?Were you able to be in touch when you were in the hospital? Take good care of yourself.

pandazankar   I tried to appologize but I guess you are one of those people who doesn't accept such things.  As I said initially, my first surgeon said I needed a mastectomy.  Before I took them at their word, I got additional opinions--another surgeon and 2 different plastic surgeons AND joined this thread and read all the cites and information here. When I did my consults with the plastic surgeons, I did discuss microfat grafting.  One of the plastic surgeons sent me to the more experienced surgeon I eventually used who was able to perform a tighter procedure.  Her skill and my good fortune is the only reason I didn't end up with a mastectomy.  A mastectomy is major surgery with potential for many complications.  Teh first surgeon I saw told me I would have to be out of work for 6 or more weeks not including reconstruction.  I have 3 kids and I am the sole bread winner in my family.  Damned right I got second opinions and  did my darnedst to avoid major surgery.  But it certainly wasn't the boob that was the issue, it was the income stream and keeping the roof over my family's head.   Moreover, in as much as I have already had a second surgical biopsy on the other breast, clearly my journey is not over and I may still find myself dealing with a mastectomy in the future.

You say you are here to exchange ideas---where is the exchange?  People said their ideas and I said mine.  Exchange of ideas does not mean that only people who agree speak up.  Exchange of ideas does not mean that if one disagrees, they say nothing.   An exchange is a give and take.I was polite, I specifically said that I did not mean to offend.  If this thread is really for the exchange of ideas, then people should be allowed to respectfully voice different ideas/opinions and snarky comments like " telling me I can live without a breast when obviously she couldn't" have no place.

Kitchenwitch,  I am so glad you are through surgery and at home and feeling better. I totally get the already out of bed thing--I am a crappy patient too.  But don't overdo it----give yourself the time you need to heal.

Kitchenwitch, so glad you're going to hang out here for a while! and yes, to the others, so sorry I didn't update about my surgery being rescheduled (now for Dec. 8 but even that's only 90% certain right now)... right now I'm not even sure whether my PS is going to do an initial fat graft at the time of mx or save it for later. Ah, the joys of being a pioneer! (or rather, the guinea pig of a pioneer!! LOL)

Teh first surgeon I saw told me I would have to be out of work for 6 or more weeks not including reconstruction. 

Out of work for SIX WEEKS??? Why in the world??

Lisang--I live in New York.  Reconstruction--was redone--needs modification.

I am desperate for the name of a PS you find to be "fantastic"

Would so appreciate a reply.  Eileen

Crunchy Poodle Mama

I looked at my notes and the least time was 4 weeks with 6 weeks more typical because a mastectomy is major surgery--never heard it described as anything but.  I have leave for that amount of time but what if there were complications.  What if I had a reoccurance or a worst cancer?  I could not drain everything down to nothing so the best option for me was to find a surgeon capable of doing a lumpectomy that would alleviate the need for the major surgery and then cross my fingers.

I have to say, I had a hysterectomy about 5 years ago--a very well done, teeny tiny crosswise incision type--and despite my best wishes to the contrary, I was completely out of work for nearly 5 weeks.  After that I came back part time after that but didn't fully recover energy etc for nearly 6 months.  I would come home and be completely wiped out.  It was terribly hard on my kids because I was basically an absentee mom for 2 months.  After that experience, I learned not to overestimate my ability or dismiss what doctors [or fellow patients] told me about recovery. The problem is that the outside can look lovely but the inside is still healing. It takes a lot longer for cut muscle tissue to heal than cut skin.  It takes a lot longer to heal completely.

Does anyone know if there is a PS in the midwest that does micro-fat grafting?  I REALLY want to avoid an implant (and TE) and would like to pursue having my micro-fat grafting in addition to my current latisumus flap to create my entire breast.  My PS is very experienced with using fat grafting to fill in after a DIEP flap or with an implant but has never done it with a lat. flap.  She has researched the possiblity and provided me the research studies from France where they have been doing it since 1999.  She is willing to give it a try in the spring (1 year after when I completed radiation).  Before I make the decision I would like to consult with another PS who has some experience in doing it.  Traveling to Miami or NY to have the fat grafting will just not work for me but I am willing to travel in the midwest at least for a consult.

Girls who have gone through this, can I ask a question? Both I and my plastic surgeon have tried to talk with Dr. K. about this but he never returns my surgeon's phone calls, and I can't wait until February when my surgeon will be doing the training.

Does anyone know how long you have to wait until a mastectomy (for the incisions to heal sufficiently) before you can start wearing the Brava?

pandazankar, I know, and that's what I was supposed to have done next week. But, my plastic surgeon had a couple of questions about how specifically it's done so that necrosis would be minimized. After two months of calling and emailing, Dr. K. never got back to him (it's been a busy couple of months, I know, because of his travel schedule). I haven't emailed Dr. K myself because I don't have his email address -- would you feel comfortable emailing it to me so I can email him?

Thanks so much, NotMyTime... I don't need Herceptin and I'm not going to do radiation, but my plastic surgeon didn't know how to do the inital fat graft without it all clumping together, migrating due to gravity to the bottom of the breast, and hardening (necrosis), since it would be injected at that point into empty space rather than expanded breast tissue. We both obviously know there's a way to do it, since Dr. K does it successfully, but since he was never able to connect with Dr. K, he doesn't feel comfortable doing it.

NotMyTime, congrats on taking the next step! (I'm with you the "hole in the chest" thing... ugh... well, the end result will be well worth it!)

psf:

Hope you're doing well, and the percocet isn't needed for too much longer. Congrats on getting this far! Are you pleased thus far? 

So for my own interests, help me with the rest of the time line. After BX you waited 5 to 5 1/2 weeks to wear the Brava (though it could have been 4 if you hadn't had some other issues) - how long did you wear it before your first fat grafting procedure? And how long between the 1st and 2nd? Good luck and thanks! 

NotMyTime2Go:  Thanks....oh...just stopped the percocet the day before yesterday.  Still painful on getting up, but then it goes away. 

Rest of the timeline:  I wore it for about 4 1/2 weeks before the first procedure.  After the first procedure, he wanted me to wear them 24/7 for 1 week -- thought I couldn't do it, but it was not too bad at all.  Then I wore it another 3 weeks( 10-12 hrs/day)...all this on just the sports box pressure.  Then I wore it 10-12/hrs. a day until my 12/3 surgery with the bulb (alternating pumping for a couple of hours each evening and the rest of the time just sports box pressure.  So after my first surgery, I wore it from 9/18-12/3 (date of my second surgery).  I had to skip a total of three days...had a little sore under one breast, that went away quickly. 

So far, I am thrilled with the results.  This was going to be my last surgery, but I apparently had formed a central cyst in the left breast (the one that had radiation 17 or so years ago).  I had gotten some good expansion on both breasts with the BRAVAS, but the cyst was expanding within the L Breast, somewhat acting as an internal expander.  Dr. K had to drain the cyst and then he was able to put some fat in that side, but not enough to match the right side.  He wants to see me in Jan. to possibly drain that cyst again, and then I will wear the Bravas for about 1 month and have my potentially last procedure in March or so.  My right breast is amazing (to me!).  It is nice and full and is softening up nicely....when wearing the BRAVAs, the swelling causes the breast area to be a bit firm or hard.  When I first take the BRAVAs off in the a.m., they are both that way, then by evening, they soften up somewhat.  The right side, although it does not look like my original breast is still beautiful, I think...and it is really shaped nicely.  This time, for the left, since he couldn't put too much fat in, he must have spent some time on the shaping and inserting fat anywhere that he saw it was needed.  He even was able to do something to bring it more horizontally in line with the right side that hangs a bit lower...partly due to the additional weight of the fat....I can really see that after I start expanding it for the next procedure that it will look more like the R side.  It is such an amazing thing to look down and see these breasts that I didn't have a few months ago.  At first I was a bit disappointed that I would have to have one more round on the left, but then I started to see that it may all be for the best, since this gives the fat that is in there a chance to make the skin and other tissue more flexible.  I noticed that I have started to have more feeling in the L breast lately, too.  I have feeling in almost the whole R breast already.  I think it is always a bit more challenging to deal with a breast that has had radiation, even so long ago.  It sometimes just takes a little longer. 

The Lipo is no fun, but it is amazing how fast it all heals up and the soreness goes away...definitely worth it all! 

So I'll be wearing the compression garment another 4 weeks, the BRAVAs until around Jan. 7, then I will send him some pictures and he will determine if he wants me to take about a 2 week break, then will wear the BRAVAs 1 month prior to the next surgery.....well....just the left BRAVA.  At least that is his plan for now.

CrunchyPoodleMama, Don't worry! I'm sure all will work out. It will just take some patience. If it comes to traveling for fat grafting, you can come to NYC and see my PS, Dr. Ahn, who has trained with Dr. K I She is fantastic. 

But I'm sure your surgeon has a plan for the skin and how to inject and give you a new breast.

Sending hugs your way! 

CrunchyPoodleMama:  I will be praying for your recovery. 

I know Dr. K does  fat grafting surgeries after implant removal, in that case, he is left with a full skin pocket....so it must work out ok with more skin....Oh....I also know another lady who had a full skin-sparing mastectomy...haven't talked with her for awhile.  She is still receiving other treatment but will have fat grafting reconstruction with Dr. K, so it apparently does work with the excess skin.

 At any rate, it sounds like you are in good hands, since your PS is planning to go to Dr. K's training.  I bet he'll be able to get tips about how to deal with your specific situation. 

So, just focus on letting your body heal and try not to worry...I remember when I took my first peek after my BX, I was so disappointed that my surgeon didn't get my incision lines level...one was quite higher than the other....also...he did a loose skin, not full skin sparing...but the left side had much less skin left....I really obsessed over this...oh..then I started worrying that the excess skin would stick to the chest....but it ALL worked out... 

 And I'm sure you recon will all work out too!

Prayers and hugs from me.....

psf - thanks for all the info. It was funny I checked messages while dressing after seeing my ps and saw your info, and I swear you might be the person my ps had just been talking about. Probably not, but the timing made me smile.  Anyway, I thought Crunchy and you others might be interested in what I learned.

First - Crunchy, it sounds we're having similar holidays. I had my skin-sparing mastectomy a year ago - which I have to say is so very emotional. Even though you sound stressed, you sound fabulous considering what you've just been through. The difference was that my ps put in expanders, so the complete mastectomy wasn't as apparent. This time though all he did was remove those expanders and put the muscles back in place. So now I have the full-effect of no boobs: flappy skin on one side, but the side with radiation is tight against the chest wall, leaving a fist-sized hole in the chest that resembles an old man sucking on something sour. The whole thing is so ugly it's hard to imagine it will ever look good again. If it weren't for you ladies I don't think I'd believe it, but it's good to have something to hold onto.

 Now to my ps. He had the training in October (the very end), and has since submitted papers to be part of the on-going study. It took him a couple of weeks to decide he wanted to do it and get the paperwork together. He is now waiting for the approval. He also had to submit papers to the hospital to get them outfitted with the proper equipment. He got approval on that rather quickly, but the requested items haven't arrived yet.

He said that several different protocols have been tried (though not a lot since this is a fairly limited procedure so far.) But that they will continue to tinker with the timing of various things until they come up with what they think is the best process. He had to write up the details of what he will be doing, which, pending approval, he will have to follow with each of his patients. They aren't the same as what Dr. Khouri did in his first study, and may not be what other doctors do, but they are what was recommended to him at the conference. 

They are: mastectomy patients will be eligible for immediate fat grafting if they don't expect herceptin or radiation. If they do they will have skin-sparing just like Crunchy. And if they have implants or expanders, they will have those removed and wait at least a month for healing. (Which is what I just did.) As for me, I can start in three weeks if he has approval. But I have to wait to order the Brava equipment until approval comes, whether it's three or six or ten weeks.

I'll then wear the Brava domes for 3 months (as opposed to 3-4 weeks that many have done before. He mentioned some minor complications like cysts that they're hoping to avoid with the longer wear. ) His protocol says 3 months for those who have had radiation, 2 months for those who haven't. After that the domes are to be worn for 3 months between every procedure. I didn't think to ask him about the 24/7 period. Maybe after 3 months that would be overkill, I don't know. I guess I'll find out.

 I asked them to call me as soon as their approval comes so I can get my domes ordered. I did get to see a sample in his office and felt a little relieved that they weren't as daunting as I'd imagined. Patience....patience....is my new battle cry.