Has anyone had micro fat grafting?

Kate:  Wow, that is just awful!!!  Can you send Dr. Khouri a note and byopass the idiots in his office?

Kate33,

If you paid by creditcard then you could kindly ask Dr. Khouri's office to credit your card.  If they refuse, then notify the bank with whom you have your credit card and advise then you have had a fradulent transaction.  It is fraud for Dr. Khouri to withhold not reimbursing you for overpayment, especially since it sounds like he shouldn't of taken your money in the first place! If you paid by check, then check with your bank and see if they have any sources for recourse on your behalf as basically you have been swindled.  Not nice to do to a woman also dealing with bc.

It does sound like he is an incredible ps, so hopefully this is a screw-up and 'oversight' by his office.

Such a shame that one has to be careful of not being taken financial advantage of at a time like this.

Last month I had to pay $140 for my post-op visit with the bs as for the visit to be included with the DM I had in March I needed to see her within 28 days of that surgery.  When came to see me the next day in the hospital she said to see her the next time she was in the office when I came to town (a 2 hours drive) to followup with the PS.  Well, it took 9 weeks to get to see her because she was always in surgery.After seeing the 2 dr's, I asked if I had to pay the BS for the visit and the receptionist said no, it's included in the surgery fee.  Then in the mail comes a bill for $140, and when I called the bookkeeper said they had to charge me as the included office visit had to be within 28 days of the surgery!  Thanks for letting me know, and I told her I didn't know and she said there was nothing she could do about it. Truthfully, if I had known, I would of insisted on seeing the bs within the 28days.  Not wanting to piss of the BS, who actually worked overtime to operate on me so swiftly I paid up. This all has cost so much money, even with australian medicare and our private insurance, and I still have at least two more surgeries to go!

Kate - go get your money!  I couldn't prove I didn't know I had to see the bs within 28days but you know what you have paid!  $3,600 can go a long way, especially with your DH not working now and a teenager in the house! 

Good luck - go get'em tiger!!!!!!!

All the problems in Dr. Khouri's office lie with his office/billing staff- not in Dr. K himself.  I would never want any of you to think less of him because of my post.  He is a total perfectionist and is so focused on his surgeries and helping women that he leaves all the rest to his staff.  He came through with everything he promised me and more.  I sent an email to his assistant yesterday asking who I need to contact to get this billing issue straightened out.  I cc'd it to Dr. K, too, since I think he should be aware of what is going on.  Within 30 minutes he had forwarded my email to 3 different people telling them to take care of this important issue (his words) immediately.  He is such a wonderful man and doctor.  I just wish his staff was equally wonderful and efficient.  

justagirl- Thanks for the suggestions.  If I don't get this resolved soon I will contact the credit card company.  But after Dr. K's email I'm confident I can get this worked out.  Sorry about your post op charge.  Don't you wish they had to tell us all of this in writing?  

sweetie- You are definitely a sweetie!  Thanks for the nice comments!  I'm sorry you are so unhappy and I can definitely relate to it.  It sucks!  We're supposed to be done with all this ****!  Please don't let Dr. K's office staff scare you off.  Despite everything I'd go through it again in a second.  I'm just trying to warn others about how to avoid some of this.  (Document, pre-authorize, etc.)  There is another site- fatgraftpatients.com and there are threads with tips on this whole process.  But more and more I am seeing other PS's out there doing Dr. K's technique.  Did you see the new thread- "Microfat grafting or BRAVA doctor recommendations"?  Women have started listing their doctors who do the fat grafting- but not all are doing Dr. K's method.  So that would be a question I would ask when interviewing anyone.  Congratulations on your daughter graduating!  You will have a busy summer.  My DS is off to high school next year (I'm an old mom!) and I know it's going to go fast.  When or if you're ready to do this I will do anything I can to help you with the process.  I know it sounds dramatic but it is truly life changing.  

For anyone wanting to do this- more and more surgeons are going to get trained in this. I think it is the safest and least disfiguring reconstruction out there with the best results.  I told my doctor here in AZ that if he got trained in it he would be the richest man in the state!  lol!  

Kate-I appreciate your support and have always related to you in so many ways dealing with this whole BC journey. I need to have my mind straight before I would go forward with this so fall is going to be best. I will document and check with my insurance and their office before I make any moves. I did see the other thread about the Dr's and the one I plan to see was highly recommended on there and she is only an hour away from me. I did email her and she seems wonderful too. One big problem though, out of network! So we'll see and just take it a step at a time. You do look wonderful and I am so impressed with the results you have and I thought you looked good before all of this! You have really inspired me because I know how much you went through to make this decision. I feel like now if you did it so can I.

Yes it will be a busy summer. My DS started HS this past fall and is moving to 10th grade. I just can't believe how the years fly and how quicly our children grow. Sometimes I still feel like a teenager inside myself and can't believe I'm mom of two teenages!

sweetie- I can understand waiting.  I probably would have, too, but with my DH going out on disability I didn't know if our medical coverage was going to be changing.  I was kind of on a timeline to get it done.  I wonder what it takes for a doctor to become in network?  Is there something this PS could do in the meantime to be added?  I'm just not sure how it all works.  Thank you for always being so encouraging and supportive to me.  My DH was very supportive but my family kind of looked on it as elective surgery.  I tried to explain that if it improves quality of life it's not elective- it's a necessity.   Of course, with that logic new shoes and chocolate are also a necessity!

Kate-I'm sorry your husband is going through issues now too on top of all you have been through. Just seems like so much sometimes. I have a friend who had a BMX and now her husband has cancer,back issues from a car accident and complications from chemo. He is also going on disability so she much work three jobs. She also is still having pain from her implants and never quite "rested" from all she went through.Us women have to deal with so much sometimes.

Anyway,regarding the insurance. I think it is up to the Dr if they want to accept the terms of an insurance plan. The reason some of them don't is because then they will have to accept a certain payment for their services which is most likely reduced. Some plastic surgeons don't want or need to do that because they get enough out of pocket payers. I noticed all the PS in network were the ones in a "surgical group" affiliated with a specific hospital. It also means those Dr's are much slower to try new procedures because sometimes they have to get approval from the hospital. For example I was the sixth person who had the NSM by my two Drs. The hospital made them stop and then allowed them to start again as a "trial" and must document everything. 

I don't feel your surgery was elective but very necessary. Your first surgery was not correct and you had pain. It was a necessary revision. When I look in the mirror standing straight on and the whole upper pole ripples top to sides I think how is this supposed to be normal results. I have seen enough pictures and talked to enough ladies to know that I should expect much better than this. I am so in agreement with you that is about quality of life. I want to stop thinking of this and at this point can't because I still don't feel whole.  I am so happy for you because I know what you went though. You are going to inspire so many of us and we really need that. Please don't leave BC.org! I know a lot of women once they are satisified with their results never return to post. We all still need your encouragement and even more so if you are finally happy and whole.

Slinky - if you are very lean, I'd be very cautious in selecting the surgeon to do your FG.  The big difference between what Dr. K does and traditional FG is that he injects the fat droplets at a time.  This gives the fat a much better chance to survive - with you having limited "supply" of fat, you want to be sure that it does.  I have Alloderm and just like I wish I had known about FG before my recon, I sure wish I never had that stuff put inside me!  During the revision, the alloderm gave Dr. K addtional challenges and those are the only areas that are still firm.  You have time, so do your research. 

Kate33-  I'm not surprised that Dr. K answered you so quickly and is helping to straighten out the insurance mess.  That's just the way he is - despite being so busy, his patients are his top priority.  I'm glad that one by one we are helping spread the word and giving others the opportunity to feel normal again.  It still frustrates me to no end that this procedure isn't better known and more readily available.  I have a hunch that if something like this were a cure for ED - it would be plastered on the front page of every magazine and the surgeon would be making the morning show rounds!  With so many of us losing our breasts to BC, wouldn't you think this is news-worthy?  Geez - ok, enough of ranting and raving.  It's too early and I should pace myself!  LOL

Anyway, to add to what Kate has said, any and all "inconveniences" are worth it to have Dr. Khouri be your surgeon.  If anyone can help you, he is the one.

Sweetie - Enjoy your summer!  Just remember that you can have this done anytime.  There's no rush.  I know how discouraging it is to look in the mirror or feel the dents and ripples, but just remember, it can be fixed.  Keep the goal in focus, but try to enjoy the now.  Time DOES fly - my son is getting married in September!  How did THAT happen?  My baby getting married?!?

Pinkbutterfly - Hope all goes well with your appointment!  We all know how everything, no matter how small or insignificant, sets off all kinds of alarms in our minds.....Good thoughts!

Climbergirl & Irishluck- Good luck on your consults!  I'm sure you will quickly see why we think the world of Dr. K.

Well, just back from the Dr. and no, they didn't find anything.  Halleluia and Praise God!!!! I am so thankful.

LeeinFL and Kate, thanks for all the good thoughts sent my way!

I wanted also to post that I have been in contact with Dr. Kishinevsky in CT. Within hours of submitting a question by email, her assistant called me and I was able to speak with her (the Dr.) directly.  She was very kind and answered my questions, then sent me a thank you email.  The thing I like about her approach is using TE's (since I already have them in) vs. Brava, which sounds like it might be a challenge, plus, for me, one more unknown in the equation since it isn't FDA approved. I still have a lot more questions (I was unprepared when she called - was in the waiting room waiting to be called back for my US, and just so glad to have her live on the phone) so I have emailed her back.

She tends to prefer tummy fat, and most of mine is on my hips and thighs, but she said to send her photos, so I will.  I think Dr. K is probably more experienced with the actual fat grafting, and I have read that technique is critical when it comes to this procedure, so I am torn. I am still on the fence about the whole thing, as I am ultra-conservative, and spent the morning reading everything I could find on the safety of fat grafting.  I have come to the conclusion that I am probably not going to get the type of answer I am looking for - the long term studies just haven't been done,  although the studies that have been done seem to indicate that, at least for the short term, laboratory concerns have not panned out clinically and the procedure is considered safe based on what is known.  Wouldn't it be great if there was actually a reconstructive procedure that reduced the risk of recurrence?

I have to say, too, that sitting in the waiting room in that robe with the pink ribbon on it, waiting for my tests, brought back bad memories, and made me wonder if I wanted anything BUT plastic put back in my breasts.  I talked to the radiologist who did my ultrasound (at this point, I'm talking to anyone who will listen, short of stopping people on the street) about his experience looking at imaging on patients with fat grafting.  Not surprisingly, he hasn't seen a whole lot, though they do some lipofilling as an adjunct to other procedures at the center where I am treated.  He did say that it can be a challenge to interpret imaging post-fat grafts, and sometimes biopsies and what- not are required. I am wondering if any of you ladies that are further out that have had any type of fat grafting can share your experiences.  I am not even sure what follow-up is entailed after mastectomy and reconstruction...

Kate-

"no more mammies to gram" I love it!

I am certain that my apprehension about fat grafting is due to my extreme cancer paranoia. I asked Dr. kishinevsky yesterday if there was any difference between cutting the fat (as in flap surgery) and placing it into the breast area ( I call this cutting and pasting) and fat grafting or lipofilling. And it's important to recognize that she's probably one of the few PS in the country that does all 3 major categories of recon - implants, flap surgery, and fat grafting, so best chance of getting an unbiased opinion. She said no, in terms of stem cells going into the breast, no difference. And how many PS are routinely doing lipofilling to fix defects? Many, including those at the center where I am treated ( my oncologist told me that.) so my fears are probably more of a personal problem. I just like posting the information in hopes it may help others. Hope I am not scaring anyone with my paranoia. I think it's bizarre how, once you have cancer, everything from there on out is scary. I am told it gets better
with time. I sure hope so.

Can totally relate to what being on this board means Ian terms of support. My DH also tells me I spend too much time here. But, with such a wealth of good information and support, I can't afford not to, wish I had more time!

Kate33,

Yes, please don't leave!  You have shown me so much. Like you, my husband a few weeks ago, when he saw me online here said 'why are you looking at that - you don't have bc anymore'.  I know all of this bc scared him to death, especially since he is 20 years older than me and looks to me to keep the home and finances in order, all while maintaining 8 acres of land, dealing with a 17yo boy in his first year at uni and me taking care of myself without being able to talk to him about anything medical.

I am now 3 1/2 months out from my dm with permanent implants (little but they are there) and I actually still need a fix-up surgery after September which will give these babies time to settle down as I had a LD flap on the radiation side and then I still need nipples as just before my surgery the bs and ps deemed it way too risky to reattach my nipples as they both have been taken off twice before and with the LD flap and all I just wasn't ready to risk any complications I could avoid.  Sure I miss my nips, but I did come through the surgery fine.

Anyway, you are one of the women here who has shown me it isn't cosmetic to want my foobs to look and feel as good as I can get them and I'm not a silly airhead.

I have two close girlfriends who are very supportive but I find all of you women to be a fountain of support, guidance, medical knowledge and true friendship.

I don't know what your DH's consider too much time spent here but I'd rather be here than watching tv!

Pinkbutterfly:

I don't think there is anything wrong with being afraid and it's not paranoia. I know for me when I rubbed the lotion on my breast and just happend to be rubbing a little harder than usual, I almost fainted when on 3 March 2010 I felt the lump. No family history, clear mammos every two years, healthy, non drinker, exerciser and eater of good foods, and wham, my whole world turns upside down.  

I think we have all been there, when you just think you can't cry another tear and the fear inside you of this dreaded bc takes your breath away!

Life is scary, but I try to give myself time to be scared and upset, and then decide that this damm bc isn't going to take any more of my time or energy.  

Life is precious, and so are we all!

Good night and to Kate33 and your DH and son, I send a thank you for all the time you share with us!

Pinkbutterfly - Not sure if I missed it (if I did, sorry ), but do you have TEs right now?  Also, not sure who told you about wearing Brava for a year....but usually 3-5 weeks before and about that following the fat grafting is it.  Hvae you been to Dr. K's website? miamibreastcenter.com - it has a lot of info on it and explains the procedure quite well.  Remember, Kate and I already had implants so we didn't have to wear the Brava and we weren't able to have total reconstruction with our own fat.  I know every person's experience is different, but I hated the TEs.  They were painful, hard and the weekly or bi-weekly fills weren't a lot of fun either.  If you go with the Brava domes, you wouldn't have to have new (or re-opened) scars (twice, once to put in and once to take out) - and no compromise of your pectoral muscles.  Which is another one of those things no one tells you about!  I know Kate and I are on the same page:  if we had only known about this procedure BEFORE the TEs and implants.......the possibility of an entire breast made of your own tissue is incredible. While I am very, very happy with what I have now - I'd love to not have any implant at all.  I'd suggest sending Dr. K your photos (and questions) and see what he can do for you.  

Well, I think I'm just at the tipping point, in a good way. Had seen an oncologist at MD Anderson, and had my first surgery there, so I emailed both the MO and the PS about lipofilling. Haven't heard yet from the PS. The MO said that it should be safe, stem cells should not behave differently just because they are moved to a different part of the body. In addition, I read on the Johns Hopkins website that they do use fat transfer in breast reconstruction, though it doesn't sound like whole breast reconstruction. Also, they quote a 60% failure rate for implants in radiated breasts (aka. me). And, although for a while I considered flap surgery, i just don't want to lose any more than i have already lost, and so permanent, (and still putting fat in my breasts). So, finally, I think I have the answers I was looking for, as I could literally feel myself breathe a sigh of relief when I read the JH website at the possibility of finally settling on a procedure. Whatever will I obsess over now?

Kareenie,

Does he answer directly, or through CIndy? She does get back to me, but it's harder to get questions answered directly without the back-and-forth of a conversation.

When will you be starting the FG?

LeeinFL,

Saw your pics on the fatgraftpatients site, and 'the girls' look fabulous!! Did you have NSM?

I think I also posted on how good Kate looks on Timtam's site. You give the rest of us hope! Really miss having nipples! Sometimes, I think that's the worst part! Still startles me when I look in the mirror!

Pinkbutterfly - Thank you!  I have PLENTY of those moments too.....lol!  No, the PS who initially did my reconstruction did my nipples.  He did a really nice job and Dr. K, as well as Judy who tattooed them, were impressed with how nice they turned out. 

I know a while back there were more posts asking if Dr. K did nipples.  I doubt it.  Not that he isn't able or willing, but it's really not the best use of his limited time.  There is so much demand for his procedure and along with all the traveling, workshops and conferences, even though nipples are important (especially to US!) I really can't see where he could fit that into his surgery schedule.  I miss my nipples too but once I got these fipples, especially after getting the 3D tattoos, I'm happy with them.

Dr. Khouri will answer you directly.  Not sure which email you are using, but right from the beginning I've used:  drkhouri@miamibreastcenter.com

Kareenie is absolutely correct - there is only a certain amount of fat that can be injected at a time.  This is why Kate and I had smaller implants placed.  There was more space (due to the larger implants) then could be filled with just fat alone.  Also correct that the internal TEs do the expansion that the Brava domes would do from the outside, however, there is better preparation of the "field" with the Brava.  More gentle but also better blood supply is established to accommodate the fat grafts.  

All,

Have been checking out the threads and this comes to mind. TE's traditionally go UNDER the pec muscle...so how are other MD's injecting in that case?  I am assuming that they still are using an under the skin injection, yes? The under the pec issue is the main reason I would never use TE's.

 Met with the Recon Rockstar Dr. Khouri today. His office is definitely on the busy side of what I have seen in my BC career but I have to say that I was taken promptly and that things went fine. I made sure that I booked the whole day so that I could stay longer if needed and my total initial visit was from 11:30- around 2:30. Lot's of info. I was laughing to myself as I over heard one of his nurses was telling him that a TV crew wanted an interview that afternoon and he was like "RIGHT" He seems quite the busy man and I did not know that her actually trained up at Beth Israel and Brigham and Women's in Boston. That makes me feel better for what it's worth. He told me he misses Boston and given the number of hospitals and Biotech  I can understand why. BUT Boston is in the 60's this week and Key Biscane weather is the bomb....so there is the payback.

 Apparently aside from my Rads, I am an ideal candidate...the rads may prolong things so that I may have to have 3-4 outpatient  procedures instead of 3. I am only going to be something like a 34B. He will also perk up the other breast which looks like it needs some love.  Cindy is an energetic and informative gal who also has her own life experience with Cancer loss. I liked her very much. I am thin but Dr Khouri assured me he had enough fat to work with which is good to hear. We went over his technique, how things go he made sure that I tried on a Brava and wore it for a half hour or so to make sure that I could understand what it would be like.  He also showed me how to do my own photos that will be used to document things as they progress. This is quite the commitment! The way that I see this is that he is the most experienced and therefore he is the person that I will work with. There are SO MANY good surgeons in Boston but I am more willing to deal with him for his experience. He is convinced that he is doing ground breaking work with tissue engineering and I can't really argue with him!

Coming at You from Miami....Be Well

~climbergirl